Cases reported "Sensation Disorders"

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1/46. Phantom erection after amputation of penis. Case description and review of the relevant literature on phantoms.

    BACKGROUND: perception of a phantom limb is frequent after an amputation of an upper or lower extremity. Phantom penis is reported infrequently. METHOD: Case description and literature review. RESULT: The phenomenon of phantom penis followed total penectomy. Several aspects were unusual, particularly the existence with phantom only in the erect state, and associated recrudescence of a preoperative painful ulcer. General features of limb phantoms after amputation are reviewed including a resume of recent studies of cortical reorganization. The phantom process is analyzed looking for clues to the nature of the underlying neural organization. The puzzle of phantom pain is briefly touched on. CONCLUSION: The development of the phantom is attributed to activity in the deafferented parietal sensory cortex.
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2/46. Multisystem neuronal involvement and sicca complex: broadening the spectrum of complications.

    We report two patients with multisystem neuronal involvement associated with sicca complex. One had a lower motor neuron syndrome combined with a flaccid bladder and rectum. The second patient had unilateral hearing loss, sensory neuronopathy, Adie's pupils, upper motor neuron signs, and autopsy-proven anterior horn cell degeneration. Our cases lead us to propose that the spectrum of neuronal involvement occurring with sicca syndrome may be wider than is currently appreciated.
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3/46. A new ambulatory foot pressure device for patients with sensory impairment. A system for continuous measurement of plantar pressure and a feed-back alarm.

    Abnormal and excessive plantar pressure is a major risk factor for the development of foot ulcers in patients with loss of protective pain sensation. Repeated pressure with each step can result in inflammation at specific points, followed by ulcer formation. patients with peripheral nerve disease are unable to prevent the development of such lesions, which often lead to amputation. For this reason, it has been suggested that a fundamental therapeutic intervention should be the reduction of high plantar pressure. We have developed a portable, battery-operated ambulatory foot pressure device (AFPD) which has two important functions: (1) to determine the areas of high plantar pressure, and (2) to provide an acoustic alarm, adjusted to a specific pressure load, which is triggered when weight-bearing exceeds the predetermined plantar pressure. A memory of plantar pressure parameters allows for downloading of the data and sequential analysis during the investigation period. Such an alarm device could replace the lack of pain sensation and may play an important role in the prevention of ulcer development and lower extremity amputation.
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4/46. Transient vestibular balance dysfunction after primary blast injury.

    Explosive munitions are used routinely in support of military operations. Moreover, service personnel are increasingly being deployed to regions where active conflict, terrorism, and land mines pose significant threats. Despite aggressive protective measures and safety practices, blast injury is an inherent risk. In contrast to secondary and tertiary blast injuries, primary blast injuries are generally limited to the air-filled organs of the respiratory, gastrointestinal, and auditory systems. We report the case of a Marine who entered the back-blast arc of a shoulder-launched multipurpose assault weapon at close range. Despite the magnitude of the blast, he sustained none of the classic findings suggestive of severe primary blast injury. However, he manifested unique vestibular balance abnormalities that precluded his return to full duty for several months. This suggests that personnel who sustain even a mild traumatic brain injury with vestibular manifestations may need prolonged observation and modified duty in certain military occupational specialties.
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5/46. Referred sensations following stroke.

    Referred sensations are recognized as phenomena experienced after amputation of a limb and have been used as proof of the consequences of changes in somatosensory body part representation in the adult brain. Such changes may accompany interruption of afferent sensory projections after subcortical stroke. This report describes some misplaced localization to touch in a subject 15 months after cerebral haemorrhage involving the posterior limb of the right internal capsule and lateral thalamus. The results revealed the occurrence of referred sensations, indicating some scrambling of the somatosensory representation of the affected limbs. While many stimuli were localized correctly, there were a number of stimuli applied to the hand and foot that were referred to more proximal limb segments. Stimuli to the upper arm were sometimes felt in more distal parts of the limb. Stimuli to the face were localized to the arm and not the hand. With the aim of determining consistency of findings, testing of the upper limb was carried out on four separate occasions. The subject had less referred sensations in each test, possibly indicating some change in his somatosensory representation that occurred with experience.
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6/46. Peripheral mechanisms in tremor after traumatic neck injury.

    tremor is a rare manifestation after neck injury, and its physiological mechanism has not been elucidated. We studied the effects of torque loading and ischaemic nerve block on coarse postural tremor in the right upper extremity, which had developed in association with a C7-C8 radiculopathy after traumatic neck injury in a 55 year old man. Loading reduced the tremor frequency from 6.1 Hz to 4.2 Hz with corresponding electromyography (EMG) bursts at the same frequencies as the tremor. Ischaemic nerve block also reduced the tremor frequency from 6.2 Hz to 2.8 Hz, and the time course of the frequency was not in parallel with that of the size of the maximal M wave. A significant reduction of the tremor frequency by loading and ischaemic nerve block indicates a mechanical reflex mechanism underlying the tremor, and association of synchronous EMG bursts suggests an increase in gain in the stretch reflex loop. The stretch reflex loop plays an important role in generation of oscillation in tremor after neck injury.
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7/46. Early use of artificial sensibility to improve sensory recovery after repair of the median and ulnar nerve.

    Artificial sensibility based on use of a "tactile glove" which substitutes for lack of sensory afferent inflow with acoustic feedback, was used early after repair of the median and ulnar nerves in a 21-year-old man. After six and 12 months the functional outcome exceeded what is expected in adults, and analysis with calculations for the minimal detectable change (MDC) in tactile gnosis showed a true change. This case highlights the timing of sensory re-education after nerve repair and also emphasises the importance of early restitution of afferent inflow from a denervated hand during rehabilitation.
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8/46. dialysis disequilibrium: another reversible posterior leukoencephalopathy syndrome?

    dialysis disequilibrium syndrome is a disorder of the central nervous system in patients on dialysis. The underlying etiology is thought to be primarily due to cerebral edema; however, neuroradiologic findings have not been described previously. We describe a patient who presented with new onset headaches and status epilepticus after beginning hemodialysis. Her neuroimaging studies revealed white matter changes in the posterior parietal and occipital lobes similar to those seen in patients with reversible posterior leukoencephalopathy syndrome (RPLS). This case suggests that dialysis disequilibrium syndrome and RPLS may represent a spectrum of disorders in which the underlying mechanism is vasogenic edema.
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9/46. Multifocal acquired demyelinating sensory and motor neuropathy: report of a case and review of the literature.

    Multifocal acquired demyelinating sensory and motor (MADSAM) neuropathy is characterized by an asymmetric multifocal pattern of motor and sensory loss, and conduction block and other features of demyelination in nerve conduction studies. MADSAM neuropathy needs to be differentiated from chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). In classic CIDP, there are symmetric proximal and distal weakness, sensory deficit in both upper and lower extremities and reduced deep tendon reflex. In MMN, limb weakness without sensory loss is asymmetric in the distribution of individual peripheral nerves and the weakness typically begins in the distal upper extremities. We report one patient with chronic progression of asymmetric numbness and weakness in four extremities. MADSAM neuropathy was diagnosed after extensive clinical and laboratory evaluations. It is very important to distinguish between CIDP, MADSAM neuropathy, and MMN by clinical, laboratory, and histological features because of different effective therapeutic strategies.
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10/46. Physiotherapy for pusher behaviour in a patient with post-stroke hemiplegia.

    OBJECTIVE: This case report describes a specific, literature-based physiotherapy treatment and the outcome for a stroke patient with pusher behaviour. Pusher behaviour is characterized by pushing strongly towards the hemiplegic side in all positions and resisting any attempt at passive correction of posture to bring the weight towards or over the midline of the body. methods: The patient was a 71-year-old man with clear pusher behaviour due to a stroke. Therapy for the pushing behaviour was performed over a 3-week period. Motor function, mobility, disability, tone anomalies and pusher behaviour were assessed before and after the study period. Immediate effects of a single training session were assessed by clinical observation. RESULTS AND CONCLUSION: Immediate effects on the pusher behaviour were observed when using visual and auditory feedback, but not when somatosensory input was used. These results were not maintained to the end of the treatment period. Treatment makes the patient able to use compensatory strategies for functional activities. The long-term effects should be investigated in more depth in the future.
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