Cases reported "Hemiplegia"

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11/73. Treatment of sporadic hemiplegic migraine with calcium-channel blocker verapamil.

    Gene mutations within the P/Q type neuronal calcium channel in familial hemiplegic migraine (FHM) suggest a therapeutic role for calcium-channel blockade. The authors have previously reported abortive therapy of FHM with IV verapamil. Here the authors describe four cases of sporadic hemiplegic migraine (SHM) responsive to verapamil, administered either orally or IV. The findings indicate that verapamil is effective therapy for both SHM and FHM.
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keywords = block
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12/73. A case of hemiparesis associated with cranial nerve lesions due to intravascular lymphomatosis(2003:4b).

    Intravascular lymphomatosis is a rare variant of non-Hodgkin's lymphoma with an unusual predilection for the central nervous system. Most cases are not diagnosed until postmortem because of variable clinical presentation and non-specific laboratory findings. We studied a 41-year-old lady who presented with progressive neurological symptoms. MR showed multifocal grey and white matter lesions. brain biopsy showed an intravascular lymphoma of the B-cell lineage. This report illustrates the ischaemic origin of the radiological lesions, as they are all hyperintense on the diffusion-weighted images. This has, to our knowledge, never been published before. MR did not show any enhancement after intravenous gadolinium-DTPA (parenchymal or meningeal)which is a very uncommon finding in this entity. Intravascular lymphomatosis should be taken into account in the differential diagnosis of repeated cerebral ischemia of unclear aetiology.
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ranking = 1.2059022452688
keywords = nerve
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13/73. Entrapment of the temporal horn: a form of focal non-communicating hydrocephalus caused by intraventricular block of cerebrospinal fluid flow--report of two cases.

    In two cases of entrapment of the temporal horn, computed tomography demonstrated the typical appearance of a comma-shaped homogeneous area isodense with water surrounded by a periventricular low-density area. The cause was probably choroid plexitis resulting in obstruction of the cerebrospinal fluid pathway at the atrium. External drainage followed by shunt emplacement is indicated.
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keywords = block
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14/73. neurocysticercosis presenting as Weber's syndrome.

    This case report describes a rare, non-epileptic manifestation of neurocysticercosis where a 22-year-old male presented with acute onset right 3rd nerve palsy with left hemiplegia (Weber syndrome). Computerized tomography and magnetic resonance imaging revealed cysticercus granuloma. The patient improved and became asymptomatic with steroid treatment. Recognizing this clinical entity would avoid unnecessary antituberculous treatment and surgical intervention.
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ranking = 0.3014755613172
keywords = nerve
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15/73. tibial nerve block with anesthetics resulting in achilles tendon avulsion.

    Diagnostic tibial nerve block with anesthetics is a common and safe procedure for the management of the spastic equinovarus foot. Side effects have been rarely reported. We present the case of a hemiplegic patient with a spastic equinovarus foot who presented with an avulsion fracture of the calcaneum at the insertion of the achilles tendon consecutive to a diagnostic tibial nerve block with anesthetic agents. Although rare, such a complication should be considered when the achilles tendon is shortened and when the patient is suspected of bone osteoporosis or dystrophy.
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ranking = 133.11421240992
keywords = nerve block, nerve, block
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16/73. A new device to introduce self-injection of insulin by his non-dominant hand in a patient with hemiplegia.

    Dominant hand dysfunction due to cerebrovascular accident or fracture makes it more difficult to self-inject insulin. This would likely lead to diminishing a patient's quality of life. We made a new device to introduce self-injection of insulin by a patient's non-dominant hand and tested it. This device was built into a 600-g block of wood 11.5 cm x 8 cm x 8 cm, to be used with the InnoLet insulin kit system (Novo Nordisk Pharmaceuticals Inc., Bagsvaerd, denmark). It had an insulin injector clamp on the front and a needle holder on the top. The bottom and the back were covered with silicon rubber, which allows the device's own weight to affix it on a table. The insulin injector is placed upright in a holder and fastened with a bar. A needle is installed on the insulin injector with a needle cap. After this cap was removed, the patient could remove any air bubbles by pushing 2 units of insulin through the needle. After the insulin injector was unfastened from the device, the patient injected the insulin subcutaneously into his abdomen or thigh. Then, the insulin injector was removed from the device. We introduced this device in a 59-year-old man with type 2 diabetes mellitus who had suffered from ischemic cerebral infarction in the left middle cerebral artery distribution, resulting in complete right hemiparesis. Our patient mastered this procedure within a few days. At the time of discharge, he could self-inject regular human insulin in a dose of 16 units in the morning, 6 units at noon, and 8 units in the evening. Two weeks after he was admitted to our hospital, he continued independent insulin self-injection three times per day without any help. His hemoglobin a(1c) level gradually decreased until it reached 5.7%. The self-injection of insulin may be introduced with a new device by the non-dominant hand in a patient with diabetes having a disabled dominant hand.
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ranking = 0.2
keywords = block
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17/73. Selective tibial neurotomy in the treatment of spastic equinovarus foot: a 2-year follow-up of three cases.

    OBJECTIVE: To objectively assess the decrease in spasticity and the improvement in gait after tibial nerve neurotomy performed to treat spastic equinovarus foot. DESIGN: Before-after trial with a 2-yr follow-up. Three hemiplegic patients with spastic equinovarus foot were treated with a selective peripheral neurotomy of the tibial motor nerve branches (soleus, lateral and medial gastrocnemius and tibialis posterior nerves). Evaluation included clinical assessment of spasticity (Ashworth scale), maximal Hoffmann reflex (H(max))/compound muscle action potential (M(max)) ratio measurement, gait analysis, and muscle stiffness evaluation performed before and 2 mos, 1 yr, and 2 yrs after the neurotomy. RESULTS: Spasticity, muscle stiffness, and H(max)/M(max) ratio decreased after neurotomy. The kinematic (ankle dorsal flexion and knee recurvatum) and kinetic variables (maximum ankle muscle moment and external work) of the gait were permanently improved after neurotomy. Interestingly, kinetic variables seemed to gradually improve with time after the neurotomy. CONCLUSION: Tibial neurotomy is an effective and durable treatment for spastic equinovarus foot.
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ranking = 0.90442668395159
keywords = nerve
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18/73. Independent insulin administration by the hemiplegic patient: stabilization of an insulin pen with a new device.

    diabetes mellitus is an independent risk factor for stroke, and the incidence of diabetes in patients presenting with stroke is 16% to 20%. Administration of insulin is an important activity of daily living that should be addressed in hemiplegic patients with diabetes. Presented here is a table-top clamp that can be used with an insulin pen allowing independent insulin dosing and subcutaneous administration with one hand. The clamp is built on a wood block base that is mounted to a smooth table surface by suction cups. Construction of the device is simple, inexpensive, and can be incorporated as a therapeutic project for the patient during the rehabilitation stay. A diabetic patient with a left hemiplegia is presented who demonstrated independence with the device prior to her discharge home.
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ranking = 0.2
keywords = block
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19/73. Transient ischaemic attack after spinal anaesthesia.

    A case of transient ischaemic attack lasting 6 h occurred after spinal anaesthesia with bupivacaine. The level of sensory block was satisfactory and there was no significant hypotension. We discuss the possible cause of this previously undescribed complication.
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ranking = 0.2
keywords = block
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20/73. Focal capsular vascular lesions can selectively deafferent the prerolandic or the parietal cortex: somatosensory evoked potentials evidence.

    Four patients with a unilateral focal vascular accident involving the internal capsule (but not the cortex) were studied electrophysiologically. Averaged somatosensory evoked potentials (SEPs) to electrical stimulation of the median nerve on the left or the right side were analyzed. In the 3 patients with hemiparesis and normal somatic sensation, the precentral P22 and N30 SEP components were lost, whereas the parietal components were preserved. In another patient with clinical somatosensory loss unaccompanied by any central motor impairment, the precentral SEP components were preserved, whereas the parietal SEP components were lost. Thus, a small capsular lesion can eliminate distinct cortical SEP components by selectively involving either the axons of the thalamic VPLc nucleus going to parietal receiving cortex or the axons of thalamic VPLo going to motor area 4. These findings extend to subcortical lesions the diagnostic value of SEPs in patients with dissociated clinical motor and sensory signs.
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ranking = 0.3014755613172
keywords = nerve
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