1/39. Multifocal motor neuropathy and asymptomatic Hashimoto's thyroiditis: first report of an association.Motor neuropathy with multifocal conduction blocks represents a recently identified autoimmune disorder of the peripheral nerve myelin. association of motor neuropathies or neuronopathies with thyroid disorders, such as hyperthyroidism, hypothyroidism or thyroid neoplasms has been rarely described. We studied a 61-year-old man with a 2-year-history of slowly progressive weakness of the left limbs with atrophy and fasciculations. Nerve conduction velocity studies revealed multifocal motor conduction blocks. serum IgM titer of antibodies against GM1 was elevated (1:1280; n.v. up to 1:640). Thyroid studies were compatible with Hashimoto's thyroiditis. Therapy with high dose intravenous immunoglobulins was followed by a prompt clinical recovery. Then the disease assumed an intravenous immunoglobulins dependent course with a full clinical, but transient, recovery. This is the first observation of an association of multifocal motor neuropathy with high titers of GM1 and Hashimoto's thyroiditis and reinforces the multifocal motor neuropathy autoimmune origin as well as the repeated clinical recoveries after intravenous immunoglobulins. This case also suggests to deeply investigate the thyroid function in patients with multifocal motor neuropathy.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/39. Acute femoral neuropathy secondary to an iliacus muscle hematoma.We present a patient with a spontaneous iliacus muscle hematoma, appearing immediately after a minor physical maneuver, presenting with pain and femoral neuropathy initially evidenced by massive quadriceps muscle fasciculations. A magnetic resonance imaging (MRI) study of the pelvic area confirmed the diagnosis, showing a hematoma secondary to a partial muscle tear. The patient was managed conservatively, and the continuous muscle activity ceased in 3 days, with progressive improvement of the pain and weakness. The recovery was complete. femoral neuropathy is uncommon and usually due to compression from psoas muscle mass lesions of diverse nature, including hematomas. Usually subacute, femoral neuropathy may present acutely in cases of large or strategically placed compressive femoral nerve lesions, and may require surgical evacuation.The case presented herein is remarkable since the muscle hematoma appeared after a nonviolent maneuver, fasciculations were present at onset, and conservative management was sufficient for a full recovery.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/39. Myokymic discharges: prompt cessation following nerve root decompression during spine surgery.In surgical cases during which spine nerve roots are at risk, we have found it useful to monitor EMG from the muscles supplied by those roots. Mechanical irritation of a root results in muscle activity, whose amplified signals can be broadcast over a loudspeaker, providing immediate feedback to the surgeon that the root is being irritated. We report here on a patient undergoing spinal canal decompression and fusion following a burst fracture of the L5 vertebral body sustained five days previously. EMG was continuously monitored from the tibialis anterior (TA) and medial gastrocnemius (MG) muscle groups bilaterally. During the period leading up to decompression, myokymic discharges from the left TA muscle were observed, whereas the other 3 muscles monitored did not show such activity. These semi-rhythmic and repetitive discharges from the left TA ceased immediately following surgical removal of a bone fragment compressing the left L5 nerve root. This indicates that the site of axonal irritation was the nerve root, and that myokymic discharges secondary to acute axonal compression can cease immediately upon nerve root decompression.- - - - - - - - - - ranking = 8keywords = nerve (Clic here for more details about this article) |
4/39. Persistent idiopathic unilateral isolated hypoglossal nerve palsy: a case report.Isolated hypoglossal nerve palsy (IHNP) although a rare condition, has been previously reported. A literature review revealed that in most cases, IHNP indicates the presence of an intracranial or extracranial space occupying lesion, head and neck injury, vascular abnormality, infection, autoimmune disease or neuropathy. Reports of idiopathic cases are rare and the vast majority of IHNP are reversible. We report a case of persistent idiopathic unilateral hypoglossal nerve palsy, with an emphasis on the investigations necessary to be undertaken on presentation of such a lesion.- - - - - - - - - - ranking = 6keywords = nerve (Clic here for more details about this article) |
5/39. Usefulness of transcervical approach for surgical treatment of hypoglossal schwannoma with paraspinal extension: case report.BACKGROUND: Usefulness of transcervical approach to hypoglossal schwannoma with paraspinal extension is described herein. CASE DESCRIPTION: A 54-year-old woman presented with gradually worsening left hypoglossal nerve palsy. The findings were of a tumor lying in the left hypoglossal canal and paraspinal region and were consistent with hypoglossal schwannoma. Subtotal intracapsular removal of the tumor was performed via transcervical approach. The symptoms improved, and no additional symptoms were noted. CONCLUSION: The transcervical approach and intracapsular removal of the tumor under electrophysiological monitoring provided for successful minimally invasive surgery in this case of hypoglossal schwannoma.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/39. Monocular elevation weakness and ptosis: an oculomotor fascicular syndrome?The topographic arrangement of the fascicular portion of the oculomotor nerve in the midbrain is not known. A patient with infarction involving the lateral portion of the fascicle had isolated monocular elevation paresis and ptosis, suggesting that the fibers destined to the elevators of the eye and eyelid course laterally in the fascicle.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/39. role of macrophages in onion-bulb formation in localized hypertrophic mononeuritis (LHM).A unique pathogenetic process for onion-bulb (Ob) formation is disclosed with disclosed with immunohistochemistry and electron microscopy. biopsy of a swollen segment of tibial nerve from a 42 year-old white female histologically demonstrated diffuse and angiocentric lymphocytic infiltrate in both endo- and perineurium with occasional lymphofollicular formation. Extensive Ob formation of nerve fibers was most striking with or without associated lymphocytes. axis-cylinders were intact in the majority of Ob. Immunocytochemically, Ob are composed of alternately laminated leaflets of schwann cells (S100 ) and mononuclear macrophage (HAM56 /LeuMl /muramidase ) processes but no perineurial (EMA ) cells. Immunohistochemical evidence of antigen presentation (HLA-DR/LN3 /Ia ) was confined to macrophages. Electron microscopy insinuates that intricate interactions between macrophages and schwann cells exists. Putative inhibition of remyelination along with proliferation of schwann cells most probably is secondary to the effects of macrophages secretory products. No direct participation of B or T lymphocytes was detected in Ob. Thus, modified macrophages may emit a factor for concomitantly promoting proliferation of schwann cells and an enzyme for myelin breakdown. In addition, only a few macrophages could be detected in some Ob and could be easily overlooked or misinterpreted as "vacuolated fibroblasts", if no immunohistochemical correlation is made, as modified macrophages making the external leaflets of Ob are more vacuolated.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
8/39. Continuous muscle activity and distal spinal muscular atrophy.A young man presented with myokymias, cramp-like difficulty in muscle relaxation and peroneal atrophy. EMG studies revealed continuous muscle activity (CMA) manifested as grouped potentials and high frequency discharges. Sensory nerve conduction studies and sural nerve biopsy gave normal results, and he was thought to suffer from distal spinal muscular atrophy with CMA. This association suggests that the lower motor neuron may have an important role in the generation of the continuous muscle activity.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
9/39. Mistaken diagnoses in continuous muscle fiber activity of peripheral nerve origin.The syndrome of continuous muscle fiber activity of peripheral nerve origin has manifestations that resemble those of many other more common neurologic disorders during childhood and infancy. This similarity often leads to misdiagnosis when an adequate index of suspicion is not entertained and a comprehensive electromyographic examination is not performed. Two affected patients from 1 family are reported to illustrate the type of diagnostic errors that were made before the establishment of the correct diagnosis.- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
10/39. Facial myokymia in syringobulbia.A patient with a 2-year history of progressive ataxia and tingling in the right hand had prominent facial myokymia. magnetic resonance imaging revealed syringomyelia and syringobulbia. After successful syringosubarachnoid shunting, the patient died of massive pulmonary embolism. Postmortem examination revealed a syrinx involving the spinal cord and lower half of the medulla; neither the facial nucleus nor facial nerve fibers were directly involved. We hypothesize that interruption of aberrant corticobulbar fibers in the medulla produced disinhibition of a rhythmic neural generator in the facial nucleus.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
| | Next -> |