Concomitant trigeminal involvement in Bell's palsy

Fifty patients [25 males and 25 females] with acute unilateral Bell's palsy were included in this study. Their average age was 36.3 years. Facial pains in the paretic side was experienced by 15 [30%] of the cases. Clinical evidence of trigeminal dysfunction on the paretic side was encountered in 24% of the cases. The facial latency of the contralateral side was prolonged in 8% of the patients [subclinical facial palsy]. Abnormal blink reflex pattern indicative of trigeminal nerve dysfunction was demonstrated in 36% of the patients [i.e. prolonged contralateral late response]. The results of this study drew the attention to the fact that Bell's palsy is a manifestation of polyneuritis cranialis and as well to the important role of blink reflex as a simple non invasive electrodiagnostic method to detect any dysfunction along trigemino-facial reflex arc

Role of scalenotomy in the management of thoracic outlet compression syndrome

Twenty patients suffering from manifestations of thoracic outlet compression were selected from a larger group, on the basis that they are not having any generalized disease that causes nerve lesions, and with radiological evidence of the absence of cervical ribs or any cervical vertebral region disease. Clinical evaluation and electro- conductivity studies revealed proximal compression. There was an associated distal compression of the median nerve in the carpal tunnel in 33.8% of limbs studied. The disease was bilateral in four patients. 80% of cases were females. Presentation by vascular manifestations was noticed in 40% of the patients. Scalenotomy and release of carpal tunnel were done in associated lesions in the same sitting. Scalenotomy alone was done to all other cases. Results were satisfactory and no remarkable complications were detected. Electrophysiological evaluation of the median and ulnar nerves, both proximally and distally, is of great help in both diagnosis and follow up of patients after surgery

Ulnar nerve entrapment at and distal to wrist: Clinical, electrophysiological and operative study

This study included 15 patients [7 females and 8 males]. Their mean age was 37.7 years. All cases demonstrated sensory and motor deficits. The clinical evidences of deep palmar entrapment was present in 5 cases. Electrophysiologically, prolongation of distal motor latency to first dorsal interosseous muscle was detected in 5 cases, i.e. latency ranged from 5.8 ms tp 6.7 ms with a mean of 6.1 ms. In 10 cases, there was a prolongation of distal motor latency to abductor digit i.e. the latency ranged from 3.9 ms to 8 ms with a mean of 4.6 ms. All cases demonstrated electromyographic changes. Exploration reveals the presence of ganglion in 7 cases, fibrosis around ulnar nerve trunk in 2 cases and in 6 cases no specific pathology was detected. Follow-up showed complete recovery in 10 cases and partial improvement was obtained in 5 cases

Thoracic outlet syndrome [TOS]: Clinical, radiological and electrophysiological study

This study included 28 patients with the clinical evidences suggestive of TOS. The age of patients ranged from 17 years to 42 years. Males constitutes 46.4% of the cases. All cases demonstrated sensorimotor deficits with predominance of the sensory manifestations. Radiological evidences of bony cervical rib were encountered in eight cases and in two of them, there is bilaterality. All cases, demonstrated significant prolongation of the averaged F. loop latency [Av FLL] of the ulnar nerve. In 15 patients, the shortest axillary F. loop latency [Ax FLL] of the ulnar N was normal, meanwhile the Av FLL was significantly prolonged. A positive correlation between median Av FLL and that of ulnar in all cases, there is significant reduction of ulnar evoked compound action potentials [ulnar CAP]. Abnormal electromyographic changes were detected in 42.8% of the cases

Peripheral neurological changes in chronic obstructive pulmonary diseases: Clinical and electrophysiological studies

Twenty five patients with COPD with mean age of 55.4 +/- 8.7 years have been investigated with pulmonary function tests [PFT], arterial blood gases [ABG], serum electrolytes [Na, K, Ca++], neurological examination and electrophysiological studies. Symptoms of neuropathy were present in 36% of the patients, while clinical signs were found only in 20%. Orthodromic distal sensory latency was prolonged in 44% of cases with lowering of amplitude of the evoked sensory action potential. Abnormalities of the sensory nerve conduction were the most common and affecting mainly the sural nerve. Motor conduction velocity was abnormal in 16% of cases. Sixteen percent of COPD patients exhibited impairment of both sensory and motor functions. Abnormal electromyographic [EMG] findings were detected in 11 cases [44%]. The EMG changes were abnormal resting potential, incomplete interference pattern and polyphase motor unit. These denoted the existence of both myelinopathic and axonopathic changes. Comparative study of COPD patients with neurological impairment [group I] versus COPD patients without such defect [group II] regarding PFT, ABG and serum electrolytes revealed insignificant difference in PFT and serum electrolytes between both groups. However, patients of group I were more hypoxemic and hypercapnic than group II patients and the difference in PaO2 and PaCO2 were statistically significant [P <0.01]. It was concluded that peripheral neuropathy is not uncommon finding in COPD and it seems possible that severe derangement in ABG in form of hypoxemia and hypercapnia are responsible for the encountered neurological abnormalities

Shoulder pain in hemiplegia: a clinical experience with 102 patients

Shoulder pain is a frequent complication of hemiplegia. In this series, 102 hemiplegic patients were regularly followed up after their cerebrovascular accident for a period up to 12 months. They were 60 males and 42 females with a mean age 54 years. Evaluation of the shoulders of the patients was done before starting the rehabilitation programme. Distinction was made between flaccid and spastic hemiplegia. In this study, 62.7% of the patients had shoulder pain, more commonly encountered in those with spasticity [84.4%]. Soft tissue inflammation was present in 48.4% and reflex sympathetic dystrophy in 17.1% of the cases more in those with spasticity. Subluxation was demonstrated in 17.1% and associated of more than one local problem was encountred in 17.1% of the cases with painful shoulder. There was a significant correlation of shoulder pain and the degree of spasticity and the age of the patients

Electrophysiology of peripheral nerves in patients with multiple sclerosis [MS]

Twenty clinically confirmed MS patients were studied clinically and electrophysiologically. Out of these cases 6 [30%] patients demonstrated clinical evidences of peripheral neuropathy. Sensory deficits were present in all casses with neuropathy and peripheral motor deficits were present in 4 [66.6%] cases of them. Electrophysiologically cases with clinical neuropathy showed a significant sensory and motor conduction delay along forearm and leg segments

Axillary F central latency [AFCL] in carpal tunnel syndrome [CTS]: a method to disguise double crush syndrome

The proximal and distal segments of the median nerve were studied in control subjects and in patients with carpal tunnel syndrome [CTS] using the technique of axillary F central latency [AFCL] together with the conventional motor conduction studies. Among 120 patients with definite CTS, there was a significant delay over the proximal segment in 22 patients [18.3%], the forearm median motor conduction was delayed in only 12 patients [10%]. In 7 cases out of the latter there was a delay of AFCL. This study proved that the technique of AFCL is a useful measure to identify a concomitant proximal nerve entrapment in patients with distal median nerve entrapment due to CTS [the presence of a double crush syndrome

Carpal tunnel syndrome: clinical and distal latency [DML] correlation

Previous studies have determined contradictory views on the correlation between the clinical severity of carpal tunnel syndrome and its electrophysiological results. The aim of this work is to study the correlation between the clinical severity of the CTS and the distal motor latency [DML] abnormality at the wrist. Forty four female patients [88 hands] with CTS were the material of this work; the clinical severity was graded from 1 to 7. The DML was measured in milliseconds using a Tonnies electromyography. The results of this study revealed the presence of significant differences among the mean DML of the distinct clinical grades [F equals 10.66]. However, further analysis showed no significant differences among cases with CTS clinically graded from 1 to 5, yet cases clinically graded 6 and 7 had a significant higher mean DML than other clinical grades. The relation between clinical grading and the mean DML was found to be curvilinear