[Underwater traction in lumbar spinal nerve root compression syndrome (technic and experiences)].
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A functional test using downhill walking was evaluated in relation to the myelographical examination in 33 patients with a suspected lumbar nerve root compression syndrome despite normal neurological findings. Any changes of motor or reflex signs or of straight leg raising were accepted as test results. They were noted in a decision matrix and the positive and negative predictive value (PPV and NPV, respectively) calculated. The PPV of any deterioration of the neurological status resulting from the test as a sign of abnormal myelographical findings was calculated to be approximately 85 per cent, the corresponding NPVs being approximately 50 per cent. In its present form, this functional test is inadequate as a screening procedure in these patients.
Neurovascular compression syndrome of the 5th and 7th cranial nerves has been recognized as the cause of trigeminal neuralgia and hemifacial spasm. On the other hand, it is still difficult to diagnose vertigo as neurovascular compression syndrome of the 8th cranial nerve. To detect some specific finding in this syndrome of the 8th cranial nerve, 5 patients with vertigo with hemifacial spasm were examined for the clinical course and neuro-otological features. In all patients MRI and/or angiography suggested vascular compression against the 8th cranial nerve. The clinical courses of these patients revealed various symptoms resembling benign paroxysmal positional vertigo, vestibular neuronitis and Meniere's disease. Audiograms showed two normal hearing patterns, bilateral high frequency hearing loss probably due to aging in one case, bilateral C5-dip in one and fluctuating unilateral hearing loss like Meniere's disease in one. The prolongation of IPL I-III on auditory brainstem response proposed as a criterion by Møller was detected in one case. No response in the caloric test was found in two cases. These abnormalities in the auditory brainstem response and caloric test appeared to be useful for diagnosis but were uncommon findings in all cases. Electronystagmographic examinations including the eye tracking test, optokinetic nystagmus and optokinetic pattern were all normal. We could not find any specific clinical findings valuable for diagnosis of neurovascular compression syndrome of the 8th cranial nerve. It is proposed that the indication of microvascular decompression should be decided carefully.
The symptoms and signs which constitute the carpal tunnel syndrome (CTS) result from entrapment or compression of the median nerve within the carpal tunnel. Electrodiagnostic studies may objectively document the presence of median neuropathy within the carpal tunnel and help distinguish CTS from other disorders such as cervical radiculopathy, neurogenic thoracic outlet syndrome, proximal median nerve compression syndromes, and polyneuropathy which may either mimic or occasionally coexist with CTS. Recording median nerve responses with wrist and palm stimulation allows determination of the wrist segment conduction velocity which is a more sensitive nerve conduction parameter than wrist latency measurements. Electrodiagnostic testing permits estimation of severity and relative contribution of axonal versus demyelinative nerve injury. This information can provide prognostic information and help guide therapeutic decisions.
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Six subjects with similar unilateral tinnitus that was fully suppressed by carbamazepine have been identified. Their ages at the time of the sudden onset of their tinnitus ranged from 39 to 87 years (mean 67). The 3 men had right ear tinnitus. Two of the 3 women had left ear tinnitus. All 6 described a staccato quality of their intermittent tinnitus ('like a typewriter in the background, pop corn, Morse code'). Five of the 6 subjects had no other hearing or vestibular complaints; their audiograms were symmetric and consistent with their ages. Vascular compression of the auditory nerve ipsilateral to the tinnitus was detected in 4 of the 5 subjects imaged. The similarities between typewriter tinnitus and other cranial nerve syndromes associated with vascular compression (trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia) suggest that surgical decompression of the auditory nerve can relieve medication-refractive cases of typewriter tinnitus.
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The interosseus anterior syndrome is a rare nerve compression syndrome that concerns only the motor branch of the median nerve. It is evidenced by paralysis of the M. flexor pollicis longus and M. flexor digitorum profundus II with weakness of flexion of the terminal joint of the thumb and index finger but without sensory loss. From the surgical point of view this complication has special importance because of pediatric fractures of the distal humerus. In this paper we discuss the differential diagnosis, therapy and prognosis of this nerve injury by presenting an illustrative case of a 7-year-old boy suffering a supracondylar fracture of the humerus with a post-traumatic anterior interosseus nerve syndrome.
Nerve compression syndromes of the upper extremity occur at predicable locations. The diagnosis of nerve compression or nerve entrapment is based on the neurologic and electrodiagnostic examinations. The anatomy, neurophysiology, and electrodiagnosis of nerve compression are discussed. Common and uncommon compression and entrapment syndromes of the upper extremity are described. Errors in diagnosis occur when the neurologic or electrodiagnostic examinations are incomplete or inaccurate.
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The evaluation and treatment of five patients with upper extremity neuropathies secondary to Charcot-Marie-Tooth disease were reviewed with emphasis on age at onset of Charcot-Marie-Tooth disease and upper extremity deformities, clinical findings, signs of associated nerve compression, and outcome of surgical treatment. The onset of the disease generally occurred in the first or second decade of life. The onset of upper extremity symptoms lagged behind by an average of 8 years. All patients had intrinsic minus hands with decreased sensibility. Three of five patients had clinical or electrophysiologic evidence of associated nerve compression syndromes. Treatment with standard tendon transfers, nerve compression releases, soft tissue releases, and joint fusions resulted in subjectively improved function in three of four patients undergoing reconstruction. Release of six compression neuropathies in one patient provided excellent pain relief, but the underlying neuropathy progressed. Pessimism regarding reconstructive surgery in the patient with upper extremity neuropathies secondary to Charcot-Marie-Tooth disease is unwarranted.
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A 55 year old male Turkish patient developed L3/L4 root compression caused by a retroperitoneal hematoma after covered perforation of the infrarenal aorta. The aneurysm was resected and a tube interposition made. For more than 20 years the patient has suffered from oral and scrotal ulcers. These signs led to the diagnosis of Behçet's disease. A review of the literature revealed 200 arterial complications (aneurysms and occlusions) in 105 patients with Behçet's disease, only 19 of them had aneurysms of the infrarenal aorta.
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Carpal tunnel syndrome is the most common peripheral nerve compression syndrome. Compression of the median nerve in the carpal tunnel, disrupts the blood-nerve barrier causing edema, inflammation and fibrosis of its surrounding connective tissues. In the next stage of the syndrome there is a disruption of the myelin coverage of the nerve followed by damage to the axons. Most carpal tunnel syndromes are idiopathic. Other causes include intrinsic factors (which cause pressure within the tunnel), extrinsic factors (which cause pressure from outside the tunnel) and overuse/exertional factors. Patients usually report numbness and pain of the palmar aspect of their 1st, 2nd, 3rd and radial half of their 4th finger, night pain and gradual worsening of their symptoms. At a later stage, weakness and atrophy of the thenar muscles appears. The physical examination may show a decrease in sensibility, positive provocative tests and a decrease in thenar strength. The typical finding in the nerve conduction tests is a prolonged latency period. The conservative treatment for carpal tunnel syndrome includes ergonomic modifications, anti inflammatory medications and splintage and less frequently, special exercise and therapeutic ultrasound. The indications for operative treatment are failure of conservative treatment or severe carpal tunnel syndrome. The purpose of the operation is to relieve the pressure in the carpal tunnel by dissecting the transverse ligament. The operation can be done in an open approach, endoscopic approach or limited invasive approach.