1/10. Meralgia paresthetica secondary to limb length discrepancy: case report.Meralgia paresthetica consists of pain and dysthesia in the lateral thigh caused by entrapment of the lateral femoral cutaneous nerve (L2-L3) underneath the inguinal ligament. Abdominal distension, tight clothing, and hip hyperextension are all described causes of this condition. To our knowledge this has never been attributed to a limb length discrepancy. We present a 51-year-old man with a long-standing history of right sided meralgia paresthetica. history and physical and radiological examination were unrewarding except that his left leg was shorter than the right by 2 cm. Nerve conduction studies of the lateral femoral cutaneous nerve on the left had a normal latency and amplitude but were absent on the right. To prove the hpothesis that the limb length discrepancy was responsible for the condition, a single subject study was performed. The presence or absence of pain and dysesthesia in the right thigh was the observed behavior. Intervention consisted of wearing a 1.5-cm lift in the left or right shoe for 2 weeks each with an intervening 2-week lift-free period. Pain was recorded on a numeric scale and numbness as being present or absent. There was continuing pain without and with the lift in the right shoe but no pain or numbness with the lift in left shoe. It was concluded that the limb length discrepancy was responsible for the meralgia paresthetica. Pertinent literature and possible pathomechanics are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. Superior orbital fissure syndrome: current management concepts.The superior orbital fissure syndrome is an uncommon complication of craniofacial fractures: middle-third facial fractures and lesions of the retrobulbar space. This article reviews the anatomy and etiology of the superior orbital fissure as it relates to pathophysiology and physical findings. Cases reported in the literature are reviewed, emphasizing diagnosis and established treatment options. Two cases are presented and their management discussed, including the use of pre- and postoperative steroids as an adjunct to standard fracture reduction and stabilization therapy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/10. Spinal osteochondromas in middle-aged to elderly patients.STUDY DESIGN: Three case reports of solitary spinal osteochondromas in middle-aged and elderly patients. OBJECTIVES: To describe the treatment of three rare cases of spinal osteochondromas in patients significantly older than the cases previously reported in the literature. SUMMARY OF BACKGROUND DATA: Osteochondromas arising in the vertebral column are considered rare. The mean age of clinical appearance is said to be in the second or third decade of life. methods: Clinical history, physical examinations, plain radiographs, magnetic resonance imaging, myelography, computed tomographic myelography, and histopathologic findings for each case were reviewed in conjunction with previous cases reported in the literature. RESULTS: Total removal of the tumor was effective in causing the symptoms to disappear. CONCLUSIONS: Spinal osteochondromas are rare and tend to appear in young adults. Three cases of spinal osteochondromas that were unusual in terms of age at clinical presentation and localization were reported, suggesting a continuous growth of the tumor beyond skeletal maturity.- - - - - - - - - - ranking = 10.023032620142keywords = physical examination, physical (Clic here for more details about this article) |
4/10. Severe interscapular pain and increased creatine kinase activity: the answer was in the ankles.Severe thoracic back pain with increased creatine kinase activity is a clinical presentation that suggests a variety of life threatening conditions. If initial examination is unrevealing, multiple diagnostic tests are usually performed attempting to identify the origin of the problem, sometimes neglecting apparently unrelated subtle physical findings. A patient is described in whom this was the initial presentation of a sensory demyelinating neuropathy, resulting in a diagnostic challenge. This case expands the differential diagnosis of severe thoracic back pain and increased creatine kinase activity, and illustrates the importance of physical examination in reaching a final diagnosis.- - - - - - - - - - ranking = 11.023032620142keywords = physical examination, physical (Clic here for more details about this article) |
5/10. Functional symptoms in neurology: case studies.In this series of case vignettes, the authors have emphasized that the diagnosis of functional symptoms should normally rest on the presence of positive evidence of the problem being functional rather than the absence of evidence of organic disease. In addition, practitioners should be prepared to make a functional diagnosis in a patient who also has evidence of disease. Misdiagnosis of functional symptoms occurs no more than for other neuro-logical and psychiatric disorders. The neurologist has an important role in being able to transmit the diagnosis in a way that will not offend the patient but will also facilitate recovery. The key elements of this explanation are making the patient feel believed and emphasizing potential reversibility. A multidisciplinary approach involving concurrent physical and psychological treatments is often recommended, although further study is required to determine the best approaches to explain and treat these conditions.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/10. Proposal for a standardized protocol for the systematic orofacial examination of patients with Hereditary Sensory Radicular Neuropathy.AIM: To apply a standardized protocol for the orofacial evaluation of two adult siblings (one male and one female) with Hereditary Sensory Radicular Neuropathy (HSRN) that presented with dental problems. SUMMARY: The systematic evaluation consisted of (a) clinical questionnaire; (b) radiographs [orthopantomography and computarized tomography (CT)]; (c) orofacial psychophysical tests (pain, thermal, mechanical and electrical sensation); and (d) histology of gingiva and pulp (optical and transmission electronic microscopy). The female patient had complete insensitivity to orofacial pain and partial facial heat sensitivity, and received dental treatment without anaesthesia or pain. She had a severe and painless jaw infection due to pulp necrosis in tooth 37. The male patient had partial insensitivity to orofacial pain and required anaesthesia for dental treatment. Histological examination of gingivae and pulpal tissue revealed an altered proportion of unmyelinated and myelinated sensory nerve fibres. KEY learning POINTS: * patients with HSRN may present with significant, silent dental disease. * A standard protocol is helpful when evaluating such patients. * If the opportunity arises, evaluation of pulp tissue may reveal an altered proportion of myelinated and unmyelinated nerve fibres. This may avoid the more estabilished sural nerve biopsy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/10. The Alcock syndrome: temporary penile insensitivity due to compression of the pudendal nerve within the Alcock canal.Penile insensitivity is a symptom commonly observed after traumatic or iatrogenic nerve lesions, or in association with neurological or vascular diseases. In contrast, we report 2 cases of intermittent genital hypesthesia that occurred in cyclists after long-term bicycle riding. Anatomical studies show that this condition was probably caused by an irritation of the pudendal nerve during its course through the Alcock canal as reported in the literature. No pathological findings were demonstrated on extensive physical examinations, medical history and all medical imagings (sonography of abdomen, prostate and testes, and magnetic resonance imaging of the pelvis and lumbar spine) as well as radiodiagnostics and Doppler sonography, nor was there evidence of other neurological disturbances. The symptoms in the 2 patients spontaneously resolved after 4 and 7 weeks, respectively, without specific medical therapy.- - - - - - - - - - ranking = 10.023032620142keywords = physical examination, physical (Clic here for more details about this article) |
8/10. Unilateral insensate macrodactyly secondary to tuberous sclerosis in a child.Primary localized gigantism of the hand is exceedingly rare and has been reported only twice in the literature. Both cases were associated with tuberous sclerosis in which the patients had normal sensation. In this case report, a very unusual combination of insensate and unilateral macrodactyly in a child with tuberous sclerosis is described using both physical and roentgenographic findings.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/10. Catamenial mononeuropathy and radiculopathy: a treatable neuropathic disorder.OBJECT: The aim of this study was to investigate the indications and treatment options in patients with lower-extremity neuropathies and radiculopathies caused by endometriosis. methods: The authors identified five patients whose symptoms included catamenial pain, weakness, and sensory loss involving the sciatic and femoral nerves and multiple lumbosacral nerve roots. Radiographic studies supported the diagnosis of catamenial neuropathy or radiculopathy, but definitive diagnosis depended on surgical and pathological examination. Treatment of symptoms, including physical therapy and a course of antiinflammatory or analgesic medication, was not helpful. patients responded favorably to hormonal therapy. laparoscopy or open exploration for extrapelvic lesions was performed for diagnosis or for treatment when hormone therapy failed. Pain and sensory symptoms responded well to therapy. Weakness improved, but never recovered completely. CONCLUSIONS: Catamenial neuropathy or radiculopathy should be considered when evaluating reproductive-age women with recurring focal neuropathic leg pain, weakness, and sensory loss.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. brown-sequard syndrome of the cervical spinal cord after chiropractic manipulation.We report a case of increased signal in the left hemicord at the C4 level on T2-weighted MR images after chiropractic manipulation, consistent with contusion. The patient displayed clinical features of brown-sequard syndrome, which stabilized with immobilization and steroids. Follow-up imaging showed decreased cord swelling with persistent increased signal. After physical therapy, the patient regained strength on the left side, with residual decreased sensation to pain involving the right arm.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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