1/1193. Postoperative gas bubble foot drop. A case report.STUDY DESIGN: An unusual case of foot drop occurring 10 days after disc surgery is reported. Imaging studies identified a gas bubble compressing the nerve root. OBJECTIVE: To describe the origin and management of a radiculopathy caused by an intraspinal gas bubble. SUMMARY OF BACKGROUND DATA: A recurrent lumbar disc herniation was diagnosed by clinical and imaging studies. A vacuum disc also was noted at the same level. These are common and not considered to be of pathologic significance. methods: The patient underwent a microdiscectomy for a lumbar disc extrusion. The postoperative course was excellent, with relief of symptoms and no neurologic deficit. Ten days later, the awoke with a foot drop and pain in the leg. Imaging studies showed a 4-mm gas bubble compressing the nerve root. Oral steroids were given for 10 days. RESULTS: Progressive improvement occurred, and the patient was asymptomatic 6 weeks later. Although in some instances it may be necessary to evacuate intraspinal gas, an initial period of observation is warranted, because the gas and its resulting symptoms may disappear spontaneously. CONCLUSION: Intradiscal gas accumulation, better known as vacuum disc, is considered to be a benign indication of degenerative disc disease. On occasion it can be a cause of symptoms. A case is reported in which gas leaked after surgery into the spinal canal, causing a foot drop. The symptoms and gas disappeared spontaneously without further treatment.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/1193. Lumbar intraspinal synovial cysts of different etiologies: diagnosis by CT and MR imaging.Intraspinal synovial cysts arises from a facet joint and may cause radicular symptoms due to nerve root compression. In the present study, three surgically and histologically proved cases of synovial cyst of the lumbar spine with different etiology are described. The purpose of this report is to illustrate the imaging features of various etiologies of intraspinal synovial cysts allowing a correct preoperative diagnosis. review of the literature enables us to say that to our knowledge, there is no reported article collecting the imaging findings of intraspinal synovial cysts with different etiologies. Only single cases with rheumatoid arthritic or traumatic origin have been reported to date. We believe that computed tomography and particularly magnetic resonance imaging are the methods of choice which provide the most valuable diagnostic information.- - - - - - - - - - ranking = 0.5keywords = nerve (Clic here for more details about this article) |
3/1193. Hyperactive rhizopathy of the vagus nerve and microvascular decompression. Case report.A 37-year-old woman underwent microvascular decompression of the superior vestibular nerve for disabling positional vertigo. Immediately following the operation, she noted severe and spontaneous gagging and dysphagia. Multiple magnetic resonance images were obtained but failed to demonstrate a brainstem lesion and attempts at medical management failed. Two years later she underwent exploration of the posterior fossa. At the second operation, the vertebral artery as well as the posterior inferior cerebellar artery were noted to be compressing the vagus nerve. The vessels were mobilized and held away from the nerve with Teflon felt. The patient's symptoms resolved immediately after the second operation and she has remained symptom free. The authors hypothesize that at least one artery was shifted at the time of her first operation, or immediately thereafter, which resulted in vascular compression of the vagus nerve. To the authors' knowledge, this is the first reported case of a hyperactive gagging response treated with microvascular decompression. The case also illustrates the occurrence of a possibly iatrogenic neurovascular compression syndrome.- - - - - - - - - - ranking = 4keywords = nerve (Clic here for more details about this article) |
4/1193. Intraoperative loss of auditory function relieved by microvascular decompression of the cochlear nerve.BACKGROUND: Brainstem auditory evoked potentials (BAEP) are useful indicators of auditory function during posterior fossa surgery. Several potential mechanisms of injury may affect the cochlear nerve, and complete loss of BAEP is often associated with postoperative hearing loss. We report two cases of intraoperative auditory loss related to vascular compression upon the cochlear nerve. methods: Intra-operative BAEP were monitored in a consecutive series of over 300 microvascular decompressions (MVD) performed in a recent twelve-month period. In two patients undergoing treatment for trigeminal neuralgia, BAEP waveforms suddenly disappeared completely during closure of the dura. RESULTS: The cerebello-pontine angle was immediately re-explored and there was no evidence of hemorrhage or cerebellar swelling. The cochlear nerve and brainstem were inspected, and prominent vascular compression was identified in both patients. A cochlear nerve MVD resulted in immediate restoration of BAEP, and both patients recovered without hearing loss. CONCLUSION: These cases illustrate that vascular compression upon the cochlear nerve may disrupt function, and is reversible with MVD. awareness of this event and recognition of BAEP changes alert the neurosurgeon to a potential reversible cause of hearing loss during posterior fossa surgery.- - - - - - - - - - ranking = 4.5013384598628keywords = nerve, injury (Clic here for more details about this article) |
5/1193. An uncommon mechanism of brachial plexus injury. A case report.PURPOSE: To report a case of brachial plexus injury occurring on the contralateral side in a patient undergoing surgery for acoustic neuroma through translabrynthine approach. CLINICAL FEATURES: A 51-yr-old woman underwent surgery for acoustic neuroma through translabrynthine approach in the left retroauricular area. She had a short neck with a BMI of 32. Under anesthesia, she was placed in supine position with Sugita pins for head fixation. The head was turned 45 degrees to the right side and the neck was slightly flexed for access to the left retroauricular area, with both arms tucked by the side of the body. Postoperatively, she developed weakness in the right upper extremity comparable with palsy of the upper trunk of the brachial plexus. hematoma at the right internal jugular vein cannulation site was ruled out by CAT scan and MRI. The only remarkable finding was considerable swelling of the right sternocleidomastoid and scalene muscle group, with some retropharyngeal edema. An EMG confirmed neuropraxia of the upper trunk of brachial plexus. She made a complete recovery of sensory and motor power in the affected limb over the next three months with conservative treatment and physiotherapy. CONCLUSIONS: brachial plexus injury is still seen during anesthesia despite the awareness about its etiology. Malpositioning of the neck during prolonged surgery could lead to compression of scalene muscles and venous drainage impedance. The resultant swelling in the structures surrounding the brachial plexus may result in a severe compression.- - - - - - - - - - ranking = 0.0080307591768584keywords = injury (Clic here for more details about this article) |
6/1193. Meralgia paresthetica secondary to limb length discrepancy: case report.Meralgia paresthetica consists of pain and dysthesia in the lateral thigh caused by entrapment of the lateral femoral cutaneous nerve (L2-L3) underneath the inguinal ligament. Abdominal distension, tight clothing, and hip hyperextension are all described causes of this condition. To our knowledge this has never been attributed to a limb length discrepancy. We present a 51-year-old man with a long-standing history of right sided meralgia paresthetica. history and physical and radiological examination were unrewarding except that his left leg was shorter than the right by 2 cm. Nerve conduction studies of the lateral femoral cutaneous nerve on the left had a normal latency and amplitude but were absent on the right. To prove the hpothesis that the limb length discrepancy was responsible for the condition, a single subject study was performed. The presence or absence of pain and dysesthesia in the right thigh was the observed behavior. Intervention consisted of wearing a 1.5-cm lift in the left or right shoe for 2 weeks each with an intervening 2-week lift-free period. pain was recorded on a numeric scale and numbness as being present or absent. There was continuing pain without and with the lift in the right shoe but no pain or numbness with the lift in left shoe. It was concluded that the limb length discrepancy was responsible for the meralgia paresthetica. Pertinent literature and possible pathomechanics are discussed.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/1193. Cranio-facial and humeral melorrheostosis.First described by LERY and JOANNY in 1992, melorrheostosis is an uncommon linear hyperostosis of unknown aetiology, which may be associated with soft tissures changes. Although all bones may be affected, cranio-facial involvement is very rare. Only six such cases have been found in the literature. This report describes a case of cranio-facial and left humeral melorrheostosis with symptomatic radial nerve involvement. Resection of the melorrheostotic bone was performed because of involvement of the radial nerve.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
8/1193. Traumatic L5-S1 spondylolisthesis.We report a case of traumatic spondylolisthesis in a 31-year-old man struck by a steel I-beam. Although most reported traumatic spondylolisthesis cases are from low-energy trauma, this was a high-energy trauma case. The initial examination revealed no signs of cauda equina syndrome, and the patient's spinal injury was primarily capsuloligamentous. We present this rare case, with a review of pertinent literature and treatment mechanisms for traumatic spondylolisthesis.- - - - - - - - - - ranking = 0.0013384598628097keywords = injury (Clic here for more details about this article) |
9/1193. Cerebral metastasis presenting with altitudinal field defect.A 75-year-old man presented with a unilateral inferior altitudinal visual field defect and a history of weight loss and night sweats. The acuity in the affected eye was 20/200, otherwise his ocular examination was normal. neuroimaging demonstrated a post-fixed chiasm, with a frontal metastasis compressing the intracerebral portion of the optic nerve. A chest x-ray showed classical cannon ball lesions, secondary to malignant melanoma. This is the first case report of an intracerebral tumor producing an inferior altitudinal field defect.- - - - - - - - - - ranking = 0.5keywords = nerve (Clic here for more details about this article) |
10/1193. Compression of the visual pathway by anterior cerebral artery aneurysm.Visual failure is an uncommon presenting symptom of an intracranial aneurysm. It is even more uncommon in aneurysms arising from the anterior cerebral artery (ACA). We presented 2 patients with an aneurysm of the A1 segment of the anterior cerebral artery causing visual field defects. One patient presented with a complete homonymous hemianopia due to compression of the optic tract by a giant aneurysm of the proximal left A1 segment. The second patient had an almost complete unilateral anopia caused by compression of the optic nerve and chiasm by an aneurysm of the distal part of the A1 segment with a small chiasmatic hemorrhage and ventricular rupture.- - - - - - - - - - ranking = 0.5keywords = nerve (Clic here for more details about this article) |
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