Focal myopathy induced by chronic intramuscular heroin injection.

A patient developed focal fibrotic myopathy after many years of intramuscular heroin use. While such changes have been associated with chronic intramuscular injections of pentazocine and meperidine, a similar myopathy resulting from chronic intramuscular heroin has not been convincingly described.

Posttraumatic osseous tunnel formation causing sciatic nerve entrapment.

Sciatic nerve entrapment in an osseous tunnel has only been reported twice previously. We describe a 19-year-old man evaluated for left lower limb pain and weakness that began one and one half years after sustaining stab wounds to the left buttock and midline back near the T11 vertebrae. The patient had sciatica and demonstrated motor and sensory deficits on physical exam. Electrodiagnostic studies demonstrated a localized injury to the sciatic nerve in the proximal thigh. Radiographic studies of the left pelvis and femur showed an 8 to 10cm linear opacification overshadowing the left femoral head and anatomic neck. An arteriogram of the left leg demonstrated a 3 x 4cm lobulated aneurysm arising from the distal portion of the inferior gluteal artery. Surgical exploration revealed the sciatic nerve to be encased in cylindrical bone. The ectopic bone was removed and the sciatic nerve released. The patient had gradual improvement with a nearly complete neurological recovery by three months after surgery.

Syringomyelia presenting as shoulder dysfunction.

An elderly woman developed humeral subluxation secondary to syringomyelic neuroarthopathy. Atypical features included her advanced age, the unilaterality of sensory symptoms and signs, the nearly normal motor function, and the absence of long tract signs. Magnetic resonance imaging confirmed the presence of a cervical syrinx, and electrodiagnostic studies suggested superimposed compressive brachial plexopathy. This case suggests that syringomyelia may be underdiagnosed in patients with atypical presentations.

Peripheral nerve involvement in sarcoidosis: an electrodiagnostic study.

The frequency of peripheral nerve involvement in sarcoidosis is uncertain. To determine how often peripheral nerves are affected in the absence of symptoms, electromyography was performed on 29 sarcoid patients and 29 age-matched controls. Nineteen sarcoid patients, compared to two controls, had abnormally low sensory amplitudes in one or more nerves, and the mean sensory amplitudes for median, ulnar, and sural nerves were lower in the patient than in the controls. Subclinical mononeuropathy multiplex appears to be common in sarcoidosis.

Acute generalized polyneuropathy accompanying lithium poisoning.

A woman with typical symptoms of lithium toxicity had, in addition, severe generalized sensorimotor peripheral neuropathy, which cleared completely as the recovered. Electrodiagnostic studies suggested axonal lesions; autopsy ten months later revealed no residual abnormalities. Previous studies have shown that lithium can affect peripheral nerve function, but this is the first reported case of peripheral neuropathy in association with lithium toxicity.

Bilateral facial palsy associated with Stevens-Johnson syndrome.

A 22-year-old man developed acute bilateral peripheral facial paralysis in association with Stevens-Johnson syndrome, probably as a result of ampicillin allergy. All symptoms cleared except the facial paralysis. He is the first patient in whom acute facial palsy and Stevens-Johnson syndrome have occurred simultaneously.

Landry-Guillain-Barré syndrome with abnormal pupils and normal eye movements: a case report.

A 66-year-old woman with acute idiopathic polyneuritis (Landry-Guillain-Barré [LGB] syndrome) had normal extraocular movements, but her pupils did not react to light or accommodation. This is the first such case to be reported. Pharmacologic testing pointed to postganglionic involvement of parasympathetic and sympathetic nerves.

Prognostic value of minimal excitability of facial nerve in Bell's palsy.

Nerve excitability is useful for prognosis in Bell's palsy. Minimal excitability values (MEV) were obtained by stimulating the facial nerve and recording the effective current (mA) required to evoke a minimal visible contraction of frontalis, orbicularis oculi, orbicularis oris, and mentalis muscles respectively. Serial MEVs were performed on 100 patients with facial palsy, of whom 87 were followed for six months or to complete recovery; 61 patients were treated with steroids of whom 57 had good recovery. Serial MEVs were not only useful for prognosis, but also helpful in regulating the dosage of prednisone.