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At least 451 records · Page 25Linked to original sources
PubMed2007

Patterns of sensory abnormality in cortical stroke: evidence for a dichotomized sensory system.

OBJECTIVE: To characterize sensory symptoms in patients with stroke occurring in the cerebral cortex. METHODS: We studied clinical and imaging findings of 24 patients who had prominent sensory symptoms without definitive motor dysfunction. RESULTS: According to the sensory manifestations, patients were divided into dominant impairment of primitive sensation (DIPS) group, dominant impairment of cortical sensation (DICS) group, and paresthesia-only group. DIPS was related to lesions involving the parietal operculum and the insular cortex, whereas DICS was related to the lesions affecting the postcentral gyrus. Patients with paresthesia only had smaller lesions located in the postcentral gyrus. DIPS group patients were more often women (p = 0.013), more often had dysarthria (n = 0.043), and more often developed central poststroke pain or paresthesia (n = 0.005) than the DICS group patients. Restricted sensory changes are common, predominantly involving the perioral or finger areas. CONCLUSIONS: Sensory patterns in these patients are generally consistent with the dichotomized (SI and SII) sensory system in the cerebral cortex. Involvement of insular and opercular areas is related to primitive sensory impairment and development of central poststroke pain, whereas postcentral gyrus involvement is related to cortical sensory loss without poststroke pain. The pattern of restricted sensory changes is generally consistent with the Penfield sensory topography.

Adult↗
PubMed2006

Superficial peroneal nerve syndrome: an unusual nerve entrapment. Case report.

Lower-extremity pain and paresthesia have multiple origins. Early recognition of the symptoms of peripheral nerve entrapment leads to timely treatment and avoids the cost of unnecessary studies. The authors report on a case of superficial peroneal nerve syndrome resulting from nerve herniation through a fascial defect, which was responsive to surgical treatment. This 22-year-old man presented with pain and paresthesias over the lateral aspect of the right calf and the dorsum of the foot without motor weakness. Exercise led to the formation of a tender bulge approximately 12 cm above the lateral malleolus. Percussion of this site worsened his symptoms. Radiography and electromyography studies were nondiagnostic. The patient underwent surgical decompression that involved division of the fascia overlying the nerve and neurolysis of the superficial peroneal nerve. The operation resulted in symptom-free relief. Superficial peroneal nerve syndrome is an entrapment neuropathy that results from mechanical compression of the nerve at or near the point where the nerve pierces the fascia to travel within the subcutaneous tissue. Surgical decompression of the mechanical entrapment usually provides relief from pain and paresthesia.

Adult↗
PubMed1976

[An epidemiologic study on vibration hazards among workers at the state forests in Kyushu (author's transl)].

There are only very few reports of epidemiologic analysis on vibration hazards among the workers at the state forests of Japan since 1970. It was necessary to perform investigations on the state of vibration hazards anew, through some labor hygienic policies on the prevention of the hazards, such as regulation of the time of using vibrating tools, had been executed to some extent since 1970. From the data of physical check-ups of 861 chain saw users of 24 District Forestry Offices in Kumamoto, Miyazaki and Kagoshima Prefectures in the south of Kyushu, the transition of vibration hazards was studied by using the incidence and prevalence of Raynaud's phenomenon and paresthesia of the fingers as indices. From the yearly transition of the hazards, a tendency was observed of increasing patients with vibration syndrome during the period from 1962 to 1970 when countermeasures on vibration hazards were not sufficient. However, since 1970 the occurrence of Raynaud's Phenomenon has shown a tendency to decrease among the workers with short history of using chain saw and the occurrence of paresthesia of the fingers as indices. From the yearly transition of the hazards, a tendency was observed of increasing patients with vibration syndrome during the period from 1962 to 1970 when countermeasures on vibration hazards were not sufficient. However, since 1970 the occurrence of Raynaud's Phenomenon has shown a tendency to decrease among the workers with short history of using chain saw and the occurrence of paresthesia of the fingers to increase among those with long history. The results are suggestive of making clear the pathophysiology of vibration hazards.

Fingers↗
PubMed2001

[Symptoms and clinical course in carpal tunnel syndrome].

BACKGROUND: We wanted to study the symptoms in carpal tunnel syndrome, evaluate postsurgical median nerve recovery in elderly patients compared to younger patients, and investigate the clinical development and median nerve changes in non-operated cases. MATERIAL AND METHODS: The study included 92 patients diagnosed with carpal tunnel syndrome on the basis of clinical symptoms and neurophysiological findings. Neurophysiological data from elderly operated (70-89 years), younger operated (30-69 years) and non-operated (25-83 years) patients were analysed separately. RESULTS: The most common symptoms were paresthesia in the third (97%) and second (88%) digits, nocturnal paresthesia (88%), increased symptoms when at work (78%), and pain in the hand (72%). Paresthesia in the entire hand (30%) and pain in the entire arm (55%) were common. Median nerve recovery in the elderly patients was comparable to the results in the younger operated patients. Some patients recovered clinically with normalisation of the median nerve without surgery. INTERPRETATION: Carpal tunnel syndrome will often have symptoms outside the median nerve territory. Elderly patients should be operated on the same indications as those applied to younger patients. Patients with no neurological findings may be monitored without surgery.

Adult↗
PubMed2001

Carpal tunnel syndrome in sarcoidosis.

Sarcoidosis is a systemic disease that may affect the musculoskeletal system. An association between carpal tunnel syndrome (CTS) and sarcoidosis has not been demonstrated. Consecutive patients from the sarcoidosis clinic at our institution were questioned about history and symptoms of carpal tunnel syndrome: hand numbness and nocturnal paresthesias with relief of symptoms by shaking of the hands (flick sign). A physical exam was performed to evaluate for Tinel's and Phalen's signs. A comparison of the presence of arthritis, prednisone treatment, spirometry, and number of organs involved with sarcoidosis was made in patients with a history or clinical findings of CTS versus those without. Eighty-nine patients were evaluated. Thirty-five patients (39%) had nocturnal paresthesias with a positive flick sign. Fourteen patients (16%) had physical findings of CTS. A history of CTS was present in 14 (16%) of the patients, four of which were documented by EMG. There was no significant difference between the frequency of prednisone treatment in patients with or without CTS history, nocturnal paresthesias, or Phalen's sign. There were significantly fewer patients with a positive Tinel's sign who were receiving prednisone. There was a trend toward an increased frequency of wrist arthritis in patients with a history or clinical findings of CTS. There was no significant difference in disease severity, assessed by spirometry or organ involvement, when comparing sarcoidosis patients with or without a history or clinical findings of CTS. Thirty-nine (44%) had symptoms and/or signs of CTS. Even when we adjusted our sarcoidosis population for other factors associated with CTS, the prevalence of symptoms and signs of CTS was much higher in our patient population than in studies of the general population. Our findings suggest that CTS is common in sarcoidosis.

Adult↗
PubMedDate not supplied

Accessing restoration margins--a multidisciplinary approach.

The problem of paresthesia after dental procedures has existed for years. The literature presents several simple precautions dentists can take to avoid paresthesia caused by injection in nonsurgical cases. Although the risks of complications are still extremely small (1:785,000), there has been an increase recently in the number of cases reported. Though not all instances cause total paresthesia, these incidents do involve prolonged numbness, which is of concern to both the patient and practitioner.

Anesthesia, Dental↗
PubMed1992

[Ulnar nerve lesion at the elbow. Epidemiological, clinical and electromyographical data. Apropos of 312 patients].

Four hundred and ninety-three electromyographic ulnar nerve lesions identified in 312 patients were reviewed. During the same period, 1,000 cases of median nerve entrapment were seen in the same department. Among ulnar nerve lesions, 84% were idiopathic and only 52% were responsible for clinical symptoms. In patients with symptoms, three main patterns of paresthesia were seen: exacerbation at night and/or in the morning upon awakening (39%), permanent isolated paresthesia (34%), and permanent paresthesia with exacerbation at night and/or in the morning upon awakening (27%). Objective sensory loss was found in 1/3 to 1/4 of cases. All patients with muscle wasting (11%) also had sensory loss; muscle strength was markedly decreased in 19% of patients. Pain was mild and infrequent (35%). Electromyographic studies revealed a decrease in motor and sensory conduction velocity at the elbow (mean value 36.2 m/sec). Sensory conduction velocity was the most sensitive parameter for detecting incipient or moderate forms, whereas motor conduction velocity was extremely helpful in severe forms. Eighty-three per cent of patients had alterations of both conduction velocities (sensory and motor). In the mildest forms, nerve conduction velocity was normal (13% of cases); in these patients diagnosis was established on the basis of either a partial motor conduction block (3%) or desynchronization of the sensory action potential (10%).

Elbow↗
PubMed2005

Type II decompression sickness in naval hypobaric chambers: A case of mistaken identity?

INTRODUCTION: Historically, U.S. Navy clinicians have used the U.S. Navy Dive Manual for guidance in the diagnosis and treatment of injuries incurred during hyper- or hypobaric operations. Based on this manual, paresthesias are considered to be central nervous system manifestations and thus are classified as Type II (severe) decompression sickness (DCS). Yet given the highly successful response to treatment of peripheral nervous system manifestations of DCS in the literature, both the diving and aviation communities have questioned its classification as "severe" DCS. This record review was undertaken to examine U.S. Naval severe cases of altitude DCS with the goal of identifying dissimilarities between hypobaric facilities in classification and incidence. METHODS: Hypobaric exposures and cases were reviewed from quarterly training reports maintained at the Naval Operational Medicine Institute, Pensacola, FL, between January 1993 and April 2004. Cases were analyzed for age, gender, flight profile, symptom complex, type of DCS, and treatment provided. RESULTS: There were 50,355 hypobaric exposures resulting in 97 cases of altitude DCS. Of the 97 cases of diagnosed DCS, 58 were classified as Type II, while 39 were Type I. Of the 58 cases of Type II DCS, 29 were diagnosed as Type II by the sole finding of non-dermatomal paresthesias. DISCUSSION: Type II DCS, a designation traditionally reserved for severe DCS, is frequently diagnosed by the sole finding of non-dermatomal paresthesias in Naval hypobaric training. A review and revision of the U.S. Naval Aviation classification system for altitude DCS should be undertaken with emphasis on severity not symptomatology.

Adult↗
PubMed2006

[A case of recurrence of cerebral hemorrhage in a patient with adult moyamoya disease in the recovery period rehabilitation ward].

A 61-year-old woman with a history of repeated cerebral hemorrhage due to moyamoya disease was admitted to our recovery period rehabilitation ward for walking training. She suddenly noticed paresthesia in her left forearm and the palm seven days later. Brain computed tomography on that day and magnetic resonance imaging on the next day after the onset of paresthesia revealed right thalamic hemorrhage. It was suggested that the hematoma localized to a small part of the central portion of the ventroposterior lateral nucleus caused paresthesia limited to the forearm and the palm. In a recovery period rehabilitation ward, we should carefully listen to the complaints of patients who are in advanced age and have a risk like our patient. Then adequate neurological examination should be performed for the pertinent inspection diagnosis, if needed.

Cerebral Angiography↗
PubMed1982

Abnormal spontaneous activity in single sensory nerve fibers in humans.

Spontaneous discharges generated in human motor nerve fibers have long been recognized, and their effects have been comfortably recorded from the muscle target with needle electrodes. Delay in documenting comparable phenomena from sensory fibers is explained by the need to record the abnormal activity directly from nerve fibers using intraneural microelectrodes. The hypothesis that a variety of positive sensory phenomena associated with nerve disease is the result of ectopic impulse generation from within the sensory unit can now be tested with microneurographic techniques. Research inaugurating microneurography in the study of positive sensory phenomena has yielded evidence of ectopic impulse generation from sensory units in subjects actually experiencing paresthesia or pain. The phenomenology of ectopic discharges in sensory fibers has been recorded with intraneural microelectrodes in: (1) transient postischemic paresthesia induced experimentally in otherwise normal nerves; (2) spontaneous paresthesia symptomatic to (probable) structural nerve pathology; and (3) in the sign of Tinel in traumatic neuromas.

Action Potentials↗
PubMed1980

Assessment of block of the sciatic nerve in the popliteal fossa.

Success of block of the sciatic nerve in the popliteal fossa in 130 patients was assessed by an anesthesiologist at the time of surgery. The patients were evaluated for complications by the anesthesiologist during postoperative rounds and by the orthopedic surgeon at the 1-month follow-up visit. Acceptance of the block by the patient was judged by answers on a questionnaire filled out by the patients after they had gone home. The questionnaire was designed to determine satisfaction with the block, discomfort associated with performance of the block, and whether sensations suggestive of paresthesias or other complications not evident at the time of discharge from the hospital had occurred. Of 119 patients responding to the questionnaire, 105 (88.2%) expressed overall satisfaction with the anesthesia. Two patients described sensations compatible with postoperative paresthesias, and two others described sensations that may have been paresthesias; in none did the sensations last longer than 1 month. Assessment of the blocks by the anesthesiologist in all 130 patients in the study revealed that anesthesia satisfactory for completion of the operative procedure was achieved in 107 (82.3%). General anesthesia was needed in eight patients (6.2%), and in 15 patients (11.5%) intravenous sedation or injection of the site of surgical incision with local anesthesia (or both) was needed.

Adolescent↗
PubMed1995

[Electrolyte changes during and after voluntary hyperventilation].

Paresthesia and tetanic finger cramps during hyperventilation-induced respiratory alkalosis are believed to derive from a pH-dependent decrease of ionized serum calcium. In the study reported here, ionized serum calcium, total calcium and total protein were measured during a three-minute hyperventilation period in ten volunteers. During hyperventilation finger paresthesias appeared in all probands without proof of any significant change in ionized serum calcium (1.26 +/- 0.05 mmol/l at the end of the three-minute hyperventilation period). Total protein increased as a consequence of hyperventilation-induced transient hemo-concentration. Paresthesias and tetanic finger cramps during the three-minute hyperventilation could not be related to changes of ionized serum calcium; however the other electrolytes, i.e. sodium, magnesium, potassium, chloride, phosphate and bicarbonate, showed, with the exception of sodium, significant changes.

Adult↗
PubMed1996

Nortriptyline-fluphenazine vs. carbamazepine in the symptomatic treatment of diabetic neuropathy.

We compared the efficacy and tolerance of the combination of nortriptyline-fluphenazine (NF) vs. carbamazepine (CMZ) in the symptomatic therapy of patients with severe, distal, symmetrical, predominantly sensitive diabetic polyneuropathy (DPN). We followed a double blind, crossover, randomized and double placebo design. Sixteen patients with severe DPN participated in the study. Patients received either NF (1 tablet three times a day (tid)), for 2 weeks and 2 tablets tid for the next 2 weeks or CMZ 1/2 tablet tid for 2 weeks and 1 tablet tid for the next 2 weeks. After this, patients received placebos of both drugs (wash-out period), until symptoms returned to baseline levels (100%), then they were crossed over to receive the other comparing drug schedule. A visual analogue scale was used to evaluate the percent changes in pain and paresthesia. HbA1, fasting serum glucose, and safety tests were performed at 2- and 4-week intervals, respectively. Both therapies produced significant improvement of both pain and paresthesia. No statistically significant differences were observed between both therapies for either pain or paresthesia. No significant biochemical changes were observed with any of the two therapies. Side effects were mild and more frequent in the NF period. In this study no superiority of either drug schedule was demonstrated; therefore, the decision to use any of them should be made according to the associated pathology and potential side effects of each drug.

Adult↗
PubMed1997

[Neuropathy associated with arteriosclerosis].

OBJECTIVE: To determine the frequency and characteristics of the neuropathy associated with arteriosclerosis. MATERIAL AND METHODS: A prospective clinical and electrophysiological study was made of 29 male patients with arteriosclerosis, in whom other causes of polyneuropathy had been excluded. RESULTS: Eleven patients complained of paresthesiae (mostly mild). In 11 patients there were signs of polyneuropathy on clinical examination. Neurophysiological studies were abnormal in 11 patients, suggesting the presence of predominantly sensitive axonal neuropathy. In five patients with paresthesiae both physical examination and electrophysiological studies were normal. In 17 patients there were changes in the somatosensory evoked potentials. The brainstem auditory evoked potentials of 27 patients were suggestive of diffuse changes in central nervous conduction, together with super-imposed focal lesions. There were no differences as regards age, signs of disease in the legs or of the involvement of widespread illness, whether they were smokers, ex-smokers or non-smokers, the number of cigarettes smoked daily or the total duration of the smoking habit between the patients with and without clinical or electrophysiological polyneuropathy. CONCLUSIONS: Approximately one third of the patients with arteriosclerosis have clinical or electrophysiological signs suggestive of predominantly sensitive axonal polyneuropathy. In some cases the patients had paresthesia but no changes were seen on physical or electrophysiological examination. The evoked potentials showed diffuse changes in central nervous conduction, and in some cases this was associated with signs of focal lesions.

Adult↗
PubMed2001

Sensory dermatomal representation in the medial lemniscus.

BACKGROUND: Restricted sensory deficits along the somatotopic topography of the medial lemniscus rarely develop in medial medullary infarction. We describe a patient with medial medullary infarction who presented with dermatomal sensory deficits caused by a medial lemniscal lesion. CASE DESCRIPTION: A 58-year-old man presented with sudden right-sided hemiparesis and paresthesia. He had noticed the paresthesia below the level of the right L5 dermatome, where his vibration and position senses were mildly diminished. His paresthesia was more severe over the right calf and foot. Magnetic resonance images of the brain showed an acute small infarct in the medial-ventral portion of the left rostral medulla oblongata. A nerve conduction study and electromyography showed no abnormalities. At follow-up, the patient's motor and sensory deficits had improved considerably. CONCLUSIONS: The patient showed lemniscal sensory deficits below the right L5 dermatome that were caused by the partial involvement of the medial lemniscus. These findings suggest that lemniscal sensory dermatomal representation is preserved at least up to the level of the medulla oblongata.

Brain Mapping↗
PubMed1997

Secondary healing of Mohs defects of the forehead, temple, and lower eyelid.

OBJECTIVE: To analyze the results of secondary healing of Mohs defects of the forehead, temple, and lower eyelid. DESIGN: Scars resulting from secondary healing in these 3 sites were rated by patient interviews and by analysis of postoperative photographs by 3 board-certified members of the American Academy of Facial Plastic and Reconstructive Surgery. SETTING: Private facial plastic and reconstructive surgery practice in Florida. PATIENTS: Patients with Mohs wounds of the forehead, temple, and lower eyelid that were allowed to heal by secondary intention between January 1, 1989, and December 31, 1993, who were available for follow-up. There were 10 wounds of the forehead, 6 of the temple, and 10 of the lower eyelid that were available for analysis. MAIN OUTCOME MEASURES: Wound color, contour, distortion of surrounding structures, presence of telangiectasias or paresthesias, pain or infection during healing, and overall cosmetic result. RESULTS: Color, contour, and overall scar cosmesis were rated using the following scale: poor (0), fair (1), good (2), and excellent (3). Telangiectasias, paresthesias, and pain or infection during healing were recorded as present or absent. The respective color and contour ratings for the 3 sites were 2.2 and 2.2 for the forehead, 2.5 and 2.7 for the temple, and 2.7 and 3 for the lower eyelid according to patient interview and 1 and 1.3 for the forehead, 1 and 1.4 for the temple, and 2.6 and 2.5 for the lower eyelid according to surgeon analysis. Pain, infection, paresthesias, and distortion of surrounding structures were rare, but 7 of 10 forehead and 4 of 6 temple wounds had telangiectasias. CONCLUSIONS: Many defects of the forehead and temple will heal with acceptable results. Partial-thickness or small full-thickness lower eyelid wounds heal with excellent cosmetic and functional results. Patient satisfaction is greater than might be predicted by surgeon analysis of wound healing.

Adult↗
PubMed2007

Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the median nerve characterized by paresthesias and pain in the first through fourth digits. We hypothesize that aberrant afferent input from CTS will lead to maladaptive cortical plasticity, which may be corrected by appropriate therapy. Functional MRI (fMRI) scanning and clinical testing was performed on CTS patients at baseline and after 5 weeks of acupuncture treatment. As a control, healthy adults were also tested 5 weeks apart. During fMRI, sensory stimulation was performed for median nerve innervated digit 2 (D2) and digit 3 (D3), and ulnar nerve innervated digit 5 (D5). Surface-based and region of interest (ROI)-based analyses demonstrated that while the extent of fMRI activity in contralateral Brodmann Area 1 (BA 1) and BA 4 was increased in CTS compared to healthy adults, after acupuncture there was a significant decrease in contralateral BA 1 (P < 0.005) and BA 4 (P < 0.05) activity during D3 sensory stimulation. Healthy adults demonstrated no significant test-retest differences for any digit tested. While D3/D2 separation was contracted or blurred in CTS patients compared to healthy adults, the D2 SI representation shifted laterally after acupuncture treatment, leading to increased D3/D2 separation. Increasing D3/D2 separation correlated with decreasing paresthesias in CTS patients (P < 0.05). As CTS-induced paresthesias constitute diffuse, synchronized, multidigit symptomatology, our results for maladaptive change and correction are consistent with Hebbian plasticity mechanisms. Acupuncture, a somatosensory conditioning stimulus, shows promise in inducing beneficial cortical plasticity manifested by more focused digital representations.

Acupuncture Therapy↗
PubMed1998

Decreased incidence of complications in parturients with the arrow (FlexTip Plus) epidural catheter.

PURPOSE: To compare the incidence of complications during placement of Arrow (FlexTip Plus) and Concord/Portex epidural catheters in parturients receiving continuous epidural analgesia. METHODS: Two hundred parturients requesting continuous epidural analgesia were prospectively and randomly assigned to receive either the Arrow (FlexTip Plus) or the Portex epidural catheter. The incidences of paresthesiae, inadvertent venous cannulation and inability to thread the catheter into the epidural space were recorded. RESULTS: A total of 222 attempts at epidural placement occurred in the parturients enrolled. The Arrow catheter displayed a lower incidence of paresthesiae (3/112 vs 39/110, P < 0.0001) and venous cannulation (0/112 vs 11/110, P = 0.0007) than did the Portex catheter. The Portex catheter demonstrated a tendency towards increased inability to be advanced into the epidural space (5/110 vs 0/112, P = 0.057) in comparison to the Arrow catheter. When a Portex catheter would not advance into the epidural space (n = 5), an Arrow catheter was threaded successfully in all five cases without the need to reposition the Tuohy needle. CONCLUSION: Compared with a less flexible catheter, the Arrow decreases the incidence of transient paresthesiae and inadvertent venous cannulation, while improving the ability to thread the catheter into the epidural space. Intravascular injection, transarachnoid migration, and the rare occurrence of epidural haematoma may be further reduced with the use of flexible, soft-tip catheters.

Adult↗