No abstract

Movement disorders from spinal cord disease are rare and can be caused by underlying neoplasm, inflammation, demyelination, or trauma. [1][2][3][4] Cervical radiculopathy caused by disc herniation or cervical spondylosis is common and important to recognize because it may improve after decompression surgery. We describe a patient with cervical disc prolapse presenting with choreoathetosis and dystonia.Case report. A previously well 62-year-old Chinese woman presented with involuntary movements of her upper extremities of 3-month duration. She observed that her fingers would wriggle on their own and her arms would move involuntarily. These movements were much worse during action than rest. She reported no premonition or any urge before these movements, and did not feel any relief afterwards. The movements were aggravated by stress, agitation, or anxiety, and were relieved by rest and sleep. She also noted that her fingers (particularly the index and middle fingers) would intermittently go into spasms, with involuntary flexion at the metacarpal-phalangeal joints; these spasms were relieved by putting her fingers in contact with other body parts. In addition, she had concurrent "tingling" sensations of the fingertips of both hands (right more severely affected). There were no abnormal movements involving the oro-facial-buccal region or lower extremities. She had no urinary or bowel complaints. There was no history of exposure to neuroleptic medications, severe head trauma, or dementia. No relatives had similar problems. She was initially evaluated by an orthopaedic surgeon who suspected underlying carpal tunnel syndrome (CTS). This was confirmed on the nerve conduction test, which revealed a mild to moderately severe right CTS. However, she was subsequently referred to the Movement Disorders Clinic for further evaluation.Neurologic examination demonstrated dystonic posturing of her fingers when upper arms were outstretched and in wingbeating position. Her index and middle fingers were flexed at the metacarpal-phalangeal joints and proximal inter-phalangeal joints, together with mild pronation at the radio-ulnar joints. Stereotypic finger movements were observed when she tried using her hands. On walking, choreoathetoid movements in both of her upper extremities were present. Power in all of her extremities was full. There was increased tone in both her lower extremities, generalized hyper-reflexia in her four extremities with no clonus. Her jaw jerk was not brisk. Plantar response was flexor bilaterally. There was no loss of sensation to pinprick, light touch, or presence of a sensory level, and proprioception and vibration sense were intact. There were no signs of cerebellar dysfunction and Romberg test was negative. She had no clinical evidence of dementia and no Kayser-Fleischer ring on ophthalmic examination.MRI of cervical spine revealed severe cord compression at C3-C4 level by a prolapsed disc ( figure, A and B). Brain MRI scan did not show any abnormalities. Transcranial magnetic stimulation study demonstrat...

m6A modification is one of the most important post-transcriptional modifications in RNA and plays an important role in promoting translation or decay of RNAs. The role of m6A modifications has been highlighted by increasing evidence in various cancers, which, however, is rarely explored in acral melanoma. Here, we demonstrated that m6A level was highly elevated in acral melanoma tissues, along with the expression of METTL3, one of the most important m6A methyltransferase. Besides, higher expression of METTL3 messenger RNA (mRNA) correlated with a higher stage in primary acral melanoma patients. Knockdown of METTL3 decreased global m6A level in melanoma cells. Furthermore, METTL3 knockdown suppressed the proliferation, migration, and invasion of melanoma cells. In METTL3 knockdown xenograft mouse models, we observed decreased volumes and weights of melanoma tissues. Mechanistically, we found that METTL3 regulates certain m6A-methylated transcripts, thioredoxin domain containing protein 5 (TXNDC5), with the confirmation of RNA-seq, MeRIP-seq, and Western blot. These data suggest that METTL3 may play a key role in the progression of acral melanoma, and targeting the m6A dependent-METTL3 signaling pathway may serve as a promising therapeutic strategy for management of patients of acral melanomas.

Introduction: Postherpetic neuralgia (PHN) is a painful condition that occurs after herpes zoster skin lesions have subsided and that lasts for more than 1 month. PHN is usually difficult to treat. We herein present two cases of PHN comorbid with spinal metastasis of a malignant tumor. Both patients responded well to an epidural block. Case presentation: Patient 1 was a 54-year-old woman who had PHN for 35 days. Patient 2 was a 74-year-old woman who had PHN for 65 days. Both patients were treated with an epidural block and found to have spinal metastasis from a malignant tumor. Discussion: The routinely used dermatological medications for the treatment of herpes zoster and PHN have slow and unsatisfactory analgesic effects. Epidural block treatment provides a new approach for patients who cannot tolerate or do not respond to these commonly used drugs. Physicians should pay special attention to patients who have a history of a malignant tumor or are suspected to have spinal disease. Computed tomography or magnetic resonance imaging of the spine is recommended for such patients, and epidural block treatment should be performed after a spinal tumor or other lesions have been excluded. Conclusion: Epidural block treatment provides a new approach for patients of herpes zoster or PHN, but the treatment should be performed after a spinal tumor or other spinal lesions have been excluded.