Nathaniel B. Dusseau

Study Design: Prospective case series with body mass index (BMI)-matched case-controls. Objectives: To compare resting and postprandial inflammasome biomarkers and metabolic measurements in people with and without chronic spinal cord injury (SCI). Setting: A tertiary academic rehabilitation center in an urban, metropolitan setting in the southeastern United States. Methods: Blood samples were collected from 5 individuals with chronic SCI and 5 BMI-matched controls without chronic SCI at baseline and at 80 and 400 min following the consumption of a 600-kcal liquid meal comprised of 35% fat, 50% carbohydrate, and 15% protein. Inflammasome biomarkers included apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), interleukin-18 (IL-18), caspase-1 (CASP-1), and triggering receptor expressed on myeloid cells-2 (TREM-2). Metabolic biomarkers included glucose, insulin, triglyceride (TG), non-esterified fatty acid (NEFA), and glycerol. Results: Individuals with chronic SCI showed higher mean baseline concentrations of all inflammatory markers. There were greater mean postprandial decreases of ASC and CASP-1, with values remaining below baseline at 400 min. IL-18 remained near baseline. TREM-2 declined modestly in both groups. There were relative differences in glycemic and lipemic postprandial responses between groups at 80 min. Conclusions: In this case series, individuals with chronic SCI exhibited higher mean baseline inflammasome biomarker levels and different postprandial trajectories compared to controls. These preliminary hypothesis-generating observations warrant adequately powered studies to clarify the role of inflammasome-related mechanisms in inflammatory and metabolic dysregulation of chronic SCI.

Varicella zoster virus (VZV) reactivation with central nervous system (CNS) involvement is an uncommon but important cause of lymphocytic meningitis in both immunocompromised and immunocompetent individuals. While cranial presentations, especially V1 involvement, are well documented, spinal-dermatomal VZV meningitis is rarely reported. We conducted a systematic review of PubMed, Scopus, and Embase using PRISMA guidelines to identify all cases of laboratory-confirmed VZV meningitis or encephalitis with a dermatomal rash in immunocompetent adults affecting spinal levels C1 and below. Data extracted included demographics, dermatome distribution, CSF findings, treatment, and outcomes. We also report a novel case from our institution involving isolated C4–C5 involvement. Seventeen total cases met inclusion, including our 44-year-old male patient who presented with fever, severe headache, and a right-sided vesicular rash in the C4–C5 dermatomes. He was initially misdiagnosed with a tick-borne illness. Mean CSF values across all cases were WBC count 382/µL (SD ± 270), protein 177 mg/dL (SD ± 106), and glucose 52.7 mg/dL (SD ± 15.8). IV acyclovir was used in 15 of 17 cases, with oral acyclovir (41%) or valacyclovir (29%) as the most common step-down therapies. Mean treatment duration was 14 days, and average length of hospital stay was 6.4 days. All patients survived and made a full recovery. Spinal-dermatomal VZV meningitis can occur in immunocompetent adults, including cases with cervical involvement. Early recognition of the rash pattern and timely PCR testing are essential for accurate diagnosis and prompt antiviral therapy, which is associated with favorable outcomes.

Background: The brachial plexus is a network of nerves responsible for the motor and sensory innervation of the upper limb. Variations in the formation and course of the brachial plexus are well documented, though combinations of multiple unilateral abnormalities are rare. The complex pathology of this structure nerve may result in clinical consequences. We present a unique set of brachial plexus abnormalities involving the C4–C6 nerve roots, superior and middle trunks, additional communicating branches, and delayed median nerve union. Case Presentation: During the routine dissection of a 70-year-old female cadaver, several unique variations in the brachial plexus anatomy were identified. The C4 root contributed to C5 before the superior trunk formed, resulting in a superior trunk composed of C4–C6. The C5 root was located anterior to the anterior scalene muscle, whereas C6 maintained its usual posterior position. Additionally, an anterior communicating branch from the middle trunk to the posterior cord was observed. A communicating branch between the lateral and medial cords split into two terminal branches: one merged with the ulnar nerve, and the other joined the medial contribution of the median nerve. The median nerve contributions from the lateral and medial cords merged approximately two inches above the elbow. Conclusions: This rare combination of brachial plexus anomalies has not been previously described in the literature and is of significant clinical relevance. The additional anterior communicating branch from the middle trunk may suggest potential flexor muscle innervation by the posterior cord, which typically innervates extensor muscles. Additionally, the delayed convergence of the median nerve may provide a protective mechanism in cases of midshaft humeral fracture. Awareness of these peripheral nerve abnormalities is important for diagnostic imaging, surgery, or peripheral nerve blocks. Knowledge of such variations is critical for clinicians managing upper limb pathologies.

BACKGROUND AND OBJECTIVES: Lipomas are benign adipocyte tumors that typically present as painless, firm nodules. In rare cases, lipomas may grow near the brachial plexus (BP) and compress various peripheral nerves. This can manifest as upper extremity motor and/or sensory deficits, numbness, tingling, or burning sensations. Surgical intervention of a brachial plexus lipoma (BPL) may be challenging because of variability in location and size. This study reviews previously reported cases of BPL causing neurological impairment and presents 5 additional cases, focusing on operative details and patient outcomes. METHODS: A systematic review of PubMed, Scopus, and World of Science was performed to identify all previously reported cases of BP lipomas resulting in neurological deficit. A retrospective review of a neurosurgeon's prospectively collected database was conducted to identify all patients operated on for BPL. Patient demographics, tumor characteristics, presentation, surgical notes, and outcomes were collected for both reviews. RESULTS: Our literature review yielded 13 articles presenting at least one case meeting the eligibility criteria, resulting in 22 eligible patients. The surgeon's database provided an additional 5 patients meeting the criteria. Of the 27 total cases, 15 were men and 12 were women. The average age was 46.5 with a range of 25 to 70. All patients had upper extremity motor and/or sensory dysfunction preoperatively. Tumors were found in various regions, with the involvement of the supraclavicular fossa reported in 52% of cases. Gross tumor resection was achieved in all but 2 of the 27 operations. Four patients had a nonconventional lipoma type on histology. Sixteen patients experienced complete resolution of neurological symptoms. CONCLUSION: BP lipomas are rare but can cause a wide range of neurological symptoms depending on their size and location. A thorough patient examination and imaging studies are essential for creating a successful surgical plan for tumor resection.