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1/198. An uncommon mechanism of brachial plexus injury. A case report.

    PURPOSE: To report a case of brachial plexus injury occurring on the contralateral side in a patient undergoing surgery for acoustic neuroma through translabrynthine approach. CLINICAL FEATURES: A 51-yr-old woman underwent surgery for acoustic neuroma through translabrynthine approach in the left retroauricular area. She had a short neck with a BMI of 32. Under anesthesia, she was placed in supine position with Sugita pins for head fixation. The head was turned 45 degrees to the right side and the neck was slightly flexed for access to the left retroauricular area, with both arms tucked by the side of the body. Postoperatively, she developed weakness in the right upper extremity comparable with palsy of the upper trunk of the brachial plexus. hematoma at the right internal jugular vein cannulation site was ruled out by CAT scan and MRI. The only remarkable finding was considerable swelling of the right sternocleidomastoid and scalene muscle group, with some retropharyngeal edema. An EMG confirmed neuropraxia of the upper trunk of brachial plexus. She made a complete recovery of sensory and motor power in the affected limb over the next three months with conservative treatment and physiotherapy. CONCLUSIONS: brachial plexus injury is still seen during anesthesia despite the awareness about its etiology. Malpositioning of the neck during prolonged surgery could lead to compression of scalene muscles and venous drainage impedance. The resultant swelling in the structures surrounding the brachial plexus may result in a severe compression.
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2/198. Cerebral metastasis presenting with altitudinal field defect.

    A 75-year-old man presented with a unilateral inferior altitudinal visual field defect and a history of weight loss and night sweats. The acuity in the affected eye was 20/200, otherwise his ocular examination was normal. neuroimaging demonstrated a post-fixed chiasm, with a frontal metastasis compressing the intracerebral portion of the optic nerve. A chest x-ray showed classical cannon ball lesions, secondary to malignant melanoma. This is the first case report of an intracerebral tumor producing an inferior altitudinal field defect.
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keywords = chest
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3/198. The "plastic bag syndrome". Compression of the digital neurovascular bundles by commercial plastic bags.

    We report a condition we call the "plastic bag syndrome" in which pressure on the neurovascular bundles causes temporary ischaemia in the distal part of the finger together with a neuropraxia of the digital nerves. Although in most cases the discomfort or numbness is fleeting, requires no medical assistance and is readily forgotten, in some instances the symptoms are such that medical advice is sought. Since the injury can lead to permanent damage and subsequent limitation in the use of the finger, we believe that the public should be advised to take simple precautions to prevent it from happening.
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keywords = discomfort
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4/198. L4-5 disk lesion resulting in back pain with bowel, bladder and sexual dysfunction without paraparesis.

    This is a case report of a patient with bowel, bladder and sexual dysfunction associated with low back pain. This patient had an essentially normal neurological examination. There was radiological evidence of a disk lesion, and urodynamic findings consistent with lower motor neuron bladder dysfunction. His symptoms are attributed to a L4-5 disk herniation resulting in a partial cauda equina syndrome. The relevant anatomy is reviewed, and the differential diagnosis is discussed.
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keywords = back pain
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5/198. Post-traumatic distal nerve entrapment syndrome.

    Eleven patients with paralysis of muscle groups in the upper or lower extremity were clinically diagnosed after previous proximal direct trauma to the corresponding peripheral nerves, without complete nerve disruption. patients were seen within an average of 8 months after trauma (minimum 3 months and maximum 2 years after). Nerve lesions were caused either by gunshot, motor-vehicle accident, and other direct trauma or, in one case, after tumor excision. All patients presented with complete sensory and motor loss distal to the trauma site, but demonstrated a positive Tinel sign and pain on testing over the "classic" (distal) anatomic nerve entrapment sites only. After surgical release through decompression of the nerve compression site distal to the trauma, a recovery of sensory function was achieved after surgery in all cases. Good-to-excellent restoration of motor function (M4/M5) was achieved in 63 percent of all cases. Twenty-five percent had no or only poor improvement in motor function, despite a good sensory recovery. Those patients in whom nerve compression sites were surgically released before 6 months after trauma had an improvement in almost all neural functions, compared to those patients who underwent surgery later than 9 months post trauma. A possible explanation of traumatically caused neurogenic paralysis with subsequent distal nerve compressions is provided, using the "double crush syndrome" hypothesis.
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6/198. Superior branch palsy of the oculomotor nerve caused by acute sphenoid sinusitis.

    A 52-year-old man presented with unilateral headache for 6 days. physical examination revealed an ipsilateral paresis of the superior division of the oculomotor nerve with chemosis. CT scan of the paranasal sinuses showed ipsilateral sphenoid sinusitis with cavernous sinus involvement. The symptoms were completely improved by medical treatment only.
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keywords = headache
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7/198. Salon sink radiculopathy: a case series.

    Cervical radiculopathy can be diagnosed on physical examination with the Spurling test, which narrows neural foramina via neck extension along with coupled rotation and side-bending. In the presence of cervical radiculopathy, this test can reproduce radicular symptoms by transmitting compressive forces to affected nerve roots as they traverse the neural foramina. Treatment of cervical radiculopathy includes patient education to avoid obvious postures that exacerbate radicular symptoms and to assume positions that centralize discomfort. A potentially harmful position to which many patients are unwittingly subjected at least several times per year occurs when their hair is being shampooed in a salon sink before a haircut. This posture causes neck extension and is combined with rotation and side-bending as the patient's head is being manipulated during the shampooing. When the stylist then also applies a mild compressive force while shampooing the patient's hair, hyperextension of the neck is produced. We present two patients with cervical radiculopathy that was significantly exacerbated after the patient's hair had been shampooed in a salon sink; subsequently, these patients required oral administration of steroids. These cases illustrate that patients with suspected or known cervical radiculopathy should be forewarned to avoid this otherwise seemingly innocuous activity.
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keywords = discomfort
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8/198. Quadrangular space syndrome associated with superficial radial sensory neuropathy.

    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.
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9/198. neurologic manifestations of compressive radiculopathy of the first thoracic root.

    Neurologic deficits in the first thoracic (T1) root distribution are uncommon and not easily defined. Myotomal charts indicate that distal arm and hand muscles receive significant contributions from both the C8 and T1 roots. A patient with focal T1 radiculopathy is presented who demonstrated motor axon loss isolated to the abductor pollicis brevis muscle. This finding provides another source of evidence that the abductor pollicis brevis is the primary T1 motor structure in the upper extremity, improving precision in clinical and electromyographic diagnosis.
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keywords = upper
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10/198. Newborn radial nerve palsy: report of four cases and review of published reports.

    Four newborns presented with isolated radial nerve palsy during the first 2 days of life. In three, there was a history of failure of progression of labor, which may have resulted in prolonged radial nerve compression. Furthermore, three infants had fat necrosis of the upper arm above the elbow, suggestive of compression of the radial nerve in the region of the spiral groove. Significant recovery of function was evident within 1 month in all four infants. The authors review published reports about the rare condition of isolated radial nerve palsy in the newborn.
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