1/49. Effects of altering cycling technique on gluteus medius syndrome.OBJECTIVE: We discuss how altering the cycling technique of a cyclist receiving periodic chiropractic care helped in the management of gluteus medius syndrome. CLINICAL FEATURES: A 24-year-old male amateur cyclist had numbness and tingling localized to a small region on the superior portion of the right buttock. The area involved demonstrated paresthesia to light touch sensory evaluation. The cyclist had received chiropractic adjustments 2 days before the onset of the symptoms. One week earlier, the patient began riding a new bicycle with different gearing than his previous one. Manual-resisted muscle testing created soreness in the lumbosacral area and buttocks. trigger points were identified in the right gluteus medius. Standing lumbar spine flexion was 70 degrees, limited by tight hamstrings. INTERVENTION AND OUTCOME: Because the patient was already receiving periodic chiropractic care, no passive therapy was used. Patient education regarding the difference in gear selection in bicycles of a higher quality was provided. He was instructed to train in lower gears than he had previously used and to maintain a cadence of 70 to 90 revolutions of the pedals per minute. After 2 days, the paresthesia on the right buttock resolved. The trigger points were only mildly tender with minimal residual soreness of the involved muscles. CONCLUSION: Management of gluteus medius syndrome by altering the cadence and gear development for a bicyclist is discussed. Either frank or cumulative injury to the gluteus medius muscle is the typical etiologic factor for this syndrome. Repetitive strain of the patient's gluteus medius muscle as a result of poor cycling technique appeared to be the cause here. knowledge of bicycle fitting, training techniques, and bicycle mechanics appeared necessary to resolve the problem.- - - - - - - - - - ranking = 1keywords = numbness (Clic here for more details about this article) |
2/49. 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 = 2keywords = numbness (Clic here for more details about this article) |
3/49. occupational exposure to methyl methacrylate monomer induces generalised neuropathy in a dental technician.A 36-year-old dental technician for 14 years developed paraesthesia and numbness in her legs. Neurophysiological studies revealed absent sensory nerve action potentials (SNAPs) from her lower limbs and normal upper limb SNAPs on presentation. Motor nerve studies were normal. Repeat studies 2 months after leaving her job showed some improvement in the lower limb SNAPs. It is suggested that her symptoms were caused by occupational exposure to methyl methacrylate monomer.- - - - - - - - - - ranking = 1keywords = numbness (Clic here for more details about this article) |
4/49. paresthesia and the traumatic bone cyst. Abbreviated case report.A case of a traumatic bone cyst is reported because of the unusual nature of the chief complaint. The initial symptom of the disease was mandibular nerve neuropathy with numbness of the left side of the lower lip and chin.- - - - - - - - - - ranking = 1keywords = numbness (Clic here for more details about this article) |
5/49. Amyloidoma of the gasserian ganglion.A case report, the third in the literature, is presented of a patient whose progressive numbness in the second and third divisions of the trigeminal nerve led to the discovery of an isolated amyloidoma of the gasserian ganglion. The clinical impression of tumor was confirmed by surgical and pathologic findings.- - - - - - - - - - ranking = 1keywords = numbness (Clic here for more details about this article) |
6/49. Idiopathic paresthesia reaction associated with rofecoxib.OBJECTIVE: To report a case of a paresthesia-type reaction due to the use of rofecoxib in standard doses for the treatment of osteoarthritis. CASE SUMMARY: A 55-year-old white woman was receiving rofecoxib for treatment of osteoarthritis. The patient began to have tongue numbness and hand tingling and numbness shortly after starting therapy with rofecoxib. The occurrence and resolution of her symptoms correlated with the start and end of the therapy. DISCUSSION: An adverse reaction with rofecoxib is a likely explanation for the patient's symptoms. Paresthesias have been reported in 0.1-1.9% of patients who took rofecoxib during premarketing studies, but no causality has been established. One case report of paresthesias occurring in a 59-year-old white man who took one 20-mg dose of piroxicam is available. Information on when the reaction occurred in relation to the dose and resolution of the reaction was not recorded in this study. Our patient's reaction is best classified as idiopathic. CONCLUSIONS: We report the first case of a paresthesia-type reaction to rofecoxib in a patient receiving the drug in standard doses for treatment of osteoarthritis. Although the reaction is rare, clinicians should be aware of its potential.- - - - - - - - - - ranking = 2keywords = numbness (Clic here for more details about this article) |
7/49. Neurological symptoms as the result of enlarged dimensions and non-typical course of inferior superficial temporal vein.Neurological symptoms as the result of non-typical course of superficial cerebral veins are described in available literature very rarely. The case described below indicates that in some circumstances the compression symptoms derived from the cerebral cortex may be incredibly more serious than their anatomical reasons. In our observation a young woman was described complaining of paroxysmal numbness of the left upper limb with paraesthesia of the left side of the face, the left eye and left half of the tongue. The patient said that in childhood she used to have paroxysmal itching of the left hand. She also said that CT of the head made a few years ago after a car accident was without pathological changes. Neurological examination, x-ray of the skull and EEG test performed during first visit proved normal. After one year of the disease, Jackson-type epilepsy, combined with loss of sensation of the left half of the face for the first time, was present. Neurological and ophthalmological examination of the bottom of the eye proved normal. skull x-ray was normal. Then disturbances of the vision in the left half of the field appeared. EEG was still in norm. The MRI test showed the asymmetry in the course and dilated superficial vein between the basis of the right temporal lobe and the tentorium of the cerebellum. The diameter of this vein was 2.5 mm, but there were no vascular malformations. Bottom of the eye was normal, but in the field of vision the white and red colours were dominated.- - - - - - - - - - ranking = 1keywords = numbness (Clic here for more details about this article) |
8/49. thalidomide-induced neuropathy.BACKGROUND: thalidomide is effective for the treatment of some refractory dermatologic and oncologic diseases. Toxic neuropathy limits its use, as embryopathy can be avoided by contraceptive measures. OBJECTIVE: To describe the clinical, electrophysiologic, and pathologic features of thalidomide-induced peripheral neuropathy. methods: Clinical and electrophysiologic examinations were performed in seven patients with thalidomide-induced peripheral neuropathy. thalidomide was used for graft-vs-host disease, pyoderma gangrenosum, and discoid lupus with dosages ranging from 100 to 1,200 mg/day for 5 to 16 months (cumulative dosages of 24 to 384 g). RESULTS: All seven patients had clinical and electrophysiologic evidence of a sensory more than motor, axonal, length-dependent polyneuropathy that presented as painful paresthesias or numbness. sural nerve biopsies, done in three patients, showed evidence of wallerian degeneration and loss of myelinated fibers. The symptoms, signs, and electrophysiologic data correlated with total cumulative dose of thalidomide. CONCLUSIONS: thalidomide induces a dose-dependent sensorimotor length-dependent axonal neuropathy; it should be judiciously used with close neurologic monitoring.- - - - - - - - - - ranking = 1keywords = numbness (Clic here for more details about this article) |
9/49. Recurrent arachnoid cyst of Meckel's cave mimicking a brain stem ischaemia. Report of a rare case.A 44-years old man developed TIA-like symptoms with dysaesthesia around the mouth, vertigo and diplopia. MRI revealed a cystic space-occupying lesion on the right Meckel's cave, which spread out into cerebellopontine angle in a further examination. Therefore surgical exploration was performed using a suboccipital approach. An arachnoidal cyst was found and removed including its wall. About three months later the patient suffered again from dysaesthesias of the right side of the face and a new MRI revealed a recurrence of the lesion, with extension into the cerebellopontine angle, too. Surgical revision was done using the same approach and the recurrent cyst was removed. Postoperatively, there were a transient hypaesthesia in the distribution area of the right trigeminal nerve and a light pulmonary embolism occurred as a complication. No symptoms have returned during an observation period of 15 months. CONCLUSION: An arachnoidal cyst must be considered as a rare cause, when a lesion is found at the Meckel's cave with intermittent clinical symptoms of a trigeminal nerve affection. As surgical treatment we favour fenestration and cyst wall resection.- - - - - - - - - - ranking = 515.30202211649keywords = hypaesthesia (Clic here for more details about this article) |
10/49. Aortic saddle embolus presenting with transient lower extremity paresthesia.We report the case of a 58-year-old woman who developed acute onset of bilateral lower-extremity numbness and difficulty ambulating at home. On presentation to the emergency department, however, the patient's symptoms essentially had resolved. An aortic saddle embolus was suspected based on the patient's cardiac history and the absence of distal pulses in the lower extremities. This case illustrates that even with vague or resolving complaints, a high index of suspicion should be maintained for the diagnosis of aortic saddle embolus based on the patient's medical history and on physical examination.- - - - - - - - - - ranking = 1keywords = numbness (Clic here for more details about this article) |
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