1/60. A case of referred pain evoked by remote light touch after partial nerve injury.An unusual case of referred pain is presented in which a 63-year-old man, who suffered a severe injury to his right hand and arm during young adulthood, describes the later development of dysesthesia and shooting pain in his arm subsequent to stimulation of the ipsilateral scalp, the temporal and infrazygomatic region of the face, and the back. Referred sensations of this type are usually reported following amputation of an arm. Clinical examination of the sensory and motor function of the arm and hand revealed partial damage to the radial, ulnar and median nerves as well as possible brachial plexus involvement. Interestingly, pain could be evoked by repeated light touches applied to the remote trigger areas suggesting the involvement of a 'wind-up'-like process.- - - - - - - - - - ranking = 1keywords = sensation (Clic here for more details about this article) |
2/60. Parietal and cingulate processes in central pain. A combined positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) study of an unusual case.Parietal, insular and anterior cingulate cortices are involved in the processing of noxious inputs and genesis of pain sensation. Parietal lesions may generate central pain by mechanisms generally assumed to involve the 'medial' pain system (i.e. medial thalamic nuclei and anterior cingulate cortex (ACC)). We report here PET and fMRI data in a patient who developed central pain and allodynia in her left side after a bifocal infarct involving both the right parietal cortex (SI and SII) and the right ACC (Brodmann areas 24 and 32), thus questioning the schematic representation of cortical pain processing. No rCBF increase was found in any part of the residual cingulate cortices, neither in the basal state (which included spontaneous pain and extended hypoperfusion around the infarct), nor during left allodynic pain. Thus, as previously observed in patients with lateral medullary infarct, neither spontaneous pain nor allodynia reproduce the cingulate activation observed after noxious pain in normal subjects. Conversely, both PET and fMRI data argue in favour of plastic changes in the 'lateral discriminative' pain system. Particularly, allodynia was associated with increased activity anteriorly to the infarct in the right insula/SII cortex. This response is likely to be responsible for the strange and very unpleasant allodynic sensation elicited on the left side by a non-noxious stimulation.- - - - - - - - - - ranking = 2keywords = sensation (Clic here for more details about this article) |
3/60. Saphenous neuralgia after arthroscopically assisted anterior cruciate ligament reconstruction with a semitendinosus and gracilis tendon graft.A case report of saphenous neuralgia following arthroscopically assisted anterior cruciate ligament reconstruction with hamstring tendons is presented. The patient complained of paresthesia in the anteromedial region of the lower leg and tenderness at the medial side of the knee without motor or reflex abnormalities. Because saphenous neuralgia can mimic disorders of the knee, peripheral vascular disease, and lumbar nerve root compression, diagnosis can be confirmed by anesthetic blockade. The patient underwent saphenous neurolysis. Six months after surgery, the patient had normal cutaneous sensation at the medial aspect of the lower leg and ankle and she no longer complained of any painful dysesthesia. To minimize the risk of damaging the saphenous nerve when harvesting hamstring tendons, the knee should be flexed and the hip external rotated.- - - - - - - - - - ranking = 1keywords = sensation (Clic here for more details about this article) |
4/60. Complete recovery of consciousness in a patient with decorticate rigidity following cardiac arrest after thoracic epidural injection.A 46-yr-old man with dysaesthesia (burning sensation) following herpes zoster in the left upper chest region was treated with a single thoracic (T2/T3) epidural injection (1.0% lidocaine 3 ml 0.125% bupivacaine 3 ml) as an outpatient. Twenty minutes after the injection, a nurse noticed the patient to be unconscious with dilated pupils, apnoea and cardiac arrest. Following immediate cardiopulmonary resuscitation, the patient was treated with an i.v. infusion of thiamylal sodium 2-4 mg kg-1 h-1 and his lungs were mechanically ventilated. When the patient developed a characteristic decorticate posture, mild hypothermia (oesophageal temperature, 33-34 degrees C) was induced. On the 17th day of this treatment, after rewarming (35.5 degrees C) and discontinuation of the barbiturate, the patient responded to command. weaning from the ventilator was successful on the 18th day. About 4 months after the incident, the patient was discharged with no apparent mental or motor disturbances. We suggest that mild hypothermia with barbiturate therapy may have contributed to the successful outcome in this case.- - - - - - - - - - ranking = 1keywords = sensation (Clic here for more details about this article) |
5/60. Pharyngeal dysesthesias as an aura in temporal lobe epilepsy associated with amygdalar pathology.PURPOSE: Pharyngeal dysesthetic auras are typically described with centrotemporal and opercular seizure-onset localizations. In this report we describe the fourth case in literature with temporal lobe seizures, apparently secondary to an amygdalar lesion on magnetic resonance imaging (MRI), presenting with prominent pharyngeal dysesthesias as the initial, or only, seizure manifestation. methods: Because of diagnostic uncertainty regarding the nature of the pharyngeal sensations, our case underwent prolonged extracranial video-EEG monitoring. RESULTS: Video-EEG information documented the epileptic origin of the dysesthesias and was concordant with the side and location of the amygdalar lesion. CONCLUSIONS: Pharyngeal dysesthetic auras may be produced by epileptic activity originating from the amygdala, and perhaps other mediotemporal structures. The underlying topography of this aura is not known with certainty, and it may reflect seizure spread from the amygdala and adjacent areas to the closely interconnected insular and opercular cortex, whose secondary activation could elicit similar sensations.- - - - - - - - - - ranking = 2keywords = sensation (Clic here for more details about this article) |
6/60. 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 = sensation (Clic here for more details about this article) |
7/60. Conversion sensory symptoms associated with parietal lobe infarct: case report, diagnostic issues and brain mechanisms.This case report suggests that diagnostic difficulties and brain mechanisms related to conversion disorder associated with cerebral lesions differ from those related to conversion disorder without cerebral lesions. A 35-year-old divorced woman was admitted to a psychiatric inpatient unit with multiple physical complaints. The symptoms first appeared 5 years previous and 2 months after a sexual assault. Three years later, she began to experience ill-defined sensory symptoms confined to the left half of her body (splitting the midline). Results of neurologic consultations were equivocal because of the subjective nature of the complaints, which were viewed as conversion symptoms. A magnetic resonance imaging scan demonstrated an old infarct in the right parietal lobe, suggesting a physical origin of the patient's symptoms. However, normal somatosensory-evoked responses from the affected area contributed little to establishing the diagnosis. The results of all further investigations to identify causes of the vascular pathology were negative. The multiple ill-defined somatic symptoms, the distribution of sensory symptoms and the resolution of symptoms with psychotherapy established the diagnosis of conversion disorder superimposed on a pre-existing right parietal lesion. This case highlights the importance of clinical features in establishing a diagnosis such as this. We suggest that reactivation of implicit sensory memories (represented at the thalamic level and resulting from decreased corticofugal inhibitions due to the lesion) may contribute to the formation of sensory conversion symptoms in individuals with parietal lobe lesions.- - - - - - - - - - ranking = 0.33691041338579keywords = somatosensory (Clic here for more details about this article) |
8/60. Hydroquinone neuropathy following use of skin bleaching creams: case report.A 30-year old black woman presented with gradual onset of weakness of the legs associated with burning sensation in the feet for two months. She had been using two hydroquinone based skin bleaching creams (MGC by M. G. C. International, MEKAKO by Anglo Fabrics BOLTON Ltd) for about four years. Her BP was 80/40 mm Hg supine with un-recordable diastolic pressure on standing. She had decreased power (Grade 3/5), loss of deep tendon reflexes and impairment of deep sensation in the lower limbs. A complete blood count, urinalysis, serum electrolytes, serum creatinine and uric acid were all normal. Oral GTT, VDRL and brucella tests were negative. Chest and abdominal radiographs did not show any abnormalities. A diagnosis of peripheral neuropathy with autonomic neuropathy possibly due to hydroquinone toxicity was made and she was advised to stop using hydroquinone based skin bleaching creams. Four months later she was asymptomatic, her BP was 120/80 mmHg supine and standing, and neurological examination was normal. The case raises the question of whether hydroquinone based skin bleaching creams could be a cause of peripheral neuropathy and underscores the need for research on hydroquinone based skin bleaching creams and neuropathy particularly in black women involved in the sale and/or use of skin bleaching creams.- - - - - - - - - - ranking = 2keywords = sensation (Clic here for more details about this article) |
9/60. Sympathetic activity-mediated neuropathic facial pain following simple tooth extraction: a case report.This is a report of a case of sympathetic activity-mediated neuropathic facial pain induced by a traumatic trigeminal nerve injury and by varicella zoster virus infection, following a simple tooth extraction. The patient had undergone extraction of the right lower third molar at a local dental clinic, and soon after the tooth extraction, she became aware of spontaneous pain in the right ear, right temporal region, and in the tooth socket. At our initial examination 30 days after the tooth extraction, the healing of the tooth socket was normal; however, the patient had a tingling and burning sensation (dysesthesia) and spontaneous pain of the right lower lip and the right temporal region, both of which were exacerbated by non-noxious stimuli (allodynia). The patient also showed paralysis of the marginal mandibular branch of the facial nerve, taste dysfunction, and increased varicella zoster serum titers. A diagnostic stellate ganglion block (SGB) 45 days after the tooth extraction using one percent lidocaine markedly alleviated the dysesthesia and allodynia. These symptoms are characteristic of neuropathic pain with sympathetic interaction. The patient was successfully treated with SGB and a tricyclic antidepressant.- - - - - - - - - - ranking = 1keywords = sensation (Clic here for more details about this article) |
10/60. Reference fields in phantom tooth pain as a marker for remapping in the facial territory.Six patients with chronic phantom tooth pain were studied for the presence of reference fields for their phantom sensation. In five of them, pain or dysesthesia in the affected oral structures was elicited by thermal or mechanical stimulation of areas that were well separate from these structures. However, a relation of topographical proximity between the stimulated areas and the areas of reference could be traced in the sensory maps. Therefore, denervation of small structures with coarse sensitivity can yield the plastic changes that have previously been described for larger deafferentations of areas endowed with finer discriminative capacity.- - - - - - - - - - ranking = 1keywords = sensation (Clic here for more details about this article) |
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