RESUMEN
Both the Phalen test and the percussion (Hoffmann-Tinel) test are considered to be the classic diagnostic tests for Carpal Tunnel Syndrome (CTS). Sensitivity of these tests, as given in the literature, ranges from 42 to 85% (Phalen) and from 38 to 100% (Hoffmann-Tinel), and specificity from 54 to 98% and from 55 to 100% respectively. The objective of this study was to evaluate sensitivity and specificity of both tests and to analyse the influence of such selected factors, such as patient's age and duration of symptoms. The clinical group consisted of 112 patients (147 hands) with CTS confirmed clinically and on nerve conduction studies. The control group of 50 patients (100 hands) was selected from hospital volunteers, who did not complain of any hand symptoms. Sensitivity and specificity of the Phalen test turned out to be respectively 85 and 89% and for the percussion test, 67 and 68%. There was no significant influence of patients' age upon the test results. Seventeen patients showed negative results for both tests, but in these individuals, the duration of symptoms was significantly longer than in the remaining group. These findings indicated essential diagnostic value for the Phalen test, but considerably smaller for the percussion test. In the diagnosis of long lasting syndromes, the usefulness of both tests is limited.
Asunto(s)
Síndrome del Túnel Carpiano/diagnóstico , Percusión , Muñeca/fisiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Síndrome del Túnel Carpiano/patología , Diagnóstico Diferencial , Reacciones Falso Negativas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conducción Nerviosa , Dolor/etiología , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
27 patients (22 women, 5 men); age 17 to 56 yr. (mean age 37 yr.) were included in this study, 4 had primary antiphospholipid syndrome and 18 secondary antiphospholipid syndrome in the course of systemic connective tissue disease and in 5 cases increased levels of anticardiolipid antibodies were found which did not meet the criteria necessary for diagnosis of secondary antiphospholipid syndrome. The mean duration of the disease was 8 yrs. Among primary antiphospholipid syndrome patients two had ischaemic stroke, one migraine-like headache and seizures. 18 patients had lupus erythematosus, two mixed connective tissue disease, one rheumatoid arthritis, one Sjögren syndrome, one Behçet disease. In 55% of patients migraine-like headache, polyneuropathies, encephalophaties, stroke, seizures and vision disturbances were present. In 18.5% of patients EEG exam revealed focal lesions with tendency for generalisation. On brain stem auditory evoked potentials examination, in 11.1% of patients conductivity lesions in mesencephalon and pons were found, visual evoked potentials, in 11.1% of patients in visual tracts. In 37% of patients, neuropathy was found on EMG exam. Neurological symptoms are one of the most frequent disorders in systemic connective tissue disease associated with the presence of anicardiolipin antibodies.
Asunto(s)
Anticuerpos Anticardiolipina/inmunología , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/inmunología , Isquemia Encefálica/complicaciones , Adolescente , Adulto , Encéfalo/irrigación sanguínea , Isquemia Encefálica/diagnóstico , Enfermedades del Tejido Conjuntivo/complicaciones , Enfermedades del Tejido Conjuntivo/inmunología , Electroencefalografía , Electromiografía , Ensayo de Inmunoadsorción Enzimática , Potenciales Evocados Auditivos del Tronco Encefálico/fisiología , Potenciales Evocados Visuales/fisiología , Extremidades/fisiopatología , Femenino , Humanos , Masculino , Mesencéfalo/fisiopatología , Persona de Mediana Edad , Conducción Nerviosa/fisiología , Puente/fisiopatologíaRESUMEN
Spinal epidural haematoma (SEH)--posttraumatic or spontaneous (SSEH) is a rare entity, usually associated with severe neurological deficit. Urgent surgical decompression of the spinal cord is mandatory procedure. A case of SSEH with unusual transient clinical symptomatology and subsequent spontaneous resolution during conservative management is reported.
Asunto(s)
Hematoma Epidural Craneal/patología , Enfermedades de la Médula Espinal/patología , Proteínas del Líquido Cefalorraquídeo/análisis , Descompresión Quirúrgica , Femenino , Hematoma Epidural Craneal/cirugía , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Enfermedades de la Médula Espinal/cirugíaRESUMEN
A coexistence of high level of intrathecal monoclonal immunoglobulin (intrathecal synthesis?) and amyloidosis as a possible cause of peripheral neuropathy in multiple myeloma patient was presented. In the reported case neurological symptoms and intrathecal monoclonal protein existence had been manifested several months before the appearance of plasmocytoma.
Asunto(s)
Amiloidosis/líquido cefalorraquídeo , Amiloidosis/complicaciones , Inmunoglobulina A/líquido cefalorraquídeo , Mieloma Múltiple/etiología , Enfermedades del Sistema Nervioso Periférico/etiología , Polineuropatías/etiología , Adulto , Anticuerpos Monoclonales , Humanos , MasculinoRESUMEN
The authors present a case of Creutzfeldt-Jakob disease in 82-year-old man. Besides the onset of the disease in the elderly and short survival time (8 weeks), other uncommon clinical and morphological features also characterized our case. An evident amyotrophic syndrome, confirmed in morphological findings, developed soon after the CJD onset. The spongiform change also observed within the white matter of cerebral hemispheres allowed us to diagnose the 'panencephalopathic' form of CJD.
Asunto(s)
Síndrome de Creutzfeldt-Jakob/patología , Anciano , Anciano de 80 o más Años , Encéfalo/patología , Recuento de Células , Síndrome de Creutzfeldt-Jakob/clasificación , Progresión de la Enfermedad , Electroencefalografía , Resultado Fatal , Gliosis/etiología , Gliosis/patología , Humanos , Masculino , Neuronas Motoras/patología , Médula Espinal/patología , Vacuolas/ultraestructuraRESUMEN
The leukemic and lymphomatous cells appear within the central nervous system (CNS) in 5 different environments: in CNS vessels, perivascular spaces, meninges, nervous tissue and in CNS hemorrhages. A computerized analysis of geometric and densitometric parameters of neoplastic cells in these compartments were done for better recognition of penetration and spreading of leukemia and lymphoma within the CNS. A post-mortem neuropathological investigations were carried out on 16 patients deceased due to acute myeloblastic leukemias (M1, M2), blastic phase of chronic myelogenous leukemia, lymphoblastic lymphoma and acute lymphoblastic leukemia. Following nuclear parameters of neoplastic cells were analyzed: area, "form factor", mean, minimal and maximal density. An evident differentiation of nuclear parameters within the CNS environments was found. The nuclei within the perivascular spaces and especially in CNS hemorrhages were significantly shrunken and dense (p < 0.01), but not evidently deformed. The intracerebral infiltrates appeared to be most differentiated group (p < 0.01). Morphometric values of leukemic and lymphomatous cells show regressive changes of neoplastic cells within the CNS perivascular spaces, nervous tissue and in CNS hemorrhages. These changes depend on unfavorable factors in the mentioned CNS environments, and also on time of cell persistence in these regions. Meninges were found to be the only CNS structure facilitating the survival and proliferation of leukemic and lymphomatous cells.
Asunto(s)
Neoplasias del Sistema Nervioso Central/patología , Leucemia/patología , Linfoma/patología , Neoplasias del Sistema Nervioso Central/ultraestructura , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Linfoma/ultraestructuraRESUMEN
Electrophysiological examinations were done on 20 patients aged 40-71 years with recently diagnosed high grade non-Hodgkin's lymphomas. General chemotherapy and intrathecal chemotherapy in order to prevent central nervous system (CNS) involvement were begun. On the first day of chemotherapeutic cycle patients received intrathecally methotrexate (ITMTX) and prednisolone. Electrophysiological study was carried out twice in each subject: before ITMTX injection and a day after injection. The study procedure included: a conventional nerve conduction examination (peripheral conduction velocity and compound muscle action potential amplitude), the F wave latency and amplitude measurement and F ratio (F-M-1/2M) calculation for peroneal and tibial nerve bilaterally. Results of the first and the second examinations were statistically compared by t-Student's test. No significant differences between values of estimated parameters were found. The study revealed no recent alterations in proximal, paraspinal motor conduction and motor neuron excitability due to antidromical activation after single ITMTX administration.
Asunto(s)
Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Linfoma no Hodgkin/tratamiento farmacológico , Metotrexato/administración & dosificación , Metotrexato/uso terapéutico , Adulto , Anciano , Antiinflamatorios/uso terapéutico , Quimioterapia Combinada , Humanos , Inyecciones Espinales , Persona de Mediana Edad , Estadificación de Neoplasias , Conducción Nerviosa , Prednisolona/uso terapéuticoRESUMEN
The clinical and neuropathological investigations have been done on 133 autopsied patients died of leukemia or non-Hodgkin's lymphoma of high malignancy. A study was performed to analyse the role of various factors particularly with respect to adhesion and aggregation in the CNS leukostasis development. The findings were also designated to evaluate the distribution of leukostasis in different CNS regions and to recognize its intensity in various CNS vessels. Basing on the studies the authors conclude that the risk of CNS leukostasis increases evidently when the leukocyte counts are elevated above 50 G/l. The adhesion and aggregation of leukemic and lymphomatous cells as well as local anatomical factors in the CNS vessels play and important role in the CNS leukostasis development, which is more intensive in the white matter and leptomeninges. The medium-sized vessels are much involved, whereas cortical capillaries are relatively less affected by leukostasis. The CNS leukostasis appears to be dynamic and reversible phenomenon, which undergoes fluctuations according to the leukocyte counts increase or decrease.
Asunto(s)
Encefalopatías/patología , Leucemia/complicaciones , Leucostasis/patología , Linfoma no Hodgkin/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Encefalopatías/sangre , Encefalopatías/etiología , Capilares/patología , Humanos , Recuento de Leucocitos , Leucostasis/sangre , Leucostasis/etiología , Persona de Mediana EdadRESUMEN
A 14-year-old boy was admitted to our Department due to peripheral palsy of right VII and bilateral of the VI cranial nerves, spasticity, cerebellar symptoms as well as to dysphagia and dysarthria. In general, he was hospitalized 13 times because of the disease of a relapsing-remitting and next progressive course. He died 31 years after onset of the disease. Multiple sclerosis was diagnosed. Brain autopsy revealed tumor involving almost all brain stem structures and a part of right cerebellar hemisphere. Histologically, cavernous angioma was diagnosed.
Asunto(s)
Neoplasias Encefálicas/diagnóstico , Hemangioma Cavernoso/diagnóstico , Esclerosis Múltiple/diagnóstico , Adolescente , Encéfalo/patología , Diagnóstico Diferencial , Resultado Fatal , Humanos , MasculinoRESUMEN
The clinical and electro-neurographic examinations were carried out in 54 patients aged 21-67 years (mean = 41.8) with IDDM of at least 10-year duration, and 25 subjects aged 19-62 years (mean = 39.0) as a control group. The aim of the study was the determination of: 1) the frequency of polyneuropathy appearance in patients with IDDM of at least 10-year duration; 2) the usefulness of electroneurography for detection of subclinical impairment of peripheral nervous system in diabetics; 3) the characterization of electro-neurographic abnormalities in diabetic neuropathy; 4) the influence of diabetes duration and metabolic control on severity of peripheral nerves affection; 5) the relationship between polyneuropathy and retinopathy, nephropathy and cataract occurrence in diabetic patients. Polyneuropathy was diagnosed--clinically in 67% of patients, electro-neurographically in 85% of patients. The neurographic study proved high sensitivity for detection of subclinical affection of peripheral nerves in diabetics. The electro-neurographic abnormalities appeared more frequently and were more considerable in the group of patients with clinical polyneuropathy. Frequency of the sensory and motor nerve fibres involvement was similar. The electroneurographical abnormalities corresponded with the features of mixed--axonal and demyelinating type of neuropathy. It was disclosed that the degree of neurographical changes did not depend on duration and severity of hyperglycemia in late period of the disease. A moderate relationship between occurrence of polyneuropathy and retinopathy, nephropathy as well as diabetic cataract was revealed.
Asunto(s)
Diabetes Mellitus Tipo 1/fisiopatología , Neuropatías Diabéticas/fisiopatología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Adulto , Anciano , Neuropatías Diabéticas/diagnóstico , Electrofisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso Periférico/diagnósticoRESUMEN
A case of 32-year-old woman was described in which progressive bilateral hearing and visual loss, hypokinesia, epileptic focal seizures were present. The brain CT-scan after a few years of the disease onset, showed the presence of multiple extracerebral tumors. Multiple meningiomas were diagnosed, probably associated with von Recklinghausen's disease. On the post-mortem examination 48 tumors of the different size and location in subdural space were found. Histologically transitional meningiomas with predominance of fibroblastic component were diagnosed. It was very interesting that apart from intracranial location of meningiomas, the same type of tumor was found within thoracic spinal root. The authors discuss the mechanisms of the development of multiple meningiomas and its association with neurofibromatosis.
Asunto(s)
Neoplasias Encefálicas/patología , Duramadre/patología , Meningioma/patología , Neoplasias Primarias Múltiples , Adulto , Edad de Inicio , Neoplasias Encefálicas/cirugía , Neoplasias Encefálicas/ultraestructura , Duramadre/cirugía , Duramadre/ultraestructura , Resultado Fatal , Femenino , Humanos , Meningioma/cirugía , Meningioma/ultraestructura , Tomografía Computarizada por Rayos XRESUMEN
Clinical examination and conduction velocity measurements in peripheral nerves have been done on 56 patients with non-Hodgkin's lymphomas of high malignancy (NHL). It is suggested that: the evaluation of the influence of chemotherapy on peripheral nervous system (PNS) is possible by means of systematic neurological and electroneurographic studies; electroneurographic assessment is most important in the diagnosis of early subclinical stages of peripheral neuropathy; toxic influence of CBVPM/AVBP protocol on PNS is greater than CHOP schedule; impairment of PNS due to chemotherapy is reversible in patients during complete remission (CR).
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Linfoma no Hodgkin/tratamiento farmacológico , Nervio Mediano/efectos de los fármacos , Nervio Peroneo/efectos de los fármacos , Reflejo Anormal/efectos de los fármacos , Reflejo de Estiramiento/efectos de los fármacos , Nervio Cubital/efectos de los fármacos , Adolescente , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bleomicina/administración & dosificación , Bleomicina/efectos adversos , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Femenino , Humanos , Linfoma no Hodgkin/fisiopatología , Masculino , Nervio Mediano/fisiopatología , Metotrexato/administración & dosificación , Metotrexato/efectos adversos , Persona de Mediana Edad , Conducción Nerviosa/efectos de los fármacos , Conducción Nerviosa/fisiología , Nervio Peroneo/fisiopatología , Prednisona/administración & dosificación , Prednisona/efectos adversos , Reflejo Anormal/fisiología , Reflejo de Estiramiento/fisiología , Nervio Cubital/fisiopatología , Vincristina/administración & dosificación , Vincristina/efectos adversosRESUMEN
The pathogenesis of neuropathy and other late, degenerative complications of diabetes remains largely unresolved. Metabolic derangements thought to be responsible for their development are induced by chronic hyperglycaemia. The present studies concern as follows: sorbitol accumulation due to increased polyol pathway activity, altered myoinositol metabolism in diabetic nerve, followed by diminished sodium-potassium ATPase activity, nonenzymatic glycosylation of structural proteins and rheologic changes in microcirculation. These processes impair nerve metabolism, function and structure directly or indirectly, due to primary vascular alternations and endoneural hypoxia. Partial elucidation of the mechanism involved in pathogenesis of diabetic neuropathy has provoked emergence of new therapeutic approaches. So far their results are equivocal and require further studies. At present, improved glycaemia control is undoubtedly the most important factor in prevention and treatment of neuropathy and other late complications of diabetes.
Asunto(s)
Neuropatías Diabéticas/etiología , Glucosa/metabolismo , Hiperglucemia/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/etiología , Neuropatías Diabéticas/tratamiento farmacológico , Humanos , Hiperglucemia/complicaciones , Hipoglucemiantes/uso terapéutico , Nervios Periféricos/efectos de los fármacos , Nervios Periféricos/metabolismo , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológicoRESUMEN
The authors present a case of coexistence of multiple sclerosis and craniopharyngioma. Such, a case has not been described up to now. The neoplasm was clinically not recognized because its signs were completely covered by multiple sclerosis symptoms.