Results in the treatment of low back syndrome from sensory neurolysis of the lumbar facets (facet rhizotomy) by thermal coagulation.
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Adolescent↗
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Results for “Nerve Compression Syndromes”
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Bony entrapment of the superficial peroneal nerve.
Peripheral nerve injury occasionally results from long bone fractures, but bony entrapment of a peripheral nerve occurs infrequently. Bony entrapment of a peripheral nerve is usually associated with upper extremity fractures. In a 34-year-old man bony entrapment of the superficial peroneal nerve occurred in a healed midshaft fibular fracture. The patient complained of progressive pain over the distribution of the superficial peroneal nerve after sustaining a closed displaced tibial and fibular fracture that healed in nonanatomic alignment. Exploration revealed bony entrapment of the superficial peroneal nerve in the fracture callus, with reactive neuroma formation. Excision of the neuroma resulted in complete relief of the symptoms. Persistent pain over the distal anterolateral leg and dorsal foot following a fibular and tibial fracture is usually derived from a compartment syndrome. If this has been ruled out, the differential diagnosis should include bony entrapment of the superficial peroneal nerve.
Adult↗
Glossopharyngeal neuralgia with cardiac syncope.
Glossopharyngeal Neuralgia is an uncommon craniofacial pain syndrome that is occasionally associated with cardiac syncope. Involvement of the glossopharyngeal nerve may be painless or may be marked by true episodic neuralgia, and this justifies the term neuralgia reported here. We present 5 cases of this uncommon syndrome, of a total of 15 observed cases of glossopharyngeal neuralgia, successfully treated by section of the rootlets of Cranial Nerves IX and X or by microvascular decompression in the posterior cranial fossa. We also analyze the relevant literature and discuss the pathogenesis and treatment of the syndrome.
Cranial Fossa, Posterior↗
Aneurysm, arteriovenous malformation and arteriovenous fistula in posterior fossa compression syndrome.
To discuss the problem of neuroradiological preoperative procedures in patients with therapy-resistant facial pain, we present 3 case examples of vascular processes in the cerebellopontine angle (aneurysm, arteriovenous malformation, arteriovenous fistula). The microsurgical treatment in combination with artificial embolization is described. The vascular causes of microvascular compression at the root entry zone of the trigeminal nerve and malformations involving the nucleus caudalis are reviewed.
Aged↗
Neck-tongue syndrome on sudden turning of the head.
A syndrome of unilateral upper nuchal or occipital pain, with or without numbness in these areas, accompanied by simultaneous ipsilateral numbness of the tongue is explicable by compression of the second cervical root in the atlantoaxial space on sharp rotation of the neck. Afferents fibres from the lingual nerve travelling via the hypoglossal nerve to the second cervical root provide a plausible anatomical explanation for compression of that root causing numbness of half the tongue.
Adolescent↗
Piriformis syndrome diagnosed by cauda equina action potentials: report of two cases.
STUDY DESIGN: Evaluation of recorded potentials from the lumbar spine after stimulation of the peroneal nerve in patients with piriformis syndrome is reported. OBJECTIVES: To report a new method of diagnosis of piriformis syndrome. SUMMARY OF BACKGROUND DATA: Clinically, the Freiberg and Pace signs were used to diagnose this entity. Among imaging examinations, computed tomography and magnetic resonance imaging have been used. An electrophysiological method using H reflex has also been reported. However, the best method for diagnosis of piriformis syndrome has yet to be clearly established. METHODS: After having an epidural electrode inserted into the lumbar spine, patients lay on their back. Cauda equina action potentials were recorded with the epidural electrode at L3/4 after stimulation of the peroneal nerve at the fibular head. As a control, the potentials were recorded with the hip and knee extended. Potentials were then also recorded with the hip flexed, and then with the hip flexed and internally rotated to stress the sciatic nerve by the piriformis muscle. RESULTS: We observed changes in amplitudes and latencies of recorded potentials. Amplitude decreased to about 70% of the control value in one case and to 67% in the other. On the nonaffected side, however, this amplitude did not decrease below 90%. The latency was also delayed on the affected side, but not on the nonaffected side. CONCLUSIONS: Recording of evoked potentials from the lumbar spine with stress to the affected leg was useful for diagnosing piriformis syndrome.
Action Potentials↗
[Piriformis syndrome. A contribution to the differential diagnosis of lumbago and coccygodynia].
The piriformis syndrome is characterized by pain in the buttock radiating to the leg and to the coccydeal region. It is an isthmus syndrome of the N. ischiadicus and/or N. cutaneous femoris posterior. The most frequent causes are blunt traumas of the buttocks and spasms of the N. piriformis. More often than not the piriformis syndrome is the cause of a "postlaminectomy syndrome" or of a coccygodynia. The diagnosis can be established by a clinical examination with sufficient reliability.
Back Pain↗
Piriformis muscle syndrome: an underdiagnosed cause of sciatica.
This is a retrospective review of 26 patients with sciatica due to the piriformis muscle syndrome. Most patients had pain in the buttock area and sciatica, and most experienced difficulty walking and sitting, even for short periods of time. Reproduction of the sciatica upon deep palpation, either by gluteal or rectal route, was diagnostic. Reproduction of sciatica occurred in 92% of the patients upon deep digital palpation and in 100% of the patients upon rectal or pelvic examination. Other signs were helpful but not consistent. After the appropriate diagnosis, the treatment was relatively easy and rewarding. This study emphasizes that the diagnosis of piriformis muscle syndrome is clinical; without the appropriate clinical examination, it can be easily misdiagnosed.
Adult↗
Piriformis syndrome: assessment of current practice and literature review.
Although piriformis syndrome was initially described in 1928, it has remained a nebulous and controversial diagnosis. A literature review reveals that there is no consensus on the diagnosis or treatment of piriformis syndrome. In addition, a survey of 75 physiatrists revealed that whether the diagnosis of piriformis syndrome even exists is controversial. This survey and literature review examines the diagnosis and treatment of piriformis syndrome. The fact that it remains controversial is likely due to a lack of objective clinical trials.
Humans↗
The pyriformis syndrome: review and case presentation.
The pyriformis syndrome is a rare entrapment neuropathy in which the sciatic nerve is compromised by the pyriformis muscle or other local structures. It usually presents with sciatic pain and hypoaesthesia and a limp caused by weakness of the gluteus maximus muscle. Peroneal nerve innervated muscles and hamstrings are also usually affected. The diagnosis relies on the clinical presentation and the EMG findings. Other causes of symptoms should be excluded by careful examination, detailed x-ray studies of the lumbosacral spine (including myelogram), sacro-iliac and hip joints. A case of this syndrome occurring in a previously healthy 42 year old woman and her follow-up investigations are reported.
Adult↗
Acupuncture treatment of compression neuropathy of the radial nerve: a single case report of "Saturday Night Palsy".
PURPOSE: Evidence that acupuncture is effective for any type of motor nerve injury is limited to case reports and case series but these findings indicate benefit. Observation that the radial nerve has the most rapid recovery of all peripheral nerves suggests that acupuncture might benefit treatment of "Saturday Night Palsy," a syndrome of radial-nerve compression. TREATMENT: A 41-year-old female with a 1-week history of inability to write or extend the right wrist received 1 acupuncture treatment utilizing the Lung and Large Intestine meridians in the forearm, with the 2 meridians interconnected using the Luo and Yuan points. A cockup wrist splint was then applied. CONCLUSIONS: Wrist motion with gravity neutralized returned immediately after treatment. As the day progressed, the patient reported increasing strength in wrist and finger extension. The next day, the patient cancelled the second acupuncture treatment, as her hand had recovered. Examination 4 months later revealed normal wrist and finger extension, sensation, and return of the brachioradialis reflex. The patient was symptom-free 1-year postinjury. Acupuncture potentially facilitates recovery and may enhance treatment of peripheral motor nerve injury.
Acupuncture Therapy↗
Mechanical disorders of the lumbar spine.
The lumbar spine is an impressive mechanical system but it can fail from injury or abuse. This paper reviews four recognisable back pain syndromes, which result from mechanical failure, symptomatic disc protrusion, root entrapment syndrome, segmental instability and neurogenic claudication--their clinical presentation, and what is understood about their multifactoral aetiology.
Back Pain↗
Intraradicular lumbar disc herniation: case report and review of the literature.
OBJECTIVE AND IMPORTANCE: Intradural or intraradicular herniation of a lumbar disc is a rare complication of disc disease. The mechanism of the tearing of the dura mater by a herniated disc is not known with certainty. Only six cases of intraradicular disc herniation have been reported. By reporting the seventh case of this rare neurosurgical entity, we emphasize its importance and review the literature on intraradicular disc herniation. CLINICAL PRESENTATION: A 41-year-old man was admitted with a 3-year history of low back pain and sciatica. A neurological examination revealed motor weakness during plantar flexion, positive Lasègue's sign, sensory deficit on the S1 dermatoma, and loss of Achilles reflex. Magnetic resonance imaging revealed disc protrusion at the L5-S1 level. Therefore, we decided to operate on the patient having made a diagnosis of lumbar disc disease. INTERVENTION: The patient underwent a standard hemilaminotomy and foraminotomy for a removal of the L5-S1 disc. There was no disc protrusion or extruded fragment. The left S1 nerve root was observed to be swollen and immobile. A longitudinal incision was made on the radicular sheet of the S1 root, and a free disc fragment, approximately 2 x 1 x 1 cm, was extirpated in one piece. CONCLUSION: The patient was immediately relieved of pain and was discharged on the 7th day after the operation with normal muscle strength. It seems probable that in some patients with "failed back syndrome," intraradicular or intradural disc herniation is the cause of failure.
Adult↗
Entrapment of the sensory branch of the radial nerve (Wartenberg's syndrome): an unusual cause.
Isolated neuropathy of the cutaneous branch of the radial nerve is a rarely recognized pathology. It was described in 1932 by Wartenberg, who suggested the name cheiralgia paraesthetica. The syndrome is described as known the entrapment of the superficial branch of the radial nerve. Many different etiologic factors for chronic nerve entrapment have been described, however our case has an unusual cause. A 52 year old man had pain and paresthesia in the area over the lateral aspect of the wrist, thumb and first web six months after Colles' fracture. The patient underwent bony spike resection after five months with ineffective conservative treatment. He has satisfied after this operation. The case was presented because of disappearing his preoperative complaints after the operation with respect to Wartenberg's syndrome constituted a rare cause of bone spike which has not been mentioned in the literature.
Accidents, Traffic↗
Neurovascular injuries in the wrists and hands of athletes.
Neurovascular syndromes in the wrist and hand are uncommon occurrences in the athlete. They are usually related to repetitive use of the wrist such as in racquet sports or sports with repetitive impact to the hands such as handball and catching. Common syndromes are discussed with regard to anatomy, pathophysiology, diagnosis, treatment, and return to sport.
Adult↗
Distal posterior interosseous nerve syndrome.
Five patients presenting with chronic dorsal wrist pain and diagnosed as distal posterior interosseous nerve syndrome are reported. Clinical examination revealed point tenderness of the fourth extensor compartment. The symptoms were reproduced by extreme wrist extension in all patients and by extreme flexion in three of the patients. The pain was relieved in all patients by a selective lidocaine block of the terminal branch of the posterior interosseous nerve at the wrist joint. All the patients failed to respond to nonoperative treatment and underwent surgical exploration of the nerve. The operative findings were an enlarged nerve in three patients and adhesion of the nerve to the joint capsule in five patients. A 2 cm section of the nerve proximal to the extensor retinaculum was resected. Four of the five patients had excellent pain relief and returned to full asymptomatic activity. One patient had improvement in pain and was satisfied with the outcome. A diagnosis of distal posterior interosseous nerve syndrome should be considered if the usual sources of dorsal wrist pain are eliminated.
Adolescent↗
Growing teratoma syndrome in a patient with a non-germinomatous germ cell tumor in the neurohypophysis--case report.
A 16-year-old woman presented with a non-germinomatous germ cell tumor in the neurohypophysis manifesting as progressive visual disturbance, amenorrhea, hydrodipsia, and polyuria. Her serum alpha-fetoprotein and human chorionic gonadotropin levels were elevated. She experienced sudden, rapid visual deterioration and underwent emergency partial tumor removal to decompress the optic nerves. Her vision subsequently improved. Histological examination of the surgical specimens confirmed immature teratoma. She received chemotherapy (ifosphamide 900 mg/m2, cisplatin 20 mg/m2, etoposide 60 mg/m2) for 5 consecutive days. Although the tumor marker levels decreased remarkably, her vision again declined rapidly due to enlargement of the tumor after the first course of chemotherapy. A second radical operation resulted in vision improvement. The tumor specimen showed only mature teratoma elements. This phenomenon, called the growing teratoma syndrome, is very rare in intracranial non-germinomatous germ cell tumors.
Adolescent↗
Laparoscopic neurolysis of the pelvic sciatic nerve in a case of catamenial footdrop.
Isolated cases of cyclic sciatica associated with endometriosis have been reported since the 1940s. Surgical intervention, either by laparoscopy for lesions within the pelvis or by open procedures for extrapelvic lesions, has usually been performed. A 37-year-old woman with catamenial footdrop and pain of the right thigh came to our observation. Previously, she underwent laparoscopy for bilateral ovarian endometriomas. In a second laparoscopy, we removed her uterosacral right ligament and recto-vaginal endometriotic nodules. After a temporary improvement, a third surgical procedure was necessary: laparoscopic neurolysis to free the sciatic nerve from fibrotic tissue. Then the patient was treated with gonadotropin-releasing hormone analogs for 6 months, and she is free of symptoms 2 years after last surgery. This is the first described case of laparoscopic neurolysis of the proximal sciatic nerve. The procedure has been successful in treating a patient with endometriosis in whom the cause of the syndrome was probably due to entrapment of the nerve in fibrous tissue.
Adult↗