Purpose of ReviewAstasia refers to the inability to maintain upright posture during standing, despite having full motor strength. However, the pathophysiology and neural pathways of astasia remains unclear.Recent FindingsWe analyzed 26, including ours, non-psychogenic astasia patients in English literature. Seventy-three percent of them were man, 73% were associated with other neurologic symptoms and 62% of reported lesions were at right side. Contralateral lateropulsion was very common followed by retropulsion while describing astasia. Infarction (54%) was the most commonly reported cause. Thalamus (65%) was the most commonly reported location. Infarction being the mostly likely to recover (mean:10.6 days), while lesions at brainstem had longer time to recover (mean: 61.6 days).SummaryThe underlying interrupted pathway may be the primary graviceptive system, which composed of at least five unilateral and contralateral projection fibers from vestibular nuclei to thalamic nuclei, and thalamo-cortical projections including subcortical white matter tracts and cortical areas.
Chronic leg ulcer occurs in up to 13% of the general population and leads to economic and health care burdens. Approximately 20% of chronic nonhealing wounds are related to autoimmune diseases or vasculitis. Of these, chronic wounds associated with IgG4-related disease, a group of fibroinflammatory disorders that can have cutaneous and systemic involvement, are rarely reported. This case report describes a chronic leg ulcer associated with cutaneous IgG4-related disease. In addition to disease control with anti-inflammatory agents, following the principles of wound management and providing adjuvant wound treatment (eg, debridement, dressing, photobiomodulation therapy, or hyperbaric oxygen therapy) can promote the wound healing process.
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