ABSTRACT
We report the case of a patient who underwent radiotherapy of the neck because of an epidermoid carcinoma in Rosenmuller's fossa. Eleven months later, T1-weighted brain magnetic resonance imaging (MRI) revealed a bulbo-pontine lesion, and the clinical course and sequential MRI results led to a diagnosis of radionecrosis-induced rhombencephalopathy. At a distance of more than three years, the lesion is no longer visible on MRI images but the severe neurological deficits remain. The clinical picture has not been improved by treatment with prednisone, hyperbaric oxygen, symptomatic therapies or anticoagulants.
Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Cerebellar Ataxia/etiology , Cranial Nerve Diseases/etiology , Hyperbaric Oxygenation , Paresis/etiology , Pharyngeal Neoplasms/radiotherapy , Radiation Injuries/etiology , Radiotherapy/adverse effects , Rhombencephalon/radiation effects , Adult , Anticoagulants/therapeutic use , Evoked Potentials , Heparin/therapeutic use , Humans , Magnetic Resonance Imaging , Male , Necrosis , Nystagmus, Pathologic/etiology , Pons/pathology , Pons/radiation effects , Radiation Injuries/pathology , Radiation Injuries/therapy , Rhombencephalon/pathologyABSTRACT
In patients with demyelinating retrobulbar optic neuritis (RON), a spontaneous or corticosteroid-induced improvement is generally observed within the first month, but this is clinically insignificant in 5%-7% of patients. We report the case histories of four patients who were considered to be "non-responders" to corticosteroids because their visus remained unchanged or had improved by only 1/10 after one month from intravenous corticoid therapy begun 2-7 days after disease onset, and who were therefore subsequently administered high intravenous doses of immunoglobulin. Three of these patients completely recovered in a period of 3-9 months; the fourth showed only a partial improvement, but this was consolidated after long-term continuation of the same therapy. These cases suggest the possible efficacy of early administration of intravenous immunoglobulin in RON patients who fail to respond to cortisone therapy. As recently demonstrated in animal models, it can be hypothesised that the result is due to immuno-mediated mechanisms of action that reduce autoimmune responses in the short- and medium-term, and in the long-term favour remyelination.
Subject(s)
Demyelinating Diseases/therapy , Immunoglobulins, Intravenous , Optic Neuritis/therapy , Acute Disease , Adult , Demyelinating Diseases/etiology , Female , Humans , Male , Multiple Sclerosis/complications , Optic Neuritis/etiology , Treatment Outcome , Visual AcuityABSTRACT
Peripheral neuropathy has been described in different rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus and systemic vasculitis, but usually in limited numbers of patients. Nerve injury is more frequently reported in mixed cryoglobulinemia. In earlier studies generally performed in small series of patients, prevalence of peripheral neuropathy varied widely. We evaluated prevalence of peripheral neuropathy in 33 unselected patients with mixed cryoglobulinemia (25 women, 8 men, aged from 45-71 years). Neurologic involvement was detected using a complete clinical and electrophysiologic assessment, including sensory motor conduction velocities, F wave and H reflex. Neurologic examination revealed a neuropathy in 48% of subjects, while electrophysiologic variables were altered in 82%; a percentage similar to that of subjective symptoms (91%). Among electrophysiologic investigations, F wave was altered in 22/33 subjects (67%); therefore, this variable seems to be the most reliable for the detection of neurologic involvement. Cryocrit levels were significantly higher in patients with peripheral neuropathy: abnormal examination (p less than 0.01), sensory motor conduction (p less than 0.04), and F wave alterations (p less than 0.008). In addition, hemorheological abnormalities seem to contribute to the pathogenesis of nerve injury. Our results indicate that peripheral neuropathy, to a variable degree, is present in the majority of patients with mixed cryoglobulinemia, and a complete clinical and electrophysiologic investigation can be useful for an early and correct diagnosis.
Subject(s)
Cryoglobulinemia/complications , Peripheral Nervous System Diseases/complications , Aged , Cryoglobulinemia/pathology , Cryoglobulinemia/physiopathology , Electrophysiology , Female , Humans , Male , Middle Aged , Motor Neurons/physiology , Neural Conduction/physiology , Peripheral Nerves/pathology , Peripheral Nerves/physiology , Peripheral Nervous System Diseases/epidemiology , Peripheral Nervous System Diseases/physiopathology , Prevalence , Reflex/physiologyABSTRACT
We report a case of calf hypertrophy due to a iatrogenic sciatic nerve lesion. Nerve damage may cause hypertrophy rather than the atrophy usually seen. Ephaptic transmission among nerve fibers at the point of lesion may cause the hypertrophy. The inability of the hypertrophic muscle fibers to compensate for the atrophic fibers accounts for the muscle weakness.
Subject(s)
Iatrogenic Disease , Leg/pathology , Sciatic Nerve/injuries , Adult , Female , Humans , Hypertrophy/etiology , Injections, IntramuscularABSTRACT
The study deals with the data resulting from the analysis of 3497 passive orthoclinostatic tests performed in the neurological Clinic of Pisa during the last 10 years. Blood pressure and heart rate values both in supine and upright positions have been analyzed, particularly focusing the orthostatic hypotension, which were 184 over 3497 tests. The results show that in young subjects only hypersympatheticotonic hypotension are present, due to a dysfunction of the regulating hypothalamic centres, while at more advanced age there is a prevalence of orthostatic hypotension with low differential values of heart rate. Differential values of heart rate as a function of age have been the calculated.
