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At least 73 records · Page 4Linked to original sources
PubMed2002

A quantitative analysis of sensory function in lumbar radiculopathy using current perception threshold testing.

STUDY DESIGN: Peripheral sensory functions in patients with radiculopathy resulting from lumbar disc herniation and in control individuals were analyzed using current perception threshold testing. OBJECTIVE: To evaluate the severity of sensory disturbance quantitatively in patients with lumbar radiculopathy. SUMMARY OF BACKGROUND DATA: Subjective evaluation of the severity of sensory disturbance associated with spinal disorders using conventional methods often is difficult. Current perception threshold evaluation is a recently proposed method for studying peripheral nerve dysfunction. This is a quantitative sensory test for analyzing functions of A-beta, A-delta, and C fibers. METHODS: In this study, 48 patients with lumbar radiculopathy resulting from lumbar disc herniation were examined. The mean age of the patients was 37.9 years. All the patients had pain distribution from the compression of one lumbar nerve root (L5 or S1), and unequivocal unilateral disc herniation of the corresponding level was shown by magnetic resonance imaging. Eleven healthy volunteers were used as control subjects. Their mean age was 38.2 years. Current perception threshold evaluation using a Neurometer device was performed at three frequencies: 2000, 250, and 5 Hz. The stimulus sites were located on the dorsal side of the first metatarsus (the L5 dermatome) and the dorsal side of the fifth metatarsus (the S1 dermatome). These sites were investigated on both legs in all the patients and control subjects. The intensity of pain was scored using a visual analog scale. RESULTS: In the control group, there were no significant differences in current perception threshold values at any frequency between the left and right legs. In the patient group, the current perception threshold values in the affected legs were significantly higher than those in the contralateral legs at all frequencies. The current perception threshold values in the affected legs in the patient group were significantly higher than those in the control subjects at 2000 and 250 Hz, whereas there were no significant differences at 5 Hz. The current perception threshold values in the affected legs were significantly higher in patients with hypesthesia than in those without hypesthesia at 2000 and 250 Hz, and in patients with severe pain than in those with less pain at 5 Hz. CONCLUSIONS: Current perception threshold testing showed that the functions of A-beta, A-delta, and C fibers deteriorated in patients with lumbar radiculopathy. This technique may be useful for quantifying sensory nerve dysfunction in patients with radiculopathy.

Adolescent↗
PubMed1996

Effects of topical aldose reductase inhibitor CT-112 on corneal sensitivity of diabetic rats.

PURPOSE: To investigate whether the loss in corneal sensation observed in human diabetics could be duplicated in diabetic rats and if this abnormality could be prevented by topical instillation of an aldose reductase inhibitor (ARI), CT-112. METHODS: Rats were made diabetic by injection of streptozotocin. Some of these rats were treated with eye drops of CT-112 while others were treated with the same vehicle solution without ARI. Normal rats served as controls. Corneal sensitivity was measured by means of a Cochet-Bonnet aesthesiometer, using the blink reflex as an objective sign. Corneal changes in ultrastructure in diabetic rats were also observed. RESULTS: The corneal sensitivity of diabetic rats was significantly decreased and this change was prevented by ARI treatment. Ultrastructurally, degenerations of axons and mitochondria of the corneal nerve were seen in the diabetic rats and the ARI treatment prevented these morphological changes. CONCLUSIONS: It is clear that corneal hypesthesia occurs in diabetic rats as it does in human diabetics, and treatment with an ARI prevents this change. Along with the functional abnormality, the ultrastructural changes of corneal nerve also occur in diabetic rats, and they are prevented by ARI. These results strongly suggest that aldose reductase is involved in corneal hypesthesia and ultrastructural changes of corneal nerve in diabetic rats. These defects are ameliorated by aldose reductase inhibitor.

Administration, Topical↗
PubMed2001

[A case of neural injury by defective epidural needle].

A 70-year-old man who had undergone an elective transverse colectomy developed neural injury caused by defective epidural needle. The stylet of the 17-gauge disposable Tuohy needle used consisted of two components. The tip of the stylet was made of teflon and the material of the body was steel. The needle was inserted at Th 11-12, Th 10-11 and Th 9-10 interspaces utilizing the loss of resistance method with saline, but all the trials resulted in failure to identify needle entry into the epidural space. The patient complained of fatigue in his right lower extremity and the blood pressure was elevated to 235/125 mmHg during the series of the needle placement. The cause of the failure was finally found to be complete obstruction of the needle with a small piece torn from the stylet tip. Right femoral pain, right instep hypesthesia and muscle weakness in the right leg remained after the operation. These symptoms gradually improved and he left the hospital with slight hypesthesia remaining in his right instep 42 days after the operation.

Aged↗
PubMed1997

Refection of orbital floor blow-out fractures with silicone implant.

In a retrospective study, the authors present the results of the surgical treatment of 6 cases of orbital floor blow-out fractures with silicone implant. The diagnosis was based on history, clinical ground and coronal tomography. The surgical procedure was the same in all patients, using silicone implant. The mean follow-up time after surgery was 3 months. The mean interval time between injury and diagnosis was 34.8 days while that between injury and surgery was 55.3 days. The fractures occurred during brawls in 3 patients, car accidents in 2 patients and child's play in 1 patient. Limitation of vertical eye movements was presents in all patients, diplopia in 4 patients, enophthalmos in 3 patients and hypesthesia in the distribution of infraorbital nerve in 1 patient. Five patients hale late repairs (> 14 days) after surgery. Postoperatively, good results were obtained with regards to limitation of vertical eye movements, diplopia, enophthalmos and hypesthesia. Only one patient had a persistent and partially reduced enophthalmos. Silicone implant was well tolerated in all cases since complications such as infection, tissue reaction and extrusion were not observed. Excellent results may be obtained after late repair of orbital floor blow-out fractures. Silicone implant has the potential to be used successfully in orbital floor fractures.

Accidents, Traffic↗
PubMed2005

Bilateral Gasser's ganglion sarcoidosis: diagnosis, treatment and unsolved questions.

Magnetic resonance imaging is currently the best means for confirming clinical suspicion of neurosarcoidosis as well as being useful in the follow-up of corticosteroid-treated patients. We report the case of a 34 year old male presenting suspected Heerfordt's syndrome with concentric facial hypesthesia. Mediastinal and parotid sarcoidosis was diagnosed and magnetic resonance imaging showed bilateral sarcoid involvement of Gasser's ganglion cisternae (such involvement was not revealed by computed tomography). The patient received corticosteroid therapy, with a clinical and radiological improvement. Magnetic resonance imaging showed disappearance of Gasser's ganglion lesions despite the persistence of mild facial hypesthesia. This case is noteworthy for its extremely rare lesion site. Post-treatment discrepancy between the clinical picture and imaging results is probably due to low MRI resolution threshold. 18-FDG positron emission tomography imaging might perhaps overcome the limits of magnetic resonance imaging.

Adrenal Cortex Hormones↗
PubMed1982

[A case of nodular calcification of the ligamentum flavum with ossification of the posterior longitudinal ligament in the cervical spine].

A 72-year-old male noted weakness in the right lower extremity in August 1979, and clumsiness of the finger movement in the right hand in April 1980. In June 1980, he became tetraplegic and was unable to stand or walk. He also developed hypesthesia in the four extremities and difficulty in voiding. On admission to this hospital (July 12, 1980), neurological examination showed spastic tetraparesis, more pronounced on the right side. Deep tendon reflexes were markedly increased in the four extremities. Chaddock reflex in the right lower extremity and Trömner reflex in the both upper extremities were elicited. Hypesthesia below the level of C4 was present with anesthesia in the Th9-11 region. Plain film and tomogram of the cervical spine showed ossification of the posterior longitudinal ligament from C3 to C6 and a lobulated nodular calcification in the posterior part of the spinal canal at the level of C4,5 intervertebral space. CT scan revealed nodular calcifications in the ligamentum flavum not only at the level of C4 but also at the level of C6. Laminectomy from C3 to C6 was performed on August 21. The ligamentum flavum with nodular calcifications was removed. His postoperative course was uneventful. Seven weeks postoperatively the patient was able to walk without assistance and had no difficulty in voiding. He was discharged on October 14 with excellent activities of daily life. The content of the nodular calcification was identified as a kind of calcium phosphate by the physico-chemical analysis. Ossification and/or calcification of the ligamentum flavum in the cervical spine is rare, while ossification of the posterior longitudinal ligament is frequently encountered in the cervical spine. Only two cases with nodular calcification of ligamentum flavum in the cervical spine have been reported. To our knowledge, this is the first case of the nodular calcification of the ligamentum flavum in the cervical spine associated with ossification of the posterior longitudinal ligament. Two dimensional analysis by CT scan was very useful in locating the lesion and deciding the operative procedure.

Aged↗
PubMedDate not supplied

Internal brow elevation at blepharoplasty.

OBJECTIVE: To present data on a transblepharoplasty technique that provides a safe and reliable brow elevation and glabellar furrow reduction by releasing inferior tethering and weakening the brow depressor muscles. DESIGN: Nonrandomized retrospective case series and surgical technique description. RESULTS: One thousand patients who underwent internal brow elevation for cosmesis associated with upper blepharoplasty over the past 9 years were reviewed. Follow-up ranged from 6 months to 9 years. There were no serious long-term complications. All patients experienced forehead hypesthesia, which was temporary in most patients. Only 2 patients complained of prolonged and bothersome forehead hypesthesia lasting longer than 2 years. CONCLUSION: The internal brow elevation at blepharoplasty is a reproducibly safe and effective technique to improve eyebrow appearance without fixation.

Blepharoplasty↗
PubMed1994

Ocular manifestations of leprosy in a noninstitutionalized community in the United States.

OBJECTIVE: Our goal was to delineate the epidemiologic and clinical patterns of ocular leprosy in an outpatient setting in the United States. DESIGN: Examinations were performed in 61 consecutive outpatients seen in a Midwestern leprosy clinic. PATIENTS: Forty-three male and 18 female patients were examined. The patients' origins included Southeast Asia (24 patients [39%]), Latin America (23 patients [38%]), India (nine patients [15%]), Europe or North America (two patients [3%]), Africa (two patients [3%]), and the Middle East (one patient [2%]). RESULTS: Thirty-nine percent of patients were classified as having polar lepromatous leprosy; 18%, borderline lepromatous leprosy; 3%, borderline borderline leprosy; 36%, borderline tuberculoid leprosy; 2%, polar tuberculoid leprosy; and 2%, indeterminate leprosy. Ninety-six percent of patients had a best-corrected visual acuity of 20/40 or better. Ocular findings included madarosis (28 patients [46%]), subconjunctival fibrosis (18 patients [30%]), punctate epithelial keratopathy (17 patients [28%]), posterior subcapsular cataract (10 patients [16%]), corneal hypesthesia (10 patients [16%]), lagophthalmos (seven patients [11%]), corneal pannus (six patients [10%]), entropion (five patients [8%]), prominent or beaded corneal nerves (four patients [7%]), iridocyclitis (four patients [7%]), focal avascular keratitis (three patients [5%]), scleritis (three patients [5%]), interstitial keratitis (two patients [3%]), iris pearls (two patients [3%]), and ocular clofazimine crystals (two patients [3%]). Madarosis, corneal hypesthesia, and posterior subcapsular cataracts were significantly associated with disease duration (P < .05). CONCLUSION: We report herein a relatively low frequency of visual impairment attributable to leprosy in our series compared with that seen among institutionalized leprous patients. However, since 48% of subjects had one or more sight-threatening complications as a result of their disease, a program of regular ophthalmic follow-up is strongly advocated for all patients with leprosy.

Adolescent↗
PubMed1983

Availability of temperature sense indices for diagnosis of vibration disease.

The correlation between stages of vibration disease and hypesthesia of temperature sense detected with our thermo-esthesiometer was analyzed. We measured the warm and cool thresholds among operators (644 males) in three occupational categories with vibration exposure from hand-held vibratory tools, such as grinder, drill, sander, impact-wrench, bush-cutter and chain-saw. Through the examination of the relationship between the temperature threshold and the stage of vibration disease, the following was revealed: The warm sense threshold elevated parallel with the aggravation of vibration disease, although the skin temperature had no change or reduction. The hypesthesia of the cool sense threshold appeared in serious cases of vibration disease. This abnormality of the cool sense indicated a more intensive disorder than that detected by the warm sense abnormality. The width of the neutral zone between the warm and cool thresholds of the intact subjects was 6.6 degrees C +/- 3.8 C degrees. This neutral zone was enlarged with the aggravation of the vibration disease. Data also showed that the measurements of temperature sense threshold should be carried out under standardized room temperature.

Humans↗
PubMed2004

Adult unilateral periventricular pseudocysts with ipsilateral headache.

OBJECTIVES: Unilateral periventricular pseudocysts (PVPC), manifesting as ipsilateral headache have been only rarely reported in adults. CASE REPORT: In a 48-year-old woman, right-sided, pulsating headache occurred in 1999. Headache exclusively extended over the right head and periorbitally; it was frequently associated with a feeling of cold, lasted maximally for 1 day, and occasionally went along with nausea and right-sided lacrimation. Since January 2003, headache occurred daily with varying intensity. For headache, she was regularly taking doxepin (25 mg). Ordinary analgesics and tryptanes were only of minimal effect. Since 2001, left-sided hemi-hypesthesia occurred. CT and MRI scans of the brain disclosed right-sided cysts in the white matter with a maximal diameter of 1cm, partially grouped and partially disseminated and bilateral calcifications of the basal ganglia. Since hypoxemia/ischemia, subependymal hemorrhage, CNS infection, developmental defect of the mantle layer, chromosomal disorder, Zellweger syndrome, carbon monoxide intoxication, trauma, or mitochondriopathy were not causative, the etiology of PVPC remained questionable. CONCLUSIONS: Rarely, unilateral PVPC become symptomatic in adulthood, manifesting as ipsilateral headache, contralateral hemi-hypesthesia, depression, collapses, and slight cognitive decline. Clinical progression of the disease is not necessarily related to the progression of the imaging findings. PVPC should be included in the differential diagnosis of unilateral headache.

Adult↗
PubMed2000

Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute.

PURPOSE: To assess the efficacy and complications of Gamma Knife radiosurgery for trigeminal neuralgia. METHODS AND MATERIALS: The Barrow Neurological Institute (BNI) Gamma Knife facility has been operational since March 17, 1997. A total of 557 patients have been treated, 89 for trigeminal neuralgia (TN). This report includes the first 54 TN patients with follow-up exceeding 3 months. Patients were treated with Gamma Knife stereotactic radiosurgery (RS) in uniform fashion according to two sequential protocols. The first 41 patients received 35 Gy prescribed to the 50% isodose via a single 4-mm isocenter targeting the ipsilateral trigeminal nerve adjacent to the pons. The dose was increased to 40 Gy for the remaining 13 patients; however, the other parameters were unvaried. Outcome was evaluated by each patient using a standardized questionnaire. Pain before and after RS was scored as level I-IV per our newly-developed BNI pain intensity scoring criteria (I: no pain; II: occasional pain, not requiring medication; III: some pain, controlled with medication; IV: some pain, not controlled with medication; V: severe pain/no pain relief). Complications, limited to mild facial numbness, were similarly graded by a BNI scoring system. RESULTS: Among our 54 TN patients, 52 experienced pain relief, BNI score I in 19 (35%), II in 3 (6%), III in 26 (48%), and IV in 4 (7%). Two patients (4%) reported no relief (BNI score V). Median follow-up was 12 months (range 3-28). Median time to onset of pain relief was 15 days (range 0-192), and to maximal relief 63 days (range 0-253). Seventeen (31%) noted immediate improvement (</= 24 h). Prior to RS, all patients were on pharmacologic therapy felt to be optimal or maximal. Twenty-two (41%) were able to stop medications entirely (BNI score I or II). Another 16 (30%), with BNI Score III relief, decreased medication intake by at least 50%. Patients with classical TN pain symptoms were more likely to stop medications than those with atypical features, 49% (21 of 43) versus 9% (1 of 11). This difference was significant at p = 0.040. Statistically, the finding most predictive for pain relief was new facial numbness following RS. Each of the 5 patients with new numbness after RS developed BNI score I relief, contrasting with 35% for the 49 patients with no new numbness (p = 0.019). Complications have been limited to delayed, mild facial sensory loss. Before RS, 17 patients had numbness from prior invasive procedures, none of whom reported a worse numbness score after treatment. Thirty-seven patients had no facial numbness at the time of RS, of whom 5 developed facial hypesthesia. Each rated this as "mild, not bothersome." There have been no other sequellae. CONCLUSION: RS is an effective treatment, and is the least invasive nonpharmacologic therapy for TN. It carries a small risk of mild facial hypesthesia, a side effect which, somewhat ironically, may be desirable, because it appears to correlate favorably with an excellent pain response. We currently include radiosurgery among the appropriate options for TN patients who have failed optimal medical management, with or without prior invasive neurosurgical procedures. We present here BNI scoring systems for pain intensity and facial numbness. These have proved simple and reliable, have facilitated data collection, rendered analysis more objective, and improved our ability to discuss results with patients and colleagues.

Adult↗
PubMed1987

Paraesthesia of the infraorbital nerve following fracture of the zygomatic complex.

68 patients with fractures of the zygomatic complex were studied. Of these, 56 had sensory disturbances of the infraorbital nerve. 50 patients were operated on and in 42% (21) some degree of persisting hypesthesia was found. No significant difference in outcome was found between the different methods of indirect reduction used. However, in 10 out of 12 patients in which direct fixation with transosseous wiring of the infraorbital margin was performed, persisting hypesthesia was encountered. In 3 out of 4 patients where the nerve was also explored primarily, the sensation returned totally. A secondary nerve deliberation was also found to be beneficial in 4 out of 5 patients with persisting total loss of sensation.

Adolescent↗
PubMedDate not supplied

Musculocutaneous nerve entrapment revisited.

Compression of the lateral cutaneous nerve of the forearm (LCNF), the distal sensory termination of the musculocutaneous nerve, can occur below the biceps aponeurosis, most commonly after strenuous elbow extension or forearm pronation. Between 1965 and 1992, 15 patients reported pain in the anterolateral elbow with "burning" into the forearm. There was a minimum 2-year follow-up of all patients in the study (average 13.4 years, median 15 years). All patients were managed conservatively for 12 weeks. Of the 15 patients, 11 required operative decompression that involved resecting a triangular wedge of aponeurosis overlying the nerve. Of the four nonoperative patients, one had persistent hypesthesia even though pain was relieved and range of motion was restored. Of the 11 patients treated operatively, none had recurrence of hypesthesia, and all patients continued to have complete relief of pain and full range of motion. One additional patient required surgery for lateral epicondylitis 2 years later. There were no operative complications.

Adolescent↗
PubMed1994

Severe penile erosion after use of a vacuum suction device for management of erectile dysfunction in a spinal cord injured patient. Case report.

We report a case of severe erosion and cellulitis at the base of the penis as a result of vacuum suction device constriction bands left on for 4 hours in a spinal cord injured patient with paraplegia and hypesthesia of the genital area. All patients using vacuum suction devices need to be properly educated regarding usage and risks with adequate follow up; patients with hypesthesias and spinal cord injuries need information specifically related to their decreased or absent level of sensation. Only two out of seven vacuum suction device brochures reviewed warn of the risk to patients with decreased sensation in the penis, but none specifically address usage or risks to men with spinal cord injuries.

Adult↗
PubMed2002

Minimally invasive thyroidectomy.

BACKGROUND: Conventional thyroidectomies by a direct approach through the neck require long incisions in the neck that can result in prominent scars, hypesthesia, and paresthesia. Minimally invasive procedures have recently been adopted for the surgical treatment of thyroid disease as a means of preventing such problems. METHODS: In the present paper, the anterior chest approach and axillary approach to endoscopic thyroidectomy are described. RESULTS: Twenty-two patients were treated by the anterior chest approach to endoscopic thyroidectomy and 28 patients by the axillary approach. The only complication was one case of postoperative emphysema. The patients were satisfied with the cosmetic results of the procedures and with the minimal degree of postoperative hypesthesia, paresthesia and discomfort. CONCLUSION: Endoscopic thyroidectomy may become the procedure of choice for the surgical treatment of carefully selected patients with thyroid disease.

Adult↗
PubMed1999

Anterior transpetrosal approach to the prepontine epidermoids.

We have operated on nine patients with a prepontine epidermoid extending to the bilateral cistern or the unilateral middle fossa using the anterior transpetrosal approach since 1986. The preoperative symptoms were unilateral trigeminal neuralgia, hearing disturbance, gait disturbance, double vision, facial hypesthesia, hemifacial spasm, and dysphagia. The most common neurological sign was unilateral trigeminal nerve disturbance. In two patients with useful hearing preoperatively lost, the labyrinth and mastoid air cells as well as the petrous apex were resected to extend the surgical field. Tumors were totally removed, except for capsules that were tightly adhered to the brain stem, cranial nerve, and vessels. The trigeminal neuralgia, hemifacial spasm, and dysphagia disappeared, but double vision improved only one out of three cases, and facial hypesthesia was unchanged in all cases. There were no postoperative deaths. New abducens palsy appeared in four cases and cerebrospinal fluid (CSF) leakage appeared in three cases postoperatively, but later these symptoms disappeared. In one case, postoperative chemical meningitis developed, and a ventricular shunt was required later to treat hydrocephalus. Postoperative follow-up, an average of 5,7 years, did not show any increases in any of the tumors. Based on our experience, we conclude that the anterior transpetrosal approach is more useful than the retromastoid suboccipital approach to resect the epidermoid located mainly in the prepontine cistern.

Journal Article↗
PubMed1997

Surgical management of meningiomas originating in Meckel's cave.

OBJECTIVE: To define the difference of meningiomas that originate in the area of Meckel's cave (MC) (primary MC meningiomas) in regard to the different surgical approaches and postoperative results. METHODS: A retrospective analysis of all meningiomas involving the cranial base displayed 21 cases of meningiomas originating in MC (primary MC meningiomas). These cases were classified according to the tumor extension in four different types: Type I, tumors mainly confined to MC; Type II, MC meningiomas with extension into the middle fossa; Type III, MC meningiomas with extension into the posterior fossa; and Type IV, MC meningiomas with extension into both middle and posterior fossae. RESULTS: Trigeminal neuralgia resolved in all cases in this series, despite tumor type. Trigeminal hypesthesia showed postoperative improvement only in Type III MC meningiomas. In Types I and III, total removal without further morbidity was frequently achieved. Cavernous sinus infiltration, especially in Types II and IV, limited (in some cases) the extent of tumor extirpation. CONCLUSION: Types I, II, and III MC meningiomas have a good prognosis. In most cases, very good outcomes are achieved. Radical tumor removal can usually be achieved without further morbidity and with postoperative improvement of the preexisting symptoms, especially in Types I and III MC meningiomas. On the contrary, Type IV MC meningiomas are usually only subtotally resected. Surgery in such cases may carry a high risk of additional morbidity, especially with regard to the IIIrd, IVth, and VIth cranial nerves. The postoperative outcome regarding facial pain in cases of all tumor types is usually very good. Trigeminal hypesthesia may persist after tumor removal in the majority of cases.

Adolescent↗