1/23. "Pseudo-conduction block" in vasculitic neuropathy.The predominant electrophysiologic feature of vasculitic mononeuropathy multiplex is axonal loss. Electrophysiologic findings interpreted as conduction block have, however, also been reported to occur in neuropathy secondary to necrotizing vasculitis. We report 3 patients with mononeuropathy multiplex and biopsy proven vasculitis in whom eight nerves met criteria for conduction block. In each circumstance, serial study demonstrated conversion of the electrophysiologic findings to those most consistent with severe axonal loss. "Conduction block" in vasculitic mononeuropathy multiplex is secondary to focal axonal conduction failure presumably related to infarctive axonal injury. The term conduction block should be used with caution in this disorder and only if serial studies demonstrate findings consistent with this electrophysiologic diagnosis.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/23. Localized neurological necrotizing vasculitides. Three cases with isolated mononeuritis multiplex.Localized vasculitic neuropathies are increasingly reported. We describe 3 cases of peripheral neuropathy with necrotizing vasculitis confined to nerves and muscles without systemic involvement. These neuropathies were severe and relapsing, in contrast to a usually benign prognosis. Our cases appear to be isolated vasculitic neuropathies, with vasculitis strictly limited to the peripheral neuromuscular system without nonspecific clinical and/or biological systemic involvement.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/23. Sensory perineuritis presented as a mononeuritis multiplex associated with livedo vasculitis.We report a 52-year-old patient affected by a mononeuritis multiplex and livedo vasculitis. sural nerve biopsy showed mild thickening of the perineurium, vascular alterations with inflammatory cell infiltration in the perineurium, and remarkable loss of large and small myelinated fibers. A therapeutic trial of acetylsalicylic acid, danazol, and dipyridamole controlled the skin lesion without improvement of nerve conduction studies.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
4/23. Peroneal mononeuropathy in pediatric Hodgkin's disease.A 12-year-old boy with Hodgkin's disease developed left peroneal nerve palsy during combination therapy with chemotherapy and low-dose irradiation. The palsy occurred twice; around 1-2 weeks after the second administration of vincristine in the second and third COPP (cyclophosphamide, vincristine, prednisolone, and procarbazine) regimens. Without any treatment, the peroneal neuropathy completely resolved clinically three months and electromyographically six months after the onset. He used to play television games for more than 6 hours a day with the legs crossed while sitting on the bedside. Compared to adult patients, little is known about the relationship between peroneal neuropathy and systemic malignant diseases in pediatric patients. This case shows for the first time that habitual leg crossing during potentially neurotoxic chemotherapy could induce peroneal mononeuropathy in a pediatric cancer patient.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
5/23. Intraneural nerve metastasis with multiple mononeuropathies.Although cancer is a frequent condition, neoplastic involvement of the peripheral nervous system is rare. The mechanisms are heterogeneous and include lesions within the cerebrospinal fluid (CSF) space, local invasion (e.g. brachial plexus), compression, rarely direct infiltration, perineurial spread and even rarer intranerval metastasis. A 47-year-old woman had been treated for a carcinoid 10 years earlier and had received axillar irradiation. At presentation she suffered from weakness of the biceps brachii and was experiencing pain radiating from the axilla into the forearm and thumb. MR scans of the brachial plexus were negative and her symptoms were primarily considered to stem from a postradiation brachial plexopathy, Because of increasing pain, the brachial plexus was explored and a metastasis in the left musculocutaneous nerve was resected. Several months later, numbness and pain appeared in the ulnar nerve and another intrafascicular metastasis in the ulnar nerve was discovered. Resection with preservation of remaining fascicles was performed. This rare case report demonstrates that multiple mononeuropathies, resembling multiplex neuropathy, may be caused by intranerval metastasis.- - - - - - - - - - ranking = 7keywords = nerve (Clic here for more details about this article) |
6/23. gasoline sniffing multifocal neuropathy.The polyneuropathy caused by chronic gasoline inhalation is reported to be a gradually progressive, symmetric, sensorimotor polyneuropathy. We report unleaded gasoline sniffing by a female 14 years of age that precipitated peripheral neuropathy. In contrast with the previously reported presentation of peripheral neuropathy in gasoline inhalation, our patient developed multiple mononeuropathies superimposed on a background of sensorimotor polyneuropathy. The patient illustrates that gasoline sniffing neuropathy may present with acute multiple mononeuropathies resembling mononeuritis multiplex, possibly related to increased peripheral nerve susceptibility to pressure in the setting of neurotoxic components of gasoline. The presence of tetraethyl lead, which is no longer present in modern gasoline mixtures, is apparently not a necessary factor in the development of gasoline sniffer's neuropathy.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/23. Idiopathic bilateral diaphragmatic paralysis.A 41-year-old man complained of subacute onset of dyspnea and pain in the neck and chest. He was diagnosed with bilateral diaphragmatic paralysis, based on clinical inspection of the breathing pattern and transdiaphragmatic pressure recording, and was trained to use a portable bi-level positive airway pressure apparatus (BiPAP). Needle electromyography showed profuse fibrillation potentials and positive waves in the diaphragm, more abundant on the right than left side, and no response to phrenic nerve stimulation. Other muscles were not involved. Follow-up examinations, performed at 9 and 12 months after onset of paralysis, demonstrated a slow but progressive improvement of the patient's respiratory function, together with the appearance of reinnervation potentials in the diaphragm, and polyphasic, long-latency responses to phrenic nerve stimulation. The subacute onset of the paralysis associated with local pain, and its subsequent recovery, suggest bilateral proximal lesions in the phrenic nerves. In the absence of traumatic or metabolic causes, these findings suggest that the phrenic nerve can be a target in idiopathic neuritis.- - - - - - - - - - ranking = 4keywords = nerve (Clic here for more details about this article) |
8/23. Spinal accessory mononeuropathy following posterior fossa decompression surgery.Isolated injury of the spinal accessory nerve is a well-recognized complication of surgeries involving the posterior triangle of the neck. The procedures most commonly implicated are lymph node biopsy and carotid endarterectomy. We present a patient with isolated injury to the spinal accessory nerve, localized proximal to the innervation of the sternocleidomastoid muscle, which was noted following suboccipital decompression for an arnold-chiari malformation. To our knowledge, this association has not been previously reported.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
9/23. Confluent peripheral multiple mononeuropathy associated to acute hepatitis B: a case report.A thirty three year-old, male patient was admitted at the Hospital of the Sao Paulo University School of medicine, at the city of Sao Paulo, brazil, with complaint of pains, tingling and decreased sensibility in the right hand for the last four months. This had progressed to the left hand, left foot and right foot, in addition to a difficulty of flexing and stretching in the left foot. Tests were positive for HBeAg, IgM anti-HBc and HBsAg, thus characterizing the condition of acute hepatitis B. The ALT serum level was 15 times above the upper normal limit. blood glucose, cerebral spinal fluid, antinuclear antibodies (ANA) and anti-hiv and anti-HCV serum tests were either normal or negative. Electroneuromyography disclosed severe peripheral neuropathy with an axon prevalence and signs of denervation; nerve biopsy disclosed intense vasculitis. The diagnosis of multiple confluent mononeuropathy associated to acute hepatitis B was done. This association is not often reported in international literature and its probable cause is the direct action of the hepatitis b virus on the nerves or a vasculitis of the vasa nervorum brought about by deposits of immune complexes.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
10/23. sural nerve lesions: a report of 20 cases.Given the rarity of sural nerve mononeuropathy, this retrospective study reports 20 cases observed during the last 12 yr, with some cases having especially unusual mechanisms of the nerve lesion. Five of the 20 cases were considered S1 root disease until electrodiagnostic findings. In the 14 other cases, the nerve lesion was suspected because of concomitant trauma. This series is the largest sample of sural nerve lesions so far reported, and it underlines the importance of iatrogenic lesions, which account for 12 of the 20 cases. Some lesions are due to unusual conditions, such as small saphenous vein stripping and compression by the deep fascia. This series also demonstrates that even when lower limb trauma exists, some cases can be considered S1 root disease and that when the area of impaired sensation corresponds exactly to the cutaneous territory of a nerve trunk, one should first consider a truncular origin of the nerve lesion.- - - - - - - - - - ranking = 10keywords = nerve (Clic here for more details about this article) |
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