1/117. Sudden recurrent laryngeal nerve paralysis due to apoplexy of parathyroid adenoma.Neoplastic lesions of the parathyroid are rare, and most of these are adenomas. Even rarer is a secondary involvement of the recurrent laryngeal nerve. A case is presented of sudden onset hoarseness in a 64-year-old man caused by acute vocal cord paralysis due to bleeding within an adenoma of the lower right parathyroid gland. Acute onset of vocal cord paralysis is rarely associated with benign processes; the current case is only the second report associated with parathyroid adenoma.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/117. Pathological jealousy appearing after cerebrovascular infarction in a 25-year-old woman.OBJECTIVE: To report pathological jealousy (Othello syndrome) occurring in a young woman with a right hemisphere cerebrovascular infarction and to review diagnosis and possible organic mechanisms for the generation of this syndrome. CLINICAL PICTURE: A 20-year-old woman was admitted to hospital with a right hemisphere stroke associated with a history of severe migraine and the use of oral contraceptives. The patient made a good recovery with minimal neurological deficits but 5 years later developed the syndrome of morbid jealousy with depression and a near fatal overdose. TREATMENT AND OUTCOME: Morbid jealousy subsided, almost completely disappearing over a 6-week period of treatment with a selective serotonin re-uptake inhibitor (SSRI). CONCLUSIONS: case reports of the Othello syndrome and other content specific delusions following right hemisphere cerebrovascular infarction have appeared in geriatric psychiatry literature. The occurrence of a similar association in a young patient lends support to the suggestion of a causal relationship and has implications for diagnosis, clinical care and research.- - - - - - - - - - ranking = 0.0039006780399525keywords = organ (Clic here for more details about this article) |
3/117. hyperalgesia with reduced laser evoked potentials in neuropathic pain.Nociceptive evoked potentials to laser stimuli (LEPs) are able to detect lesions of pain and temperature pathways at peripheral, spinal and supraspinal levels. It is commonly accepted that LEP attenuation correlates with the loss of pain and temperature sensations, while pathological heat-pain hypersensitivity has been associated with increased LEP amplitude. Here we present two patients in whom increased pain sensation (hyperalgesia) to laser stimuli was, on the contrary, associated to delayed, desynchronized and attenuated LEPs. Both patients experienced increased unpleasantness and affective reactions to laser, associated to poor ability to localize the stimulus. In both cases the results may be explained by an overactivation of the 'medial pain system', in one patient due to deafferentation of cortical sensory areas by a capsular lesion, and in the other to imbalance between A-delta and C fiber excitation due to peripheral nerve injury. Our results suggest that LEPs, as currently recorded, reflect the activity of a 'lateral' pain system subserved by rapidly conducting fibers. They may therefore, assess the sensory and cognitive dimensions of pain, but may not index adequately the affective-emotional aspects of pain sensation conveyed by the 'medial' pain system. The dissociation between pain sensation and cortical EPs deserve to be added to the current semiology of LEPs, as the presence of abnormal pain to laser on the background of reduced LEPs substantiates the neuropathic nature of the pain.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
4/117. The experience of transition for a daughter caregiver of a stroke survivor.The purpose of this study was to describe the experience of transition for a daughter caregiver of a stroke survivor. A phenomenologic, longitudinal case study of a woman in her late twenties provided the means by which the lived experience of transition could be studied and understood. The eleven unstructured, audiotaped interviews took place approximately every two weeks over a six and a half month period. They began six weeks after her mother's stroke and lasted until three months after her mother returned home, when life became more organized and predictable for a time. The interviews were transcribed verbatim and analyzed according to a modified version of Colaizzi's descriptive phenomenologic methodology. Since there was a temporal consideration, a time-ordered matrix was used to identify themes over time. The themes that emerged over time included: (a) changing relationships, (b) becoming a caregiver then stepping back, (c) enduring emotional turbulence, (d) taking one day at a time and (e) struggling to hang onto hope. Integration of the themes provided an exhaustive description. The experience of transition was a process that involved disruptions in close relations and daily living. The connection to a network of relationships changed to disconnection, and the fabric of interrelated lives began to unravel. The many sensations experienced were different and conflicting, revealing a rapidly changing perception of the world. An unknown future threatened to become overwhelming. Focusing on the present helped to quell the turbulent sensations experienced. An unknown future temporarily provided the opportunity to hope that daily life could once again become familiar and comfortable. The extent and object of hope changed over time. A pattern of chaos exemplified the process of transition. The passage of time revealed that life as it was known before the transition had changed. A new way of being in the world was experienced.- - - - - - - - - - ranking = 0.0039006780399525keywords = organ (Clic here for more details about this article) |
5/117. organophosphate poisoning versus brainstem stroke.Two patients presented unconscious after deliberate organophosphate ingestion. Both were initially misdiagnosed as having brainstem stroke, and plans were made for withdrawing treatment within 24 hours. Once correctly diagnosed and appropriately treated, both recovered, illustrating the importance of considering a wide differential diagnosis before withdrawing support and of not relying on routine "drug screens" to detect organophosphates.- - - - - - - - - - ranking = 0.007801356079905keywords = organ (Clic here for more details about this article) |
6/117. Decreases in blood pressure and sympathetic nerve activity by microvascular decompression of the rostral ventrolateral medulla in essential hypertension.BACKGROUND: Neurovascular compression of the rostral ventrolateral medulla, a major center regulating sympathetic nerve activity, may be causally related to essential hypertension. Microvascular decompression of the rostral ventrolateral medulla decreases elevated blood pressure. CASE DESCRIPTION: A 47-year-old male essential hypertension patient with hemifacial nerve spasms exhibited neurovascular compression of the rostral ventrolateral medulla and facial nerve. Microvascular decompression of the rostral ventrolateral medulla successfully reduced blood pressure and plasma and urine norepinephrine levels, low-frequency to high-frequency ratio obtained by power spectral analysis, and muscle sympathetic nerve activity. CONCLUSIONS: This case suggests not only that reduction in blood pressure by microvascular decompression of the rostral ventrolateral medulla may be mediated by a decrease in sympathetic nerve activity but also that neurovascular compression of this area may be a cause of blood pressure elevation via increased sympathetic nerve activity.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
7/117. Neurofibromatosis, stroke and basilar impression. Case report.Neurofibromatosis type 1 (NF1) can virtually affect any organ, presenting most frequently with "cafe au lait" spots and neurofibromas. Vasculopathy is a known complication of NF1, but cerebrovascular disease is rare. We report the case of a 51-year-old man admitted to the hospital with a history of stroke four months before admission. On physical examination, he presented various "cafe au lait" spots and cutaneous neurofibromas. neurologic examination demonstrated right-sided facial paralysis, right-sided hemiplegia, and aphasia. Computed tomography scan of head showed hypodense areas in the basal ganglia and centrum semiovale. Radiographs of cranium and cervical spine showed basilar impression. angiography revealed complete occlusion of both vertebral and left internal carotid arteries, and partial stenosis of the right internal carotid artery. A large network of collateral vessels was present (moyamoya syndrome). It is an uncommon case of occlusive cerebrovascular disease associated with NF1, since most cases described in the literature are in young people, and tend to spare the posterior cerebral circulation. Basilar impression associated with this case may be considered a pure coincidence, but rare cases of basilar impression and NF1 have been described.- - - - - - - - - - ranking = 0.0039006780399525keywords = organ (Clic here for more details about this article) |
8/117. Vascular compression of the medulla oblongata by the vertebral artery: report of two cases.OBJECTIVE AND IMPORTANCE: Compression of the medulla oblongata by a tortuous vertebral artery is rare. We report two patients with this lesion who were treated with vascular decompression of the vertebral artery. CLINICAL PRESENTATION: A 36-year-old man developed right hemiparesis with lower cranial nerve deficits, and a 47-year-old man developed left lower cranial nerve deficits and left cerebellar dysfunction. In both patients, magnetic resonance imaging revealed a tortuous vertebral artery compressing the medulla oblongata. INTERVENTION: In both patients, the compressed medulla oblongata was treated by detaching the vertebral artery from the medulla oblongata, shifting it, and anchoring it to the nearby dura mater. Postoperatively, both patients are asymptomatic and have returned to their previous jobs. CONCLUSION: Although compression of the medulla oblongata by a tortuous vertebral artery is rare, it can cause brainstem dysfunction. magnetic resonance imaging clearly revealed the vascular compression in these patients. Surgical treatment was effective. The symptoms related to a tortuous vertebral artery and some techniques for surgical treatment are discussed. awareness of this rare lesion is necessary to ensure appropriate treatment.- - - - - - - - - - ranking = 0.4keywords = nerve (Clic here for more details about this article) |
9/117. gait analysis in stroke patients to assess treatments of foot-drop.By using the combined, computerized analysis of stroboscopic photography, pattern recognition devices, electromyography and foot switch outputs, gait patterns were studied in 15 stroke patients with foot-drop. Three patients were treated with a peroneal nerve stimulator for five weeks; six received intensive physical therapy; and six received both physical therapy and biofeedback training three times a week for five weeks. Each patient was examined at initial visit and after five weeks. Based upon case evaluations, both the patients with the stimulator treatment and those with biofeedback training showed and maintained improvement of gait pattern following the treatment period. This result suggests that the biofeedback and peroneal-stimulator technique may have a common mechanism that should be exploited in the rehabilitation of stroke patients.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
10/117. Snake bite presenting as acute myocardial infarction, ischaemic cerebrovascular accident, acute renal failure and disseminated intravascular coagulopathy.An unusual presentation of a viperine snake bite presenting with ischaemic damage to the major organs like brain and heart leading to cerebrovascular accident and acute myocardial infarction along with acute renal failure and disseminated intravascular coagulopathy (DIC) is described in this report.- - - - - - - - - - ranking = 0.0039006780399525keywords = organ (Clic here for more details about this article) |
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