ABSTRACT
We describe a 90-year-old woman with right upper limb monoparesis secondary to varicella zoster virus infection as a result of extensive inflammatory involvement of the entire brachial plexus at root level. To our knowledge, this is the first report of entire brachial plexus involvement in a living patient of such advanced age. Despite a delay in presentation and thus initiation of treatment, a favourable clinical response was observed.
Subject(s)
Brachial Plexus/physiopathology , Herpes Zoster/complications , Herpesvirus 3, Human , Paresis/virology , Aged, 80 and over , Female , Herpes Zoster/physiopathology , Humans , Upper Extremity/physiopathologySubject(s)
Abdomen/surgery , Anesthesia, Epidural/adverse effects , Anesthesia, General/adverse effects , Leg , Paresis/etiology , Aged , Analgesia, Epidural/adverse effects , Analgesics, Opioid/adverse effects , Anesthetics, Local/adverse effects , Bupivacaine/adverse effects , Fentanyl/adverse effects , Humans , MaleABSTRACT
Fifty patients underwent superficial temporal lobectomy for intractable temporal lobe epilepsy. Total cure rate was 52%, and significant improvement was achieved in 88%. Cytoarchitectural changes in gray and white tissue were analyzed under light microscopy. Neuronal dysgenesis was correlated with the duration of seizure disorder, age of onset, and other etiologic factors, and with clinical outcome. Temporal lobes from 33 neurologically normal autopsy brains which were age- and sex-matched with patients were examined as controls. Severe neuronal ectopia (greater than 8 neurons/2 mm2 white matter) was present in 42% of patients with epilepsy and in none of controls. There was neuronal clustering in 28% of those with epilepsy, and Chaslin's (subpial) gliosis in 38%. Controls did not have these changes. The presence of severe neuronal ectopia and clustering was predictive of a favorable clinical outcome following surgery (p less than 0.05). No correlation was found between microdysgenesis and other factors. These findings suggest that the presence of neuronal dysgenesis may be of significance in the clinical outcome following surgery, and that the abnormal tissue may be important as a morphologic substrate for seizures in some patients.
Subject(s)
Epilepsy, Temporal Lobe/pathology , Temporal Lobe/pathology , Adolescent , Adult , Child , Epilepsy, Temporal Lobe/etiology , Epilepsy, Temporal Lobe/surgery , Female , Humans , Male , Middle Aged , Neurons/pathology , Reference Values , Temporal Lobe/surgeryABSTRACT
Esophageal function in 20 subjects with diabetes mellitus was assessed using esophageal manometry, 24-hr ambulatory esophageal pH monitoring, and esophageal scintigraphy. Seven patients had abnormal esophageal manometric studies, and this abnormality was significantly associated with peripheral neuropathy. Almost half of the subjects studied demonstrated excessive gastroesophageal acid reflux, but there was no correlation between the likelihood of abnormal reflux and the presence of peripheral neuropathy. Esophageal scintigraphy was relatively insensitive in the detection of abnormal esophageal function in diabetics.
Subject(s)
Diabetes Mellitus/physiopathology , Esophagus/physiopathology , Gastroesophageal Reflux/physiopathology , Peripheral Nervous System Diseases/physiopathology , Adult , Aged , Diabetes Complications , Esophagus/diagnostic imaging , Female , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/diagnostic imaging , Humans , Hydrogen-Ion Concentration , Male , Manometry , Middle Aged , Peripheral Nervous System Diseases/complications , Radionuclide ImagingABSTRACT
Thirty-four patients with intractable temporal lobe epilepsy underwent preoperative and perioperative EEG activation with methohexitone sodium. Subsequently, all patients underwent anterior temporal lobectomy with deep structure preservation. Preoperative spike localisation with methohexitone was concordant with peroperative recording in most cases. Large doses of methohexitone were administered to two patients, rendering the EEG almost isoelectric. Areas of abnormal spiking activity were refractory to the effects of methohexitone, and recovery was marked by an increase in spike frequency. Postoperative clinical evaluation confirmed the specificity of methohexitone for abnormally epileptogenic tissue.
Subject(s)
Epilepsy, Temporal Lobe/diagnosis , Methohexital , Electroencephalography , Epilepsy, Temporal Lobe/surgery , Humans , Intraoperative Care/methods , Monitoring, Physiologic/methods , Temporal Lobe/surgerySubject(s)
Epilepsy, Temporal Lobe/surgery , Psychosurgery , Temporal Lobe/surgery , Adolescent , Adult , Child , Electroencephalography , Female , Humans , Male , Middle AgedABSTRACT
Three patients are presented, each showing clinical and electrophysiological findings indicative of the anterior spinal artery syndrome: sudden onset of nonprogressive weakness and spasticity of one or both legs, associated in one patient with pain and in all three patients with selective impairment of temperature sensation, radiological evidence of aortic calcification, normal sensory and motor conduction velocities and normal amplitude of sensory potentials, but diminished amplitude of evoked motor responses. Electromyography showed widespread fibrillation in muscles of the leg in two patients and evidence of marked loss of motor units in all three patients.
