1/13. 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 = 1keywords = physical (Clic here for more details about this article) |
2/13. Functional improvement after physiotherapy with a continuous infusion of local anaesthetics in patients with complex regional pain syndrome.Three patients were referred to our pain clinic with evidence of complex regional pain syndrome in their extremities. Two presented at the atrophic stage with joint contractures. Multiple analgesics had been prescribed without long-lasting relief. Physiotherapy was required to improve physical activity but was severely limited by pain. We instituted local anaesthetic infusion with the possibility of self-supplementation to facilitate physiotherapy; two via brachial plexus catheters for hand pain and one via epidural catheter for knee pain. Although their resultant pain scores were variable after cessation of local anaesthetic infusion, all the affected joints exhibited marked improvement in range of movement. We propose that this technique is a useful option for patients in all stages of complex regional pain syndrome where the emphasis is now directed toward functional improvement.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/13. Management of spinal cord and cauda equina compression secondary to epidural metastatic disease in adults with malignant germ cell tumours.AIM: To review the management and clinical outcome of 10 patients, presenting to a single centre with symptoms and signs of spinal cord or cauda equina compression secondary to epidural metastatic disease from a testicular germ cell cancer. methods: Clinical data regarding presenting history, physical examination, staging investigations, treatment and clinical outcome were retrospectively obtained from patient records. RESULTS: Eight patients exhibited neurological deficits at the time of initial presentation of germ cell cancer or as a first manifestation of relapse following dog leg irradiation. Four of these cases were managed with chemotherapy alone, with excellent neurological recovery, whilst four underwent decompressive laminectomy--in three cases prior to referral and in one case after commencing chemotherapy. Five of the eight patients relapsed. Four required further chemotherapy (high dose in two cases). The remaining patient underwent thoracic surgery, with resection of teratoma differentiated. Six of the eight patients are currently alive and disease free. Two patients had chemorefractory disease and died, though one was treated in the pre-cisplatin era. Two patients presented with cord compression as a feature of disease relapse following chemotherapy, and were managed with radiotherapy alone in an attempt to achieve local disease control and limit neurological dysfunction. However, both subsequently died with progressive disease. CONCLUSION: Epidural spinal cord or cauda equina compression is a rare complication of metastatic germ cell cancer, which can be successfully managed in chemo-naive patients with good neurological outcome.- - - - - - - - - - ranking = 17.231945679012keywords = physical examination, physical (Clic here for more details about this article) |
4/13. Management of patients with schwannomatosis: report of six cases and review of the literature.BACKGROUND: Schwannomatosis is a rare tumor syndrome characterized by the presence of multiple schwannomas without the stigmata of neurofibromatosis (NF) Type 1 or 2. To better understand the natural history and clinical management of the syndrome, a retrospective review was conducted of patients diagnosed with schwannomatosis over an 11-year period at the University of pennsylvania Medical Center (UPMC). methods: Between 1990 and 2001, 131 patients underwent surgery for resection of spinal or peripheral nerve schwannomas in the Department of neurosurgery at the University of pennsylvania Medical Center. Among the 131 patients, there were 6 who had two or more pathologically proven schwannomas without radiographic or clinical evidence of vestibular schwannomas. The hospital charts, clinic notes, radiology films, operative reports, pathology slides, and reports from all 6 patients were retrospectively reviewed. RESULTS: The patient population consisted of 6 patients with a mean age of 48.7 (3 male: 3 female). All patients had enhanced brain magnetic resonance imaging (MRI) scans that were negative for vestibular schwannomas. Ophthalmological and general physical examinations did not reveal any findings suggestive of NF. There was no family history of NF or schwannomatosis. The locations of the schwannomas included intraspinal (multiple sites), paraspinal, brachial plexus, femoral nerve, sciatic nerve, calf, forearm, retroperitoneum, and middle cranial/infratemporal fossa region. The common presenting symptoms included paresthesias, palpable mass, pain, or weakness. All 6 patients underwent surgical resection of symptomatic lesions. CONCLUSIONS: For patients with schwannomatosis, surgery is indicated for symptomatic lesions, while asymptomatic tumors are followed conservatively. Because these patients are at increased risk for developing multiple schwannomas, we recommend regular surveillance and offer genetic counseling even though the pattern of inheritance is unknown.- - - - - - - - - - ranking = 17.231945679012keywords = physical examination, physical (Clic here for more details about this article) |
5/13. Iatrogenic Horner's syndrome.PURPOSE: To report two cases of Horner's syndrome. One presented after the ablation of a schwannoma of the cervical sympathetic chain, the second after upper thorascopic sympathectomy for primary palmar hyperhidrosis. methods: A 42-year-old man underwent excision of a left neck mass found during routine physical examination. A 20-year-old girl with axillary and palmar hyperhidrosis was treated with cervical sympathectomy. RESULTS: In the early postoperative days, miosis, ptosis, anhidrosis, and enophthalmos were observed. CONCLUSIONS: In the ablation of a schwannoma, postoperative Horner's syndrome is associated with the relationship between nerves and the tumor mass, which makes it impossible to separate them surgically in most cases. In thorascopic sympathectomy, patients should be warned of this complication.- - - - - - - - - - ranking = 17.231945679012keywords = physical examination, physical (Clic here for more details about this article) |
6/13. sciatica in a patient with unusual peripheral nerve sheath tumors.BACKGROUND: Other causes such as peripheral schwannomas can mimic lumbar disk disease. CASE DESCRIPTION: We present an unusual case of multiple nerve sheath tumors in a patient with left radicular leg pain accompanied by a Tinel sign. Initial lumbar MR imaging revealed a mass in the right lumbar plexus, side opposite the patient's symptoms. Magnetic resonance neurography subsequently revealed a compressive mass of the sciatic nerve proximal to the popliteal fossa, histologically identified as a schwannoma. CONCLUSION: This case emphasizes the importance of continued investigation when the radiographic findings do not correlate with the patient's history in the presence of localizing signs on physical examination.- - - - - - - - - - ranking = 17.231945679012keywords = physical examination, physical (Clic here for more details about this article) |
7/13. Malignant schwannoma.This paper reports a patient suffering from a malignant peripheral nerve sheath tumor, also known as a Schwannoma or neurilemoma. The patient demonstrated an increase in left thigh circumference, without apparent trauma. The report establishes the relationship of the lack of trauma and relatively mild symptomatology with malignant conditions, as well as the need for chiropractors to do thorough history, physical and radiological examinations. A brief review of pathophysiology and incidence is given.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/13. Ultrastructural diagnosis of facial nerve schwannoma using fine needle aspiration.In a 14-year-old boy presenting with left facial nerve paralysis, physical examination revealed a soft, round mass in the floor of the left external auditory canal. A fine needle aspiration biopsy was performed to obtain material for light and electron microscopy. Several small groups of uniform, spindle-shaped neoplastic cells were present on the slides; a malignant mesenchymal tumor was considered, but a definite diagnosis could not be established under light microscopy. The ultrastructural examination revealed spindle-shaped and stellate cells with multiple parallel cytoplasmic processes lined with a well-developed basal lamina; these features are highly characteristic of a benign schwannoma.- - - - - - - - - - ranking = 17.231945679012keywords = physical examination, physical (Clic here for more details about this article) |
9/13. Cephalgia secondary to neuroma in a patient with ankylosing spondylitis: a case report.A case is presented in which a 26-year-old male with intermittent headaches of many years duration, presents to the Arlington chiropractic Clinic for evaluation and therapy. Routine palpation of the painful area reveals a small mass in the region of the greater occipital nerve. Microscopic examination of the tumor after surgical removal suggests neuroma formation. Headaches did not recur. This patient also experienced exacerbations and remissions of vague low back pain with no radiation. A sacroiliitis was both clinically and radiographically evident. These findings, a positive HLA B27 and the consistent symptom complex allowed a diagnosis of ankylosing spondylitis to be ascertained. It is concluded that palpation of the painful area is a vital portion of the physical examination and must be included in all evaluations. This case also demonstrates that the diagnosis of one problem does not preclude the presence of others. When one condition is diagnosed and therapy is instituted, diagnostic suspicion must not be relaxed.- - - - - - - - - - ranking = 17.231945679012keywords = physical examination, physical (Clic here for more details about this article) |
10/13. breast cancer recurrence in a patient with a previous history of radiation injury of the brachial plexus: a case report.brachial plexus injury with resultant pain and attendant impairment may occur in cancer patients from either disease recurrence or as a consequence of radiation therapy. Distinguishing between these two causes of plexus dysfunction may be difficult, but physical findings and appropriate workup may assist in diagnosis. Additionally, lymphedema may be seen as a result of surgical, radiation, or combination therapy for breast cancer. patients typically present with arm swelling, but neurological impairment, including pain, may also be noted. This case report describes an individual who developed pain and weakness, initially from radiation injury, and later developed local disease recurrence.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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