Nonparalytic polio and postpolio syndrome.

We describe four cases of postpolio syndrome with typical histories, physical examination results, and electrodiagnostic evidence of extensive anterior horn cell disease, as well as the putative pathophysiology of postpolio syndrome in persons with histories of nonparalytic polio and the diagnostic implications for individuals older than 40 yr of age who are experiencing unexplained new weakness, fatigue, and muscle or joint pain. Although the diagnosis of postpolio syndrome traditionally has required a remote history of paralytic polio, many persons such as the ones described here with typical symptoms of postpolio syndrome have no clear history of paralytic disease and are being misdiagnosed. With this in mind, we believe that the diagnostic criteria for postpolio syndrome should be modified to include the following: a history of remote paralytic polio or findings on history, physical examination results, and laboratory studies compatible with poliovirus damage of the central nervous system earlier in life.

Piriformis syndrome: assessment of current practice and literature review.

Although piriformis syndrome was initially described in 1928, it has remained a nebulous and controversial diagnosis. A literature review reveals that there is no consensus on the diagnosis or treatment of piriformis syndrome. In addition, a survey of 75 physiatrists revealed that whether the diagnosis of piriformis syndrome even exists is controversial. This survey and literature review examines the diagnosis and treatment of piriformis syndrome. The fact that it remains controversial is likely due to a lack of objective clinical trials.

Overuse tendinitis of the intrinsic muscles.

Repetitive strain injuries are currently the leading cause of occupational illnesses. This report describes seven patients who presented with the sole symptom of hand pain and subsequently were diagnosed with intrinsic tendinitis. Six of the 7 patients were given injections of a local anesthetic and steroid solution into the region of the lumbrical tunnels for both diagnostic and therapeutic purposes. All 6 patients had immediate short-term resolution of their symptoms in the office, thereby confirming the diagnosis. Complete resolution of symptoms after both the injection and other treatment interventions occurred in 4 patients, and partial resolution of symptoms occurred in the remaining two patients. Follow-up ranged from 3 to 20 months for 6 patients, and the seventh patient was lost to follow-up. The clinical presentation, diagnostic work-up, and treatment of intrinsic tendinitis are described.

Early onset dystonia following traumatic brain injury.

Dystonia, a movement disorder resulting from dysfunction of the basal ganglia and thalamus, has not been described during the acute post-traumatic period after severe traumatic brain injury. We reported three patients who developed early onset dystonia after sustaining severe closed head injuries. The first patient went on to complete resolution of the dystonia; the second patient improved and had minimal residual dystonia that did not limit function; and the third patient became frankly agitated at which time the dystonic features became difficult to track. In contrast, delayed onset dystonia after traumatic brain injury has been reported to be relatively persistent. All of our patients also presented with autonomic instability. Because injuries that cause damage to the basal ganglia and thalamus may also affect the nearby hypothalamus, both dystonic posturing and autonomic instability may result.