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Khalilzadeh, Omid, Laura M. Fayad, and Shivani Ahlawat. "3D MR Neurography." Seminars in Musculoskeletal Radiology 25, no. 03 (June 2021): 409–17. http://dx.doi.org/10.1055/s-0041-1730909.
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AbstractHigh-resolution isotropic volumetric three-dimensional (3D) magnetic resonance neurography (MRN) techniques enable multiplanar depiction of peripheral nerves. In addition, 3D MRN provides anatomical and functional tissue characterization of different disease conditions affecting the peripheral nerves. In this review article, we summarize clinically relevant technical considerations of 3D MRN image acquisition and review clinical applications of 3D MRN to assess peripheral nerve diseases, such as entrapments, trauma, inflammatory or infectious neuropathies, and neoplasms.
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Koenig, Ralph W., Maria T. Pedro, Christian P. G. Heinen, Thomas Schmidt, Hans-Peter Richter, Gregor Antoniadis, and Thomas Kretschmer. "High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma." Neurosurgical Focus 26, no. 2 (February 2009): E13. http://dx.doi.org/10.3171/foc.2009.26.2.e13.
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High-resolution ultrasonography is a noninvasive, readily applicable imaging modality, capable of depicting real-time static and dynamic morphological information concerning the peripheral nerves and their surrounding tissues. Continuous progress in ultrasonographic technology results in highly improved spatial and contrast resolution. Therefore, nerve imaging is possible to a fascicular level, and most peripheral nerves can now be depicted along their entire anatomical course. An increasing number of publications have evaluated the role of high-resolution ultrasonography in peripheral nerve diseases, especially in peripheral nerve entrapment. Ultrasonography has been shown to be a precious complementary tool for assessing peripheral nerve lesions with respect to their exact location, course, continuity, and extent in traumatic nerve lesions, and for assessing nerve entrapment and tumors. In this article, the authors discuss the basic technical considerations for using ultrasoniography in peripheral nerve assessment, and some of the clinical applications are illustrated.
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Rukmana Tri Pratistha, Indra, Nyoman Gede Bimantara, I. Gede Mahardika Putra, Made Bramantya Karna, Anak Agung Gde Yuda Asmara, and Putu Feryawan Meregawa. "Nerves Transfer Procedure in Patients with Left Upper Extremities Weakness Following Gunshot Wounds: A Case Report." Open Access Macedonian Journal of Medical Sciences 9, no. C (September 5, 2021): 140–45. http://dx.doi.org/10.3889/oamjms.2021.6393.
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BACKGROUND: Gunshot wounds (GSWs) to the extremities can result in damage to the neurovascular structure which results in high morbidity and loss of function. According to the Centers for Disease Control report, the incidence of non-fatal GSWs has increased in the past decade. Trauma to the brachial plexus is a type of peripheral nerve trauma that is most difficult to treat due to its complex surgical procedures. Early exploration and reconstruction of peripheral nerve trauma are still being debated to this day. However, most recommend surgical exploration when the suspicion of neurovascular trauma is very high based on clinical findings. Nerve transfer is one of the recommended methods of nerve reconstruction even in pre-ganglionic lesions. We report a case of a patient with weakness of the upper limb after a gunshot wound to his left shoulder. Based on clinical considerations and investigations, nerve transfer procedure is carried out to restore patient’s shoulder function. CASE REPORT: Male, 32 years old, working as a policeman, complained difficulty on moving his shoulder for 3 months. Patients had a history of GSWs to the left shoulder which also results in a left clavicular fracture. First aid, debridement, and fracture management were performed at Bhayangkara Hospital, Palu. Physical examination revealed winging scapula positive on his left shoulder, shoulder abduction 5/1, and hypoesthesia at left C5 level. Electromyographic examination revealed lesions on the left posterior chord and left brachial plexus. Based on clinical findings and supporting examination, we performed nerve transfers procedure from the accessory nerve to suprascapular notch. In the previous study, 63% of cases GSWs associated with nerve dysfunction. About 75% of patients with nerve palsy are associated with nerve lacerations during surgical exploration. However, many surgeons continue to recommend early exploration after GSWs to the upper extremities, especially in patients who will undergo surgical treatment for other indications. Based on this, we suggest the probable cause of brachial plexus lesions in this case resulted from gunshot wound which injures the brachial plexus or as a complication from previous procedures. Surgery that is too early can interfere with the spontaneous reinnervation process, but late surgical procedures can result in failure of reinnervation. In general, optimal time is set between 3 and 6 months after trauma. Nerve transfer is one method of reconstructing peripheral nerve lesions that can be applied to pre-ganglionic or post-ganglionic lesions. CONCLUSION: This procedure has several benefits, namely, the proximity of the donor and the recipient nerve anatomy, shorter operating time and does not require grafts. Brachial plexus trauma due to trauma or non-trauma together has an impact on the patient’s quality of life. However, advances in surgical techniques and further understanding of nerve physiology have led clinicians and patients to better outcomes. The current trend of treatment strategies for brachial plexus trauma is surgical reconstruction with the nerve transfer procedure.
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Zheng, Tong, Shuoke Qiu, Lei Li, Binglong Li, and Meng Zhang. "Polymers containing natural plant phenolic compounds for peripheral nerve injury." Biomaterials and Biosensors 1, no. 1 (December 30, 2022): 48–61. http://dx.doi.org/10.58567/bab01010004.
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Peripheral nerve injury is a serious and disabling disease prevalent in the world. It caused by trauma is often accompanied with soft tissue injuries, fractures, infections, etc., and can cause permanent damage. The treatment methods of peripheral nerve injury mainly include traditional microsurgical repair, neurotrophic drug treatment, as well as cuttingedge nerve conduit treatment, nerve stimulation, cell therapy, etc. However, more than 30% of patients with peripheral nerve injury still have poor recovery, including partial loss or complete loss of motor and/or sensory function, muscle atrophy，chronic pain and severe disability, among can lead to permanent disease. Phenolic compounds are secondary metabolites which is the most abundant in plants, consisting of an aromatic ring and one or more hydroxyl substituents, the main groups including flavonoids, phenolic acids, tannins, stilbene and lignans. A lot of studies have shown that natural phenolic compounds have various properties, such as antioxidant, anti-infective, anticancer, anti-inflammatory, etc., and have broad applications in the prevention of heart disease, cancer, diabetes, oxidative stress-related diseases, and neuroprotection prospect. This review discusses the potential applications and molecular mechanisms of natural phenolic compounds its polymer derivatives in the treatment of peripheral nerve injury.
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Motswaledi, M. H. "Herpes zoster (Shingles)." South African Family Practice 60, no. 4 (August 28, 2018): 28–30. http://dx.doi.org/10.4102/safp.v60i4.4898.
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Herpes zoster or Shingles is caused by varicella-zoster virus (VZV), the same virus that causes chicken-pox (varicella).Primary infection with varicella-zoster virus causes chicken-pox (varicella), then the virus persists in nerve ganglia of sensory but rarely motor nerves, in a latent stage.If the virus gets reactivated it causes herpes zoster, which presents as painful vesicles following a dermatome. It is more common in the elderly and the immunocompromised.Herpes zoster is a common skin and mucous membrane disease caused by reactivation of latent varicella zoster virus, which had lodged previously in nerve ganglia.Trigeminal nerve nuclei and thoracic spinal ganglia are the most commonly affected.Reactivation of latent varicella-zoster virus can be triggered by old age, that is why herpes zoster is common in the elderly, above 60 years of age. This is due to age related decline in specific cell mediated immune response to VZV. Other triggering factors are malignancies malnutrition, emotional stress, physical trauma, chronic diseases like diabetes mellitus and immunosuppression from drugs and HIV.¹,²
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Hasan, Syed Asif, Abdulrahman Saad Aljammaz, Mosleh Motesh AlGhamdi, Mohamed Jasim ALQattan, Abdulrahman Hussain Alsalman, Wafaa Sulaiman Alhifzi, Hassan Ahmed Aljudia, et al. "The different causes of branchial plexus injuries." International Journal Of Community Medicine And Public Health 8, no. 8 (July 27, 2021): 4119. http://dx.doi.org/10.18203/2394-6040.ijcmph20213052.
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Many etiologies have been reported to account for injuries to the brachial plexus, peripheral nerves and trauma. Additionally, many diseases have also been reported to cause the injury with many different pathophysiologies. For instance, some diseases have been classified as the primary diseases of the peripheral nerves including hereditary neuropathy. In the same context, brachial plexus damage or injury might also result secondary to a systemic disease, leading to a significant peripheral nerve injury as in cases with most metabolic neuropathies, which may result secondary to renal insufficiency, diabetes, amyloidosis and many other diseases. Furthermore, toxic and iatrogenic causes were also reported as potential causes for brachial plexus injuries. However, traumatic events are the most commonly reported, owing to motorcycle accidents, being the most common etiology. Although evidence is now abundant regarding the etiology, further studies are needed to furtherly validate the evidence and for more specification of the etiology and the underlying mechanisms.
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Soman, Soja, and Sanjairaj Vijayavenkataraman. "Perspectives on 3D Bioprinting of Peripheral Nerve Conduits." International Journal of Molecular Sciences 21, no. 16 (August 12, 2020): 5792. http://dx.doi.org/10.3390/ijms21165792.
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The peripheral nervous system controls the functions of sensation, movement and motor coordination of the body. Peripheral nerves can get damaged easily by trauma or neurodegenerative diseases. The injury can cause a devastating effect on the affected individual and his aides. Treatment modalities include anti-inflammatory medications, physiotherapy, surgery, nerve grafting and rehabilitation. 3D bioprinted peripheral nerve conduits serve as nerve grafts to fill the gaps of severed nerve bodies. The application of induced pluripotent stem cells, its derivatives and bioprinting are important techniques that come in handy while making living peripheral nerve conduits. The design of nerve conduits and bioprinting require comprehensive information on neural architecture, type of injury, neural supporting cells, scaffold materials to use, neural growth factors to add and to streamline the mechanical properties of the conduit. This paper gives a perspective on the factors to consider while bioprinting the peripheral nerve conduits.
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Placheta-Györi, Eva, Lea Maria Brandstetter, Jakob Zemann-Schälss, Sonja Wolf, and Christine Radtke. "Myelination, axonal loss and Schwann cell characteristics in axonal polyneuropathy compared to controls." PLOS ONE 16, no. 11 (November 4, 2021): e0259654. http://dx.doi.org/10.1371/journal.pone.0259654.
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Introduction Polyneuropathy is a debilitating condition characterized by distal sensory and motor deficits. Schwann cell dysfunction and axonal loss are integral factors in pathophysiology and disease progression of polyneuropathy. Aims The aim of this study was the assessment of Schwann cell characteristics, nerve fibers and myelination parameters in polyneuropathy patients compared to controls. Methods Nerve tissue was obtained from polyneuropathy patients (n = 10) undergoing diagnostic sural nerve biopsies. Biopsies of healthy peripheral nerves (n = 5) were harvested during elective sural nerve grafting for chronic peripheral nerve lesions. Exclusion criteria for the healthy control group were recent neurological trauma, diabetes, neurological and cardiovascular disease, as well as active malignancies and cytotoxic medication within the last 12 months. The over-all architecture of nerve sections and myelination parameters were histomorphometrically analyzed. Immunofluorescent imaging was used to evaluate Schwann cell phenotypes, senescence markers and myelination parameters. Results Histomorphometric analysis of nerve biopsies showed significant axonal loss in polyneuropathy patients compared to controls, which was in accordance with the neuropathological findings. Immunofluorescent staining of Schwann cells and myelin basic protein indicated a significant impairment of myelination and lower Schwann cell counts compared to controls. Phenotypic alterations and increased numbers of non-myelinating p75-positive Schwann cells were found in polyneuropathy patients. Discussion This study provided quantitative data of axonal loss, reduced myelination and Schwann cell dysfunction of polyneuropathy patients compared to neurologically healthy controls. Phenotypic alterations of Schwann cells were similar to those seen after peripheral nerve injury, highlighting the clinical relevance of Schwann cell dysfunction.
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Guyennet, Eloïse, Jean-Laurent Guyomard, Emilie Barnay, Franck Jegoux, and Jean-François Charlin. "Cephalic Tetanus from Penetrating Orbital Wound." Case Reports in Medicine 2009 (2009): 1–3. http://dx.doi.org/10.1155/2009/548343.
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Tetanus is a neurologic disorder caused by tetanospasmin, a protein toxin elaborated by Clostridium tetani. Cephalic tetanus is a localized form of the disease causing trismus and dysfunction of cranial nerves. We report the case of a man who presented with facial trauma, complete ophthalmoplegia, exophthalmos, areactive mydriasis, and periorbital hematoma. An orbital CT revealed air bubbles in the right orbital apex. The patient was given a tetanus toxoid booster and antibiotherapy. After extraction of a wooden foreign body, the patient developed right facial nerve palsy, disorders of swallowing, contralateral III cranial nerve palsy, and trismus. Only one case of cephalic tetanus from penetrating orbital wound has been reported in literature 20 years ago. When a patient presents with an orbital wound with ophthalmoplegia and signs of anaerobic infection, cephalic tetanus should be ruled out.
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Sparapani, Fabio Veiga de Castro, Marcela Fernandes, Leonardo Favi Bocca, Luis Renato Nakachima, and Sergio Cavalheiro. "Acute handlebar syndrome: Two extremes of a challenging diagnosis." Surgical Neurology International 11 (October 29, 2020): 366. http://dx.doi.org/10.25259/sni_606_2020.
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Background: Ulnar nerve mononeuropathy diagnosis can be challenging depending on where neural lesion is present. Repetitive trauma during cycling is a rare cause of ulnar neuropathy. Case Description: We describe two patients who developed the handlebar syndrome, an ulnar nerve palsy at Guyon’s canal after cycling. The first patient had the syndrome after a short-distance ride and she was treated surgically, while the second patient developed the classical syndrome after a long ride and received conservative treatment. Surgical treatment of the first patient led to functional recovery. Conclusion: Handlebar syndrome is a neuropathy caused by extrinsic repetitive compression of ulnar nerve at wrist. Increasing incidence of this disease can be expected after increasing popularity of cycling sports. Avoid of repetitive trauma is the main management goal, with surgical treatment reserved for failure of conservative treatment.
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Gurung, Anu, Ramesh Raj Bist, Sagar Rajkarnikar, and Ram Shrestha. "Causes of Isolated Oculomotor Nerve Palsy in Patients Presenting to Eye Outpatient Department at Shree Birendra Hospital." Medical Journal of Shree Birendra Hospital 11, no. 1 (March 13, 2013): 21–23. http://dx.doi.org/10.3126/mjsbh.v11i1.7762.
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Introduction: Although oculomotor nerve palsy is associated with signifycant morbidity. The etiology of oculomotor nerve palsy are ischemic, trauma, aneurysm, tumors, inflammatory, idiopathic etc. The present study was performed to determine the etiology of isolated oculomotor nerve palsy in our population. Methods: The hospital data of patients of isolated oculomotor nerve palsy cases reported to the eye department of Shree Birendra Hospital from March 2009 to March 2011 were collected and retrospectively analyzed for the etiology of the disease. The detail history (ocular and medical), examination and investigations were collected from patient’s case records. All patients had been evaluated for hypertension and diabetes mellitus. Neuroimaging, MRI had been performed in all cases. The etiology of isolated oculomotor nerve palsy was classified into ischemia, idiopathic, trauma, aneurysm and neoplastic. Results: During the study period there were 16 eyes of 16 patients who were suffering from isolated oculomotor nerve palsy. The commonest cause was found to be ischemic in 7 patients (43.75%) followed by idiopathic in 5 patients (31.25%). Pupil was involved in 3 patients (18.75%). MRI was carried out in all 16 patients, but revealed positive only in two cases (one intracranial aneurysm and other Non Hodgkin’s Lymphoma). Remaining 14 MRI were normal. Conclusions: Oculomotor nerve palsy is an uncommon disease and commonest cause was ischemic followed by idiopathic. The cause should be ruled out as the treatment depends on the cause. Medical Journal of Shree Birendra Hospital; Jan-June 2012/vol.11/Issue1/21-23 DOI: http://dx.doi.org/10.3126/mjsbh.v11i1.7762
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Ayad, Micheal, Anumeha Whisenhunt, EnYaw Hong, Josh Heller, Dawn Salvatore, Babak Abai, and Paul J. DiMuzio. "Posterior tibial vein aneurysm presenting as tarsal tunnel syndrome." Vascular 23, no. 3 (September 8, 2014): 322–26. http://dx.doi.org/10.1177/1708538114548715.
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Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve within the tarsal tunnel. Its etiology varies, including space occupying lesions, trauma, inflammation, anatomic deformity, iatrogenic injury, and idiopathic and systemic causes. Herein, we describe a 46-year-old man who presented with left foot pain. Work up revealed a venous aneurysm impinging on the posterior tibial nerve. Following resection of the aneurysm and lysis of the nerve, his symptoms were alleviated. Review of the literature reveals an association between venous disease and tarsal tunnel syndrome; however, this report represents the first case of venous aneurysm causing symptomatic compression of the nerve.
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Bodduluri, Sri Gautham, Mary Thomas, Uma Radhakrishnan, and Adithya Tellakula. "A Hospital-Based Study on Aetiology of Third, Fourth and Sixth Cranial Nerve Palsies." Journal of Evolution of Medical and Dental Sciences 10, no. 41 (October 11, 2021): 3587–91. http://dx.doi.org/10.14260/jemds/2021/727.
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BACKGROUND Neuro-ophthalmology deals with complex systemic diseases that affect the visual system and pose a challenge for ophthalmologists. Here the focus is on the diseases of the nervous system that affect vision, ocular motility, or pupillary reflexes. Diplopia, a common symptom of cranial nerve palsy, may result from ophthalmic, orbital, or neurologic disorders. Our study intended to determine the aetiology of ocular motor nerve palsies. METHODS A cross-sectional study was conducted for two years at a tertiary care centre in South India. We evaluated 30 patients who came to the Ophthalmology OPD or were admitted, after obtaining the approval of the Ethics committee. RESULTS A total number of 30 patients who fulfilled the inclusion criteria were studied. There were 14 male and 16 female patients. The age range was 12 - 87 years with a mean age of 45 years. The highest incidence noticed was isolated sixth nerve palsy in 13 (43.3 %) patients. 11 patients had isolated third nerve palsy (36.7 %), while mixed ocular motor nerve palsies (third, fourth and sixth) were seen in 6 patients (20 %). None of them had isolated fourth nerve palsy. CONCLUSIONS The sixth nerve continued to be the most common among the ocular motor nerve palsies. Meningitis was the major cause. Diabetes and trauma, infections with CNS inflammation accounted for a majority of third nerve palsies. Multiple cranial nerve palsies had varied aetiology like HIV Infection, Tolosa Hunt Syndrome, aneurysm of intracavernous part of ICA, cavernous sinus thrombosis and trauma. The patient’s age, associated symptoms, clinical features and types of palsy are of great importance to choose appropriate radiological methods to study and treat these isolated cranial nerve palsies. KEY WORDS Diabetes, Meningitis, Oculomotor Nerve, Trochlear Nerve, Abducent Nerve, Trauma
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Maracheva, N. M., and I. E. Panova. "Clinical and instrumental criteria in predicting the clinical course of chronic posttraumatic uveitis after penetrating ocular trauma." Kazan medical journal 93, no. 5 (October 15, 2012): 764–67. http://dx.doi.org/10.17816/kmj1706.
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Aim. To identify the prognostic criteria for the recovery or transformation to chronic form in patients with prolonged clinical course of uveitis associated with penetrating ocular trauma basing on the results of clinical examination and instrumental methods. Methods. 120 patients with chronic clinical course of post-traumatic uveitis were examined 2-3 months after the penetrating ocular trauma using clinical examination and ultrasonography of eye and orbita. 1st group consisted of 60 convalescents, 2nd included 60 patients with chronic disease. The control group consisted of 40 healthy volunteers. Ultrasonography included measurement of innermost eye coat thickness and the retrobulbar part of the optic nerve thickness measured 10 mm behind the eyeball bilaterally. Results were statistically analyzed. Results. Prognostic criteria for recovery or chronic inflammation development in chronic post-traumatic uveitis were found. They are: G-index and interocular asymmetry coefficient of innermost eye coat and optic nerve thickness. At calculation of G-index, which characterizes inflammatory consequences of trauma, presence of cornea imbibition, rubeosis iridis, cataract, vitreous body fibrosis, pulled-in cornea and sclera scars, retinal and choroidal detachment, the eyeball subatrophy, decreased eye fluid pressure, optic nerve thickening. The value of all the parameters equaled 1. An interocular thickness asymmetry coefficient characterized innermost eye coat thickness or optic nerve thickness ratio in injured eye compared to other eye. 2-3 weeks after the trauma characteristic G-index value of G ≥4, an interocular asymmetry coefficient value of ≥1,3 for innermost eye coat thickness and ≥1,1 for optic nerve thickness are the indicators of a high risk of chronic development. Lesser values predict recovery. Conclusion. Use of the set of found prognostic criteria in patients with prolonged clinical course of uveitis provides high prognosis accuracy of 93,3% at predicting recovery or chronic uveitis development.
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Uhl, Jean-François, and Claude Gillot. "Anatomy and embryology of the small saphenous vein: nerve relationships and implications for treatment." Phlebology: The Journal of Venous Disease 28, no. 1 (February 2013): 4–15. http://dx.doi.org/10.1258/phleb.2012.012j08.
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The aim of this paper is to describe the anatomical relations of the small saphenous vein (SSV) in order to define the high-risk zones for the treatment of chronic venous disease. The SSV runs in the saphenous compartment demarcated by two fascia layers: a muscular fascia and a membranous layer of subcutaneous tissue. The clinician should be keenly aware of the anatomical pitfalls related to the close proximity of nerves to the SSV in order to avoid their injury: At the ankle, the origin of the SSV is often plexiform, located deep below the fascia, and the nerve is really stuck to the vein. The apex of the calf is an area of high risk due to the confluence of nerves which perforate the aponeurosis. Moreover, the possible existence of a ‘short saphenous artery’ which poses a high risk for injection of a sclerosing agent due to a highly variable disposition of this artery surrounding the SSV trunk. For this reason, procedures under echo guidance in this area are mandatory. The popliteal fossa is probably a higher risk zone due to the vicinity of the nerves: the small saphenous arch is close to the tibial nerve, or sometimes the nerve of the medial head of the gastrocnemius muscle. In conclusion, before foam injection or surgery, a triple mapping of the small saphenous territory is mandatory: venous haemodynamical mapping verifying the anatomy that is highly variable, nerve mapping to avoid trauma of the nerves and arterial mapping. This anatomical study will help to define the main high-risk zones.
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Singh, Kunwar Pal, Prabhjot Singh, and Kamlesh Gupta. "Reference values for the cross-sectional area of the normal sciatic nerve using high-resolution ultrasonography." Journal of Ultrasonography 21, no. 85 (2021): e95-e104. http://dx.doi.org/10.15557/jou.2021.0018.
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Aim: High-resolution ultrasonography is a new and promising technique to evaluate peripheral and spinal nerves. Its validity as a diagnostic tool in neurological diseases has been demonstrated in adults. The aims of study were to establish the reference values for the cross-sectional area of the normal sciatic nerve on high-resolution ultrasonography, and to determine the relationship between the cross-sectional area of the normal sciatic nerve and the subjects’ age, gender, height (in cm), weight (in kg), and body mass index. Material and methods: Two hundred subjects of both genders and above 18 years of age were studied with high-resolution ultrasonography. The subjects had no history of peripheral neuropathy or trauma to the lower limb. The cross-sectional areas of the normal sciatic nerves were obtained at two different levels in both lower limbs. The mean cross-sectional areas of the sciatic nerves were measured at two different levels, one located at 1 cm above the bifurcation of the sciatic nerve into the tibial and common peroneal nerves, and the other 4 cm above the bifurcation of the sciatic nerve into the tibial and common peroneal nerves. Results: A positive correlation of the mean cross-sectional area was established with height, weight, and body mass index. Women had smaller cross-sectional areas of the normal sciatic nerves than men at both measuring sites. No significant relationship was established with the age of the subjects. Conclusions: The established reference values of the cross-sectional area of the sciatic nerve can facilitate the analysis of pathological nerve conditions.
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Umar, Muhammad, Syed Zoherul Alam, Zamil Zaidur Rahim, Mohammad Saifur Rahman, and Nahid Akhter. "Magnetic Resonance Image Findings in Radicular Low Back Pain." Journal of Armed Forces Medical College, Bangladesh 17, no. 2 (May 30, 2022): 47–51. http://dx.doi.org/10.3329/jafmc.v17i2.58367.
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Introduction: Low back pain (LBP) is the most common symptom associated with degenerative disc disease. Common causes of radicular low back pain are narrowing of the space where nerve roots exit the spine, which can be result of stenosis or disc herniation. Magnetic Resonance Imaging (MRI) is the key investigation for diagnosis of radicular LBP. Objective: To find the association between radicular low back pain and MRI findings of degenerative disc disease. Materials & Methods: This cross-sectional study was conducted in the Combined Military Hospital (CMH), Dhaka, from January to June 2018. A total of 128 patients with LBP with or without radiculopathy were included in the study. Lumbosacral MRI was carried out in all patients. Results: One third (34.4%) of the patients had LBP with radiculopathy. A substantial proportion (68%) of patients had history of trauma to back-bone. Majority (97.7%) of the patients had disc degeneration. Approximately 72% had nerve-root compression and over three-quarters (76.6%) had spinal canal stenosis. Radiculopathy was significantly associated with past history of trauma to the back-bone (p < 0.01) and history of loadbearing (p < 0.001). Signs of degenerative disease were evident as Modic changes in 80.5%, disc displacement in 100% and disc herniation in 75%. All degenerative lesions were predominantly found at L4/L5. Highly significant (p <0.001) association of radiculopathy with Modic changes, disc herniation, nerve root compression and spinal canal stenosis was found. Conclusion: Signs of degenerative disc disease are significantly associated with radicular low back pain. JAFMC Bangladesh. Vol 17, No 2 (December) 2021: 47-51
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Mah, Jean K., and Nens van Alfen. "Neuromuscular Ultrasound: Clinical Applications and Diagnostic Values." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 45, no. 6 (September 24, 2018): 605–19. http://dx.doi.org/10.1017/cjn.2018.314.
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AbstractAdvances in high-resolution ultrasound have provided clinicians with unique opportunities to study diseases of the peripheral nervous system. Ultrasound complements the clinical and electrophysiology exam by showing the degree of abnormalities in myopathies, as well as spontaneous muscle activities in motor neuron diseases and other disorders. In experienced hands, ultrasound is more sensitive than MRI in detecting peripheral nerve pathologies. It can also guide needle placement for electromyography exam, therapeutic injections, and muscle biopsy. Ultrasound enhances the ability to detect carpal tunnel syndrome and other focal nerve entrapment, as well as pathological nerve enlargements in genetic and acquired neuropathies. Furthermore, ultrasound can potentially be used as a biomarker for muscular dystrophy and spinal muscular atrophy. The combination of electromyography and ultrasound can increase the diagnostic certainty of amyotrophic lateral sclerosis, aid in the localization of brachial plexus or peripheral nerve trauma and allow for surveillance of nerve tumor progression in neurofibromatosis. Potential limitations of ultrasound include an inability to image deeper structures, with lower sensitivities in detecting neuromuscular diseases in young children and those with mitochondrial myopathies, due to subtle changes or early phase of the disease. As well, its utility in detecting critical illness neuromyopathy remains unclear. This review will focus on the clinical applications of neuromuscular ultrasound. The diagnostic values of ultrasound for screening of myopathies, neuropathies, and motor neuron diseases will be presented.
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Yassini, Patrick R., Kent Sauter, Sydney S. Schochet, Howard H. Kaufman, and Stephen M. Bloomfield. "Localized hypertrophic mononeuropathy involving spinal roots and associated with sacral meningocele." Journal of Neurosurgery 79, no. 5 (November 1993): 774–78. http://dx.doi.org/10.3171/jns.1993.79.5.0774.
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✓ Hypertrophic nerve lesions displaying onion-bulb cellular formations are quite rare in the absence of a generalized hypertrophic neuropathy. The isolated peripheral nerve lesion has been termed “localized hypertrophic mononeuropathy” (LHN), and fewer than 30 cases of this condition have been reported. Very little is known regarding the etiology and the natural course of this rare disorder. A unique case of LHN afflicting spinal roots in association with a sacral meningocele is reported with a brief review of the relevant literature. The unique features of this case not only reveal a variable clinical presentation of the disease but also support the theory that LHN may be a localized reaction to nerve trauma or entrapment.
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Fallah, Aria, Joey Grochmal, Jian-Qiang Lu, Lisa M. DiFrancesco, Moosa Khalil, Arthur W. Clark, and Rajiv Midha. "Nodular Fasciitis Presenting in the Obturator Nerve and Gracilis Muscle." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 35, no. 1 (March 2008): 111–14. http://dx.doi.org/10.1017/s0317167100007678.
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Nodular fasciitis is a reactive proliferation of fibroblasts/myofibroblasts characterized by a rapidly growing non-tender subcutaneous mass and subsequently self-limited course. It is commonly found on the upper extremities, face, and shoulder, although it may occur in any superficial location. Its etiology is largely unknown, but associations have been made with local trauma, infection and inflammation. We report a case of an intraneural and intramuscular nodular fasciitis presenting in the obturator nerve and gracilis muscle, respectively. To our knowledge, this is the second reported case of this disease presenting in a nerve of the lower extremity, as well as the first reported case of it presenting within muscle and nerve simultaneously.
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Greenbarg, A. "Sciatica and its treatment with antipyrine injections with simultaneous galvanization." Kazan medical journal 25, no. 11 (October 29, 2021): 1179–84. http://dx.doi.org/10.17816/kazmj80420.
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Taking into account the practical difficulties encountered in this disease, as well as of a pathogenetic nature, most authors still distinguish between sciatica brainstem and radicular. Among the causes of sciatica, there are acute and chronic infections, intoxication and autointoxication, endocrine diseases and sciatica without a definite etiological moment, the so-called. idiopathic sciatica. The reasons for the occurrence of sciatic nerve neuralgia also include chronically recurring, at first glance, trauma, inflammation, tumors, congestion in the small pelvis, in the spinal column and its cavity, and changes in the spine itself.
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Patyakina, O. K. "Current issues of middle ear microsurgery." Kazan medical journal 76, no. 1 (January 15, 1995): 74–75. http://dx.doi.org/10.17816/kazmj83733.
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Ear microsurgery, which has more than 40 years of history, is associated with the name of S. Rosen (1952). To improve hearing in patients with otosclerosis, he proposed an operation to mobilize the stirrup, which led to the rapid development of stapedoplasty. Currently, microsurgical techniques are widely used for atresia, trauma and benign tumors of the external auditory canal, for congenital anomalies, trauma and benign tumors of the middle ear, in addition to otosclerosis and inflammatory pathology, for traumatic fistulas of the labyrinth windows, Meniere's disease, peripheral paralysis of the facial nerve, noise, otogenic liquorrhea, with cochlear implantation, etc.
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Muratori, Luisa, Federica Fregnan, Monica Maurina, Kirsten Haastert-Talini, and Giulia Ronchi. "The Potential Benefits of Dietary Polyphenols for Peripheral Nerve Regeneration." International Journal of Molecular Sciences 23, no. 9 (May 5, 2022): 5177. http://dx.doi.org/10.3390/ijms23095177.
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Peripheral nerves are frequently affected by lesions caused by trauma (work accidents, car incidents, combat injuries) and following surgical procedures (for instance cancer resection), resulting in loss of motor and sensory function with lifelong impairments. Irrespective of the intrinsic capability of the peripheral nervous system for regeneration, spontaneous or surgically supported regeneration is often unsatisfactory with the limited functional success of nerve repair. For this reason, many efforts have been made to improve the regeneration process. Beyond innovative microsurgical methods that, in certain cases, are necessary to repair nerve injuries, different nonsurgical treatment approaches and adjunctive therapies have been investigated to enhance nerve regeneration. One possibility could be taking advantage of a healthy diet or lifestyle and their relation with proper body functions. Over the years, scientific evidence has been obtained on the benefits of the intake of polyphenols or polyphenol-rich foods in humans, highlighting the neuroprotective effects of these compounds in many neurodegenerative diseases. In order to improve the available knowledge about the potential beneficial role of polyphenols in the process of peripheral nerve regeneration, this review assessed the biological effects of polyphenol administration in supporting and promoting the regenerative process after peripheral nerve injury.
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Mesolella, Massimo, Filippo Ricciardiello, Domenico Tafuri, Roberto Varriale, and Domenico Testa. "Delayed recurrent nerve paralysis following post-traumatic aortic pseudoaneurysm." Open Medicine 11, no. 1 (January 1, 2016): 215–19. http://dx.doi.org/10.1515/med-2016-0041.
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AbstractBlunt trauma to the neck or to the chest are increasingly observed in the emergency clinical practice. They usually follow motor vehicle accidents or may be work or sports related. A wide pattern of clinical presentation can be potentially encountered. We report the uncommon case of a patient who was referred to our observation presenting with hoarseness and disphagia. Twenty days before he had sustained a car accident with trauma to the chest, neck and the mandible. Laryngoscopy showed a left recurrent laryngeal nerve palsy. Further otolaryngo-logical examination showed no other abnormality. At CT and MR imaging a post-traumatic aortic pseudoaneurysm was revealed. The aortic pseudoaneurysm was consequently repaired by implantation of an endovascular stent graft under local anesthesia. The patient was discharged 10 days later. At 30-days follow-up laryngoscopy the left vocal cord palsy was completely resolved.Hoarseness associated with a dilated left atrium in a patient with mitral valve stenosis was initially described by Ortner more than a century ago. Since then several non malignant, cardiovascular, intrathoracic disease that results in embarrassment from recurrent laryngeal nerve palsy usually by stretching, pulling or compression; thus, the correlations of these pathologies was termed as cardiovocal syndrome or Ortner’s syndrome. The reported case illustrates that life-threatening cardiovascular comorbidities can cause hoarseness and that an impaired recurrent laryngeal nerve might be correctable.
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Rao, Rajesh C., and Dong Feng Chen. "Nanomedicine and Optic Nerve Regeneration—Implications for Ophthalmology." US Ophthalmic Review 04, no. 01 (2011): 108. http://dx.doi.org/10.17925/usor.2011.04.01.108.
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The optic nerve transmits visual information from the retina to the brain. When injured in adult mammals, the optic nerve does not regenerate. Optic neuropathies such as glaucoma are a leading cause of blindness worldwide. Optic neuropathies can also occur after ischemia, inflammation, infection, neoplasia, trauma, and/or as a result of hereditary conditions. One of the most exciting therapeutic strategies to promote optic nerve regeneration is nanomedicine. Nanomedicine utilizes the assembly and manipulation of structures less than 100 nanometers in size to treat disease. Structural elements such as protein-coated nanofibers and self-assembling peptide scaffolds are designed to enhance axon regeneration. Nanoscale spheres can deliver intraocular pressure-lowering medications and therapeutic proteins. By ‘tagging’ cells with nanoparticles, stem cell transplants can be tracked and axons redirected via a magnetic field. Finally, nanoparticles with an ability to scavenge the toxic reactive oxygen species generated in hereditary and glaucomatous optic neuropathies may provide a new avenue to treat specific types of optic nerve disorders.
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Flor-de-Lima, Filipa, Liliana Macedo, Ricardo Taipa, Manuel Melo-Pires, and Maria Lurdes Rodrigues. "Hereditary Neuropathy with Liability to Pressure Palsy: A Recurrent and Bilateral Foot Drop Case Report." Case Reports in Pediatrics 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/230541.
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Hereditary neuropathy with liability to pressure palsy is characterized by acute, painless, recurrent mononeuropathies secondary to minor trauma or compression. A 16-year-old boy had the first episode of right foot drop after minor motorcycle accident. Electromyography revealed conduction block and slowing velocity conduction of the right deep peroneal nerve at the fibular head. After motor rehabilitation, he fully recovered. Six months later he had the second episode of foot drop in the opposite site after prolonged squatting position. Electromyography revealed sensorimotor polyneuropathy of left peroneal, sural, posterior tibial, and deep peroneal nerves and also of ulnar, radial, and median nerves of both upper limbs. Histological examination revealed sensory nerve demyelination and focal thickenings of myelin fibers. The diagnosis of hereditary neuropathy with liability to pressure palsy was confirmed by PMP22 deletion of chromosome 17p11.2. He started motor rehabilitation and avoidance of stressing factors with progressive recovery. After one-year followup, he was completely asymptomatic. Recurrent bilateral foot drop history, “sausage-like” swellings of myelin in histological examination, and the results of electromyography led the authors to consider the diagnosis despite negative family history. The authors highlight this rare disease in pediatric population and the importance of high index of clinical suspicion for its diagnosis.
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Schmidt, Richard H., Lisa A. Rietz, Bhupendra C. K. Patel, Anne G. Osborne, David Pratt, and Kathleen B. Digre. "Compressive optic neuropathy caused by renal osteodystrophy." Journal of Neurosurgery 95, no. 4 (October 2001): 704–9. http://dx.doi.org/10.3171/jns.2001.95.4.0704.
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✓ Compressive optic neuropathy with acute or chronic vision loss has been associated with various skull base tumors, aneurysms, Graves disease, trauma, and, less commonly, fibrous dysplasia and osteopetrosis. The authors present a case of acute visual deterioration in a 25-year-old woman who had massive calvarial hypertrophy with optic canal stenosis secondary to renal osteodystrophy (uremic leontiasis ossea [ULO]: bighead disease). Significant visual field restoration was achieved with high-dose corticosteroids followed by optic nerve decompression. This is the first case report of cranial neuropathy associated with ULO.
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Yuan and Jing. "Cardiovocal syndrome secondary to an aortic pseudoaneurysm." Vasa 38, no. 4 (November 1, 2009): 382–89. http://dx.doi.org/10.1024/0301-1526.38.4.382.
Full textAbstract:
Left recurrent laryngeal nerve palsy characterized by hoarseness due to a cardiovascular disorder, which is termed as cardiovocal syndrome or Ortner’s syndrome, is an unusual condition. The syndrome might be associated with diverse cardiovascular diseases. However, it is rarely caused by an aortic pseudoaneurysm. The prominent clinical features of such patients are a history of trauma and the injury to or compression of the aortic isthmus involving the laryngeal nerve. Surgical or interventional treatment is necessary, and recurrent laryngeal nerve palsy is usually expected to recover after the surgical intervention of the aortic pseudoaneurysm.
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Juybari, Kobra B., Azam Hosseinzadeh, Habib Ghaznavi, Mahboobeh Kamali, Ahad Sedaghat, Saeed Mehrzadi, and Masood Naseripour. "Melatonin As a Modulator of Degenerative and Regenerative Signaling Pathways in Injured Retinal Ganglion Cells." Current Pharmaceutical Design 25, no. 28 (October 21, 2019): 3057–73. http://dx.doi.org/10.2174/1381612825666190829151314.
Full textAbstract:
Optic neuropathies refer to the dysfunction or degeneration of optic nerve fibers caused by any reasons including ischemia, inflammation, trauma, tumor, mitochondrial dysfunction, toxins, nutritional deficiency, inheritance, etc. Post-mitotic CNS neurons, including retinal ganglion cells (RGCs) intrinsically have a limited capacity for axon growth after either trauma or disease, leading to irreversible vision loss. In recent years, an increasing number of laboratory evidence has evaluated optic nerve injuries, focusing on molecular signaling pathways involved in RGC death. Trophic factor deprivation (TFD), inflammation, oxidative stress, mitochondrial dysfunction, glutamate-induced excitotoxicity, ischemia, hypoxia, etc. have been recognized as important molecular mechanisms leading to RGC apoptosis. Understanding these obstacles provides a better view to find out new strategies against retinal cell damage. Melatonin, as a wide-spectrum antioxidant and powerful freeradical scavenger, has the ability to protect RGCs or other cells against a variety of deleterious conditions such as oxidative/nitrosative stress, hypoxia/ischemia, inflammatory processes, and apoptosis. In this review, we primarily highlight the molecular regenerative and degenerative mechanisms involved in RGC survival/death and then summarize the possible protective effects of melatonin in the process of RGC death in some ocular diseases including optic neuropathies. Based on the information provided in this review, melatonin may act as a promising agent to reduce RGC death in various retinal pathologic conditions.
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Pernando, Yonky. "Parestesia Expert System! Expert System To Detect Paresthesia (Parestesia Expert System! Sistem Pakar Untuk Mendeteksi Penyakit Parestesia)." Jurnal KomtekInfo 7, no. 3 (September 1, 2020): 186–96. http://dx.doi.org/10.35134/komtekinfo.v7i3.79.
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Paresthesia is a condition where the sensation on the skin is abnormal, such as tingling, itching or numbness, for no apparent reason. This condition can occur only temporarily or for a long time (chronic). Bucharestesia can be temporary (temporary) or chronic. Almost everyone has experienced temporary paresthesia. This sensation occurs when nerves are accidentally compressed in certain body positions, such as sitting cross-legged for too long or sleeping with your head on your hands. Temporary paraesthesia will go away on its own when the pressure on the nerves is relieved. However, if the tingling feeling persists even though the pressure has been relieved, then there may be another disease or disorder in the body that is the cause. Chronic paresthesia is often a symptom of a neurological disease or caused by trauma to the nerve tissue. A variety of diseases can cause chronic paresthesia including vitamin deficiency, neurological disorders due to repetitive movements or other diseases. Chronic paraesthesia requires medication and management to heal. However, sometimes chronic paresthesia cannot completely heal even after undergoing treatment even though an expert system is a computer-based system that uses knowledge, facts, and reasoning techniques to solve problems that usually only one person can solve. Expert systems also help their activities as highly experienced assistants. Expert systems can also provide analysis of problems and can also recommend to users some actions to make improvements.
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Cigna, Emanuele, Anna Maria Spagnoli, Mauro Tarallo, Liliana De Santo, Giampaolo Monacelli, and Nicolò Scuderi. "Therapeutic Management of Hypothenar Hammer Syndrome Causing Ulnar Nerve Entrapment." Plastic Surgery International 2010 (June 7, 2010): 1–5. http://dx.doi.org/10.1155/2010/343820.
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Introduction. The hypothenar hammer syndrome is a rare traumatic vascular disease of the hand. Method and Materials. We report the case of a 43-years-old man with a painful tumefaction of the left hypothenar region. The ulnar artery appeared thrombosed clinically and radiologically. The patient underwent surgery to resolve the ulnar nerve compression and revascularise the artery. Results. The symptoms disappeared immediately after surgery. The arterial flow was reestablished. Postoperatively on day 20, a new thrombosis of the ulnar artery occurred. Conclusion. Hypothenar hammer syndrome is caused by repetitive trauma to the heel of the hand. The alterations of the vessel due to its chronic inflammation caused an acute compression of the ulnar nerve at the Guyon's canal and, in our case, do not allow a permanent revascularisation of the ulnar artery.
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Faramarzi, Mohammad, Ali Faramarzi, and Milad Hosseinialhashemi. "Is Early Traumatic Facial Nerve Surgery a Priority during the COVID-19 Pandemic?" International Archives of Otorhinolaryngology 25, no. 02 (March 15, 2021): e177-e178. http://dx.doi.org/10.1055/s-0041-1724089.
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AbstractAs otolaryngologists are exposed to high risk of coronavirus disease 2019 (COVID-19) infection, logic and evidence-based prioritization for surgeries is essential to reduce the risk of infection amongst healthcare workers. Several clinical guidelines and surgery prioritizing recommendations have been published during the COVID-19 pandemic. They recommended the surgery in the setting of immediate facial nerve paralysis within 72 hours after trauma, but none of the previous studies in the literature suggests that the optimal timing of operation should be less than 2 weeks from injury.
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Chau, Destiny F., Eudice E. Fontenot, and Michael L. Schmitz. "Chronic intercostal neuralgia after placement of right ventricle to pulmonary artery conduit with prosthetic valve." BMJ Case Reports 14, no. 3 (March 2021): e239264. http://dx.doi.org/10.1136/bcr-2020-239264.
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Adults with congenital heart disease often have complex medical issues requiring individualised multidisciplinary care for optimising outcomes and quality of life. Chronic pain is an example. We report a rare case of intercostal neuralgia seemingly caused by irritation from a prosthetic valve in a right ventricle to pulmonary artery conduit in a patient with tetralogy of Fallot. Intercostal neuralgia is a painful disorder linked to nerve irritation or injury from trauma, infection or pressure. Although chronic postsurgical pain after cardiac surgery is prevalent, rarely the aetiology relates to valve irritation on a single intercostal nerve. After failing pharmacological therapy for 8 months, the neuralgia completely resolved after an ultrasound-guided neurolytic block with long-term effectiveness and improvement in patient satisfaction.
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Silverstein, Herbert, Alan McDaniel, Jack Wazen, and Horace Norrell. "Retrolabyrinthine Vestibular Neurectomy with Simultaneous Monitoring of Eighth Nerve and Brain Stem Auditory Evoked Potentials." Otolaryngology–Head and Neck Surgery 93, no. 6 (December 1985): 736–42. http://dx.doi.org/10.1177/019459988509300607.
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We have used retrolabyrinthine vestibular neurectomy In 36 of 49 cases as the primary surgical procedure to relieve vertigo. Most of the patients (46 of 49) had Meniere's disease. Results indicate that 71% (35 of 49) of the patients had no vertigo after the operation, while 22% (11 of 49) had much Improvement. Hearing was maintained within 20 dB of the preoperative level in 78% (38 of 49) of the patients. During surgery in the last 23 patients, direct nerve potentials were recorded from the middle ear promontory and the intracranial cochlear nerve. Brain stem auditory evoked responses were simultaneously recorded in the last 10 patients. It appears that the intraoperative direct cochlear nerve potentials can be used as a sensitive monitor of trauma to the cochlear nerve during and after vestibular neurectomy. If the latency of the eighth nerve action potential changes less than 0.3 msec and the waveform does not change after vestibular neurectomy, there is an excellent chance that hearing at 1 month after surgery will be within 15 dB of the level before surgery. The retrolabyrinthine vestibular neurectomy has replaced the middle fossa vestibular neurectomy and the endolymphatic subarachnoid shunt procedure in our clinic.
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Koogler, Andrew T., and Michael Kushelev. "Ultrasound-Guided Interscalene Catheter Complicated by Persistent Phrenic Nerve Palsy." Case Reports in Anesthesiology 2018 (2018): 1–5. http://dx.doi.org/10.1155/2018/9873621.
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A 76-year-old male presented for reverse total shoulder arthroplasty (TSA) in the beach chair position. A preoperative interscalene nerve catheter was placed under direct ultrasound-guidance utilizing a posterior in-plane approach. On POD 2, the catheter was removed. Three weeks postoperatively, the patient reported worsening dyspnea with a subsequent chest X-ray demonstrating an elevated right hemidiaphragm. Pulmonary function testing revealed worsening deficit from presurgical values consistent with phrenic nerve palsy. The patient decided to continue conservative management and declined further invasive testing or treatment. He was followed for one year postoperatively with moderate improvement of his exertional dyspnea over that period of time. The close proximity of the phrenic nerve to the brachial plexus in combination with its frequent anatomical variation can lead to unintentional mechanical trauma, intraneural injection, or chemical injury during performance of ISB. The only previously identified risk factor for PPNP is cervical degenerative disc disease. Although PPNP has been reported following TSA in the beach chair position without the presence of a nerve block, it is typically presumed as a complication of the interscalene block. Previously published case reports and case series of PPNP complicating ISBs all describe nerve blocks performed with either paresthesia technique or localization with nerve stimulation. We report a case of a patient experiencing PPNP following an ultrasound-guided placement of an interscalene nerve catheter.
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JD, Coyne, and Chatzipantelis P. "Naevus Sebaceous with Tumour of the Follicular Infundibulum, Trichilemmoma, Desmoplastic Trichilemmoma, Apocrine Adenoma and Syringocystadenoma Papilliferum: Report of a Case." Dermatology and Dermatitis 4, no. 1 (August 9, 2019): 01–02. http://dx.doi.org/10.31579/2578-8949/051.
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Due to the increasing prevalence of so called "life style diseases", such as diabetes, obesity or hypertension, the number of associated vascular and nerve lesions increases. In the lower limbs in particular, bagatelle trauma causes wounds that lead to wound healing disorders and chronic wounds
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K. Stuermer, Ewa. "Influence of Antihypertensive and Antidiabetic Drugs on Wound Healing – Essentials of a Systematic In-Vitro Study." Dermatology and Dermatitis 4, no. 1 (August 9, 2019): 01–04. http://dx.doi.org/10.31579/2578-8949/050.
Full textAbstract:
Due to the increasing prevalence of so called "life style diseases", such as diabetes, obesity or hypertension, the number of associated vascular and nerve lesions increases. In the lower limbs in particular, bagatelle trauma causes wounds that lead to wound healing disorders and chronic wounds
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Jarratt, JA, CN Morgan, JA Twomey, R. Abraham, PC Sheaff, JB Pilling, J. Payan, et al. "Neuropathy in chronic obstructive pulmonary disease: a multicentre electrophysiological and clinical study." European Respiratory Journal 5, no. 5 (May 1, 1992): 517–24. http://dx.doi.org/10.1183/09031936.93.05050517.
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The incidence and type of neuropathy in patients with chronic obstructive pulmonary disease (COPD) were assessed. In a selected group of 89 patients, abnormal nerve conduction studies were found in 44%. Electrophysiological signs of a generalized peripheral neuropathy were found in 5-18%, depending on diagnostic criteria. Lesions which were thought to be due to compression or other forms of trauma were present in a further 24%. In the patients with peripheral neuropathy, the changes were distally predominant, affected mainly sensory fibres, and were consistent with an axonal type of neuropathy. There was a significant correlation between age and the incidence of peripheral neuropathy. Electrophysiological evidence of neuropathy was three times as common as clinical evidence. Much of the variation in the reported incidence of neuropathy in COPD is probably due to imprecise diagnostic criteria.
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Park, Dou-Young, Il Choi, Tae-Gyum Kim, Woo-Jae Kim, Il-Young Shin, and Eun-Kyung Khil. "Gray Ramus Communicans Nerve Block for Acute Pain Control in Vertebral Compression Fracture." Medicina 57, no. 8 (July 23, 2021): 744. http://dx.doi.org/10.3390/medicina57080744.
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Background and Objectives: The current options for acute pain control of vertebral compression fracture include hard brace, vertebroplasty, early surgery, and analgesic injection. We hypothesize that the gray ramus communicans nerve block (GRNB) controls the acute pain experienced during vertebral compression fractures. This study assessed the time course of pain control after injection and evaluated the risk factors affecting pain control failure. Materials and methods: Sixty-three patients (24 male, 66.19 ± 15.17 y) with a thoracolumbar vertebral fracture at the T10-L5 spine, who presented to our hospital from November 2018 to October 2019, were included in this retrospective cohort study. GRNB was performed within 1 week of the trauma. The patients were followed up on days 3, 14, 30, 90, and 180 and assessed with the serial visual analog scale (VAS, resting and motion), Oswestry Low Back Disability (ODI) questionnaire, and Roland–Morris Disability Questionnaire (RDQ). The failure group was defined by the need for an additional block or cement injection after a single GRNB. The failure group’s risk factors, such as body mass index, initial thoracolumbar injury classification and severity score, Kummel’s disease, age, bone marrow density (BMD), and underlying disease, were analyzed. Results: The motion VAS score improved from preoperative to three months post-procedure, but the resting VAS was affected by the procedure for only three days. The quality of life index improved at postoperative six months. A lower BMD was the only risk that affected treatment failure in the logistic regression analysis (p = 0.0038). Conclusion: The effect of GRNB was maintained even at three months after trauma based on motion VAS results. The only risk factor identified for GRNB failure was lower BMD.
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Nasser, Ahmed Abdul Hadi, Sara Al-Saad, Rashad Khamis Awad, and Fahad Alkhalifa. "Post Traumatic Diffuse Neurofibroma in the Foot: An Unusual Presentation." Open Orthopaedics Journal 12, no. 1 (November 30, 2018): 496–99. http://dx.doi.org/10.2174/1874325001812010496.
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Background: Neurofibromas are benign peripheral nerve sheath tumors that present as solitary or multiple lesions. They can present alone or as part of the disease process called neurofibromatosis type 1. The etiology behind solitary neurofibromas is still poorly understood, however, trauma has been proposed to be a possible cause. Methods: We present a rare case of a 23-year-old male, without any known medical history, who fell and injured his left foot 3 years prior to presentation. He was treated conservatively at that time and presented to Bahrain Defence Force hospital complaining of a progressive painless swelling in his left forefoot post trauma. Results: The patient underwent imaging studies, which misdiagnosed the lesion as a possible lymphangioma, haemangioma, or a chronic inflammatory swelling. An excisional biopsy was taken, and the pathology specimen proved the lesion to be a diffuse neurofibroma. Conclusion: Trauma may possibly be a predisposing factor behind the development of solitary diffuse neurofibromas in patients that are not known to have neurofibromatosis. Further studies should be conducted to prove whether or not trauma is a predisposing factor for the development of solitary neurofibromas.
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Stidd, David A. "Peripheral Nerve Stimulation for Trigeminal Neuropathic Pain." Pain Physician 1;15, no. 1;1 (January 14, 2012): 27–33. http://dx.doi.org/10.36076/ppj.2012/15/27.
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Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic pain (TNP) is defined as pain caused by a lesion or disease of the trigeminal branch of the peripheral nervous system resulting in chronic facial pain over the distribution of the injured nerve. First line treatment of TNP includes management with anticonvulsant medication (carbamazepine, phenytoin, gabapentin, etc.), baclofen, and analgesics. TNP, however, can be a condition difficult to adequately treat with medical management alone. Patients with TNP can suffer from significant morbidity as a result of inadequate treatment or the side effects of pharmacologic therapy. TNP refractory to medical management can be considered for treatment with a growing number of invasive procedures. Peripheral nerve stimulation (PNS) is a minimally invasive option that has been shown to effectively treat medically intractable TNP. We present a case series of common causes of TNP successfully treated with PNS with up to a 2 year follow-up. Only one patient required implantation of new electrode leads secondary to electrode migration. The patients in this case series continue to have significant symptomatic relief, demonstrating PNS as an effective treatment option for intractable TNP. Though there are no randomized trials, peripheral neuromodulation has been shown to be an effective means of treating TNP refractory to medical management in a growing number of case series. PNS is a safe procedure that can be performed even on patients that are not optimal surgical candidates and should be considered for patients suffering from TNP that have failed medical management. Key words: Trigeminal neuropathic pain, peripheral nerve stimulation, neuromodulation, intractable pain, facial trauma, postherpetic neuralgia
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Fadda, G. L., M. Gisolo, E. Crosetti, A. Fulcheri, and G. Succo. "Intracranial Complication of Rhinosinusitis from Actinomycosis of the Paranasal Sinuses: A Rare Case of Abducens Nerve Palsy." Case Reports in Otolaryngology 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/601671.
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Sinonasal actinomycosis should be suspected when a patient with chronic sinusitis does not respond to medical therapy or has a history of facial trauma, dental disease, cancer, immunodeficiency, long-term steroid therapy, diabetes, or malnutrition. Radiological evaluation with computed tomography and magnetic resonance imaging are important in differential diagnosis, evaluating the extent of disease, and understanding clinical symptoms. Endoscopic sinus surgery associated with long-term intravenous antibiotic therapy is the gold standard for treatment of sinonasal actinomycosis. We report an unusual case of abducens nerve palsy resulting from invasive sinonasal actinomycosis in a patient with an abnormally enlarged sphenoid sinus. A review of the current literature highlighting clinical presentation, radiological findings, and treatment of this uncommon complication is also presented.
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Athawale, Vrushali K., Dushyant P. Bawiskar, and Pratik Arun Phansopkar. "Rehabilitation of a Patient with Bell’s Palsy." Journal of Evolution of Medical and Dental Sciences 10, no. 20 (May 17, 2021): 1551–54. http://dx.doi.org/10.14260/jemds/2021/323.
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Facial nerve palsy is the disease of cranial nerve. From the total number of cases, 60 to 75 % of Bell's palsy cases are idiopathic form of facial palsy. Facial nerve palsy results in weakness of facial muscles, atrophy, asymmetry of face and also disturbs the quality of life. Bell’s palsy occurs in every class of population affecting people of all the age groups but the most common age group affected is 15 - 50 years with equal sex prediliction accounting 11 - 40 cases per 100,000. If facial palsy is not treated properly then it may result in variety of complications like motor synkinesis, dysarthria, contractures of facial muscles, and crocodile tear. Currently facial paralysis treatment consists of combination of pharmacological therapy, facial neuromuscular re-entrainment physiotherapy or surgical intervention by static and dynamic facial reanimation techniques. Physiotherapy treatment is effective for treating facial paralysis with minimal complications and can be individualized. Bell's palsy is the idiopathic form of facial nerve palsy which accounts for 60 to 75 % of cases and male to female ratio is 1:3.1 The aetiology of facial paralysis is not yet thoroughly understood. Cases of varicella-zoster, mononucleosis, herpes simplex virus, mumps and measles have demonstrated good serology in several reports for their association but still stands unclear. 2 Peripheral facial nerve palsy may be idiopathic (primary cause) or Bell’s palsy (secondary). Causes of the secondary unilateral facial nerve palsy are diabetes, stroke, Hansen's disease, herpes simplex infection, birth injury, trauma, tumour, Guillain-Barre syndrome, and immune system disorders. Causes of the bilateral facial nerve palsy are leukemia, brainstem encephalitis, leprosy, and meningitis. The most prominent current theories of facial nerve paralysis pathophysiology include the reactivation of herpes simplex virus infection (HSV type 1). Current facial paralysis treatment consists of a combination of pharmacological therapy, facial neuromuscular re-entrainment physiotherapy or surgical intervention by dynamic and static facial reanimation techniques.7 This is a diagnosed case of right facial nerve palsy which was treated under physiotherapy department with proper rehabilitation protocol.
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Ward, Thomas Robert William, Kanai Garala, Ian Dos Remedios, and Justin Lim. "Piriformis syndrome as a result of intramuscular haematoma mimicking cauda equina effectively treated with piriformis tendon release." BMJ Case Reports 15, no. 3 (March 2022): e247988. http://dx.doi.org/10.1136/bcr-2021-247988.
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We present a case of piriformis syndrome in a woman in her 30’s following low energy trauma, presenting with unilateral lower limb weakness, altered sensation and urinary retention. CT imaging revealed a bulky piriformis muscle which was further clarified on MRI as an intramuscular haematoma within the left piriformis causing compression of the left lumbosacral plexus. Haematoma formation was exacerbated due to use of an antiplatelet medication the patient was taking for Moyamoya disease, which carries an increased risk of cerebrovascular accident. Surgical exploration of the piriformis and sciatic nerve was undertaken and confirmed a haematoma within the piriformis. A full release of the piriformis tendon was undertaken, and the sciatic nerve was inspected, no further abnormality was found. After review in clinic post-discharge, the patient reported normal sensation and normal muscle power in her feet.
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Richner, Mette, Lone T. Pallesen, Maj Ulrichsen, Ebbe T. Poulsen, Thomas H. Holm, Hande Login, Annie Castonguay, et al. "Sortilin gates neurotensin and BDNF signaling to control peripheral neuropathic pain." Science Advances 5, no. 6 (June 2019): eaav9946. http://dx.doi.org/10.1126/sciadv.aav9946.
Full textAbstract:
Neuropathic pain is a major incurable clinical problem resulting from peripheral nerve trauma or disease. A central mechanism is the reduced expression of the potassium chloride cotransporter 2 (KCC2) in dorsal horn neurons induced by brain-derived neurotrophic factor (BDNF), causing neuronal disinhibition within spinal nociceptive pathways. Here, we demonstrate how neurotensin receptor 2 (NTSR2) signaling impairs BDNF-induced spinal KCC2 down-regulation, showing how these two pathways converge to control the abnormal sensory response following peripheral nerve injury. We establish how sortilin regulates this convergence by scavenging neurotensin from binding to NTSR2, thus modulating its inhibitory effect on BDNF-mediated mechanical allodynia. Using sortilin-deficient mice or receptor inhibition by antibodies or a small-molecule antagonist, we lastly demonstrate that we are able to fully block BDNF-induced pain and alleviate injury-induced neuropathic pain, validating sortilin as a clinically relevant target.
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Say, Tiffany Ella Rose, and Raymond L. Rosales. "Constrictive Entrapment Neuropathies of a Limb Secondary to Restraint Strapping: A Case Report." Journal of Medicine, University of Santo Tomas 5, no. 2 (December 31, 2021): 798–801. http://dx.doi.org/10.35460/2546-1621.2021-0154.
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Rationale: Entrapment neuropathies are peripheral nerve disorders at specific anatomical locations. They may be caused by trauma in a manner of sprains or bone fracture, but it is often caused by repetitive insults or compression of nerves as they travel through a narrow anatomic space. Pregnancy and pre-existing comorbidities such as diabetes, obesity, cancer, or autoimmune diseases may also cause nerve entrapment. Objective: To highlight the case of a 52-year-old female developing right foot dysesthesia and weakness after continuous restraint strapping from her previous hospitalization. Case: Here we have the case of a 52-year-old Filipino female consulted because of right foot dysesthesia, allodynia, and mild weakness. She had a history of bipolar disorder and recent onset of acute psychosis and overdosing with her irregularly taken maintenance olanzapine tablets. She was put on restraint strapping of the right lower limb in her one-week hospital stay. This resulted in developing restraint marks on her right ankle accompanied by difficulty walking on heels and toes, spontaneous dysesthesia, and touch allodynia of her entire right foot. An electrodiagnosis yielded right lower limb focal neuropathies involving the right fibular nerve, right tibial nerve, right superficial fibular, and right sural nerves. The prescribed amitriptyline and gabapentin for 6 months led to gradual improvement of neuropathic pain. Discussion and Summary: Our case exemplifies focal limb neuropathies from entrapment due to restraint strapping. Electrodiagnostic confirmation of neuropathies of the same limb sensory and motor nerves was mandated to corroborate clinical neuropathic pain and after ruling out other causes of entrapment neuropathies. Prolonged use of neuropathic pain medications were needed to attain relief in this present case. Restrictive strapping is an iatrogenic cause of entrapment neuropathy that is preventable, had there been proper medical attention applied.
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Khan, Abdul Rahman, Aziz Ullah, Muhammad Shuaib Chandio, Zulfiqar Ali Jatoi, Sajjad Hussain Bhatti, Sartaj Lakhani, and Niaz Hussain Keerio. "Causes and Treatment of Birth Trauma-Related Femoral Fracture: A Longitudinal Study." Pakistan Journal of Medical and Health Sciences 16, no. 8 (August 31, 2022): 642–43. http://dx.doi.org/10.53350/pjmhs22168642.
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Aim: To determine the causes and treatment of birth trauma related femoral fractures. Study design: A longitudinal study Place and Duration: This study was conducted at DIMC, Dow University of Health Sciences, Karachi from January2021 to January 2022. Methodology:The study included cases of femoral fractures in neonates caused by birth trauma. The cases of birth histories were investigated in terms of gestational age, birth weight,and mode of delivery. The category of femoral fracturesand the treatment performed were both noted. Cases were followed until they were recovered.A comprehensive clinical examination was performed. Other birth traumas, fractures, nerve palsies, and/or symptoms of other musculoskeletal, genetic diseases, such as blue sclera and hypermobile joints (osteogenesis imperfecta), were noted. Results:A total of 15 newborns with femoral fractures were included in this study.The average gestational age was 38.2 weeks, with an average diagnosis time of 3 days. In the majority of cases, the infant was born breech and delivered via Caesarean section. Eleven instances had mid-shaft fractures, while four had subtrochanteric fractures. After an average of 3.1 weeks, all patients had a complete union. Conclusion:A femoral fracture in a neonate due to birth related trauma is quite uncommon. It occurs more frequently in Caesarean sections performed for breech presentation. Preterm and/or low birth weight newborns are at a higher risk. The femur shaft is commonly fractured. The prognosis for these fractures is excellent, and they heal completely after immobilization. Keywords: Birth Trauma, Femoral Fracture, Management, Risk Factors
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Nathan, John, Lynda Asadourian, and Mark A. Erlich. "A Brief History of Local Anesthesia." International Journal of Head and Neck Surgery 7, no. 1 (2016): 29–32. http://dx.doi.org/10.5005/jp-journals-10001-1261.
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ABSTRACT Mankind has, throughout its existence, been engaged in the quest to control the pain associated with disease and trauma. Evidence from over 4500 years ago demonstrates the Egyptians use of methods to compress peripheral nerves. Homer's Iliad relates the use of herbal remedies for pain control. Other early writings describe the use of electricity generated by the Torpedo ray for pain control as well as cold water and ice for pain reduction. These techniques, in their various incarnations, comprised the main armamentarium of local pain control until the early 1800's when the early framework for the hypodermic syringe emerged in America. Cocaine, noted for its stimulant effect as well as numbing properties, was first brought to Europe by Vespucci. The combination of a workable syringe and the purification of Cocaine by Niemann essentially gave birth to modern local anesthesia. Halsted would perform the first injections of cocaine via hypodermic syringe into a proximal nerve for distal pain control, introducing modern conduction local anesthesia. All that remained was the introduction of numerous blockers of nerve depolarization, combined with vasoconstrictors, to minimize systemic toxicity, and we arrive at the modern state of local anesthesia. How to cite this article Nathan J, Asadourian L, Erlich MA. A Brief History of Local Anesthesia. Int J Head Neck Surg 2016; 7(1):29-32.
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Dubljanin-Raspopović, Emilija, Goran Tulić, Una Nedeljković, Nela Ilić, Milica Aleksić, Marko Kadija, and Sanja Tomanović-Vujadinović. "Complex regional pain syndrome: Literature review as a guide for the practicing clinician." Srpski medicinski casopis Lekarske komore 3, no. 3 (2022): 374–83. http://dx.doi.org/10.5937/smclk3-39589.
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Complex regional pain syndrome (CRPS) is a chronic complex disorder that significantly affects the quality of life of the people suffering from it. This syndrome affects the extremities after trauma or nerve injury. Hyperalgesia and allodynia of the extremities often accompany this condition. Diagnosing and treating this disease is very complex. The Budapest criteria are currently the most widely accepted diagnostic criteria. Early diagnosis and treatment are essential for a favorable outcome in CRPS. Therapeutic modalities available for the treatment of CRPS include physical therapy, pharmacotherapy, and interventional techniques. Additional high-quality studies are needed to determine the best therapeutic option.
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Suryaningtyas, Wihasto. "Spinal Arachnoid Cyst in Children." Neurologico Spinale Medico Chirurgico 1, no. 2 (August 7, 2018): 25. http://dx.doi.org/10.15562/nsmc.v1i2.103.
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Spinal arachnoid cyst is rarely seen in children. The presenting features can be mistakenly assumed as myelitis or Guillan-Barre syndrome. Intermittent weaknesses of the leg, progressive ascending weakness of the leg, sensory disturbance, and altered physiological reflexes are the hallmark of the disease. Nabors classified the pathology of the spinal arachnoid cyst into three types: extradural without nerve root involvement; extradural with nerve root; and intradural. It is mostly located in mid- to lower thoracic. The causes and natural history of pediatric arachnoid cysts are unclear. They usually are associated with trauma, surgery, arachnoiditis, and neural tube defects. MRI is a useful diagnostic tool. We present two cases of extradural and intradural arachnoid cysts in children. The follow-up and surgical results are reviewed. The surgical therapy itself is straightforward. However, the wrong conclusion might cause a financial burden and may cause preventable sequel.