RESUMEN
Infection with SARS-CoV-2 leading to COVID-19 induces hyperinflammatory and hypercoagulable states, resulting in arterial and venous thromboembolic events. Deep vein thrombosis (DVT) has been well reported in COVID-19 patients. While most DVTs occur in a lower extremity, involvement of the upper extremity is uncommon. In this report, we describe the first reported patient with an upper extremity DVT recurrence secondary to COVID-19 infection.
Asunto(s)
COVID-19/complicaciones , COVID-19/diagnóstico , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico , Anciano de 80 o más Años , Trastornos de la Coagulación Sanguínea/complicaciones , Humanos , Masculino , Recurrencia Local de Neoplasia , Reacción en Cadena de la Polimerasa , ARN Viral , Recurrencia , Factores de Riesgo , Extremidad Superior/irrigación sanguínea , Trombosis de la Vena/terapiaRESUMEN
Coronavirus 2019 (COVID-19) has been reported to trigger Guillain-Barré syndrome (GBS). While uncommon, recurrent GBS (rGBS) episodes, triggered by antecedent viral infections, have been reported in a small proportion of GBS patients, here we describe a patient with a recurrent case of GBS, occurring secondary to COVID-19 infection. Before this patient's episode, he had two prior GBS flares, each precipitated by a viral infection followed by complete recovery besides intermittent paresthesias. We also consider the nosology of this illness in the spectrum of rGBS and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), with their differing natural histories, prognosis, and therapeutic approaches. For patients who have a history of inflammatory demyelinating polyradiculopathies who develop COVID-19, we recommend close observation for neurologic symptoms over the next days and weeks.
RESUMEN
This video will be demonstrating the surgical treatment of complete foot drop with partial tibial nerve transfer to the motor branch of the tibialis anterior. Foot drop occurs when there is injury to the deep peroneal nerve that results in the paralysis of the tibialis anterior muscle and subsequent loss of ankle dorsiflexion.1-5 The patient who is the subject of this video is a 27-yr-old female with a 6-mo history of foot drop. She presented with complete loss of ankle dorsiflexion and great toe extension due to traumatic fall on her left knee while running. Upon physical examination, she had all the features of complete foot drop with loss of ankle dorsiflexion and ankle eversion. She also had decreased sensation to light touch over left dorsal foot, left great toe, and left lateral lower leg. The patient has consented to this procedure. The partial tibial nerve transfer to the motor branch of tibialis anterior muscle is the preferred treatment option for foot drop as it restores ankle dorsiflexion with minimal donor site complications. At 12 mo postsurgery, she has regained 4/5 for ankle dorsiflexion on motor testing compared to the 0/5 she had preoperatively.