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PubMed1993

[A case of Listeria rhombencephalitis with a secondary vasculitis suggested by MRI].

We reported a rare case of Listeria rhombencephalitis with meningitis. A 48-year-old healthy man suddenly experienced high fever and headache, then he had lower cranial nerve's palsies and mental dysfunction developed during one week period. On admission, his temperature was 38 degrees C. He was slightly delirious and euphoric. He had nuchal rigidity, mild paresthesia over his left cheek to left upper lip, a right sixth nerve palsy, dysphagia, hiccup, nasal voice and left cerebellar ataxia. His tongue deviated toward the right side on protrusion. A CSF culture grew Listeria monocytogenes. Intravenous antibiotic therapy (PIPC, minocycline hydrochloride) produced improvement in one month except for mild paresthesia and dysphagia. He almost recovered after 7 months of illness. Brain MRI on T2 weighted image demonstrated multiple small ischemic lesions in the left lateral medulla, upper pontine tegmentum in the right side, and pontine tegmentum in the left side. These lesions enhanced by Gd. were assumed to be due to the secondary vasculitis. Listeria rhombencephalitis is extremely rare in human beings. To our knowledge only thirteen cases have been reported. In seven cases, post-mortem pathological findings confirmed necrotizing angitis in brainstem. Clinical aspects of Listeria rhombencephalitis were discussed, and the entity of this disease should be considered as a treatable cause of acute progressive brainstem meningoencephalitis.

Humans↗

PubMed1993

[Loco-regional anesthesia and orthopedic surgery of the shoulder].

Interscalene block can induce by itself anesthesia for shoulder surgery, if the opening does not reach the delto-pectoral site nor the shoulder-blade, but medical indications must be thoroughly talked over on account of the risk of phrenic paralysis with patients suffering from breezing trouble, and the surgical position that may disturb the anesthesiologist in case he has to increase anesthesia. A superficial cervical plexus block is required in anesthesia of the upper part of the shoulder. Regional anesthesia is quite useful too as a complement to general anesthesia, for it provides excellent postsurgical analgesia. A catheter may be inserted at the end of the surgical process through a nerve stimulator, but the patient does not tolerate it long, its efficiency greatly diminishes after the first day, and paresthesias may occur as after-effects. Today we prefer set interscalene block before the patient is anaesthetized, searching for paresthesias with a thin needle: this process does not take long to install, it is relatively painless and provides excellent analgesia during the per and post-surgical period, until the next day with long acting local anesthetics. Not any complication happened in fifty patients for one year.

Cervical Plexus↗

PubMed1996

Carpal tunnel release. Correlations with preoperative symptomatology.

Fifty patients (54 hands) who underwent carpal tunnel release for carpal tunnel syndrome were evaluated to determine the relationship between the prominence of specific clinical symptoms and the early results of carpal tunnel release. Patients were evaluated preoperatively, 3 weeks after surgery, and 3 months after surgery by questionnaire, physical examination, and Semmes-Weinstein monofilament pressure testing. The symptoms evaluated included hand/wrist/forearm pain, night pain/paresthesias, intermittent paresthesias, hand clumsiness, hand weakness, constant numbness, and difficulty with work related tasks. All symptoms showed significant improvements at 3 months after surgery. Overall symptom reduction at 3 months after surgery was 49% +/- 73%. Overall satisfaction at 3 months after surgery was 7.8 +/- 2.8 (0 to 10 scale). the severity of preoperative subjective hand weakness was significantly associated with surgery and with less improvement of function at 3 months after surgery and with less satisfaction with overall symptom relief at 3 months after surgery. Although subjective outcomes in this study were markedly improved after carpal tunnel release regardless of preoperative symptomatology, patients with more preoperative night symptoms and intermittent paresthesias and less preoperative hand/wrist pain, numbness, weakness, clumsiness, and difficulty with work related tasks were the most satisfied with their surgery.

Adult↗

PubMed1996

Long ago and far away: a retrospective on the implications of Minamata.

Minamata claimed entry into the lexicon of toxicology 40 years ago as a definition of methylmercury poisoning, but deposited a legacy of unsolved puzzles that still endures. In fact, they scatter ramifications across the entire domain of neurotoxicology. One puzzle is how the earliest clinical index of adult toxicity, paresthesia, can remain stable, even with continued exposure. Does damage, like body burden, reach a plateau? A second enigma is the question of silent damage to nerve cell populations even more vulnerable than those whose loss of function results in minimal symptoms such as paresthesia. Is there a population of unidentified humans exposed to methylmercury whose deficits might be uncloaked by neurobehavioral test methods that have succeeded in revealing silent toxicity in populations exposed to lead, manganese, and elemental mercury? A third puzzle arises in the context of aging. Attrition of nerve cells occurs naturally as the brain ages, but is also accompanied by dendritic sprouting in those that remain. Damage incurred earlier in life, as in mild polio infections that seemed to fade, may emerge late in life in the form of the post-polio syndrome. Most explanations ascribe the syndrome to compensatory dendritic sprouting by surviving neurons and the consequent metabolic overload imposed on them. Could parallel processes be induced by neurotoxicants such as methylmercury? Or, alternatively, might the compensatory sprouting accompanying aging be inhibited by neurotoxic agents? All such questions have a bearing on how the risks of low-level exposures are evaluated.

Adult↗

PubMed1996

[Brachial plexus anesthesia: results of a modified perivascular supraclavicular technique].

OBJECTIVES: To compare a modified supraclavicular perivascular approach with the axillary perivascular technique for providing brachial plexus blockade. PATIENTS AND METHODS: We studied 100 ASA I/II patients undergoing surgery on upper extremities. Patients were divided into two groups: group 1 (axillary, n = 50) and group 2 (modified supraclavicular, n = 50 ). Patients needing shoulder surgery were excluded from group 1. In both groups 35 ml of 1.5% mepivacaine plus 0.05 mEq/ml of bicarbonate was used. The Winnie axillary perivascular technique was used in group 1. In group 2 we used a modification of the lateral perivascular supraclavicular technique described by Brown, with the needle directed cephalad, medial and posterior to provide paresis in the upper extremity. We recorded the degree of difficulty and time needed for each technique, time until start of paresis and time of motor paralysis in the extremity, area of nerve deficit, and quality of block. In group 2 we measured the depth of paresthesia. Perioperative complications were noted for each group. RESULTS: There were no significant differences in difficulty, time or quality of block. Time until start of paresis and time of motor paralysis were significantly shorter in group 2 (12.0 +/- 2.5 versus 4.9 +/- 0.2 min, and 15.2 +/- 6.9 min versus 35.3 +/- 5.2, in groups 2 and 1, respectively). Mean depth of paresthesia was 44.1 +/- 5.2 min. The most frequently recorded complications were Horner's syndrome in group 2 and vascular puncture in group 1. CONCLUSIONS: The modified perivascular lateral supraclavicular technique is a safe, effective method for providing brachial plexus block.

Adult↗

PubMed1996

Management of the patient with a Chance fracture of the lumbar spine and concomitant subluxation.

OBJECTIVE: To document the chiropractic management of a patient who sustained a Chance fracture of the third lumbar vertebra. This case study represents the first report in the scientific literature of such an injury managed through chiropractic methods. CLINICAL FEATURES: An 18-yr-old man complained of low back pain and paresthesia in the lower extremities 10 days after suffering an automobile accident. Examination revealed a large circular edematous area from L1 to L4, tenderness to palpation at the L3 spinous process, reduction in global range of motion at the thoracolumbar region, and positive Lasègue and Kemp tests (bilaterally). Radiographic and computed tomographic scans revealed a Chance fracture of the L3 vertebra. INTERVENTION AND OUTCOME: The patient received specific-contact, short-lever arm spinal adjustments delivered primarily at L3 and L5, as well as bracing. Four months after initial treatment, the patient's complaint of paresthesia had resolved and he suffered only occasional minor low back pain. The comparative radiographs demonstrate a reduction in the separation of the fracture fragments. CONCLUSION: A case report is presented of a patient who suffered a Chance fracture of L3. The patient was eventually managed by chiropractic methods including a specific contact high-velocity thrust procedure administered at the level of the fractured vertebra. The case represents the first known reporting of this type of chiropractic procedure applied to a patient with a Chance fracture.

Accidents, Traffic↗

PubMed1997

Some uncharacteristic clinical signs and symptoms of acoustic neuroma.

OBJECTIVE: The most common initial symptoms of the acoustic neuroma are unilateral hearing loss that evolves gradually, tinnitus, and unsteadiness. However, atypical presentations may sometimes occur, more often with a small intracanalicular neuroma or with a large medial neuroma placed in the cerebellopontine angle. RESULTS: In our group of 51 patients suffering from acoustic neuroma, atypical presentations were observed in 9 cases (17.6%). Two patients had normal hearing function but reported tinnitus; two patients reported sudden hearing loss, with partial recovery; two patients had a history of fluctuating hearing loss; two patients reported neurologic symptoms (one reported trigeminal paresthesia and the other had a history of trigeminal paresthesia and recurrent headache); and one patient reported profound hearing loss for many years and the recent onset of unsteadiness. CONCLUSION: Patients with these atypical presentations have to undergo a diagnostic evaluation for acoustic neuroma and must be evaluated with BAEPs and then with gadolinium-enhanced MRI.

Adult↗

PubMed1997

[Heparan sulfate in the therapy of postphlebitic syndrome. Evaluation of the efficacy and tolerability as compared to mesoglycan].

BACKGROUND: Antithrombotics and profibrinolytics are indicated in several clinical thrombophilic conditions such as postphlebitic syndrome. Heparansulphate, a glycosaminoglycan, shows an antithrombotic activity with low anticoagulant effect. The aim of the study was to evaluate the efficacy and the safety of heparansulphate (100 mg b.i.d.) versus mesoglycan (50 mg b.i.d.), both administered for three months in patients with postphlebitic syndrome. METHODS: The trial was performed in an open-label, controlled, with parallel and randomized groups, design. Thirty patients, with chronic venous insufficiency and a history of venous thrombosis were enrolled. Coagulative and fibrinolytic parameters (PT, aPTT, euglobulin lysis time, fibrinogen, D-dimer, t-PA, PAI-1) and signs and symptoms (cramps, paresthesia, itch, edema, local pain, skin trophism) were assessed at enrollment, 15 days later after the pharmacological washout period and after 1, 2, 3 months of treatment. Safety was evaluated by monitoring any adverse event during the study and performing clinical laboratory tests at the beginning and at the end of treatment. RESULTS: The two drugs showed a superimposable efficacy and very good tolerability. Coagulative and fibrinolytic parameters were positively affected by both treatments and the clinical benefit was particularly evident in the heparansulphate group with a significant decrease "between times" of local pain, edema, paresthesia and itching. CONCLUSIONS: These data support the use of heparansulphate, and in general of glycosaminoglycans, in the postflebitic syndrome.

Drug Evaluation↗

PubMed1997

[Intoxication by marine animal venoms in Madagascar (ichthyosarcotoxism and chelonitoxism): recent epidemiological data].

If seafood poisonings are well documented in the Pacific region, they are not often reported in the Indian Ocean. In Madagascar, fishermen and people living in coastal areas are traditionally aware of seafood poisonings. Mass intoxications were described in the sixties, including lethal cases following sardine ingestion. From 1989 to 1993, 28 ichtyosarcotoxism cases, mainly ciguatera occurring in children, were reported in Tulear hospital. From July 1993 to May 1996, nine seafood poisoning outbreaks occurred in coastal villages after turtle, shark and sardine meals. Clinical symptoms were related to marine toxins. For turtle intoxications, gastro-intestinal symptoms are the most frequently seen (acute stomatitis, dysphagia, vomiting and diarrhea), with case fatality rates around 7%. For shark intoxications, the most frequent symptoms were neurologic (paresthesia specially peribuccal and extremities), and gastro-intestinal (diarrhea and vomiting), with specific case fatality rates varying from 0% to 30%. For sardine intoxication, symptoms were gastro-intestinal (vomiting) and neurologic (paresthesia), and from the two intoxicated people one died. Two previously unknown biotoxins were isolated from the liver of a shark responsible for a mass poisoning, namely carchatoxins. For the turtles, the search of chelonitoxin is under way. For the sardines, clupeotoxin was isolated. Because of the frequency and the gravity of collective seafood poisonings occurring in recent years, the Ministry of Health has implemented a Seafood Poisoning National Control Programme. This programme is based on three major strategies: the setting of an epidemiological surveillance network, the prevention of the communities through educational programmes, and the development of research on marine eco-environment.

Animals↗

PubMed1998

[Neuralgic amyotrophy].

Neuralgic amyotrophy is an inflammatory condition of the nerves of the brachial plexus, the cause of which is unknown. Clinically, it presents as acute, severe pain in the shoulder girdle, followed by paresthesia and flaccid paralysis of selected muscles in the upper limb. In its initial stages, the disease may easily be misdiagnosed as a musculoskeletal disorder. We describe a 38-year-old man who experienced acute, severe pain in both shoulders, and hypoesthesia and paresthesias in the right arm without preceeding trauma. The condition was first diagnosed as capsulitis of the shoulder joint, and the patient was treated with naproxen with no effect. Eight days after onset of the disease, flaccid paralysis occurred abruptly in the right biceps muscle and in the left spinati and serratus anterior muscles. Sensibility and muscle strength improved gradually without treatment during the following months.

Adult↗

PubMed1976

An outbreak of methylmercury poisoning due to consumption of contaminated grain.

An outbreak of methylmercury poisoning took place in the fall and winter of 1971-72 in Iraq. Six thousand five hundred and thirty cases were admitted to hospitals throughout the country and 459 died in hospital. The outbreak was the result of eating homemade bread prepared from wheat treated with a methylmercury fungicide. The wheat was intended for planting purposes only. Signs and symptoms of poisonings in adults indicate that the major site of action of this form of mercury is the central nervous system. Severe brain damage also resulted from prenatal exposure when the mother ingested large amounts of the contaminated bread. The frequency of signs and symptoms in an exposed population was found to be related to the estimated maximum blood levels, i.e., the concentration in blood at the end of exposure. A small percentage of the population exhibited a significant increase in complaints of paresthesia at maximum blood levels in the range of 240 to 480 ng Hg/ml. At higher blood levels a greater proportion of the population complained of paresthesia and other signs and symptoms became apparent.

Central Nervous System Diseases↗

PubMed1998

Dual channel electrostimulation in pain.

Spinal cord stimulation is an accepted treatment for neuropathic pain. Technical advances in electrode design and better patient selection have led to better and sustained pain control by these devices. Multilead electrical stimulation is the latest innovation in implantable electrostimulation (Mattrix, Medtronic Minneapolis, USA). Two combined multipolar leads connected to a radiofrequency--coupled system can deliver electrical pulses of various amplitudes and pulse widths at different dermatome levels. Single stimulation is applied with different electrode configurations using both electrodes with identical stimulation parameters. In dual stimulation, the amplitude and the pulse width can vary between the electrode configurations. Dual channel stimulation helps steering stimulation paresthesias. Three patients illustrate the technical advantages of dual channel electrostimulation in the pain relief at multiple sites. Two patients with failed back surgery syndrome obtained more easily stimulation-induced paresthesias in the back and the legs. Dual channel stimulation is cost saving in patients implanted with two electrodes. This is presented in a third patient with an electrode in the thalamus--as pain treatment for cervicobrachialgia and a second in the epidural space--as treatment for the failed back surgery syndrome. These electrodes were connected to the Mattrix stimulator.

Adult↗

PubMed1998

[Carpal tunnel syndrome: clinical and neurophysiological correlation: review of 100 cases].

INTRODUCTION: The diagnosis of carpal tunnel syndrome (CTS) continues to be neurophysiologically and clinically controversial. This study attempts to find the correlation between the subjective symptomatology and the neurophysiological affectation, establishing a diagnostic guide for the family doctor in order to recognize early CTS for referral to the specialist doctor. PATIENTS AND METHODS: After a sample of 100 cases with clinical suspicion of CTS, a clinical evaluation was made with the symptoms (paresthesias, pain, loss of strength), signs (Tinel, Phalen), and the neurophysiological evaluation with electroneurography (ENG) of the median and cubital nerve (sensory velocity (SV), motor distal latency (MDL)), and electromyography (EMG) of tenar eminence muscles. With this data an epidemiological study was made with correlation between the clinical and neurophysiological parameters. RESULTS: The patients with pain, loss of strength and Tinel's sign had significant alteration of the parameters of ENG and EMG. Tinel's sign had a sensitivity (SE) = 30.1% and a specificity (SP) = 73% for MDL, a SE = 32.5% and a SP = 88.2% for SV. Phalen's sign had a SE = 22.2% and a SP = 94.6% for MDL, a SE = 18.1% and a SP = 94.1% for SV. CONCLUSIONS: The guide to recognize clinically the patients which must be studied neurophysiologically that have a high probability to suffer CTS is: diagnosis for motor alteration, pain (SE = 79%), loss of strength (SP = 86%) and Phalen's sign (SP = 94.6%). Sensory alteration: paresthesias (SE = 97%), Tinel's sign (SP = 88.2%) and Phalen's sign (SP = 94.1%).

Adult↗

PubMed1998

[Spontaneous resolution of idiopathic spinal subdural hematoma: case report].

A 32-year-old female presented with about a week's history of dull pain in the head and neck pain. On the day of admission, she experienced a sudden onset of severe pain, extending from the occipital to the lower back region and hypesthesia and paresthesia of the right C8-Th3 dermatome. On admission, she was alert but there was a band of hypesthesia and paresthesia at the level of C8-Th3. Cervical X-ray, computed tomography scan (CT) and magnetic resonance images (MRI) of the head revealed no definite abnormalities. The peripheral blood picture was normal, and the bleeding and clotting times were in the normal range. The cerebrospinal fluid (CSF) was bloody and the CSF pressure was 220 mm H2O. An emergent 4-vessel intracranial angiography disclosed no abnormal findings. MRI and myelography revealed an intradural extramedullary lesion extending from the Th2 to the Th5 levels, ventral to the spinal cord. A T1-weighted MR image showed iso-low intensity and a T2-weighted MR image showed low intensity at these lesions. Spinal angiography revealed no abnormal vessels. In one month, spinal compression cleared gradually without surgery and her clinical symptoms disappeared about 40 days after admission. Spontaneous spinal subdural hematoma is uncommon and only 28 cases have been reported. 15 cases have been treated with surgical procedure, but spinal compression cleared spontaneously in this case. This spontaneous recovery is such a rare event that only 3 such cases have been reported in the literature. However, with the prevailing MRI, this disease will be detected more frequently in the future.

Adult↗

PubMed1998

[Continuous parascalene block for shoulder surgery].

OBJECTIVE: To evaluate the efficacy and incidence of side effects of parascalene brachial plexus block for shoulder surgery and for postoperative analgesia. PATIENTS AND METHODS: This prospective descriptive study enrolled 186 patients scheduled for conventional (open) and arthroscopic shoulder operations. The parascalene approach to the brachial plexus was used, with an 18-G x 4.5 cm cannula (30 degrees bevel), applying the technique of detecting perforation of the prevertebral fascia. Mepivacaine 1.5% was administered for anesthesia, beginning with a test dose of 5 ml followed by doses of 25 ml. Bupivacaine 0.125% with 1/400,000 adrenaline was given for postoperative analgesia. Two groups were established according to type of surgery. In group A were patients undergoing open surgery and those with articular stiffness undergoing arthroscopic surgery; analgesics were delivered in continuous perfusion of 5 to 8 ml/h. Group B patients, who underwent arthroscopic surgery, received the analgesic in boluses of 10 to 14 ml every 4 to 6 hours. We assessed perception of perforation of the fascia, provocation of paresthesia, number of puncture attempts, anesthetic efficacy, postsurgical analgesia (visual analogue scale from 0 to 10) and complications. RESULTS: Blockade was effective for 155 of the 186 patients (83.33%). In 118 (63.44%) the perception of perforation of the prevertebral fascia was ostensible, in 52 (27.95%) it was slight and in 16 (8.6%) it was undetectable. Paresthesia was triggered by the cannula in 18 cases (9.13%) and by the test dose in 181 cases (97.31%). The mean number of puncture attempts was 1.2 +/- 0.09 per patient. During the early postoperative period analgesia was adequate for 92 (84.40%) of the 109 patients in group A. In group B, 45 patients (97.82%) required 1 to 2 analgesic doses (mean 1.4 +/- 2 doses) and one patient (2.17%) needed 6 doses within the first 24 hours. Catheters remained inserted as long as 36 hours to 10 days (mean 3.5 days) in group A. In group B they had been removed by 24 hours. Complications were transitory and slight. No cases of pneumothorax, no intra- or epidural anesthesia was required and no instances of vascular puncture occurred. CONCLUSIONS: The parascalene approach is easy to use and entails few risks while providing excellent anesthetic conditions for open and arthroscopic shoulder operations. It is useful for ambulatory analgesia to facilitate early rehabilitation after surgery.

Adult↗

PubMed1981

Transmissible spongiform encephalopathy (Creutzfeldt-Jakob disease). Atypical clinical and pathological findings.

A middle-aged neurosurgeon had an 18-month illness characterized by abnormal sleep patterns, paresthesias, and necrotizing cutaneous lesions with vasculitis and signs of cerebral, brainstem, vestibulocerebellar, and progressive spinal cord involvement. Biopsy specimens of nerve and skin showed an acute vasculitis with endovascular cellular proliferation in the pattern of a Köhlmeier-Degos lesion and focal epidermal necrosis. Mental changes and cranial-nerve signs developed. Myoclonus occurred occasionally during sleep. Akinetic mutism ensued. At autopsy, major abnormalities were limited to the nervous system and skin. Spongiform encephalopathy typical of Creutzfeldt-Jakob disease was found with amyloid kuru plaques. A cribriform change distinct from the spongiform change was seen focally in the white matter. Scarred skin lesions and a healed, partially obliterative arteritis were noted. Inoculation of brain and lung into nonhuman primates resulted in a spongiform encephalopathy.

Brain Stem↗

PubMed2001

Linear pontine trigeminal root lesions in multiple sclerosis: clinical and magnetic resonance imaging studies in 5 cases.

BACKGROUND: Magnetic resonance imaging (MRI) is useful for demonstrating demyelinating lesions in patients with multiple sclerosis (MS). Magnetic resonance imaging studies show that MS lesions are generally not uniform in shape, size, or distribution. Linearly shaped lesions at the trigeminal root entry zone have been occasionally reported in single cases of MS, but, to our knowlege, the frequency and the clinical features of such patients have not been comprehensively characterized. OBJECTIVE: To describe the frequency and the clinical and laboratory features of patients with MS who had linearly shaped lesions at the trigeminal root as seen on MRI. DESIGN AND SETTING: A retrospective review of medical records and MRI films of Japanese patients with MS admitted to a university hospital and its affiliated hospital in Sendai, Japan. PATIENTS AND METHODS: Brain MRI films of 74 consecutive Japanese patients with MS (51 females and 23 males) were studied retrospectively and the clinical and laboratory features of the patients with linearly shaped lesions at the trigeminal root were also investigated retrospectively. RESULTS: Five patients (6.8%) were shown to have T1-weighted-hypointense, T2-weighted-hyperintense, nonenhanced linear lesions in the pons on MRI, and these were uniformly localized in the intramedullary portion of the trigeminal root. All of these patients had clinically definite MS and had various types of facial sensory disturbances, such as neuralgia (1 patient), hypesthesia (2 patients), or paresthesia (3 patients). No other clinical or laboratory feature was characteristic in these 5 patients. CONCLUSIONS: Linear pontine trigeminal root lesions were common in our patients with MS. They were associated with various facial sensory symptoms. Since similar lesions are formed in animal models of herpes simplex virus infection, further study is needed to clarify whether these MS lesions are virally induced.

Adolescent↗

PubMed1987

Clinical observations of effects on central nervous system in patients with acute facial palsy.

Twenty-eight consecutive patients with acute unilateral facial palsy were examined with special reference to clinical signs of central nervous system involvement. The clinical investigation in the acute stage of the disease showed that only seven patients had solitary facial nerve dysfunction, while the remaining patients had evidence of more widespread disease involvement. The most frequent finding was a trigeminal dysfunction of the paretic side, as shown by paresthesia and sensibility disturbance corresponding to the sensoritrigeminal area, as well as a dysfunction of the trigeminal component of the corneal reflex of the paretic side. Three patients showed migrating symptoms that were suggestive of a brain-stem disorder. In addition, four patients had an optic neuropathy, while an abnormal brain-stem audiometry response was demonstrated in five patients. The outcome of acute facial palsy one to two years after onset, however, could not be predicted from the clinical central nervous system signs. The degree of the palsy in the acute stage of the disease still seemed to be one of the most important prognostic factors. It is concluded that acute facial palsy is not a single entity, but rather a feature of different neurologic conditions.

Acute Disease↗