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Results for “sensory function”

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PubMed2004

Alpha-MSH inhibits inflammatory signalling in Schwann cells.

Peripheral nervous system injury may be corrected by surgical repair, but in many cases this is not possible and will result in loss of motor and sensory function. Schwann cells provide many neurotrophic signals essential for axon regeneration and immediately after injury inflammatory cytokines are released necessary for Schwann cell de-differentiation. However, extended periods of inflammation after injury prevent Schwann cell proliferation, and therefore interventional approaches to enhance proliferation may in turn improve axon regeneration. We therefore investigated the ability of alpha-melanocyte stimulating hormone (alpha-MSH; a potent anti-inflammatory peptide) to inhibit the activation of the NF-kappaB transcription factor (required for inflammatory signalling) in cultured rat primary Schwann cells, stimulated with tumour necrosis factor-alpha (TNF-alpha) or interferon-gamma (IFN-gamma). Both cytokines activated NF-kappaB rapidly after 60 min incubation, observed as a translocation from the cytoplasm to the nucleus. alpha-MSH inhibited activation (i.e. inhibited nuclear translocation) in response to TNF-alpha or IFN-gamma by 81% and 100% respectively. The anti-inflammatory properties of this peptide may therefore have potential for treatment of peripheral nerve injury to improve the healing response.

Animals↗

PubMed1998

Quadriceps weakness in osteoarthritis.

Involvement of the quadriceps muscle group in knee osteoarthritis is receiving increasing research interest. The motor and sensory functions of muscle are intimately linked, and deficits in the sensorimotor functions of the quadriceps have been identified and proposed as possible factors in the pathogenesis of knee osteoarthritis or as consequences of the disease. Weakness of the quadriceps as a clinical feature of knee osteoarthritis has been well recognized for some time, but causes for this weakness and its significance as a determinant of the patient's disability is only now being investigated. Rehabilitation regimens that increase quadriceps weakness also effect improvements in the patient's disability, but the length and cost most of these research regimens would be impractical in the clinical setting. More clinically practicable rehabilitation regimens need to be devised that could be implemented in the community, if the management of this chronic, prevalent condition is to be managed effectively and cost-effectively.

Disability Evaluation↗

PubMed1997

Shoulder fusion for paralyzed upper limb.

Fusion of the shoulder joint after a brachial plexus injury is a well known procedure in cases of flail shoulder in combination with normal motor and sensory function in the band. However, in combination with modern orthoses to stabilize the elbow, fusion of the shoulder in cases of a totally flaccid and afunctional arm might be more beneficial. In a retrospective study the impact of shoulder fusion on daily abilities in a population with a completely flaccid arm caused by a brachial plexus injury was investigated. Compared with a similar population, consisting of 16 patients with an afunctional unstable shoulder, all 12 patients who underwent shoulder fusion proved to perform at a higher functional level. Shoulder fusion in combination with an elbow stabilizing orthosis for a completely flaccid upper limb is a beneficial procedure that leads to less disability and results in a better quality of life.

Brachial Plexus↗

PubMed2002

Bilateral multiple cervical root avulsions without skeletal or ligamentous damage resulting from blast injury: case report.

OBJECTIVE AND IMPORTANCE: We describe a unique case of multiple bilateral cervical root injuries without ligamentous or bony injury secondary to a sandblast accident. CLINICAL PRESENTATION: A 19-year-old man sustained a sandblast injury to his face, neck, chest, and upper extremities, with immediate loss of motor and sensory function occurring in both of his upper extremities. Cervical spine x-rays, computed tomography, and magnetic resonance imaging demonstrated no fracture, soft tissue abnormality, or malalignment. The restriction of deficits to the patient's upper extremities suggested a central cervical spinal cord injury, bilateral brachial injuries, or a conversion disorder. INTERVENTION: Cervical computed tomographic myelography revealed multiple bilateral nerve root injuries. CONCLUSION: This case report is unique in the literature in that it describes a patient with multiple cervical nerve root injuries secondary to sandblast injury without ligamentous or bony injury. Although magnetic resonance imaging remains the diagnostic modality of choice in patients with acute spinal cord injury, it is deficient in demonstrating cervical root injury in the acute setting. In this setting, computed tomographic myelography is superior.

Adult↗

PubMed1977

A study of vision in cerebral palsy.

One hundred twenty-eight patients (most less than 13 years old) with various types of cerebral palsy were examined to assess visual acuity, refractive state, oculomotor functions, sensory fusion, and ocular health. Special procedures for examining these patients are described. Vision or ocular defects were found to be present in 86% of these cerebral palsy patients. Significant refractive errors and strabismus were the most common defects, being present in 50% or more of the patients. Ocular disease was relatively uncommon.

Adolescent↗

PubMed1983

Auditory feedback in the control of congenital nystagmus.

The control of oscillatory eye movements in congenital nystagmus was studied in five human subjects. Auditory feedback of eye position and eye motion was given to each subject to aid in controlling the abnormal eye movement. Less than one hour was needed for all the subjects to learn to use the auditory information. Reductions in eye movement amplitude ranged from 41 to 73%. Sensory functions like visual acuity and contrast sensitivity also improved under the auditory feedback condition. Auditory feedback of eye position is thought to have potential usefulness in the treatment of congenital nystagmus.

Adolescent↗

PubMed1995

Aging and pattern visual evoked potentials.

Visual abilities decline during senescence. Age-related declines cannot be attributed entirely to changes in optical factors (senile miosis and opacification of the ocular media) and must therefore be caused by changes in the visual pathways. Because pattern visual evoked potentials (VEPs) provide information regarding the sensory function and integrity of the visual system, recent research on age-related changes in VEPs is reviewed. The results of this review show that stimulus parameters of VEPs (luminance, contrast, spatial and temporal frequencies) modify the age-related changes in VEPs. The visual system consists of multiple, parallel channels which process different information. Therefore, it is hypothesized that aging may affect the specific functional subdivisions in the visual pathways differentially.

Adolescent↗

PubMed1981

Neural influences on experimental flap survival.

We have constructed a consistent, reproducible experimental model for the study of skin flap survival consisting of paired flaps that are identical except for the presence or absence of innervation. While the denervated flap survived to only 70 percent of its original length, the innervated flap survived completely in all cases. We then studied the effect of adrenergic innervation on flap survival by performing a chemical sympathectomy using 6-hydroxydopamine. We observed that loss of sympathetic innervation, as measured by absence of piloerection and catecholamine fluorescent staining, resulted in flap necrosis even in the presence of intact somatic and sensory function. We have concluded that the observed differences in survival between the innervated and denervated flaps appear to be dependent at least in part of the presence or absence of noradrenergic regulation of the microcirculation within the flaps.

Animals↗

PubMed2002

The relationship of facial two-point discrimination to applied force under clinical test conditions.

When an interside comparison is hampered, for example, in cases of bilateral trauma, normal threshold values of two-point discrimination from healthy subjects might be used to delineate abnormal from normal sensory function in patients. To determine threshold pin distances, two devices, the Disk-Criminator and the Aesthesiometer, have often been applied in a clinical setting. Because these devices are hand-operated, the force of applying a device might vary considerably. The general applicability of normal threshold values from the literature may therefore be questioned. Five subjects participated in experiments with two observers, in which a hand-operated device with a constant pin distance (5 or 10 mm) was pushed on a facial site, until the point at which blanching of the skin started, and the applied force was recorded. To that end, the devices were modified by providing them with force transducers. These recordings revealed a considerable variation in force variables (level, duration, and rate). Significant differences in mean force level, duration, and rate occurred, particularly between devices, pin distances, and/or sites (cheek, upper and lower lips, and mental region) and also in mean duration between observers (p < 0.01 to 0.001, analysis of variance). However, the observed force levels were always at an extremely supra-threshold stimulus intensity. The threshold pin distances in subsequent experiments (four subjects, the two devices and two sites: cheek and mental region) were therefore almost invariant to the difference in the extreme low and high force levels that were applied, using acoustic feedback on the force signal. Furthermore, these thresholds were also similar when one or two observers performed repeated measures on groups of 15 to 18 subjects under the influence of a usual variation of force level, using an interval of at least 1 week and both nonmodified devices. Because of invariance, normal values of threshold pin distance are generally applicable to any well-trained observer and are related to the density of afferent nerve fibers. In contrast, recently reported force thresholds determined at a constant pin distance might not be related to fiber density only. The findings regarding dependency on site and pin distance of the force level suggest that force thresholds will also be related to tissue stiffness and to the extent to which a pair of pins co-operate mechanically.

Adult↗

PubMed1998

Spontaneous spinal epidural hematoma with spinal cord compression complicating plasma cell myeloma. A case report.

STUDY DESIGN: A case is reported in which a patient had acute paraplegia with sensory loss caused by a spontaneous epidural hematoma that was ascribed to bleeding of pre-existing myeloma lesions of the thoracic vertebrae. OBJECTIVES: To highlight the causes of secondary epidural hematomas with special attention to pre-existing vertebral or epidural lesions. SUMMARY OF BACKGROUND DATA: There are no apparent previous reports of epidural spinal hematomas ascribed to underlying malignant diseases. Benign dysplasia, such as hemangioma or Paget's disease, has been implicated in a few cases. METHODS: A case of spontaneous dorsal epidural hematoma is reported in a patient followed up for plasma cell myeloma with osteolytic lesions in the lower thoracic spine. There was no history of major trauma or coagulation disorders. Complete loss of motor and sensory function in both lower limbs was noted, with sphincter dysfunction. Magnetic resonance imaging of the thoracic spine showed a large posterolateral epidural hematoma responsible for spinal cord compression. RESULTS: The patient failed to improve despite surgical decompression within 6 hours of symptom onset. He died 13 days later of refractory bacterial pneumonia. A large epidural hematoma adjacent to myelomatous lesions of the thoracic vertebrae was found at autopsy. CONCLUSIONS: This is the first reported case of spontaneous epidural hematoma ascribed to underlying malignant disease, with confirmation of the diagnosis by postmortem examination. Possible mechanisms include tumor-related epidural inflammation and fragility of epidural venous plexuses.

Aged↗

PubMed1999

Thoracic disc herniation mimicking acute lumbar disc disease.

STUDY DESIGN: Case report of a 49-year-old woman with a lower thoracic disc herniation mimicking acute lumbosacral radiculopathy. OBJECTIVE: To describe an unusual case of thoracic disc herniation mimicking acute lumbar disc disease. SUMMARY OF BACKGROUND DATA: Symptomatic thoracic disc herniation is rare and its clinical manifestations differ widely from those of cervical and lumbar disc herniations. Midline back pain and signs of spinal cord compression progressing over months or years are the predominant clinical features. Acute and subacute thoracic disc herniation occurs in less than 10% of patients, and isolated root pain is unusual. METHODS: A 49-year-old woman had acute low back pain radiation into the left buttock and the lateral aspect of the left leg and left foot. Magnetic resonance imaging study showed a bulging disc and posterior osteophytes at T11-T12. RESULTS: Surgical removal of the herniated disc and osteophytes rapidly relieved her symptoms and neurologic deficits. A follow-up neurologic examination 3 years later showed normal motor and sensory functions, although low back soreness was noted occasionally. CONCLUSION: A case of thoracic disc herniation mimicking an acute lumbosacral radiculopathy is presented. Compression of the lumbosacral spinal nerve roots at the lower thoracic level after exit from the lumbar enlargement may be the mechanism for this unusual presentation.

Acute Disease↗

PubMed2000

Surgical outcome of cervical expansive laminoplasty in patients with diabetes mellitus.

STUDY DESIGN: The results from cervical laminoplasty in 18 patients with diabetes mellitus were compared with results from the same procedure in 34 nondiabetic patients matched for age, gender, and disease. OBJECTIVE: To analyze the effects of diabetes mellitus on the surgical outcome after cervical laminoplasty. SUMMARY OF BACKGROUND DATA: There have been no reports on the results of cervical laminoplasty patients with diabetes. METHODS: A retrospective analysis of 18 patients with diabetes mellitus who underwent cervical laminoplasty and 34 nondiabetic patients who underwent the same surgical procedure was undertaken. The postoperative score, intra- and postoperative findings, complications, and radiologic factors were compared between the two groups. In the group with diabetes, the correlation between the recovery rate of the Japanese Orthopedic Association score and the factors indicating the severity of diabetes was assessed. RESULTS: There was no statistical difference between the total Japanese Orthopedic Association scores of the two groups. However, the group with diabetes mellitus showed a poor recovery of sensory function of the lower extremities. Three patients in the group with diabetes had superficial wound complication after surgery. In contrast, none of the patients in the control group had a wound problem. Furthermore, a negative correlation was observed between the recovery rate and the preoperative HbA1 level in the group with diabetes. CONCLUSIONS: Although patients with diabetes mellitus who had cervical myelopathy experienced benefits from cervical laminoplasty similar to those of nondiabetic patients, the patients with diabetes were more likely to have wound complication. Furthermore, the negative correlation between the recovery rate and the preoperative HbA1 value might suggest that long-term diabetes control of more than 2 to 3 months before surgery at least is recommended for a favorable surgical outcome.

Aged↗

PubMed2004

Distal-type cervical spondylotic amyotrophy: assessment of pathophysiology from radiological findings on magnetic resonance imaging and epidurally recorded spinal cord responses.

STUDY DESIGN: Six cases with distal-type cervical spondylotic amyotrophy are reported. OBJECTIVE: To investigate the pathophysiology of distal-type cervical spondylotic amyotrophy from magnetic resonance imaging and intraoperative evoked spinal cord responses. SUMMARY OF BACKGROUND DATA: Cervical spondylotic amyotrophy had a characteristic clinical symptom of severe muscular atrophy with no or insignificant sensory deficit. Selective ventral root lesions or intrinsic spinal cord lesions have been proposed as the pathophysiology of cervical spondylotic amyotrophy, but they have not been well understood. METHOD: Six patients with distal-type cervical spondylotic amyotrophy were described, and their magnetic resonance imaging and evoked spinal cord potentials after median nerve, motor cortex, and spinal cord stimulation were investigated. RESULTS: Sagittal T2-weighted magnetic resonance imaging showed high signal intensity change within the spinal cord at C4-C5, C5-C6, and C6-C7. All patients underwent laminoplasty. The attenuation of postsynaptic potentials with preserved presynaptic potentials at C4-C5, C5-C6, and C6-C7 was characteristic in the evoked spinal cord potentials after median nerve stimulation. The amplitude of the evoked spinal cord potentials after median nerve stimulation was preserved at C2-C3. This means that lateral posterior column in the spinal cord had less or no involvement in distal-type cervical spondylotic amyotrophy. Concomitant hyperactivity of the patellar tendon reflex was correlated with the abnormality in the evoked spinal cord potentials after transcranial electric stimulation. CONCLUSIONS: The results suggest a longitudinal gray matter lesion as one pathophysiologic feature, and that less damage to the lateral posterior column is the reason for the preservation of sensory function in the patients with distal-type cervical spondylotic amyotrophy described in this study.

Aged↗

PubMed2002

Permanent thoracic myelopathy resulting from herniation of a calcified intervertebral disc in a child.

This retrospective study was made to illustrate the rare occurrence of neurologic deficits resulting from intervertebral disc calcification (IDC) in a child. Most authors agree that juvenile IDC is usually a benign, self-limiting disease with excellent prognosis. The symptoms subside spontaneously in 95% of patients. Conservative treatment is therefore usually sufficient. Reviewing the English-speaking literature, only two further cases of operated juvenile IDC with myelopathy have been published. In the current report, we describe a case of permanent thoracic myelopathy resulting from juvenile IDC treated by urgent decompressive thoracic laminectomy. At the 3-year follow-up examination, the patient had not recovered fully. Persisting deficits in motor and sensory function were observed.

Calcinosis↗

PubMed2002

Effect of transient chemically induced colitis on the visceromotor response to mechanical colorectal distension.

BACKGROUND: Acute mucosal inflammation may initiate alterations of visceral sensory function. However, experimental studies on the potential effects of a transient inflammation on visceral sensitivity are lacking. METHODS: We performed colorectal distensions with a barostat device in fasted, conscious, male Lewis rats (n = 20) and assessed the nociceptive response (visceromotor response; VMR) to tonic colorectal distension (CRD) (60 mmHg/3 min) by abdominal-wall electromyography. Measurements were taken before and 3, 5 and 14 days after induction of a transient and self-limiting colitis by instillation of trinitrobenzenesulphonic acid (TNB)/ethanol (or saline as control). Tissue samples from paired controls were obtained to assess histological tissue alterations. RESULTS: TNB/ethanol but not saline induced an acute colitis, with most severe histological lesions occurring 5 days after instillation. After 14 days, there was no histological evidence for persisting mucosal alterations. Five days after induction of TNB/ethanol colitis, the VMR to CRD reached a transient increase (P < 0.05 v. baseline), which returned to baseline levels by day 14. In control experiments (rectal saline instillation), the VMR to CRD decreased significantly compared with baseline values (P < 0.05). CONCLUSION: Following an acute colitis due to single colorectal instillation of TNB/ethanol, histological changes are associated with an enhanced nociceptive response to CRD.

Animals↗

PubMed2003

Abnormal levels of neuropeptide Y and peptide YY in the colon in irritable bowel syndrome.

OBJECTIVE: To assess the levels of gut peptides involved in gastrointestinal motor, secretory and sensory function in colonic biopsies in irritable bowel syndrome (IBS) patients and healthy controls. METHODS: We studied 34 patients with IBS and 15 subjects without gastrointestinal symptoms. The predominant bowel pattern in the IBS patients was constipation in 17 patients (IBS-C) and diarrhoea in 17 patients (IBS-D). With radioimmunoassay, the levels of vasoactive intestinal peptide (VIP), substance P, neuropeptide Y (NPY) and peptide YY (PYY) were analysed in biopsies from the descending colon and ascending colon obtained during colonoscopy. RESULTS: The IBS patients had lower levels of PYY in the descending colon than the controls, but the levels in the ascending colon did not differ. The NPY levels were lower in IBS-D than in IBS-C, both in the ascending colon and in the descending colon. Low levels of VIP were more common in IBS patients, but mean levels did not differ between groups. No group differences were observed for substance P. The levels of VIP, substance P and NPY were higher in the ascending colon than in the descending colon, whereas the opposite pattern was seen for PYY. CONCLUSION: IBS patients demonstrate lower levels of PYY in the descending colon than controls. Colonic NPY levels differ between IBS subgroups based on the predominant bowel pattern. These findings may reflect the pathophysiology of IBS and the symptom variation within the IBS population.

Adult↗

PubMed2000

New therapies with potential neuro-ophthalmologic toxicity.

Given the ever-increasing number of drugs available for the treatment of a variety of ocular and systemic disorders, it is not surprising that neuro-ophthalmologic complications are being recognized with increasing frequency. In this chapter, we describe both previously unreported (or rarely described) neuro-ophthalmologic complications produced by well known medications and neuro-ophthalmologic complications produced by new medications. The medications discussed include antidepressants, antiepileptic medications, topical antiglaucoma medications, and chemotherapeutic/immunosuppressive agents. Most of the side effects produced by these medications affect visual sensory function; however, some produce disturbances of ocular motility and alignment. Some of these effects are related directly to drug toxicity, whereas others are related to secondary effects of the drug. The heterogeneity of the pathogenesis of side effects from these drugs explains why some of the side effects are reversible, whereas others are not.

Antidepressive Agents↗

PubMed2005

Acute quadriplegia following closed traction reduction of a cervical facet dislocation in the setting of ossification of the posterior longitudinal ligament: case report.

STUDY DESIGN: A case report of acute quadriplegia resulting from closed traction reduction of traumatic bilateral cervical facet dislocation in a 54-year-old male with concomitant ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: To report an unusual presentation of a spinal cord injury, examine the approach to reversal of the injury, and review the treatment and management controversies of acute cervical facet dislocations in specific patient subgroups. SUMMARY OF BACKGROUND DATA: The treatment of acute cervical facet dislocations is an area of ongoing controversy, especially regarding the question of the necessity of advanced imaging studies before closed traction reduction of the dislocated cervical spine. The safety of an immediate closed, traction reduction of the cervical spine in awake, alert, cooperative, and appropriately select patients has been reported in several studies. To date, there have been no permanent neurologic deficits resulting from awake, closed reduction reported in the literature. A case of temporary, acute quadriplegia with complete neurologic recovery following successful closed traction reduction of a bilateral cervical facet dislocation in the setting of OPLL is presented. METHODS: The clinical neurologic examination, radiographic, and advanced imaging studies before and after closed, traction reduction of a cervical facet dislocation are evaluated and discussed. A review of the literature regarding the treatment of acute cervical facet dislocations is presented. RESULTS: Radiographs showed approximately 50% subluxation of the fifth on the sixth cervical vertebrae, along with computerized tomography revealing extensive discontinuous OPLL. The cervical facet dislocation was successfully reduced with an awake, closed traction reduction, before magnetic resonance imaging (MRI) evaluation. The patient subsequently had acute quadriplegia develop, with the ensuing MRI study illustrating severe spinal stenosis at the C5, C6 level as a result of OPLL or a large extruded disc herniation. Following an immediate anterior decompression and a posterior stabilization procedure, the patient regained full motor and sensory function. CONCLUSIONS: This case report highlights the advantages and shows some safety concerns regarding immediate, closed traction reduction of cervical facet dislocation with real-time neural monitoring in an awake, alert, oriented, and appropriately select patient before MRI studies in the setting of preexisting central stenosis from OPLL.

Acute Disease↗