Cases reported "Hypesthesia"

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1/40. 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.
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2/40. Surgical treatment of vascular lesions of the spinal cord.

    Paravertebral block and resection of upper thoracic sympathetic ganglions were performed on cases in which vascular disturbance of the spinal cord was considered partly responsible. Block was performed in 14 cases and clinical improvement was seen in 10 cases out of them while resection was considered effective in 2 out of 3 cases. The evoked EMG of patients was assumed recovery of a part of synaptic function in the ischemic cord after the block. On the other hand, the skin temperature of the lower extremity did not show considerable change and this supports the view that the restoration of clinical picture was not due to the improvement of the periphral circulation of extremities. From these observations, it would be well presumed that favorable effect of sympathectomy consists partly in the improvement of vascular disturbance of the spinal cord.
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3/40. Neurological deficit following spinal anaesthesia: MRI and CT evidence of spinal cord gas embolism.

    A 62-year-old diabetic woman developed permanent neurological deficits in the legs following spinal anaesthesia. MRI showed oedema in the spinal cord and a small intramedullary focus of signal void at the T10 level, with negative density at CT. Intramedullary gas bubbles have not been reported previously among the possible neurological complications of spinal anaesthesia; a combined ischaemic/embolic mechanism is hypothesised.
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4/40. Spinal angiolipoma: case report and review of literature.

    Spinal extradural angiolipomas are distinct, benign, and rare lesions composed of mature lipocytes admixed with abnormal blood vessels. They account for 0.14% of all spinal axis tumors. The case described here was a 72-year-old patient presenting with a history of paraparesis, hypoesthesia under the T2 level, hyperreflexia, and urinary overflow incontinence that appeared within 7 days after the administration of a coronary vasodilator drug regimen. The spinal magnetic resonance scan showed a lipomatous mass with signal void lesions, suggesting a vascular component of the tumor. The patient improved rapidly after surgical resection of the epidural tumor and decompression of the cord. According to the present literature, the duration of neurological symptoms ranges from 1 to 180 months (mean 28 months). But this patient's neurological deterioration took place 4 days before hospitalization. We believe that this can be explained by the increased tumor blood volume caused by vasodilator drugs, which in turn exerted a pulsatile compressive effect on the cord.
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5/40. Spinal intramedullary cavernoma: clinical presentation and surgical outcome.

    OBJECT: Improved neuroimaging techniques have led to an increase in the reported cases of intramedullary cavernomas. The purpose of this study was to define the spectrum of presenting signs and symptoms in patients with spinal intramedullary cavernomas and to analyze the role of surgery as a treatment for these lesions. methods: The authors reviewed the charts of 16 patients who underwent surgery for spinal intramedullary cavernomas. All patients underwent preoperative magnetic resonance imaging studies. Cavernomas represented 14 (5.0%) of 280 intramedullary lesions found in adults and two (1.1%) of 181 intramedullary lesions found in pediatric cases. A posterior laminectomy and surgical resection of the malformation were performed in all 16 patients. CONCLUSIONS: magnetic resonance imaging is virtually diagnostic for spinal cavernoma lesions. patients with spinal intramedullary cavernomas presented with either an acute onset of neurological compromise or a slowly progressive neurological decline. Acute neurological decline occurs secondary to hemorrhage within the spinal cord. Chronic progressive myelopathy occurs due to microhemorrhages and the resulting gliotic reaction to hemorrhagic products. There is no evidence that cavernomas increase in size. The rate of rebleeding is unknown, but spinal cavernomas appear to be clinically more aggressive than cranial cavernomas, probably because the spinal cord is less tolerant of mass lesions. Complete surgical removal of the cavernoma was possible in 15 of 16 of the authors' cases.
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6/40. Non-Hodgkin's tumor and Pancoast's syndrome.

    A 60-year old man presented with Horner's syndrome, and acute right hand and lower extremity weakness. Chest X-ray and MRI revealed a right apical lung tumor (presumed to be a primary lung cancer), with brachial plexus infiltration and spinal cord compression. Emergent radiotherapy was initiated for spinal cord compression and a biopsy was obtained 24 h later. A careful review of pathology demonstrated a non-Hodgkin's lymphoma. The patient subsequently received chemotherapy, and is now in remission. This case illustrates the importance of a tissue diagnosis before initiating therapy for a Pancoast's tumor.
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7/40. Eosinophilic pleocytosis and myelitis related to toxocara canis infection.

    toxocara canis causes the visceral larva migrans syndrome in which central nervous involvement is rare. We report the case of a 40-year-old woman presenting with a subacute weakness of the right leg and dysaesthesiae in the right Th8-Th10 dermatomas. Spinal magnetic resonance imaging examination showed abnormal hyperintensity within the spinal cord. cerebrospinal fluid analysis revealed eosinophilic pleocytosis. Antibody titres to toxocara canis were higher in the cerebrospinal fluid than in the serum. Treatment using mebendazole led to a complete clinical recovery, normalization of cerebrospinal fluid parameters and improvement in spinal magnetic resonance imaging abnormalities.
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8/40. 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.
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9/40. MRI confirmed cervical cord injury caused by spinal manipulation in a Chinese patient.

    OBJECTIVE: To report a rare case of cervical cord injury caused by spinal manipulation in a Chinese patient. METHOD: A 46-year-old man suffered from acute tetraplegia immediately after spinal manipulation by a bonesetter. There was nothing abnormal in the plain X-ray but magnetic resonance imaging (MRI) of his cervical spine demonstrated cervical cord oedema at the level of C1/2. RESULT: The patient was treated with high doses of methylprednisolone. Coupled with intensive rehabilitation, the patient made a nearly complete recovery 6 months after injury. Repeated MRI demonstrated syrinx formation at the previous location of cervical cord oedema. CONCLUSION: Spinal manipulation may cause cervical cord injury. MRI is useful in the documentation of this injury and exclusion of other pathology.
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10/40. Spinal wedge osteotomy by a single posterior approach for correction of severe and rigid kyphosis or kyphoscoliosis.

    STUDY DESIGN: Seven patients with severe angular kyphotic deformity of the spine were treated by circumferential spinal wedge osteotomy using a single posterior approach. OBJECTIVE: To evaluate the surgical outcomes for seven patients with severe angular kyphosis or kyphoscoliosis treated by spinal wedge osteotomy. SUMMARY OF BACKGROUND DATA: Excellent surgical outcomes have been reported for procedures such as hemivertebra excision, vertebral body resection, and spinal osteotomy for angular kyphosis or kyphoscoliosis. However, the safety and efficacy of these procedures for severe and rigid deformities have not been established. methods: The surgical procedure involves circumferential exposure of the apex vertebra to the anterior aspect using a single posterior approach. Sparing only the spinal cord, the surgeon performs circumferential wedge bone resection, closure, correction, and stabilization by instrumentation while monitoring the spinal cord. Seven patients (3 kyphotics and 4 kyphoscoliotics) treated by this procedure were evaluated for a minimum of 2 years. Underlying conditions comprised five cases of congenital deformity with hemivertebrae and two cases of skeletal dysplasias. The mean age at surgery was 16.5 years, and the mean follow-up period was 6.9 years. RESULTS: Before surgery, the mean kyphotic curve was 105.4 degrees (range, 68-150 degrees ), and the mean scoliotic curve was 85.3 degrees (range, 60-132 degrees ). After surgery, the curves averaged 48.9 degrees and 40 degrees, respectively, yielding corrections of 52.9% and 54.9%. The mean posterior trunk shift in global sagittal balance was 21 mm before surgery, becoming 3 mm after surgery. Progressive spinal cord dysfunction had developed in three patients before surgery. In all three, postoperative neurologic improvement was observed. postoperative complications consisted of transient, unilateral leg paresis in two patients. No incidents of infection or pseudarthrosis were observed. CONCLUSIONS: Spinal wedge osteotomy by the single posterior approach is a reliable and safe surgical technique for correcting severe rigid angular kyphosis or kyphoscoliosis.
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