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Proximal neuropathy

Seok-Youl Choi, Jong Woong Park, Dong Hwee Kim
Ultrasonographic study is useful for decision making of treatment for focal neuropathy with unusual electrodiagnostic findings. We present a patient with severe acute radial neuropathy with sensory sparing around the distal arm secondary to twisting of the radial nerve following blunt trauma. A 24-year-old man with a 2-week history of left wrist drop and severe pain around the left elbow presented after hitting the left distal arm on the doorknob. The left wrist and finger extensions were grade 0, but elbow extension could not be tested because of severe pain during this action...
November 2016: American Journal of Physical Medicine & Rehabilitation
Philipp Bäumer, Henrich Kele, Annie Xia, Markus Weiler, Daniel Schwarz, Martin Bendszus, Mirko Pham
OBJECTIVE: To investigate the spatial pattern of lesion dispersion in posterior interosseous neuropathy syndrome (PINS) by high-resolution magnetic resonance neurography. METHODS: This prospective study was approved by the local ethics committee and written informed consent was obtained from all patients. In 19 patients with PINS and 20 healthy controls, a standardized magnetic resonance neurography protocol at 3-tesla was performed with coverage of the upper arm and elbow (T2-weighted fat-saturated: echo time/repetition time 52/7,020 milliseconds, in-plane resolution 0...
September 28, 2016: Neurology
Yu-Cheng Pei, Hsueh-Yu Li, Cheng-Lun Chen, Alice M K Wong, Pei-Chi Huang, Tuan-Jen Fang
OBJECTIVE: The detailed characteristics and prognosis of nonsurgery-related unilateral vocal fold paralysis (NSUVFP) are currently unclear. This study evaluated the extent of laryngeal nerve lesions and the individual characteristics for patients with NSUVFP. STUDY DESIGN: Retrospective, case series. METHODS: Patients with unilateral vocal fold paralysis (UVFP) were evaluated using videolaryngostroboscopy and quantitative laryngeal electromyography...
September 26, 2016: Laryngoscope
Murat Zumrut, Mehmet Demirayak, Ahmet Kucukapan
Peripheral neuropathies caused by ganglion cysts are quite rare, especially in the lower extremities. The case of a 64-year-old male with a 2-day history of foot drop and tenderness in the region of the left fibular neck is presented. Physical examination and electromyogram findings verified peroneal nerve palsy. Ultrasonography showed cystic mass localized proximal of the peroneal muscle structures. Magnetic resonance imaging revealed a cystic-appearing mass around the fibular neck that compressed the common peroneal nerve...
July 2016: Pakistan Journal of Medical Sciences Quarterly
Atilla Suleyman Dikici, Fethi Emre Ustabasioglu, Sakir Delil, Mecbure Nalbantoglu, Bektas Korkmaz, Selim Bakan, Osman Kula, Nurten Uzun, Ismail Mihmanli, Fatih Kantarci
Purpose To evaluate the value of shear-wave elastography (SWE) in the detection of diabetic peripheral neuropathy (DPN) of the tibial nerve. Materials and Methods This study was approved by the institutional review board, and written informed consent was obtained from all study participants. The study included 20 diabetic patients with DPN (10 men, 10 women), 20 diabetic patients without DPN (eight men, 12 women), and 20 healthy control subjects (nine men, 11 women). The tibial nerve was examined at 4 cm proximal to the medial malleolus with gray-scale ultrasonography and SWE...
September 19, 2016: Radiology
Karan Malhotra, Joseph S Butler, Adam Benton, Sean Molloy
Foot drop is a debilitating condition, which may take many months to recover. The most common cause of foot drop is a neuropathy of the common peroneal nerve (CPN). However, similar symptoms can be caused by proximal lesions of the sciatic nerve, lumbar plexus or L5 nerve root. We present a rare and unusual case of a patient undergoing spinal surgery at the level of L5/S1 and presenting 4 weeks postoperatively with progressive foot drop. Although the initial concern was a postoperative lesion at L5, the cause for this delayed presentation was extrinsic compression of the CPN at the level of the fibular head by a tight-fitting below-knee thromboembolic deterrent stocking...
September 2016: Oxford Medical Case Reports
J Rodriguez Miralles, L Natera Cisneros, A Escolà, J C Fallone, M Cots, X Espiga
INTRODUCTION: Two types of ganglion cysts at the elbow have been described depending on their anatomic location. Type A ganglion cyst is located proximal to the arcade of Frohse, and type B distal to it. Compressive neuropathies of the radial nerve at the level of the radial tunnel may lead to two different clinical entities with different clinical manifestations. These different conditions depend on which branch is involved. Although compression of the deep motor branch due to a ganglion cyst has been previously described, affection of the superficial sensory branch is considered much rarer...
October 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
James D Nicholson, Yan Guo, Steven L Bernstein
Ischemia-reperfusion injury after central nervous system (CNS) injury presents a major health care challenge with few promising treatments. Recently, it has become possible to reduce edema after CNS injury by antagonizing a sulfonylurea receptor 1 (SUR1) regulated ion channel expressed after injury. SUR1 upregulation after injury is a necessary precondition for the formation of this channel, and has been implicated in white matter injury after clinical spinal cord trauma. Glibenclamide, an SUR1 antagonist, appears to have neuroprotective effect against cerebral stroke in an open-label small clinical trial and great effectiveness in reducing damage after varied experimental CNS injury models...
2016: PloS One
Souichi Ohta, Ryosuke Ikeguchi, Takashi Noguchi, Yukitoshi Kaizawa, Hiroki Oda, Shuichi Matsuda
Surgical treatment for recurrent, common peroneal neuropathy has not been reported. Herein, we describe a successfully treated case using the proximally based sural fasciocutaneous flap after reneurolysis of the adhesive common peroneal nerve. A 33-year-old man received a neurolysis operation for entrapment neuropathy of the common peroneal nerve 2 years before first admission in our clinic. Although motor nerve conduction studies showed a marked improvement after the primary operation, the patient always required the use of a crutch because of severe pain radiating to the lower leg during standing or walking...
July 2016: Plastic and Reconstructive Surgery. Global Open
Shishir Suranigi, Kanagasabai Rengasamy, Syed Najimudeen, James Gnanadoss
Osteochondroma or exostosis is the most common benign bone tumor, and occurring frequently in the proximal humerus, tibia, and distal femur. It rarely affects talus. Osteochondroma of talus is a very rare etiology of tarsal tunnel syndrome (TTS). We report a rare case of extensive osteochondroma of the talus in a 60 year old female presenting with multiple swellings around the ankle and symptoms suggestive of tarsal tunnel syndrome. En-block excision of the multiple masses was done. Histopathological examination confirmed the diagnosis of osteochondroma...
June 2016: Archives of Bone and Joint Surgery
Marcus R Bair, Michael T Gross, Jennifer R Cooke, Carla H Hill
Study Design Resident's case problem. Background Entrapment neuropathies represent a diagnostic challenge and require a comprehensive understanding of the nerve's path and the anatomical structures that may cause compression of the nerve. This resident's case problem details the evaluation and differential diagnosis process for median nerve entrapment resulting from forceful and repetitive pronation/supination motions. Diagnosis Median nerve compression syndromes include pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome...
September 2016: Journal of Orthopaedic and Sports Physical Therapy
Jennifer A Smith, Barbara S Slusher, Krystyna M Wozniak, Mohamed H Farah, Gregoriy Smiyun, Leslie Wilson, Stuart Feinstein, Mary Ann Jordan
Peripheral neuropathy is a serious, dose-limiting side effect of cancer treatment with microtubule-targeting drugs. Symptoms present in a "stocking-glove" distribution, with longest nerves affected most acutely, suggesting a length-dependent component to the toxicity. Axonal transport of ATP-producing mitochondria along neuronal microtubules from cell body to synapse is crucial to neuronal function. We compared the effects of the drugs paclitaxel and ixabepilone that bind along the lengths of microtubules and the drugs eribulin and vincristine that bind at microtubule ends, on mitochondrial trafficking in cultured human neuronal SK-N-SH cells and on axonal transport in mouse sciatic nerves...
September 1, 2016: Cancer Research
Matthew J Snyder, Lawrence M Gibbs, Tammy J Lindsay
Painful diabetic peripheral neuropathy occurs in approximately 25% of patients with diabetes mellitus who are treated in the office setting and significantly affects quality of life. It typically causes burning pain, paresthesias, and numbness in a stocking-glove pattern that progresses proximally from the feet and hands. Clinicians should carefully consider the patient's goals and functional status and potential adverse effects of medication when choosing a treatment for painful diabetic peripheral neuropathy...
August 1, 2016: American Family Physician
Michael Vaeggemose, Mirko Pham, Steffen Ringgaard, Hatice Tankisi, Niels Ejskjaer, Sabine Heiland, Per L Poulsen, Henning Andersen
PURPOSE: To evaluate if diffusion tensor imaging MR neurography (DTI-MRN) can detect lesions of peripheral nerves in patients with type 1 diabetes. MATERIALS AND METHODS: Eleven type 1 diabetic patients with polyneuropathy (DPN), 10 type 1 diabetic patients without polyneuropathy (nDPN), and 10 healthy controls (HC) were investigated with a 3T MRI scanner. Clinical examinations, nerve-conduction studies, and vibratory-perception thresholds determined the presence of DPN...
July 29, 2016: Journal of Magnetic Resonance Imaging: JMRI
Jennifer Robblee, Hans Katzberg
Identifying "where is the lesion" is particularly important in the approach to the patient with focal dysfunction where a peripheral localization is suspected. This article outlines a methodical approach to the neuromuscular patient in distinguishing focal neuropathies versus radiculopathies, both of which are common presentations to the neurology clinic. This approach begins with evaluation of the sensory examination to determine whether there are irritative or negative sensory signs in a peripheral nerve or dermatomal distribution...
2016: Frontiers in Neurology
Kyoung Jin Cho, Sangkuk Kang, Sanghyung Ko, Junghyun Baek, Yeongkyun Kim, Noh Kyoung Park
Popliteal entrapment syndrome caused by isolated popliteus muscle enlargement is very rare, although its occurrence has been reported after discrete trauma. However, popliteal artery stenosis with combined peroneal and proximal tibial neuropathy caused by popliteus muscle enlargement without preceding trauma has not been reported. A 57-year-old man presented with a tingling sensation and pain in his left calf. He had no previous history of an injury. The symptoms were similar to those of lumbosacral radiculopathy...
June 2016: Annals of Rehabilitation Medicine
Eran Tamir, Aharon S Finestone, Erez Avisar, Gabriel Agar
BACKGROUND: Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy...
2016: Journal of Orthopaedic Surgery and Research
Aniqa Tasnim, Zoe Rammelkamp, Amy B Slusher, Krystyna Wozniak, Barbara S Slusher, Mohamed H Farah
BACKGROUND: Peripheral neuropathy is a common and dose-limiting side effect of many cancer chemotherapies. The taxane agents, including paclitaxel (Taxol(®)), are effective chemotherapeutic drugs but cause degeneration of predominantly large myelinated afferent sensory fibers of the peripheral nervous system in humans and animal models. Dorsal root ganglia (DRG) neurons are sensory neurons that have unipolar axons each with two branches: peripheral and central. While taxane agents induce degeneration of peripheral axons, whether they also cause degeneration of central nervous system axons is not clear...
2016: BMC Neuroscience
Nurcan Üçeyler, Silvia Braunsdorf, Ekkehard Kunze, Nadja Riediger, Sarah Scheytt, Šarka Divisova, Can Ebru Bekircan-Kurt, Klaus Viktor Toyka, Claudia Sommer
INTRODUCTION: To analyze the diagnostic usefulness of skin punch biopsies with emphasis on visualization and quantification of T-cells and macrophages in patients with polyneuropathies. METHODS: We quantified inflammatory cells in skin samples (lower leg, upper thigh) of 187 patients and compared data with counts in their sural nerve biopsies and with skin biopsies from 32 healthy volunteers. RESULTS: Vessel-bound T-cells and macrophages were increased in proximal and distal skin samples of neuropathy patients compared to controls (P<0...
July 7, 2016: Muscle & Nerve
Pamela S Hinton
Worldwide, 387 million adults live with type 2 diabetes (T2D) and an additional 205 million cases are projected by 2035. Because T2D has numerous complications, there is significant morbidity and mortality associated with the disease. Identification of early events in the pathogenesis of insulin resistance and T2D might lead to more effective treatments that would mitigate health and monetary costs. Here, we present our hypothesis that impaired bone blood flow is an early event in the pathogenesis of whole-body metabolic insulin resistance that ultimately leads to T2D...
August 2016: Medical Hypotheses
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