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PubMed1986

Median palmar digital neuropathy in a cheerleader.

Median palmar digital neuropathy developed in a 16-year-old girl as a result of chronic trauma to the palm during cheerleading activities. The clinical findings on examination, which included paresthesias in the distribution of a palmar digital nerve and exacerbation of symptoms with compression of the palm, were consistent with this diagnosis. Nerve conduction studies documented a lesion of the median palmar digital nerve. Avoidance of cheerleading activities resulted in nearly total resolution of the symptoms. Awareness of this entity and the value of nerve conduction studies in establishing the diagnosis may avoid confusion and facilitate correct diagnosis and management.

Adolescent↗
PubMed1985

Sweethearts' syndrome: purpura of a pleasant nature.

A common and a less common form of purpura seen in lovers are briefly reviewed. The diagnosis and course of a newly described syndrome of axillary purpura and paresthesia of the upper extremity in sweethearts is also discussed.

Adult↗
PubMed1977

'Burning hands' in football spinal cord injuries.

Central spinal cord injury in two high school football players caused only complaints of burning paresthesias and dysesthesias in the hands at the time of injury. Strength was affected only in the upper extremities where it was slightly reduced. Failure to recognize the relationship of "burning hands" as a symptom of cord injury can result in injudicious management of unstable cervical fracture dislocations with disastrous consequences.

Acute Disease↗
PubMed1966

Rheumatoid arthritis--atlanto-axial subluxation and its clinical presentation.

The clinical picture, radiological findings and treatment of 22 patients with atlantoaxial subluxation and rheumatoid arthritis are described. This lesion, untreated, may result in damage to the spinal cord, paresis or sudden death. Occipital headache, present in 13 of 22 patients, was often aggravated by working with the head in forward flexion. Paresthesias were present in six patients. The spine of the axis was often prominent. In three patients there was objective evidence of cord compression with sensory and/or pyramidal signs. In eight the lesion was asymptomatic and discovered by routine lateral radiography in flexion, the position of maximum subluxation.Conservative treatment involved the continuous use of a cervical collar to limit neck flexion. This usually relieved subjective symptoms including headaches. Successful surgical fixation was performed in two individuals. Surgical indications included acute or chronic cord compression or severe symptoms unrelieved by a collar.

Adult↗
PubMed1984

Hypersensitivity reaction to sulindac (Clinoril).

Sulindac (Clinoril), a nonsteroidal anti-inflammatory agent, has few reported neurologic toxic effects, all of which have been associated with systemic disease. To our knowledge, we describe the first reported case of isolated paresthesia and peripheral neuropathy, without systemic involvement, secondary to sulindac administration. A healthy, 30-year-old man, exposed to sulindac on two separate occasions, had an incapacitating isolated idential sensory neuropathy. The onset and duration of symptoms correlated directly to drug ingestion. This hypersensitivity response cannot be explained pathophysiologically by any mechanism. Repeated exposure and rechallenge of the subject to sulindac was deemed too dangerous, and precludes exact method to establish mechanisms to explain this transient, reproducible, idiosyncratic, adverse drug reaction.

Adult↗
PubMed1980

Peripheral neuropathy after cis-platinum (II) (DDP) therapy.

A 56-year-old man developed a malignant fibrous histiocytoma in the left antecubital space in THE LEFT ANTECUBITAL SPACE IN September 1974. He underwent local resection, local radiation therapy, and chemotherapy with Adriamycin and Levamisole with resolution of the disease. In January 1977, a recurrent mass developed in the left antecubital space and electrophysiologic studies revealed segmental demyelination of the left median nerve across the tumor site. In July 1977, a Cis-diamminedichloplatinum (II) (DDP) therapy was instituted and 5 months later the patient developed paresthesias in both hands and both feet. Repeat nerve conduction studies revealed abnormalities in all 4 extremities consistent with a mixed sensorimotor peripheral neuropathy. Serial studies at 2-month intervals during DDP therapy showed further deterioration in nerve conduction. Following completion of DDP therapy, the patient's symptoms improved and subsequent nerve conduction studies done over an 11-month period showed improvement in nerve conduction with values approaching normal.

Cisplatin↗
PubMed1984

Mechanical injury of peripheral nerves. Fine structure and dysfunction.

In summary we have examined the morphology of the normal peripheral nerve, presented the types of mechanical nerve injury and associated histopathology, and discussed possible mechanisms responsible for symptoms of pain, paresthesiae, and weakness associated with these lesions. Neurapraxia consists of intussusception of axon and myelin through the nodes of Ranvier resulting in prolonged nerve conduction block. Axonotmesis and neurotmesis describe more severe disruptions of nerve fiber architecture, are difficult to distinguish electrophysiologically, and have poorer prognoses for functional regenerative repair. Chronic entrapment lesions consist of telescoping myelin internodes and tapering of the sheaths with bulbous polarization of internodes away from the site of injury. Both acute and chronic lesions chiefly involve large myelinated fibers and both may create neuralgia, although the mechanism by which this occurs is poorly understood. Presently, increasing evidence suggests ectopic impulse generators and ephaptic transmission may be responsible for sensorimotor phenomena in these lesions.

Humans↗
PubMed1984

[Mental neuropathy].

Twelve cases of mental nerve neuropathy observed over a 20-month period are reported. Although benign in appearance, the condition frequently is of somber significance being most often, and sometimes initially, associated with malignant diseases. Cancer, and in particular breast cancer, is the most common cause, but malignant blood diseases may also be responsible. Metastatic lesions of the mandible and/or the mental nerve most probably explain why paresthesia and pain in the chin are relieved by local radiotherapy, combined or not with chemotherapy.

Adolescent↗
PubMedDate not supplied

Containing the cost of third-molar extractions: a dilemma for health insurance.

No known scientific studies support the extraction of third molars (wisdom teeth) to prevent future disease. Yet, third-molar surgery for this purpose has become so common that in at least one major U.S. health insurance plan, the cumulative cost exceeds that for every other kind of major surgery. Many third molars that are developing normally in adolescents are classified as impacted and removed before they erupt, a practice that results in large expenditures for unnecessary surgery. In addition, the difficulty of the extractions is frequently exaggerated, so that patients and insurance plans are overcharged. Third molar surgery is not without risk of iatrogenic injury. Fracture of the jaw, permanent numbness of the lip (paresthesia), and injury to other teeth may occur. This paper presents a mechanism for containing the cost of third-molar surgery by elimination of payment for nonessential extractions and of the related overcharges. Adoption of this policy by administrators of dental insurance plans would save millions of dollars each year, money that could be better used in providing care for more people with real dental disease.

Adolescent↗
PubMed1983

The incidence of prepatellar neuropathy following medial meniscectomy.

The frequency of lasting prepatellar dysesthesia following medial meniscectomy has been under-estimated. Analysis of 87 patients undergoing medial meniscectomy in a prospective study with a minimum follow-up period of six months showed dysesthesia in 63.2% immediately after operation. The condition persisted in 44.4% at six months. Female patients had a higher incidence of dysesthesia than male patients and had a slower recovery rate. Numbness had a less favorable prognosis than paresthesia.

Female↗
PubMed1984

Thalidomide neurotoxicity.

Of six patients treated with thalidomide for either prurigo nodularis or discoid lupus erythematosus, four had paresthesias in the hands and feet and one also complained of muscular pain and stiffness. Clinical neurological findings in all four patients were normal. Subsequent electrophysiological examination disclosed a peripheral neuropathy in five of the six patients; two had electrophysiological signs of a polyneuropathy and three of a carpal tunnel syndrome. Symptoms and abnormal electrophysiological findings were still present in one patient one year after the discontinuation of thalidomide therapy. Since reports on thalidomide neurotoxicity have shown that the neurological symptoms are long standing and possibly irreversible, it is obviously important to inform patients of this possible side effect and to evaluate them closely for the symptoms and electrophysiological signs of evolving neurological changes.

Adult↗
PubMed1980

Hypophosphatemia and neurological changes secondary to oral caloric intake: a variant of hyperalimentation syndrome.

Previous reports have described a syndrome of paresthesias, weakness, seizures and hypophosphatemia in patients and animals receiving intravenous hyperalimentation. In this report we describe a group of five patients who developed this syndrome while on oral caloric intake and three patients who received only modest amounts of hyperalimentation therapy. As an experimental corollary, studies were performed in starved and normal dogs with calories infused via an intragastric catheter. The serum inorganic phosphorus (Pi) fell slightly in normal animals from 4.8-2.5 mg. %. In the starved dogs with diarrhea or vomiting the Pi fell gradually from 4.8-1.6. In starved dogs without gastrointestinal symptoms the Pi fell precipitously from 3.7-1.4 mg % on the first day of infusion and remained at that level. Approximately 50% of the starved animals developed the neurological syndrome; none of the normal animals had neurological symptoms.

Adult↗
PubMedDate not supplied

Reversible brachial plexopathy following primary radiation therapy for breast cancer.

Reversible brachial plexopathy has occurred in very low incidence in patients with breast carcinoma treated definitively with radiation therapy. Of 565 patients treated between January 1968 and December 1979 with moderate doses of supervoltage radiation therapy (average axillary dose of 5000 rad in 5 weeks), eight patients (1.4%) developed the characteristic symptoms at a median time of 4.5 months after radiation therapy. This syndrome consists of paresthesias in all patients, with weakness and pain less commonly seen. The symptom complex differs from other previously described brachial plexus syndromes, including paralytic brachial neuritis, radiation-induced injury, and carcinoma. A possible relationship to adjuvant chemotherapy exists, though the etiology is not well-understood. The cases described demonstrate temporal clustering. Resolution is always seen.

Adult↗
PubMed1980

[Gasserian differential thermocoagulation in trigeminal neuralgia: a medium-term follow up (author's transl)].

The results of thermo-coagulation have been evaluated in a series of 50 patients followed up from two to six years (average three years). Neuralgia disappeared in nearly 80 p. 100 of the cases (however this was obtained with a second operation in nine cases). The frequency of recurrences increase with time: 20 p. 100 during the first two years reaching 40 p. 100 after three years. They were more likely to occur if the post-operative sensory deficit is moderate. Complications directly related to the surgical technique were rare: some faded away relatively quickly (oculo-motor palsies less than 1 p. 100, masseter weakness 20 p. 100 in the first weeks). The only residual problems were related to sensory deficits: in general they were limited to a small cutaneous area and total anesthesia was never been observed. Although paresthesias were noted in 12 p. 100 of the cases, these usually were not really troublesome. Our conclusion, therefore, is that differential thermocoagulation appears to be the best surgical treatment for trigeminal neuralgia.

Aged↗
PubMed1982

Metronidazole therapy for perineal Crohn's disease: a follow-up study.

The present study of metronidazole in perineal Crohn's disease includes 26 patients, and is composed of 17 of 21 patients who were previously reported and 9 additional consecutive patients. The course of these patients was evaluated to determine if the drug could be reduced or stopped, whether or not it continued to be effective for prolonged periods, and what long-term side effects were encountered. Dosage reduction was associated with exacerbation of disease activity in all patients, but in all, the perineal manifestations of disease healed promptly when the full dosage of metronidazole was reinstituted. The drug could be successfully discontinued in only 28% of those in whom cessation was attempted; in those patients whose perineal disease worsened with cessation of therapy, rapid healing was achieved if the drug was reintroduced. Sixteen patients received metronidazole for at least 12 mo including 7 for 18-36 mo. Eight of these 16 patients, including 4 on and 4 off the drug, remain healed; the other 8 patients had advanced healing. The only major side effect observed was paresthesias. These occurred in 50% of the patients and developed in the patients at a mean of 6.5 mo after the onset of treatment. They appeared to be dose related and nonprogressive but tended to persist for prolonged periods even after discontinuance of the drug.

Adult↗
PubMed1981

Somatic sensation and discomfort in the arm of post-mastectomy patients.

From a group of 928 randomly allocated women that had undergone mastectomy for cancer, 475 were examined with respect to the somatic sensations and discomfort in the arm on the side of the operation. The women rated psychological variables such as sensations and discomfort according to an 8-degree scale. The variables investigated were: heaviness of the arm and hardness of the arm tissue, tension, weakness and paresthesia. Eighty per cent of the women recorded a rating of 0. For most of the variables the means were thus low and corresponded to a rating of less than 1. The standard deviation was fairly large. In the women with a rating of 1 or more there was a weak but significant correlation between some of the psychological and somatic variables, including volume (positive correlation) and gripping force (negative correlation). Women with 15% oedema or more recorded the highest rating for the variables heaviness, hardness, weakness. The sensation and discomfort were rated significantly higher by the patients with than by those without discomfort or pain in the cervical and thoracic spine, chest and shoulder. The ratings were significantly higher by the women receiving radiotherapy than in those receiving only surgical treatment. There was no significant difference between the ratings for the women given radiotherapy before and those so treated after the operation.

Activities of Daily Living↗
PubMed1981

Phase II trial of methyl-G (methylglyoxal bis-guanylhydrazone) in patients with metastatic renal cell carcinoma.

Fourteen patients with metastatic renal cell carcinoma received methyl-G weekly at a starting dose of 600 mg/m2 (five patients) and 500 mg/m2 (nine patients) intravenously. All 14 patients are evaluable for response and toxicity. No antitumor responses were observed. Six patients achieved stabilization of disease for 8 to 42 weeks. Toxicity was nonhematologic and included nausea or vomiting (35%), fever with shaking chills (28%), diarrhea (21%), myalgia (63%), paresthesia (49%), and bilateral foot drop (7%). Methyl-G does not appear to have activity against renal cell carcinoma.

Adenocarcinoma↗
PubMed1980

[Minor toxic effects of local anaesthetics. 7 cases (author's transl)].

In a study of 7 cases of adverse reactions to local anaesthetics the early symptoms of toxicity (malaise, anxiety, feeling of impending death, peripheral paresthesias and tachycardia) are reviewed. Minor toxic reactions produced by these drugs are common, whereas immediate allergic reactions are rare and even, for some authors, non-existent with lignocaine and derivatives. Biological investigations aimed at demonstrating the "allergic" nature of these reactions are valueless and costly.

Adult↗