1/20. femoral nerve palsy in hip replacement due to pelvic cement extrusion.We report a case in which cement protrusion into the pelvis led to a major complication. During reaming and preparation of the anterosuperior acetabulum, a bony defect resulted which made fixation of an uncemented cup impossible, and a cemented polyethylene cup was used instead. After surgery the patient suffered a complete loss of femoral nerve function. Postoperative x-rays and CTs showed that a huge mass of bone cement protruded into the pelvis in close proximity to the iliac vessels and the femoral nerve. This probably led to nerve damage during the cement's polymerisation process due to the heat.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/20. Fascicular torsion in the median nerve within the distal third of the upper arm: three cases of nontraumatic anterior interosseous nerve palsy.Three patients with nontraumatic anterior interosseous nerve palsy are presented. All patients also had paralysis of the pronator teres, flexor carpi radialis, and/or palmaris longus. One patient also had sensory disturbance and palsy of the thenar muscles. An hourglass-like constriction was seen within a 7-cm section of the nerve fascicles (2-9 cm proximal from the medial epicondyle of the humerus) in the median nerve trunk. All constrictions exhibited approximately 30 degrees of fascicular torsion. Because this nerve section is anatomically proximal to the branching point for the earlier mentioned motor branches and the anterior interosseous nerve, the nerve fascicles may have been structurally twisted before the onset of palsy. Structural abnormalities causing inflammation and edema of nerve fascicles as well as factors such as compression from surrounding small vessels may have maximized torsion, resulting in the formation of constrictions.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/20. Multiple bullae and paresis after drug-induced coma.Two cases of bullous skin lesions and paresis following coma due to the ingestion of many antipsychotic drugs were reported. Histological examination showed an intra-epidermal blister in case 1 and degeneration of sweat glands in both cases. An immunofluorescence study showed massive deposits of IgM and C3 in the dermal vessels. As similar deposits of immunoglobulin and complement were not observed in patients with ordinary lesions such as decubitus, a different mechanism in the formation of the bullous skin lesion other than pressure is suggested.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/20. Traumatic dissection of the internal maxillary artery associated with isolated glossopharyngeal nerve palsy: case report.OBJECTIVE AND IMPORTANCE: Spontaneous or traumatic dissection of the internal carotid artery with resultant lower cranial nerve palsies is well documented. However, dissection of the external carotid artery with lower cranial palsies has not been reported previously. CLINICAL PRESENTATION: A 42-year-old man experienced an epidural hematoma as the result of a fall and underwent a craniotomy and hematoma removal. Subsequently, he developed dysgeusia and difficulty in swallowing. brain magnetic resonance imaging showed a dilated linear structure, with isosignal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images. Strong enhancement was seen on postcontrast T1-weighted images, indicating a dissected internal maxillary artery. This was confirmed on selective angiography of the left common carotid artery. INTERVENTION: Guglielmi detachable coils were introduced into the false lumen of the dissected artery. Subsequently, 0.5 ml of glue mixed with Lipiodol (Lafayette Pharmacal, Lafayette, IN) was packed into the remnant of the false lumen. Repeat angiograms demonstrated complete occlusion of the dissected vessel. The patient's postoperative course was uneventful, and the neurological deficits gradually improved. CONCLUSION: We describe the first reported case of internal maxillary artery dissection and pseudoaneurysm presenting with isolated glossopharyngeal nerve palsy. The association between cranial nerve palsy and dissection of the external carotid artery branch may be the result of a compressive mechanism, as suggested by its anatomic relationships, the characteristics of the dissection, and the good prognosis. Endovascular embolization of the external carotid artery dissection and pseudoaneurysm is suggested as an effective therapeutic method for improving or alleviating neurological deficits produced by mass effect.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/20. Ischemic gastroparesis: resolution after revascularization.patients with chronic nausea and vomiting frequently present challenging diagnostic and therapeutic problems. In such patients, gastroparesis of unknown cause, or "idiopathic" gastroparesis, may be the only objective finding. Two middle-aged women with nausea, vomiting, and weight loss of 10 and 26 kg over 6 and 18 months, respectively, were evaluated. Routine laboratory and barium study results were normal. Solid-phase gastric emptying studies showed severe gastroparesis in both patients. Upper endoscopies excluded gastric outlet obstruction. Gastric dysrhythmias (4-cpm and 1-cpm patterns) were recorded using cutaneous electrodes. An abdominal bruit was ascultated in one patient. Abdominal arteriograms in both patients showed total occlusion of all three major mesenteric vessels with collaterals supplied via hemorrhoidal arteries. Bypass grafting procedures of the celiac and superior mesenteric arteries in one patient and of the celiac artery in the other patient were performed. Six months after mesenteric artery revascularization, upper gastrointestinal symptoms had resolved and original weights were regained. Furthermore, normal 3-cpm gastric myoelectrical activity and normal gastric emptying of solids were restored in both patients. In these patients, chronic mesenteric ischemia resulted in a novel and reversible cause of gastroparesis, gastric dysrhythmias, and accompanying symptoms.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/20. Complete infraclavicular brachial plexus palsy with occlusion of axillary vessels following anterior dislocation of the shoulder joint.Two cases of complete infraclavicular brachial plexus palsy after anterior dislocation of the shoulder joint are reported. Both patients had transient motor brachial plexus paralysis and extensive anesthesia of the whole upper limb. Additionally, one of them had occlusion of the axillary vessels. Vascular recovery occurred immediately after manipulation and reduction of the affected shoulder joint. Neurological recovery occurred 9 to 12 months later in both cases without surgery, other than closed reductions. Such neurological and vascular complications after anterior dislocation of the shoulder joint are unique.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
7/20. mobius syndrome and transposition of the great vessels.A case of mobius syndrome was associated with transposition of the aorta and pulmonary artery, as well as acheiria. This combination of anomalies supports the hypothesis that mobius syndrome is caused by an intrapartum insult during the fourth to seventh week of gestation and is consistent with the vascular theory of embryopathogenesis.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
8/20. Capsular infarcts: the underlying vascular lesions.In ten patients, 11 infarcts involving mainly the internal capsule have been examined pathologically. Serial sections of the involved basal ganglia were studied in ten infarcts and only a gross dissection was made in the other. The implicated penetrating arteries were traced throughout their length and obstructive vascular lesions were found in nine instances. In two of the nine there was an atheromatous plaque with a superimposed thrombus, in four an atheromatous plaque had caused severe stenosis, in one a destructive arterial process lipohyalinosis had occurred, in one case the nature of the obstruction remained "uncertained," and in one the penetrating arteries were obstructed at their orifices by an atheroma in the superior division of the middle cerebral artery. In two cases the vessels were patent, suggesting embolism. The atheromas consisted almost exclusively of a conglomerate of fat-filled macrophages. The clinical correlate was a pure motor hemiplegia or hemiparesis involving the face, arm, and leg without sensory deficit, homonymous hemianopia, receptive aphasia, or apractognosia. confusion was prominent in one patient.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/20. Vessel and nerve injuries complicating total hip arthroplasty.Arterial and neural damage following total hip replacement is not common. Three cases are reported. The first patient had an isolated femoral nerve damage. The second case developed a false aneurysm arising from the external iliac artery 2 months after hip surgery and the third patient sustained a tear of the external iliac artery during the operation. The nerve and vessel injuries were caused by retractors. In both patients with arterial damages a transitory femoral nerve involvement occurred. The prognosis was good in all patients. Preventive measures are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/20. Hypoglossal paralysis due to compression by a tortuous internal carotid artery in the neck.Severe hemiatrophy of the right half of the tongue in a 22 year old patient was demonstrated to be due to compression of the hypoglossal nerve by a tortuous internal carotid artery in the neck. The nerve was trapped between an abnormal loop of the internal carotid artery and the sternocleidomastoid branch of the occipital artery. Although impairment of cranial nerve function with cases of tortuous and dilated vessels has been reported frequently, twelfth nerve palsy has never been demonstrated before.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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