11/46. Posterior alien hand syndrome: case report and rehabilitative treatment.alien hand syndrome (AHS) is a rare syndrome characterized by involuntary, uncontrollable, and purposeless movement of one upper limb, which is considered as extraneous by the patient. The term AHS was previously used to describe a syndrome due to lesions in the anterior corpus callosum. Successively, some authors reported cases of AHS in patients due to posterior cerebral lesions, without lesions of the corpus callosum. Thus, it was possible to distinguish the posterior variant of AHS from the anterior form. The authors report an unusual case of posterior AHS due to a unique parieto-occipital lesion of the dominant hemisphere. However, the patient showed clinical findings that were similar to the anterior AHS. The rehabilitative treatment, individualized and targeted toward the specific needs of the patient, allowed the improvement of the patient's participation in activities of daily living.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
12/46. Closed partial rupture of a common digital nerve in the palm: a case report.Nerve injuries in the upper extremity after trauma are common. Typically nerve damage is the result of traction, crush injury, ischemic insult, or direct laceration of the peripheral nerve. Examination of the literature shows that nerve damage in closed traumatic injury is much less common than in open trauma, especially when this standard is applied to closed nerve injuries distal to the wrist. We report a case of closed partial neurotomy of a common digital nerve.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
13/46. Trigeminal neurinoma associated with Chiari malformation and syringomyelia.We report a 36 year-old woman who presented with headaches and hypoesthesia of the face. MRI revealed a large dumbbell shaped trigeminal neurinoma extending into both the middle and the posterior cranial fossae. In addition, there was a Chiari I malformation and syringomyelia. Within two months of tumor resection, both the Chiari malformation and the syringomyelia resolved. The association of an intracranial space-occupying lesion with Chiari malformation and syringomyelia is reviewed.- - - - - - - - - - ranking = 3.4879643274892keywords = headache (Clic here for more details about this article) |
14/46. Idiopathic spinal cord herniation causing progressive brown-sequard syndrome.We report a 59-year-old woman with a 2.5 year history of progressive loss of temperature sensation and dysesthesia in the right and weakness in the contralateral lower limb. magnetic resonance imaging (MRI) and computed tomography myelography of the spinal cord demonstrated transdural herniation and deformation of the spinal cord in the upper thoracic spine. The herniated part of the spinal cord was untethered and replaced, and the anterior dural defect was closed. At a clinical follow-up 3 months later, the motor and sensory functions were almost restored. MRI at this time showed disentanglement of spinal cord adherence.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
15/46. Cavernous malformation with hemorrhage of the conus medullaris and progressive sensory loss.Numerous studies have shown that cavernous malformations may be localized in almost every region of the brain as well as in the spinal cord. spinal cord cavernous malformations (SCCM) have been diagnosed more frequently since magnetic resonance imaging (MRI) has become more widely available. Most are asymptomatic but may present as a diagnostic challenge with diffuse symptoms ranging from mere sensory deficits to paraparesis possibly affecting both upper and lower motor neuron. A 29-year-old Arabian man was admitted to the hospital with a progressive sensory loss to light touch, pin prick and vibration of the right and in a lesser extent of the left leg without any association to a particular dermatome. He additionally presented with progressing paresthesias in both legs, unsteady gait and incipient bladder- and bowl incontinence starting approximately 1 week prior to admission. Spinal MRI showed a central, slightly lateralized intramedullary lesion 1 cm in diameter located within the conus medullaris that was suspicious for an intramedullary cavernous malformation. The lesion was accompanied by a perifocal edema and showed an inhomogeneous hypointense core on T2WI consistent with an acute cavernous hemorrhage. Treatment of symptomatic intramedullary cavernous angiomas should, if possible, consist of total surgical excision. It is essential to achieve complete removal during the first operation to avoid any residues that may lead to further bleeding.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
16/46. Histoid leprosy - unusual presentation.A 39-year-old man presented with a chronic nonhealing toe ulcer and multiple skin-colored papules on the back, arms, and knees. From an initial small erosion, the toe lesion ulcerated over a 1.5-year period, while the papules progressed over a 6-month period, first appearing on the back and then spreading to the arms and knees. The past medical and family history were non-contributory. Pertinent findings included the aforementioned well-defined, asymmetric, shiny papules (Fig. 1). There were multiple, discrete, erythematous, pedunculated, tumor-like masses of various sizes over the right thigh (Fig. 2) and a well-defined 4 cm x 3 cm ulcer on the second toe of the left foot, the floor of which was covered by necrotic slough. There was distal loss of sensation to temperature, touch, and pain. The greater auricular, ulnar, radial cutaneous and common peroneal nerves were thickened bilaterally, but non-tender. A clinical diagnosis of histoid leprosy was made. The differential diagnosis for the tumor-like thigh masses included dermatofibroma, neurofibroma, and Kaposi's sarcoma. The hemogram, liver/renal function tests, chest X-ray, and abdominal ultrasound were normal. Human immunodeficiency virus enzyme-linked immunosorbent assay (hiv ELISA) was negative. The ear lobe smear (ELS) for acid-fast bacilli showed a bacterial index (BI) of 6 [> 1000 organisms/oil immersion field (oif)] and a morphological index (MI) of 50%. The skin-colored papules on the back and the pedunculated masses showed a BI of 5 (100-1,000 organisms/oif) and an MI of 50%. The normal skin showed a BI of 4 (10-100 organisms/oif) and an MI of 5%. biopsy of the papules and pedunculated tumors showed a well-circumscribed area of the dermis packed with many acid-fast organisms and foamy macrophages, consistent with histoid leprosy (Fig. 3). Fite-Faraco stain demonstrated cells packed with lepra bacilli. A final diagnosis of lepromatous leprosy, histoid variant, was made. dapsone, clofazimine, rifampicin, and, later, ofloxacin were started.- - - - - - - - - - ranking = 1.5990378070459keywords = back (Clic here for more details about this article) |
17/46. Intramedullary endometriosis of the conus medullaris: case report.OBJECTIVE: Intraspinal endometriosis is an extremely rare condition with characteristic symptoms, including lower back pain that increases in severity during each menstrual cycle. methods: Here, we report a case of endometriosis involving the conus cauda region. This patient presented with acute deterioration secondary to hemorrhage. We also review the relevant literature. RESULTS: magnetic resonance imaging scans of the dorsolumbar region showed a mass lesion within the spinal canal at the L1-L2 level with evidence of acute hemorrhage. The patient underwent an emergency D12-L2 laminectomy and microdecompression of the lesion. The histological and immunohistochemical features were characteristic of intraspinal endometriosis. CONCLUSION: Intraspinal endometriosis must be recognized as a potential cause of periodic neurological signs and symptoms in young and middle-aged women.- - - - - - - - - - ranking = 3.0081746750286keywords = back pain, back (Clic here for more details about this article) |
18/46. Relationship between the anatomic and dermatomal levels of spinal cord tumors in the thoracic region.In neurologic examination of patients with a suspected compressive lesion at the thoracic region, the dermatomic level of sensory disturbance is the only index indicating the anatomic level of a lesion. Because spinal cord tumors usually are solitary compressive lesions, the relationship between the anatomic and dermatomic levels is conveniently examined. We examined the relationship between the highest dermatomic level of sensory disturbance and the anatomic level, axial location, and type of spinal cord tumors in the thoracic region in 19 patients (8 men and 11 women aged 27-78 years; 11 neurinomas, 7 meningiomas, 1 neurofibroma). The distribution of sensory disturbance was evaluated with 3-g Frey hair and 1-g pin-prick examinations. The dermatomic distribution of sensory disturbance was diagnosed according to the dermatome chart of Keegan and Garrett. The anatomic level and axial location of the tumor were highly related to the sensory disturbance. Eight of 12 tumors in which the dermatomic level of sensory disturbance was within one vertebral segment of the anatomic level were situated in the middle or lower thoracic region (T6-T10). All five tumors in which the dermatomic level was two or more vertebral segments away from the anatomic level were situated at the conus medullaris (T12) or upper thoracic region (T1-T5); the highest level of sensory disturbance was from 4 to 11 segments below the anatomic level of the tumor. In two patients with no sensory disturbance, the tumor was in the upper thoracic region (T5) and compressed the spinal cord from the dorsal side. When a spinal cord tumor at the thoracic region is suspected, imaging examinations should be performed sufficiently cranially.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
19/46. evoked potentials in a subject with a large-fibre sensory neuropathy below the neck.The results from experiments in various modalities of evoked potentials are described in a subject with a complete large peripheral neuropathy below the neck. He has no tactile or position sensitivity below that level, but has retained fatigue, pain, and temperature sensation. Percutaneous electrical stimulation of peripheral nerves led to scalp recorded evoked potentials with thresholds and propagation velocities compatible with conduction along A-delta peripheral pathways. CO2 laser evoked potentials were similar to those seen in controls, further support for intact A-delta peripheral fibres. movement-related cortical potentials (MRCPs) were recorded associated with active and passive movement of the middle finger. The former were normal, evidence that the termination of the MRCP is not dependent on peripheral feedback. By comparing passive MRCPs between controls and the subject it was possible to establish which parts of the potentials are visual and which are proprioceptive and to gain evidence of central reorganisation in the subject. Magnetic brain stimulation was used to show that the subject did not perceive induced movement, had a normal centrally originating silent period, and could focus his attention during real and imagined movement of the finger more successfully than could normal controls.- - - - - - - - - - ranking = 0.53301260234865keywords = back (Clic here for more details about this article) |
20/46. Case report: the role of arteriography in patients with isolated neurological deficit following a penetrating upper limb injury.Two cases are described of patients who presented with isolated neurological deficit following penetrating injury to the upper limb. Arteriography demonstrated brachial artery false aneurysm formation in each case. There are accepted indications for emergency angiography following stab wounds including pulse deficit, vascular bruit, expanding haematoma and hypotension with no obvious cause. Indirect indicators of vascular damage include proximity of the injury to an artery with no physical signs or isolated neurological deficit. These indications do have a significant association with concurrent arterial injury and should be investigated by elective angiography if the patient is haemodynamically stable.- - - - - - - - - - ranking = 5keywords = upper (Clic here for more details about this article) |
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