ABSTRACT
BACKGROUND: Carpal tunnel syndrome (CTS) is defined by symptoms associated with damage to the median nerve within the carpal tunnel. Abnormal sensation in the median nerve territory is one of the primary clinical diagnostic criteria for CTS. However, extramedian sensory abnormalities in CTS are common. The purpose of this study was to identify the clinical significance of the paresthesia distribution in CTS. METHODS: This was a cross-sectional retrospective study involving patients with CTS diagnosed based on the American Academy of Neurology criteria between January 2009 and January 2011. In total, 109 hands of 57 enrolled patients were analyzed. The participants were divided into two groups according to the distribution of sensory abnormalities: (1) sensory symptoms confined to the median nerve distribution (median group), and (2) sensory symptoms distributed diffusely over the entire hand (glove group). Clinical features and electrophysiological findings were investigated by thorough chart reviews. RESULTS: Forty-seven (43.1%) hands belonged to the glove group. The frequency of sensory abnormalities and motor weakness was higher in the median group (38.7 vs 9.7%) than in the glove group (12.8% vs. 0.0%) on neurological examination. The conduction velocities of sensory nerves of the wrist and finger were significantly slower in the median group than in the glove group. CONCLUSIONS: Evaluation of the sensory symptom distribution in CTS may predict the degree of nerve damage, with sensory abnormality restricted to the median nerve distribution reflecting more severe nerve damage in CTS.
Subject(s)
Humans , Carpal Tunnel Syndrome , Fingers , Hand , Median Nerve , Neurologic Examination , Neurology , Paresthesia , Retrospective Studies , Sensation , WristABSTRACT
No abstract available.
Subject(s)
Frontotemporal Dementia , Serotonin , Supranuclear Palsy, ProgressiveABSTRACT
BACKGROUND AND OBJECTIVES: Although several methods of repositioning maneuver have been introduced for the benign paroxysmal positional vertigo involving horizontal canal (HC-BPPV), no study has investigated the nystagmus pattern during the repositioning maneuver and its correlation with the repositioning results. Therefore, we evaluated the predictive value of the nystagmus for successful repositioning by studying the nystagmus pattern during the position of the Gufoni's maneuver. MATERIALS AND METHODS: Seventeen consecutive patients (age range=36~76 years, median age=64), with a diagnosis of HC-BPPV were recruited between July and August 2010. The Gufoni's maneuver for apogeotropic and geotropic nystagmus was performed. After 30 minutes, the treatment outcome was evaluated according to the nystagmus pattern at the individual stage of Gufoni's maneuver. Successful treatment was defined by the resolution of positional vertigo in geotropic HC-BPPV and nystagmus shifted from apogeotropic to geotropic in apogeotropic HC-BPPV. RESULTS: In the successfully treated patients, 4 of 6 patients had the contralesional nystagmus between 1st and 2nd position of Gufoni's maneuver. Ipsilesional nystagmus in 1st position of Gufoni's maneuver was observed in 1 patient with apogeotropic nystagmus. And the other 1 patient with Geotropic HC-BPPV showed no nystagmus in 2nd position after contralesional nystagmus in 1st position of Gufoni's maneuver. Unsuccessfully treated 11 patients had a conversion of nystagmus direction in 2nd position after 1st step. CONCLUSION: During the 2nd position of the Gufoni's maneuver, a nystagmus toward unaffected side predicts a successful repositioning, whereas reversed nystagmus is suggestive of poor response to repositioning.