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At least 109 records · Page 6Linked to original sources
PubMed1992

[An adult case of transverse myelitis with erythema infectiosum].

We reported an adult case of transverse myelitis with erythema infectiosum. A 33-year-old female was admitted to Kyoto University Hospital because of a weakness in the lower extremities and "cloth-wearing" sensation of the trunk and legs. One month before admission, she became febrile and developed a symmetrical erythema on the extremities. At the same time she noticed a slight weakness of the legs and numbness in her fingers and toes, which disappeared next few days. A week later, she again developed a fever, severe weakness of the legs and "cloth-wearing" sensation on the trunk, and erythema appeared on the cheek. Physical examination on admission revealed a weakness and hyperreflexia in the extremities, in particular, knee and ankle jerk, and hypesthesia of the trunk and legs below the level of Th6. Cerebrospinal fluid (CSF) examination revealed 181/mm3 cells (mononuclear cell dominant) and 30 mg/dl protein. Magnetic resonance imaging, CT and electrophysiological studies indicated no abnormalities. IgM antibody against human parvovirus (B19) was detected in the serum and CSF. She was diagnosed as transverse myelitis with parvovirus infection and was medicated with prednisolone 40-60 mg/day, and improved gradually with the residua of a mild weakness of the legs and hypesthesia on the trunk between the level of Th6 and Th10.

Adult↗
PubMed1992

[A case of rheumatoid arthritis complicated with pseudotumor around odontoid process successfully treated by methotrexate].

A 69-year-old-female with a history of rheumatoid arthritis since 1975 had suffered from dysesthesia of extremities since October 1989. Radiating pain and weakness occurred when she tried to stand up on Dec. 25 in 1989. She was admitted to our hospital in October 1990. Physical examination showed emaciation, hypesthesia of extremities, hypesthesia over the right chest and back, impaired vibration and position sense, and hyperreflexia. Laboratory findings revealed that the erythrocyte sedimentation rate was elevated to 46mm/hr, rheumatoid factor (RF) to 83.1IU/ml and CRP to 3.7mg/dl. Her blood sugar was high and she was diagnosed as having diabetes mellitus. Cervical X ray film showed atlanto-axial subluxation. A pseudotumor around the odontoid process bulging into the spinal canal and compression of the upper cervical cord was observed by MRI. In spite of administration of bucillamine (100mg/day), the size of pseudotumor did not change. Methotrexate (MTX) at a dose of 5mg/week was started in February 1991 and the pseudotumor decreased in size with a concurrent reduction of ESR, RF and CRP. However, the high intensity lesion by T2 weighed image did not change and dysesthesia persisted. The pseudotumor was thought to be due to pannus and it was revealed that MTX was effective for reduction. The persistent dysesthesia was probably due to the degeneration of the upper cervical cord, although diabetic neuropathy may also have played a role.

Aged↗
PubMed1989

[Two patients with cervical diastematomyelia].

Two patients with cervical diastematomyelia are reported here. A nineteen year-old-man (patient 1) admitted to our hospital because of muscular weakness of right upper limb. He noted muscular atrophy of right upper limb at 16 years old, and then paresthesia was gradually aggravated in the ulnar side of the right hand. Physical examination showed muscular atrophy of right upper limb and hypesthesia in the right eight cervical and first thoracic dermatomes. The deep tendon reflexes were decreased in the right upper limb and were increased in the lower limb without pathological reflexes. In electromyographic examination, neurogenic motor units were observed in the upper right limb, dominantly in 1st interosseous muscle (between the fourth cervical and the first thoracic dermatome). Metrizamide computed tomographic (CT) myelography revealed sagittal splitting of the spinal cord from the third to the sixth cervical vertebra, producing two asymmetrical hemicords. A osseous or fibrous septum were not seen. The right hemicord was smaller than the left one. Patient 2 was a twenty-four-year-old woman. She visited our hospital because of muscular weakness of the right upper limb. In physical examination, there were the muscular atrophy of right hand and hypesthesia in the right eighth and first thoracic dermatomes. The deep tendon reflexes were decreased in the right upper limb and were increased in the right lower limb without pathological reflexes. The EMG studies revealed the neurogenic NMU in the right upper limb (between the fourth cervical and the first thoracic dermatome). Magnetic resonance imaging showed marked narrowing of the dural sac in flexion of the neck.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Spinal epidural meningioma--a case report with special reference to neuroradiological findings].

Spinal meningiomas are common as intradural-extramedullary neoplasm, but solitaly epidural spinal meningiomas are extremely rare. They may often be misdiagnosed as malignant neoplasms which are much more common in this location. Furthermore, at the time of operation, it is often difficult to distinguish the epidural meningioma from malignant tumors, even by the microscopic examination of the fresh frozen section. We present a case of spinal epidural meningioma, and emphasize the importance of preoperative neuroradiological examinations. A 26-year-old woman was referred to us from a neurologist of another hospital under the diagnosis of thoracic spinal tumor. She noticed sensory numbness in the lower extremities and thermal hypesthesia below the breasts about one year previously, and progressive gait disturbance about half a year prior to admission. Neurological examination revealed spastic paraparesis with hypesthesia of all modalities below T3. Plain films of the thoracic spine showed scalloping of the posterior margine of the T3 vertebral body. Metrizamide myelography showed a complete block at T3/4, and metrizamide CT revealed marked dural compression by an epidural mass which occupied the left side of the spinal canal from T2 to T4. The subarachnoid space all around the spinal cord was preserved comparatively well. The tumor was homogeneously enhanced by intravenous contrast enhanced CT scan, and the extracanalicular extension was not revealed. MRI [SE (400/25)] showed an iso-intensity signal tumor. Neither extracanalicular nor intrathecal extension of the tumor was showed. In addition to the possibility of the malignant tumors, we considered the possibility of spinal epidural meningioma. At operation, of highly vascularized, moderately firm epidural tumor was found invading the surrounding epidural fat.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Inhibition by sedatives of compensatory vasoconstriction during lumbar epidural anesthesia].

Compensatory vasoconstriction in an upper extremity during lumbar epidural anesthesia contributes to the stability of hemodynamics. We measured blood flow of an index fingertip (FBF) with laser-Doppler flowmetry, surface temperature of a middle fingertip (FT), deep body temperature of the forehead (HDT) and a big toe (BDT) by an insulated thermistor probe of zero thermal flow between skin and subcutaneous tissue, and mean arterial pressure (MAP) in 16 patients undergoing elective lower abdominal surgery under lumbar epidural anesthesia. Epidural puncture was done at L1-2 (n = 2), L2-3 (n = 8) or L3-4 (n = 6), and the initial dose of 13 +/- 1 ml (mean +/- SD) of 2% plain mepivacaine (n = 14) or 2% plain lidocaine (n = 2) was injected five minutes after the test dose of 3 ml. Five minutes after the initial injection, the hypesthesia region of cold sensation examined by alcohol absorbent cotton was T9 +/- 3 (range, T2-T12) at the upper limit and S2 +/- 2 (range, L2-S3) at the lower limit. After determination of the hypesthesia region, a combination of butorphanol 1.0 +/- 0.1 mg and midazolam 2.0 +/- 0.9 mg or diazepam 7.5 +/- 2.5 mg alone was administered intravenously. The difference between HDT and BDT decreased significantly from 6.4 degrees C (P < 0.01) at the time of test dose injection to 0.4 degrees C (P < 0.001) 20 minutes after the initial dose injection of local anesthetics. FBF showed a twofold significant increase (P < 0.01) 20 minutes after the initial dose injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Congenital extradural cyst causing a 30-year history of myelopathy with long-term remission].

We reported a peculiar case of a patient with a thoracic extradural cyst, who had a 30-year history of thoracic-myelopathy with a very long-term remission. A 42-year-old male was admitted to our hospital complaining of gait disturbance and hypesthesia of his bilateral lower limbs. Neurological examination revealed that he had spastic paraparesis and hypesthesia of all sensory modalities below Th11/12 dermatomes. Investigation of his past history disclosed that he had experienced gait disturbance due to paraplegia 29 years previously and had been able to move only with the aid of wheel-chairs. However these signs had resolved themselves gradually in a period of 3 years, and after that he had been able to live almost without any neurological handicaps until the recent appearance of weakness in both of his legs. Neuroradiological study revealed that plain X-Ps of the thoracic spine showed thinning of the pedicles and widening of the interpedicular distances between Th4-Th7 vertebrae. The old iodine contrast media injected 29 years previously for myelography in an other hospital was also observed. MRI showed a dorsal cystic mass compressing the thoracic spinal cord and subarachnoid space. Myelography showed also that the spinal cord and subarachnoid space were compressed anteriorly between the level of Th3 to Th7 by the dorsal mass. CT myelography disclosed that soon after the injection of contrast media a small part of the cyst was visualized as having direct communication with the subarachnoid space. The contrast media penetrated the major part of the cyst only 19 hours after its injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Multiple meningiomas of thoracic spinal cord: report of two cases].

Multiple spinal meningiomas are relatively rare and account for from only 2 to 3.5% of all spinal meningiomas. Two cases of multiple meningiomas of the thoracic spinal cord were reported. Case 1. A 73-year-old woman was admitted with a 5 month history of progressive motor weakness and sensory disturbance in the legs bilaterally. Neurological findings on admission revealed paraparesis, hypesthesia and hypalgesia under the Th10 level, hyperreflexia of both legs, and urinary incontinence. Myelography and MRI revealed two intradural extramedullary lesions at the Th7 and Th10 level. Both tumors were removed completely. Histopathological examination showed psammomatous meningiomas. Case 2. A 52-year-old man was admitted with a 2 month history of progressive motor weakness and numbness of both legs. Neurological findings on admission revealed paraparesis, hypesthesia and hypalgesia under the Th10 level, hyperreflexia of both legs, and genitourinary incontinence. Lumbar myelography showed complete block at the Th9 level. MRI showed stenosis of the spinal canal at the Th8/9 level, and a deviation of the spinal cord. MRI with Gd-DTPA showed that the spinal cord was compressed by intradural extramedullary tumors. However, myelography and MRI could not detect the multiplicity of tumors. CT myelography demonstrated three separate tumors from the Th7 to the Th9. Three tumors were totally removed. Histopathologically, they were meningotheliomatous meningiomas. These cases were considered as being multiple meningiomas of the spine. Both patients showed no manifestations of von Recklinghausen's disease. The cause of the multiplicity in these cases was uncertain. Multiple spinal tumor is very difficult to diagnose because of unusual clinical symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Dumbbell cervical neurinomas with subcutaneous extension: report of two cases].

Two cases of dumbbell cervical neurinomas with massive subcutaneous extension were reported. The first case was A 30-year-old woman who was admitted to our hospital because she had been aware of a left lateral cervical subcutaneous mass and was suffering from shoulder dullness. On admission, neurological examination revealed hypesthesia to touch and pain in the segmental area of C4, and hyperreflexia in the left biceps and patellar tendon reflexes. Plain X-ray showed enlargement of the left C3/4 intervertebral foramen. CT scan, post-myelogram CT and MRI demonstrated a dumbbell shaped tumor at the level of C3-4. Angiogram showed an anterior shift of the left vertebral artery (VA) and tumor stain. Temporary occlusion of the left VA by a balloon catheter was performed leaving no neurological deficits. The second case was a 36-year-old woman who had been aware of a left lateral cervical subcutaneous mass. She complained of shoulder pain and finger clumsiness. On admission, neurological examination revealed weakness of the left deltoid muscle, hypesthesia in the segmental area of C3-4 and exaggeration of all deep tendon reflexes in the left-side extremities. Plain X-ray showed enlargement of the C2/3, C3/4 and C4/5 intervertebral foramina. CT scan, post myelogram CT and MRI demonstrated a dumbbell shaped tumor at the level of C2-5. Angiogram showed an anteromedial shift of the left VA and tumor stain. Temporary occlusion test of the left VA by a balloon catheter was performed with negative results. In each case two-stage operations were undertaken with excellent results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Percutaneous retrogasserian glycerol rhizolysis for treatment of trigeminal neuralgia. Technique and results in 191 patients.

Percutaneous retrogasserian glycerol rhizolysis (PRGR) became a diffuse and valuable method for treatment of trigeminal neuralgia, following its introduction by Hakanson in 1981. Its main advantages are: a) mild postoperative facial sensory loss, b) simplification of the technique, c) reduction of costs. Our results in a series of 191 patients treated between September 1983 and September 1990 are reported. The procedure was performed according to Hakanson's method with minor modifications. In 11 cases (5.7%) we failed to pierce the foramen ovale; the procedure was successfully repeated a week or two later. In 17 cases it was impossible to obtain CSF from the needle. Complete relief of pain was achieved in 177 patients (92.7%), in 124 (64.9%) immediately, in 53 (27.8%) within 6 days; the operation was unsuccessful in 14 (7.3%). Postoperative sensory evaluation showed: no sensory loss in 33 cases (17.3%); hypalgesia in 8 (4.2%); mild hypesthesia in 88 cases (46.1%), confined to the affected divisions in 45 (23.6%), exceeding it in 43 (22.5%); moderate hypesthesia in 62 cases (32.4%), restricted to the target divisions in 36 (18.8%), exceeding them in 26 (13.6%). No case of anesthesia occurred. Complications of PRGR were: circum-oral ipsilateral herpetic eruption (herpes simplex type), spontaneously and completely regressing: 63 cases (33%); minor dysesthesia, seldom reported as painful: 33 cases (17.3%); impairment of corneal reflex: 19 cases (9.9%), the first branch being the target of the treatment in 11; regressive masticatory weakness; 11 patients (5.7%); aseptic meningitis, promptly regressed: 2 cases (1.0%). Follow-up ranges from 1 to 7 years (Sept. 1983-Sept. 1990). A recurrence was observed in 44 cases (23%): in 15 patients (7.8%) a partial relapse occurred, well controlled by drug therapy and not requiring further surgical treatment; in 29 cases (15.2%) a new percutaneous procedure was required. The mean time of recurrence was 30.5 months. The recurrence rate in the patients of our series at the end of the follow-up period was 23%. Glycerol produces a weak neurolytic lesion, that generates minor post-operative facial deafferentation; it is the best technique, in our opinion, for treatment of tic douloreux.

Adult↗
PubMed1996

[Late outcome and complications of mandibular compression osteosynthesis with intraoral approach--a 10-year study].

Late results and complications following rigid internal fixation of mandibular fractures-a 10 year survey. From 1984 to 1993 541 fractures of the mandible in 332 patients have been treated by rigid internal fixation with the mandibular compression system (MCS). In 0.8% we saw serious complications like pseudarthrosis or osteomyelitis. In a retrospective study 105 patients with 171 fractures of the mandible could be examined 4.1 years after osteosynthesis. In case of preoperative normesthesia of the inferior alveolar nerve in 74.1% of the fractures nomesthesia was still present, 18.1% of the fractures showed hypesthesia and 4.2% showed complete anesthesia. In case of already preoperatively existent hypesthesia in 81.8% of the fractures normesthesia and in 8.2% hyp- or paresthesia were seen. There were no anesthesias seen in this group. 3.6% of the fractures showed mild occlusal disharmonies.

Adult↗
PubMed1996

[A case of neuroborreliosis with unilateral radiculoneuropathy and elevated serum antibodies for Borrelia garinii and Borrelia afzelii].

A 24-year-old male patient was admitted to our hospital because of dysesthesia and weakness of the right leg. Six weeks before admission he traveled to southern China. A week later he noticed multiple papules with itching on his right leg that were suspected to be insect bites. Four days later numbness of the right leg developed. Then he began to limp because of the leg weakness. Two weeks before admission severe pain in the right leg developed. On admission neurological examination revealed hypesthesia, muscle weakness and atrophy, areflexia, radicular pain and Lasègue sign of the right leg, and patchy hypesthesia of the left leg. The cranial nerves were intact, and meningeal signs were negative. Complete blood counts and serum biochemistry were unremarkable except for eosinophilia and mild elevation of IgE. A test for antinuclear antibody was positive. Cerebrospinal fluid was normal. Nerve conduction study and sural nerve biopsy showed multifocal severe axonopathy. Although antibody for Borrelia burgdorferi sensu stricto was negative, antibodies for B. garinii and for B. afzelii were positive in serum immunoblotting. Neurological symptoms improved after administration of intravenous ceftriaxon following oral doxycycline. In Japan, this is the second case of neuroborreliosis not due to B. burgdorferi sensu stricto. To test antibodies for B.garinii and for B. afzelii is recommended in patients with suspected neuroborreliosis.

Adult↗
PubMed1997

[A case of epidermoid tumor inside the Meckel's cave].

An epidermoid tumor inside the Meckel's cave is rare. The symptoms caused by this tumor include trigeminal neuralgia, facial hypesthesia and paresis of the 3rd, 4th and 6th nerves. A case of epidermoid tumor inside Meckel's cave was presented. A 54-year-old female who had complained of 3rd nerve palsy with right facial hypesthesia since 3 years before was referred to our clinic. Magnetic resonance imaging (MRI) showed the tumor at Meckel's cave. The tumor removal was performed using the orbito-zygomatic approach. To avoid injury of the internal carotid artery and nerves inside the cavernous sinus, removal of the tumor inside the capsule was carried out leaving the capsule. Postoperatively, the tumor removal was confirmed by MRI and improvement of the 3rd and the 5th nerve palsy was obtained three months after surgery. This case suggests that the capsule of the tumor inside the Meckel's cave should be allowed to remain to avoid injury of the adjacent 4th, 5th and 6th nerves and of the internal carotid artery.

Brain Diseases↗
PubMed1998

[Epidural hematoma associated with epidural catheterization in a cirrhotic patient].

We present a case of epidural hematoma in a liver cirrhosis patient with a depressed platelet count but normal prothrombin and activated thromboplastin times. A 60-year-old woman hospitalized with liver cirrhosis was referred to us for low back pain. She suffered the fracture of the body of the 12 th thoracic vertebra in a fall. Her platelet count was below normal ranges, but, other coagulation tests were within normal ranges. We inserted an 18-gauge epidural catheter at Th 12-L1 interspace. Twenty-one days later, paresis and hypesthesia in both legs, and a loss of sphincter function occurred. Magnetic resonance imaging revealed a posteriorly placed hematoma extending from Th 12 to L1. Considering the hemorrhagic tendency and hepatic insufficiency, we did not perform laminectomy. After 4 days, the patient's strength began to recover, and after 7 days paresis and hypesthesia improved. We should avoid performing epidural catheterization to improve chronic pain for a patient with liver cirrhosis if his or her platelet count is below 100,000.mm-3.

Analgesia, Epidural↗
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↗
PubMed2005

Miniplate osteosynthesis of fractures of the edentulous mandible.

This study was performed to analyze treatment of fractures of the edentulous mandible and to discuss this method in relation to the mandibular height at the fracture site. Fifteen fracture sites in 11 patients with an edentulous mandible were retrospectively examined. These fractures were located: nine fractures in the mandibular body, three in the paramedian region, and three in the mandibular angle. Fractures in a mandible measuring more than 10 mm in the vertical height were treated with one miniplate. Fractures in an extremely atrophic mandible with 10 mm or less were treated using one or two miniplates, also using a modified Champy plate with 1.3 mm in thickness. A mandibular fracture with a height of 5 mm was treated with a combination of a microplate on the buccal side and a miniplate on the inferior border of the mandible with additional direct circumferential wiring. Oblique or splitting fractures were treated with direct circumferential wiring or a Herbert screw, at one fracture site each, respectively. Complications, including infection, fibrous union, nonunion and trismus, were not seen. In one patient, hypesthesia of the lower lip was, however, persistent 1 month after surgery. Miniplate osteosynthesis is the less invasive treatment, and it is suitable for fractures of the atrophic edentulous mandible, except for comminuted or defect fractures. To obtain stable fixation in severely atrophic mandibles, we need to consider the use of two miniplates or a combination with microplates.

Aged↗
PubMed1994

The effect of prostaglandin E1.alpha CD on vibratory threshold determined with the SMV-5 vibrometer in patients with diabetic neuropathy.

We studied the effect of prostaglandin E1.alpha CD (PGE1) on diabetic peripheral neuropathy by evaluating subjective symptoms and vibration sensation using a new vibrometer (SMV-5). Patients with diabetic neuropathy (n = 38) were divided into three groups; group A received no drugs (control), group B was treated with 1500 micrograms/day of oral methyl vitamin B12 (VB12) for four weeks, and group C received 1.2 micrograms/kg/day PGE1 intravenously for four weeks. There was a close relationship between symptom scores and vibratory threshold (VT). The effect of PGE1 on subjective symptoms and VT were compared with those in groups A and B. Patients who received PGE1 showed a significant improvement rate in pain and hypesthesia compared to patients in groups A and B, and in numbness compared to group A. During the study period, there was no significant change in VT in groups A and B, whereas VT was significantly improved at styloid process (P < 0.05) and at medial malleolus (P < 0.001) in group C. Our results confirmed that PGE1 significantly improved both subjective symptoms and VT, indicating that PGE1 therapy may be useful in diabetic neuropathy.

Administration, Oral↗
PubMed1988

A retrospective study of untreated orbital blow-out fractures.

A retrospective study of 27 cases of untreated orbital blow-out fractures is presented. These patients were managed non-surgically because they presented with minimal ophthalmologic symptoms, or they sustained other injuries that prevented early repair. Twelve patients returned for follow-up examination and eight were contacted by telephone. In evaluating patients for diplopia, enophthalmos, hypesthesia, and restricted ocular movement, 85% showed complete resolution of symptoms. Based on these findings, surgical intervention is recommended only in those patients who demonstrate residual diplopia in primary gaze and restricted ocular motility that persist after 10 to 14 days, the presence of enophthalmos greater than 2 mm, and gross disruption of the orbital floor as confirmed by CT or tomography.

Adolescent↗
PubMed2005

Delayed ischemic stroke associated with methamphetamine use.

A 19-year-old woman had right occipital infarction 3 months after she had injected methamphetamine. No other possible causes of stroke could be found in this case. Magnetic resonance angiography revealed beading of the right posterior cerebral artery, which suggested vasculitis. Her symptoms were right-sided headache, left superior quadrant hemianopia, and left hypesthesia, which gradually improved without any treatment. Methamphetamine has been known to cause hemorrhagic and ischemic stroke relatively soon after administration. We report here that methamphetamine may also cause chronic cerebral vasculitis and delayed ischemic stroke.

Adult↗