1/37. Chronic axonal sensory and autonomic polyneuropathy without motor involvement: a new 'chronic inflammatory neuropathy?'.We report the case of a woman with axonal sensory and autonomic neuropathy lasting several months who improved in association with steroid administration. During the course of her disease and in the follow-up, the patient underwent repeated cerebrospinal fluid (CSF) examinations, neurophysiological somatic, autonomic nervous system studies and sural nerve biopsy. Clinical and laboratory assessments demonstrated the occurrence of a monophasic, chronic sensory and autonomic neuropathy. A sural nerve biopsy suggested an axonopathy. After a progressive worsening of symptoms lasting about 6 months, steroid treatment was started and within 6 months a complete recovery, with normalization of the CSF findings, was observed. Although the 'chronic inflammatory neuropathies' are still debated entities, the features of this chronic, exclusively sensory and autonomic neuropathy are new, and the occurrence of a high protein level in the CSF, together with the favorable outcome associated with steroid treatment, suggests that our case might be another variant in this debated area.- - - - - - - - - - ranking = 1keywords = nervous system (Clic here for more details about this article) |
2/37. Minimally invasive stereotactically-guided extirpation of brain stem cavernoma with the aid of electrophysiological methods.The surgical extirpation of brain stem cavernomas always includes a risk of neurological deficits. To minimize the risk of deficits and control the motor and sensory function intraoperative monitoring of SEP and MEP seems to be helpful. The high density of motor and sensory fibers within the brain stem makes bilateral intraoperative monitoring necessary. The following case demonstrates a stereotactically-guided supratentorial, transventricular approach for extirpation of a brain stem cavernoma. Sensory and motoric functions were observed by transcranial recording of SEP's and by transcranial stimulation of motor cortex.- - - - - - - - - - ranking = 10.985324266826keywords = brain (Clic here for more details about this article) |
3/37. electrodiagnosis in spinal cord injured persons with new weakness or sensory loss: central and peripheral etiologies.OBJECTIVE: To assess the prevalence and causes of late neurologic decline of persons with spinal cord injury (SCI). DESIGN: Retrospective review of persons with SCI over a 9-year period. Those with complaints of new weakness or sensory loss were grouped into three categories based on clinical examination, electrodiagnosis, and imaging: (1) central pathology (ie, brain, spinal cord, or nerve root); (2) peripheral pathology (plexus or peripheral nerve); or (3) no identifiable etiology. The specific diagnoses of late neurologic decline were identified. SETTING: Regional veterans Affairs spinal cord Injury Service. patients: Five hundred two inpatient and outpatient adults with SCI. RESULTS: Nineteen percent of the study population complained of new weakness and/or sensory loss. Neurologic abnormalities were noted in 13.5%, 7.2% with central and 6.4% with peripheral causes. The most common pathologies were posttraumatic syringomyelia (2.4%) and cervical (1.6%) and lumbosacral (1.2%) myelopathy/radiculopathy. A specific etiology was not determined in 6 cases (1.6%). Peripheral involvement was mostly from ulnar nerve entrapment (3.4%) and carpal tunnel syndrome (3.0%). CONCLUSIONS: Late-onset neurologic decline is common after SCI and can result from central or peripheral pathology. Regular neurologic monitoring of SCI patients is recommended, since many with neurologic decline respond favorably if diagnosed and treated early.- - - - - - - - - - ranking = 1.569332038118keywords = brain (Clic here for more details about this article) |
4/37. Acute mercury vapour poisoning in a shipyard worker--a case report.Acute mercury vapour poisoning is a serious, potentially fatal but fortunately rarely encountered problem. It is most commonly due to industrial accidents. The vapour is a direct respiratory tract irritant as well as a cell poison, exerting its greatest effects in the lungs, nervous system, kidneys and liver. We present a case of mercury vapour poisoning in a shipyard workers presenting as an acute chemical pneumonitis, which resolved with aggressive supportive therapy. Further investigations later revealed transient mild neuropsychiatric symptoms, and residual peripheral neuropathy. No chelation therapy was instituted. The detailed investigative work that led to the discovery of the source of mercury is also presented. This case alerts us to the potential hazard to shipyard workers who may work in ships previously carrying oil contaminated with mercury. There have been no previous reports of mercury poisoning in shipyard workers. A high index of suspicion leading to early diagnosis and institution of appropriate supportive measures in suspected cases can be life-saving.- - - - - - - - - - ranking = 1keywords = nervous system (Clic here for more details about this article) |
5/37. Subacute sensory neuropathy associated with Epstein-Barr virus.A 35-year-old man experienced severe sensory loss, pseudoathetosis, and areflexia during recovery from a severe viral illness. Sensory nerve action potentials were absent, motor conduction velocities were mildly slowed, and blink reflexes were normal. magnetic resonance imaging (MRI) revealed abnormal signal within the central and dorsal aspects of the thoracic cord. Acute and convalescent Epstein-Barr virus (EBV) titers suggested EBV as the etiology. Subacute sensory neuropathy, with peripheral and central nervous system involvement, is a rare complication of EBV infection.- - - - - - - - - - ranking = 1.8017155503137keywords = nervous system, central nervous system (Clic here for more details about this article) |
6/37. Injury severity and neuropsychological and balance outcomes of four college athletes.Recent evidence suggests significant short-term neurocognitive deficits following mild traumatic brain injury (MTBI) in sports. However, sequelae of mild head injuries is complicated by many factors including a history of multiple head injuries and injury severity. Few studies have considered the influence these variables may have on proper classification of a MTBI and their meaning for return-to-play guidelines. This study presents the short-term neuropsychological and balance outcomes of four college athletes who sustained mild head injuries of different severity (grade I, grade II, grade III and multiple head injured with a grade II based on American Academy of neurology guidelines). The results demonstrated that self-report symptoms of concussion were slow to resolve in the grade III and multiple concussed individuals. For neuropsychological testing, Trails A & B, Symbol Digit Modalities Test and Digits Span Backwards were the most sensitive in identifying differences between the injuries. For balance assessments using the Neurocom Smart Balance System, the Sensory Organization Test and reaction time were also important variables in detecting differences among the various injuries. When these data are used together, it can assist physicians in determining safe return-to-play for athletes who sustain MTBI. There are contradindications in the numerous grading systems and return-to-play guidelines for MTBI. The results from this study provides new evidence which can be assimilated into a valid grading scale for MTBI sustained in sport.- - - - - - - - - - ranking = 1.569332038118keywords = brain (Clic here for more details about this article) |
7/37. Sensory dermatomal representation in the medial lemniscus.BACKGROUND: Restricted sensory deficits along the somatotopic topography of the medial lemniscus rarely develop in medial medullary infarction. We describe a patient with medial medullary infarction who presented with dermatomal sensory deficits caused by a medial lemniscal lesion. CASE DESCRIPTION: A 58-year-old man presented with sudden right-sided hemiparesis and paresthesia. He had noticed the paresthesia below the level of the right L5 dermatome, where his vibration and position senses were mildly diminished. His paresthesia was more severe over the right calf and foot. Magnetic resonance images of the brain showed an acute small infarct in the medial-ventral portion of the left rostral medulla oblongata. A nerve conduction study and electromyography showed no abnormalities. At follow-up, the patient's motor and sensory deficits had improved considerably. CONCLUSIONS: The patient showed lemniscal sensory deficits below the right L5 dermatome that were caused by the partial involvement of the medial lemniscus. These findings suggest that lemniscal sensory dermatomal representation is preserved at least up to the level of the medulla oblongata.- - - - - - - - - - ranking = 1.569332038118keywords = brain (Clic here for more details about this article) |
8/37. Transient vestibular balance dysfunction after primary blast injury.Explosive munitions are used routinely in support of military operations. Moreover, service personnel are increasingly being deployed to regions where active conflict, terrorism, and land mines pose significant threats. Despite aggressive protective measures and safety practices, blast injury is an inherent risk. In contrast to secondary and tertiary blast injuries, primary blast injuries are generally limited to the air-filled organs of the respiratory, gastrointestinal, and auditory systems. We report the case of a Marine who entered the back-blast arc of a shoulder-launched multipurpose assault weapon at close range. Despite the magnitude of the blast, he sustained none of the classic findings suggestive of severe primary blast injury. However, he manifested unique vestibular balance abnormalities that precluded his return to full duty for several months. This suggests that personnel who sustain even a mild traumatic brain injury with vestibular manifestations may need prolonged observation and modified duty in certain military occupational specialties.- - - - - - - - - - ranking = 1.569332038118keywords = brain (Clic here for more details about this article) |
9/37. Referred sensations following stroke.Referred sensations are recognized as phenomena experienced after amputation of a limb and have been used as proof of the consequences of changes in somatosensory body part representation in the adult brain. Such changes may accompany interruption of afferent sensory projections after subcortical stroke. This report describes some misplaced localization to touch in a subject 15 months after cerebral haemorrhage involving the posterior limb of the right internal capsule and lateral thalamus. The results revealed the occurrence of referred sensations, indicating some scrambling of the somatosensory representation of the affected limbs. While many stimuli were localized correctly, there were a number of stimuli applied to the hand and foot that were referred to more proximal limb segments. Stimuli to the upper arm were sometimes felt in more distal parts of the limb. Stimuli to the face were localized to the arm and not the hand. With the aim of determining consistency of findings, testing of the upper limb was carried out on four separate occasions. The subject had less referred sensations in each test, possibly indicating some change in his somatosensory representation that occurred with experience.- - - - - - - - - - ranking = 1.569332038118keywords = brain (Clic here for more details about this article) |
10/37. Otorhinolaryngologic manifestations in Chiari malformation.The Chiari malformation causes herniation of the cerebellar amygdalae through the foramen magnum, resulting in the descent of the brain stem and/or traction on the lower cranial pairs. It is important for otolaryngologists to recognize Chiari malformations as part of the differential diagnosis of balance disorders, because patients may initially exhibit symptoms related to the vestibular system, including ataxia, nystagmus, or vertigo. We report 2 cases.- - - - - - - - - - ranking = 1.569332038118keywords = brain (Clic here for more details about this article) |
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