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Cases reported "Paresthesia"

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201/612. 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. (+info)

202/612. Emergency department presentations of transverse myelitis: two case reports.

    Transverse myelitis, a diagnosis that may be made in the emergency department (ED) by emergency physicians, can be difficult to diagnose because of its variable signs and symptoms and its poorly understood pathogenesis. In this article, we recount 2 cases of transverse myelitis to demonstrate its presentation, diagnosis, and management in the ED. (+info)

203/612. Thoracic extradural paragangliomas: a case report and review of the literature.

    STUDY DESIGN: Case report. OBJECTIVES: To report on a case of paraganglioma presenting in an uncommon extradural thoracic localization. SETTING: Department of neurosurgery, Florence, italy. CASE REPORT: A 43-year-old woman with a thoracic lesion extending into the extradural space along four levels, T(1)-T(4), presented with sudden spastic incomplete paraplegia and paresthesia at the lower limbs. RESULTS: The neoplasm was surgically resected 'en bloc' and histological findings corresponded to paraganglioma. One year after surgery, the patient was walking without assistance, a T(3)-T(4) hypoesthesia was still present and an magnetic resonance imaging (MRI) study showed no signs of focal recurrence. CONCLUSIONS: The imaging features of thoracic paragangliomas may be misleading and an advanced malignant lesion could be primarily suspected; thus, a histological study is always needed. Total resection is the gold standard therapy. Owing to the risk of recurrence or multicentric growth, follow-up must be prolonged and accurate. (+info)

204/612. Epidural catheter-induced paresthesia accompanied by changes in skin color and temperature in an obstetric patient.

    Placement of epidural catheters for labor analgesia is a common procedure that has become more popular in recent years. However, this procedure can often cause paresthesia, which is typically characterized as a transient and intense burning pain radiating to the hip or leg. In this case report, we describe a patient who had persistent paresthesia in her right foot caused by an indwelling epidural catheter, which was successfully relieved following a partial withdrawal of the epidural catheter. More interestingly, we also observed dramatic changes in skin color and temperature (cold and pale) on her right foot that was well correlated both in time and location with the epidural-induced paresthesia. This cold and pale skin on the right foot represents a localized sympathetic discharge associated with the epidural-induced paresthesia, a phenomenon that has not previously been described. Based on the location of the paresthesia and the pathway of the sympathetic nerve fibers, it is unlikely that this localized sympathetic discharge was due to a direct irritation of the preganglionic sympathetic fibers in the spinal nerve roots by the epidural catheter and thus, a spinal reflex was probably involved. This phenomenon provided us with additional clinical evidence of nerve root irritation, which prompted us to act quickly, and resulted in a favorable outcome. (+info)

205/612. "Burning tongue" sensation during routine coronary angiography--a phenomenon related to a rare coronary anomaly.

    We present the case of rare coronary circulation anomaly discovered during the routine coronary angiography that was associated with unusual "burning" sensation reported by the patient. (+info)

206/612. Chondromyxoid fibroma of the skull base: differential diagnosis and radiotherapy: two case reports and a review of the literature.

    Chondromyxoid fibromas are uncommon tumours mostly arising in long bones of young males. Involvement of the skull base is extremely rare. We describe two new cases of base of the skull chondromyxoid fibromas. The tumours were incompletely excised and irradiated with protons because of the high risk of complications of another surgical procedure. The rationale for proton therapy was based on the intimate relations between the tumour and the organs at risk. skull base chondromyxoid fibroma is a very rare, slowly growing benign tumour that can cause severe disabilities due to tumour compression of critical structures. Only surgical resection has been shown to be relatively effective. We report two cases of incompletely excised lesions treated by postoperative high-dose radiation including proton therapy with no active disease and complication. Our review of the literature allows us to conclude that histological diagnosis of lesions in this site is a trap for pathologists and that radiotherapy is not contraindicated. (+info)

207/612. Simultaneous paresthesia of the lingual nerve and inferior alveolar nerve caused by a radicular cyst.

    The inferior alveolar nerve is sometimes affected by periapical pathoses and mandibular cysts. However, mandibular intraosseous lesions have not been reported to disturb the lingual nerve. A case of simultaneous paresthesia of the right lingual nerve and the right inferior alveolar nerve is presented. The possible mechanisms of this extremely uncommon condition are discussed. (+info)

208/612. polyradiculopathy post-concomitant chemoradiation for carcinoma of the uterine cervix treated with pelvic and para-aortic fields.

    BACKGROUND: It is becoming more common to include the para-aortic lymph nodes in the radiation fields of patients treated with concomitant weekly cisplatin for node-positive squamous cell carcinoma of the cervix. CASE: We report on two patients who developed unexpected subacute neurological toxicity with lower extremity paresis and paresthesis, beginning 1 and 4 months post-treatment. CONCLUSION: We believe this to be a rare side effect of chemoradiation. As the dose delivered to the spinal nerve roots was less than 37 Gy in 25 fractions, we believe that the extended fields and concomitant cisplatin had a synergistic effect on the nerves. (+info)

209/612. Palmar-plantar erythrodysesthesia due to docetaxel-capecitabine therapy is treated with vitamin e without dose reduction.

    Palmar-plantar erythrodysesthesia (PPE) is a distinctive and relatively frequent toxic reaction related to some chemotherapeutic agents. doxorubicin, cytarabine, docetaxel, fluorouracil, and capecitabine are the most frequently implicated agents. Recently, taxanes, especially docetaxel, have been widely used in combination with capecitabine in patients with metastatic breast cancer (MBC). A high percentage of PPE has been seen in patients undergoing this combination therapy. PPE seems to be dose dependent and both peak drug concentration and total cumulative dose determine its occurrence. Withdrawal or dose reduction of the implicated drug usually gives rise to amelioration of the symptoms. Supportive treatments such as topical wound care, elevation, and cold compresses may help to relieve the pain. Use of systemic corticosteroids, pyridoxine (vitamin B6), blood flow reduction, and, recently, topical 99% dimethyl-sulfoxide have been used with variable outcomes. vitamin e treatment has not been published before, especially without dose reduction of docetaxel-capecitabine therapy. Here we present five MBC patients treated with docetaxel-capecitabine combination therapy in whom PPE was observed during the clinical follow-up period. In all patients grade 2-3 PPE was observed. vitamin e therapy was started at 300 mg/day p.o. without dose reduction of therapy and after 1 week of treatment PPE began to disappear. We suggest that it could be of interest to consider vitamin e as a preventive drug when drugs with a strong association with PPE are going to be administered. (+info)

210/612. Can direct spinal cord injury occur without paresthesia? A report of delayed spinal cord injury after epidural placement in an awake patient.

    We discuss the etiology of a delayed spinal cord injury after epidural anesthesia without paresthesia. The description of such a case in an awake, adult patient who underwent a Whipple resection is provided. An epidural was performed at approximately the T8-9 interspace with the patient in the sitting position after 1 mg of midazolam was administered. On the first attempt, a dural puncture occurred. The patient did not report any paresthesia or pain. The needle was withdrawn and a second attempt was made one interspace lower. At this level, the epidural catheter was advanced into the epidural space uneventfully. Postoperatively, the patient suffered decreased motor function in the right leg. magnetic resonance imaging revealed high signal intensity within the spinal cord, indicating cord edema compatible with direct needle trauma. An extradural fluid collection consistent with a hematoma was also noted. Although it may be impossible to confirm if the spinal cord injury was a result of direct needle trauma, hematoma, or a combination of needle trauma and hematoma, these events clearly raise the important question of whether an awake patient will always report paresthesia secondary to spinal cord trauma. IMPLICATIONS: This case reminds anesthesiologists that we should not simply assume paresthesia will always occur and be reported if a needle encroaches on the spinal cord even in an awake patient. (+info)
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Last update: April 2009
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