1/174. Neuromyotonia: an unusual presentation of intrathoracic malignancy.A 48 year old woman is described who presented with increasing muscular rigidity and who was found to have a mediastinal tumour. Electrophysiological studies revealed that the muscular stiffness resulted from very high frequency motor unit activity which outlasted voluntary effort, and which was abolished by nerve block. The abnormal activity may have arisen at the anterior horn cell level. Marked improvement followed the administration of diphenylhydantoin.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/174. Autonomic failure and proximal skeletal myopathy in a patient with primary Sjogren syndrome.Autonomic failure and proximal skeletal myopathy are rare features of the Sjogren syndrome (SS). We describe a 51-year-old woman with primary SS who had development of esophageal dysmotility, urinary retention, severe orthostatism, and skeletal myopathy during a 3-month period after the diagnosis of SS. Her symptoms and signs responded well to corticosteroid therapy. Although dysfunction of the peripheral nervous system has a prevalence rate of 20% in patients with SS, most commonly the nerve dysfunction is a sensory deficit, and autonomic neuropathy is less frequent. Autonomic neuropathy due to SS may be underreported. The cause of our patient's myopathy remains undetermined. We speculate that the myopathy was due to either a form of polymyositis or an immune-mediated neuropathy with muscle involvement.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/174. Envenomation by the scorpion (Centruroides limbatus) outside its natural range and recognition of medically important scorpions.A 67-year-old woman presented to a community emergency department in Orange County, CA, after she was stung by a scorpion identified as Centruroides limbatus from central america. She developed local pain and systemic symptoms, including parasthesias, flushing, hypertension, and wheezing. Envenomation by this genus of scorpion has not previously been reported in Orange County. scorpions have been reported to be accidentally transported to areas where they are not indigenous, and patients may present anywhere with envenomation by dangerous scorpion species. physicians should recognize general identifying characteristics of dangerous scorpions and serious signs of envenomation. Almost all dangerous genera of scorpions (including Centruroides sp.) are in the family Buthidae, which can be identified by a triangular sternal plate. Severe systemic signs of envenomation by Centruroides sp. may include respiratory difficulty, somatic neuromuscular dysfunction, and cranial nerve dysfunction. patients stung by dangerous scorpions may require airway support, extended observation, antivenin, and avoidance of respiratory depressive medications.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/174. Hereditary neuropathy and vocal cord paralysis in a man with childhood diphtheria.We present the case of a 37-year-old Afghani man with a history of childhood diphtheria, who was diagnosed with bilateral vocal cord paralysis at age 15 years. At about this time he developed progressive muscular wasting and distally predominant weakness, and subsequently developed respiratory insufficiency, necessitating nocturnal ventilatory support. His examination suggested a distal symmetric sensorimotor neuropathy, and his brother was similarly affected, although to a lesser degree. electromyography (EMG) and nerve conduction studies revealed this process to be purely axonal. A diagnosis of possible hereditary motor and sensory neuropathy (HMSN) type IIc, hereditary axonal polyneuropathy with vocal cord paralysis, is proposed, although the question of early diphtheritic involvement of the vocal cords and peripheral nerves is also considered.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
5/174. Mononeuropathy of the deep palmar branch of the ulnar nerve. A case occurring in a diabetic woman.A diabetic woman developed mononeuropathy of the deep palmar branch of the ulnar nerve six months following repetitive palmar trauma. The illness was initially incorrectly diagnosed as motor neuron disease, emphasizing the importance of accurate diagnosis of diseases that cause wasting of intrinslc muscles in the hand.- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
6/174. Resection of the hook of the hamate. Its place in the treatment of median and ulnar nerve entrapment in the hand.Poor results can be anticipated with conventional surgical decompression of nerves entrapped within the hand in (1) those with underlying systemic disease causing primary neuropathy, (2) those with combined median and ulnar nerve palsies, and (3) those who have been previously operated upon for nerve entrapment within the hand. Eighteen patients belonging in these categories were surgically treated by resection of the hook of the hamate and (in some) by intraneural neurolysis. Using this technique, we have decreased our failure rate from 20 percent to less than one percent. We believe that failures can be eliminated if the patients destined to have poor results from the usual treatment are identified preoperatively and a more aggressive surgical decompression is used on this "at risk" group.- - - - - - - - - - ranking = 7.1278818370707keywords = nerve, median (Clic here for more details about this article) |
7/174. Neuromyotonia. A mild case.A mild case of the syndrome of generalized, sustained, fine muscular twitchings and impaired relaxation after a vigorous contraction (but without a myotonic response), which is presumably due to peripheral motor nerve hyperactivity is described. In this case, generalized muscle stiffness, deformities of the hands and feet, excessive sweating and an increased basal metabolic rate were not present.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
8/174. colchicine neuromyopathy: a report of six cases.colchicine has been in use for therapeutic purposes for many years. It can, however, cause subacute onset muscle and peripheral nerve toxicity in patients with chronic renal failure. In this report we describe 6 patients who developed neuromyopathy after the administration of colchicine. All patients presented with proximal muscle weakness, elevated serum creatine kinase (CK) levels, and neuropathy and/or myopathy on electromyography (EMG). The diagnosis of colchicine toxicity was confirmed in all cases by the normalization of CK levels and EMG after discontinuation of the drug. Toxicity developed in 4 renal failure patients on therapeutic doses of the drug, while one patient took a massive dose for suicidal reasons, and the other was on high-dose therapy. patients using colchicine--especially those with renal failure--should be warned about the side effects of the drug and physicians should be careful in the administration of the drug.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
9/174. The pulmonary physician in critical care * illustrative case 4: neuromusculoskeletal disorders.The case history is presented of a patient admitted to the ICU with ventilatory insufficiency following thoracotomy for thymic resection. The role of non-invasive ventilation for weaning in patients following phrenic nerve injury is discussed.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
10/174. The intermediate syndrome in organophosphate poisoning: presentation of a case and review of the literature.A dimethoate-poisoned woman gradually developed a moderately severe cholinergic crisis that was readily treated by atropine. After being symptom-free for nearly two days, she suffered from sudden life-threatening respiratory paresis and weakness of the facial, extraocular, neck flexor and proximal limb muscles. Muscarinic symptoms were absent. Cholinesterase inhibition was severe, and EMG revealed marked decrements at low rates of repetitive nerve stimulation, and increments at a high rate. The clinical course was compatible with the Intermediate syndrome. This syndrome seems due to persistent cholinesterase inhibition presumably leading to combined pre- and postsynaptic impairment of neuromuscular transmission. Inadequate pralidoxime therapy is proposed but not established as contributory. Prolonged monitoring of respiratory function in patients poisoned by particular organophosphate agents is mandatory.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
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