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At least 199 records · Page 11Linked to original sources
PubMed2005

[Value of arthroscopy in the treatment of upper ankle arthritis].

OBJECTIVE: The purpose of this retrospective study was to evaluate arthroscopy in upper ankle osteoarthritis. METHODS: In the period from 1988 to 1997, 358 arthroscopies of the upper ankle joint were performed in 178 cases due to arthritis. Of 132 accessible patients, 124 replied to our questionnaire: 90 (73%) of the responders underwent clinical examination 94 (37-152) months following the initial arthroscopy and were graded according to the score of Evanski and Waugh. All arthroscopies were performed under fluid filling using anterolateral and anteromedial approaches. In only five cases was the posterior compartment additionally investigated. Generally, neither tourniquet nor mechanical joint distraction were applied. RESULTS: Of a total of 12 (6.7%) complications, only 3 (1.7%) hematomas needed surgical revision. One hematoma was due to an arteriovenous fistula treated by double ligation. All complications including five hypesthesias were temporary and subsided spontaneously. The 124 patients of the questionnaire group assessed the result of arthroscopic surgery as excellent in 11%, good in 46%, fair in 22%, and poor in 21%. Of all patients, 22% required further surgery of the upper ankle: in 9% further arthroscopy, in 3% arthrodesis, and in 10% microsurgical denervation. The total range of motion increased from 10/0/40 degrees (extension/flexion) preoperatively to 15/0/44 degrees at the follow-up examination. The Evanski score improved significantly (p<0.001) from 41 to 76 points. CONCLUSION: Due to minimal invasiveness and low risk of complications, arthroscopy is recommended for the following indications of upper ankle osteoarthritis: focal arthrosis, limited range of motion caused by osteophytes, soft tissue impingement, corpora libera, and synovitis. Severity and extent of upper ankle arthritis, range of motion, pain, local bone and soft tissue quality as well as the age, physical activity and compliance of the patient concerned are decisive for the individual therapeutic protocol. Alternative surgical techniques in upper ankle osteoarthritis are assessed such as denervation, distraction arthroplasty, correction osteotomy, ankle arthrodesis and total ankle replacement.

Adolescent↗
PubMed2001

[Intravenous immunoglobulin and prednisolone treatment of cryoglobulinemic polyneuropathy].

A 71-year-old man with cryoglobulinemia associated with severe symmetrical sensorimotor polyneuropathy was successfully treated with intravenous immunoglobulin (IVIG) and a corticosteroid. Within 2-3 months, he developed distal motor and sensory deficits and burning feet deteriorating after cold exposure. On examination, symmetric hypesthesia and hypalgesia were found along with bilateral loss of vibration and position sense, loss of ankle jerks, and paralysis of the pretibial muscles with step-page gait. The laboratory exam revealed elevated cryoglobulin levels and reduced complement C4. Nerve conduction studies were consistent with a severe axonal sensorimotor polyneuropathy. Sural nerve biopsy showed chronic neuropathy with an acute component. The patient underwent a combined treatment with prednisolone (initially 100 mg) and intravenous immunoglobulin. His condition markedly improved after almost a year of treatment. Unfortunately, the treatment with intravenous immunoglobulin had to be interrupted due to an allergic reaction after the sixth application.

Aged↗
PubMed2000

Prolonged peroneal nerve dysfunction after high tibial osteotomy: pre- and postoperative electrophysiological study.

To evaluate electrophysiological incidence and the type of peroneal nerve lesions seen after high tibial osteotomy we conducted an electrophysiological study (electromyography and nerve conduction velocity studies) in 11 patients who were suffering from medial gonarthrosis and treated by Maquet barrel-vault type high tibial valgization osteotomy. All the patients were tested both pre- and postoperatively. Every patient was examined postoperatively for a minimum of a 6 months after surgery to eliminate spontaneously reversible lesions. Results obtained from nonoperated legs served as controls. Three patients (27%) with peroneal nerve lesions were detected electrophysiologically; one had only motor involvement, one only sensory involvement, and one both motor and sensory involvement. Clinically only one of these patients was symptomatic, and the other two were detected by electrophysiological means. Peroneal nerve lesions which may be overlooked by mild weakness and hypesthesia in the early postoperative period can be detected by electrophysiological means at a higher rate than expected. These lesions persist a relatively long time and even can be permanent despite the absence of clinical symptoms.

Aged↗
PubMed1998

Difficulties and early results of the endoscopic carpal tunnel release using the modified Chow technique.

In reporting on the preliminary results of our series of 76 patients, this paper aims to identify potentially complicating aspects of endoscopic carpal tunnel release (ECTR) using the two-portal Chow technique, and to recommended solutions, based on our early experience, which enhance the ease and safety of this minimally invasive technique. Of the first 24 patients, 16 cases required conversion to an open procedure. Based on these initial cases, we developed certain modifications of the Chow technique which precluded any need for open conversion in the 60 remaining cases. During a follow-up interval ranging from 4 to 24 months, there was no recurrence of carpal tunnel symptoms, and the average time to resumption of work activity was 14 days. The complication rate was 5% and included one case of transient hypesthesia, one case of extended hematoma, and one hypersensitive scar. All complications resolved at subsequent follow-up. In our experience, correct positioning of the hand, proper injection of local anesthetic, use of magnifying loupes, and correct use of instruments are essential for a safe and successful procedure.

Carpal Tunnel Syndrome↗
PubMed2002

[Fatal cardiomyopathy in adult in polyglucosan body disease].

Adult polyglucosan body disease (APBD) is a rare genetic disorder, inherited in an autosomal recessive mode. The disease is caused by mutations of the gene coding for the glycogen-branching enzyme, which is essential for branching of polyglucose chains in the normal glycogen molecule. The age of clinical manifestation of the disease mostly is between 40 and 60 years and its course is slowly progressive. Characteristic globular deposits (polyglucosan bodies, PGB) can be detected in biopsies of skin and skeletal muscle as well as in the peripheral and central nervous system. Biochemically, PGBs consist of poorly branched glycogen molecules with abnormally long polysaccharide chains. We report the case of a 50-year-old female patient with APBD who suffered from neurological symptoms such as spastic tetraparesis, urinary incontinence, hypesthesia and dementia. She died unexpectedly of cardiac failure. At autopsy a severe cardiomyopathy with abundant PGBs in the heart muscle fibres could be proven as the cause of death. This observation shows that in addition to the known deposition of PGBs in nervous system and skeletal muscle, an involvement of the heart has to be considered in APBD as well.

1,4-alpha-Glucan Branching Enzyme↗
PubMed2000

Cytomegalovirus infection in systemic necrotizing vasculitis: causative agent or opportunistic infection?

We report on a 69-year-old woman who presented with myalgia, hearing impairment, fever, night sweats, weight loss, muscular weakness, paresthesia, hypesthesia, and hypalgesia. Sural nerve biopsy showed demyelinative and axonal polyneuropathy due to necrotizing vasculitis with fibrinoid necrosis. A positive test for antineutrophil cytoplasmic antibodies (ANCA) with a perinuclear immunofluorescence pattern directed against myeloperoxidase was more suggestive of microscopic polyangiitis (MPA) than of polyarteritis nodosa (PAN), the possible differential diagnoses. In addition, positive tests for cytomegalovirus (CMV) antibodies (immunoglobulin (Ig)M and IgG) and the detection of CMV-DNA in sputum specimens by polymerase chain reaction (PCR) were indicative of active CMV infection. Treatment with ganciclovir and anti-CMV immunoglobulin in addition to prednisolone medication for 6 months resulted in rapid improvement of the clinical symptoms without relapse. CMV infection has been described to be related to ANCA-associated vasculitis in non-immunocompromized patients and may be either a causative agent or an opportunistic infection. Identification of a viral etiology in patients with atypical ANCA-associated vasculitides may lead to different, less aggressive treatment approaches, including antiviral therapy.

Aged↗
PubMed1998

Oligodendroglioma of the "widespread" type in the spinal cord.

The authors present clinical, radiological, and pathological features of the "widespread" type of primary spinal oligodendroglioma arising in a 12-year-old boy. The initial symptoms were gait disturbance, hypesthesia of the lower trunk, and scoliosis. Gadolinium-enhanced magnetic resonance imaging revealed an intramedullary tumor with syringomyelia. The tumor spread rapidly in a "widespread" pattern within the spinal cord between C7 and T12. One year after surgery the patient had made a poor neurological recovery despite the two-stage tumor resection. Only five cases of widespread tumors, including our case, have been described with discussion of their clinical manifestations.

Child↗
PubMed2003

[Atypical Leriche syndrome].

A 73-year old woman presented with mild paraparesis and hypesthesia of the legs. Furthermore, she complained dizziness, fainting and dyspnea. There was a history of peripheral artery disease, diabetes mellitus, arterial hypertension and chronic atrial fibrillation. Five years ago she had breast cancer with removal of the left mamma and additional radiation therapy. Cardiac catheterization at that time demonstrated no significant coronary stenoses. A contrast-enhanced CT-scan excluded lumbal spinal metastases. Instead, a subtotal occlusion of the abdominal aorta was noticed, but was initially interpreted as a chronic thrombosis because there were no typical symptoms and only moderate pain. About 24 hours later the patient developed an acute ischemic syndrome of the legs with progressive paraparesis, cold and pale legs in combination with acidosis and hyperventilation. Color-coded duplex ultrasound showed only a small turbulent flow in the ilial arteries, highly suspicious of a complete occlusion of the distal aorta. Angiography revealed an acute total occlusion of the infrarenal aorta without collaterals. During surgical intervention, complete obstruction of the abdominal aorta above the bifurcation was confirmed. Subsequent embolectomy was performed and an embolus consisting of several layers of different age was extracted. After successful surgical intervention with subsequent clinical improvement, the patient's clinical condition deteriorated a few day later. She died on day 9 after surgery from a complete ischemia of the small intestine and the colon ascendens.

Aged↗
PubMed2002

Polyneuropathy in neurofibromatosis 2: clinical findings, molecular genetics and neuropathological alterations in sural nerve biopsy specimens.

Neurofibromatosis 2 (NF2) is an autosomal dominant disease characterised by development of tumours in the central and peripheral nervous system. Some NF2 patients develop acro-distal sensory motor polyneuropathy that can hardly be explained by the tumour burden alone. In the present study eight sural nerve biopsy specimens from seven NF2 patients suffering from polyneuropathy were investigated, data including clinical course of the disease, electrophysiological findings, teased fibre preparations, histopathological, morphometric, immunohistochemical, electron microscopic and molecular genetic findings. All patients suffered from distal symmetric reflex loss, symmetrical stocking-like hypalgesia and hypesthesia and loss of vibration sense later followed by a slowly progressive distal muscle atrophy and paresis. Sural nerve biopsy specimens revealed a pathological reduction of nerve fibre density correlating with age. In addition, diffuse proliferation of Schwann cells was observed in five of eight biopsies, and small endoneurial tumourlets of schwannomas and perineuriomas were found in two of eight and one of eight samples, respectively. Ki-67 labelling revealed a slight endoneurial proliferative activity in three cases. Schwann cell onion bulbs with or without central myelinated axon were seen in two cases. The findings suggest an axonopathy of multifactorial origin resulting not only from gross tumour growth but, in addition, from small endoneurial tumourlets, diffuse proliferation of Schwann cells and proliferation of perineurial cells.

Adolescent↗
PubMed2002

Uterine leiomyosarcoma metastatic to the brain stem.

A patient with a history of an uterine leiomyosarcoma presented with diplopia, gait disturbances, and hypesthesia of the right face. MRI of the head showed a lesion located in the pons and causing obstructive hydrocephalus. Open biopsy revealed a metastatic tumor with histological features of leiomyosarcoma. Despite whole-brain irradiation, the patient died due to respiratory arrest. This case illustrates that brain stem metastasis may occur as a rare complication in uterine leiomyosarcoma.

Brain Neoplasms↗
PubMed2000

Infraorbital nerve recovery after minimally dislocated facial fractures.

There is evidence that rigid fixation of zygomaticomaxillary suture enhances the recovery of the infraorbital nerve compared with other means of surgical treatments. There is, however, no agreement as to whether any surgery decreases the number of sensory disturbance in cases with little or no dislocation, or whether infraorbital numbness alone should be considered an indication for surgery. An operation may even increase the edema and hemorrhage around the nerve. This retrospective study was carried out among patients with infraorbital hypesthesia but little or not at all dislocated midfacial fractures. Two special types of trauma patients were selected; those with a blow-out fracture but an intact infraorbital rim (BO) and those with a zygomaticomaxillary complex fracture (ZMC). A questionnaire was sent to the patients (n = 226) 2.2 years (mean) after the accident. There were 128 responses (BO n = 41, ZMC n = 87). Of these, 27 BO and 29 ZMC patients had been treated by observation. An orbital exploration had been carried out in 14 BO patients, and 58 ZMC patients had received malar bone elevation without rigid fixation. At the end of the follow-up period nontreated patients had fewer symptoms than those who had had surgery. This was clearer in the ZCM group (symptom free 69% vs. 52%) than in the BO group (69% vs. 50%). The differences between surgically and nontreated BO or ZMC patients, however, were statistically nonsignificant. According to our findings, exploration of the orbital floor or an attempted elevation of a minimally or nondislocated fracture of the ZMC does not enhance the recovery of the infraorbital nerve. On the contrary, the procedure may itself increase the morbidity and sensory dysfunction. Further studies are needed to determine whether the results could be improved by selective decompression of the infraorbital nerve and a rigid fixation.

Adult↗
PubMed2005

Upper cranial nerve palsy resulting from spontaneous carotid dissection.

INTRODUCTION: Upper cranial nerve palsy has a variety of causes such as cerebral and nerve ischemia, diabetes, infectious and non-infectious meningitis, subarachnoid hemorrhage and intracranial aneurysm. CASE 1 : A 45-year-old man suffered from holocephalic headaches and a right-sided neck pain for two weeks. He presented to our emergency department because of a sudden ptosis of the right eye. On admission neurological examination revealed a right sided Horner's syndrome and hypesthesia of the right side of the face. Magnetic resonance angiography identified a circumscribed dissection of the right extracranial internal carotid artery originating from the carotid bifurcation. Conventional angiography 2 weeks later showed a nearly recanalized artery. CASE 2 : A 55-year-old previously healthy man without cardiovascular risk factors developed right sided neck pain when loading a seeder with several sacks of crop. A few hours later he noticed a left-sided weakness. On admission a severe left sided hemiparesis and a mild neglect were present. Duplex sonography revealed a right-sided distal internal carotid artery (ICA) occlusion. The next morning the patient complained of double vision; he had a right-sided pupil-sparing oculomotor palsy. The diagnosis of ICA dissection was confirmed by conventional angiography, at that time showing a partially recanalized ICA without involvement of the cavernous region by the dissection. CONCLUSION: ICA dissection must be included in the differential diagnosis of upper cranial nerve palsy and should be assessed by duplex ultrasound and magnetic resonance imaging. A possible explanation is nerve ischemia due to a transient or permanent interruption of the blood supply by compression of the vasa nervorum originating from the intracranial carotid artery.

Carotid Artery, Internal, Dissection↗
PubMed2006

Between Wallenberg syndrome and hemimedullary lesion: Cestan-Chenais and Babinski-Nageotte syndromes in medullary infarctions.

In comparison with the lateral (Wallenberg), medial (Dejerine) and hemimedullary (Reinhold) medulla oblongata syndromes, the Babinski-Nageotte and Cestan-Chenais syndromes are much less familiar cerebrovascular disorders. While the Babinski-Nageotte syndrome is usually confused with the hemimedullary syndrome, reports of the extremely rare Cestan-Chenais syndrome are missing from the modern neurological literature. The pathological and magnetic resonance imaging (MRI) correlations of the Cestan-Chenais syndrome have not been shown so far. We compared clinical and MRI features of two patients exhibiting classical Babinski-Nageotte and Cestan-Chenais syndromes according to their original descriptions with those of three patients with lateral, medial and hemimedullary syndromes. Our study shows that Babinski-Nageotte syndrome includes all symptoms of the Wallenberg syndrome and additionally contralateral hemiparesis due to a spreading of the "Wallenbergian" lateral lesion to the pyramidal tract. The Cestan-Chenais syndrome includes all symptoms of the Babinski-Nageotte syndrome with the exception of the ipsilateral cerebellary hemiataxia because of sparing of the posterior spinocerebellar tract. The Babinski-Nageotte syndrome is neither clinically nor on MRI identical with hemimedullary syndrome. Hypoglossal palsy, an invariable symptom of hemimedullary lesion is not part of the Babinski-Nageotte syndrome. The contralateral hypesthesia is dissociated in the Babinski-Nageotte syndrome. The Babinski-Nageotte and Cestan-Chenais syndromes are intermediolateral medullary syndromes with all (Babinski-Nageotte) or nearly all (Cestan-Chenais) features of the lateral and some features of the medial medulla oblongata syndromes.

Adult↗
PubMed1999

Neurological manifestations of chronic hepatitis C.

Hepatitis C virus (HCV) infection is often associated with abnormal immunological responses. We describe four patients with vasculitic neurological signs and symptoms following HCV infection. A 56-year-old woman with HCV infection developed peripheral neuropathy characterized by asymmetric distal painful hypesthesia, dysesthesia and moderate motor weakness of the lower limbs. Serological examinations revealed cryoglobulinemia and low levels of complement C4. A biopsy of the sural nerve revealed vasculitic neuropathy. HCV infection associated immunomediated vasculitis was diagnosed. While steroid therapy was ineffective, treatment with interferon-alpha improved the neuropathy considerably without, however, eliminating HCV infection. A 62-year-old man with HCV infection developed peripheral sensory neuropathy. Complement C3 was slightly diminished. Nerve biopsy revealed vasculitic neuropathy. A 71-year-old woman developed chronic symmetric sensomotor polyneuropathy. HCV hepatitis followed blood transfusions. Cryoglobulins tested positive, consistent with type II cryoglobulinemia. Complements C3 and C4 were diminished. Inflammatory infiltrates in the sural nerve biopsy specimen led to the diagnosis of chronic vasculitic disorder. A 55-year-old woman with HCV infection developed vasculitis of the skin, connective tissue, visceral organs, and kidney, leading to hemodialysis. Neurologically she developed severe apathy and drowsiness, myoclonic jerks, exaggerated deep tendon reflexes, and positive pyramidal signs. Magnetic resonance imaging of the brain showed diffuse increased signal abnormalities involving supra- and infratentorial white matter suggesting cerebral vasculitis. Cryoglobulins were positive, complements C3 and C4 slightly diminished (54 mg/dl, 4.3 mg/dl). Supportive therapy resulted in neurological improvement. Treatment with interferon-alpha was discontinued because of agranulocytosis. In patients with peripheral neuropathy or signs of leucencephalopathy, a hepatitis C associated vasculitis should be considered in the differential diagnosis.

Aged↗
PubMed1999

Pseudochoreoathetosis in four patients with hypesthetic ataxic hemiparesis in a thalamic lesion.

Thalamic lesions give rise to a variety of clinical syndromes including choreoathetotic movements and ataxic hemiparesis as well as sensory deficits. We describe four patients exhibiting pseudochoreoathetosis, hypesthesia, and ataxic hemiparesis in the limbs contralateral to a thalamic lesion. Three of the four patients showed the involuntary movements within 10 days of stroke onset; the remaining patient was not seen until 4 years later. Three had infarction and the other one hemorrhage in the posterior and lateral thalamus. All the patients had both cerebellar and sensory ataxia. These cases suggest that failure to convey proprioceptive information be the basic pathophysiology of pseudochoreoathetosis.

Ataxia↗
PubMed2002

[Neurosurgical therapy of facial neuralgias].

INTRODUCTION: Neuralgias of the face, especially trigeminal neuralgia and glossopharyngeal neuralgia are indications for surgical interventions after failed medical therapy. In contrast to other forms of headache or atypical facial pain, where surgical measures are considered to be contraindicated, percutaneous procedures or microvascular decompression are able to produce immediate and longstanding pain relief. Careful preoperative evaluation is essential to confirm the clinical diagnosis and to rule out other causes as multiple sclerosis or tumors afflicting the cranial nerves. The following study will summarize the common surgical techniques and their role considering a mechanism-based therapy as well as document long-term results of these measures. METHODS: Between 1977 and 1997 316 thermo-controlled radiofrequency trigeminal rhizotomies (TK) and 379 microvascular decompressions (MVD) were performed in our hospital to treat trigeminal neuralgia; additional 6 MVDs for glossopharyngeal neuralgia and one MVD of the intermediate facial nerve were carried out. Questionnaires were sent out to all patients still living in 1981, 1982, 1992 and 1998. For all other patients, interviews with relatives or the general practitioners were conducted. A retrospective analysis of postoperative pain relief was performed using Kaplan-Meier curves at the latest follow-up. Additionally 80 patients underwent careful quantitative sensory testing with Von-Frey-hairs. RESULTS: 225 patients who underwent microvascular decompression and 206 with radiofrequency trigeminal rhizotomies were further analyzed. There was a 50% risk for pain recurrence two years after radiofrequency rhizotomy. On the other hand 64% of patients who underwent microvascular decompression remained painfree 20 years postoperatively. Patients with microvascular decompression without sensory deficit were painfree significantly longer than patients with postoperative hypesthesia. DISCUSSION: Etiology and pathogenesis of facial neuralgias are far from understood despite several hypotheses. Based on current models there is no explanation for the immediate pain relief especially after microvascular decompression. Some authors even discuss surgical trauma as the only cause for postoperative pain relief.

Diagnosis, Differential↗
PubMed2005

Multiple spinal dural arteriovenous fistulas.

Multiple spinal dural arteriovenous fistulas (DAVFs) have been rarely reported and only two such cases are found in the literature. A 71-year-old man complained of muscle weakness and hypesthesia in both legs and angiographically diagnosed as thoracic DAVF. The fistula was surgically treated, however, the symptoms recurred 14 months after the first treatment. Angiography revealed a new fistula in the lumbar region and this was also treated surgically. In the previously reported cases of multiple spinal DAVFs, the second fistulas were also diagnosed after the initial treatment. Symptomatic patients after the initial treatment of DAVF should be re-examined angiographically.

Aged↗
PubMed2003

Measuring of the compensation of a nerve root in a cervical schwannoma: a case report.

A 64-year-old woman experienced numbness and hypesthesia of the right C6 dermatome a year ago. Enhanced magnetic resonance imaging of the cervical spine revealed an enhanced tumor continuing into the foramen from the spinal cord at the C5/6 intervertebral level. It was thought to be an Eden type 2 schwannoma. Right unilateral laminectomy was performed on C5. The tumor was present in the intradural area and arose from the right C6 anterior root. Compound muscle action potentials (CMAPs) from the deltoid, biceps, and extensor carpi radial (ECR) muscles were recorded following electric cervical nerve root stimulation (0.2 ms duration, and 7 mA intensity). CMAPs of large amplitude were obtained from the deltoid, biceps, and ECR muscles following C5 root stimulation, but those following C6 root stimulation were small. As a result it was determined that the right C6 root was not associated with the nerve distribution for these muscles, so it was resected en bloc with the tumor. No apparent loss of motor function was observed. Standard needle electromyography showed no denervation potentials or decrease in motor unit potentials in either the deltoid or biceps muscles. Intraoperative investigation for compensation of nerve root is clinically useful for determining whether resection of a nerve root results in muscle weakness after surgery for a cervical schwannoma.

Action Potentials↗