Shoulder pain from glomus tumour.
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Biomedical subjects
Publications and source records attributed to E W Massey.
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Underwater diving may cause several unique neurologic injuries because of exposure to rapid changes in pressure and volume. DCS, which results from extended deep dives and too rapid ascent, is a systemic disease that frequently causes spinal cord injury but may involve other organs as well. AGE results from pulmonary overpressure on ascent, with extravasation of air into the arterial system, and causes stroke-like brain injury. Both conditions are of sudden onset, progress rapidly, and require urgent attention. Definitive treatment includes administration of oxygen and recompression in a chamber. Permanent neurologic injury may result.
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The syndrome first described in 1904 by the Spanish otolaryngologist, Antonio Garcia Tapia, has been variously interpreted by subsequent authors such that there is little current agreement as to the site of the lesion responsible for the condition or the specific symptoms included in this disorder. The confusion arose in part because Tapia's original patient had associated neurologic findings. Careful review of Tapia's reports reveals (1) that he regarded the syndrome as consisting of ipsilateral hemiplegia of the larynx and tongue with normal function of the soft palate and (2) that he believed the lesion resulting in these signs was outside the CNS.
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In patients with diabetes, a carefully taken history and meticulously performed neurologic examination enable the clinician to separate superimposed mononeuropathy from more generalized symmetric polyneuropathy. Recognition of mononeuroparhy is important, since often it is reversible.
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In three patients we found unilateral asterixis in limbs contralateral to a discrete lesion adjacent to the internal capsule. Etiology was vascular in each, with no metabolic or toxic disturbance. Unilateral asterixis bespeaks focal disease arising from lesions in the thalamus or internal capsule and is a sign of motor integrative dysfunction.
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