RESUMO
After injury of the brachial plexus, sensory disturbance in the affected limb varies according to the extent of root involvement. The goal of this study was to match sensory assessments and pain complaints with findings on CT myelo scans and surgical observations. One hundred fifty patients with supraclavicular stretch injury of the brachial plexus were operated upon within an average of 5.4 months of trauma. Preoperatively, upper limb sensation was evaluated using Semmes-Weinstein monofilaments. Pain complaints were recorded for each patient. With lesions affecting the upper roots of the brachial plexus, hand sensation was largerly preserved. Sensory disturbances were identified over a longitudinal bundle on the lateral arm and forearm. In C8-T1 root injuries, diminished protective sensation was observed on the ulnar aspect of the hand. If the C7 root also was injured, sensation in the long finger was impaired. Eighty-four percent of our 64 patients with total palsy reported pain, versus just 47% of our 72 patients with upper type palsies. This rate dropped to 29% in the 14 patients with a lower-type palsy. C8 and T1, when injured, always were avulsed from the cord; when avulsion of these roots was the only nerve injury, pain was absent. Hand sensation was largely preserved in patients with partial injuries of the brachial plexus, particularly on the radial side. Even when T1 was the only preserved root, hand sensation was mostly spared. This indicates that overlapping of the dermatomal zones seems much more widespread than previously reported.
Assuntos
Neuropatias do Plexo Braquial/etiologia , Plexo Braquial/lesões , Plexo Braquial/fisiopatologia , Dor/etiologia , Polirradiculopatia/fisiopatologia , Distúrbios Somatossensoriais/etiologia , Extremidade Superior/lesões , Extremidade Superior/fisiopatologia , Adulto , Plexo Braquial/diagnóstico por imagem , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/diagnóstico , Feminino , Humanos , Masculino , Mielografia , Dor/diagnóstico , Paralisia/diagnóstico , Paralisia/etiologia , Paralisia/fisiopatologia , Polirradiculopatia/diagnóstico , Polirradiculopatia/diagnóstico por imagem , Polirradiculopatia/etiologia , Estudos Prospectivos , Distúrbios Somatossensoriais/diagnóstico , Distúrbios Somatossensoriais/fisiopatologia , Tomografia Computadorizada por Raios X , Extremidade Superior/diagnóstico por imagem , Extremidade Superior/cirurgiaRESUMO
INTRODUCTION: Lumbar spinal stenosis is defined as a narrowing of the neural canal and foramina that result in compression of the lumbosacral nerve roots or cauda equina. Patients with lumbar spinal stenosis may present a variety of signs and symptoms. One such syndrome is neurogenic intermittent claudication, characterized by radicular symptoms exacerbated by walking or standing and relieved by rest. Infrequently, lumbar spinal stenosis produces a cauda equina compression, characterized by intermittent urinary or fecal incontinence, impotence and in rare cases priapism. CASE REPORT: A 50 year-aged male, presented with spontaneous intermittent priapism and few months later weakness, numbness and pain of his legs provoked by bipedestation or physical exertion that completely disappeared by sitting or lying down. A computed tomographic scan showed a lumbar canal narrowing of L4 through L5. A diagnosis of neurogenic intermittent claudication with dysfunction of the cauda equina roots secondary to the presence of lumbar spinal stenosis was carried out. The symptoms completely resolved after descompressive lumbar laminectomy of L4 and L5. CONCLUSIONS: Causal interpretation of neurogenic intermittent claudication still remains obscure. An inadequate blood supply provoked by increased intra-raquid pressure among the roots may act as a dynamic factor. This mechanism could cause stagnant anoxia during the exercise resulting in clinical symptoms. Lumbar spinal stenosis should be kept in mind when autonomic features appear.
Assuntos
Polirradiculopatia/etiologia , Priapismo/etiologia , Estenose Espinal/complicações , Descompressão Cirúrgica , Diagnóstico Diferencial , Humanos , Hiperemia/etiologia , Claudicação Intermitente/diagnóstico , Laminectomia , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Polirradiculopatia/diagnóstico , Polirradiculopatia/fisiopatologia , Polirradiculopatia/cirurgia , Postura , Raízes Nervosas Espinhais/irrigação sanguínea , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Tomografia Computadorizada EspiralAssuntos
Humanos , Masculino , Adulto , Ileíte/complicações , Polirradiculopatia/complicações , Síndromes de Compressão Nervosa/complicações , Articulação Sacroilíaca/fisiopatologia , Diagnóstico Diferencial , Lincomicina/uso terapêutico , Polirradiculopatia/diagnóstico , Polirradiculopatia/tratamento farmacológico , Proteína C-ReativaRESUMO
Twenty two cases of Guillian-Barré syndrome were studied at the Children's Hospital of the City of Morelia (State of Michoacán, México), in a four-year period; such that number represents tow out 1 000 of the patients hospitalized in that length of time. The subject of this paper is to get acquainted with the clinical features of this syndrome in this part of the country, to establish the usefulness of the study of the spinal fluid and to know the evolution of the disease in relation to the treatment with corticoids. In all of our twenty two cases, there were coincidental features with the ones reported by others; eventhough, the statistics of this syndrome in the childhood are few. The dissociation between the amounts of albumin and the count of cells in the spinal fluid confirms the diagnosis, but its abscence is not enough to exclude it. Apparently, the clinical evolution of this disease is not modified by ths use of corticoids. Finally, the most moderns etiopathogenic concepts of this syndrome are reviewed as well as its probable etiological association with the infectious mononucleosis virus (Epstein-Barr's virus).