RESUMO
Two cases of carpal tunnel syndrome with Riche-Cannieu anomalies are reported. Despite complete absence of a median nerve evoked compound muscle action potential from the thenar eminence, these patients had significant preservation of function and minimal muscle atrophy. Activation of the ulnar nerve at both the wrist and elbow generated easily obtainable compound muscle action potentials from the thenar eminence with initial negative onset. This observed preservation of function and electrophysiologic responses are best explained by the presence of a Riche-Cannieu anastomosis innervating the thenar eminence through branches from ulnar nerve. To our knowledge there has not been a report of similar cases in patients with profound carpal tunnel syndrome and a Riche-Cannieu anomaly. We review the clinical findings, the electrodiagnostic data, and the impact of a Riche-Cannieu anastomosis on advanced carpal tunnel syndrome.
Assuntos
Síndrome do Túnel Carpal/diagnóstico , Nervo Mediano/fisiopatologia , Neurônios Motores/fisiologia , Músculo Esquelético/inervação , Polegar/inervação , Nervo Ulnar/fisiopatologia , Adulto , Síndrome do Túnel Carpal/fisiopatologia , Diagnóstico Diferencial , Eletromiografia , Feminino , Humanos , Atrofia Muscular/diagnóstico , Atrofia Muscular/fisiopatologia , Valores de Referência , Transmissão Sináptica/fisiologiaRESUMO
Intraventricular neurocysticercosis is of concern because it is associated with a poorer prognosis than is parenchymatous disease. Frequently, associated hydrocephalus occurs, which may recur after treatment. We report on 11 patients with intraventricular cysticercosis (from a larger case series of 33 patients) and evaluate clinical presentations, neuroimaging findings, and responses to treatment, especially of ventricular disease. Intraventricular cysticercosis represented 33% of our cases. Seven patients presented with increased intracranial pressure; four required ventriculoperitoneal shunting. Parenchymatous symptomatic cysticercosis is largely a result of the host inflammatory response, presenting in our series with epileptic seizures in 73% of the patients (tonic clonic generalized seizures occurred in 64% and partial simple seizures in 9%). The prognosis for parenchymatous inflammatory disease is good. We advocate the use of anthelmintic treatment with albendazole in all cases of intraventricular cysts, and if hydrocephalus occurs, then shunt procedures or ventriculostomy is necessary. These patients must be monitored closely for recurrent hydrocephalus.
Assuntos
Ventrículos Cerebrais/parasitologia , Cisticercose/complicações , Adolescente , Adulto , Idoso , Cisticercose/diagnóstico , Cisticercose/terapia , Eletroencefalografia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
Venous thrombosis is a frequent complication in patients with paroxysmal nocturnal hemoglobinuria (PNH). However, arterial thrombosis is rare, and cerebral arterial thrombosis has been reported only in postmortem studies. We discuss the case of a PNH patient in whom both clinical and neuroimaging findings were compatible with cerebral arterial and venous thrombosis.
Assuntos
Hemoglobinúria Paroxística/complicações , Embolia e Trombose Intracraniana/etiologia , Infarto Cerebral/etiologia , Humanos , Embolia e Trombose Intracraniana/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Patients who have clinically recovered from Guillain-Barré syndrome (GBS) may exhibit a deficit during strenuous exercises that require maximal effort and muscular endurance. The Army Physical Fitness Test (APFT) is a quantitative tool that challenges neuromuscular endurance and unmasks a subclinical deficit in soldiers who have apparently recovered from GBS. The impact of this subclinical deficit on active duty soldiers and strategies for managing their poor performance on the APFT are discussed.
Assuntos
Militares , Polirradiculoneuropatia/fisiopatologia , Adulto , Exercício Físico/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resistência Física/fisiologia , Aptidão Física/fisiologiaRESUMO
This review is an objective critique of the thoracic outlet syndrome, with emphasis on the need to separate true neurogenic and vascular syndromes from nonspecific ones. Major controversies in the diagnosis and management of thoracic outlet syndromes are discussed, with an analysis of major pitfalls encountered in the diagnosis and treatment of patients with nonspecific syndromes. Recommendations to improve diagnostic methods in patients with chronic neurovascular abnormalities in the upper extremities are outlined.
Assuntos
Síndrome do Desfiladeiro Torácico , Diagnóstico Diferencial , Humanos , Síndrome do Desfiladeiro Torácico/diagnóstico , Síndrome do Desfiladeiro Torácico/terapiaAssuntos
Doenças Cardiovasculares/terapia , Doenças do Sistema Nervoso/etiologia , Cateterismo Cardíaco/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Cardioversão Elétrica/efeitos adversos , Endarterectomia/efeitos adversos , Transplante de Coração , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Complicações Pós-Operatórias , Ressuscitação/efeitos adversosRESUMO
Spinal manifestations of syphilis are now uncommon. Three adults with presumptive nontabetic spinal syphilis are presented. This paper should serve as a reminder to physicians that cases of late syphilis continue to occur and may be manifested as obscure spinal syndromes and be misdiagnosed unless the possibility of syphilis is constantly kept in mind. Some of the clinical dilemmas associated with the reactivity of fluorescent treponemal antibody in the cerebrospinal fluid are discussed,
