1/13. Idiopathic spinal cord herniation associated with a large erosive bone defect: a case report and review of the literature.We report a case of idiopathic spinal cord herniation associated with a large bone defect. MRI and computed tomographic myelography revealed ventral deviation of the spinal cord and erosion of the vertebral body at T6-T7. Microscopic surgery revealed a dural defect. The etiology of this condition has not been clarified. In most previously reported cases, the peak portion of the herniation was around the intervertebral disc space. In addition, in our patient, it was hard to think that the intervertebral disc has become depressed due to the pressure exerted by the spinal cord. We considered that a certain condition of the intervertebral disc, such as herniation, was one of the causes of the dural defect, and cerebrospinal fluid pulsation pushed the spinal cord toward that portion, causing herniation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/13. Bilateral lower limb hypoesthesia after radical prostatectomy in the hyperlordotic position under general anesthesia.PURPOSE: To report a case of postoperative bilateral lower limb hypoesthesia occurring after surgery under general anesthesia in the hyperlordotic position for radical prostatectomy. The possible pathophysiologic mechanisms are discussed. Clinical features: This 52-yr-old patient was slightly overweight and was on fenofibrate for hypercholesterolemia. He had no history of cardiovascular disease. Arterial blood pressure was overall well maintained except for a very transient hypotension at surgical incision. Blood loss was moderate and did not require transfusion. Soon after recovery, the patient complained of paresthesia in both legs and neurological examination revealed bilateral lower limb hypoesthesia, compatible with an incomplete medullar syndrome at the level of T12-L1. On postoperative day one, a plain magnetic resonance imaging scan demonstrated a hyperintense signal in the spinal cord from T8 to T9 on T2-weighted images consistent with ischemia of the spinal cord whereas the heterogeneous aspect of the spinal cord was due to an unusually high fat content of the epidural space. Neurological signs improved progressively and one week later the patient had recovered normal sensory functions of both lower limbs. CONCLUSION: Although arterial ischemia is the most common cause of postoperative spinal cord injury, other mechanisms may be invoked. We raise the possibility that a combination of intraoperative risk factors (hypotension, excessive postural changes) with anatomic predispositions (increased epidural venous pressure or fat content, previous bone disease) can produce arterial and/or venous ischemia of the spinal cord.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/13. Bilateral corneal anesthesia associated with diaphragmatic paralysis, ovarian failure, and developmental delay.PURPOSE: To describe two siblings with bilateral corneal anesthesia associated with multiple systemic abnormalities. DESIGN: Interventional case report. methods: A 38-year-old Hispanic woman was seen for bilateral corneal ulcers, exposure keratitis, hemorrhagic retinopathy, and multiple systemic abnormalities. A younger sibling with similar but milder findings was also examined. Medical and genetic evaluation was investigated in these two siblings with bilateral decreased sensation and multiple abnormalities from a consanguineous union. RESULTS: Examination of the patient showed bilateral corneal anesthesia, and multiple systemic abnormalities included diaphragmatic paralysis, ovarian failure, multiple thrombotic cerebrovascular accidents, pedal edema, mandibular hypoplasia, and developmental delay. Milder findings were seen in a sibling. Corneal ulcers were stabilized after treatment that included bandage contact lens, pressure patching, topical antibiotics, and tarsorrhaphy. CONCLUSIONS: The combination of corneal anesthesia and systemic abnormalities, with parental consanguinity, suggests an inherited syndrome.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/13. Chiari I malformation with or without syringomyelia and pregnancy: case studies and review of the literature.women with Chiari I malformation with or without syringomyelia are of particular concern because of the potential risk of increased intracranial pressure during pregnancy and delivery. The following questions are most often asked in the clinical setting: Is it safe to have a planned pregnancy? Will the symptoms become worse or recur during pregnancy and will the baby be normal? Seven patients with Chiari I malformation, with and without syringomyelia, submitted checklists of self-reported symptoms experienced during pregnancy, labor, and postpartum. Seven patients with Chiari I malformation with and without syringomyelia were queried for symptoms during pregnancy, labor, and postpartum. None of the patients reported significant increase or recurrence of Chiari-related symptoms during delivery or postpartum. Four of the women had epidural anesthesia for delivery and reported no related symptoms. This series represents a small number of women with Chiari I malformation who had uncomplicated pregnancy, labor, and delivery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/13. femoral neuropathy associated with anticoagulant therapy.The English literature concerning femoral neuropathy associated with anticoagulant therapy is reviewed. Anatomical dissections were carried out in order to determine how the neuropathy might be produced. It is postulated that hemorrhage occurs within the iliacus muscle and that a pressure neuropathy of the femoral nerve ensues. Conservative management is recommended. The condition is probably more prevalent than previously thought, as evidenced by the fact that two cases were diagnosed in as many years by one orthopedic surgeon in a 300-bed general hospital.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/13. Initial agonist burst duration changes with movement amplitude in a deafferented patient.Changes in the duration of the initial agonist burst were studied in a deafferented human. The patient had been functionally deafferented for five years, having no touch, vibration, pressure or kinesthetic sensation nor any tendon reflexes in the four limbs. pain and temperature sensation were intact and motor fibres were unaffected. The subject made visually guided step-tracking movements using flexion/extension movements about the elbow. Initial agonist burst duration increased with movement amplitude. Burst duration was approximately 65 ms in small movements (6-12 deg) increasing to 136 ms in intermediate (36 deg) and 200 ms in large (54 and 60 deg) movements. Similar changes in initial burst duration with movement amplitude were seen when the subject made non-visually guided movements. It is concluded that the duration of the initial agonist burst is centrally determined.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/13. compartment syndromes of the forearm: early recognition using tissue pressure measurements.A compartment syndrome of the forearm can be a devastating injury if not relieved promptly by early fasciotomy. Of five patients who developed compartment syndromes, compartment pressures were measured in four and found to average 69 mm Hg. Tissue pressure measurements provided early objective evidence of the presence of the compartment syndrome and contributed significantly to the ultimate functional recovery. We would advise repeating the measurement for pressures in excess of 30 mm Hg in the upper extremity, and fasciotomy for pressures in excess of 40 mm Hg when accompanied by any neurovascular compromise.- - - - - - - - - - ranking = 8keywords = pressure (Clic here for more details about this article) |
8/13. Electrophysiological findings in pressure palsy of the brachial plexus.Two patients with signs and symptoms of paralysis of the brachial plexus, caused by compression during surgery in one (case 1) and by a knapsack in the other (case 2), were examined. The characteristic electrophysiological findings were: (i) severe attenuation of amplitude of motor and sensory nerve action potentials evoked or recorded above the site of nerve injury compared to those evoked or recorded below, and (ii) slowing of motor and sensory conduction across the damaged area. Case 1 made a complete recovery clinically and electrophysiologically; EMG in case 2 suggested the presence of wallerian degeneration. The palsies were classified as a local demyelinating block alone (case 1) or combined with axonal loss (case 2).- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
9/13. methods of providing sensation to anesthetic areas.Loss of sensation in body areas subject to pressure, shearing forces, or changes in temperature can lead to pressure ulcers, necrosis, local infection, systemic sepsis and further tissue destruction. In the 6 cases reported here, sensation was restored to soft-tissue coverage to improve function and allow sustained healing. The musculocutaneous flap is very effective in wound closure in paraplegics and in patients with traumatic injury and extensive tissue loss.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
10/13. Neurologic symptoms after epidural anaesthesia. Report of three cases.We describe 3 patients, who exhibited neurological symptoms after single dose epidural anaesthesia. In patient 1 an unrecognized spinal arteriovenous fistula (AVF) caused paraparesis following epidural block. The dilated veins draining an AVF are space-occupying structures and the injection of the anaesthetic solution may have precipitated latent ischaemic hypoxia of the spinal cord due to raised venous pressure. In patient 2, epidural block was followed by postoperative permanent saddle pain and hypoaesthesia. The injection of the anaesthetic in a narrow spinal canal with multiple discal protrusions and restriction of interlaminar foramina may have acutely produced mechanical compression of the spinal cord or roots. Patient 3 exhibited post-epidural block spinal arachnoiditis. Although the few reported cases of this syndrome exhibit severe neurological damage, our patient presented with scarse symptoms. Our cases point out the importance of accurate neurological history and examination of candidates for epidural anaesthesia and of accurate anaesthetic history for neurological patients.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
| | Next -> |