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Biomedical subjects

M Ellenberg

Publications and source records attributed to M Ellenberg.

At least 19 recordsLinked to original sources
PubMed1991

Reflex sympathetic dystrophy syndrome secondary to L5 radiculopathy.

A 47-year-old woman developed radiating right lower extremity pain with weakness in the L5 myotomes. A CT scan, subsequent myelogram, and postmyelogram CT scan were reported as negative. Two months of bed rest diminished the radiating symptoms, but the weakness persisted. Three months post onset a severe burning dysesthesia developed in the right foot, and the patient became unable to bear weight on that extremity. Physical examination revealed 4-/5 weakness of the ankle dorsiflexors, foot evertors, toe extensors, and hip abductors. The entire right foot was swollen and had a red, mottled discoloration. An EMG was equivocal, and a three-phase bone scan was positive in the right foot in all three phases, which is characteristic of reflex sympathetic dystrophy. A repeat CT scan and review of the earlier scans revealed a high lateral disc fragment at the exit foramina of the L5 nerve root. Upon laminectomy, a free disc fragment at the exit foramina was removed, and the patient's symptoms resolved completely. Reflex sympathetic dystrophy syndrome is very rarely reported in association with lumbar radiculopathy. This case emphasizes the need to carefully evaluate the far lateral exit foramina on CT scan in patients with symptoms of radiculopathy. Myelogram is characteristically normal in these cases.

Electromyography↗
PubMed1989

Minitracheotomy in the early respiratory management of patients with spinal injuries.

Minitracheotomy is a new technique of tracheal suction by the introduction under local anaesthetic of a small bore tube into the trachea through the cricothyroid membrane. The use of minitracheotomy in the early management of respiratory problems in patients with spinal injuries is described with a few illustrative cases. This technique is an adjunct to good physiotherapy in clearing secretions from the trachea. Its advantages and disadvantages are discussed.

Adult↗
PubMed1989

Ultrasound imaging of residual limbs: new use for an old technique.

The use of ultrasound for diagnosing problems in the residual limb of an individual with an amputation has not been documented in the literature. We present a case where this modality was particularly useful in the diagnosis of an extensive abscess in the distal stump. Ultrasound imaging of compromised residual limbs is useful in the diagnosis of stump infections with infected muscle tissue and deep fluid collection. This technique can help shorten the course of intravenous antibiotics by clarifying the need for surgical intervention.

Aged↗
PubMed1989

Regression of herniated nucleus pulposus: two patients with lumbar radiculopathy.

Thirty percent to 95% of patients with lumbar radiculopathy secondary to a bulging or herniated disc improve to a pain-free and functional level with nonsurgical treatment. What happens to the herniated disc material as this improvement occurs is unclear. We present two patients with lumbar radiculopathy documented by physical examination and electrodiagnostic testing. Both patients had herniated disc material at the L5 to S1 level on computed tomography (CT) scans corresponding to the side and level of their lesion on physical examination and electrodiagnostic testing. In both instances, the radiculopathy resolved with conservative treatment. CT scans were repeated in three months on one patient and four months on the other. The scans showed major resolution of the herniated disc material in both patients. These two cases demonstrate that in some patients with proven radiculopathy secondary to herniated nucleus pulposus, the herniated disc material will no longer be visible on CT scan and is presumed to resorb as the symptoms abate.

Adult↗
PubMed1988

Complete hemidiaphragmatic paralysis in a patient with multiple sclerosis.

We present a case history of a patient with definite multiple sclerosis who developed an abrupt onset of unilateral diaphragmatic paralysis, minor increase in lower extremity spasticity and complaint of marked neck stiffness. Her vital capacity during this episode was 600 mL and she was in impending respiratory failure. The diaphragmatic paralysis was demonstrated by radiographic plain films and fluoroscopy. Phrenic nerve stimulation was performed during fluoroscopy and the evoked motor response from the diaphragm recorded. There was a normal amplitude diaphragmatic twitch observed with an evoked motor response latency of 1 ms and amplitude of 300 microV. After high dose intravenous steroids, her neck stiffness and spasticity improved, her vital capacity improved to 1500 mL and her diaphragm regained its normal position and movement confirmed by followup radiographic plain films and fluoroscopy. We postulate the presence of a demyelinating plaque in the brainstem fibers descending to the phrenic nucleus as the etiology of the diaphragmatic paralysis. We are unaware of any other case reports of unilateral "upper motor neuron" phrenic nerve paralysis secondary to multiple sclerosis.

Adult↗
PubMed1986

Spinal cord seizures in transverse myelopathy: report of two cases.

Paroxysmal sensorimotor phenomena of spinal cord origin are well documented in the literature dealing with multiple sclerosis, but have seldom been identified in other conditions. These seizures are characterized by tonic spasm in the extremities, often accompanied by painful dysesthesias, and are fleeting, usually lasting no more than two minutes. Although they may occur spontaneously, they are commonly precipitated by tactile stimulation or movement of the extremity. These episodes must be clinically differentiated from spasticity as they have been shown to be responsive to anticonvulsants such as carbamazepine (Tegretol). We present two patients admitted to our rehabilitation facility with a diagnosis of idiopathic transverse myelopathy. Clinical and diagnostic evaluation revealed no evidence of multiple sclerosis and follow-up studies for two and one-half years in case 1 and one year in case 2 continued to support the admitting diagnoses. Each patient developed focal sensorimotor phenomena relatively early in the course of the disease which interfered with rehabilitation. Effective treatment was obtained with administration of carbamazepine. Subsequently, both patients developed signs and symptoms of multiple sclerosis. The complication of spinal cord seizures may become a limiting factor in the rehabilitation of patients with idiopathic transverse myelopathy unless the disorder is recognized and appropriate anticonvulsant therapy initiated. It may also be the first indicator that multiple sclerosis rather than "idiopathic" transverse myelopathy is present.

Acute Disease↗
PubMed1986

Aphasia associated with verified subcortical lesions: three case reports.

Aphasia classically has been described as an acquired impairment of language behavior subsequent to cortical brain injury to the dominant hemisphere. Traditionally, lesions in the internal capsule have been described as resulting in pure motor deficits, which may be accompanied by dysarthria without aphasia. Only recently has the literature suggested that lesions in the putamen and internal capsule may result in aphasia. We describe three clinical cases in which aphasia resulted from left subcortical lesions. The lesions were demonstrated using computed tomographic (CT) scan; language deficits were measured objectively using the Porch Index of Communicative Ability (PICA). Two of the three patients experienced excellent recovery of language skills, suggesting that subcortical lesions may have a more favorable prognosis in recovery from aphasia than do cortical lesions. The encouraging recovery may be related to fiber pathway disruption rather than cortical destruction.

Adult↗
PubMed1985

Partial cauda equina compromise: result of sacral stenosis.

Although partial or complete cauda equina compromise due to lumbar stenosis is a recognized entity, cauda equina compromise due to sacral stenosis is extremely uncommon. We present a patient with a three-week history of right thigh and buttock pain who developed right scrotal and buttock numbness, urinary retention, and difficulty with bowel evacuation. The patient had diminished sensation to right buttock and anus pinprick with decreased anal sphincter tone and absent bulbocavernosus reflex. Lumbosacral spine films revealed only minimal degenerative changes, while lumbar myelogram showed L4-L5 and L5-S1 ventral extradural defects. Only a drop of pantopaque descended caudally below the level of the L5-S1 interspace. Operatively, significant stenosis and thickening of the posterior sacrum with compromise of the lower sacral nerve roots was noted. Bilateral sacral laminectomy was performed and the symptoms resolved postoperatively. This case illustrates an unusual clinical entity: partial cauda equina compromise due to sacral stenosis.

Adult↗
PubMed1978

Lupoid sclerosis.

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed1976

Diabetic neuropathy: clinical aspects.

The importance of diabetic neuropathy derives from its remarkable frequency and its clinical impact. In view of the varying underlying pathogenetic mechanisms and the resulting diversity of clinical representations, it becomes apparent that there are diabetic neuropathies, rather than a single entity of diabetic neuropathy. The scope of involvement is widespread with virtually every system at risk. Although peripheral neuropathy is by far the most common expression, visceral neuropathy is also highly significant. It may affect every part of the gastrointestinal tract, the genitourinary tract, and sexual function, as well as direct autonomic nerve pathology. Clearly, neuropathy in diabetes offers a specific and important diagnostic challenge to the clinician and plays a definitive role in differential diagnosis. The problem is heightened by the fact that any and all of the diabetic neuropathic syndromes may be the initial clinical manifestation of diabetes in the absence of covert manifestations of carbohydrate metabolic disorder. It is to be stressed that the diagnosis is more than an academic exercise, since each diabetic neuropathic syndrome carries with it some beneficial therapeutic modality to aid the patient.

Arm↗
PubMed1976

The evolving picture of diabetes.

The clinical picture of diabetes has changed dramatically in recent years. The early promise of insulin has remained unfulfilled. Its beneficial effects have permitted the development of severe complications in a dramatically increased number of diabetics. Present research is encouraging, but the disease obviously requires a determined, aggressive, and concerted attack, so that we may fully understand the nature of the diabetic syndrome, as well as its treatment, cure, and prevention.

Animals↗