Cervical Spondylotic Myelopathy Presenting as Peripheral Nerve Disease: A Case Report.

Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in the elderly population. It is a degenerative disease that classically presents with fine motor dysfunction of the hands and gait instability. These symptoms can easily be masked by old age, complex medical history, and more benign diseases. We describe the case of a 67-year-old male who was referred to orthopedic surgery for bilateral hand numbness and weakness attributed to carpal tunnel syndrome (CTS). The patient had trouble ambulating, rhythmic clonus in his ankles, and a bilateral positive Hoffman sign resulting in a referral to neurosurgery for an emergent spinal cord decompression. To our knowledge, few case reports exist demonstrating how cervical myelopathy can mimic more benign peripheral nerve diseases such as CTS. We describe how difficult early recognition can be, as well as the importance of primary care doctors maintaining a high degree of suspicion for a disease that has nonspecific examination findings and can easily mimic more benign processes.

Chylous Ascites Developing Into Bilateral Chylothorax in High-Grade Lymphoma: A Case Report.

Chylothorax and chylous ascites occur when lymphatic fluid accumulates in the pleural space or peritoneum, respectively. They are classified as either traumatic or non-traumatic, and lymphomas are the most common non-traumatic cause. Lymphomas can obstruct the lymphatic architecture causing lipid-rich chyle to leak out below the level of the obstructing mass. Bilateral chylothoraces presenting in the presence of chylous ascites, secondary to Non-Hodgkin Lymphoma, are rare. We describe a case of a 55-year-old man with recurring large-volume chylous ascites secondary to Non-Hodgkin lymphoma who developed bilateral chylothoraces. Initially, he presented with dyspnea and hypoxia and was found to have bilateral pleural effusions, requiring bilateral thoracentesis for diagnostic and therapeutic management. The fluid removed from the pleural space was found to be lymphatic fluid, and the patient was eventually discharged home with instructions to follow up with oncology for further management. The case reveals a temporal relationship where a huge volume of chylous ascites develops into a chylothorax.

Immature olfactory sensory neurons provide behaviourally relevant sensory input to the olfactory bulb.

Postnatal neurogenesis provides an opportunity to understand how newborn neurons integrate into circuits to restore function. Newborn olfactory sensory neurons (OSNs) wire into highly organized olfactory bulb (OB) circuits throughout life, enabling lifelong plasticity and regeneration. Immature OSNs form functional synapses capable of evoking firing in OB projection neurons but what contribution, if any, they make to odor processing is unknown. Here, we show that immature OSNs provide odor input to the mouse OB, where they form monosynaptic connections with excitatory neurons. Importantly, immature OSNs respond as selectively to odorants as mature OSNs and exhibit graded responses across a wider range of odorant concentrations than mature OSNs, suggesting that immature and mature OSNs provide distinct odor input streams. Furthermore, mice can successfully perform odor detection and discrimination tasks using sensory input from immature OSNs alone. Together, our findings suggest that immature OSNs play a previously unappreciated role in olfactory-guided behavior.

Chronic Exertional Compartment Syndrome of the Hand With Simultaneous Carpal Tunnel Syndrome and Ulnar Nerve Neuropathy: A Clinical Case Report.

Chronic exertional compartment syndrome is a reversible form of compartment syndrome that occurs with exertion and is relieved with rest. Chronic exertional compartment syndrome most commonly occurs in the lower leg and has only rarely been reported in the hand. We report a case of exertional compartment syndrome in the left hand of a 37-year-old male heavy equipment technician with concurrent carpal tunnel syndrome and ulnar neuropathy. Physical examination showed non-exertional numbness and tingling in all five digits while at rest with a reproducible Tinel's test over the carpal tunnel and Guyon's canal. Acute swelling and hand muscle weakness appeared after repetitive pinch and usage of the thenar and intrinsic musculature with acute sensory and motor changes in the ulnar nerve distribution. Elective fasciotomies were performed in the first dorsal interosseous and thenar compartments with concomitant release of the carpal tunnel and ulnar nerve at the wrist. The patient exhibited a full recovery from symptoms with no residual functional deficits. Although rare, patients that perform repetitive hand motions can develop chronic exertional compartment syndrome. To our knowledge, this is the first reported case of chronic exertional compartment syndrome in the hand that occurred with chronic overuse neuropathies and an acute ulnar neuropathy with intrinsic hand muscle weakness at the same time. It is important for providers to conduct a thorough history and physical examination to differentiate multiple hand pathologies that may present simultaneously.