1/18. paresthesia and the traumatic bone cyst. Abbreviated case report.A case of a traumatic bone cyst is reported because of the unusual nature of the chief complaint. The initial symptom of the disease was mandibular nerve neuropathy with numbness of the left side of the lower lip and chin.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/18. Clinics in diagnostic imaging (55). Ossification of the posterior longitudinal ligament.Ossification of the posterior longitudinal ligament (OPLL) of the cervical spine associated with diffuse idiopathic skeletal hyperostosis is described in a 70-year-old Caucasian man presenting with a rapidly progressive myelopathy. The acute nature of his myelopathic symptoms and cervical canal stenosis necessitated posterior decompressive surgery. Four other patients with OPLL are presented to illustrate the spectrum of imaging findings. The computed tomographic features of OPLL are distinctive.A 2-5 mm thick linear ossified strip along the posterior vertebral margin usually at mid cervical (C3 to C5) level characterises the condition. Magnetic resonance (MR) imaging is valuable in excluding possible cord damage and associated disc lesions prior to surgery. A calcified central sequestrated disc is the only condition that may be mistaken for the segmental and retrodiscal forms of OPLL In a clinical setting of compressive myelopathy, it is pertinent to distinguish between these two conditions since a sequestrated disc has a more favourable surgical prognosis. The merits and relevance of anterior and posterior surgery together with their possible complications are outlined.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/18. Pharyngeal dysesthesias as an aura in temporal lobe epilepsy associated with amygdalar pathology.PURPOSE: Pharyngeal dysesthetic auras are typically described with centrotemporal and opercular seizure-onset localizations. In this report we describe the fourth case in literature with temporal lobe seizures, apparently secondary to an amygdalar lesion on magnetic resonance imaging (MRI), presenting with prominent pharyngeal dysesthesias as the initial, or only, seizure manifestation. methods: Because of diagnostic uncertainty regarding the nature of the pharyngeal sensations, our case underwent prolonged extracranial video-EEG monitoring. RESULTS: Video-EEG information documented the epileptic origin of the dysesthesias and was concordant with the side and location of the amygdalar lesion. CONCLUSIONS: Pharyngeal dysesthetic auras may be produced by epileptic activity originating from the amygdala, and perhaps other mediotemporal structures. The underlying topography of this aura is not known with certainty, and it may reflect seizure spread from the amygdala and adjacent areas to the closely interconnected insular and opercular cortex, whose secondary activation could elicit similar sensations.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/18. Conversion sensory symptoms associated with parietal lobe infarct: case report, diagnostic issues and brain mechanisms.This case report suggests that diagnostic difficulties and brain mechanisms related to conversion disorder associated with cerebral lesions differ from those related to conversion disorder without cerebral lesions. A 35-year-old divorced woman was admitted to a psychiatric inpatient unit with multiple physical complaints. The symptoms first appeared 5 years previous and 2 months after a sexual assault. Three years later, she began to experience ill-defined sensory symptoms confined to the left half of her body (splitting the midline). Results of neurologic consultations were equivocal because of the subjective nature of the complaints, which were viewed as conversion symptoms. A magnetic resonance imaging scan demonstrated an old infarct in the right parietal lobe, suggesting a physical origin of the patient's symptoms. However, normal somatosensory-evoked responses from the affected area contributed little to establishing the diagnosis. The results of all further investigations to identify causes of the vascular pathology were negative. The multiple ill-defined somatic symptoms, the distribution of sensory symptoms and the resolution of symptoms with psychotherapy established the diagnosis of conversion disorder superimposed on a pre-existing right parietal lesion. This case highlights the importance of clinical features in establishing a diagnosis such as this. We suggest that reactivation of implicit sensory memories (represented at the thalamic level and resulting from decreased corticofugal inhibitions due to the lesion) may contribute to the formation of sensory conversion symptoms in individuals with parietal lobe lesions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/18. Episodic snapping of the medial head of the triceps due to weightlifting.We describe two patients who had episodic elbow snapping and ulnar nerve dysesthesias only after weightlifting. These symptoms would disappear soon afterward. The episodic nature of their complaints and findings led to misdiagnosis. We documented by repeated clinical examinations and magnetic resonance imaging that the presence of these symptoms correlated directly with the finding of intermittent, activity-related snapping of the medial triceps. In both patients, the symptoms disappeared when the medial portion of the triceps migrated medially but did not dislocate over the medial epicondyle with elbow flexion. Thus, a minor change in the configuration of the medial portion of the triceps (fluid accumulation) in the same individual at different times can cause intermittent dislocation of the medial triceps. Previous papers dealing with patients with snapping of the medial triceps describe symptoms exacerbated by athletic activities, but the constant finding of snapping on sequential examinations.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/18. Deblocking effect of TRH-T in three cases of chronic progressive multifocal neuropathy.Three cases of acquired demyelinating multifocal neuropathy with persistent conduction blocks are reported. In one of them protyreline tartrate (TRH-T) had an evident deblocking effect; similar but milder effects were seen in the other two cases. The course and consistency of this effect is analyzed on the grounds of clinical and electromyographic findings. The nature of the THR-T responsive conduction block is analysed as a mild variant of CIDP with regard to its occurrence in a late and chronic phase without signs of active immune processes.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/18. Transient global amnesia after general anesthesia.Transient global amnesia (TGA) is an amnestic syndrome, clinically dramatic but benign in nature. The hallmark of TGA is brief inability to form new memories and recall past memories despite otherwise normal neurological function. In a significant number of patients with TGA a stressful precipitating factor can be identified. We report two cases of TGA after uneventful general anesthesia. anesthesia per se does not appear to be a direct trigger of TGA, as our first patient had a second anesthetic the next day without recurrence of TGA. Because the presentation of TGA can be dramatic and may mimic an acute cerebral ischemic event, a thorough neurologic evaluation should be pursued.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/18. Seeing the invisible: painless aortic dissection in the emergency setting.Acute dissection of the aorta can be one of the most dramatic cardiovascular emergencies. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterised as ripping or tearing in nature. However, a timely diagnosis can be elusive in the event of an atypical presentation. In this report, the authors present two patients with painless aortic dissection who were misdiagnosed during their initial evaluation in the emergency department.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/18. Two cases of variant Creutzfeldt-Jakob disease (vCJD) referred to the Department of Community mental health, Aldershot Garrison in 2003.In the year 2003 the Department of Community mental health (DCMH) at Aldershot Garrison received referrals of two soldiers, a sergeant and a lance corporal, who presented with a complex picture of neurological and psychiatric symptoms. Both had been investigated very thoroughly by neurologists who, owing to the mainly negative results of their investigations, were unable to make a diagnosis. Of the two patients one had also been assessed as a psychiatric in-patient in a civilian hospital and had been referred to the Aldershot DCMH for continuing care. The other had been transferred, after investigations, to the Defence Services Medical rehabilitation Centre (DSMRC) at Headley Court but, failing to make progress, was also referred for psychiatric assessment. Both patients were obviously unwell but the nature of their illnesses remained obscure. Within a few months both had died and the diagnosis of one of the human transmissible spongiform encaphalopathies (TSEs), vCJD, was made at autopsy in one of them, but both were registered by the National CJD Surveillance Unit (3) with a diagnosis of vCJD. The circumstances were so unusual and prompted the writing of this paper by one of the psychiatrists involved.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/18. Extraosseous schwannoma of the mental nerve clinically simulating intraosseous.We report a case of a benign neurilemmoma arising from the right mental nerve. Schwannomas are rare neurogenic tumours that originate from schwann cells of the peripheral nervous system. Frequent locations are the head and neck region. Most of the tumours occur in the soft tissue whereas intraosseous schwannomas are rare. This case report deals with a young patient who was referred to our hospital with an unidentified fast-growing tumour located mainly in the premolar region of the right mandible. The tumour presented as an expansive, unilocular, well defined, radiolucent lesion on orthopantomography. No expansion of the mandibular canal could be seen. Computerized tomography scans of the mandible helped to identify the solid nature of the tumour. A biopsy was necessary to make the final diagnosis and the tumour was then excised surgically. Postoperative magnetic resonance imaging scans and a histological examination of the surgical specimen showed no signs of neurofibromatosis type 2.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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