Cases reported "Hypesthesia"

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1/5. Neuropathic complications of mandibular implant surgery: review and case presentations.

    Injuries to trigeminal nerves during endosseous implant placement in the posterior mandible appear to occur acutely in approximately 5-15 of cases, with permanent neurosensory disorder resulting in approximately 8%. Nerve lateralization holds even higher risks from epineurial damage or ischaemic stretching. Neuropathy from implant compression and drill punctures can result in neuroma formation of all types, and in some cases precipitate centralized pain syndrome. Two patterns of clinical neuropathy are seen to result; hypoaesthesias with impaired sensory function, often seen with phantom pain, and hyperaesthesias with minimal sensory impairment but presence of much-evoked pain phenomena. The clinician must differentiate, through careful patient questioning and stimulus-response testing, those patients who are undergoing satisfactory spontaneous nerve recovery from those who are developing dysfunctional or dysaesthetic syndromes. Acute nerve injuries are treated with fixture and nerve decompression and combined with supportive anti-inflammatory, narcotic and anti-convulsant therapy. Surgical exploration, neuroma resection and microsurgical repair, with or without nerve grafting, are indicated when unsatisfactory spontaneous sensory return has been demonstrated, and in the presence of function impairment and intractable pain.
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2/5. Neurolymphomatosis associated with muscle and cerebral involvement caused by natural killer cell lymphoma: a case report and review of literature.

    We report a biopsy-proven case of neurolymphomatosis (NL) presenting with sensory motor axonal polyneuropathy, polymyositis, and cerebral involvement. Ours is the second reported case of NL caused by natural killer-cell lymphoma defined by morphology and immunophenotyping. For 3 months, the patient developed stocking-glove distribution of hypesthesia, subacute progressive weakness and mental deterioration. EMG showed severe sensorimotor mixed axonal-demyelinating polyradiculoneuropathy. Lumbar puncture revealed mildly high protein level with normal glucose and cell count. sural nerve biopsy demonstrated lymphomatous axonal neuropathy and muscle biopsy was indicative of lymphomatous polymyositis. brain MRI revealed multiple white matter lesions, consistent either with progressive multifocal leukoencephalopathy or cerebral lymphoma. bone marrow biopsy showed neoplastic infiltrates. The patient died of multiple organ failure prior to initiation of chemotherapy.
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3/5. Galloping ophthalmoplegia and numb chin in burkitt lymphoma.

    A 57-year-old man developed complete bilateral ophthalmoplegia over a period of 10 days, together with bilateral facial pain and numbness of the chin. He had no other clinical manifestations. Findings on brain magnetic resonance imaging and spinal fluid formula from the first lumbar puncture were normal, but cerebrospinal fluid flow cytometry disclosed a kappa restriction monoclonal B-cell population, indicating malignant lymphoma. Computed tomography of the chest, abdomen, and pelvis then revealed multiple enlarged lymph nodes. biopsy of an inguinal node showed findings consistent with burkitt lymphoma. Within six weeks, intravenous and intrathecal chemotherapy resolved all neurologic findings except a partial right-side sixth nerve palsy and mild chin numbness. Eighteen months after disease onset, the patient remained in remission. Meningeal spread of burkitt lymphoma is not commonly a presenting feature in immunocompetent adults. chin numbness, a characteristic feature caused by infiltration of the mental nerve, should facilitate earlier recognition, which may be life saving.
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4/5. acupuncture treatment of compression neuropathy of the radial nerve: a single case report of "Saturday Night Palsy".

    PURPOSE: Evidence that acupuncture is effective for any type of motor nerve injury is limited to case reports and case series but these findings indicate benefit. observation that the radial nerve has the most rapid recovery of all peripheral nerves suggests that acupuncture might benefit treatment of "Saturday Night Palsy," a syndrome of radial-nerve compression. TREATMENT: A 41-year-old female with a 1-week history of inability to write or extend the right wrist received 1 acupuncture treatment utilizing the lung and Large Intestine meridians in the forearm, with the 2 meridians interconnected using the Luo and Yuan points. A cockup wrist splint was then applied. CONCLUSIONS: wrist motion with gravity neutralized returned immediately after treatment. As the day progressed, the patient reported increasing strength in wrist and finger extension. The next day, the patient cancelled the second acupuncture treatment, as her hand had recovered. Examination 4 months later revealed normal wrist and finger extension, sensation, and return of the brachioradialis reflex. The patient was symptom-free 1-year postinjury. acupuncture potentially facilitates recovery and may enhance treatment of peripheral motor nerve injury.
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5/5. Facial numbness in a man with inguinal and retroperitoneal masses.

    BACKGROUND: A 37-year-old Brazilian man was admitted to massachusetts General Hospital for evaluation of left-sided facial numbness, left-sided ataxia, dizziness, and vertigo. Seven weeks prior to admission, he reported numbness of the left oral cavity and tongue after a dental procedure. Three weeks prior to presentation, he developed left-sided incoordination with dizziness and vertigo. One week later, he noticed difficulty using a box cutter at work and presented to the emergency department for evaluation. A CT scan without contrast revealed no abnormalities and he was discharged home. Three days prior to admission, the patient developed diplopia. Cranial MRI revealed a 1.6 cm irregular enhancing mass in the left middle cerebellar peduncle. neurologic examination was significant for diminished sensation over the left face to pinprick, left-sided dysmetria, and mild lateral instability of the trunk while walking. INVESTIGATIONS: MRI, lumbar puncture, CT scans of the abdomen and pelvis, needle biopsy of the lymph node, and paraneoplastic antibodies. diagnosis: Possible paraneoplastic demyelination. MANAGEMENT: orchiectomy, adjuvant radiation, and corticosteroids.
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