1/19. No neurological involvement for more than 40 years in klippel-feil syndrome with severe hypermobility of the upper cervical spine.We report the case of a 42-year-old woman with klippel-feil syndrome, who showed severe hypermobility of the upper cervical spine without neurological involvement for more than 40 years. Radiographs revealed the presence of the odontoid bone and fusion of the atlas, odontoid bone, and occiput. Congenital fusion was present from the axis to C5 as a block vertebra. Lateral flexion-extension radiographs revealed severe hypermobility at the junction between the odontoid bone and the axis. Prophylactic surgical stabilization has been recommended in patients with severe hypermobility, but adjacent disc problems may possibly occur at the unfused levels in the future. We believe that early prophylactic stabilization should not be indicated for klippel-feil syndrome without neurological involvement only because of hypermobility.- - - - - - - - - - ranking = 1keywords = junction (Clic here for more details about this article) |
2/19. Delayed hypoglossal palsy following occipital condyle fracture--case report.Occipital condyle fractures are rare. When present, they produce lower cranial palsies and/or brainstem dysfunction. A 32 year old man sustained multiple injuries. At the time of admission the patient had no neurological deficits. Three weeks after the accident, the patient complained of slurring of speech. Clinical examination revealed an isolated hypoglossal palsy. Radiological evaluation revealed an occipital condyle fracture. The patient was treated with a rigid collar. Eighteen months after the injury, the patient noted slight improvement in his speech. However, clinical examination showed a persistent hypoglosssal palsy. Occipital condyle fractures are rare. They may be associated with lower cranial nerve palsies. As demonstrated by this case, this entity should be included in the differential diagnosis of hypoglossal palsy. Since occipital condyle fractures can exist without neurological deficits, special attention should be paid to imaging of the craniovertebral junction in patients with head injury.- - - - - - - - - - ranking = 1keywords = junction (Clic here for more details about this article) |
3/19. Anterior corpectomy and fusion with fibular strut grafts for multilevel cervical myelopathy.OBJECT: The authors conducted a study to investigate the long-term results and postoperative complications of a new surgical technique, fibular strut graft-assisted anterior corpectomy and fusion for multilevel (> four) cervical myelopathy. Multilevel anterior corpectomy and subsequent strut graft placement is considered a challenging procedure because of complications relating to graft dislodgment, pseudarthrosis, greater operative duration, and increased blood loss. methods: The study comprised 100 patients with cervical myelopathy who underwent anterior corpectomy and fusion and fibular strut graft placement at more than four disc space levels between 1989 and 1998. Single-screw fixation was used in conjunction with the autologous strut graft. Preoperative and postoperative plain radiographs, computerized tomography myelograms, and magnetic resonance images were obtained for assessment of fusion status. All complications and outcomes were analyzed based on clinical records to evaluate the results of the technique. There were no cases of graft dislodgment. The graft union rate was 85%. Analysis of clinical data showed that pseudarthrosis had no adverse effect on the clinical results. Adjacent-level disc degeneration occurred in 12% of patients, but in all cases the patients were asymptomatic. In 9% of cases C-5 palsy was observed but it recovered spontaneously. There were no infections and no case of neurological deterioration. CONCLUSIONS: With this new graft technique, graft dislodgment, the major complication associated with strut graft surgery, was resolved completely. This simple technique involving single-screw fixation provided good results when used in conjunction with anterior decompression and strut graft fixation with a very low incidence of complications.- - - - - - - - - - ranking = 2keywords = junction (Clic here for more details about this article) |
4/19. The neurophysiologic examination in organophosphate ester poisoning. Case report and review of the literature.A 65-year-old woman who has been admitted after organophosphate-induced poisoning (fenthion), develops pareses as a result of neuromuscular junctional dysfunction 7 days post-exposure. These findings are consistent with an intermediate syndrome, which may appear within 24 to 96 hours of exposure and subsides after 5 to 18 days. Delayed polyneuropathy develops within 1 to 3 weeks and abates after 6 to 12 months. A distal axonopathy can be demonstrated. Several authors have attempted EMG monitoring of pesticide-workers in agricultural and industrial settings. The electrophysiologic examination is an important diagnostic adjunct in the development and course of muscle paresis following organophosphate-ester poising.- - - - - - - - - - ranking = 576.56382333698keywords = neuromuscular junction, junction (Clic here for more details about this article) |
5/19. Prolonged paralysis after treatment with neuromuscular junction blocking agents.OBJECTIVES: Previous reports have described prolonged paralysis after treatment with neuromuscular junction blocking agents in critically ill patients. The purpose of this study was to further describe a group of patients who developed prolonged weakness after treatment with these agents. DESIGN: Clinical information, electrodiagnostic and muscle pathology results are described in this group of patients. Clinical information includes diagnoses, dosage of neuromuscular junction blocker, other medications affecting the neuromuscular system, and neuromuscular examination and clinical course. SETTING: All patients were seen in the ICUs of three local hospitals. patients: Included were critically ill patients with a variety of diagnoses, all of whom developed severe weakness after discontinuation of neuromuscular junction blocking agents. INTERVENTIONS: Electrodiagnostic studies and muscle biopsies were performed on several of the patients. MEASUREMENTS AND MAIN RESULTS: All patients had pronounced weakness without sensory loss. Electrodiagnostic and muscle pathology findings were consistent with failed neuromuscular transmission. Although many patients had disorders or were taking medications that can injure the neuromuscular system, no disorder or medication was common to all. Recovery of strength often took several months and most patients were slow to wean from mechanical ventilator support. CONCLUSIONS: Although alternative explanations cannot be excluded with certainty, the use of neuromuscular junction blocking agents may lead to neurogenic atrophy and care must be taken when using them.- - - - - - - - - - ranking = 4612.5105866959keywords = neuromuscular junction, junction (Clic here for more details about this article) |
6/19. Combined arterial gas embolism and decompression sickness following no-stop dives.decompression sickness (DCS) has been clinically classified as Type I (predominantly joint pain) or Type II (predominantly spinal cord lesions). We present 3 cases that are all characterized by severe (Type II) DCS with signs and symptoms of spinal cord injury occurring in conjunction with arterial gas embolism (AGE). We consider the AGE "minor" because only 2 of the 3 subjects initially lost consciousness, and in all cases the signs and symptoms of the AGE had essentially resolved within 1 h or by the time recompression therapy began. DCS was resistant to recompression therapy, even though treatment began promptly after the accident in 2 of the 3 cases. None of the cases had a good neurologic outcome and there has been one death. None of the divers exceeded the U.S. Navy "no-stop" limits for the depths at which they were diving. We have observed a previously unreported clinical syndrome characterized by severe Type II DCS subsequent to AGE following pressure-time exposures that would normally not be expected to produce DCS. We postulate that AGE may have precipitated or predisposed to this form of DCS.- - - - - - - - - - ranking = 1keywords = junction (Clic here for more details about this article) |
7/19. Cruciate paralysis: a clinical and radiographic analysis of injuries to the cervicomedullary junction.Fourteen patients with superior cervical spinal cord injuries and the clinical signs and symptoms of cruciate paralysis are presented. This rare injury pattern is characterized by weakness of the upper extremities with little or no compromise of lower-extremity function following trauma to the superior spinal cord. Anatomically, cruciate paralysis is thought to represent selective injury to descending corticospinal tracts as they decussate at the cervicomedullary junction. The clinical and radiographic findings of each patient are outlined and the incidence and natural history of the injury syndrome, including a review of the literature, are presented.- - - - - - - - - - ranking = 5keywords = junction (Clic here for more details about this article) |
8/19. radial nerve palsy: a complication of walker usage.A patient with diabetic peripheral neuropathy experienced the acute onset of a proximal radial nerve palsy after prolonged use of a walker. Nerve conduction and electromyographic studies confirmed an isolated, severe neurapraxic lesion distal to branches innervating the triceps and anconeus muscles. The acute onset and severity of this lesion suggests that it was caused by mechanical compression of the radial nerve as it exits the spiral groove. Radial mononeuropathy has been reported in conjunction with muscular effort of the triceps muscle. Previous case studies and a review of the literature are discussed. awareness of this complication in patients using walkers and wheelchairs is important for prevention and diagnosis in rehabilitation.- - - - - - - - - - ranking = 1keywords = junction (Clic here for more details about this article) |
9/19. Bilateral hypoglossal nerve palsy due to vertical subluxation of the odontoid process in rheumatoid arthritis.Two patients with rheumatoid arthritis involving the cervical spine developed a rapidly progressive dysarthria due to bilateral hypoglossal nerve palsies, in one patient as an isolated lesion, and in the other in conjunction with dysfunction of the vagus and glossopharyngeal nerves. Both patients showed upward movement of the axis, relative to the foramen magnum, which has been termed 'vertical subluxation of the odontoid' or 'cranial settling'. Mechanical injury to the nerves, secondary to this process, is the most likely mechanism.- - - - - - - - - - ranking = 1keywords = junction (Clic here for more details about this article) |
10/19. Bilateral upper extremity paralysis (Bell's cruciate paralysis) from a gunshot wound to the cervicomedullary junction.Cruciate paralysis is characterized by midline involvement of the rostral portion of the pyramidal decussation, resulting in paralysis of the upper extremity without lower extremity involvement. The neuroanatomical basis is the more rostral and medial decussation of the upper extremity motor fibers in the medulla compared with the more caudal and lateral decussating fibers of the lower extremity at the lower boundary of the cervicomedullary junction. We believe this to be the first reported case of Bell's cruciate paralysis caused by a gunshot wound to this region. The neuroanatomical basis and the mechanisms that produce this unique clinical entity are discussed.- - - - - - - - - - ranking = 5keywords = junction (Clic here for more details about this article) |
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