211/612. Lichen simplex chronicus as the initial manifestation of intramedullary neoplasm and syringomyelia. Neurogenic causes of pruritus and a rash are uncommon. We report a patient with dermatomal pruritus and a rash who had a cervicothoracic syrinx and a thoracic spinal cord tumor. We believe the syrinx interrupted fibers subserving itch, resulting in dermatomal pruritus with secondary scratching and a rash. ( info) |
212/612. Neurological complications following extrusion of sodium hypochlorite solution during root canal treatment. AIM: To report the presentation and management of two cases with neurological complications secondary to the extrusion of sodium hypochlorite solution into the facial soft tissues during root canal treatment. SUMMARY: The clinical features, with particular emphasis on nerve deficit following inadvertent extrusion of sodium hypochlorite, are discussed and its management highlighted. Early and aggressive treatment is advocated following such incidents in order to reduce potentially serious complications. KEY learning POINTS: *Neurological sequelae can follow inadvertent hypochlorite extrusion. *Early recognition may avert a potentially more serious outcome. *Active hospital treatment including intravenous steroids and antibiotics is recommended. ( info) |
213/612. Distal lower extremity paresthesia and foot drop developing during adalimumab therapy. The development of tumor necrosis factor inhibitor biologic therapy is arguably one of the most significant achievements in the treatment of rheumatic diseases to date. Neurologic events suggestive of demyelination have been reported for patients receiving treatment with the antitumor necrosis factor agents etanercept and infliximab. We describe the onset of lower extremity paresthesia and foot drop in a patient who was receiving adalimumab for the treatment of psoriasis and examine the relationship of tumor necrosis factor antagonism and demyelinating disease. ( info) |
214/612. carpal tunnel syndrome and flexion contracture of the digits in a child with familial hypercholesterolaemia. This paper presents a 9 year-old girl who had flexion contracture of digits, carpal tunnel syndrome and multiple xanthomas covering the extremities. ( info) |
215/612. Injection injuries to the median and ulnar nerves at the wrist. carpal tunnel syndrome is often treated nonoperatively with temporary wrist immobilization and local steroid injections. A direct injection into a peripheral nerve can result in permanent damage. Two cases of median nerve injection injury and one involving the ulnar nerve are presented; all were treated with neurolysis and debridement of the injected material. At follow-up ranging from 1 to 11 years, all patients showed significant improvement, but with some functional loss. The literature is confusing because of the variety of injection techniques used for the treatment of carpal tunnel syndrome, some of which put the median nerve at risk. We recommend that the injection be made midway between the palmaris longus tendon and the flexor carpi ulnaris tendon just proximal to the proximal edge of the transverse carpal ligament in a line with the superficialis tendon of the ring finger. The injection should be stopped and redirected if the patient experiences paresthesia of any kind. ( info) |
216/612. Unexpected return of sensation following 4.5 years of paresthesia: case report. Neural damage leads to a transient or persistent alteration, depending on the severity or type of injury sustained. During the last decade, many investigators reported on paresthesia related to dental implants. In this case report, the patient had presented repeatedly with swelling and suppuration, showing typical signs of peri-implantitis. In addition, the implant was placed in proximity to the mental foramen and possibly had traumatized the mental nerve because the patient had had an altered sensation on his left side for the past 4.5 years. After removal of the implant, a significant diminishing of the paresthesia had occurred, described by the patient as a 40% improvement. Further improvement occurred at 6 and 9 months. In this case report, the findings differ from the current literature in that the return of sensation occurred following a prolonged state of paresthesia. This report documents 2 unique findings. First, an area of persistent paresthesia significantly improved 50 months after the initial injury, upon the removal of the offending implant. Second, the placement of another implant in the same vicinity did not result in recurrent paresthesia. ( info) |
217/612. Meralgia paresthetica after liver transplantation: a case report. The focal neuropathies after orthotropic liver transplantation (OLTx) have been well documented to date. Most injuries to the peripheral nervous system involve the peroneal nerve and brachial plexus. We report the first case of lateral femoral cutaneous nerve (LFCN) injury after OLTx. The patient presented with pain and numbness on the lateral aspect of the right thigh that had progressively worsened since operation. Electrodiagnostic studies were indicative for right meralgia paresthetica (MP). The symptoms of MP improved progressively after physical therapy applications during the first 3 months. The etiology of MP in this case is unclear. However, it may be considered that ascites, surgical mechanisms, and immunosuppressive therapy were possible causative factors. ( info) |
218/612. Somatization disorders in dermatology. This paper reviews a wide range of somatization-related symptoms that are encountered in dermatology. These include the unexplained cutaneous sensory syndromes especially the cutaneous dysesthesias associated with pain, numbness and pruritus; traumatic memories in post-traumatic stress disorder (PTSD) which are experienced on a sensory level as 'body memories' and may present as local or generalized pruritic states, urticaria and angioedema; and unexplained flushing reactions and profuse perspiration, in addition to unexplained exacerbations of stress-reactive dermatoses such as psoriasis and atopic eczema secondary to the autonomic hyperarousal in PTSD; classic 'pseudoneurologic' symptoms associated with dissociation including unexplained loss of touch or pain, in addition to the self-induced dermatoses such as dermatitis artefacta and trichotillomania that are encountered with dissociative states; and body dysmorphic disorder where the patient often presents with a somatic preoccupation involving the skin or hair. ( info) |
219/612. hemangioblastoma of the filum terminale. A 52-year-old man presented with low backache, paraesthesiae and spasticity of both lower limbs. He had urinary retention and constipation. Investigations revealed a vascular intradural cauda equina-conus tumor. MRI scan demonstrated an enhancing mass at the second and third lumbar vertebral levels. There were multiple dilated and tortuous veins draining from both poles of the tumor. Digital subtraction spinal angiogram showed the tumor to be supplied mainly by the radiculo-medullary artery from first lumbar artery and dural branches of the second and third lumbar arteries. At surgery, after pre-operative embolization, a well-defined tumor with an orange hue and fleshy consistency was encountered arising from the filum terminale. The tumor was excised en bloc. A sporadic hemangioblastoma arising from the filum terminale should be considered as a rare cause of back pain and sciatica. Total excision of the tumor offers cure. ( info) |
220/612. Allodynia in the flank after thalamic stroke. Lesions responsible for thalamic pain are often thought to involve the ventral posteromedial nucleus and ventral posterolateral nucleus of the thalamus. We describe two patients with allodynia and hyperpathia in the contralateral flank caused by a small lesion in the posteroventral part of the thalamus. When considered with the literature, involvement of the ventral posteroinferior nucleus may be responsible for this unique post-stroke pain syndrome. ( info) |