[Little known forms of compression neuropathies of the lower extremities]. / Maloizvestnye formy kompressionnykh nevropatii nizhnikh konechnostei.

Neuropathies of the sural nerve, deep peroneal nerve and tibial nerve at the level of the tendinous arch of the musculus soleus pertain to the little-known forms of compression neuropathies. Examinations of 36 patients with 57 cases of such compression neuropathies have demonstrated that the main etiological moments of the disease are orthopedic diseases, illnesses of the joints and veins of the lower limbs and loading factor. The major clinical symptoms of the disease are spontaneous pains at the site of nerve compression, paresthesias, disorders of sensitivity in the area of innervation of the damaged nerve as well as pains on palpation at the level of nerve compression. Diagnosis is verified by the positive tests inducing pains and paresthesias and by stimulation electromyography. The principal treatment method lies in paraneural injection of glucocorticoids.

Diphtheria with polyneuropathy in a closed community despite receiving recent booster vaccination.

INTRODUCTION AND METHODS: We report 20 patients aged 18-24 years from Latvia with diphtheritic polyneuropathy. All lived in a closed community and 80% were known to have been fully vaccinated against diphtheria until at least 14 years old. Diphtheria antitoxin had been administered within 3 days of the onset of upper respiratory tract infection in 16 patients and 15 received antibiotics. RESULTS: Neurological symptoms developed after a median of 43 days (range 35-58) compared to only 10 days in previous studies of unvaccinated patients. All showed evidence of mild limb polyneuropathy with electrophysiological evidence of polyneuropathy. Only 30% showed early bulbar abnormalities compared to the usual rate of over 95% in diphtheritic polyneuropathy. However, 45% had later bulbar deterioration coinciding with the limb polyneuropathy. CONCLUSIONS: These patients show that an attenuated form of polyneuropathy of later onset, with less prominent early bulbar features, can occur in patients vaccinated against diphtheria according to schedule but living in a closed community in a country where diphtheria remains endemic.

[Occurrence of carpal tunnel syndrome among workers engaged in manual labor]. / Rasprostranenie sindroma zapiastnogo kanala sredi rabochikh, zaniatykh ruchnym trudom.

Examinations of 835 manual workers were performed, as a result of which high prevalence of carpal tunnel syndrome (CTS) was revealed (36.6%). Neurological studies proved a predominant (90.1%) occurrence of the 3rd stage of CTS cases. The analysis performed showed that the right arm was more affected, which was proved by lower sensitivity registered through electroneuromyography. In about 1/3 of the CTS patients, the disease was registered within 3 years of work. In 13.5% cases, the syndrome developed within several months of intensive manual labour.

Peripheral neuropathy in chronic occupational inorganic lead exposure: a clinical and electrophysiological study.

BACKGROUND AND OBJECTIVES: Traditionally the neuromuscular disorder associated with lead poisoning has been purely motor. This study assessed peripheral nerve function clinically and electrophysiologically in 46 patients with neuropathic features out of a total population of 151 workers with raised blood and/or urinary lead concentrations. RESULTS: Average duration of occupational exposure for the neuropathic group ranged from 8-47 years (mean 21.7). Their mean blood lead concentration (SD) was 63.9 (18.3) microg/dl (normal <40), urinary lead 8.6 (3.3) microg/dl (normal<5.0), urinary coproporphyrins 66.7 (38.4) microg/g creatinine (20-80), urinary aminolaevulinic acid 1.54 (0.39) mg/g creatinine (0.5-2.5). All 46 had distal paraesthesiae, pain, impaired pin prick sensation, diminished or absent ankle jerks, and autonomic vasomotor or sudomotor disturbances. Reduced vibration sensation and postural hypotension were present in all 20 studied. None of these 46 patients had motor abnormalities. Motor conduction velocity and compound muscle action potential amplitudes were normal, with marginally prolonged distal motor latencies. Sensory nerve action potential amplitudes lay at the lower end of the normal range, and the distal sensory latencies were prolonged. No direct correlation was found between the biochemical variables, and the clinical or electrophysiological data. CONCLUSIONS: One additional patient was seen with shorter term exposure to lead fumes with subacute development of colicky abdominal pain, severe limb weakness, and only minor sensory symptoms. Unlike the patients chronically exposed to lead, he had massively raised porphyrins (aminolaevulinic acid 21 mg/g creatinine, coproporphyrins 2102 microg/g creatinine). Patients with unusually long term inorganic lead exposure showed mild sensory and autonomic neuropathic features rather than the motor neuropathy classically attributed to lead toxicity. It is proposed that the traditional motor syndrome associated with subacute lead poisoning is more likely to be a form of lead induced porphyria rather than a direct neurotoxic effect of lead.