Cases reported "Neuritis"

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1/117. Surgical findings in idiopathic trigeminal neuropathy mimicking a trigeminal neurinoma.

    Idiopathic trigeminal neuropathy is a benign disorder where the main clinical feature is facial numbness limited to the territory of one or more divisions of the trigeminal nerve, persisting for a few weeks to several years and in which no underlying disease can be identified. The case of a 37-year-old man with a brief history of sensory and motor trigeminal symptoms who showed magnetic resonance imaging (MRI) findings consistent with a small trigeminal neurinoma is reported. The patient was operated on but no tumour could be found during surgery and a biopsy was taken from the portio major. Pathological diagnosis was chronic non granulomatous inflammatory reaction with areas of coagulation necrosis. Control MRI showed complete resolution of the trigeminal abnormalities. It is concluded that in patients with MRI findings suggestive of a small trigeminal schwannoma, benign idiopathic trigeminal neuropathy should also be considered in the differential diagnosis. A conservative approach with sequential MRI studies may avoid an unnecessary surgical exploration.
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2/117. Delayed facial paralysis after stapedotomy using KTP laser.

    OBJECTIVE: Delayed facial paralysis after stapes surgery is uncommon and has been reported after traditional, nonlaser techniques for stapedotomy. The purpose of this paper is to inform the reader of the potential risk of delayed facial nerve paralysis associated with the use of the potassium titanyl phosphate (KTP) laser for stapedotomy. Etiologic mechanisms are discussed. STUDY DESIGN: The study was a descriptive study-case report. SETTING: The study was conducted at a university-based otologic practice. patients: Two patients with otosclerosis and delayed onset facial palsy 5 to 7 days after uncomplicated stapedotomy using the KTP laser were included in the study. INTERVENTION: potassium titanyl phosphate laser stapedotomy was performed. patients received treatment of facial palsy with a tapering course of oral steroids. MAIN OUTCOME MEASURE: House-Brackmann facial nerve grade scores were used. RESULTS: Improvement of House-Brackmann facial nerve scores from Grade VI to Grade I-II in one patient, and improvement from Grade IV to Grade I-II in the other was seen. CONCLUSION: The probable etiology of delayed facial palsy is viral neuritis from reactivation of dormant virus within the facial nerve, initiated by thermal stress of the KTP laser. Presentation and resolution of the facial palsy is similar to other types of delayed facial palsy resulting from nonlaser techniques of stapes surgery and other types of middle ear and neurotologic surgeries previously reported.
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3/117. Isolated neuritis of the sciatic nerve in a case of lyme disease.

    lyme disease is an infectious disease caused by the spirochete borrelia burgdorferi. The course of the disease is divided into three stages, the second of which may include various types of peripheral nervous system disturbances. We report the case of a patient with persistent deficits caused by the prevalent involvement of the sciatic nerve, confirmed by electrophysiological and neuropathological findings. The most significant bioptic results were axonal degeneration and perivascular inflammation. Damage to a single peripheral nerve as the dominant clinical expression during the course of lyme disease is an unusual finding that has been rarely described in the literature.
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4/117. Migrant sensory neuropathy: report of 5 cases and review of the literature.

    There are only a few case descriptions of migrant sensory neuropathy. We report the clinical, laboratory, and electrophysiological findings observed in 5 patients whose presentation conformed with Wartenberg's description of a chronic, disseminated migrant sensory mononeuritis. In one patient, intermittent cranial motor nerve involvement occurred as well. The sural nerve biopsy in this patient showed changes suggestive of focal ischemic nerve damage and electron microscopy confirmed a vasculopathy.
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5/117. Ski boot compression syndrome.

    The extensor tendons and peroneal nerve can be compressed at the ankle by the tongue of the ski boot. The resulting neuritis and synovitis may be severe enough to mimick an anterior compartment syndrome. Treatment consists of conservative methods but the paresthesiae may remain for long periods of time.
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6/117. Wartenberg's migrant sensory neuritis.

    We describe a patient with the sudden onset of a painful, purely sensory, mononeuritis multiplex. Investigations showed no evidence for any underlying systemic condition. A nerve biopsy showed fascicular wallerian degeneration with perineurial thickening, inflammatory cells, and immunoglobulin g (IgG) deposition. His painful sensory deficits persisted, with no improvement after treatment with prednisone. The clinical characteristics in this case were very similar to those originally described by Wartenberg, and subsequently by other investigators. The investigations in our case strongly suggest that there may be an underlying immune pathogenesis for cases of Wartenberg's migrant sensory neuritis.
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7/117. "Pseudo-conduction block" in a patient with vasculitic neuropathy.

    A 63-year-old man presented with progressive asymmetric weakness and numbness in his hands of 2 weeks duration. Nerve conduction studies showed low amplitude motor evoked potentials of both median nerves. The right ulnar, left tibial and peroneal nerves had normal potentials on distal stimulation with markedly decreased amplitudes proximally, suggestive of "conduction block". Three weeks later, amplitudes were decreased throughout. The patient was diagnosed with vasculitis. The acute ischemic injury presumably resulted in axonal damage between the distal and proximal stimulation sites, with subsequent wallerian degeneration.
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keywords = nerve, block
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8/117. A case of Dejerine-Sottas disease with schizophrenic symptoms. A clinical and pathological study.

    A case of hypertrophic interstitial neuritis with a disturbance of intelligence and schizophrenic symptoms was reported. The patient, a 41-year-old male, showed monologia at the age of 14 and auditory hallucination at the age of 21. He was diagnosed as schizophrenia. Torsion of the head to the right side and muscular atrophy were also noticed at 21 years. Atrophy of the muscles progressed gradually, particularly in the distal parts of the upper and lower extremeties. Psychiatric examination revealed schizophrenic symptoms such as auditory hallucination, thought disorder, lack of spontaneity, autism, apathy, etc. There was also a disturbance of intelligence (imbecility). In neurological examination, the torsion of the head to the right side, slight exaggeration of the peripheral reflexes, muscular atrophy in the distal parts of the extremeties were noted. The bilateral ulnar nerves were markedly hypertrophied. The biopsy of the right ulnar nerve revealed a remarkable thickening of the endoneuria and "onion bulb" formations. A large amount of the interstitial accumulation of PAS positive substance, which showed metachromasia in cresyl violet staining, was also noted. Schwann cell processes were proved electron-microscopically to surround the myelin sheaths and some of them meandered and extended and into the metachromatic substance. The basement membrane of the sheath cell was hypertrophic in some portions and elongated into interstitium. The nucleus of the sheath cell was hyperchromic and showed marked atrophy. Histological examination of the biopsy specimen obtained from the gastrocnemius muscle suggested neurogenic muscular atrophy. The relationship among the hypertrophic interstitial neuritis, schizophrenic symptoms, disturbance of intelligence and torsion of the head was also discussed.
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9/117. gasoline sniffing multifocal neuropathy.

    The polyneuropathy caused by chronic gasoline inhalation is reported to be a gradually progressive, symmetric, sensorimotor polyneuropathy. We report unleaded gasoline sniffing by a female 14 years of age that precipitated peripheral neuropathy. In contrast with the previously reported presentation of peripheral neuropathy in gasoline inhalation, our patient developed multiple mononeuropathies superimposed on a background of sensorimotor polyneuropathy. The patient illustrates that gasoline sniffing neuropathy may present with acute multiple mononeuropathies resembling mononeuritis multiplex, possibly related to increased peripheral nerve susceptibility to pressure in the setting of neurotoxic components of gasoline. The presence of tetraethyl lead, which is no longer present in modern gasoline mixtures, is apparently not a necessary factor in the development of gasoline sniffer's neuropathy.
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10/117. Idiopathic neuritis--reasons for surgical treatment.

    Idiopathic neuritis is a neurological condition of unknown etiology. Typical clinical findings are sudden onset of pain lasting for two-three weeks and remaining weakness in distal muscles. Non-surgical treatment is the consensus today for idiopathic neuritis. However, when exploring peripheral nerves affected by this syndrome that gave persistent paresis, we found an external fibrosis. After neurolysis motor function recovered. We suggest that with persisting motor deficits in idiopathic neuritis the affected peripheral nerves might be surgically explored at the latest one year after onset of the syndrome.
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