Cases reported "Hypesthesia"

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11/20. Sacral hemangioblastoma in a patient with von hippel-lindau disease. Case report and review of the literature.

    Hemangioblastomas are histologically benign neoplasms that occur sporadically or as part of von hippel-lindau disease. Hemangioblastomas may occur anywhere along the neuraxis, but sacral hemangioblastomas are extremely rare. To identify features that will help guide the operative and clinical management of these lesions, the authors describe the management of a large von hippel-lindau disease-associated sacral hemangioblastoma and review the literature. The authors present the case of a 38-year-old woman with von hippel-lindau disease and a 10-year history of progressive back pain, as well as left lower-extremity pain and numbness. Neurological examination revealed decreased sensation in the left S-1 and S-2 dermatomes. magnetic resonance imaging demonstrated a large enhancing lesion in the sacral region, with associated erosion of the sacrum. The patient underwent arteriography and embolization of the tumor and then resection. The histopathological diagnosis was consistent with hemangioblastoma and showed intrafascicular tumor infiltration of the S-2 nerve root. At 1-year follow-up examination, pain had resolved and numbness improved. Sacral nerve root hemangioblastomas may be safely removed in most patients, resulting in stabilization or improvement in symptomatology. Generally, hemangioblastomas of the sacral nerve roots should be removed when they cause symptoms. Because they originate from the nerve root, the nerve root from which the hemangioblastoma originates must be sacrificed to achieve complete resection.
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12/20. Cervical spine meningioma presenting as otalgia: case report.

    OBJECTIVE AND IMPORTANCE: Cervical spine meningiomas have not been reported to present as otalgia. It is important to include otalgia in the differential diagnosis and workup, especially when more common causes of ear pain have been excluded. CLINICAL PRESENTATION: A 66-year-old woman presented to her primary care physician with severe ear pain. She underwent routine diagnostic testing and eventually was referred to a neurologist. After conservative management failed, the patient underwent cervical spine magnetic resonance imaging, which revealed a large meningioma encompassing C2-C3. INTERVENTION: The patient underwent a cervical laminectomy with complete resection of the tumor. She experienced immediate postoperative resolution of her symptoms. CONCLUSION: This case illustrates the importance of aggressive evaluation of otalgia when routine diagnostic studies are inconclusive. Cervical meningiomas are associated with significant potential morbidity and should be excluded early in the diagnostic process.
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keywords = operative
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13/20. radial nerve injury after general anaesthesia in the lateral decubitus position.

    A 43-year-old female patient underwent pyelolithotomy in the left lateral decubitus position. Her upper right arm was placed on a padded armboard. Surgery lasted for 240 min. Postoperatively, she complained of numbness of the dorsal part of her right hand and wrist drop. Neurological examination revealed hypoaesthesia of the dermatome of the right forearm and hand innervated by the radial nerve. electromyography revealed advanced axonal degeneration of the radial nerve below the level of the elbow. Treatment with diclofenac, vitamin B and physiotherapy was started. Her symptoms improved gradually and at the 60th postoperative day, motor weakness had completely resolved. In order to prevent peri-operative nerve injury, careful positioning of every patient on the operating table with proper padding is essential, with attention paid to time-dependent risks. If an injury occurs, diagnosis and treatment should be started as rapidly as possible.
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ranking = 3
keywords = operative
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14/20. Bilateral traumatic neuroma of the anterior cervical nerve root: case report.

    STUDY DESIGN: Case report. OBJECTIVES: A rare case of anterior cervical second root traumatic neuroma with no history of trauma is reported, and possible etiology is discussed. SUMMARY OF BACKGROUND DATA: Traumatic neuroma is the reactive, nonneoplastic proliferation in the injured nerve. Several atypical locations of traumatic neuroma have been reported. To date, only 4 cervical traumatic neuroma cases with no history of trauma have been reported, and, to our knowledge, there is no case of bilateral cervical traumatic neuroma published in the literature. methods: A patient with a history of neck and left upper extremity pain, who had hypoesthesia in left C2 dermatome on neurologic examination is presented. A left C2-C3 hemilaminectomy and tumor extirpation were performed. RESULTS: A histopathologic study revealed features of a typical traumatic neuroma. The patient had no deficits on her postoperative neurologic examination, and her neck and left arm pain improved. The unusual location of this lesion and possible etiology of such a traumatic neuroma are discussed. CONCLUSIONS: A rare case of anterior bilateral cervical second root traumatic neuroma with no history of trauma is reported. An unnoticed history of trauma may play an etiologic role in the development of these lesions.
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keywords = operative
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15/20. Pacemaker syndrome: a non-invasive means to its diagnosis and treatment.

    vertigo, lightheadedness, syncope, and hypotension occurring after implantation of a ventricular pacemaker has become known as pacemaker syndrome. In one patient with this syndrome we have demonstrated an associated decrease in the pulse amplitude of the ophthalmic arteries during ventricular pacing by utilizing ocular pneumoplethysmography (O.P.G.). This non-invasive technique was subsequently used intra-operatively to test the presence of ophthalmic artery pulse amplitude changes after implantation of the ventricular electrode. An A-V sequential pacemaker was then implanted and eliminated all symptoms of pacemaker syndrome.
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keywords = operative
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16/20. Neck tongue syndrome: operative management.

    A 53-year-old woman with assimilation of the atlas to the occiput presented with paraesthesiae in the right half of her tongue and ipsilateral neck pain aggravated by head turning. After being intermittent for several years, the symptoms eventually became persistent and increasingly incapacitating. At operation, the C2 spinal nerves were found to be compressed by protuberant atlanto-axial joints, particularly on the right side. The superficial parts of the resected C2 spinal nerves showed a loss of both myelinated and unmyelinated nerve fibres. After operation, the patient experienced partial relief of her symptoms.
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ranking = 4
keywords = operative
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17/20. A rare complication of extradural analgesia.

    A case is reported of probable subdural injection of bupivacaine during attempted extradural analgesia for an operative obstetric procedure.
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18/20. Chronic spinal subdural haematoma.

    Chronic spinal subdural haematomas are uncommon. This is the report of a 62-year-old hypertensive and diabetic white female, with progressing paraparesis and sensory loss in the lower limbs for six months. There was no history of trauma to the spine. Ascending myelography disclosed a complete block at the first lumbar vertebra. At operation, a characteristic chronic subdural haematoma was found and removed. Postoperative course was uneventful, and nine months after surgery she was asymptomatic. Spontaneous chronic subdural haematoma, although rare, should be considered in the diagnosis of spinal cord compression. Surgical treatment may lead to complete recovery of the neurological deficit.
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ranking = 1
keywords = operative
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19/20. Neurologic symptoms after epidural anaesthesia. Report of three cases.

    We describe 3 patients, who exhibited neurological symptoms after single dose epidural anaesthesia. In patient 1 an unrecognized spinal arteriovenous fistula (AVF) caused paraparesis following epidural block. The dilated veins draining an AVF are space-occupying structures and the injection of the anaesthetic solution may have precipitated latent ischaemic hypoxia of the spinal cord due to raised venous pressure. In patient 2, epidural block was followed by postoperative permanent saddle pain and hypoaesthesia. The injection of the anaesthetic in a narrow spinal canal with multiple discal protrusions and restriction of interlaminar foramina may have acutely produced mechanical compression of the spinal cord or roots. Patient 3 exhibited post-epidural block spinal arachnoiditis. Although the few reported cases of this syndrome exhibit severe neurological damage, our patient presented with scarse symptoms. Our cases point out the importance of accurate neurological history and examination of candidates for epidural anaesthesia and of accurate anaesthetic history for neurological patients.
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keywords = operative
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20/20. ulnar nerve compression following flexor digitorum superficialis tendon transfers around the ulnar border of the forearm to restore digital extension: case report.

    This case report describes a complication that occurred following long and ring finger flexor digitorum superficialis tendon transfers routed around the ulnar border of the forearm to restore digital extension. An ulnar mononeuropathy developed in the early postoperative period that was characterized by decreased ring and small finger sensation and interosseous muscle weakness. Operative exploration demonstrated extrinsic compression of the ulnar nerve by the long and ring finger flexor digitorum superficialis tendons. When superficialis tendon transfers are chosen to restore digital extension, passage around the radial side of the forearm or through the interosseous space are recommended to avoid this potential complication.
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keywords = operative
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