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PubMed1979

A reticulothalamic system mediating proprioceptive attention and tremor in man.

This report descirbes the electrophysiological characteristics of thalamic and subthalamic targets used to control tremor. In these targets exploratory electrodes recorded one or more of the following events. Electrical stimulation produced enhancement of tremor or other complex motor responses. Somatic evoked potentials (SEPs) induced by proprioceptive stimulation showed only late components, the amplitudes of which changed in various attentive situations. Multiunit activity showed spontaneous 3- to 6-Hz rhythmic bursts. And a lesion produced neglect of contralateral extremities and an ipsilateral decrease of scalp-recorded SEP late components. In contrast, in the areas located immediately posterior and dorsal, electrical stimulation produced contralateral paresthesias. Early components of SEPs could be recorded, as were rhythmic bursts of multiunit activity after the occurrence of peripheral tremor. Lesions produced sensory deficits in the contralateral extremities and ipsilateral blocking of all components of scalp SEPs. The latter areas are identified as the lemniscal system, but the former seem to be extralemniscal. Their electrophysiological characteristics suggest that they are probably involved in the process of selective attention and motor control.

Attention↗
PubMed1986

Burning hands syndrome revisited.

The burning hands syndrome of spinal cord injury was first described in 1977. The syndrome is characterized by burning dysesthesias and paresthesias in the hands and may be associated with either cervical fracture/dislocation or no detectable cervical spine abnormalities. A case of burning hands syndrome without cervical spine injury is presented in which somatosensory evoked potentials and magnetic resonance imaging were used to delineate the pathophysiology of this syndrome.

Adolescent↗
PubMed2004

Outcomes of cubital tunnel surgery among patients with absent sensory nerve conduction.

OBJECTIVE: To report the outcomes of cubital tunnel surgery for patients with absent ulnar sensory nerve conduction. METHODS: The charts of 34 patients who exhibited clinical symptoms of ulnar nerve entrapment at the elbow and who had electromyography-confirmed prolonged motor nerve conduction across the cubital tunnel in association with absent sensory nerve conduction were reviewed. The mean age was 63 years, and the mean symptom duration was 17 months. Four patients had bilateral symptoms. Surgery was performed for 38 limbs, i.e., neurolysis for 21 limbs and subcutaneous transposition for 17 limbs. Fifteen limbs demonstrated associated ulnar nerve-related motor weakness. The mean postoperative follow-up period was 4 years (range, 3 mo to 11 yr). RESULTS: Sensory symptoms (i.e., pain, paresthesia, and two-point discrimination) improved in 20 limbs (53%), and muscle strength improved in 2 limbs (13%). Improvements in sensory symptoms were not related to patient age, symptom duration, cause, severity of prolonged motor nerve conduction, select psychological factors, associated medical diseases, associated cervical pathological conditions, or type of surgery. Improvements in sensory symptoms were significantly decreased among patients who had experienced cervical disease for more than 1 year and patients with bilateral symptoms. CONCLUSION: Patients with cubital tunnel syndrome who have absent sensory nerve conduction seem to experience less improvement of sensory symptoms after surgery, compared with all patients with cubital tunnel syndrome described in the literature. Bilateral symptoms and delayed surgery secondary to associated cervical spine disease seem to be significant negative factors for postoperative improvement of sensory symptoms. Sensory symptoms improved similarly among patients who underwent neurolysis or subcutaneous transposition

Adult↗
PubMed1987

Residual and recurrent acoustic neuromas.

A retrospective study was conducted on all 23 patients who underwent operation for residual or recurrent acoustic neuromas during the 10-year period January 1976 through December 1985. The most common symptoms at the time of reoperation were ataxia (16 patients), facial paresthesias (13 patients), and headaches (9 patients). Primary procedures had consisted of suboccipital posterior fossa approaches in 22 patients and a middle fossa approach in one. Reoperation for recurrent or residual tumor consisted of a retrosigmoid approach in 17 patients and a translabyrinthine or translabyrinthine/retrosigmoid approach in six patients. This study confirms that residual or recurrent acoustic tumors are not common. It also suggests that long-term follow-up, for at least 7 to 8 years, is indicated.

Adult↗
PubMed1988

The Caldwell-Luc procedure: institutional review of 670 cases: 1975-1985.

The Caldwell-Luc procedure, which has long been fundamental in the treatment of perisinus disease, has undergone increasing scrutiny when used for inflammatory antritis. Individual morbidity rates of less than 10% to greater than 40% have been reported. To assess the data from our own institution, a retrospective study of 670 Caldwell-Luc procedures was undertaken. Patients ranged in age from 10 to 82, with a mean age of 42.9 years. There were 271 males and 325 females. Parameters studied included symptoms, physical findings, operative techniques, surgical findings, length of hospitalization, and postoperative complications. Immediate postoperative complications included facial swelling in 89% of patients, cheek discomfort in 33%, significant hemorrhage in 2.9%, and temperature elevation in 12.1%. Long-term follow-up ranged from 2 years to 10 years. Overall complication rates in 464 patients included facial asymmetry (3), facial numbness or paresthesia (42), oroantral fistulas (5), gingivolabial wound dehiscences (7), dacryocystitis (12), devitalized tooth (2), recurrent sinusitis (56), and recurrent polyposis (25). A revision antrostomy was required in 37 patients, a revision Caldwell-Luc in 22 patients, an intranasal sphenoethmoidectomy in 17, and root canal therapy in 2 patients. The most frequent complication was recurrent nasal obstruction, occurring in 28% of patients. Overall complication rates tended to increase with a longer follow-up period.

Adolescent↗
PubMed1988

Trigeminal trophic syndrome.

Trigeminal trophic syndrome is an unusual condition also known as trigeminal neurotrophic ulceration or trigeminal neuropathy with nasal ulceration. The diagnosis is suggested when ulceration of the face, especially of the ala nasi, occurs in a dermatome of the trigeminal nerve that has been rendered anesthetic by a surgical or other process involving the trigeminal nerve or its central sensory connections. A history of paresthesias and self-induced trauma to the area further support the diagnosis. Neurological deficits causing trigeminal trophic syndrome may result from surgical trigeminal ablation, vascular disorders and infarction of the brainstem, acoustic neuroma, postencephalitic parkinsonism, and syringobulbia. The following etiologies of nasal ulceration should be excluded: postsurgical herpetic reactivation and ulceration, syphilis, leishmaniasis, leprous trigeminal neuritis, yaws, blastomycosis, paracoccidioidomycosis, lethal midline granuloma, pyoderma gangrenosum, Wegener's granulomatosis, and basal cell carcinoma. In the case reported here, the diagnosis of TTS was made primarily as a result of previous experience with the syndrome, underscoring the importance of physician recognition of this unusual disorder.

Cerebrovascular Disorders↗
PubMed1985

Traumatic bone cyst: report of case.

A case of traumatic bone cyst has been presented that illustrates the less common findings of cortical expansion, inferior alveolar paresthesia, and multiplicity of lesions. A brief review of the literature is also presented.

Adolescent↗
PubMed2003

Avoiding complications in local anesthesia induction: anatomical considerations.

BACKGROUND: Dentists administer thousands of local anesthetic injections every day with few reports of serious complications. However, misjudging the anatomy involved during local anesthetic administration can result not only in inadequate or incomplete anesthesia, but in other complications such as paresthesia, bleeding or hematoma formation, or in serious systemic complications. OVERVIEW: The authors discuss anatomical considerations that dentists should keep in mind when administering local anesthetic injections. In particular, they discuss ways in which dentists can minimize the risk of nerve or vascular injury, as well as systemic complications. CONCLUSIONS AND CLINICAL IMPLICATIONS: Even the most experienced practitioner can benefit from a periodic review of the anatomy associated with local anesthesia. This article offers dentists the opportunity to consider needle placement with regard to location of nerves, blood vessels and glands, and to review injection protocols that can minimize the risk of complications.

Anesthesia, Dental↗
PubMed2007

Damage to the inferior alveolar nerve as the result of root canal therapy.

BACKGROUND: Endodontic treatment of mandibular molar teeth has the potential to damage the inferior alveolar nerve via direct trauma, pressure or neurotoxicity. METHODS: The author reviewed all cases of involvement of the inferior alveolar nerve resulting from root canal therapy in patients seen in a tertiary referral center during an eight-year period (1998 through 2005). The author had encouraged practitioners to refer patients immediately to a university clinic. RESULTS: The author saw 61 patients during the eight-year period. Eight patients were asymptomatic and received no treatment. Forty-two patients exhibited only mild symptoms or were seen more than three months after undergoing root canal therapy, and they received no surgical treatment. Only 10 percent of these patients experienced any resolution of symptoms. Eleven patients underwent surgical exploration. Five of these patients underwent exploration and received treatment within 48 hours, and all recovered completely. The remaining six patients underwent surgical exploration and received treatment between 10 days and three months after receiving endodontic therapy. Of these patients, four experienced partial recovery and two experienced no recovery at all. CONCLUSIONS: Early surgical exploration and débridement may reverse the side effects of endodontic treatment on the inferior alveolar nerve. CLINICAL IMPLICATIONS: If the radiograph obtained after endodontic therapy shows sealant in the inferior alveolar canal, then immediate referral to an oral and maxillofacial surgeon is indicated if the patient has continued symptoms of paresthesia or pain once the local anesthetic should have worn off. Immediate surgical exploration and débridement may provide satisfactory results.

Debridement↗
PubMed2000

Distal sensory polyneuropathy in a cohort of HIV-infected children over five years of age.

BACKGROUND: Peripheral neuropathy in children with human immunodeficiency virus (HIV) infection has not been systematically studied. Objectives. To describe the symptoms and signs of peripheral neuropathy in HIV-infected children and to determine their frequency. METHODS: A cross-sectional study was conducted on a convenience sample from a cohort of children older than 5 years of age at the pediatric HIV outpatient clinic of the Federal University of Rio de Janeiro. Those patients were interviewed and examined systematically for peripheral nerve symptoms and signs. RESULTS: A total of 39 patients were clinically evaluated. Their ages ranged from 5 to 14 years, and 13 patients (34%) had symptoms and signs of peripheral nerve involvement. Distal paresthesia and/or pain plus diminished ankle jerks and/or diminished vibration sense were the most common clinical findings. Symptoms were chronic and fluctuating, and pain was, in general, not severe. Nerve conduction studies primarily revealed axonal changes. CONCLUSIONS: Peripheral neuropathy occurs in one third of HIV-infected children, and, in general, has less severe features than the distal sensory polyneuropathy described in adults. peripheral neuropathy, human immunodeficiency virus, children.

Adolescent↗
PubMed2001

Management of an implant case that required retreatment: a case report.

The presented case represents how the lack of a preoperative panoramic radiograph or any radiograph contributed to incorrect case planning, poor implant selection, and the careless surgical placement of an implant into or dangerously close to the lower left mental foramen, resulting in a paresthesia of 9 months duration. Two implants were surgically removed and the bone defects were grafted with a mixture of irradiated cancellous bone plus Biogran. One implant was sectioned and intentionally "put to sleep." The case was successfully completed with a lower bar overdenture supported by 4 screw implants placed in alternate sites, opposing a custom fabricated maxillary denture with a lingualized occlusal scheme.

Alveolar Ridge Augmentation↗
PubMed2001

Alternative to the inferior alveolar nerve block anesthesia when placing mandibular dental implants posterior to the mental foramen.

Local anesthesia block of the inferior alveolar nerve is routinely taught throughout dental education. This commonly used technique eliminates all somatosensory perception of the mandible, mandibular teeth, floor of the mouth, ipsilateral tongue, and all but the lateral (buccal) gingivae. Generally, the dentist or surgeon desires these structures to be anesthetized. However, in the placement of mandibular implants, it may be useful for the patient to be able to sense when the inferior alveolar nerve is in danger of being damaged, possibly producing permanent paresthesia. In this article, the technique of mandibular infiltration prior to mandibular implant placement in the mandible is discussed.

Anesthesia, Dental↗
PubMed2003

[Surgical treatment of meralgia paresthetica: case report].

Meralgia paresthetica is characterized by pain, paresthesias or burning, and decreased touch and pain sensation on the anterolateral aspect of the thigh. It is due to neuropathy of the lateral femoral cutaneous nerve (LFCN). Conservative treatment is usually successful in relieving the symptoms in most of the patients. We describe a case of a woman, 37 years old, who required surgical treatment for intractable symptoms. Although neurolysis with transposition is the most common procedure, we preferred neurectomy with excision of a portion of the LFCN for its very low recurrence rate as opposed to neurolysis. The area of anesthesia generated by this procedure in the distribution of the LFCN tends to shrink with time. This patient achieved excellent outcome following this surgical technique.

Adult↗
PubMed1989

Unusual periodontal findings in an AIDS patient with Burkitt's lymphoma. A case report.

This report deals with a case of AIDS-related Burkitt's lymphoma in which some of the earliest findings were dental and periodontal in nature. The patient presented initially with painless and extremely loose teeth accompanied by progressive paresthesia of the lower jaw. Unique radiographic findings included extensive periodontal ligament space widening and bulbous, granuloma-like lesions about the apices of the teeth. These findings were associated with progressive tumor infiltration of the mandible and do not appear to be related to other reports of aggressive periodontitis associated with impaired immunologic functions in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Complex reconstruction for the treatment of dorsolateral peritalar subluxation of the foot. Early results after distraction arthrodesis of the calcaneocuboid joint in conjunction with stabilization of, and transfer of the flexor digitorum longus tendon to, the midfoot to treat acquired pes planovalgus in adults.

BACKGROUND: The successful correction of flatfoot in children through lengthening of the lateral column, osteotomy of the medial cuneiform, and advancement of the posterior tibial tendon led to the introduction of similar procedures to treat acquired pes planovalgus secondary to attrition or rupture of the posterior tibial tendon in adults. However, to our knowledge, no study has been published documenting whether these procedures are effective treatment for acquired flatfoot in adults. METHODS: The functional and radiographic results of complex reconstruction of a painful, flexible flatfoot associated with attrition or rupture of the posterior tibial tendon were evaluated in thirty-six patients (forty-one feet) with use of a detailed questionnaire, a comprehensive physical examination, and a review of the radiographs and the medical record. RESULTS: At a mean of thirty-four months (range, twenty-four to fifty months) postoperatively, thirty-six feet (88 percent) were less painful compared with the preoperative status or were pain-free and five of the six parameters that had been used to assess correction of the deformity radiographically had improved significantly (p<0.0001). Eight feet (20 percent) had a non-union at the calcaneocuboid joint, and thirteen feet (32 percent) had anesthesia or paresthesia of the sural nerve. Twenty-nine feet (71 percent) had had additional operations, including removal of hardware from twenty feet; bone-grafting to treat a nonunion at the site of the calcaneocuboid arthrodesis and revision of the internal fixation in four feet; a medial displacement calcaneal osteotomy because of recurrent valgus angulation of the hindfoot in two feet; and a Lapidus procedure because of a hypermobile tarsometatarsal joint with hallux valgus, a triple arthrodesis because of a nonunion at the site of the calcaneocuboid arthrodesis associated with loss of correction, and a dorsiflexion-abduction wedge osteotomy through the site of the calcaneocuboid arthrodesis (which had healed) for alignment of an overcorrected foot in one foot each. The outcomes of the procedures in thirty-five feet (85 percent) were rated by the patients as satisfactory, and thirty-three (92 percent) of the thirty-six patients (thirty-eight [93 percent] of the forty-one feet) stated that they would have the procedure again if the circumstances were similar. CONCLUSIONS: Despite the high prevalence of postoperative complications, most of our patients were satisfied with the result of the procedure after the short duration of follow-up. We believe that the relief of pain and the restoration of function achieved through effective correction of the severe pes planovalgus deformity account for the satisfactory outcomes in our patients.

Adult↗
PubMed2004

Primary Souter-Strathclyde total elbow prosthesis in rheumatoid arthritis.

BACKGROUND: Total elbow arthroplasty is a well-established treatment for the painful elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total elbow prosthesis. METHODS: Between June 1982 and December 2000, 204 primary total elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter. RESULTS: Six of the 204 elbows had pain at rest at the time of the latest follow-up. Ten patients (ten elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four elbows had revision of the total elbow prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the prosthesis (one). One prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years. CONCLUSIONS: Total elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total elbow prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concern. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Activities of Daily Living↗
PubMed2004

A 12-week structured education and exercise program improved climacteric symptoms in middle-aged women.

In the present study, 40- to 60-year-old women with climacteric symptoms were placed on a 12-week structured education and exercise program to ascertain the effects of this program on climacteric symptoms, quality of life (QOL), and attitude towards exercise. A total of 35 women served as subjects. Twenty women were enrolled in an educational and exercise program that involved learning about menopause and participating in physical activity at least three times a week (Group E). For comparison, the other 15 women did not participate in this program and were instructed to refrain from exercising during study period (Group C). The effects of the 12-week interventional program on climacteric symptoms, QOL, and attitude towards exercise were thereby investigated. The program demonstrated significant effects on climacteric symptoms in terms of Kupperman index and psychosomatic symptoms, especially paresthesia and nervousness. In other words, climacteric symptoms improved significantly in Group E. Furthermore, scores for QOL and attitude towards exercise improved in Group E after the 12-week program; however, these trends did not reach statistical significance. Hence, the 12-week structured education and exercise program was shown to be effective in alleviating climacteric symptoms.

Adult↗
PubMed2000

Parietal cheiro-oral syndrome.

Cheiro-oral syndrome due to a parietal lesion has been reported in conjuction with a brain tumor, infarction and migraine. Only six reports of cheiro-oral syndrome due to a parietal infarction have been reported to date. We treated a 45-year-old woman with cheiro-oral syndrome due to a parietal infarction. Her sensory disturbance was characterized by paresthesia in the lower face and hand on the left side, and severe involvement of stereognosis and graphesthesia in the left hand. The pathogenesis of parietal cheiro-oral syndrome is discussed.

Cerebral Infarction↗