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At least 19 recordsLinked to original sources

Familial corneal hypesthesia.

A 4-year-old boy with severe, diffuse, asymptomatic, punctate, epithelial corneal erosions had bilateral sharply decreased corneal sensation with normal skin sensation in the distribution of the trigeminal nerves. Subsequent family studies disclosed five family members with similar corneal changes and decreased corneal sensation and no punctate erosions. None had decreased skin sensation in the distribution of the fifth cranial nerve. No environmental factors or evidence of local or systemic disease accounted for these findings.

Adolescent

Influence of Caldwell-Luc operation on developing permanent teeth.

The influence of Caldwell-Luc operation on the permanent teeth of school children was studied in a material of 21 six to 14-year-old children, who had undergone, altogether, 30 Caldwell-Luc operations. Ten of the children had also undergone 23 endonasal antrostomies. The control material consisted of a class of 27 healthy school children, their mean age being 10.2 years. Total anesthesia was found in five teeth on the operated side and in one tooth on the non-operated side. Additionally, the operation had caused slight hypesthesia in part of the teeth, mostly in the first incisors. All sensory disturbances were caused by nerve lesion only, and no tooth had died as a result of the operation. The operation could not be shown to be conducive to caries. Correctly performed, Caldwell-Luc operation does not cause serious dental injuries in school children, and is indicated especially in chronic sinobronchitis when conservative methods of treatment fail.

Adolescent

The deep posterior compartmental syndrome of the leg.

Fourteen cases of deep posterior compartmental syndrome of the leg complicating lower-extremity trauma were analyzed. Caused by increased pressure within the deep posterior compartment, the syndrome was characterized by pain, plantar hypesthesia, weakness of toe flexion, pain on passive toe extension, and tenseness of the fascia between the tibia and the triceps surae in the distal medial part of the leg. Decompression of the compartment within twelve hours of the onset of the syndrome prevented permanent sequelae.

Adult

Local anesthetic effect of intrathecal normal saline.

The effects of intrathecally administered normal saline have been studied in patients undergoing graduated spinal anesthesia. The injection of 5 or 10 ml volumes resulted in segmental hypesthesia to pin-scratch and cold stimuli extending from the lower thoracic to the sacral dermatomes. There was also partial sympathetic block evidenced by a diminished psychogalvanic skin reflex. The sites and possible mechanisms of action of saline are discussed; its use as placebo in graduated spinal anesthesia is questioned. It is concluded that normal saline acts as a weak local anesthetic when injected intrathecally.

Adult

The needle effect in the relief of myofascial pain.

In reviewing techniques for therapeutic local anaesthesia of pain spots, it appeared that the common denominator was puncture by the needle and not the anaesthetic employed. The present study examines short- and long-term effects of dry needling in the treatment of chronic myofascial pain. 241 patients and 312 pain sites were treated by needling. When the most painful spot was touched by the needle, immediate analgesia without hypesthesia was observed in 86.8% of cases. Permanent relief of tenderness in the needled structure was obtained for 92 structures; relief for several months in 58; for several weeks in 63; and for several days in 32 out of 288 pain sites followed up. The effectiveness of treatment was related to the intensity of pain produced at the trigger zone, and to the precision with which the site of maximal tenderness was located by the needle. The immediate analgesia produced by needling the pain spot has been called the "needle effect".

Acupuncture Therapy

Orbital floor fractures--should they be explored early?

One hundred consecutive cases of orbital floor fractures from varying causes are reviewed, and the admission symptoms and signs are compared to the late results. We considered the early findings of diplopia, infraorbital rim step-off, and hypesthesia (with an associated clinical diagnosis of malar bone involvement) an indication for exploration of the orbital floor and possible placement of silicone sheeting. When this was done, minimal complications resulted.

Adolescent

Carpal tunnel syndrome in pregnancy.

Occurrence of the carpal tunnel syndrome in pregnancy was studied by examining 100 consecutive obstetric admissions. Twenty-one patients reported paresthesias or hypesthesia in the median nerve sensory distribution of the hand during the pregnancy; eight of these had decreased sensation subjectively at the time of examination one to three days after delivery; two had trophic changes, loss of sudomotor function, thenar atrophy, and decreased two-point discrimination; and one had a delay in motor conduction time across the carpal tunnel. Of the 21 patients, 18 became asymptomatic before or shortly after delivery. The remaining three were asymptomatic three months after delivery. We conclude that the incidence of symptoms is probably greater than usually appreciated, but that few patients require treatment. Steroid injection may occassionally be necessary, but the need for surgical intervention is rare.

Carpal Tunnel Syndrome

Diabetic polyneuropathy. Corneal sensitivity, vibratory perception and Achilles tendon reflex in diabetics.

In a controlled study, corneal sensitivity, vibratory perception of the left index finger and great toe and achilles tendon reflex were examined in 100 diabetes patients and 100 controls. The result showed significantly reduced corneal sensitivity, vibratory perception and increased number of areflexi in the diabetic group. Furthermore, the decrease of corneal sensitivity, vibratory perception and presence of areflexi correlated well to one another and to age, duration of D. M. above 15 years and diabetic retinopathy. Significant intercorrelations suggest that a reduced corneal touch threshold forms part of a polyneuropathy in diabetes. A corneal hypesthesia cannot be considered a valuable index in screening a population for diabetes as previously has been suggested.

Achilles Tendon

Experimental allergic neuritis induced by sensitization with galactocerebroside.

Thirteen of 31 rabbits immunized repeatedly with bovine brain galactocerebroside developed experimental allergic neuritis, manifested by flaccid paresis and hypesthesia of four limbs, 2 to 11 months after the initial inoculation. Electrophysiological studies revealed multifocal conduction block of peripheral nerves. Perivenular demyelinative lesions associated with phagocytic mononuclear cells occurred in spinal ganglia, roots, and less frequently in distal nerves.

Animals

Notalgia paresthetica.

Notalgia paresthetica was described by Astwazaturow in 1934. We have seen six cases in the past year, suggesting that it is not rare. This sensory neuritis affects the posterior rami of several spinal nerves (arising from thoracic segments T2 to T6), causing pruritus, burning, and dysesthesias. Examination reveals hypesthesia. Although the cause is not known, the course seems benign. The posterior rami of these five dorsal roots traverse a 90-degree course through the multifidus spinae muscle, making them unique among the posterior rami.

Adult

Facial palsy: interpretation of neurologic findings.

A review of the otoneurologic findings in 500 patients with facial paralysis revealed their importance for diagnosis, prognosis, and understanding the pathophysiology of Bell's palsy. Diagnosis. The presence of simultaneous bilateral palsy, facial paralysis associated with lateral rectus palsy, slowly progressive facial weakness with or without hyperkinesis, and facial paralysis that showed no recovery after six months excluded Bell's palsy from the diagnosis. Ipsilateral recurrent palsies were another indication to suspect an underlying cause, since a tumor of the facial nerve caused the paralysis in 30% of the patients with this finding. Signs such as intact forehead movement, alterations in facial sensation, and corneal hypesthesia--although often associated with lesions in the cerebral cortex, cerebellopontine angle, or internal auditory canal--were also found in patients with Bell's palsy. Prognosis. A spontaneous complete recovery following Bell's palsy occurs in about 70% of the patients; but in the presence of a dry eye or dysacousis, the prognosis for a complete recovery drops 10 and 25%, respectively. Pathophysiology. It is proposed that the wide range of neurologic findings associated with Bell's palsy is due to a viral polyneuropathy. This is a disorder that primarily involves sensory nerves, and the facial motor deficit results from involvement of the sensory fibers carried with the facial nerve within the fallopian canal.

Cornea

Recurrent transient ischemic attacks secondary to an embolizing saccular middle cerebral artery aneurysm. Case report.

Over a 1-year period, a 60-year-old woman had nine episodes of transient weakness, clumsiness, and hypesthesia of the right upper extremity. Angiography revealed normal extracranial vessels and a left middle cerebral artery aneurysm. The aneurysmal sac, removed at operation, had an organized thrombus, which was believed to be the cause of the transient ischemic attacks. Postoperatively, the patient has remained free of neurological symptoms.

Female

[Late results after surgical treatment of carpal tunnel syndrome. A clinical follow-up study of 60 cases].

In a follow-up study 60 hands of 49 patients were examined 1-12 years after operation for carpal tunnel syndrome. The syndrome was diagnosied in the majority of cases on clinical examination only. Paresthesia, hypesthesia or anesthesia in the 3 1/2 radial fingers of the hand are typical signs. Some patients complained of severe pain irradiating towards the elbow and shoulder. The method of surgical treatment is described in detail. Of the 49 patients only 2 were dissatisfied with the result. Both patients suffered from stenosing arteriosclerotic disease of the peripheral arteries of the hand and their pain and paresthesia were relieved by thoracic sympahtectomy. 58% of patients had complete relief from from symptoms while the remaining cases had a significant reduction of symptoms and were satisfied with the result of surgical treatment. The results were better in those patients who were operated on soon after the onset of symptoms. From the results of this study it is clear that surgical treatment of carpal tunnel syndrome provides good results and that surgical treatment should be recommended without delay if conservative treatment is unsuccessful.

Adult

Corneal ulcers associated with Goldenhar syndrome.

Two patients with Goldenhar syndrome developed corneal ulcers. Previous acid burn of the cornea and prolonged topical corticosteroid administration occurred in Patient 1. Predisposing ocular anomalies in patients with Goldenhar syndrome include corneal hypesthesia; keratoconjunctivitis sicca, and exposure secondary to eyelid colobomas, lacrimal gland and duct anomalies, dermoids and lipodermoids, and neurologic deficits. Serious ocular morbidity may be prevented by searching for and adequately treating these predisposing factors. It is possible that embryonic events contribute to ocular complications in Goldenhar syndrome, in part, by causing hypoplasia or abnormal function of the trigeminal and facial nerves.

Abnormalities, Multiple

[A case of bilateral spontaneous external carotid-cavernous fistulae with intrahepatic gallbladder (author's transl)].

A 55-year-old female presented bilateral external ophthalmoplegias and a hypesthesia in the left face and then an intracranial bruit, bilateral conjunctival injections and bilateral chemosis. In her past history, there were right retinal hemorrhage, diabetes mellitus and hypertension but no cranial trauma. The arteriographical aspects were almost identical in both sides: selective external carotid arteriography revealed an opacification of the cavernous sinus through the ascending pharyngeal artery, the accessory meningeal artery and the middle meningeal artery, but the internal carotid arteries and the vertebral arteries did not participate in these fistulae. The association in our case of spontaneous external carotid-cavernous fistulae with intrahepatic gallbladder derived from a developmental arrest in the early stage of embryonic life suggests that spontaneous external carotid-cavernous fistula is derived from communications between extra-cranial vessels and the sinuses in the early stage of embryonic life.

Arteriovenous Fistula

Zygomycosis of the maxillary sinus and palate caused by Basidiobolus haptosporus.

Basidiobolus haptosporus is known to cause subcutaneous zygomycosis in tropical Africa and Asia. We cared for a 49-year-old hyperglycemic, asplenic man who had never traveled outside the United States and who was seen initially for a painless palatal ulcer with cutaneous hypesthesia of the right cheek and upper lip. An invasive process involved the right middle nasal turbinate, maxillary antrum, maxillary division of the trigeminal nerve, and bony palate. Histological examination of biopsy tissue showed necrotizing granulomata with broad, nonseptate hyphae. Basidiobolus haptosporus was cultured from this tissue. Various laboratory studies revealed no immunologic defect and his lesions responded to therapy with amphotericin B. To our knowledge, this represents the first case of zygomycosis caused by B haptosporus in the Americas and the first culture-documented case of invasive mycosis caused by this mold.

Fungi