11/128. quinine induced coagulopathy--a near fatal experience.A 67 year old man presented to his local dentist for restorative treatment. He stated he was fit and well and denied taking any medications. When he was given an inferior alveolar nerve block, excessive bleeding was noted at the injection site and the dentist advised the patient see an oral and maxillofacial surgeon. An appointment was made for the patient but he did not attend. Three days later, he presented with evidence of massive deep haemorrhage to the point of airway compromise. He underwent hospital admission, early intubation, intensive care for nine days and hospitalization for six weeks. The cause of his bleeding was a severe thrombocytopoaenia, induced by chronic ingestion of quinine. He was self-medicating with this to relieve muscular cramps. Despite this experience, the patient continued to deny that quinine was the cause of his problem and that he had failed in his obligations to advise the dentist of his drug history. dentists need to be alert to the risk that patients may not reveal their true medical history. There are, however, obligations on the dentist to ensure the accuracy of information the patient gives and to ensure that patients whom they believe are at risk follow their advice. Teamwork and skillful airway management prevented this patient's demise.- - - - - - - - - - ranking = 1keywords = cramp (Clic here for more details about this article) |
12/128. A congenital dermal sinus presenting the muscle fasciculation and hypertrophy.OBJECTIVE: To report unique and unknown clinical features of muscle fasciculation and muscle hypertrophy in a case of congenital dermal sinus. patients: A 16-year-old girl presented with continuous fasciculation, often cramp, and hypertrophy of the left calf muscle. The radiography showed spina bifida of L4, L5 and S1. MRI revealed dermal sinus tract from the skin dimple of the back to the dura mater, and connected to the intradural inclusion tumor. At surgery the inclusion tumor contained many short hairs, and the cauda equina were severely adherent. microdissection of the tumor and the adhesion was performed. At 2 years after surgery fasciculation decreased but continued; however, painful cramps of the calf muscle do not occur. CONCLUSIONS: Short hairs of dermoid and the adherence might be irritative to the cauda equina. The hyperactivity of the stimulated motor neuron may cause the muscle fasciculation leading to hypertrophy of the calf muscle.- - - - - - - - - - ranking = 2.0009453551485keywords = cramp, muscle (Clic here for more details about this article) |
13/128. Axillary injection of botulinum A toxin in a patient with muscle cramps associated with severe axillary hyperhidrosis.Muscle cramps may be caused by fluid and salt loss induced by diffuse or focal hyperhidrosis. Recent reports have described the efficacy of botulinum, toxin in the treatment of primary focal hyperhidrosis. Botulinum toxin inhibits sweating by blocking exocytosis of acetylcholine from presynaptic cholinergic nerve terminals. We report the case of a patient who complained of frequent muscle cramps associated with unusually severe axillary hyperhidrosis. We used botulinum toxin to treat the excessive focal sweating presuming that it would also reduce the muscle cramps. A total dose of 200 MU of botulinum A toxin (Dysport) per axilla markedly reduced sweating and cramps. The beneficial effect started four days after the injection and it was still present five months later. Treatment was repeated in the sixth month with analogous results. No side-effects were observed and no compensatory sweating occurred.- - - - - - - - - - ranking = 12.71920520835keywords = cramp, muscle cramp, muscle (Clic here for more details about this article) |
14/128. hypothyroidism with subacute pseudomyotonia--an early form of Hoffmann's syndrome? Report of a case.A 25-year-old man was admitted to the hospital because of painful muscle cramps and action myospams of subacute onset and 6 weeks' duration. No myotonia could be demonstrated objectively and his deep tendon reflexes showed no prolongation of the relaxation phase. serum creatinine was raised but creatinine clearance was normal. serum levels of aldose, CPK, ASAT and ALAT were increased but ordinary light microscopy revealed no histological signs of muscle disease in a quadriceps biopsy. ECG showed a prolonged PQ interval and flat T waves in the left precordial leads. Laboratory tests of thyroid function revealed intensive hypothyroidism, and high titers of circulating thyroid antibodies were demonstrated. During 2 1/2 months of thyroid therapy, the muscle symptoms gradually disappeared completely and the patient could return to work. By that time the serum enzymes and the ECG had normalized. Despite the lack of objective signs of myotonia, we consider that the very dominant subjective muscle symptoms, severe enough to prevent the patient from performing his ordinary manual work and completely reversible on thyroid therapy, justify the designation of hypothyroid myopathy. The question is raised whether the case represents an early form of Hoffmann's syndrome.- - - - - - - - - - ranking = 1.7868178079361keywords = cramp, muscle cramp, muscle (Clic here for more details about this article) |
15/128. Contraindication of magnesium sulfate in a pregnancy complicated with late-onset diabetes mellitus and sensory deafness due to mitochondrial myopathy.A primipara affected by late-onset diabetes and sensory deafness because of mitochondrial myopathy was hospitalized for threatened preterm delivery. magnesium sulfate was started for tocolysis, resulting in general muscle damage, although the mitochondrial myopathy did not deteriorate during pregnancy. magnesium sulfate may be contraindicated in pregnancy with mitochondrial myopathy.- - - - - - - - - - ranking = 9.4535514845646E-5keywords = muscle (Clic here for more details about this article) |
16/128. Rabbitfish ("aras"): an unusual source of ciguatera poisoning.BACKGROUND: ciguatera poisoning is the commonest fish-borne seafood intoxication. It is endemic to warm water tropical areas and is caused by consumption of bottom-dwelling shore reef fish, mostly during spring and summer. The causative agent, ciguatoxin, is a heat-stable ester complex that becomes concentrated in fish feeding on toxic dinoflagellates. The common clinical manifestations are a combination of gastrointestinal and neurologic symptoms. Severe poisoning may be associated with seizures and respiratory paralysis. OBJECTIVE: To describe a series of patients who sustained ciguatera poisoning in an uncommon region and from an unexpected source. patients: Two families complained of a sensation of "electrical currents," tremors, muscle cramps, nightmares, hallucinations, agitation, anxiety and nausea of varying severity several hours after consuming rabbitfish ("aras"). These symptoms lasted between 12 and 30 hours and resolved completely. The temporal relationship to a summer fish meal, the typical clinical manifestations along with the known feeding pattern of the rabbitfish suggested ciguatera poisoning. CONCLUSIONS: The Eastern Mediterranean basin is an unusual region and the rabbitfish an unusual source for ciguatera poisoning. There are no readily available and reliable means for detecting ciguatoxin in humans. A high index of suspicion is needed for diagnosis and a thorough differential diagnosis is essential to eliminate other poisonings, decompression sickness and encephalitis. Supportive therapy is the mainstay of treatment.- - - - - - - - - - ranking = 1.7865342013916keywords = cramp, muscle cramp, muscle (Clic here for more details about this article) |
17/128. Exercise-induced, persistent and generalized muscle cramps. A case report.We are reporting on a 46-year-old man who has suffered of muscle cramps for 4 years, occurring immediately after jogging and playing tennis and lasting for 7-8 hours. Repeated neurological, orthopedic, internal medical and endocrinological examinations showed no pathological findings. Physiotherapy, supplementation of fluids and electrolytes had no effect, nor did medication therapy with muscle relaxants. During spiroergometry without medication, there was an overproportional increase of heart rate and respiratory rate with delayed pCO2 increase after exercise with otherwise normal blood gas levels. This reaction was considerably reduced during spiroergometry under beta-blockade (metoprolol 100 mg); at the same time, the muscle cramps could no longer be induced. Both excessive respiratory regulation and direct hyperadrenergic stimulation should be discussed as the primary cause of the muscle cramps. According to recent findings, b-blockers with intrinsic sympathocomimetic activity should be avoided in therapy.- - - - - - - - - - ranking = 12.505833945256keywords = cramp, muscle cramp, muscle (Clic here for more details about this article) |
18/128. Repetitive nerve stimulation and muscle membrane excitability: case report and review.Few muscle disorders can be diagnosed by repetitive nerve stimulation (RNS). Decreasing compound muscle action potentials (CMAP) on high frequency RNS is recorded in muscle channelopathies, and particularly in sporadic and recessive congenital myotonia. In this myopathy, decreasing CMAP after exercise test and RNS are the most sensitive electrophysiological in detecting muscle membrane dysfunction and are considered highly informative even in mildly symptomatic patients. We report on a patient with excercise-induced diffuse muscle cramps and myalgia; muscle biopsy and laboratory investigations were normal. Decreasing CMAP on high frequency RNS suggested muscle membrane conduction anomalies and, though clinical and electrical myotonia was not detected, the neurophysiological finding raised the suspicion of congenital myotonia and addressed to molecular investigation.- - - - - - - - - - ranking = 1.78747955654keywords = cramp, muscle cramp, muscle (Clic here for more details about this article) |
19/128. Neurologic and cardiac progression of glycogenosis type VII over an eight-year period.Little is known about the progression of phosphofructokinase deficiency (glycogenosis type VII, Tarui's disease). We describe a 66-year-old woman who had this disease diagnosed in 1997. Initial manifestations had included simple partial seizures since 1977, anginal chest pain since 1982, and muscle cramps since 1983. To prevent recurrent myocardial infarction, anticoagulation therapy with phenprocumon was initiated. Cardiac involvement progressed over an 8-year period, manifesting as low-voltage electrocardiogram (ECG), ectopic supraventricular tachycardia, thickened mitral valve, mitral valve insufficiency, enlarged left atrium, left ventricular hypertrophy, and diastolic dysfunction. Progression of neurologic involvement manifested as complex partial seizures, double vision, reduced tendon reflexes, central facial palsy, bradydiadochokinesia, and distal weakness of the upper extremities. Discontinuance of oral anticoagulation after 19 years, initiation of enalapril therapy, and administration of carbamazepine markedly improved the patient's condition.- - - - - - - - - - ranking = 1.7865342013916keywords = cramp, muscle cramp, muscle (Clic here for more details about this article) |
20/128. Medial compartment syndrome of the foot: an unusual complication of spine surgery.STUDY DESIGN: Descriptive case report. OBJECTIVES: To report the case of a child with medial compartment syndrome of the foot following posterior spinal instrumentation and fusion. SUMMARY OF BACKGROUND DATA: No previous study has reported medial compartment syndrome of the foot following spinal surgery. methods: A 15-year-old female with progressive idiopathic scoliosis was taken for posterior instrumentation and fusion. The patient had a history of severe postexertional cramping in the feet following athletics. Surgery progressed uneventfully and the patient was continuously monitored with somatosensory-evoked potentials, which showed no changes. In the recovery room, the patient complained of severe cramping in one foot that was similar to her postexertional cramping. This was lessened with massage and ketorolac. Soreness continued in the foot into postoperative day one and then increased overnight. On the morning of postoperative day 2, pressure in the medial compartment was found to be 97 mm Hg and she was taken for fasciotomy, which found necrosis of the abductor hallucis muscle, and all other compartments of the foot were normal. RESULTS: At the 6-month follow-up, the patient is doing well with no known sequelae. CONCLUSION: This was a very rare case of medial compartment syndrome of the foot following spine surgery. We believe that the patient had a predisposition, whether neurologic or vascular, toward cramping in the foot and that this activity was stimulated by the nerve stimulation during the evoked potential monitoring. Although the patient had thoracic epidural analgesia after surgery, it was not felt to have contributed to the development or result of the compartment syndrome. We strongly advocate for checking patients feet and legs during surgery for overactivity and stress the need for a high index of suspicion for compartment syndrome for unexplained pain after surgery.- - - - - - - - - - ranking = 4.0000945355148keywords = cramp, muscle (Clic here for more details about this article) |
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