ABSTRACT
Brachial plexus injury is a rare complication of the fractured clavicle. The authors describe the second reported case of brachial plexus injury due to secondary fracture displacement. This case emphasizes the following points: the neurologic status of the arm after a fracture of the clavicle must be documented; fractures of the middle one-third of the clavicle are prone to displacement; patients should be advised to report immediately any new symptoms in the arm; when fracture displacement is the cause of brachial-plexus compression then a trial of conservative therapy is indicated; the prognosis for neurologic recovery after this injury is good.
Subject(s)
Brachial Plexus/injuries , Clavicle/injuries , Shoulder Fractures/complications , Clavicle/diagnostic imaging , Fractures, Closed/complications , Fractures, Closed/diagnostic imaging , Humans , Male , Middle Aged , Radiography , Shoulder Fractures/diagnostic imagingABSTRACT
A 60 year old white male presented with atypical chest pain and exercise-induced myalgia. Physical examination revealed slight proximal limb muscle weakness and wasting. Serum creatine phosphokinase levels were persistently elevated and electromyography showed changes consistent with a mild myopathy. Light microscopic and ultrastructural study revealed excess free glycogen within skeletal muscle, and histochemical staining showed absence of myophosphorylase activity. Biochemical quantitation confirmed the diagnosis of McArdle's disease by demonstrating absent phosphorylase activity in skeletal muscle with increased glycogen. In addition, increased amounts of free and membrane-bound glycogen were found within axons, Schwann cells, fibroblasts and occasional vascular smooth muscle and endothelial cells that had been included within the skeletal muscle biopsy. This case demonstrates more widespread glycogen accumulation than has been previously reported in McArdle's disease.
Subject(s)
Blood Vessels/pathology , Glycogen Storage Disease Type V/pathology , Peripheral Nerves/pathology , Phosphorylases/deficiency , Biopsy , Blood Vessels/metabolism , Glycogen/metabolism , Glycogen Storage Disease Type V/genetics , Glycogen Storage Disease Type V/metabolism , Histocytochemistry , Humans , Male , Microscopy, Electron , Middle Aged , Muscles/metabolism , Peripheral Nerves/metabolismABSTRACT
Sixty-six patients with ulnar nerve entrapment at the elbow underwent neurolysis and the application of a Silastic envelope in an attempt to prevent postoperative scarring and recurrence of symptoms. All patients were evaluated pre- and postoperatively using a numerical scoring system that included clinical, motor, and sensory evaluation as well as nerve conduction studies. The Silastic material was well tolerated in the 70 cases. The overall 66% score improvement was more closely related to clinical relief (64%) than to improvement in motor conduction velocities (45%). Our 10-year experience indicates that ulnar neurolysis with Silastic envelope interposition is a safe surgical method of treatment for ulnar nerve entrapment at the elbow.
Subject(s)
Nerve Compression Syndromes/surgery , Ulnar Nerve/surgery , Adult , Aged , Elbow/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Nerve Compression Syndromes/physiopathology , Neural Conduction , Postoperative Complications/prevention & control , Recurrence , Retrospective Studies , Silicone ElastomersABSTRACT
Radial compression neuropathy developed in four patients with advanced Parkinson's disease. Electrodiagnostic studies in two patients documented the upper middle part of the arm as the site of nerve injury. The conditions of three patients improved over four months. One markedly disabled, bradykinetic patient had a permanent flexion deformity of the wrist and hand. Radial compression neuropathy may be an initiating factor in the development of hand deformities in patients with late-stage parkinsonism.
Subject(s)
Nerve Compression Syndromes/etiology , Parkinson Disease/etiology , Radial Nerve , Aged , Female , Humans , Male , Middle AgedABSTRACT
A young adult with lupus anticoagulant and systemic lupus erythematosus had onset of multiple transient ischemic attacks four years after a major left hemispheric infarct. The symptoms were stereotyped, recurred several times daily over three years and ceased when aspirin was added to steroid therapy. It is speculated that her symptoms were due to recurrent embolism from the heart in the presence of a thrombotic state.
Subject(s)
Endocarditis/complications , Ischemic Attack, Transient/etiology , Lupus Erythematosus, Systemic/complications , Adult , Aspirin/therapeutic use , Cerebrovascular Disorders/etiology , Female , Humans , Ischemic Attack, Transient/prevention & control , Prednisone/therapeutic use , Thromboembolism/complicationsABSTRACT
Metoclopramide hydrochloride is now commonly prescribed for a variety of gastrointestinal disorders. Over a 2-year period 18 patients with neurologic disorders induced by metoclopramide were assessed at the Parkinson's disease clinic of the Ottawa Civic Hospital. During metoclopramide therapy acute transient dystonic reactions were seen in 4 patients, and parkinsonism, which was frequently misdiagnosed and treated as classic Parkinson's disease, was seen in 12 patients. After treatment with metoclopramide was stopped, tardive dyskinesia appeared in seven patients and has persisted for up to 15 months in three patients. Parkinsonism and tardive dyskinesia occurred in older patients undergoing long-term therapy with metoclopramide. This experience, therefore, suggests that such treatment, especially in older patients, should be avoided.
