191/612. tibial nerve mistakenly used as a tendon graft. Reports of three cases. We describe three patients in whom the tibial nerve was used, in mistake for the plantaris tendon, to repair a ruptured calcaneal tendon. The tendon repair was successful in all cases, but despite attempted reconstruction of the nerve, no patient had any motor recovery although two regained some protective sensation. ( info) |
192/612. U.S. navy diver/aviator/skydiver with AGE from a previously unknown PFO. A 32 year old US Naval aerospace physiologist with dive, jump and flight qualifications presented to a US Navy hyperbaric medicine department complaining of nausea, unsteadiness and left hand and forearm paresthesia that began almost immediately after completing a 28ft/ 40min recreational dive. Following an abbreviated history and physical examination the patient was diagnosed to be suffering from an arterial gas embolism. He was treated with hyperbaric therapy during which his symptoms resolved. Follow-on transesophageal echocardiography revealed an atrial septal aneurysm with a patent foramen ovale resulting in a right-to-left shunt after valsalva maneuver, but no evidence of ventricular dysfunction, wall motion abnormalities, or abnormal ejection. His episode was attributed to paradoxical air embolism and he was disqualified from further special duty. In order to regain his dive, jump and flight qualifications, the patient elected to undergo repair of the cardiac defect with a device that is relatively new in the operational military setting. The procedure was a success, he was granted waivers for his prior qualifications, and remains in that status to this day. This is the first known case where an atrial septal occluder has been used to preserve these special duty qualifications. ( info) |
| cysticercosis is the most common parasitic infection of the central nervous system. It infrequently affects the spine, but when it does, it can present with symptoms similar to other more common spinal diseases. The authors present a case of isolated intramedullary cysticercosis of the cervical spine and review the literature. ( info) |
194/612. Paraesthesia of the lip and chin area resolved by endodontic treatment: A case report and review of literature. Lower lip numbness is a symptom that may be due to entirely benign causes, or it may be the first sign of a more sinister problem. It has been reported as being the sole symptom of pathological lesions and metastatic tumours in the mandible. ( info) |
195/612. Fracture in the chin area: an unusual case of mandibular torus fracture. Mandibular torus fracture as a result of accidental trauma has not been reported to date in the dental literature. This study describes the case of a young adult male who suffered multiple fractures affecting the teeth and mandibular torus secondary to chin area trauma due to a bicycle accident; the first manifestation of bone damage being left unilateral paraesthesia of the lip. An occlusal x-ray study of the affected area was made to evaluate possible fracture, as unlike centred periapical x-rays and orthopantomography, it is able to reveal the existence of a fracture line of the alveolar wall. In the associated presence of paraesthesia, a computed tomographic study is advisable. ( info) |
196/612. Patterns of sensory recovery in the lingual nerve after surgical trauma. OBJECTIVE: To examine the pattern of sensory recovery in the lingual nerve following injury, with an emphasis on qualitative changes. methods: Using data from one patient with prolonged dysaesthesia after surgical trauma to the lingual nerve, we correlated changes in perceived sensory function during recovery with results from qualitative and quantitative taste tests, and patient-reported quality-of-life measures. RESULTS: Recovery of quantitative taste testing as measured by automated electrogustometry, and qualitative whole of mouth taste testing, preceded perceptual recovery of taste. On the other hand, taste acuity as measured by regional qualitative taste testing tended to lag behind perceptual recovery. The pattern of recovery in the different qualitative taste sensations suggests variation in sensitivity of the nerve fibres responsible for carrying taste sensation, with the fibres relating to bitter and sour taste being the last to recover. CONCLUSION: To our knowledge, taking into account the limitations of this study, this picture of differential recovery of taste function in the lingual nerve has not been previously reported. ( info) |
197/612. Ventral cervicomedullary junction compression secondary to condylus occipitalis (median occipital condyle), a rare entity. OBJECTIVE: Condylus occipitalis is presented in postmortem anatomic studies. There is no clinical study in the literature. Myelopathy due to anomalies of the craniovertebral junction is rare in neurosurgical practices. To our knowledge, myelopathy due to condylus occipitalis has not been reported before. Deaths of two cases were previously reported, but these were not live cases. methods: We describe the case of a 40-year-old woman presenting with progressive myelopathy related to condylus occipitalis located in the anterior foramen magnum region. RESULTS: magnetic resonance imaging and computed tomography showed the condylus occipitalis, marked stenosis of the spinal canal at the level of the atlas, with cord compression and evidence of myelopathy. We performed posterior decompression without fusion and duraplasty. Because the cervicomedullary compression syndrome was not resolved, a transoral decompression could not be done owing to pulmonary insufficiency. CONCLUSIONS: This unique clinical article (a live case), not anatomic, presents a very rare abnormality of the craniovertebral junction. Myelopathy is a very important complication of this congenital craniovertebral junction abnormality. Posterior decompression seems not to be effective for myelopathy due to condylus occipitalis. In our opinion, anterior decompression is needed in this condition. A larger series will be needed to better define its role in the management of this anomaly. ( info) |
198/612. radiation myelopathy visualized as increased FDG uptake on positron emission tomography. A woman with a history of desmoid tumor involving the T9-T10 vertebrae was treated with local irradiation. After treatment, she developed tingling sensations in both legs. An FDG PET study demonstrated focally increased activity posterior to the vertebral bodies at the levels of T9-T10, which was vertical in orientation, corresponding to the location of the spinal cord at this level. This finding is consistent with the clinical suspicion of radiation myelopathy. ( info) |
199/612. Bilateral spontaneous carotid artery dissection. Bilateral internal carotid artery dissections have been reported, but spontaneous bilateral dissections are rare. Internal carotid artery dissection can present with a spectrum of symptoms ranging from headache to completed stroke. Two cases of spontaneous bilateral carotid artery dissection are presented, one with headache and minimal symptoms and the other with a stroke syndrome. No cause could be found in either case, making the dissections completely spontaneous. Bilateral internal carotid artery dissection (ICAD) should be considered in young patients with unexplained head and neck pain with or without focal neurological symptoms and signs. The increasing availability of imaging would sustain the higher index of suspicion. ( info) |
200/612. Meralgia paraesthetica following open appendicectomy. Meralgia paraesthetica is a painful condition attributed to entrapment or injury to the lateral femoral cutaneous nerve. It has been described following operations which could result in direct injury to the nerve such as iliac crest bone harvesting. It has also been reported following surgery remote from the nerve. Following open appendicectomy injury may occur following direct trauma to an anatomical variant of this nerve, which can occur in up to 25% of the population. We report two cases that became clinically evident immediately following open appendicectomy with subsequent confirmatory electromyography studies. Meralgia paraesthetica following open appendicectomy has not been reported in the medical literature. This is an under-recognised complication of open appendicectomy. Management can be challenging for patient and clinician. ( info) |