Cases reported "Sensation Disorders"

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1/19. Phantom erection after amputation of penis. Case description and review of the relevant literature on phantoms.

    BACKGROUND: perception of a phantom limb is frequent after an amputation of an upper or lower extremity. Phantom penis is reported infrequently. METHOD: Case description and literature review. RESULT: The phenomenon of phantom penis followed total penectomy. Several aspects were unusual, particularly the existence with phantom only in the erect state, and associated recrudescence of a preoperative painful ulcer. General features of limb phantoms after amputation are reviewed including a resume of recent studies of cortical reorganization. The phantom process is analyzed looking for clues to the nature of the underlying neural organization. The puzzle of phantom pain is briefly touched on. CONCLUSION: The development of the phantom is attributed to activity in the deafferented parietal sensory cortex.
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2/19. Minimally invasive stereotactically-guided extirpation of brain stem cavernoma with the aid of electrophysiological methods.

    The surgical extirpation of brain stem cavernomas always includes a risk of neurological deficits. To minimize the risk of deficits and control the motor and sensory function intraoperative monitoring of SEP and MEP seems to be helpful. The high density of motor and sensory fibers within the brain stem makes bilateral intraoperative monitoring necessary. The following case demonstrates a stereotactically-guided supratentorial, transventricular approach for extirpation of a brain stem cavernoma. Sensory and motoric functions were observed by transcranial recording of SEP's and by transcranial stimulation of motor cortex.
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3/19. multiple sclerosis and oral care.

    multiple sclerosis is a complex neurological condition affecting sensory and motor nerve transmission. Its progression and symptoms are unpredictable and vary from person to person as well as over time. Common early symptoms include visual disturbances, facial pain or trigeminal neuralgia and paraesthesia or numbness of feet, legs, hands and arms. These, plus symptoms of spasticity, spasms, tremor, fatigue, depression and progressive disability, impact on the individual's ability to maintain oral health, cope with dental treatment and access dental services. Also, many of the medications used in the symptomatic management of the condition have the potential to cause dry mouth and associated oral disease. There is no cure for multiple sclerosis, and treatment focuses on prevention of disability and maintenance of quality of life. Increasingly a multi-disciplinary team approach is used where the individual, if appropriate his/her carer, and the specialist nurse are key figures. The dental team plays an essential role in ensuring that oral health impacts positively on general health.
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ranking = 0.15873912820994
keywords = visual
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4/19. Physiotherapy for pusher behaviour in a patient with post-stroke hemiplegia.

    OBJECTIVE: This case report describes a specific, literature-based physiotherapy treatment and the outcome for a stroke patient with pusher behaviour. Pusher behaviour is characterized by pushing strongly towards the hemiplegic side in all positions and resisting any attempt at passive correction of posture to bring the weight towards or over the midline of the body. methods: The patient was a 71-year-old man with clear pusher behaviour due to a stroke. Therapy for the pushing behaviour was performed over a 3-week period. Motor function, mobility, disability, tone anomalies and pusher behaviour were assessed before and after the study period. Immediate effects of a single training session were assessed by clinical observation. RESULTS AND CONCLUSION: Immediate effects on the pusher behaviour were observed when using visual and auditory feedback, but not when somatosensory input was used. These results were not maintained to the end of the treatment period. Treatment makes the patient able to use compensatory strategies for functional activities. The long-term effects should be investigated in more depth in the future.
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ranking = 0.15873912820994
keywords = visual
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5/19. Pure sensory stroke as an isolated manifestation of the lateral medullary infarction.

    Pure sensory stroke is a common manifestation of a thalamic stroke and may occur less frequently in the infarction of the brainstem, internal capsule, and parietal cortex. The authors report a 47-year-old man who presented with loss of pain and temperature sensation in the left face, arm, trunk, and leg and was found to have a right lateral medullary infarction on diffusion-weighted magnetic resonance imaging. To the authors' knowledge, this is the first case describing pure sensory stroke as a single, isolated manifestation of the lateral medullary infarction that was detected by diffusion-weighted magnetic resonance imaging. This case suggests that with the availability of diffusion-weighted magnetic resonance imaging, pure sensory stroke may carry a broader spectrum of the anatomical localizations than previously determined and can localize to the lateral medulla. Therefore, a possibility of medullary infarction should be considered when a patient presents with pure sensory stroke, especially when diffusion-weighted magnetic resonance imaging is not immediately available to provide radiographic correlation.
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6/19. Balloon-in-stent technique for the constructive endovascular treatment of "ultra-wide necked" circumferential aneurysms.

    INTRODUCTION: Circumferential aneurysms, which incorporate >180 degrees of the circumference of the parent vessel, present a unique therapeutic challenge, particularly in circumstances in which a deconstructive treatment strategy is not feasible. We detail a novel technique for endovascular parent vessel reconstruction with aneurysm embolization. methods: We performed a retrospective review of the prospectively maintained databases of our two institutions to identify cases in which a balloon-in-stent technique had been used to treat circumferential aneurysms. During the first stage of this technique, a stent (Neuroform [boston Scientific, Natick, MA], Multilink Vision [Guidant, Indianapolis, IN], or Bx Velocity [Cordis, new brunswick, NJ]) is placed across the neck of the aneurysm to achieve parent vessel reconstruction. During the second stage, aneurysm coil embolization is performed with a compliant temporary occlusion balloon (Sentry [boston Scientific, Natick, MA] or Hyperglide [Microtherapeutics, Irvine, CA]) placed within the stent to unambiguously demarcate and protect the parent vessel. In some cases, during the course of the embolization, coils project over and obscure the parent vessel in both working views. Before each coil detachment, the protection balloon is deflated under blank fluoroscopic roadmap visualization. The absence of shifting of any portion of the coil mass during balloon deflation indicates that the introduced coil is external to the stent-reconstructed parent vessel (i.e., within the aneurysm) and can be detached. This process is repeated until satisfactory aneurysm embolization is achieved. After embolization, the balloon catheter may be exchanged for a stent delivery system to facilitate the placement of a second stent. RESULTS: Seven patients underwent balloon-in-stent-assisted embolization over a 15-month period. Three were performed for internal carotid aneurysms, three for basilar trunk or basilar apex aneurysms, and one for a dissecting/fusiform V4 segment vertebral artery aneurysm. In three cases, the presence of the inflated balloon facilitated the manipulation of the image intensifier into a position which produced a "down-the-barrel" view of the parent vessel. In the four additional cases, for anatomic reasons, this view could not be achieved and coil mass projected over the reconstructed parent vessel in both views. Partial aneurysm occlusion (75-90%), was achieved in five cases, and near complete (>95%) occlusion was achieved in two cases. Complications included two significant retroperitoneal hematomas and two brainstem infarcts, both of which resulted in hemisensory symptoms. CONCLUSION: The balloon-in-stent technique provides a practical and safe treatment strategy for the management of circumferential aneurysms that are not amenable to deconstructive embolization.
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ranking = 0.15873912820994
keywords = visual
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7/19. Thermal and tactile sensory deficits and allodynia in a nerve-injured patient: a multimodal psychophysical and functional magnetic resonance imaging study.

    OBJECTIVE: A case study was conducted to examine a patient with chronic neuropathic pain of the right foot following peripheral nerve injury and characterize associated sensory abnormalities. methods: Multimodal psychophysical examination of the patient's affected and nonaffected foot included thermal sensibility, dynamic touch, and directional sensibility. In addition, we used functional magnetic resonance imaging to study cortical representation of brush-evoked allodynia. RESULTS: Detailed psychophysical examination revealed substantial deficits in warm, cool, and tactile perception on the injured foot. These findings indicated severe dysfunction of perceptual processes mediated by A beta, A delta, and C fibers. Despite reduced tactile perception, light touch evoked a deep burning pain in the foot. Functional magnetic resonance imaging during brushing of the patient's injured foot showed that tactile allodynia led to activation of several cortical regions including secondary somatosensory cortex, anterior and posterior insular cortex, and anterior cingulate cortex. Brushing of the patient's nonaffected foot led to fewer activated regions. DISCUSSION: The profound sensory disturbances suggest a possible deafferentation type of tactile allodynia mediated by changes within the central nervous system, such as a disruption of normal tactile or thermal inhibition of nociception. The functional magnetic resonance imaging data suggest that tactile allodynia is represented in similar brain regions as experimental pain.
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8/19. Resection of parietal lobe gliomas: incidence and evolution of neurological deficits in 28 consecutive patients correlated to the location and morphological characteristics of the tumor.

    OBJECT: The goal of this study is to report the incidence and clinical evolution of neurological deficits in patients who underwent resection of gliomas confined to the parietal lobe. methods: Patient demographics, findings of serial neurological examinations, tumor location and neuroimaging characteristics, extent of resection, and surgical outcomes were tabulated by reviewing inpatient and office records, as well as all pre- and postoperative magnetic resonance (MR) images obtained in 28 consecutive patients who underwent resection of a glial neoplasm found on imaging studies to be confined to the parietal lobe. Neurological deficits were correlated with hemispheric dominance, location of the lesion within the superior or inferior parietal lobules, subcortical extension, and involvement of the postcentral gyrus. The tumors were located in the dominant hemisphere in 18 patients (64%); had a mean diameter of 39 mm (range 14-69 mm); were isolated to the superior parietal lobule in six patients (21%) and to the inferior parietal lobule in eight patients (29%); and involved both lobules in 14 patients (50%). Gross-total resection, documented by MR imaging, was achieved in 24 patients (86%). Postoperatively, nine patients (32%) experienced new neurological deficits, whereas seven (25%) had an improvement in their preoperative deficit. A correlation was noted between larger tumors and the presence of neurological deficits both before and after resection. Postoperatively higher-level (association) parietal deficits were noted only in patients with tumors involving both the superior and inferior parietal lobules in the dominant hemisphere. At the 3-month follow-up examination, five of nine new postoperative deficits had resolved. CONCLUSIONS: Neurological deterioration and improvement occur after resection of parietal lobe gliomas. parietal lobe association deficits, specifically the components of gerstmann syndrome, are mostly associated with large tumors that involve both the superior and inferior parietal lobules of the dominant hemisphere. New hemineglect or sensory extinction was not noted in any patient following resection of lesions located in the nondominant hemisphere. Nevertheless, primary parietal lobe deficits (for example, a visual field loss or cortical sensory syndrome) occurred in patients regardless of hemispheric dominance.
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ranking = 0.15873912820994
keywords = visual
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9/19. Positional nystagmus of central origin.

    Audiometric, electrophysiologic, and radiographic findings for a 68-year-old male with an "imbalance" concern are presented. This paper has a two-fold purpose: (1) to present an unusual electronystagmography case study and (2) to highlight the importance of test conditions in lesion localization. The specific disease pathophysiology remains obscure. Repeated hearing tests documented a known hearing impairment with worsening word-recognition ability of the right ear. An initial electronystagmographic exam was normal except for a mild ageotropic direction-changing positional nystagmus with eyes open and fixed. No repeatable click-evoked auditory brainstem response waveforms could be collected. A magnetic resonance imaging of the brain documents diffuse ischemic white matter disease. A repeated vestibular examination some months later supports the initial findings. The case illustrates the importance of following diagnostic protocol, of repeated measures, and of using both a visual fixation and a nonfixation condition for select electronystagmographic subtests.
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ranking = 0.15873912820994
keywords = visual
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10/19. vertigo and imbalance caused by a small lesion in the anterior insula.

    The exact location of the vestibular cortex in humans has not yet been established. Isolated lesions in the insula are exceptional. We describe a patient with recurrent episodes of vertigo and imbalance following a small lesion in the anterior insula. Myogenic and neurogenic vestibular evoked potentials were both performed using auditory stimuli. The former was recorded from the sternocleidomastoid muscle and the latter from the parietal areas on the scalp. Brainstem auditory evoked potentials, threshold latency series, pure tone audiometry and video nystagmography were also performed, as was brain MRI. All evoked potential studies and pure tone audiometry were within normal limits, ruling out peripheral and brainstem causes for the patient's symptoms. Video nystagmography revealed high slow phase velocities bilaterally with caloric stimulation, and saccadic tracking on the smooth pursuit examination. The MRI revealed a small lesion in the right anterior insula. To our knowledge this is the first reported case of vestibular symptoms and signs from a lesion in the anterior insula on MRI. In addition, its effects on the nystagmogram suggest that this area may be part of the pathway that controls smooth pursuit.
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