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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Carpal tunnel syndrome is well known to be associated with hypothyroidism, but other mononeuropathies have been rarely reported. We report a 65-year-old male who showed right deep peroneal nerve palsy caused by hypothyroidism. The patient was admitted to our hospital because of general fatigue and right drop foot. On admission, bilateral pretibial pitting edema was observed, predominant on the right side. There was no muscle contraction in the right anterior tibial muscle and extensor hallucis longus in addition to slight weakness of the proximal muscles; whereas, muscle atrophy of the anterior tibial muscle was not noted. There was no sensory disturbance. On an electrophysiological examination, there was no muscle action potentials by the stimulation of the right deep peroneal nerve. Other nerves showed normal results both in the conduction velocity and in the compound action potential. Two months after the administration of levothyroxine sodium (0.025 mg/day), the right deep peroneal nerve palsy was completely recovered, associated with disappearance of pretibial edema. It is not yet determined which of axonopathy or demyelination is dominantly responsible for neuropathy associated with hypothyroidism. These results suggested a conduction block in deep peroneal nerve associated with focal edema. It is necessary to consider hypothyroidism as well as trauma, diabetes mellitus, and vasculitis when investigating mononeuropathy of deep peroneal nerve.
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PMID:[Deep peroneal nerve palsy associated with hypothyroidism]. 839 65

Lower extremity symptoms are caused by lesions at any level of the neuraxis, from cortex to muscle. HIV affects virtually every level of the nervous system, either directly or indirectly. The presence of pathology at multiple levels and by multiple processes further complicates the bedside diagnosis of a patient with AIDS and neurologic symptoms. Many neuropathies and other conditions that affect the lower extremities can be identified with careful history and physical examination, confirmed with limited testing, and can be treated successfully. Distal symmetric polyneuropathy is the most common lower extremity disorder, but it must be distinguished from similar-appearing neuropathies caused by medications, B12 deficiency, or vasculitis. Diffuse infiltrative lymphocytosis syndrome also causes a painful peripheral neuropathy that must be distinguished from distal symmetric polyneuropathy. Inflammatory demyelinating polyneuropathies are characterized by muscle weakness. They occur in early, asymptomatic HIV infection and respond to plasmapheresis or steroids. Mononeuropathies in patients with CD4 counts more than 200 often resolve on their own. Multiple mononeuropathies, which occur in patients with CD4 counts less than 50, are often associated with cytomegalovirus infection and may follow a rapidly progressive course unless treated promptly and aggressively. Progressive polyradiculopathy occurs late in the course of AIDS, is often caused by cytomegalovirus, is rapidly progressive, and generally is fatal unless recognized and treated promptly. Muscle weakness, myalgia, and fatigue are common in HIV and have multiple causes. Lower extremity spasticity may be caused by treatable etiologies such as spinal cord abscess, tumor, disc compression, B12 deficiency, or ischemia. Gait disturbances are common but nonspecific and may be caused by treatable neurologic disorders at any level of the neuraxis.
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PMID:Neurologic problems of the lower extremity associated with HIV and AIDS. 957 54

Queen Maria de' Medici (1573-1642) died in a miserable, marasmic state. Infections, gangrene, weight loss, fatigue and respiratory problems suggest a progressive decompensation of a previously existing Type 2 diabetes. The lack of biochemical data, however, permits only circumstantial evidence of this hypothesis. The author proposes that the queen developed subclinical diabetes after the age of 45, when she became obese due to excessive eating and lack of exercise. With a clear familial predisposition, she could have become insulin resistant and chronically hyperglycaemic. The presence of an internal deviation of the left eye, visible on several late portraits, suggests a mononeuropathy of cranial nerve VI. Repeated skin infections and gangrene of the lower limbs during the last month of her life complete the clinical diagnosis. Hyperglycaemic ketosis with Kussmaul respiration without adequate treatment may have caused her death.
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PMID:Was Maria de' Medici a diabetic patient? 1984 81

A 52-year-old man was admitted to hospital with abdominal pain, erythema and mild eosinophilia. Medical history revealed fatigue and dyspnoea on exertion after returning from the Gambia a year previously, and allergic rhinitis with nasal polyps that were surgically excised. Before a cause of the abdominal symptoms was determined he developed mononeuropathy, severe eosinophilia and arthralgia in combination with positive anti-neutrophil cytoplasmic antibodies (ANCA) against myeloperoxidase, which lead to the diagnosis of 'Churg-Strauss syndrome'. Despite treatment with high-dose corticosteroids (prednisone 1 mg/kg) his abdominal complaints intensified. A CT-scan of the abdomen showed a soft tissue mass around the caecum. Subsequent colonoscopy showed severe ulcerative lesions and signs of colonic ischemia. When PCR for cytomegalovirus appeared to be negative, treatment was intensified with cyclophosphamide 2 mg/kg, resulting in resolution of the abdominal complaints and healing of the ulcerative lesions in the colon.
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PMID:[Vasculitis associated with Churg-Strauss syndrome]. 2132 49

Intravascular malignant lymphomatosis (IML) is a relatively rare type of malignant lymphoma that is mostly caused by B-cell type neoplastic lymphocytes and rarely by T-cell and NL-cell type cells. B-cell type IML is currently considered to consist of 2 types: a conventional European type and an Asian variant that was originally reported from Japan. In IML, the tumor cells primarily grow within the blood vessel lumina but may cause minimal extravascular infiltration around the involved vessels in some patients. IML usually affects elderly patients and is characterized by B symptoms, general fatigue, disorders of various organs, and elevated serum lactate dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R) levels. Common symptoms include skin eruptions, neurological abnormalities, and gastrointestinal abnormalities. The skin changes and neurological symptoms are more frequent in the conventional type of IML but are not rare in the Asian variant. Neurological manifestations are primarily caused by varying degrees of ischemia due to intravascular tumor cells. These symptoms are usually subacute in onset and have a progressive course: They include, in the order of frequency, 1) multiple cerebral infarcts, 2) disorders of lumbosacral cord and its nerve roots accompanied by paraparesis, 3) subacute encephalopathy, and 4) mononeuropathy and multiple mononeuropathy that include cranial nerves. The most important diagnostic finding in IML is the histological demonstration of tumor cells within small vessel lumina. Although the antemortem diagnosis of IML has been difficult, the results of recent studies involving random skin biopsy are promising for such a diagnosis. Since the recent addition of rituximab to CHOP therapy has proven to markedly improve the prognosis of IML. We should therefore try to avoid overlooking this treatable disease.
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PMID:[Neurological disturbances caused by intravascular lymphomatosis]. 2151 23

Separate discussion of immune-mediated neuropathies from other neuropathies is justified by the serious consequences of the natural course of these diseases, like disability and sometimes even life threatening conditions. On the other hand nowadays effective treatments already exist, and with timely and correct diagnosis an appropriately chosen treatment may result in significant improvement of quality of life, occasionally even complete recovery. These are rare diseases, and the increasing number of different variants makes it more difficult to recognize them. Their diagnosis is based on the precise knowledge of clinical signs and symptoms, and it is verified by the help of neurophysiologic and laboratory, first of all CSF examinations. Description of clinical features of the classic acute immune-mediated neuropathy, characterized by ascending paresis and demyelination is followed by a summary of characteristics of newly recognized axonal, regional and functional variants. Chronic immune-mediated demyelinating polyneuropathies are not diagnosed in due number even today. This paper does not only present the classic form but it also introduces the ever increasing special variants, like distal acquired demyelinating sensory neuropathy, Lewis-Sumner syndrome, multifocal motor neuropathy and paraproteinemic neuropathies. Vasculitic neuropathies can be divided into two groups: systemic and non-systemic ones. The first sign of a vasculitic neuropathy is a progressive, painful mononeuropathy; the classic clinical presentation is the mononeuritis multiplex. It is characterized by general signs like fever, loss of weight, fatigue. In systemic vasculitis organ specific symptoms are also present. From the paraneoplastic diseases the subacute sensory neuropathy and the sensory neuronopathy are members of the immune-mediated neuropathies, being most frequently associated with small cell lung cancer.
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PMID:[Diagnosis of immune-mediated neuropathies]. 2192 Aug 42

Lymphocytic meningitis, cranial neuritis or radiculoneuritis occur in up to 15% of patients with untreated Borrelia burgdorferi infection. Presentations of multifocal PNS involvement can range from painful monoradiculitis to confluent mononeuropathy multiplex. Serologic testing is highly accurate after 4 to 6 weeks of infection. In CNS infection, production of anti-Bburgdorferi antibody is often demonstrable in CSF. Oral antimicrobials are microbiologically curative in virtually all patients, including acute European neuroborreliosis. Severe cases may require parenteral treatment. The fatigue and cognitive symptoms seen in some patients with extra-neurological disease are neither evidence of CNS infection nor specific to Lyme disease.
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PMID:Nervous system Lyme disease. 2599 21

Lewis-Sumner syndrome (LSS) is a rare disease characterized by asymmetrical and multifocal mononeuropathy commonly located in the upper limbs. Some rare cases affecting cranial nerve have been described, but LSS is unknown to affect especially laryngeal nerves. This paper presents the first case of unilateral vocal fold paresis caused by an LSS in a 59-year-old man complaining of dysphonia, breathy voice, and vocal fatigue. Epidemiology, clinical features, diagnosis, and treatment will be described.
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PMID:Lewis-Sumner Syndrome Manifesting as Unilateral Vocal Fold Paresis and Laryngeal Fasciculations. 2878 Oct 97