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The clinical picture is described of 4 patients with the syndrome of lesion of the peroneal developing during fixation of some physiological postures (squatting position etc.). The pathogenetic mechanisms of the disease are discussed. The authors report a characteristic monotypical clinical symptom complex of compression-ischemic peroneal neuropathy.
Fifteen cases of perineal neuralgia are reviewed, the lesion arising from a canal syndrome due to compression of the pudendal nerve in the ischiorectal fossa (Alcock's canal syndrome). The clinical characteristic of the pain syndrome was its postural nature with the existence of a true Tinel sign (increased pain on sitting). Diagnosis was confirmed in all cases by a perineal electrophysiological which showed peripheral neurogenic signs on examination of perineal muscles and an increase in sacral evoked potentials latencies (latency of bulbocavernous or clitorido-anal reflexes, cortical somesthetic evoked potential from pudendal nerve). Treatment was infiltration of cortisone derivatives into the pudendal nerve canal, under CT guidance because of the difficulty of infiltrating the pudendal nerve by an external perineal approach. Results were satisfactory in 9 of the 15 patients.
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The anatomic site of entrapment of the deep peroneal nerve's sensory branch over the dorsum of the foot is described. The clinical syndrome in 20 patients is reported. An operative approach to release the entrapment is illustrated. The results in twenty nerves in eighteen patients followed a mean of 25.9 months after surgery is excellent in 60%, good in 20%, and not improved in 20%.
Magnetic stimulation of the motor cortex, motor roots, and proximal nerve trunks was performed in 46 healthy adults and in 73 consecutive patients with disorders of the lumbar spine. In combination with neurography and F-wave recordings, the fractionated stimulation of the motor pathways allowed calculation of conduction times of the pyramidal tract fibers, of the motor roots (ie, caudal fibers), and of the motor fibers of the lumbosacral plexus. Normal values for motor conduction times to the quadriceps, anterior tibial, and extensor digitorum brevis muscles were established. Patients had clinical and radiologic diagnoses of spinal stenosis (n = 43) and nerve root compression syndromes (n = 30). Motor conduction times to lower limb muscles were significantly delayed (above mean normal value +/- 2 x SD) in 65% of the patients with spinal stenosis and 50% of the patients with nerve root compression syndromes. Conduction slowing could be localized within the motor root and caudal fiber segment of the motor pathways in 80% of the patients in whom F-waves could be recorded. This method can be used to verify, quantify, and locate lesions of the motor pathways in conditions such as compression of the spinal cord, the caudal fibers (spinal stenosis), or the motor root passing through the intervertebral canal.
INTRODUCTION: The seventh and eighth cranial nerves course toward the internal auditory canal within the cerebellopontine angle. Lesions in this region are usually related to malfunctions of these cranial nerves. Although an acoustic schwannoma is one of the main etiologies of cerebellopontine angle pathology, various inflammatory processes and vascular anomalies even though rare must be considered. PATIENTS/METHODS: We describe 5 cases with vascular loops of the basilar or vertebral arteries as a possible cause for hearing loss, vertigo and pulsatile tinnitus. In two cases the vascular lesion was confirmed at surgery, in which a decompression procedure was performed. The work-up for each patient included an auditory test battery and electronystagmography. Imaging studies included MRI and angiography in two cases. RESULTS/CONCLUSIONS: Our experiences show that while the cerebellopontine angle syndrome is mostly caused by benign tumors an abnormal vascular loop has to be considered in any differential diagnosis.
McCune-Albright syndrome (MAS) is a disease of noninheritable, genetic origin defined by the triad of café-au-lait pigmentation of the skin, precocious puberty, and polyostotic fibrous dysplasia. This syndrome, which affects young girls primarily, has also been reported with other endocrinopathies, and rarely with acromegaly and hyperprolactinemia. The fibrous dysplasia in MAS is of the polyostotic type and, apart from the characteristic sites such as the proximal aspects of the femur and the pelvis, the craniofacial region is frequently involved. A male patient with MAS presented with juvenile gigantism, precocious puberty, pituitary adenoma-secreting growth hormone and prolactin, hypothalamic pituitary gonadal and thyroid dysfunction, and polyostotic fibrous dysplasia causing optic nerve compression. Visual deterioration and its surgical management are presented.
PURPOSE: Radial tunnel syndrome refers to pain on the lateral aspect of the forearm as a result of compression of the posterior interosseous nerve within a tunnel with specific anatomical boundaries. Diagnosis of the condition is difficult because of its close association with lateral epicondylitis, which warrants different methods of treatment. Based on a cadaveric study, a new clinical test, the Rule-of-Nine test, is proposed to improve the diagnostic accuracy in radial tunnel syndrome. The test involves constructing 9 equal squares on the anterior aspect of the forearm and noting those squares where tenderness can be elicited. METHODS: 19 upper limbs were dissected to delineate the path of the posterior interosseous nerve through the radial tunnel, and the relationship of the path of the nerve with the 9 squares. RESULTS: A consistent mapping of the posterior interosseous nerve to the lateral column of 3 squares was observed. CONCLUSION: The Rule-of-Nine test is proposed as a reliable method of diagnosing radial tunnel syndrome.
Observation of a 60 year-old-man with superior gluteal nerve (SGN) entrapment neuropathy in the suprapiriformis foramen encouraged us to explore, through anatomical dissection, the possible morphological etiologies of this condition. Ten SGNs in five embalmed cadavers were dissected via gluteal and pelvic access. The origin, course and distribution of the nervous trunk and its relations were studied. In most cases, the nerve fibers of the SGN arose from ventral branches of L4, L5 and S1 to constitute the nervous trunk in the pelvis, then reached the gluteal area and divided into two branches, cranial and caudal. By running through the suprapiriformis foramen with the cranial gluteal vascular pedicle, the nervous trunk was always up between the superior edge of the piriformis muscle and the greater sciatic notch; rarely some of the nerve fibers went through the muscle. Bone, muscular and vascular morphological factors liable to cause SGN entrapment syndrome, and the circumstances of discovery, were analyzed. The role of hypertrophy of the piriformis muscle, resulting in a narrow suprapiriformis foramen, was confirmed through surgery.
The author investigated in 130 anatomical specimens the topographical relations of the sciatic nerve and the musculus piriformis in order to explain the clinical syndrome of the m. piriformis. The author found that in 6.15% of cases the nervus peroneus communis passes between the tendinous parts of the m. piriformis, and he considers this variation of practical significance for the development of the 'piriformis syndrome'. In unward rotation of the thigh, the m. piriformis is extended and the tendons of the divided muscle are tightly pressed together thus pinching the nerve between them. Pinching of the nerve causes the characteristic sciatic pain. In such a case, the patient can be relieved by cutting one of the tendons.
A case of bilateral entrapment of the superficial peroneal nerve at the anterior aspect of the ankle was seen in a 51 year old patient. After failure of the conservative treatment, surgical neurolysis resulted in complete relief.
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Three cases of painful ophthalmoplegia with acute onset due to an unruptured aneurysm of the intracavernous portion of the internal carotid artery are reported. The possible pathogenetic mechanisms responsible for this unusual mode of clinical manifestation are discussed and the neurovascular relationships of the cavernous sinus are analyzed in respect of ischemic versus compressive damage to the intracavernous neural structures.
The C2 nerve roots and rami were dissected in five cadavers to explore the pathogenesis of Neck-Tongue Syndrome. The most likely cause of the simultaneous occurrence of suboccipital pain and ipsilateral numbness of the tongue is an abnormal subluxation of one lateral atlanto-axial joint with impaction of the C2 ventral ramus against the subluxated articular processes.
Calcium pyrophosphate deposition disease is a relatively uncommon arthropathy characterized by the clinical features of pseudogout, the radiographic manifestations of chondrocalcinosis, and the pathological deposition of calcium pyrophosphate crystals in both hyaline and fibrocartilage. Symptomatic involvement of the spine by calcium pyrophosphate deposition disease is rare except by nodular deposition in the ligamentum flavum and atlanto-occipital ligament. We report a 50-year-old woman who presented with an acute herniated disc syndrome secondary to an intraspinal inflammatory calcium pyrophosphate deposition disease mass at the level of the L4-L5 interspace. The magnetic resonance image and histopathological features of the case are also discussed.
Development of the abdominal pain spinal syndrome is due to alterations in motor segments of the low-thoracic spine which bring about compression and dyscirculatory shifts in the nervous roots and their vegetative branches. Manual therapy was successful in recovery of physiological coordination between elements of the spinal motor segment thus correcting abnormalities in the nervous roots related to compression and affected circulation in 30 out of 36 patients treated.
From 1969 through 1978, 30 adults presented with painful idiopathic scoliosis and associated radicular symptoms. Fifteen had major thoracolumbar curves and 15 had major lumbar curves. Ten (33%) had physical findings of the nerve root entrapment, 4 having two roots entrapped. Root entrapments in the sciatic distribution were most common and arose on the side opposite the major curve, coming from the concavity of compensatory lumbosacral curves (7 of 9 patients). Root entrapment in a femoral nerve distribution came from the concavity of the major curve (1 patient). Whether in a major or compensatory curve, entrapments usually arise in the concavity (8 of 10 patients). Mechanisms of root entrapment vary, but foraminal compression and pedicular kinking were most common. When major deforming curves are corrected fairly completely, most nerve root entrapments are relieved; sciatic entrapments are decompressed by spontaneous straightening of the lumbosacral curve. Dwyer instrumentation and fusion has been the most effective method of surgical management in carefully selected cases.
The condition in which pain is felt over the area at the ischial tuberosity and radiating down the back of the thigh is labelled the hamstring syndrome. The pain is typically incurred by assuming a sitting position, stretching the affected leg or/and running fast. The symptoms are caused by tight, tendinous structures of the hamstring muscle at the area of its insertion into the ischial tuberosity. Following division of these structures, complete relief is obtained.