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Biomedical subjects

K H Levin

Publications and source records attributed to K H Levin.

9 recordsLinked to original sources
PubMed1990

Hypertrophic mononeuritis clinically presenting with painful legs and moving toes.

A 40-year-old woman presented with progressive lower leg pain and spontaneous toe movement. The EMG showed a posterior tibial nerve mononeuropathy and continuous myokymic discharges in posterior tibial-innervated muscles. The MRI revealed a markedly enlarged posterior tibial nerve. Toe movements and myokymia were unaffected by the proximal transection of the lesion but ceased abruptly when the distal end of the fusiform "tumor" was resected, suggesting that spontaneous electrical foci may have been located along the nerve lesion. The markedly enlarged nerve segment contained edematous, swollen fascicles with marked Schwann cell onion-bulb lesions and angiocentric, lymphocytic, and lymphofollicular infiltration. This nerve lesion is an example of a newly recognized entity called hypertrophic mononeuritis.

Adult↗
PubMed1989

Systemic vasculitis in association with human immunodeficiency virus infection.

Fourteen cases of vasculitis associated with human immunodeficiency virus infection have thus far been described. Five of these cases may be classified as angiocentric immunoproliferative disorders, including benign lymphocytic angiitis, lymphomatoid granulomatosis, and angiocentric lymphoma. We report a case of benign lymphocytic angiitis of T cell lineage. Extensive studies found no evidence of viral antigens in the inflammatory infiltrates, and immunologic evaluation of the pathologic lesions revealed the infiltrating cells to be predominantly CD3+, CD8+, CD4-. A significant number of these lymphocytes demonstrated a deletion of T cell antigen receptor determinants. We believe that in certain cases of human immunodeficiency virus disease, there occurs a spectrum of lymphoproliferative disorders with angiocentric features that lead to the clinical picture of systemic necrotizing vasculitis. Clinicians should be aware of this association.

Acquired Immunodeficiency Syndrome↗
PubMed1989

AAEE case report #19: ischemic monomelic neuropathy.

A case study of a 50-year-old man who awakened from aortobifemoral bypass graft surgery with painful burning and numbness of the left foot is reported. Angiography showed embolic occlusion of the left popliteal artery proximal to the knee. Nerve conduction studies performed 1 year after occlusion showed loss or severe reduction of distal left sensory and motor amplitudes, and needle electrode examination showed fibrillation potentials in foot and distal leg muscles. The findings were felt to represent the result of acute ischemic nerve damage in the left leg. The clinical and electromyographic features of this entity will be described and comparisons will be drawn to experimental ischemic neuropathy and diabetic neuropathy.

Coronary Artery Bypass↗
PubMed1987

Acute infection with the human immunodeficiency virus (HIV) associated with acute brachial neuritis and exanthematous rash.

Clinical descriptions of acute or primary infection with the human immunodeficiency virus (HIV) are rare. Among cases previously reported, most describe an acute illness resembling infectious mononucleosis. We describe the case of a 32-year-old homosexual man with an acute illness associated with strong serologic evidence of a primary infection with HIV. This case illustrates two new clinical features: an acute, bilateral brachial neuritis, and a vesicular, pustular exanthematous and enanthematous rash. Studies of HIV-related serologic results show differential sensitivities for enzyme-linked immunosorbent assay, Western blot, immunofluorescence, and viral antigen techniques in the acute phase of HIV infection. There appears to be significant clinical heterogeneity of the acute phase of HIV infection.

Acute Disease↗
PubMed1986

Superficial peroneal nerve conduction studies for electromyographic diagnosis.

A new standardized surface technique for conduction studies of the superficial peroneal nerve was developed and applied to 35 normal subjects and 63 patients with peroneal mononeuropathies, lumbar radiculopathies, sciatic neuropathies, lumbosacral plexopathies, or peripheral neuropathies. The response amplitude was greater than 5 microV and the response peak latency was less than 4.1 msec in all normal subjects; however, 8.6% of normal subjects had at least one unelicitable superficial peroneal nerve response (6% of all limbs tested). These data were compared with those of previous studies. Although this technique did not improve the diagnosis of peroneal neuropathy, it did distinguish lumbosacral plexopathy and sciatic neuropathy from L5 radiculopathy and served as a second, easily approachable, sensory conduction study of the leg.

Action Potentials↗
PubMedDate not supplied

Childhood peroneal neuropathy from bone tumors.

Nontraumatic childhood peroneal mononeuropathy is uncommon and should initiate a search for surgically correctable causes. In 3 children, 2 age 12 years and 1 age 13 years, unilateral footdrop developed over a few days to a month. Electrodiagnostic findings demonstrated lesions with maximal or exclusive involvement of the deep peroneal nerve. Radiologically, bony exostoses were identified at or near the fibular head in each patient. In 2 patients, the lesions were clinically occult. An osteochondroma was removed from each patient and 2 patients had excellent clinical recoveries.

Adolescent↗
PubMedDate not supplied

Response of CSF IgG to steroids in an 18-month-old with chronic inflammatory polyradiculoneuropathy.

During recovery from a upper respiratory infection, an acquired chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) developed in a previously healthy 18-month-old girl. The CIDP followed a monophasic course and left her severely quadriparetic. One year after her neurologic deficit had stabilized, the cerebrospinal fluid (CSF) IgG synthesis rate was markedly elevated, and oligoclonal bands were identified in her CSF, suggesting ongoing inflammation. Her electromyogram (EMG) and nerve biopsy were consistent with a severe acquired segmental demyelinating polyradiculoneuropathy. A course of corticosteroid therapy resulted in dramatic, sustained, clinical and electromyographic improvement, normalization of CSF IgG synthesis rate, and disappearance of the oligoclonal bands. We are not aware of any previous reports that correlate serial measurements of CSF IgG synthesis rate and oligoclonal bands with clinical and electromyographic responses to corticosteroids in a child with acquired CIDP. We suggest that these CSF parameters are potentially useful in demonstrating active inflammation in cases of acquired CIDP even after clinical stabilization of neurologic deficits, predicting response to therapy, and monitoring resolution of the pathologic process.

Chronic Disease↗