1/7. Convulsive syncope following placement of sphenoidal electrodes.Two cases of convulsive syncope following the insertion of sphenoidal electrodes are reported. The episodes occurred shortly after an uneventful insertion of the needle. Both patients exhibited behavioral arrest with loss of muscle tone, followed by flexor posturing, jerking of the extremities, then followed by what appeared to be a panic attack. Episodes were clinically distinct from the patients' typical spells and were initially interpreted as representing psychogenic events. EEGs during the episodes showed diffuse slowing followed by generalized suppression of rhythms. Simultaneous EKG showed bradycardia followed by brief asystole and then resumption of normal heart rhythms in both cases. Vagally mediated cardioinhibitory reactions induced by fear, pain and possibly stimulation of branches of the trigeminal nerve in the face represent an uncommon but potentially serious complication of placement of sphenoidal electrodes.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/7. Sudden unconsciousness during a lesser occipital nerve block in a patient with the occipital bone defect.Occipital nerve block is usually considered to be a very simple and safe regional anaesthetic technique. We describe a case of sudden unconsciousness during a lesser occipital nerve block in a patient with an occipital bone defect. A 63-year-old man complained of headache, which was localized to the right occipital region. A right lesser occipital nerve block with a local anaesthetic was performed for treatment. During the lesser occipital nerve block, the patient suddenly became disturbed and lost consciousness. Two hours after the incident, the patient was fully awake without neurological sequelae. He had previously undergone a microvascular decompression for right trigeminal neuralgia. The patient had a bone defect following craniotomy. We believed that the loss of consciousness during lesser nerve block may be due to a subarachnoid injection. Occipital nerve block is relatively contraindicated in the presence of a bone defect.- - - - - - - - - - ranking = 10keywords = nerve (Clic here for more details about this article) |
3/7. Acute rhabdomyolysis and brachial plexopathy following alcohol ingestion.An unusual case of brachial plexopathy following alcohol-induced rhabdomyolysis is presented. The patient's rhabdomyolysis developed during sleep after an acute alcohol binge and there was no history of muscle trauma. It is thought that the brachial plexopathy developed due to direct compression of the plexus from swollen muscles of the shoulder girdle. The lack of similar reported cases despite the common clinical scenario of prolonged unconsciousness following excess alcohol intake suggests that other factors may be important in the development of muscle and nerve damage in susceptible individuals.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/7. Bitemporal head crush injuries: clinical and radiological features of a distinctive type of head injury.OBJECT: Most craniocerebral injuries are caused by mechanisms of acceleration and/or deceleration. Traumatic injuries following progressive compression to the head are certainly unusual. The authors reviewed clinical and radiological features in a series of patients who had sustained a special type of cranial crush injury produced by the bilateral application of rather static forces to the temporal region. Their aim was to define the characteristic clinical features in this group of patients and to assess the mechanisms involved in the production of the cranial injuries and those of the associated cerebral and endocrine lesions found in this peculiar type of head injury. methods: Clinical records of 11 patients were analyzed with regard to the state of consciousness, cranial nerve involvement, findings on neuroimaging studies, endocrine symptoms, and outcome. Furthermore, an experimental model of bitemporal crush injury was developed by compressing a dried skull with a carpenter's vice. Seven of the 11 patients were 16 years old or younger. All patients presented with a characteristic clinical picture consisting of no loss of consciousness (six patients), epistaxis (nine patients), otorrhagia (11 patients), peripheral paralysis of the sixth and/or seventh cranial nerves (10 patients), hearing loss (five patients), skull base fractures (11 patients), pneumocephalus (11 patients), and diabetes insipidus (seven patients). Ten patients survived the injury and most recovered neurological function. CONCLUSIONS: Static forces applied to the head in a transverse axis produce fractures in the skull base that cross the midline structures without producing significant cerebral damage. Stretching of cranial nerves at the skull base explains the nearly universal finding of paralysis of these structures, whereas an increase in the vertical diameter of the skull accounts for the occurrence of diabetes insipidus in the presence of an intact function of the anterior pituitary lobe. The association of clinical, endocrine, and neuroimaging findings encountered in this peculiar type of head injury supports the idea that this subset of injured patients has a distinctive clinical condition, namely the syndrome of bitemporal crush injury to the head.- - - - - - - - - - ranking = 3keywords = nerve (Clic here for more details about this article) |
5/7. Cyanotic breath-holding spell: a life-threatening complication after radical resection of a cervicomedullary ganglioglioma.Cyanotic breath-holding spell is a benign and self-limiting disease of young children but occasionally associated with sudden, unexpected death. The authors report a rare case in a 2-year-old girl with a severe form that started after radical resection of a cervicomedullary ganglioglioma. She was admitted to our hospital because of delayed and unstable gait. Since magnetic resonance imaging showed a cervicomedullary tumor, she underwent a radical resection and histology showed the tumor to be a ganglioglioma. Postoperatively, the function of the lower cranial nerves and cerebellum deteriorated and hemiparesis on the left became apparent, but she returned to the preoperative state in a few months. In addition, mild sleep apnea (Ondine curse) and severe cyanotic breath-holding spells occurred. The former responded to medication but the latter failed and continued several times per day with a rapid onset and progression of hypoxemia, loss of consciousness, sweating and opisthotonos. Five months after the operation, the patient returned home with a portable oxygen saturation monitor equipped with an alarm. This case indicates that cyanotic breath-holding spell, as well as sleep apnea, is critical during the early postoperative period. This is the first report observing that such spells may occur as a complication of radical resection of a cervicomedullary tumor.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/7. Division of the recurrent laryngeal nerve for idiopathic laryngeal spasm.A rare case of idiopathic laryngeal spasm presented itself as sleep apnea in a middle-aged man. A tracheostomy followed by the division of the recurrent laryngeal nerve relieved all of the symptoms.- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
7/7. Serious arrhythmias coinciding with alteration of consciousness in aircrew during Gz stress.The Japanese Air Self Defense Force has been conducting high-G training to enhance the Gz tolerance of F-15 and F-4 fighter pilots since 1981. All the trainees have received ECG monitoring during the Gz stress, both for safety and for medical evaluation. Various arrhythmias have been found previously, but most of the pilots who developed them were qualified for fighter aircraft because these arrhythmias were considered as non-hazardous for flight safety. Rarely, cases of aeromedically "serious" arrhythmias were observed with alteration of consciousness during the centrifuge ride. Three cases of sinoatrial block and one case of ventricular tachycardia were reviewed with their aeromedical dispositions. Imbalance of autonomic nerves induced by high Gz is discussed as a possible etiology. The importance of ECG monitoring during centrifuge training is reemphasized as a means of medical evaluation of fighter pilots.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |