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Compression of the axillary nerve in the quadrangular space is an unusual cause of pain and paresthesia of the upper extremity. In this report, the authors present a patient with a 1-year history of an undiagnosed axillary nerve compression associated with radial sensory neuropathy who improved after surgical decompression of the quadrangular space.
OBJECTIVE: To estimate the risk of developing fibromyalgia (FM) in women with self-reported pain and to estimate the relative risk of a series of variables. METHODS: As part of a population study, 214 women with self-reported pain were interviewed and examined in 1990 and 1995. In 1990, 39 of these women fulfilled the American College of Rheumatology criteria for FM. The other 175 women represented a continuum of pain extent from nonchronic pain to chronic widespread pain, and were assessed as individuals at risk for developing FM. Potential risk factors for FM were registered in 1990 and analyzed by bivariate and multiple statistical methods in the total sample and also in a subgroup of 115 women with limited pain. RESULTS: Forty-three (25%) women developed FM. Having > or = 4 associated symptoms, pain of > or = 6 years' duration, back pain, alternately hard/loose stools, and self-assessed depression were found to be predictors. Pain in the lower arm and a feeling of swelling were more weakly associated. In women with limited pain, pain > or = 6 years' duration, > or = 4 associated symptoms, not feeling refreshed in the morning, and paresthesia were found to be predictors. A weaker association was found with self-assessed depression and a lack of formal education. CONCLUSION: A high cumulative incidence of FM was found and a diversity of predictors for FM were identified in the total sample and also in women with limited pain. Of the variables that were part of the FM syndrome, back pain predicted FM, while tender points and pain in the neck did not. Moreover, > or = 4 associated symptoms, self-assessed depression, and longlasting pain were shown to be important predictors.
Video-assisted thoracic surgery (VATS) may be used for resection of posterior mediastinal tumors to avoid thoracotomy and shorten hospital stay. Between October 1990 and June 1998, 23 patients had VATS resection of posterior neurogenic tumors. The 14 females and 9 males ranged in age from 14 months to 70 years, with a median of 35 years. Operation time ranged from 30 to 120 minutes (median, 83), and intraoperative complications were limited to minor problems as well as conversion to thoracotomy to enhance complete tumor resection in four cases. Tumor pathology included nerve sheath origin (20) and autonomic ganglia (3). There was only one malignant schwannoma. Tumor size ranged from 0.7 to 13 cm in diameter. Median chest tube days was 1 day (range, 1-4), and hospital stay was 2 days (range, 1-9). Postoperative complications included transient paresthesia (three cases), ileus (two cases), pleural effusion (one case), and transient intercostal pain (one case). Posterior neurogenic tumors may be resected safely using video-assisted techniques. Conversion to thoracotomy to enhance complete resection is both possible and encouraged. The use of VATS seems to decrease hospital stay and minimize postoperative complications. In posterior neurogenic tumors without tumor extension to the spinal canal, VATS has become our preferred method for resection.
This report describes the onset of symptoms of spinal cord compression by tumor after spinal anesthesia. Two patients underwent caesarean section. Postoperatively, they complained of backache and heaviness in the legs. MRI demonstrated spinal tumor and laminectomy was performed in one case. Postoperatively symptoms improved rapidly. In another case, operation was not performed, but the patient recovered gradually. Onset of symptoms of spinal cord compression by tumor after lumbar puncture can be attributed to displacement of the mass or to vascular engorgement. If after the lumbar puncture, a patient complains numbness, loss of strength, and paresthesias in the legs, we should suspect the presence of the spinal tumor.
We report a case of Fabry's disease, diagnosed in a 39-year-old patient treated for 4 years because of glomerulonephritis. The disease manifested itself by the presence of typical petechiae-like skin lesions in the bathing trunk area (angiokeratoma), eye changes, paresthesia, and--in additional investigations--mild proteinuria, lowered creatinine clearance, along with changes in the central nervous system. A biopsy of the kidney revealed the presence of foamy cells in all glomeruli, and in electron microscopy multilamellar bodies (zebra bodies). The diagnose of the disease was confirmed by a marked decrease in leucocyte alpha-galactosidase activity. An early diagnosis of non-inflammatory character of Fabry's disease allows to avoid an unnecessary immunosuppressive treatment.
The neurogenic thoracic outlet syndrome includes the symptoms caused by the compression of the brachial plexus at some point between the interscalene triangle and the inferior border of the axilla. Five patients diagnosed as having neurogenic thoracic outlet syndrome were examined. We determinated clinical and electrophysiological features which lead to thoracic outlet syndrome diagnosis. The clinical features included paresthesia and pain along the inner part of the arm, forearm and hand. Diminished sensation was rare. Muscle weakness was usual and muscle atrophy was associated in severe cases. The association with a lower cervical rib was useful. Electrodiagnostic studies always showed abnormalities. Electromyographic studies showed a reduced recruitment pattern of motor unit activation in intrinsic hand muscles. The medial antebrachial cutaneous nerve action potential amplitude was low. Nerve conduction studies also showed loss of amplitude of the ulnar sensory and median motor responses.
Local anesthetics are the safest and most effective drugs for pain control. Over 300 million local anesthetic cartridges are administered by dentists in the United States of America annually, yet serious complications reported number but a handful. Complications are categorised as localised or systemic. Localised complications arise at the site of needle penetration or anesthetic administration while systemic complications involve the entire organism. Localised complications include needle breakage, paresthesia, trismus, haematoma and facial nerve paralysis, while systemic complications are psychogenic to the act of receiving an injection, allergy and drug overdose (toxic reaction). These potential complications are briefly described in the following paper.
Polyneuropathy is one of the most frequent manifestations in chronic uremia. Among the factors related to polyneuropathy, vitamin B6 deficiency is well known. The exact prevalence of vitamin B6 deficiency related to neurological manifestations has not been previously reported. We studied vitamin B6 status, collected self-reported symptoms, and carried out full neurological examinations in 66 patients on chronic peritoneal dialysis. Vitamin B6 status was estimated by direct measurement of pyridoxal phosphate. In general, symptoms related to vitamin B6 deficiency are peripheral neuropathies, such as paresthesia, burning and painful dysesthesias, and thermal sensations. These symptoms were reported and assigned one of five grade scores. Of our 66 patients, 12 patients complained at least one sensory abnormality. The levels of vitamin B6 in the patients varied between 1.0 ng/mL and 30 ng/mL. Patients who complained of neurological symptoms owing to vitamin B6 deficiency were significantly older than the other patients. In analyzing the symptomatic cases before and after vitamin B6 supplementation, a significant correlation was seen between the level of vitamin B6 and symptoms. Within one month after initiation of oral vitamin B6 supplementations (30 mg daily), levels of pyridoxal phosphate rose, and sensory abnormalities improved in 8 of 12 patients. When peripheral neuropathy is suspected in elderly patients on chronic peritoneal dialysis, vitamin B6 deficiency should be taken into consideration as the cause. If vitamin B6 deficiency is appropriately treated by oral supplementation, sensory abnormalities can be eliminated.
Ankle dislocation without fracture is an extremely rare injury. The results of treatment are reported for three patients who had a posteromedial open dislocation, a lateral open dislocation, and a posterior closed dislocation of the ankle. Management consisted of immediate reduction, debridement and capsular suture in the open dislocations, and immobilization with a short leg cast in all patients. At followup no patient had tibiotalar joint instability; a 10 degrees to 15 degrees loss in the range of dorsiflexion was observed in two patients. One patient reported paresthesia in the area of the superficial peroneal nerve. The three patients achieved good long-term functional and radiographic results. Predisposing factors that contribute to the pathogenesis of this lesion are internal malleolus hypoplasia, ligamentous laxity, weakness of the peroneal muscles, and previous ankle sprains. Among the three patients, medial malleolus hypoplasia was present in one patient and previous sprains were seen in the clinical history of another patient.
Lesion of cranial nerves due to vascular damage at pontine level generally associates affectation of near nerve tracts. Isolated fifth nerve palsy due to vascular pontine lesions has been scarcely reported. We present a hypertense 57 year old woman who suffered from sudden paresthesias and hypoesthesia on the three divisions of trigeminal nerve without motor involvement and with preservation of corneal and masseter reflexes. Cranial magnetic resonance showed small dorsolateral pontine infarct over the right fifth cranial nerve entry. Isolated sensitive trigeminal neuropathy is a rare debut form of pontine infarct.
Pseudohypoparathyroidism (PHP) is characterized by unresponsiveness of target tissues to the biological actions of the parathyroid hormone (PTH), with resulting hypocalcemia and hyperphosphatemia, despite the elevated serum levels of PTH. PHP is divided into types Ia, b, c and II, depending on the presence of Albright's hereditary osteodystrophy (AHO), defective urinary excretion of phosphate (U-P) and response in urinary excretion of cyclic adenosine monophosphate (U-cAMP) after the administration of exogenous PTH. Patients with PHP might exhibit various manifestations of neuropsychic disturbances. We present two boys, aged 14 and 16 years, both with paresthesia, anxiety and epilepsy; the former patient also suffered from mild mental retardation. In both patients, hypocalcemia and hyperphosphatemia together with increased serum levels of PTH suggested the diagnosis of PHP. After administration of exogenous PTH (Ellsworth-Howard test), there was a drop in U-P in both patients, while U-cAMP was decreased in the first patient and increased in the second one, thus confirming the diagnoses of PHP Ia and II, respectively. Neuropsychic disturbances and epilepsy resolved completely in both patients after treatment with calcium and dihydrotachysterol. Evaluation of calcemia and phosphatemia should be mandatory in all patients with neuropsychic disorders. Ellsworth-Howard test remains a useful tool in the differential diagnosis of PHP.
An axonal sensory neuropathy is a frequent complication in the course of HIV infection; more than 30% of all HIV-infected individuals will develop a polyneuropathy. Low CD4 cell counts and high HIV RNA loads increase the risk. This neuropathy causes pain, paresthesias and burning sensations and/or numbness in the feet, which sometimes occurs in the hands as well. Neurological examination reveals sensory deficits in a stocking and glove distribution and depressed or absent ankle reflexes, without severe paresis. The cause of the sensory neuropathy is unknown. Either the HIV infection or certain other infections, for example cytomegalovirus, may play a role in the pathogenesis; vasculitis may be a process associated with this. Some antiretroviral drugs within the nucleoside analogue group cause a neuropathy but the pathogenesis of this remains unclear. Amitriptyline, tramadol and carbamazepine can be used for symptomatic treatment. The efficacy of lamotrigine and gabapentin has yet to be confirmed.
The sagittal split ramus osteotomy is probably the most frequently used procedure for correction of mandibular skeletal dento-facial deformities. In the 30 years since the procedure was introduced, a number of complications has been reported: unfavorable fracture during surgery, paresthesia or anesthesia and relapse. The literature seems to be very poor concerning the esthetical and morphological complications of the sagittal split ramus osteotomy; especially when treating Class II dento-facial deformity frequently associated with a genioplasty. The purpose of this study was to determine and analyze the esthetical complications occurring after mandibular surgery in patients with Class II dento-facial deformities: Pre-angular notches, Widening of the bi-angular distance, The unaesthetic effects of the associated genioplasty, Class III like "dento-facial deformities", Plates and screws visibility. Each of those complications has been analyzed to find a preventive treatment.
THE ROLE OF IONIC CHANNEL DYSFUNCTION: During various neurological diseases has been evoked for many years on electro-physiological data. Molecular biology has led to great progress in neurology, and can be considered "functional" since it is surpasses the classical anatomo-clinical methods. IONIC CHANNEL DYSFUNCTION: Can be determined genetically, resulting from the mutation of a gene code of a channel sub-unit. CHANNELOPATHIES ARE RESPONSIBLE: For muscular diseases (myotonia, familial periodic paralysis, malignant hyperthermia and congenital myasthenia), but also for central nervous system disorders such as familial hemiplegic migraine, hereditary paroxystic ataxia and certain forms of Mendel's law hereditary epilepsy. ACQUIRED IONIC CHANNEL DYSFUNCTION: Resulting from auto-immune aggression is implied in diseases such as Lambert-Eaton's myasthenic syndrome and Isaac's neuromyotonia syndrome. It probably plays a part in the clinical, and particularly the sensitive expression (paresthesia and pain) of some peripheral neuropathies and certain central nervous system affections, such as multiple sclerosis.
Cysts of the maxillary sinus of odontogenic origin have been well-documented in the literature. Most of these lesions involve the apex of the offending tooth and appear as a well-defined periapical radiolucency. Presented here is a case of an unusually large lesion, which involved the entire maxillary sinus and extended into the floor of the nose. The lesion also caused paresthesia on the affected side. The lesion was removed with conservative treatment without any postoperative complications.
The thoracic outlet syndrome and the entrapment syndrome involving the popliteal artery are two major examples of arterial compression syndrome. Since not only the arteries, but also the entire neurovascular bundle is compressed, the initial symptoms are often neurological: paresthesias, tingling, numbness, etc., in particular when certain movements are carried out. In such a case, bilateral blood pressure measurements, provocative tests and Doppler (duplex) examination are indicated. A point that is, perhaps, less well-known is the fact that compression can lead to serious vascular lesions ranging from post-stenotic aneurysms to complete thrombotic occlusion and peripheral emboli. When the diagnosis has been confirmed, early surgery is indicated.
A case of delayed injury to the median nerve by glass fragment is described. A median nerve palsy developed 3 years after a minor injury, totally forgotten by patient. A 34-year-old patient presented with a painful progressive median nerve lesion, with a Tinel sign just below elbow. Surgical exploration revealed a glass fragment in close proximity to median nerve. The foreign body was removed. Improvement was noted immediately, but the patient continues to have slight paresthesiae in the fingers 1 year later.
We report the case of a 72-year-old left-handed woman presenting with episodes of paresthesias of the left arm and dysarthria consistent with transient ischemic attacks. The diffusion MRI showed hypersignals of the right corona radiata suggesting recent ischemic process whereas gradient-echo MRI revealed multiple small hypointense regions consistent with petechial hemorrhages restricted to the corticosubcortical regions. Gadolinium-enhanced, T1-weighted MRI showed focal meningeal enhancement. The diagnosis of cerebral amyloid angiopathy was supported by leptomeningeal biopsy. The association of ischemic suffering, petechial haemorrhage and meningeal enhancement as demonstrated by multisequence MRI highly suggest a cerebral amyloid angiopathy.