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1/157. Cerebral arteriovenous malformations and movement disorders.

    A series of six patients with movement disorders associated with cerebral arteriovenous malformations (AVM) is reported. The AVMs were classified according to the Spetzler-Martin classification as grade V (one patient), grade IV (four patients), and as grade III (one patient). One patient had action-induced hemidystonia caused by a contralateral frontoparietal AVM which compressed the putamen and was supplied partially by enlarged lenticulostriate arteries. Two patients presented with unilateral cortical tremor associated with contralateral high-frontal cortical/subcortical AVMs sparing the basal ganglia. Another patient developed hemidystonia and hemichorea-hemiballism after bleeding of a contralateral temporooccipital AVM and subsequent ischemia. Two patients had focal dystonia after thalamic and basal ganglia hemorrhage from AVMs. Five patients were operated on. The movement disorder was abolished in one patient postoperatively. Different mechanisms were identified that are relevant for the development of AVM-related movement disorders: mass effect, diaschisis, local parenchymal altered cerebral blood flow, and hemorrhagic or ischemic structural lesions. ( info)

2/157. Subacute sensory neuropathy associated with Epstein-Barr virus.

    A 35-year-old man experienced severe sensory loss, pseudoathetosis, and areflexia during recovery from a severe viral illness. Sensory nerve action potentials were absent, motor conduction velocities were mildly slowed, and blink reflexes were normal. magnetic resonance imaging (MRI) revealed abnormal signal within the central and dorsal aspects of the thoracic cord. Acute and convalescent Epstein-Barr virus (EBV) titers suggested EBV as the etiology. Subacute sensory neuropathy, with peripheral and central nervous system involvement, is a rare complication of EBV infection. ( info)

3/157. iliac artery aneurysm causing isolated superior gluteal nerve lesion.

    Lesions of the superior gluteal nerve (SGN) lead to weakness of hip abduction, manifesting itself as a gait abnormality, with contralateral tilting of the pelvis with each step. Causes are numerous and may occur at different anatomical locations before the nerve enters the suprapiriform foramen, in the foramen itself, or after the nerve has exited the foramen. This case report describes an SGN lesion by a large iliac artery aneurysm in a patient presenting with a gait disorder. ( info)

4/157. walking with a hybrid orthosis system.

    OBJECTIVE: The purpose of this case study was to determine the functional effectiveness of the hybrid orthosis system (HOS) for sit-to-stand and walking compared with the reciprocal gait orthosis (RGO) alone in a subject with significant orthopedic abnormalities. DESIGN: A subject with complete T7 paraplegia and a 13 cm leg length discrepancy was implanted with 14 intramuscular electrodes and fitted with a custom isocentric RGO. The subject was instructed in the use of the HOS and a two wheeled walker in the home and community settings. MAIN OUTCOME MEASURES: Using the Functional Independence Measure (FIM), and the Borg exertion scale the subject's level of independence and his perceived exertion was determined as well as the safety and efficacy of system use in the community. RESULTS: Results show that the HOS provided safe, independent ambulation with a two wheeled walker and met established criteria for limited community use. walking in the RGO alone was feasible, however, the addition of functional electrical stimulation (FES) allowed this subject to walk farther and with less perceived exertion. CONCLUSION: This case study suggests that a hybrid orthosis system can be an effective clinical option for individuals with significant orthopedic complications that might otherwise contra-indicate the prescription of either conventional braces or FES alone. ( info)

5/157. Thoracic myelopathy due to enlarged ossified yellow ligaments. Case report and review of the literature.

    Enlarged ossified yellow ligaments are a rare and poorly understood cause of thoracic myelopathy. The authors report the case of a patient in whom thoracic myelopathy was caused by enlarged ossified yellow ligaments. ( info)

6/157. Interfacing the body's own sensing receptors into neural prosthesis devices.

    Functional electric stimulation (FES) is today available as a tool in muscle activation used in picking up objects, in standing and walking, in controlling bladder emptying, and for breathing. Despite substantial progress over nearly three decades of development, many challenges remain to provide a more efficient functionality of FES systems. The most important of these is an improved control of the activated muscles. Instead of artificial sensors for feedback, new developments in electrodes to do long-term and reliable recordings from peripheral nerves emphasize the use of the body's own sensors. These are already installed and optimised through millions of years of natural evolution. This paper presents recent results on a system using electrical stimulation of motor nerves to produce movement and using the natural sensors as feedback signals to control the stimulation that can replicate some of the functions of the spinal cord and its communication with the brain. We have used the nerve signal recorded from cutaneous nerves in two different human applications: (1) to replace the external heel switch of a system for correction of spastic drop foot by peroneal stimulation, and (2) to provide an FES system for restoration of hand grasp with sensory feedback from the fingertip. For the bladder function, the sacral root stimulator is a useful control tool in emptying the bladder. To decide when to stimulate, we are at present carrying out experiments on pigs and cats using cuff electrodes on the pelvic nerve and sacral roots to record the neural information from bladder afferents. This information can potentially be used to inhibit unwanted bladder contractions and to trigger the FES system and thereby bladder emptying. Future research will show whether cuffs and other types of electrodes can be used to reliably extract signals from the large number of other receptors in the body to improve and expand on the use of natural sensors in clinical FES systems. ( info)

7/157. gait analysis in myelomeningocele: possibilities and applications.

    gait analysis with a fully integrated laboratory is a relatively new instrument in the armamentarium of the pediatric orthopedic surgeon. The introduction of it has been especially successful in neuromuscular pathology and, particularly, in cerebral palsy. In spina bifida, however, it also enhances substantially the possibilities of detailed analysis of the locomotion problem. It is, furthermore, a very useful instrument in evaluating treatment and in follow-up. With a few examples, this paper tries to show the possibilities and advantages of a gait laboratory in the evaluation of patients with ambulatory spina bifida. ( info)

8/157. Usefulness of gait analysis combined with motor point block in a stroke patient.

    This clinical note describes a typical case of dynamic varus deformity of the rear foot in a stroke patient. An overactive Tibialis Posterior muscle seemed mainly responsible for the varus deformity. However, this hypothesis was not confirmed by a motor point block of this muscle. It appeared that the Tibialis Posterior and Extensor Hallucis Longus muscles were both involved in the varus deformity. A double motor point block of both the Tibialis Posterior and Extensor Hallucis Longus muscles was performed. Kinematic and kinetic data showed improvement. This case report illustrates the usefulness of gait analysis combined with motor point block in the diagnosis and management of gait disturbance. ( info)

9/157. A case of peroneal neuropathy-induced footdrop. Correlated and compensatory lower-extremity function.

    This article reports on the case of a man with peroneal neuropathy-induced footdrop who was seen at the authors' institution 3 years after open reduction and internal fixation of a proximal fibular fracture and a distal, spiral, oblique tibial fracture of the right leg. A comprehensive gait analysis was conducted. A significant footdrop in gait resulted in a "reverse check mark" center-of-pressure pattern, an increased transverse-plane rotation of the foot, and excessive knee and hip flexion in the sagittal plane. These objective findings documented significant dysfunction within the involved lower extremity; in addition, aberrant biomechanics were observed in structures other than the site of initial injury within both limbs. ( info)

10/157. Primary pelvic hydatid cyst: an unusual cause of sciatica and foot drop.

    STUDY DESIGN: A case report of primary pelvic hydatid cyst causing sciatica and foot drop. OBJECTIVE: To document the occurrence of primary pelvic hydatid cyst as one of the hidden causes of lower limb weakness and foot drop, and to recommend inclusion of the pelvic cavity when assessing sciatica and foot drop. SUMMARY OF BACKGROUND DATA: It is common to see foot drop caused by peripheral lesions around the knee or disc herniation in the lumbar spine, but if these sites were excluded, the pelvic cavity must be examined for hidden disease that may explain the cause of foot drop and sciatica. methods: The authors involved in the care and management of this patient were interviewed and all medical records, radiologic investigations, and related literature were reviewed. RESULTS: After exclusion of spinal and peripheral causes of foot drop, computed tomography of the pelvis showed a well-localized cystic swelling in the right side of the pelvis over the lumbosacral plexus roots. Surgical excision of the cyst resulted in partial recovery of the foot drop at 3 years of follow-up. CONCLUSION: Primary pelvic hydatid cyst rarely causes pressure on the lumbosacral plexus. This was a case of hydatid cyst in the pelvis causing sciatica and foot drop, and it indicates the pelvis as a hidden source of sciatica and foot drop. After surgical excision followed by 4 months' mebendazole therapy, there was no evidence of recurrence on long-term follow-up. ( info)
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