1/119. Pseudo Chiari type I malformation secondary to cerebrospinal fluid leakage.cerebrospinal fluid (CSF) leakage may occur spontaneously, iatrogenically or from spinal trauma. Postural headache is the cardinal symptom; dizziness, diminished hearing, nausea and vomiting are additional symptoms. In neurological examinations cranial nerve palsies may be found. Due to low CSF pressure neuroimaging studies may reveal dural enhancement and vertical displacement of the brain. We describe a patient with the history of an uncomplicated lumbar discectomy at the level L4-5 and the typical clinical symptoms of intracranial hypotension. MRI of the craniocervical junction showed typical features of a Chiari type-I malformation. After neurosurgical ligation of a CSF leak at L4-5 caused by lumbar disc surgery, the patient was free of orthostatic headache. A repeated MRI showed a striking reduction of the previous downward displacement of the cerebellar tonsils and pons.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/119. Virtual reality in paraplegia: a VR-enhanced orthopaedic appliance for walking and rehabilitation.spinal cord injuries (SCIs) have a profound physical, social and emotional cost to patients and their families. Obviously SCIs severely disrupt normal patterns of interaction with the environment. Firstly, the opportunities for active interaction are inevitably diminished due to motor or sensory impairment. Moreover, such problems may increase as the time since injury lengthens and the patient becomes more withdrawn and isolated in all spheres of activity. However, advances in Information technology are providing new opportunities for rehabilitation technology. These advances are helping people to overcome the physical limitations affecting their mobility or their ability to hear, see or speak. In this chapter an overview is given of the design issues of a VR-enhanced orthopaedic appliance to be used in SCI rehabilitation. The basis for this approach is that physical therapy and motivation are crucial for maintaining flexibility and muscle strength and for reorganizing the nervous system after SCIs. First some design considerations are described and an outline of aims which the tool should pursue given. Finally, the design issues are described focusing both on the development of a test-bed rehabilitation device and on the description of a preliminary study detailing the use of the device with a long-term SCI patient.- - - - - - - - - - ranking = 0.003168062709403keywords = organ (Clic here for more details about this article) |
3/119. Prevention of human diaphragm atrophy with short periods of electrical stimulation.We determined whether prolonged complete inactivation of the human diaphragm results in atrophy and whether this could be prevented by brief periods of electrical phrenic nerve stimulation. We studied a subject with high spinal cord injury who required removal of his left phrenic nerve pacemaker (PNP) and the reinstitution of positive-pressure ventilation for 8 mo. During this time, the right phrenic nerve was stimulated 30 min per day. Thickness of each diaphragm (tdi) was determined by ultrasonography. Maximal tidal volume (VT) was measured during stimulation of each diaphragm separately. After left PNP reimplantation, VT and tdi were measured just before the resumption of electrical stimulation and serially for 33 wk. On the previously nonfunctioning side, there were substantial changes in VT (from 220 to 600 ml) and tdi (from 0.18 to 0.34 cm). On the side that had been stimulated, neither VT nor tdi changed appreciably (VT from 770 to 900 ml; tdi from 0.25 to 0.28 cm). We conclude that prolonged inactivation of the diaphragm causes atrophy which may be prevented by brief periods of daily phrenic nerve stimulation.- - - - - - - - - - ranking = 4keywords = nerve (Clic here for more details about this article) |
4/119. Diagnosis and treatment of acute central cervical cord injury.OBJECTIVE: To clarify the diagnosis and management of acute central cervical cord injury. methods: Eighty-nine patients with acute cervical central cord injury were retrospectively reviewed. Sixty-three patients were treated conservatively and 26 were treated surgically. There were two acute deaths. Eighty-seven patients were followed up for 3 months to 15 years. RESULTS: Their average neurological score (asia) was increased from 41.7 at admission to 83.1 at follow-up. CONCLUSIONS: Acute central cervical cord injury should be differentiated from complete spinal cord injury, cervical myelopathy, cruciate paralysis and C8 nerve root injury. When compression of nerve tissue or cervical instability is identified, operative intervention should be indicated. The prognosis is less optimistic in the patients with severe primary injury and at old age.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
5/119. 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 = 3keywords = nerve (Clic here for more details about this article) |
6/119. Perinatal spinal cord injury requiring long-term home mechanical ventilation: a report of four cases.Although perinatal spinal cord injury has been discussed in detail in the literature with respect to aetiology and diagnosis, few studies address long-term outcome, and none address the outcome of long-term home mechanical ventilation in this population. The four patients reported here with perinatal spinal cord injury have used home mechanical ventilation for time periods ranging from 6 to 17 years, with varying results. Their courses with respect to respiratory, neuromuscular, neuropsychological, and nutritional issues are described with reference to the current literature. It is believed that, with the advent of organized home mechanical ventilation programmes and increased acceptance of this technology by the lay public and medical community, the prognosis of the child with perinatal spinal cord injury requiring assisted ventilation is much improved, and may be more positive than the literature currently suggests.- - - - - - - - - - ranking = 0.003168062709403keywords = organ (Clic here for more details about this article) |
7/119. Phantom sensations in a patient with cervical nerve root avulsion.This case study reports detailed phantom sensations in a 35-yr.-old man who had his C5 and C6 cervical nerve roots avulsed from the cord during a motorcycle accident at the age of 22 years. The subject, who was left with a paralyzed right deltoid muscle, anesthetic sensation along the upper lateral portion of the right arm, and absent right biceps reflex, became aware of phantom right arm and hand sensations a few months after the original injury. This finding--which has important implications for understanding the process involved in bodily perception as well as the development of these perceptions--provides evidence of a distributed neural representation of the body that has both genetic and experiential determinants. The implications of these findings are discussed with reference to recent concepts of phantom limb experiences and related phenomena.- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
8/119. Interfacing the body's own sensing receptors into neural prosthesis devices.Functional electric stimulation (FES) is today available as a tool in muscle activation used in picking up objects, in standing and walking, in controlling bladder emptying, and for breathing. Despite substantial progress over nearly three decades of development, many challenges remain to provide a more efficient functionality of FES systems. The most important of these is an improved control of the activated muscles. Instead of artificial sensors for feedback, new developments in electrodes to do long-term and reliable recordings from peripheral nerves emphasize the use of the body's own sensors. These are already installed and optimised through millions of years of natural evolution. This paper presents recent results on a system using electrical stimulation of motor nerves to produce movement and using the natural sensors as feedback signals to control the stimulation that can replicate some of the functions of the spinal cord and its communication with the brain. We have used the nerve signal recorded from cutaneous nerves in two different human applications: (1) to replace the external heel switch of a system for correction of spastic drop foot by peroneal stimulation, and (2) to provide an FES system for restoration of hand grasp with sensory feedback from the fingertip. For the bladder function, the sacral root stimulator is a useful control tool in emptying the bladder. To decide when to stimulate, we are at present carrying out experiments on pigs and cats using cuff electrodes on the pelvic nerve and sacral roots to record the neural information from bladder afferents. This information can potentially be used to inhibit unwanted bladder contractions and to trigger the FES system and thereby bladder emptying. Future research will show whether cuffs and other types of electrodes can be used to reliably extract signals from the large number of other receptors in the body to improve and expand on the use of natural sensors in clinical FES systems.- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
9/119. Bilateral S3 nerve stimulation, a minimally invasive alternative treatment for postoperative stress incontinence after implantation of an anterior root stimulator with posterior rhizotomy: a preliminary observation.STUDY DESIGN: A preliminary report. OBJECTIVES: Urinary stress incontinence following implantation of an anterior root stimulator and a posterior rhizotomy is a rare complication which is difficult to treat. It is seen in patients with an open bladder neck (T9-L2 lesion). An artificial urinary sphincter is a possible treatment for this condition but has a higher failure rate in patients with neurogenic bladder disease and could complicate micturition. SETTING: Ghent, belgium. methods: A male paraplegic patient (T9, complete lesion) aged 36 was suffering from severe urinary incontinence due to detrusor hyperreflexia. Preoperatively the bladder neck was closed on cystography. Following implantation (6/95) of an intradural anterior root stimulator with posterior rhizotomy, severe urinary stress incontinence presented. Bilateral S3 foramen leads were implanted and connected to a pulse generator. RESULTS: The patient has been continent with continuous stimulation of both S3 roots for 4 years, and no fatigue of the levator muscles has been seen. Preoperative urodynamics are compared to results 3 years postoperatively. CONCLUSION: Bilateral S3 stimulation is a feasible and minimally invasive treatment of urinary stress incontinence following implantation of an anterior root stimulator.- - - - - - - - - - ranking = 4keywords = nerve (Clic here for more details about this article) |
10/119. Persistent or severe back pain and stiffness are ominous symptoms requiring prompt attention.BACKGROUND: Children with severe or persistent back pain and stiffness often have an underlying organic cause but there is a large differential diagnosis, examination may be difficult and the problem is relatively rare in general paediatric practice. These difficulties appeared to lead to delays in diagnosis and management of children with this problem. OBJECTIVES: To provide an approach to the diagnosis and management children with severe or persistent back pain or stiffness based on our clinical experience and the literature. METHODOLOGY: The case histories of 10 children with severe back pain seen by the authors over a 5-year period were reviewed. They were chosen as illustrative examples of the diagnostic and management problems and did not represent a systematic review of all cases seen by the authors over that time. RESULTS: Underlying causes included infection, inflammation, neoplasm, trauma and vascular malformation. Four of the children had spinal cord compression which required urgent decompression. There was one child with a conversion disorder but three children with organic disease were initially felt to have a conversion disorder. Investigations generally proceeded relatively slowly and the problem was not regarded as a semi-urgent situation carrying the risk of permanent paraplegia. magnetic resonance imaging (MRI) scan of the spine was the investigation of choice. CONCLUSION: Children with severe or persistent back pain and stiffness have a wide variety of underlying causes. The possibility of underlying spinal cord compression should always be considered in children with this presentation. If the diagnosis is not obvious, MRI scan of the spine should be arranged without delay.- - - - - - - - - - ranking = 0.0063361254188061keywords = organ (Clic here for more details about this article) |
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