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PubMed1996

Probabilistic assessment of health risks of methylmercury from burning coal.

This paper describes a probabilistic assessment of neurological risks incurred from consuming fish containing methylmercury (MeHg), focusing on the incremental effects of Hg deposited from local coal combustion. A Monte Carlo model is used to simulate a "worst case" scenario in which a population of 5000 fish eaters in the upper midwestern United States derive the freshwater fish portion of their diet from local waters near a hypothetical large coal-fired power plant. This population is characterized by distributions of body mass, half-life of MeHg, and the ratios of blood to body burden and hair to blood MeHg. Each person's diet consists of varying amounts of tuna fish, freshwater sportfish, and marine fish and shellfish, the MeHg contents of which are characterized by national distribution statistics, as are the consumption rates for marine fish. The consumption rates for freshwater fish are specific to the region. The fish portion size is linked to body mass by a variable correlation. Each meal is assumed to be an independent sample; thus, as metabolic equilibrium is approached, each person's body burden of MeHg tends to approach the value corresponding to the mean MeHg intake for the population. Predictions of MeHg levels in hair by this model compared well with an observed distribution of 1437 women. Two neurological endpoints were examined: adult paresthesia, as related to MeHg body burden, and congenital neurological effects, as associated with average concentrations of MeHg in maternal hair during pregnancy. Two exposure scenarios are considered: a "baseline" in which the source of the mercury in fish is from background atmospheric deposition, and an "impact" scenario, in which local Hg deposition and concentrations in fish are roughly doubled to represent additional deposition from the hypothetical nearby power plant. For both scenarios, the 99th percentile of MeHg body burden was more than an order of magnitude below the lowest level at which increased transient adult paresthesia was experienced in an acute MeHg poisoning incident in Iraq. We thus conclude that neurological risks to adults from MeHg resulting from atmospheric Hg deposition are trivial. Based on three epidemiological studies of congenital neurological risks, we find that fetal effects appear to be more critical and that there is a smaller margin of safety for pregnant consumers of freshwater sportfish. However, the margin of safety is still considerable and may have been diminished by uncertainties in the relationships between maternal hair Hg and the actual fetal exposures.

Adult↗
PubMed1997

Ciguatera fish poisoning following travel to the tropics.

A 40-year-old man-as well as 15 more participants of the same meal-suddenly experienced vomiting and watery diarrhea four hours after having eaten a meal of grouper in the Dominican Republic. Symptoms persisted for four hours and were followed by a generalized pruritus and paresthesias of the lips, tongue, palms, and soles of the feet. Physical examination was normal with the exception of a pulse of 45 beats per minute, a blood pressure of 80/50 mmHg, and paradoxical temperature perception. Laboratory values were regular except for the erythrocyte sedimentation rate of 40 mm per hour. 24-hour Holter electrocardiogram showed a normal sinus rhythm with impaired heart rate variability (37-100 beats per minute). Due to the typical history and the clinical findings, ciguatera toxin ingestion was diagnosed. Pruritus decreased slightly with symptomatic therapy, but it took 16 weeks for all symptoms to resolve. Ciguatera fish poisoning is rare in temperate countries. Symptoms of this neurotoxic disease are gastrointestinal, neurologic, and cardiovascular manifestations with paresthesias, paradoxical sensor disturbances, and muscular weakness as well as bradycardia and hypotension. With travel to and from the tropics and increasing imports of tropical fish ciguatera will be of growing importance even in nontropical areas.

Adult↗
PubMed1998

Gamma knife radiosurgery for trigeminal neuralgia: results and expectations.

BACKGROUND: Trigeminal neuralgia is a disabling pain syndrome responsive to both medical and surgical therapies. Stereotactic radiosurgery using the gamma knife can be used to inactivate a specified volume in the brain by cross firing 201 photon beams. We evaluated pain relief and treatment morbidity after trigeminal neuralgia radiosurgery. METHODS: All evaluable patients (n = 106) had medically or surgically refractory trigeminal neuralgia. A single 4-mm isocenter of radiation was focused on the proximal trigeminal nerve just anterior to the pons. For follow-up an independent physician who was unaware of treatment parameters contacted all patients. RESULTS: After radiosurgery, 64 patients (60%) became free of pain and required no medical therapy (excellent result), 18 (17%) had a 50% to 90% reduction (good result) in pain severity or frequency (some still used medications), and 9 (9%) had slight improvement. At last follow-up (median, 18 months; range, 6-48 months), 77% of patients maintained significant relief (good plus excellent results). Only 6 (10%) of 64 patients who initially attained complete relief had some recurrent pain. Radiosurgery dose (70-90 Gy), age, surgical history, or facial sensory loss did not correlate with pain relief. Poorer results were found in patients with multiple sclerosis. Twelve patients developed new or increased facial paresthesias after radiosurgery (10%). No patient developed anesthesia dolorosa. There was no other procedural morbidity. CONCLUSIONS: Gamma knife radiosurgery is a minimally invasive technique to treat trigeminal neuralgia. It is associated with a low risk of facial paresthesias, an approximate 80% rate of significant pain relief, and a low recurrence rate in patients who initially attain complete relief. Longer-term evaluations are warranted.

Adult↗
PubMed1984

Diagnosis and management of genitofemoral neuralgia.

Genitofemoral neuralgia is a syndrome characterized by chronic pain and paresthesia in the region of genitofemoral nerve distribution. Genitofemoral nerve entrapment has been described after inguinal herniorrhaphy, appendectomy, and cesarean section. Failure to distinguish it from ilioinguinal nerve entrapment can result in unnecessary inguinal reexploration, or patients severely debilitated from chronic pain. We recommend that patients with persistent pain and paresthesia in the inguinal region following surgery should have a local ilioinguinal nerve block. If this is unsuccessful in affecting relief of symptoms, a paravertebral block of L-1 and L-2 should be considered. Using these two blocks, a rational decision can then be made to operate on either the ilioinguinal nerve or the genitofemoral nerve. We describe three cases of genitofemoral neuralgia treated by extraperitoneal excision of the genitofemoral nerve.

Adult↗
PubMed1996

Perineural invasion of the trigeminal nerve in patients with nasopharyngeal carcinoma. Imaging and clinical correlations.

BACKGROUND: A nasopharyngeal carcinoma (NPC) arising from the fossa of Rosenmüller frequently extends to the paranasopharyngeal space. The common clinical manifestations are neck masses, ear symptoms, bloody nasal discharge, and cranial nerve palsy. Among the patients with cranial nerve palsy, trigeminal neuropathy is one of the most observable neurologic manifestations. This study was designed to evaluate trigeminal perineural tumor invasion. METHODS: One hundred and ten patients with newly diagnosed NPC were studied. Both computed tomography and magnetic resonance imaging of the head and neck, including the nasopharynx, were performed during the same visit. The extent of the trigeminal perineural tumor invasion was evaluated and correlated with neurologic symptoms. RESULTS: At the time of diagnosis, facial pain or paresthesia was noted in 23.6% (26 of 110) of the patients. However, 53.6% (59 of 110) of the patients radiologically had demonstrable trigeminal perineural tumor invasion. Perineural invasion of the extracranial portion of the mandibular division (V3) frequently occurred when an NPC encroached on the paranasopharyngeal region. Nevertheless, the patients usually did not have any subjective sensory impairment. Perineural invasion of the intracranial segment of the mandibular and maxillary divisions (V2) might occur when an NPC spread along the V3 through the foramen ovale. The majority of the patients who had tumor invasion of the intracranial paracavernous region suffered from facial pain or paresthesia over the distribution of the V2 and/or V3. Sensory impairment of the opthalmic division was less common. CONCLUSIONS: These findings suggest that patients can tolerate perineural infiltration of the extracranial segment of the trigeminal nerve by NPC in the early stage of the disease when the tumor is still confined beneath the base of the skull. Dysfunction of the trigeminal nerve is closely related to perineural tumor invasion of the intracranial segment.

Adolescent↗
PubMed1999

Symptoms of 100 patients with electromyographically verified carpal tunnel syndrome.

To determine the symptoms of carpal tunnel syndrome (CTS), screening evaluations were performed in 244 consecutive patients with sensory symptoms in the hand and unequivocal slowing of median nerve conduction at the wrist. This yielded 100 patients thought to have no explanation other than CTS for their upper limb complaints. These patients completed a hand symptom diagram (HSD) and questionnaire (HSQ) about their symptoms. CTS symptoms were most commonly reported in median and ulnar digits, followed by median digits only and a glove distribution. Unusual sensory patterns were reported by some patients. Based on the HSQ, paresthesias or pain proximal to the wrist occurred in 36.5% of hands. The usefulness of the HSD and HSQ for diagnosis was determined by asking three physicians, blinded to the diagnosis, to rate the likelihood of CTS in the patients with CTS and in 50 patients with other causes of upper extremity paresthesia. The sensitivities of the instruments ranged from 54.1% to 85.5%. Combining the HSD and HSQ ratings increased the range of sensitivities to 79.3% to 93.7%.

Adult↗
PubMed1976

Intrathecal N, N', N"-triethylenethiophosphoramide [thio-TEPA (NSC 6396)] in the treatment of malignant meningeal disease: phase I-II study.

N, N', N"-Triethylenethiophosphoramide [Thio-TEPA (NSC 6396)] is the third drug to be evaluated for the treatment of meningeal neoplasia. Eleven patients with meningeal leukemia, lymphoma, or ependymoma were treated with intrathecal thio-TEPA in doses from 1 to 10 mg/m2 of body surface area. There was no hematologic toxicity definitely attributable to thio-TEPA, and neurologic toxcity was limited to mild transient paresthesias of the lower extremities during lumbar sac injection in three patients. Two of those experiencing such paresthesias received concentrated drug solutions to decrease the large injected volumes associated with the higher dosages of thio-TEPA. Three patients achieved complete meningeal remission, and five others had a partial response to therapy.

Adolescent↗
PubMed2002

Vagus nerve stimulation for partial seizures.

BACKGROUND: Vagus nerve stimulation (VNS) has recently been introduced as an adjunct for treating patients with seizures. The aim of this systematic review was to overview the current evidence for the effects of vagus nerve stimulation, when used as an adjunctive treatment for patients with drug-resistant partial epilepsy. OBJECTIVES: To determine the effects of VNS high-level stimulation compared to low-level (presumed subtherapeutic dose) stimulation. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group trials register, MEDLINE (January 1966 to October 2000) and The Cochrane Controlled Trials Register (Cochrane Library Issue 4, 2000). SELECTION CRITERIA: Randomized, double-blind controlled trials of VNS comparing high and low stimulation paradigms. Studies in adults or children with drug-resistant partial seizures. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion and extracted data. The following outcomes were assessed: (a) 50% or greater reduction in total seizure frequency; (b) treatment withdrawal (any reason); (c) side effects. Primary analyses were intention to treat. Sensitivity best and worst case analyses were also undertaken. Summary odds ratios (ORs) were estimated for each outcome. MAIN RESULTS: Results of the overall efficacy analysis show that VNS stimulation using the high stimulation paradigm was significantly better than low stimulation. The overall OR (95% Confidence Interval (CI)) for 50% responders across all studies is 1.93 (1.1,3.3). This effect did not vary substantially and remained statistically significant for both the best and worst case scenarios. Results for the outcome "withdrawal of allocated treatment" suggest that VNS is well tolerated as no significant difference was found between the high and low stimulation groups, and withdrawals were rare. Statistically significant adverse effects associated with implantation (low versus baseline) were hoarseness, cough, pain and paresthesia. Statistically significant adverse effects associated with stimulation (high versus low) were hoarseness and dyspnea, suggesting the implantation is associated with hoarseness, but the stimulation produces additional hoarseness. REVIEWER'S CONCLUSIONS: VNS for partial seizures appears to be an effective and well tolerated treatment. Adverse effects of hoarseness, cough, pain, paresthesias and dyspnea are associated with the treatment but appear to be reasonably well tolerated as dropouts were rare. Typical central nervous system adverse effects of antiepileptic drugs such as ataxia, dizziness, fatigue, nausea and somnolence were not statistically significantly associated with VNS treatment.

Electric Stimulation Therapy↗
PubMed1978

The prognosis of acute and subacute transverse myelopathy based on early signs and symptoms.

Fifty-two patients with acute and subacute transverse myelopathy (TM) were evaluated at the Massachusetts General Hospital between 1955 and 1975 and followed for 1 to 23 years (average, 5). Nineteen had symptoms of a recent acute infectious illness, 3 had cancer, and 1 had undergone a recent operation. There were four types of initial symptom. Twenty-four patients had paresthesias at the onset of the illness, 18 had pain, usually interscapular, 7 had leg weakness, and 3 had urine retention. Prognosis depended on the nature of the onset of TM. An acute catastrophic onset was generally associated with back pain and led to a poor outcome in 7 and a good outcome in only 1 of 11 patients. A subacute progressive onset over several days to four weeks, generally with ascending paresthesias or leg weakness, was associated with a good outcome in 15 and fair outcome in 17 of 37 patients. Preceding febrile illness, treatment with corticosteroids, and the nature of CSF abnormalities had no effect on outcome. Multiple sclerosis evolved in 7 patients during the follow-up period. Because of the frequency with which mass lesions were missed, the need for myelography in the diagnosis of TM is emphasized. The distinguishing clinical characteristics of TM provide guidelines for diagnosis and prognosis.

Acute Disease↗
PubMed2005

Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial.

OBJECTIVE: Optimal treatment of carpal tunnel syndrome (CTS) has not been established. This study compared the effects of local steroid injection versus surgical decompression in new-onset CTS of at least 3 months' duration. METHODS: In a 1-year, prospective, randomized, open, controlled clinical trial, we studied the effects of surgical decompression versus local steroid injection in 163 wrists with a clinical and neurophysiologic diagnosis of CTS. Clinical assessments were done at baseline and at 3, 6, and 12 months after treatment. The primary end point was the percentage of wrists that reached a >or=20% improvement in the visual analog scale score for nocturnal paresthesias at 3 months of followup. Statistical analysis was done by Student's t-test for continuous variables and by chi-square test for categorical variables. Analyses were performed on an intent-to-treat basis. P values less than 0.05 were considered statistically significant. RESULTS: Both treatment groups had comparable severity of CTS at baseline. Eighty wrists were randomly assigned to the surgery group and 83 wrists to the local steroid injection group. In the intent-to-treat analysis, at 3 months of followup, 94.0% of the wrists in the steroid injection group versus 75.0% in the surgery group reached a 20% response for nocturnal paresthesias (P = 0.001). At 6 and 12 months, the percentages of responders were 85.5% versus 76.3% (P = 0.163) and 69.9% versus 75.0% (P = 0.488), for local steroid injection and surgical decompression, respectively. CONCLUSION: Over the short term, local steroid injection is better than surgical decompression for the symptomatic relief of CTS. At 1 year, local steroid injection is as effective as surgical decompression for the symptomatic relief of CTS.

Carpal Tunnel Syndrome↗
PubMed1989

Results of median nerve repair in children.

Seven children ranging in age from 1 to 13 years (mean 8 years) were evaluated at a range of 8 months to 15 years (mean 4.7 years) following group fascicular repair of the median nerve at the wrist following a sharp transection of the nerve. At the follow-up evaluation, they were measured with Semmes-Weinstein nylon monofilaments, moving and static two-point discrimination, and were judged for the presence or absence of paresthesias in their hands. The children did not receive sensory reeducation in the postoperative period. All children recovered to normal levels of moving and static two-point discrimination and were free from disabling paresthesias. These results are contrasted with a group of similar nerve injuries in adult patients treated in the same way and over the same period of time. It is concluded that the capacity for peripheral neural regeneration and cerebral plasticity in children is such that excellent recovery of functional sensation in the hand can occur without the need for sensory reeducation.

Adolescent↗
PubMed2004

Clinical utility of electrodiagnostic consultation in suspected polyneuropathy.

Although paresthesias of the distal lower limbs are characteristic features of polyneuropathy, they may also herald the presence of a focal neuropathy, polyradiculopathy, or myelopathy. Electromyography and nerve conduction studies (EMG/NCS) are widely used in the evaluation of such symptoms, but their utility has not been subjected to vigorous scrutiny. We investigated the clinical impact of the electrodiagnostic consultation in assessing suspected polyneuropathy. When compared with the clinical impression, the result of the electrodiagnostic consultation was confirmatory in only 39% of all patients, and changed the diagnosis or uncovered an additional diagnosis in 43%. An alternative diagnosis was likely when either weakness was present (75%) or the Achilles stretch reflex was preserved (48%). These data support the use of EMG/NCS in the diagnostic evaluation of patients presenting with distal paresthesias, especially in those with preserved Achilles reflexes or motor deficits.

Adult↗
PubMed1996

770 consecutive supraclavicular first rib resections for thoracic outlet syndrome.

During a 28-year period, 637 patients underwent 770 supraclavicular first rib resections and scalenectomies for thoracic outlet syndrome (TOS). The neurologic type of TOS was found in 705 cases (92%) and the remaining 65 cases (8%) had the vascular form of TOS. Of those extremities with brachial plexus irritation, the symptom complex consisted of paresthesia in 30 (4%), pain in 221 (31%), and pain with paresthesia in 454 (64%). In the cases of vascular TOS, 47 limbs (6%) had venous complications and 18 limbs (2%) had arterial sequelae. Following supraclavicular scalenectomy and rib resection, an excellent response was achieved in 59% (455 cases) and a good result was achieved in another 27% (206 cases). A fair outcome was present in 13% (95 cases) and a poor result was found in only 1% (13 cases). There was a single occurrence of lymphatic leakage and no brachial plexus injuries resulted. Postoperative causalgia requiring subsequent sympathectomy developed in two cases. No vascular or permanent phrenic nerve injuries occured and only 12 patients (2%) required operative intervention for recurrent TOS. First rib resection and scalenectomy can be performed by the supraclavicular route with an acceptable outcome, minimal morbidity, and long-lasting results.

Adult↗
PubMed1994

Efficacy of cyclosporine in treatment of fistula of Crohn's disease.

Sixteen Crohn's disease patients with active fistula who had failed standard medical therapy were treated with intravenous cyclosporine. Ten patients had perirectal disease, four had enterocutaneous fistula, and two had rectovaginal fistula. Patients were initially treated with intravenous cyclosporine, 4 mg/kg/day, and then switched to oral cyclosporine, 6-8 mg/kg/day. Improvement was graded using the Present-Korelitz criteria, and success was defined as moderate to total closure of the fistula. Fourteen of 16 patients (88%) responded in the acute phase to parenteral cyclosporine. Closure of fistula occurred in seven (44%) with moderate improvement in the remaining seven (44%). Subsequently, five patients (36%) relapsed to some degree on oral cyclosporine (three severe and two mild relapses). Nine (64%) patients maintained their improvement in the chronic phase. Chronic steroids could be discontinued in 6/8 (75%) of patients. Mild side effects were common [paresthesias (75%) and hirsutism (19%)]. A single patient had severe paresthesias requiring discontinuation of therapy. Mild hypertension was noted in four (25%) and one patient (6%) had to be withdrawn because of nephrotoxicity, which reversed after stopping cyclosporine. We conclude that intravenous cyclosporine is effective therapy for perianal, rectovaginal, and enterocutaneous fistula in Crohn's disease. Its future role awaits controlled trials as well as determination of the risk-benefit ratio.

Adult↗
PubMed1987

[Rush pin osteosynthesis of the clavicles as an alternative to conservative treatment].

Fractures of the clavicle in the middle third usually undergo closed treatment by external fixation, because they heal spontaneously in most cases. However, a correct reposition and fixation by external manner is sometimes impossible, and consolidation in malposition with functional and esthetic disturbance occurs. External fixation can be painful and inconvenient to the patient, and congestion and paresthesia of the upper limbs may occur. Therefore the indication for internal fixation has been extended on fractures in persisting severe malposition despite external fixation and painful congestion and paresthesia of the arms. A method of internal fixation by a Rush pin has been used. The fracture is exposed by a minimal incision, and both fragments are bored open axially and exactly reposed. The Rusph pin is inserted from the medial side through a second small incision. The corticalis layer on both sides of the bend of the clavicle is also to be penetrated by the pin. Postoperatively no external fixation is necessary, and the patient is told to move the shoulder as soon as possible. The pin is removed after three to six months on outpatient basis under local anesthesia. 43 cases of clavicle fractures and three cases of painful non-union after closed treatment, operated in this way, have been analyzed. In two cases of the fractures (4.6%) non-union occurred. Both healed after refixation by a plate. 34 of 41 fractures healed without radiologically visible callus. 64% of the registered patients have been handicapped in their daily activities only for two weeks or even less.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Low dose axillary block by targeted injections of the terminal nerves.

PURPOSE: To compare anesthetic time, success rate and adverse effects of axillary block by single or multiple injections of local anesthetic. METHODS: Two groups of patients were studied. In group T (targeted injections, n = 53) the four terminal nerves were located by electrical stimulation, and anesthetized with 5 ml mepivacaine 1% with epinephrine 5 microg x ml(-1) (MEPE). In group S (single injection, n = 53) 80 mL MEPE 1% were injected into the neurovascular sheath, transarterially or after eliciting paresthesia. Patchy blocks were supplemented after 30 min. The patient was ready for surgery when analgesia was present in all areas distal to the elbow. RESULTS: The block was complete at 11 min (6-15) in Group T and 7 min (5-13) in group S, P<0.01. Supplementation was required in 46% in group S compared with 13% in group T P<0.001: anesthesia time was 32 min (19-52) in group T, and 39 min (16-58) in group S, P = 0.02. The average doses of MEPE were 3.5 mg x kg(-1) (2.4-5.6) in T group and 12.0 mg x kg(-1) (8.9-16.4), in S group. However, 22% of patients in group T and 4% in group S reported tourniquet pain, P = 0.02. Paresthesia was elicited in 42% of patients in group S and 8% in group T, P<0.001. CONCLUSIONS: Small targeted injections of MEPE reduce total anesthetic time, give better spread of analgesia in the hand and forearm, and may be safer than a single large injection.

Adolescent↗
PubMed2003

Fibromyalgia syndrome in patients with hepatitis C infection.

Fibromyalgia syndrome (FS) is characterized by widespread pain and tenderness at specific anatomic sites. Different theories have been proposed in the etiopathogenesis of this syndrome, and besides genetic, neuroendocrine, psychologic, and traumatic causes, infections have also been reported. The aim of the present study was to evaluate the presence of FS in patients with hepatitis C virus (HCV) infection. Ninety-five patients with chronic HCV infection and 95 healthy controls were enrolled in the study. The 1990 American College of Rheumatology classification criteria were used for the diagnosis of FS. Tender point count, pain intensity, sleep disturbance, stiffness, headache, paresthesia, fatigue, irritable bowel syndrome (IBS), and sicca- and Raynaud-like symptoms were assessed. Fibromyalgia was found in 18.9% of patients and 5.3% of healthy controls. Mean tender point count, pain intensity scored on a visual analog scale (VAS), sleep disturbance, stiffness, paresthesia, and fatigue were higher in the HCV group. No significant relationship was observed between the two groups regarding headache, IBS, and sicca- and Raynaud-like symptoms. In addition, mean tender point count and pain intensity scores were also significantly higher in HCV patients with FS than in control subjects with FS. All of the symptoms except stiffness were not statistically significant between the HCV and control groups with FS. Our results demonstrate a tendency toward higher prevalence of FS in patients with HCV infection. Besides various extrahepatic features, musculoskeletal disorders including fibromyalgia might be expected in the progression of HCV infection. Detailed examination of the patients helps to differentiate FS from other musculoskeletal complications of HCV infection. This will provide appropriate management approaches and better quality of life for them.

Adolescent↗
PubMed2000

Multiple radiculopathy of the lower limbs in a cancer patient with meningeal carcinomatosis.

Meningeal carcinomatosis occurs in 1%-5% of patients with breast cancer. Early diagnosis and aggressive treatment of neurologic involvement are important factors of prognosis. We report a case of a 52-year-old woman who was affected by bilateral breast carcinoma treated with surgery and chemotherapy. Six years after she had become asymptomatic, X-rays showed lumbar spine metastases which were treated with radiotherapy. After 1 year she began to suffer from lower limb paresthesias, unsteadiness and unstable gait. Clinical examination showed lower limb sensory ataxia with lack of knee and ankle reflexes, and hypopallesthesia from the iliac spine to the foot. Spinal magnetic resonance imaging (MRI) with contrast agent revealed no medullar compression. Electromyography disclosed bilateral involvement of L4-L5-S1 roots and corresponding paraspinal muscles. Sensory and motor conductions were normal. Cerebrospinal fluid (CSF) examination showed the presence of neoplastic cells, confirming the diagnosis of meningeal carcinomatosis. Our patient underwent 9 cycles of intrathecal methotrexate therapy (25 mg/cycle) with improvement of ataxia and relief of paresthesias. One year later, CSF examination is still negative. We point out the importance of electrodiagnostic studies and CSF examination in the early documentation of root involvement in cancer patients, when computed tomography, MRI and myelography are normal. Early diagnosis may lead to effective therapy which prolongs survival.

Antimetabolites, Antineoplastic↗