1/33. Spinal subarachnoid hemorrhage attributable to schwannoma of the cauda equina.BACKGROUND: cauda equina syndrome occurring as a result of spontaneous spinal subarachnoid hemorrhage (SAH) from a spinal tumor is reported to be rare. CASE DESCRIPTION: A 28-year-old woman presented at our clinic with a history of severe back pain for 10 days, progressive paraparesis, and urinary retention. Her physical examination revealed a mass located intradurally at the level of L1-2 and a massive SAH. An L1-L2, laminectomy and a hemilaminectomy from D9 to D12 were performed and the SAH was evacuated and the cord was decompressed. CONCLUSION: At the first year follow-up, her restricted dorsal and plantar flexion continued. Post-gadolinium magnetic resonance imaging revealed no mass.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/33. Pathologic causes of the superior oblique click syndrome.PURPOSE: To describe the clinical features in two patients with superior oblique click syndrome and the pathologic causes of their symptoms. DESIGN: Two observational case reports. PARTICIPANTS: Two patients. methods: The clinical histories, results of physical examinations, treatment, and pathologic findings in two patients with superior oblique click syndrome are reviewed and analyzed with reference to the literature. MAIN OUTCOME MEASURES: Relief of symptoms. RESULTS: Both patients were operated on; one was found to have a schwannoma and the other a giant cell tumor of tendon sheath as causes of their symptoms. Symptoms were relieved by removal of the lesions and have not recurred. CONCLUSION: Definite pathologic lesions may cause the superior oblique click syndrome.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/33. Cutaneous-evoked tinnitus. I. Phenomenology, psychophysics and functional imaging.DC00166e and acute unilateral deafferentation of the auditory periphery (auditory and vestibular afferents) can induce changes in the central nervous system that may result in unique forms of tinnitus. These tinnitus perceptions can be controlled (turned on and off) or modulated (changed in pitch or loudness) by performing certain overt behaviors in other sensory/motor systems. Clinical reports from our laboratory and several other independent sources indicate that static change in eye gaze, from a neutral head-referenced position, is one such behavior that can evoke, modulate and/or suppress these phantom auditory events. This report deals with a new clinical entity and a form of tinnitus that can be evoked directly by cutaneous stimulation of the upper hand and fingertip regions. In 2 adults, cutaneous-evoked tinnitus was reported following neurosurgery for space-occupying lesions at the base of the skull and posterior craniofossa, where hearing and vestibular functions were lost completely and acutely in one ear (unilateral deafferentation) and facial nerve paralysis (unilateral deefferentation) was present either immediately following neurosurgery or had occurred as a delayed-onset event. Herein, we focus on the phenomenology of this discovery, provide perceptual correlates using contemporary psychophysical methods and document in one individual cutaneous-evoked tinnitus-related neural activity using functional magnetic resonance imaging. In a companion paper, neuroanatomical and physiological interactions between auditory and somatosensory systems, possible mechanistic accounts and relevant functional neuroimaging studies are reviewed.- - - - - - - - - - ranking = 0.072700296735905keywords = physical (Clic here for more details about this article) |
4/33. Unsuspected intravestibular schwannoma.The intravestibular schwannoma is physically minute and will often elude preoperative diagnosis. From time to time, such a tumor will be unexpectedly encountered during transcanal labyrinthectomy. A review of pathologic and surgical literature suggests that the lesion can be well managed by the transcanal route. A standard labyrinthectomy may be sufficient, but the translabyrinthine approach may be necessary for more extensive tumors.- - - - - - - - - - ranking = 0.072700296735905keywords = physical (Clic here for more details about this article) |
5/33. Fine-needle aspiration diagnosis of psammomatous melanotic schwannoma.A 51-yr-old male presented with an 8-mo history of lower back pain. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) studies showed a 3.5 X 3.0 cm sacral mass within the spinal canal in the region of the left S2 nerve root. A fine-needle aspirate biopsy (FNAB) was performed under CT guidance. The cytologic findings included a spindle-cell population with a fibrillary background arranged in a vaguely streaming pattern, wavy nuclei with mild atypia, wispy cytoplasm, rare intranuclear inclusions, and dilated vascular spaces. Some cells contained a nonrefractile granular brown pigment consistent with melanin. Also identified were calcified concentric laminations typical of psammoma bodies. Immunohistochemically, the neoplastic cells were strongly immunoreactive for S-100 protein and HMB-45. A diagnosis of psammomatous melanotic schwannoma was rendered. No stigmata of Carney's complex were identified on physical examination. The patient has declined the recommendation of surgical excision of the mass. We herein describe a case unequivocally diagnosed as psammomatous melanotic schwannoma by FNAB.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/33. neurilemmoma arising in the brachial plexus in association with breast cancer: report of case.A 48-year-old woman without von Recklinghausen's disease presented to our department for investigation of a left breast lump and a lump in the left axilla. A presumptive diagnosis of left breast cancer with axillary lymph node involvement was made based on the findings of physical examination and needle biopsy of the left breast lump. However, on exploration we discovered that the axillary lump was a neurogenic tumor arising in the brachial plexus. Enucleation of the neurogenic tumor, which was subsequently histologically confirmed as neurilemmoma, as well as a modified radical mastectomy, was performed. Postoperatively, the patient experienced slight numbness in her left second and third fingers, but this symptom improved within 5 months. When last seen 21 months after her operation, there were no signs of recurrence of either the breast cancer or the neurilemmoma.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/33. Mediastinal neurilemmoma complicated with spinal subarachnoid hemorrhage.A 28-year-old woman suffered severe back pain and headache during exercising on three occasions during the prior two-month period. On admission, the physical examination revealed symptoms of meningeal irritation, nuchal rigidity, severe headache, continuous nausea, and vomiting. Cerebral computed tomography of the intracranial subarachnoidal space revealed no subarachnoid hemorrhage. Her cerebrospinal fluid was bloody. Spinal magnetic resonance imaging identified a posterior mediastinal tumor adherent to the left side of the 5th thoracic vertebra and an abnormally expanded blood vessel near the mediastinal tumor. In addition, a high signal intensity lesion appeared to be present on the surface of the spinal cord. A mediastinal neoplasm was removed through standard thoracotomy. During surgery, marked enlargement was noted in some veins (hemiazygos and 5th intercostal veins) which apparently had been constricted by the mediastinal tumor. Surgical and radiological findings suggested a relationship between the constricted venous return due to the tumor and the patient's spinal subarachnoid hemorrhage.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/33. Presacral schwannoma with purely cystic form.STUDY DESIGN: Case report. OBJECTIVE: To point out that presacral schwannoma can display markedly cystic degeneration. SUMMARY OF BACKGROUND DATA: Benign schwannoma sometimes displays degenerative changes, such as cyst formation, calcification, hemorrhage, and hyalinization. Usually these degenerations are partially seen in the tumors. methods: Medical history, physical findings, imaging features, and histologic findings were reviewed in a case with a large presacral schwannoma. RESULTS: A 62-year-old woman presented with an 18-month history of right sciatic pain. Magnetic resonance images detected a large cystic, presacral tumor. Initially the tumor was misdiagnosed as a cystic ovarian tumor. Preoperative diagnostic workup led to the diagnosis of cystic schwannoma. Intralesional curettage achieved good pain relief. CONCLUSIONS: This tumor was unusual in its totally cystic appearance and resemblance to a cystic ovarian tumor or anterior sacral meningocele. Preoperative diagnosis is important to prevent major neurologic deficit at surgery.- - - - - - - - - - ranking = 0.072700296735905keywords = physical (Clic here for more details about this article) |
9/33. A case of multiple schwannomas of the trigeminal nerves, acoustic nerves, lower cranial nerves, brachial plexuses and spinal canal: schwannomatosis or neurofibromatosis?In most cases, while schwannoma is sporadically manifested as a single benign neoplasm, the presence of multiple schwannomas in one patient is usually indicative of neurofibromatosis 2. However, several recent reports have suggested that schwannomatosis itself may also be a distinct clinical entity. This study examines an extremely rare case of probable schwannomatosis associated with intracranial, intraspinal and peripheral involvements. A 63-year-old woman presented with a seven-year history of palpable lumps on both sides of the supraclavicular area and hearing impairment in both ears. On physical examination, no skin manifestations were evident. Facial sensory change, deafness in the left ear and decreased gag reflex were revealed by neurological examination. magnetic resonance imaging revealed multiple lesions of the trigeminal nerves, acoustic nerves, lower cranial nerves, spinal accessory nerve, brachial plexuses, and spinal nerves. Pathological examination of tumors from the bilateral brachial plexuses, the spinal nerve in the T8 spinal position and the neck mass revealed benign schwannomas. Following is this patient case report of multiple schwannomas presenting with no skin manifestations of neurofibromatosis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/33. July 2002: 66-year-old female with a one-year history of progressive left proptosis.The July 2002 Case of the Month (COM). This 66-year-old Caucasian female presented with gradually increasing protrusion of her left eye over a one-year period. She complained of increased tearing and foreign body sensation. The physical examination revealed a visual acuity of 20/20, normal color testing, full vision field with motility of her left eye limited in lateral gaze. Pupils were round, symmetric, with no afferent pupillary defect noted. On external examination, her left eye was grossly proptotic with resistance to retropulsion. She had 4 mm proptosis of the left eye. Computed tomography and MR imaging demonstrated a left retro-orbital mass with gadolinium enhancement and focal remodeling of orbital bones. She underwent surgical resection of tumor with a diagnosis of solitary fibrous tumor, and postoperatively she was symptom free. The histopathological differential diagnoses of spindle cell neoplasms of the orbit are discussed. Five months after surgery, no evidence of tumor recurrence was seen on neuroimaging and her vision was 20/20.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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