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PubMed1990

Nerve conduction studies and their clinical applications.

Nerve conduction studies provide the most sensitive and accurate account of peripheral neuropathophysiology. Though nerve conduction studies should never be performed in lieu of a clinical examination, the electrodiagnostic evaluation provides an optimal adjuvant to the clinical examination. Indications for nerve conduction studies are many, including evaluation of the nature of the pathophysiology, quantification of the severity of involvement, detection of the level of a neurologic deficit, and determining prognosis. Among other indications, limitations of the study should also be acknowledged, such as its confined evaluation of large myelinated peripheral nerve fibers. It should be understood that nerve conduction studies are conventionally performed with EMG studies, typically performed consecutively in order to provide a comprehensive evaluation of suspected neuromuscular impairment. It is imperative to emphasize that utilization of nerve conduction findings is limited and potentially misdirected without a thorough knowledge of peripheral neuropathophysiology and related conditions. Parameters by which the studies are evaluated are outlined in detail within this article and discussed in terms of clinical and neurophysiological significance. Reference tables are provided on the normal values of individual peripheral nerves, as established by various investigators. Nerve conduction findings and their clinical significance relative to various pathophysiological conditions are reviewed. Radiculopathies, lesions of the lumbosacral plexus, polyneuropathies, as well as mononeuropathy multiplex and simplex, are also discussed relative to their various etiologies, and respective forms of pathogenesis. Finally, nerve conduction studies may be effectively used to select the most beneficial therapy. Appropriate consultative referral is addressed with regard to primary pathologic conditions requiring neurosurgical, neurologic, rheumatologic, and immunologic care, among other disciplines relative to the underlying pathologic process. Local therapy may invariably be gauged in terms of various modes of medical, orthopedic, and surgical intervention, depending on the degree, nature, and distribution of involvement of the neuropathy, as ultimately determined by the nerve conduction studies. In conclusion, nerve conduction studies provide a reliable index of measurement in the diagnosis, treatment, and prognosis of the patient.

Electromyography↗
PubMed1990

Gluteal necrosis after acute ischemia of the internal iliac arteries.

Ligation of the internal iliac artery mostly remains without consequences because of the well established collateral network. In patients with compromised collateral circulation however, acute interruption of both hypogastric arteries during aorto-iliac surgery or transluminal embolisation can lead to necrosis of the gluteal muscles and other adjacent organs (rectum, bladder, lumbosacral plexus). Experience with 3 similar cases after aorto-iliac surgery demonstrates two main intraoperative mechanisms: 1. Embolisation, 2. Ligature of both internal iliac arteries in patients with compromised arteriosclerotic collaterals. Despite of adequate therapy, mortality is over 70%. The most important feature during aorto-iliac operations is to preserve at least one internal iliac artery by either reimplantation of the main stem or by an additional bypass to this artery.

Aged↗
PubMed1990

[Occlusion of an implanted peridural catheter by a plug of epidermis].

A patient suffering from intensive perianal pain due to recurrent rectal cancer, not controllable by systemic analgesics, was treated by continuous epidural morphine for a period of 8 months. Satisfactory pain relief was achieved although sometimes problems arose with the permeability of the epidural catheter. As a reason for increased resistance, the literature mentions nonspecific foreign-body reactions next to the catheter. In our patient, tumour infiltration into both the lumbosacral plexus and the epidural space leading to compression of the catheter could not positively be excluded. At autopsy an unexpected obstruction of the catheter by epidermis was observed. It could be demonstrated that pieces of epidermis may enter the catheter, bypassing the bacterial filter of the port, and can then clog the tip of the catheter.

Analgesia, Epidural↗
PubMed1989

The developmental anatomy of pes valgo planus.

Pes planus or flatfoot becomes a medical problem only when symptoms develop. The mere absence of a well-formed medial longitudinal arch does not necessarily imply pathology. Many apparently "flat feet" demonstrate congruent joints, and the extremities function normally. The size and shape, as well as the angles of declination for the talus or astragulers and the calcaneus or os calcis, are most often determined at the moment of fertilization by the genes of the patients. The zygote or fertilized ovum is a first totipotent. Cell division normally occurs as development proceeds, but the embryo is vulnerable to alterations of the cell cycle. Teratogenic substances can induce death or substantial structural modifications to the developing fetus. The post-World War II tragedy of the medical use of the drug thalidomide in pregnant mothers resulting in amelia is testimony as to how the lower extremity can be adversely affected. Early chromosomal aberrations including duplication, deletion, breakage, inversion, translocation, and mosaicism have been shown to be involved in faulty development of the foot, and there is no reason not to implicate pes valgo planus to these events. Intrauterine development apart from the genetic considerations just mentioned place the fetus under additional jeopardy. Even extraembryonic membranes can form strands of tissue that can entangle the delicate developing foot plate, and calcaneovalgus deformities could conceivably be established. The developing embryo and fetus first demonstrate a blastema that forms limb buds on the ventral caudal aspect. Anlage of the scleroblastema and myoblastema of the prospective leg and foot develop in the presence of nerve trunks. Such nerves are related to the lumbosacral plexus and they are thought to exert inductive developmental influences. Interference with any of these events may be implicated in pedal deformities such as pes valgo planus. This is also true of subsequent morphogenetic events involving embryonic rotations, osteogenesis, and myogenesis. Many pedal deformities have congenital basis and it is clear that pes valgo planus is one of them. Post-natal structural changes further accentuate underlying etiologies. For example, the calcaneus normally exhibits a varus position at birth, but this feature diminishes until the cessation of bone growth. The adult talar neck-calcaneal angle is normally about 24 degrees, representing a 6-degrees reduction from that of 30 degrees, which is demonstrated at birth.(ABSTRACT TRUNCATED AT 400 WORDS)

Chromosome Aberrations↗
PubMed1988

Paraparesis in a patient with Crohn disease resulting from septic arthritis of the hip and psoas abscess.

A psoas abscess is a recognized complication of Crohn disease. Less commonly, septic arthritis has been described with this entity. The occurrence of both these complications together in Crohn disease is quite rare. A 56-year-old patient with Crohn disease presented with weakness and pain in both lower extremities. Computerized body tomograms demonstrated a large psoas abscess with fistulous connections to the bowel as well as extending into the capsule of the left hip joint. X-ray examination revealed evidence of acute septic arthritis. Electromyographic studies demonstrated lumbosacral plexus involvement bilaterally. The patient subsequently underwent ileocolectomy with drainage of the left psoas abscess, followed by extensive inpatient rehabilitation. Some immediate strength improvement was noted bilaterally. At discharge, the patient remained paraparetic. In patients with known history of Crohn disease, a psoas abscess should be considered when there are symptoms of lower extremity pain, hip flexion contractures, and progressive weakness.

Abscess↗
PubMed1988

Spinal nerve root origins of the cutaneous nerves of the canine pelvic limb.

The spinal nerve root origins of the cutaneous nerves innervating the canine pelvic limb were determined in 12 barbiturate-anesthetized, healthy dogs by stimulating the dorsal roots L1-S3 and recording the evoked-action potentials from each cutaneous nerve. The dogs were then euthanatized, identification of each dorsal root and cutaneous nerve was verified by dissection, and the type of lumbosacral plexus (prefixed, median fixed, or postfixed) was determined. With one exception, the dorsal cutaneous branches and lateral cutaneous branches of L1-L3 originated only from their corresponding spinal nerve roots. The genitofemoral nerve received afferent fibers predominantly from L3-L4 nerve roots. The lateral cutaneous femoral nerve originated from L3-L5 nerve roots, and the saphenous nerve from L4-L6 nerve roots. The proximal caudal cutaneous sural nerve originated from L6-S1. The lateral cutaneous sural nerve originated from L5-S1; the deep and superficial fibular nerves arose primarily from L6-L7. The distal caudal cutaneous sural nerve originated predominantly from L7-S1, and the medial cutaneous tarsal nerve originated from L6-S1. The medial plantar nerve originated predominantly from L6-S1 roots, whereas the lateral plantar nerve originated from L6-S2 roots. The middle clunial nerve received afferent fibers primarily from S1-S2; the caudal clunial nerve received fibers from S1-S3. The caudal cutaneous femoral nerve originated predominantly from L7-S2. The dorsal nerve of the penis originated predominantly from S1-S2, and the superficial perineal nerve originated from S1-S3. One dog had a prefixed plexus, 8 dogs had median-fixed plexuses, and 1 dog had a postfixed plexus.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Neuropathological findings in a case of chronic inflammatory polyneuropathy.

A 52-year-old woman presented with increasing pain, weakness, and paraesthesiae of four months' duration in the lower limbs. She suffered from chronic obstructive airways disease and hypertension. Neurological examination revealed wasting of the quadriceps muscles, weakness of the lower limbs, and absent ankle jerks. The sensory examination was normal. Full blood count, ESR, biochemical, immunological, and viral studies, urinary heavy metal assays, and cerebrospinal fluid examination were normal. Nerve conduction studies were consistent with a sensorimotor neuropathy, and electromyographic sampling was consistent with acute denervation. A sural nerve biopsy showed axonal degeneration and segmental demyelination. One month after admission, she developed carbon dioxide retention. Her weakness spread to affect the upper limbs, and she could not be resuscitated after a cardiac arrest three months after admission. General autopsy examination revealed bronchopneumonia. Neuropathological examination showed a lymphocytic infiltrate in the nerve roots of the cauda equina, the lumbosacral plexus, and the sural and vagal nerves. Increased cellularity and collagen were evident in these nerves. A diagnosis of chronic inflammatory polyneuropathy was made. The neuropathology of this entity is discussed.

Brain↗
PubMed1979

Bladder and urethral responses to sympathetic stimulation.

Bladder and urethral pressure responses were recorded in 47 cats subjected to electrical stimulation of sympathetic fibers isolated at the caudal mesenteric ganglion before and after complete sacral denervation. Recorded responses were complex and seemed to be at least partially dependent on afferent and efferent pelvic nerve activity. Sacral denervation alone did not influence urethral closing pressure but the combination of sacral and hypogastric denervation resulted in a marked loss of urethral sphincter function.

Animals↗
PubMedDate not supplied

Sacral agenesis with associated anomalies (caudal regression syndrome): autopsy case report.

Autopsy findings of an infant with sacral agenesis and multiple anomalies of the lower half of the body which fit the description of the caudal regression syndrome are reported. The lumbosacral plexus of nerves was more abundant on one side despite symmetrical lumbar vertebral dysgenesis with agenesis below S1. The presence of intrathecal kidney tissue has not been previously reported in this syndrome. Diethylopropion hydrochloride, an appetite supressant, which was ingested by the patient's mother during the first month of pregnancy, was cited as a possible etiologic agent.

Abnormalities, Multiple↗
PubMed1982

Strain differences of tumorigenic effect of neonatally administered N-ethyl-N-nitrosourea in rats.

The tumorigenicity of neonatally administered N-ethyl-N-nitrosourea (ENU) was studied in four different inbred strain rats, that is Wistar/Furth (WF), Long-Evans (LE), F1 of Wistar/Furth and Long-Evans (F1) and Fischer 344 (F344) rats. All strains developed tumors of the nervous system with high incidence (97-100%) during 6 months of observation. The incidence of tumor of the central nervous system, including the brain (82-88%) and the spinal cord (53-76%), was high in all strains, but that of the peripheral nervous system, including the cranial nerve (21-89%) and the spinal root (13-93%), differed by strain. The peripheral nervous system of WF and F344 rats had a low susceptibility to the tumorigenic effect of ENU, but that of LE rats had a high susceptibility. Many brain tumors were induced in the temporal and frontal cortex and subcortex in all strains of rats. Spinal cord tumors were observed at all levels of the white matter of the spinal cord without any predilection site. Spinal root tumors were located in lumbosacral plexuses in WF and F344 rats, but in LE and F1 rats cervical and thoracic root tumors were also observed. Histological examination revealed that most of the brain and spinal cord tumors were oligodendroglioma, but in F344 rats about half of the brain tumors were mixed glioma. Epidermoid cysts of the lumbar spinal cord were observed only in F344 rats. Tumors of the peripheral nervous system were so-called anaplastic schwannoma.

Animals↗