Paroxismia vestibular: reporte de un caso / Vestibular paroxysmia: case report

Presentamos el caso de un paciente joven quien presenta 4 a 5 crisis diarias de vértigo espontáneo de segundos de duración, todos o casi todos los días desde hace 9 meses. Estas crisis no tienen gatillo posicional, y hay completa ausencia de sintomatologia entre crisis. Como discutimos en el artículo, este cuadro coíncide con los recientemente publicados criterios para una paroxismia vestibular, entidad supuestamente secundaria a la compresión neurovascular del nervio vestibular. El paciente respondió de forma inmediata y completa a carbamazepina a dosis bajas, el tratamiento de elección en la paroxismia vestibular.

We present the case of a young patient, with a 9-month long history of 4 to 5 daily spells of spontaneous vertigo, each lasting only seconds. There is no positional trigger, and there is a complete lack of symptoms between attacks. As is discussed in the article, this matches the recently published criteria for Vestibular Paroxysmia, an entity allegedly secondary to neurovascular compression of the vestibular nerve. The patient responded immediately and completely to carbamazepine at low dosage, the preferred treatment for vestibular paroxysmia.

Avaliação da força de preensão em ratos Wistar, normais e obesos, submetidos à natação com sobrecarga após compressão do nervo mediano / Evaluation of grip strength in normal and obese Wistar rats submitted to swimming with overload after median nerve compression

Objetivo Verificar a funcionalidade por meio da força muscular de preensão em animais com obesidade induzida por glutamato monossódico (MSG) e animais controle, que sofreram compressão do nervo mediano direito, tendo como tratamento a natação com carga. Métodos Ratos Wistar neonatos durante os primeiros cinco dias de vida receberam injeções subcutâneas de MSG. O grupo controle recebeu solução salina hiperosmótica. Quarenta e oito ratos foram divididos em seis grupos: G1(controle); G2 (controle com lesão); G3 (controle com lesão + natação); G4 (obesos); G5 (obesos com lesão); G6 (obesos com lesão + natação). Os animais dos grupos G2, G3, G5 e G6 foram submetidos à compressão do nervo mediano e os dos grupos G3 e G6 foram tratados, após a lesão, com exercício de natação com carga durante três semanas. A natação teve duração progressiva conforme as semanas, de 20, 30 e 40 minutos. A força muscular foi avaliada por meio de um medidor de força de preensão no pré-operatório, no terceiro, sétimo, 14° e 21° dia pós-operatório. Os resultados foram expressos e analisados por estatística descritiva e inferencial. Resultados Quando comparada a força de preensão entre as avaliações, indiferentemente de grupos, na segunda avaliação os animais apresentaram menor força de preensão. Os grupos G1 e G4 apresentaram força de preensão maior, em comparação com os grupos G2, G3, G4 e G6. Conclusão O exercício de natação com sobrecarga não foi eficaz em promover melhoria na força muscular de preensão após lesão de compressão do nervo mediano direito em ratos controle e obesos-MSG. .

Objective To verify the functionality through muscle grip strength in animals with obesity induced by monosodium glutamate (MSG) and in control animals, which suffered compression of the right median nerve, and treated with swimming with overload. Methods During the first five days of life, neonatal Wistar rats received subcutaneous injections of MSG. The control group received a hypertonic saline solution. Forty-eight rats were divided into six groups: G1 (control); G2 (control + injury); G3 (control + injury + swimming); G4 (obese); G5 (obese + injury); and G6 (obese + injury + swimming). The animals in groups G2, G3, G5 and G6 were submitted to compression of the median nerve and G3 and G6 groups were treated, after injury, with swimming exercise with load for three weeks. The swimming exercise had a progressive duration, according to the week, of 20, 30 and 40 min. Muscle strength was assessed using a grip strength meter preoperatively and on the 3rd, 7th, 14th and 21st days after surgery. The results were expressed and analyzed using descriptive and inferential statistics. Results When the grip strength was compared among assessments regardless of group, in the second assessment the animals exhibited lower grip strength. G1 and G4 groups had greater grip strength, compared to G2, G3, G4 and G6. Conclusion The swimming exercise with overload has not been effective in promoting improvement in muscle grip strength after compression injury of the right median nerve in control and in obese-MSG rats. .

Estudio comparativo entre dos intensidades de ultrasonido continuo en la reparación del nervio espinal lesionado por compresión / Comparative study between two intensities of continuous ultrasound in the repair of the spinal nerve injured by compression

El ultrasonido continuo fundamenta su efectividad en la energía térmica que genera, favoreciendo la reparación nerviosa. Es por esto que surge la interrogante de que si al aplicar diferentes intensidades de ultrasonido continuo sobre el nervio espinal lesionado, la respuesta reparativa será igual o distinta. Para ello se utilizaron 12 ratas de sexo masculino a las que se les aisló quirúrgicamente el nervio isquiático, el cual fue pinzado durante 45 segundos con una fuerza constante de 40N. La compresión se realizó a 10mm sobre la bifurcación, luego se desinfectó y suturó. Inmediatamente después de la operación las ratas fueron agrupadas de a 3: A) control sano, B) control lesionado, C) aplicación de ultrasonido terapéutico de 0,5w/cm2 y D) aplicación de ultrasonido terapéutico de 1w/cm2. El grupo A se utilizó como control sano y no recibió irradiación. Las ratas del grupo B fueron lesionadas y no recibieron irradiación y las del grupo C y D fueron lesionadas e irradiadas transcutáneamente en la región correspondiente al recorrido del nervio isquiático utilizando intensidades de 0,5w/cm2 y 1w/cm2, 3 MHZ de frecuencia, un cabezal de 0,5cm2, durante 1 minuto y 10 días consecutivos. 28 días post operatorio se extrajeron los nervios isquiáticos y fueron sometidos a técnicas de tinción de H-E y Van Gieson. Se realizó el diagnóstico histopatológico y la morfometría: se midió el Grosor del Perineuro, Perímetro del núcleo del Schwannocito, Perímetro del Axón Mielínicoy Perímetro de la Mielina. Los resultados revelan que el ultrasonido continuo es efectivo en la reparación del nervio espinal, siéndolo más con 1w/cm2 que con 0,5w/cm2.

The continuous ultrasound bases its efficiency on the heat energy it generates, favoring the nervous repair. Therefore, the question arises whether the reparative response will be equal or different under varying intensities of continuous ultrasound application on the disabled spinal nerve. For the study we used 12 male rats; the ischiatic nerve was surgically isolated and compressed during 45 seconds with a constant force of 40N. The compression was realized at 10 mm on the bifurcation, and was subsequently disinfected and sutured. Immediately following the operation the rats were separated in groups of 3: A) Healthy control, B) Injured control, C) Application of therapeutic ultrasound of 0.5 w/cm2 and D) Application of therapeutic ultrasound of 1 w/cm2. Group A was used as healthy control and did not receive irradiation. The rats in group B were injured and did not receive irradiation and those of groups C and D were injured and were transcutaneously irradiated in the area corresponding to the ischiatic nerve using intensities of 0.5 w/cm2 and 1 w/cm2, 3 MHZ of frequency. We used a compress of 0.5 cm2, during 1 minute and for 10 consecutive days. 28 days post operative ischiatic nerves were removed and submitted to technologies of H.E and VG stain. Histopathological and morphometrical diagnosis was realized: Thickness of the Perineurium, schwannocyte perimeter, Myelin Axon and Myelin perimeters were measured. The results revealed that the continuous ultrasound is effective in the repair of the spinal nerve, more so with 1 w/cm2 than with 0.5 w/cm 2.

Uso da corrente catódica de alta voltagem sobre a dor em compressão nervosa experimental / Use of high-voltage cathodic current for pain in experimental nerve compression

OBJETIVO: Avaliar o efeito da corrente catódica de alta voltagem sobre a dor em um modelo experimental de ciatalgia. MÉTODOS: Foram utilizados 16 ratos Wistar, machos, submetidos a um modelo de ciatalgia experimental no membro pélvico direito. Os sujeitos foram divididos em grupo simulacro (GS) e grupo tratado com corrente catódica (GP-) por 20 min diários durante 10 dias. O modelo de compressão foi realizado com amarria por fio catgut 4.0 cromado, em quatro pontos ao longo do nervo isquiático. A avaliação da nocicepção foi realizada, de forma funcional, com o tempo de elevação da pata (TEP), e à pressão, pelo limiar de retirada, via analgesímetro eletrônico. Os dados foram coletados antes do modelo de ciatalgia (AV1), três dias depois da compressão (antes, AV2, e após o tratamento, AV3), após o quinto dia de tratamento (AV4) e em seguida ao décimo dia de tratamento (AV5). RESULTADOS: Pela avaliação funcional, em ambos os grupos houve aumento da nocicepção, sem redução da mesma em qualquer momento da avaliação. À pressão, no entanto, o GS mostrou redução do limiar de retirada em todos os momentos, enquanto o GP- apresentou redução do limiar apenas inicialmente - em AV5 o limiar foi restaurado. CONCLUSÃO: Não houve alteração na nocicepção pela avaliação funcional; porém, à pressão, o tratamento com corrente catódica mostrou efeito com a somatória de terapias.

OBJECTIVE: To assess the effect of high-voltage cathodic current on pain from a sciatica experimental model. METHODS: A total of 16 male Wistar rats were submitted to the sciatica experimental model in the right hind paw. They were divided into sham group (GS) and group treated with cathodic current (GP-) for 20 min/daily, for 10 days). The model of sciatic compression was performed with a 4.0-chromic catgut thread tie in four points of the sciatic nerve. Assessment of nociception was performed by measuring the time during which the animal held its hind paw in a guarded position (THHP) and the pressure withdrawal threshold, by use of a digital electronic analgesymeter. Data collection was carried out before the sciatica experimental model (AS1), three days after compression (before, AS2, and after treatment, AS3), and five and 10 days after treatment (AS4 and AS5, respectively). RESULTS: According to the functional disability test, both groups showed an increase in nociception, with no reduction at any assessment time. Submitted to pressure, however, GS showed a reduction in the hind paw withdrawal threshold at all assessment times, while GP- showed a reduction in the hind paw withdrawal threshold only initially - at AS5, the threshold was restored. CONCLUSION: No change in nociception was observed on functional assessment; however, on pressure hind paw withdrawal assessment, the treatment with cathodic current showed to be effective with the summation of therapies.

Relationship between visual field sensitivity loss and quadrantic macular thickness measured with Stratus-Optical coherence tomography in patients with chiasmal syndrome / Correlação entre defeito de campo visual e espessura macular quadrântica avaliada através da tomografia de coerência óptica em pacientes com compressão quiasmática

PURPOSE: To correlate visual field sensitivity (VFS) loss on standard automated perimetry (SAP) and quadrantic macular thickness on optical coherence tomography (OCT) in patients with permanent temporal hemianopia from chiasmal compression. METHODS: Forty eyes from 40 patients with chiasmal compression and 40 healthy eyes were submitted to standard automated perimetry and Stratus-OCT scanning. Raw data of the fast macular thickness scanning protocol were exported and macular thickness measurements were recorded and averaged for each quadrant and half of the central area. The correlation between visual field sensitivity loss and optical coherence tomography measurements was tested with Pearson's correlation coefficients and with linear regression analysis. RESULTS: A significant association was found between each macular thickness parameter and the corresponding central VF mean sensitivity. The strongest association was observed between superonasal macular thickness and the inferotemporal mean defect measured both in decibel (R=0.47; p=0.001) and in 1/Lambert (R=0.59; p<0.0001) units. CONCLUSION: Stratus-OCT-measured macular thickness was topographically related with visual field sensitivity loss in patients with temporal hemianopia from chiasmal compression. Such measurements could prove clinically useful in the diagnosis and follow-up of patients with chiasmal compression. ClinicalTrial.gov identifier number: NCT0039122.

OBJETIVO: Avaliar a correlação entre o defeito de campo visual ao exame de perimetria computadorizada e a espessura macular quadrântica ao exame de tomografia de coerência óptica (OCT) em pacientes com hemianopsia temporal permanente causada por compressão quiasmática. MÉTODOS: Quarenta olhos de 40 pacientes com compressão quiasmática e 40 olhos de 40 indivíduos controles foram submetidos aos exames de perimetria computadorizada e tomografia de coerência óptica. Dados não processados foram exportados e as medidas de espessura macular foram calculadas para cada quadrante e metade da área macular central. A correlação entre o defeito campimétrico e as medidas de espessura macular foi avaliada por coeficiente de correlação de Pearson e por análise de regressão linear. RESULTADOS: Associação significante foi encontrada entre os parâmetros de espessura macular e seus respectivos defeitos campimétricos. A correlação mais forte foi encontrada entre o parâmetro espessura macular nasal superior e o defeito campimétrico médio temporal inferior medido em decibel (R=0,47; p=0,001) e em 1/Lambert (R=0,59; p<0,0001). CONCLUSÃO: Medidas de espessura macular avaliada através da tomografia de coerência óptica foi topograficamente relacionada ao defeito campimétrico em pacientes com hemianopsia temporal por compressão quiasmática. Estas medidas podem provar a importância clínica no diagnóstico e seguimento dos pacientes com compressão quiasmática. ClinicalTrial.gov identifier number: NCT0039122.

Treatment of atypical trigeminal neuralgia with microvascular decompression.

AIM: To explore the methods for achieving pain relief in patients with atypical trigeminal neuralgia (TN) using microvascular decompression (MVD). STUDY DESIGN AND SETTINGS: Retrospective study of 26 patients treated during the years 2000 to 2004. MATERIALS AND METHODS: Twenty-six patients in whom vascular compression of the trigeminal nerve was identified by high definition magnetic resonance tomographic angiography (MRTA) were treated with MVD for atypical TN in our department. Clinical presentations, surgical findings and clinical outcomes were analyzed retrospectively. RESULTS: In this study, single trigeminal division was involved in only 2 patients (8%) and two or three divisions in the other 24 patients (92%). Of prime importance is the fact that in 46.2% of the patients, several conflicting vessels were found in association. Location of the conflicts around the circumference of the trigeminal root was supero-medial to the root in 53.5%, supero-lateral in 30.8% and inferior in 15.7%. MVD for atypical TN resulted in complete pain relief in 50% of the patients with complete decompression, partial pain relief in 30.8% and poor pain relief or pain recurrence in 19.2% of the patients without complete decompression postoperatively. CONCLUSIONS: Complete decompression of the entire trigeminal root plays an important role in achieving pain relief in patients with atypical TN with MVD.

Atrapamiento del nervio pudendo: un síndrome por conocer / Pudendal nerve entrapment syndrome

El atrapamiento del nervio pudendo comprende un síndrome descrito por primera vez en 1987. Entre los múltiples motivos de consulta se encuentra principalmente el dolor perineal y/o pelviano, lo que puede asociarse a disfunción urinaria, anal e incluso sexual. Las tres ramas terminales poseen en diferente proporción fibras motoras, sensitivas y autonómicas. Por ello su atrapamiento puede causar signos y síntomas de expresión en cualquiera de los tres ámbitos. En total se estima que el 30 por ciento es autonómico y el 70 por ciento es somático (50 por ciento sensitivo y 20 por ciento motor). El dolor es la causa más común de consulta. Clásicamente se describe como perineal, que se agrava al sentarse, disminuye o desaparece al estar de pie, habitualmente ausente al acostarse, y no compromete el sueño. Para su diagnóstico se utiliza la certificación de 2 criterios mayores o 1 criterio mayor asociado a 2 criterios menores. El mejor esquema de tratamiento es secuencial y comprende las siguientes etapas: etapa 1 o de autocuidado, etapa 2 o de inyecciones perineurales y etapa 3 o cirugía de descompresión del nervio pudendo.

role of MRI in the diagnosis of vertebrobasilar dolicoectasia

Aging changes especially when it is associated with hypertension and arteriosclerosis may lead to elongation, dilatation and so tortuosity of the involved arteries. The clinical effect of this is either pressure symptoms or ischemic events. This phenomenon is called Dolicoectasia. It is defined as fusiform dilatation and elongation of an artery. The process can involve vertebral, basilar, posterior or anterior inferior cerebellar or labyrinthine arteries, The Vertebrobasilar system is more commonly involved by this process. The clinical presentations are non specific and could be related to wide range of pathological vascular and non vascular causes. The aim of the study was to demonstrate different MRI and MRA patterns of The vertebrobasilar Dolicoectasia as a respectable cause for neurological symptoms and signs including nerve palsies and posterior fossa infarctions. One hundred patient with neurological symptoms related to the portrait of the vertebrobasilar system were evaluated with MRI and MRA. Patients were referred from the outpatient clinics with retrolabyrinthine Hearing deficit, pulsatile tinnitus. facial spasm, trigeminal neuralgia or vertebrobasilar stroke features. The average age was 59 years with a standard deviation of 12 years. The females represent one third of cases while the males were two thirds. The most common presentation was vertebrobasilar insufficiency [VBI] in thirty percent, followed by facial spasm and pulsatile tinnitus in twenty three percent, trigeminal neuralgia in twenty one percent, cerebellar infarctions in seventeen percent and brain stem stroke in nine percent. Basilar and vertebral arteries were more commonly involved, while Labyrinthine artery was the least involved vessel The commonly missed vertebrobasilar Dolicoectasia should be considered as a respectable cause for neurological symptoms and signs including nerve palsies and posterior fossa infarctions. MRI and MRA are the modalities of choice to demonstrate the wide range of vascular changes occurred with Dolicoectasia and also their effect as nerve compression or vascular occlusions by embolization or thrombosis. The most common nerves to be involved is the trigeminal, acoustic and facial ones. If the radiologist does not consider this pathological entity as a cause for cranial nerve compression palsy, false negative results could occur. Vertebrobasilar Dolicoectasia [VBD] is considered uncommon, but this consideration should be changed in searching for causes of posterior fossa neurological symptoms especially in nerve compression or strokes

Bilateral Suprascapular Nerve Entrapment

Bilateral suprascapular nerve entrapment syndrome is very rare. It presents with shoulder pain, weakness and atrophy of the supraspinatus and infraspinatus muscles. We present a twenty-year old man having a history of bilateral shoulder pain associated with weakness. Electromyographic studies revealed signs of a lesion that caused a neupraxic state of the left suprascapular nerve, moderate axonal loss of the right suprascapular nerve and denervation of the right suprascapular muscle. The patient was treated with physical and medical therapy. Due to worsening of the symptoms, a surgical operation was performed by the excision of the transverse scapular ligaments bilaterally. His pain, weakness and atrophy had diminished on examination six weeks later. Suprascapular nerve entrapment should be considered in patients with shoulder pain, particularly those with weakness and atrophy of the supraspinatus and infraspinatus muscles.

El síndrome de la cola de caballo asociado con anestesia regional subaracnoidea / Cauda equina syndrome associated with subarachnoid regional anesthesia

El síndrome de la cola de caballo comprende un grupo de síntomas y signos localizados en zonas inervadas por la porción terminal de la médula espinal, afectando principalmente las raíces nerviosas que emergen del cono terminal (L2 a S5). Las manifestaciones neurológicas pueden ser transitorias o definitivas y raramente son secundarias a una punción lumbar traumática. Más frecuentemente se presentan como consecuencia de la inyección de una solución anestésica local concentrada en el espacio subaracnoideo y/o de la mala distribución que ella sufre en un espacio estrecho como es el fondo de saco dural, en el cual las raíces nerviosas de la cola de caballo están desprovistas de duramadre. El cuadro se ha vinculado, sobre todo, con la utilización de catéteres finos multiperforados para realizar anestesia subaracnoidea continua.

Síndrome de silla de montar (cauda equina) posterior a anestesia peridural contínua / The cauda aquina syndrome: a clinical, pathological and immunohistochemical study

Se comunican dos casos de pacientes con síndrome de silla de montar, posterior a anestesia peridural continua. Uno de ellos es un caso consecutivo de resección transureteral de la próstata (RTU) y el otro consecutivo a RTU papiloma vesical y hernioplastia inguinal. La técnica de anestesia raquídea o peridural continua se ha usado desde hace muchos años. El síndrome de silla de montar se ha comunicado en la literatura como una complicación de la anestesia raquídea. Los casos aquí comunicados posiblemente sean los dos primeros que se informan con este síndrome, utilizándose anestesia peridural continua

Neuralgia vago-glossofaringea sintomática: relato de dois casos / Symptomatic vagus-glossopharyngeal neuralgia: report of 2 cases

Descrevem-se dois casos de neuralgia vago-glossofaringea por compressäo neurovascular. O caso n§ 1, apresentou episódios de assistolia cardíaca e hipotensäo arterial sistêmica transitórias, em uma paciente de 43 anos, que possuía um ramo da artéria cerebelar póstero-inferior D situado entre os nervos glossofaríngeo e vago. O caso n§ 2, tem associado um síndrome de pré-excitaçäo cardíaca do tipo Lown-Ganong-Levine, em uma paciente de 58 anos, portadora de aderências unindo a artéria cerebelar póstero-inferior E e os nervos glossofaríngeo e vago. Ambos os casos caracterizam-se como neuralgias sintomáticas e como tal merecem ser relatados