ABSTRACT
We analyzed 27 sciatic nerve injuries associated with total hip arthroplasty (THA). The patients were 23 women and 4 men, and their median age was 55 years (range, 28-75 years). In 1987 to 1995, 4,339 THAs were performed. Primary arthroplasties accounted for 3,471 and 868 were revisions. Nine patients had developmental dysplasia of the hip. Six operations were revisions. Radiologic lengthening was median 1.4 cm (range, -1 to 4.1 cm); in 8 cases, lengthening was greater than 2 cm. The median follow-up period was 58 months (range, 24-110 months). Eight patients recovered fully, the recovery of 7 patients was fair, and 12 patients had a considerable permanent disability. The risk of nerve injury was not related to the extent of lengthening. The recovery of the nerve injury was only weakly correlated to its primary postoperative extent. The sciatic nerve injury rate was 0.6%.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Peripheral Nervous System Diseases/physiopathology , Sciatic Nerve/injuries , Female , Follow-Up Studies , Humans , Intraoperative Complications/epidemiology , Male , Middle Aged , Peripheral Nervous System Diseases/epidemiology , Peripheral Nervous System Diseases/etiology , Sciatic Nerve/physiopathology , Time FactorsABSTRACT
We report the case of a patient with concomitant Lyme borreliosis and acute paraplegia. The paraplegia was complete, flaccid and of upper motor neurone type. The diagnosis of borreliosis was based on the detection of large amounts of IgM and IgG borrelia antibodies in the acute phase serum and on the complete disappearance of IgM antibody during the review period. IgG borrelia antibodies were also detected in the CSF, but leakage of antibodies from the blood to the intrathecal space could not be ruled out. Lymphocytosis and increased total protein concentration in the CSF were signs compatible with neuroborreliosis. Ceftriaxone therapy effected dramatic recovery of the patient. This case suggests that borreliosis should be considered a possible cause of acute flaccid paraplegia.
Subject(s)
Lyme Disease/complications , Muscle Hypotonia/etiology , Paraplegia/etiology , Acute Disease , Aged , Finland , Humans , Immunoglobulin G/analysis , Immunoglobulin M/analysis , Lyme Disease/diagnosis , Lyme Disease/drug therapy , Male , PrognosisABSTRACT
This paper describes the work undertaken to establish principles for the development of multicenter databases for reference values in clinical neurophysiology. The study was initiated because of interest of the involved laboratories in knowledge-based systems in electromyographic diagnosis, for which it was necessary to formalize the key concepts in the diagnostic process: diseases, pathophysiology and test results. The paper deals specifically with the structuring of results of motor and sensory nerve conduction studies.
Subject(s)
Artificial Intelligence , Databases, Factual , Diagnosis, Computer-Assisted , Neurophysiology , Action Potentials/physiology , Body Temperature , Data Collection , Electromyography , Female , Humans , Male , Median Nerve/physiology , Models, Biological , Models, Statistical , Neural Conduction/physiology , Neurophysiology/methods , Neurophysiology/standards , Peroneal Nerve/physiology , Radial Nerve/physiology , Reaction Time , Reference Values , Regression Analysis , Sural Nerve/physiology , Ulnar Nerve/physiologyABSTRACT
Motor and sensory nerve conduction velocities (NCV) were recorded in several nerves of a total of 99 patients with juvenile rheumatoid arthritis (JRA), and the results were compared to those obtained for two reference groups, one consisting of healthy children and the other of 30 children with different articular manifestations. The JRA and the affected reference group were not found to differ significantly from each other. NCV values were systematically slightly higher and the distal median nerve latencies slightly shorter in the patients with JRA than in the healthy reference group. Several measurement values differed from each other significantly. Some patients with JRA showed slightly decreased NCVs in individual nerves, but manifest mononeuropathy was not found. The results show that complications of peripheral nervous system origin do not typically occur in association with JRA.
Subject(s)
Arthritis, Juvenile/physiopathology , Neural Conduction , Peripheral Nerves/physiopathology , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Peripheral Nerves/physiologyABSTRACT
Sensory and/or motor nerve conduction velocities (NCVs) were measured in median, radial, sural, and peroneal nerves of 54 healthy girls and 75 healthy boys aged 3-19 years. Independent of the nerve and sex, both motor and sensory NCVs increased in the upper extremities and decreased in the lower ones as a function of age/growth in length. NCV increased in the upper limbs on an average 3.17 m/sec in the boys and in the girls 1.47 m/sec per 10 years of life. As for the nerves of the lower extremities, NCV slowed down on the average 1.81 m/sec in the boys and in the girls 3.62 m/sec per 10 years of age. The change varied in different nerves. A highly significant one (P less than 0.001) was found in both the motor and sensory NCVs of peroneal nerve in the girls and in the sensory NCV of radial nerve in boys. On the average NCV was in most nerves faster in the girls than in boys of the same age. According to these results, changes occur in the function---and thus probably also in the morphology---of peripheral nerves even in later childhood and adolescence. These changes pertain to general maturation, growth in length of the limbs, and possibly also sex.
Subject(s)
Neural Conduction , Adolescent , Adult , Age Factors , Axons/physiology , Child , Child, Preschool , Female , Humans , Male , Motor Neurons/physiology , Peripheral Nerves/physiology , Sex Factors , Skin TemperatureABSTRACT
Compound neural action potentials (NAPs) were recorded from N. suralis and the digital nerves of N. medianus in man using the antidromic technique. The nerves were cooled either at the site of the recording ("local cooling") avoiding temperature change proximally, or between the stimulating and recording electrodes ("segmental cooling") avoiding temperature change at the recording site. Local cooling was followed by a pronounced increase in NAP amplitude and rise time without any change in the onset latency. The values of Q10 were identical for both amplitude and rise time changes. Segmental cooling caused a definite fall in the amplitude of NAP and a slight increase in its rise time. The practical consequences of the dual temperature effect on NAP are discussed.
Subject(s)
Peripheral Nerves/physiology , Temperature , Action Potentials , Adult , Humans , Middle Aged , Nerve Fibers/physiology , Regression AnalysisABSTRACT
In a selected series of twenty-three RA patients, aged from 23 to 56 years, mean 41, the neurophysiological functions of six sensory nerves were measured and the results were correlated with clinical and laboratory data. Significant changes in the functions of one or more nerves were found in 10 patients, 2 of whom had no symptoms of clinical neuropathy. There was a highly significant correlation between neurophysiological symptoms and clinical neuropathy symptoms, although the combination of the clinical and electrophysiological findings was variable. On the other hand, there was no significant correlation between neurophysiological/neurological findings and clinical/laboratory data (age, sex, duration of disease, stage of disease, rheumatoid factor and erythrocyte sedimentation rate). Manifest or sub-clinical mono-neuropathies in n. medianus were found in 5 patients. In the light of these results it would seem in order to recommend the inclusion of an electro-neurophysiological examination of the medianus nerves of RA patients in routine diagnostic procedures.
