ABSTRACT
Neuropathies secondary to tophus compression in gout patients are well known; however, limited data exist on other types of peripheral neuropathies (PN). Our aim was to describe PN frequency, characteristics, distribution, patterns, and associated factors in gout patients through clinical evaluation, a PN questionnaire, and nerve conduction studies (NCS). This cross-sectional descriptive study included consecutive gout patients (ACR/EULAR 2015 criteria) from our clinic. All underwent evaluation by Rheumatology and Rehabilitation departments, with IRB approval. Based on NCS, patients were categorized as PN + (presence) or PN- (absence). PN + patients were further classified as local peripheral neuropathy (LPN) or generalized somatic peripheral neuropathy (GPN). We enrolled 162 patients, 98% male (72% tophaceous gout). Mean age (SD): 49.4 (12) years; mean BMI: 27.9 (6.0) kg/m2. Comorbidities included dyslipidemia (53%), hypertension (28%), and obesity (23.5%). Abnormal NCS: 65% (n = 106); 52% LPN, 48% GPN. PN + patients were older, had lower education, and severe tophaceous gout. GPN patients were older, had lower education, and higher DN4 scores compared to LPN or PN- groups (p = 0.05); other risk factors were not significant. Over half of gout patients experienced neuropathy, with 48% having multiplex mononeuropathy or polyneuropathy. This was associated with joint damage and functional impairment. Mechanisms and risk factors remain unclear. Early recognition and management are crucial for optimizing clinical outcomes and quality of life in these patients. Key Points Peripheral neuropathies in gout patients had been scarcely reported and studied. This paper report that: ⢠PN in gout is more frequent and more diverse than previously reported. ⢠Mononeuropathies are frequent, median but also ulnar, peroneal and tibial nerves could be injured. ⢠Unexpected, generalized neuropathies (polyneuropathy and multiplex mononeuropathy) are frequent and associated to severe gout. ⢠The direct role of hyperuricemia /or gout in peripheral nerves require further studies.
Subject(s)
Gout , Peripheral Nervous System Diseases , Humans , Cross-Sectional Studies , Gout/complications , Gout/epidemiology , Male , Middle Aged , Female , Peripheral Nervous System Diseases/complications , Peripheral Nervous System Diseases/epidemiology , Adult , Neural Conduction , Comorbidity , Nerve Compression Syndromes/complications , Surveys and Questionnaires , Aged , Risk FactorsABSTRACT
PURPOSE: To evaluate the ability of confocal near-infrared reflectance (NIR) to diagnose retrograde microcystic maculopathy (RMM) in eyes with temporal visual field (VF) loss and optic atrophy from chiasmal compression. To compare NIR findings with optical coherence tomography (OCT) findings in the same group of patients. METHODS: Thirty-four eyes (26 patients) with temporal VF loss from chiasmal compression and 41 healthy eyes (22 controls) underwent NIR fundus photography, and macular OCT scanning. VF loss was estimated and retinal layers thickness were measured on OCT. Two examiners blinded to the diagnosis randomly examined NIR images for the presence of hyporeflective abnormality (HA) and OCT scans for the presence of microcystic macular abnormalities (MMA). The total average and hemi-macular HA area and number of microcysts were determined. The groups were compared and the level of agreement was estimated. RESULTS: The OCT-measured macular retinal nerve fiber and ganglion cell layers were thinner and the inner nuclear layer was thicker in patients compared to controls. HA and MMA were detected in 22 and 12 patient eyes, respectively, and in 0 controls (p<0.001, both comparisons). HA was significantly more frequent than MMA in patients with optic atrophy, and agreement between HA and MMA (both total and hemi-macular) was fair (kappa range: 0.24-0.29). The mean HA area was significantly greater in the nasal than temporal hemi-macula. A re-analysis of the 14 eyes with discrepant findings allowed to confirm RMM in 20 eyes (20/34) indicating that OCT detected RMM in 12 and missed it in 8 eyes. On the other hand, NIR correctly detected 18 out of 20 eyes, overcalled 4 and missed 2. CONCLUSIONS: RMM is a frequent finding in eyes with severe VF loss from long-standing chiasmal compression. NIR photography appears to be more sensitive than OCT for detecting RMM and may be useful as screening method for its presence.
Subject(s)
Fundus Oculi , Macular Degeneration , Nerve Compression Syndromes , Optic Chiasm/diagnostic imaging , Optic Nerve Diseases , Tomography, Optical Coherence , Adult , Diagnostic Techniques, Ophthalmological , Female , Humans , Macular Degeneration/diagnostic imaging , Macular Degeneration/etiology , Male , Middle Aged , Nerve Compression Syndromes/complications , Nerve Compression Syndromes/diagnostic imaging , Optic Nerve Diseases/complications , Optic Nerve Diseases/diagnostic imaging , Prospective StudiesABSTRACT
Presentamos el caso de un paciente joven quien presenta 4 a 5 crisis diarias de vértigo espontáneo de segundos de duración, todos o casi todos los días desde hace 9 meses. Estas crisis no tienen gatillo posicional, y hay completa ausencia de sintomatologia entre crisis. Como discutimos en el artículo, este cuadro coíncide con los recientemente publicados criterios para una paroxismia vestibular, entidad supuestamente secundaria a la compresión neurovascular del nervio vestibular. El paciente respondió de forma inmediata y completa a carbamazepina a dosis bajas, el tratamiento de elección en la paroxismia vestibular.
We present the case of a young patient, with a 9-month long history of 4 to 5 daily spells of spontaneous vertigo, each lasting only seconds. There is no positional trigger, and there is a complete lack of symptoms between attacks. As is discussed in the article, this matches the recently published criteria for Vestibular Paroxysmia, an entity allegedly secondary to neurovascular compression of the vestibular nerve. The patient responded immediately and completely to carbamazepine at low dosage, the preferred treatment for vestibular paroxysmia.
Subject(s)
Humans , Male , Adult , Vestibulocochlear Nerve Diseases/complications , Vertigo/etiology , Nerve Compression Syndromes/complications , Vestibular Nerve/pathology , Vestibulocochlear Nerve Diseases/drug therapy , Vestibulocochlear Nerve Diseases/diagnostic imaging , Carbamazepine/therapeutic use , Vertigo/drug therapy , Anticonvulsants/therapeutic use , Nerve Compression Syndromes/drug therapy , Nerve Compression Syndromes/diagnostic imagingABSTRACT
Chronic abdominal wall pain (CAWP) refers to a condition wherein pain originates from the abdominal wall itself rather than the underlying viscera. According to various estimates, 10% to 30% of patients with chronic abdominal pain are eventually diagnosed with CAWP, usually after expensive testing has failed to uncover another etiology. The most common cause of CAWP is anterior cutaneous nerve entrapment syndrome. The diagnosis of CAWP is made using an oft-forgotten physical examination finding known as Carnett's sign, where focal abdominal tenderness is either the same or worsened during contraction of the abdominal musculature. CAWP can be confirmed by response to trigger point injection of local anesthetic. Once diagnosis is made, treatment ranges from conservative management to trigger point injection and in refractory cases, even surgery. This review provides an overview of CAWP, discusses the cost and implications of a missed diagnosis, compares somatic versus visceral innervation, describes the pathophysiology of nerve entrapment, and reviews the evidence behind available treatment modalities.
Subject(s)
Abdominal Pain/etiology , Abdominal Wall/innervation , Nerve Compression Syndromes/diagnosis , Humans , Nerve Compression Syndromes/complicationsABSTRACT
BACKGROUND: The coexistence of hemifacial spasm and trigeminal neuralgia, a clinical entity known as painful tic convulsive, was first described in 1910. It is an uncommon condition that is worthy of interest in neurosurgical practice, because of its common pathophysiology mechanism: Neuro-vascular compression in most of the cases. OBJECTIVE: To present 2 cases of painful tic convulsive that received treatment at our institution, and to give a brief review of the existing literature related to this. The benefits of micro-surgical decompression and the most common medical therapy used (botulin toxin) are also presented. CLINICAL CASES: Two cases of typical painful tic convulsive are described, showing representative slices of magnetic resonance imaging corresponding to the aetiology of each case, as well as a description of the surgical technique employed in our institution. The immediate relief of symptomatology, and the clinical condition at one-year follow-up in each case is described. A brief review of the literature on this condition is presented. CONCLUSION: This very rare neurological entity represents less than 1% of rhizopathies and in a large proportion of cases it is caused by vascular compression, attributed to an aberrant dolichoectatic course of the vertebro-basilar complex. The standard modality of treatment is micro-vascular surgical decompression, which has shown greater effectiveness and control of symptoms in the long-term. However medical treatment, which includes percutaneous infiltration of botulinum toxin, has produced similar results at medium-term in the control of each individual clinical manifestation, but it must be considered as an alternative in the choice of treatment.
Subject(s)
Botulinum Toxins, Type A/therapeutic use , Hemifacial Spasm/surgery , Microvascular Decompression Surgery/methods , Nerve Compression Syndromes/complications , Trigeminal Neuralgia/surgery , Aged , Basilar Artery/diagnostic imaging , Basilar Artery/pathology , Basilar Artery/surgery , Botulinum Toxins, Type A/administration & dosage , Female , Follow-Up Studies , Hemifacial Spasm/drug therapy , Hemifacial Spasm/etiology , Hemifacial Spasm/physiopathology , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Nerve Compression Syndromes/drug therapy , Nerve Compression Syndromes/physiopathology , Nerve Compression Syndromes/surgery , Trigeminal Neuralgia/drug therapy , Trigeminal Neuralgia/etiology , Trigeminal Neuralgia/physiopathology , Vertebral Artery/diagnostic imaging , Vertebral Artery/pathology , Vertebral Artery/surgeryABSTRACT
Objetivo Verificar a funcionalidade por meio da força muscular de preensão em animais com obesidade induzida por glutamato monossódico (MSG) e animais controle, que sofreram compressão do nervo mediano direito, tendo como tratamento a natação com carga. Métodos Ratos Wistar neonatos durante os primeiros cinco dias de vida receberam injeções subcutâneas de MSG. O grupo controle recebeu solução salina hiperosmótica. Quarenta e oito ratos foram divididos em seis grupos: G1(controle); G2 (controle com lesão); G3 (controle com lesão + natação); G4 (obesos); G5 (obesos com lesão); G6 (obesos com lesão + natação). Os animais dos grupos G2, G3, G5 e G6 foram submetidos à compressão do nervo mediano e os dos grupos G3 e G6 foram tratados, após a lesão, com exercício de natação com carga durante três semanas. A natação teve duração progressiva conforme as semanas, de 20, 30 e 40 minutos. A força muscular foi avaliada por meio de um medidor de força de preensão no pré-operatório, no terceiro, sétimo, 14° e 21° dia pós-operatório. Os resultados foram expressos e analisados por estatística descritiva e inferencial. Resultados Quando comparada a força de preensão entre as avaliações, indiferentemente de grupos, na segunda avaliação os animais apresentaram menor força de preensão. Os grupos G1 e G4 apresentaram força de preensão maior, em comparação com os grupos G2, G3, G4 e G6. Conclusão O exercício de natação com sobrecarga não foi eficaz em promover melhoria na força muscular de preensão após lesão de compressão do nervo mediano direito em ratos controle e obesos-MSG. .
Objective To verify the functionality through muscle grip strength in animals with obesity induced by monosodium glutamate (MSG) and in control animals, which suffered compression of the right median nerve, and treated with swimming with overload. Methods During the first five days of life, neonatal Wistar rats received subcutaneous injections of MSG. The control group received a hypertonic saline solution. Forty-eight rats were divided into six groups: G1 (control); G2 (control + injury); G3 (control + injury + swimming); G4 (obese); G5 (obese + injury); and G6 (obese + injury + swimming). The animals in groups G2, G3, G5 and G6 were submitted to compression of the median nerve and G3 and G6 groups were treated, after injury, with swimming exercise with load for three weeks. The swimming exercise had a progressive duration, according to the week, of 20, 30 and 40 min. Muscle strength was assessed using a grip strength meter preoperatively and on the 3rd, 7th, 14th and 21st days after surgery. The results were expressed and analyzed using descriptive and inferential statistics. Results When the grip strength was compared among assessments regardless of group, in the second assessment the animals exhibited lower grip strength. G1 and G4 groups had greater grip strength, compared to G2, G3, G4 and G6. Conclusion The swimming exercise with overload has not been effective in promoting improvement in muscle grip strength after compression injury of the right median nerve in control and in obese-MSG rats. .
Subject(s)
Animals , Rats , Hand Strength , Nerve Compression Syndromes/physiopathology , Obesity/physiopathology , Swimming , Median Nerve , Nerve Compression Syndromes/complications , Obesity/complications , Rats, Wistar , Weight-BearingABSTRACT
OBJECTIVE: To verify the functionality through muscle grip strength in animals with obesity induced by monosodium glutamate (MSG) and in control animals, which suffered compression of the right median nerve, and treated with swimming with overload. METHODS: During the first five days of life, neonatal Wistar rats received subcutaneous injections of MSG. The control group received a hypertonic saline solution. Forty-eight rats were divided into six groups: G1 (control); G2 (control + injury); G3 (control + injury + swimming); G4 (obese); G5 (obese + injury); G6 (obese + injury + swimming). The animals in groups G2, G3, G5 and G6 were submitted to compression of the median nerve and G3 and G6 groups were treated, after injury, with swimming exercise with load for three weeks. The swimming exercise had a progressive duration, according to the week, of 20, 30 and 40minutes. Muscle strength was assessed using a grip strength meter preoperatively and on the 3rd, 7th, 14th and 21st days after surgery. The results were expressed and analyzed using descriptive and inferential statistics. RESULTS: When the grip strength was compared among assessments regardless of group, in the second assessment the animals exhibited lower grip strength. G1 and G4 groups had greater grip strength, compared to G2, G3, G4 and G6. CONCLUSION: The swimming exercise with overload has not been effective in promoting improvement in muscle grip strength after compression injury of the right median nerve in control and in obese-MSG rats.
Subject(s)
Hand Strength , Nerve Compression Syndromes/physiopathology , Obesity/physiopathology , Swimming , Animals , Median Nerve , Nerve Compression Syndromes/complications , Obesity/complications , Rats , Rats, Wistar , Weight-BearingABSTRACT
El ultrasonido continuo fundamenta su efectividad en la energía térmica que genera, favoreciendo la reparación nerviosa. Es por esto que surge la interrogante de que si al aplicar diferentes intensidades de ultrasonido continuo sobre el nervio espinal lesionado, la respuesta reparativa será igual o distinta. Para ello se utilizaron 12 ratas de sexo masculino a las que se les aisló quirúrgicamente el nervio isquiático, el cual fue pinzado durante 45 segundos con una fuerza constante de 40N. La compresión se realizó a 10mm sobre la bifurcación, luego se desinfectó y suturó. Inmediatamente después de la operación las ratas fueron agrupadas de a 3: A) control sano, B) control lesionado, C) aplicación de ultrasonido terapéutico de 0,5w/cm2 y D) aplicación de ultrasonido terapéutico de 1w/cm2. El grupo A se utilizó como control sano y no recibió irradiación. Las ratas del grupo B fueron lesionadas y no recibieron irradiación y las del grupo C y D fueron lesionadas e irradiadas transcutáneamente en la región correspondiente al recorrido del nervio isquiático utilizando intensidades de 0,5w/cm2 y 1w/cm2, 3 MHZ de frecuencia, un cabezal de 0,5cm2, durante 1 minuto y 10 días consecutivos. 28 días post operatorio se extrajeron los nervios isquiáticos y fueron sometidos a técnicas de tinción de H-E y Van Gieson. Se realizó el diagnóstico histopatológico y la morfometría: se midió el Grosor del Perineuro, Perímetro del núcleo del Schwannocito, Perímetro del Axón Mielínicoy Perímetro de la Mielina. Los resultados revelan que el ultrasonido continuo es efectivo en la reparación del nervio espinal, siéndolo más con 1w/cm2 que con 0,5w/cm2.
The continuous ultrasound bases its efficiency on the heat energy it generates, favoring the nervous repair. Therefore, the question arises whether the reparative response will be equal or different under varying intensities of continuous ultrasound application on the disabled spinal nerve. For the study we used 12 male rats; the ischiatic nerve was surgically isolated and compressed during 45 seconds with a constant force of 40N. The compression was realized at 10 mm on the bifurcation, and was subsequently disinfected and sutured. Immediately following the operation the rats were separated in groups of 3: A) Healthy control, B) Injured control, C) Application of therapeutic ultrasound of 0.5 w/cm2 and D) Application of therapeutic ultrasound of 1 w/cm2. Group A was used as healthy control and did not receive irradiation. The rats in group B were injured and did not receive irradiation and those of groups C and D were injured and were transcutaneously irradiated in the area corresponding to the ischiatic nerve using intensities of 0.5 w/cm2 and 1 w/cm2, 3 MHZ of frequency. We used a compress of 0.5 cm2, during 1 minute and for 10 consecutive days. 28 days post operative ischiatic nerves were removed and submitted to technologies of H.E and VG stain. Histopathological and morphometrical diagnosis was realized: Thickness of the Perineurium, schwannocyte perimeter, Myelin Axon and Myelin perimeters were measured. The results revealed that the continuous ultrasound is effective in the repair of the spinal nerve, more so with 1 w/cm2 than with 0.5 w/cm 2.
Subject(s)
Male , Animals , Rats , Peripheral Nervous System Diseases/therapy , Sciatic Nerve/injuries , Ultrasonic Therapy/methods , Spinal Nerves/injuries , Rats, Sprague-Dawley , Nerve Compression Syndromes/complicationsABSTRACT
PURPOSE: To evaluate the correlation between multifocal pattern electroretinography (mfPERG) and Fourier-domain optical coherence tomography (FD-OCT) with regard to macular and retinal nerve fiber layer (RNFL) thickness in eyes with temporal hemianopia from chiasmal compression. METHODS: Twenty-five eyes from 25 patients with permanent temporal visual field defects from chiasmal compression and 25 healthy eyes were submitted to mfPERG using a stimulus pattern of 19 rectangles, standard automated perimetry and FD-OCT measurements. The mfPERG response was determined for groups of three rectangles for the nasal and temporal hemifields and for each quadrant. Macular thickness measurements were registered according to an overlaid OCT-generated checkerboard with 36 checks and averaged for the central area, and for each scanned quadrant and hemifield. RNFL thickness was determined for all twelve 30-degree segments around the disc, and averaged for the segments corresponding to the 6, 7, 8, 9, 10, 11 and 12 o'clock position. Correlations were verified with Pearson's correlation coefficients and linear regression analysis. RESULTS: Both mfPERG amplitudes and OCT measurements were significantly smaller in eyes with temporal visual field defects than in normals. A significant and strong correlation was found between most mfPERG and macular or RNFL thickness OCT parameters. CONCLUSIONS: mfPERG amplitudes and OCT measurements are significantly correlated in patients with chiasmal compression. Both technologies can quantify neuronal loss and, if used in combination, may help clarify structure-function relationships in this patient population.
Subject(s)
Electroretinography , Hemianopsia/physiopathology , Nerve Compression Syndromes/physiopathology , Optic Chiasm/physiopathology , Optic Nerve Diseases/physiopathology , Retinal Ganglion Cells/pathology , Tomography, Optical Coherence , Adenoma/pathology , Adenoma/surgery , Adult , Cross-Sectional Studies , Female , Fourier Analysis , Hemianopsia/etiology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nerve Compression Syndromes/complications , Nerve Fibers/pathology , Optic Nerve Diseases/complications , Pituitary Neoplasms/pathology , Pituitary Neoplasms/surgery , Prospective Studies , Statistics as Topic , Visual Field Tests , Visual FieldsABSTRACT
AIMS: There is mounting evidence that use of B vitamins can help control neuropathic pain. This study investigated if treatment with B1, B6 and B12 vitamins, alone or in combination with carbamazepine, can ameliorate distinct nociceptive behaviors in a model of trigeminal neuropathic pain. MAIN METHODS: Male Wistar rats were submitted to infraorbital nerve constriction or sham surgery and received a 5-day treatment with one of the B vitamins, a single carbamazepine injection or the association of both treatments and were tested for facial thermal and mechanical hyperalgesia at different time intervals. KEY FINDINGS: Repeated treatment with B1 (thiamine), B6 (pyridoxine) and B12 (cyanocobalamin) vitamins (at 180, 180 and 18 mg/kg/day, respectively, for 5 days) prevented the development of heat hyperalgesia after infraorbital nerve injury, but only B12 and B6 treatments attenuated cold and mechanical hyperalgesia, respectively. A single injection of carbamazepine (30 mg/kg) significantly reduced thermal, but not mechanical, hyperalgesia after nerve injury. Combinations of lower doses of each B vitamin (B1 and B6 at 18 mg/kg/day and B12 at 1.8 mg/kg/day for 5 days) with carbamazepine (10mg/kg) markedly reduced heat hyperalgesia after infraorbital nerve injury. Treatment with B12 (1.8 mg/kg/day) combined with carbamazepine (10mg/kg) also synergized to attenuate cold hyperalgesia at some time points, but combination of B6 (18 mg/kg/day) with carbamazepine (30 mg/kg) failed to modify mechanical hyperalgesia. SIGNIFICANCE: We suggest that B vitamins might constitute a relevant adjuvant to control some aspects of the pain afflicting patients suffering from trigeminal neuropathic pain.
Subject(s)
Nerve Compression Syndromes/complications , Neuralgia/drug therapy , Neuralgia/etiology , Orbit/innervation , Vitamin B Complex/therapeutic use , Analysis of Variance , Animals , Carbamazepine/pharmacology , Hyperalgesia/prevention & control , Male , Physical Stimulation , Rats , Rats, Wistar , Vitamin B Complex/pharmacologyABSTRACT
OBJETIVO: Avaliar o efeito da corrente catódica de alta voltagem sobre a dor em um modelo experimental de ciatalgia. MÉTODOS: Foram utilizados 16 ratos Wistar, machos, submetidos a um modelo de ciatalgia experimental no membro pélvico direito. Os sujeitos foram divididos em grupo simulacro (GS) e grupo tratado com corrente catódica (GP-) por 20 min diários durante 10 dias. O modelo de compressão foi realizado com amarria por fio catgut 4.0 cromado, em quatro pontos ao longo do nervo isquiático. A avaliação da nocicepção foi realizada, de forma funcional, com o tempo de elevação da pata (TEP), e à pressão, pelo limiar de retirada, via analgesímetro eletrônico. Os dados foram coletados antes do modelo de ciatalgia (AV1), três dias depois da compressão (antes, AV2, e após o tratamento, AV3), após o quinto dia de tratamento (AV4) e em seguida ao décimo dia de tratamento (AV5). RESULTADOS: Pela avaliação funcional, em ambos os grupos houve aumento da nocicepção, sem redução da mesma em qualquer momento da avaliação. À pressão, no entanto, o GS mostrou redução do limiar de retirada em todos os momentos, enquanto o GP- apresentou redução do limiar apenas inicialmente - em AV5 o limiar foi restaurado. CONCLUSÃO: Não houve alteração na nocicepção pela avaliação funcional; porém, à pressão, o tratamento com corrente catódica mostrou efeito com a somatória de terapias.
OBJECTIVE: To assess the effect of high-voltage cathodic current on pain from a sciatica experimental model. METHODS: A total of 16 male Wistar rats were submitted to the sciatica experimental model in the right hind paw. They were divided into sham group (GS) and group treated with cathodic current (GP-) for 20 min/daily, for 10 days). The model of sciatic compression was performed with a 4.0-chromic catgut thread tie in four points of the sciatic nerve. Assessment of nociception was performed by measuring the time during which the animal held its hind paw in a guarded position (THHP) and the pressure withdrawal threshold, by use of a digital electronic analgesymeter. Data collection was carried out before the sciatica experimental model (AS1), three days after compression (before, AS2, and after treatment, AS3), and five and 10 days after treatment (AS4 and AS5, respectively). RESULTS: According to the functional disability test, both groups showed an increase in nociception, with no reduction at any assessment time. Submitted to pressure, however, GS showed a reduction in the hind paw withdrawal threshold at all assessment times, while GP- showed a reduction in the hind paw withdrawal threshold only initially - at AS5, the threshold was restored. CONCLUSION: No change in nociception was observed on functional assessment; however, on pressure hind paw withdrawal assessment, the treatment with cathodic current showed to be effective with the summation of therapies.
Subject(s)
Animals , Male , Rats , Electric Stimulation Therapy/methods , Pain Management/methods , Sciatica/therapy , Disease Models, Animal , Nerve Compression Syndromes/complications , Pain/etiology , Rats, WistarABSTRACT
OBJECTIVE: To assess the effect of high-voltage cathodic current on pain from a sciatica experimental model. METHODS: A total of 16 male Wistar rats were submitted to the sciatica experimental model in the right hind paw. They were divided into sham group (GS) and group treated with cathodic current (GP-) for 20 min/daily, for 10 days). The model of sciatic compression was performed with a 4.0-chromic catgut thread tie in four points of the sciatic nerve. Assessment of nociception was performed by measuring the time during which the animal held its hind paw in a guarded position (THHP) and the pressure withdrawal threshold, by use of a digital electronic analgesymeter. Data collection was carried out before the sciatica experimental model (AS1), three days after compression (before, AS2, and after treatment, AS3), and five and 10 days after treatment (AS4 and AS5, respectively). RESULTS: According to the functional disability test, both groups showed an increase in nociception, with no reduction at any assessment time. Submitted to pressure, however, GS showed a reduction in the hind paw withdrawal threshold at all assessment times, while GP- showed a reduction in the hind paw withdrawal threshold only initially - at AS5, the threshold was restored. CONCLUSION: No change in nociception was observed on functional assessment; however, on pressure hind paw withdrawal assessment, the treatment with cathodic current showed to be effective with the summation of therapies.
Subject(s)
Electric Stimulation Therapy/methods , Pain Management/methods , Sciatica/therapy , Animals , Disease Models, Animal , Male , Nerve Compression Syndromes/complications , Pain/etiology , Rats , Rats, WistarABSTRACT
AIMS: To evaluate the ability of multifocal transient pattern electroretinography (mfPERG) to detect neural loss and assess the relationship between mfPERG and visual-field (VF) loss in eyes with chiasmal compression. METHODS: 23 eyes from 23 patients with temporal VF defects and band atrophy of the optic nerve and 21 controls underwent standard automated perimetry and mfPERG using a stimulus pattern of 19 rectangles, each consisting of 12 squares. The response was determined for the central rectangle, for the nasal and temporal hemifields (eight rectangles each) and for each quadrant (three rectangles) in both patients and controls. Comparisons were made using variance analysis. Correlations between VF and mfPERG measurements were verified by linear regression analysis. RESULTS: Mean ± SD mfPERG amplitudes from the temporal hemifield (0.50 ± 0.17 and 0.62 ± 0.32) and temporal quadrants (superior 0.42 ± 0.21 and 0.52 ± 0.35, inferior 0.51 ± 0.23 and 0.74 ± 0.40) were significantly lower in eyes with band atrophy than in controls (0.78 ± 0.24, 0.89 ± 0.28, 0.73 ± 0.26, 0.96 ± 0.36, 0.79 ± 0.26 and 0.91 ± 0.31, respectively). No significant difference was observed in nasal hemifield measurements. Significant correlations (0.36-0.73) were found between VF relative sensitivity and mfPERG amplitude in different VF sectors. CONCLUSIONS: mfPERG amplitude measurements clearly differentiate eyes with temporal VF defect from controls. The good correlation between mfPERG amplitudes and the severity of VF defect suggests that mfPERG may be used as an indicator of ganglion cell dysfunction.
Subject(s)
Electroretinography/methods , Hemianopsia/pathology , Nerve Compression Syndromes/complications , Optic Chiasm/pathology , Retinal Ganglion Cells/pathology , Adult , Aged , Atrophy/etiology , Atrophy/pathology , Atrophy/physiopathology , Denture Liners , Female , Hemianopsia/etiology , Hemianopsia/physiopathology , Humans , Male , Middle Aged , Nerve Compression Syndromes/pathology , Retinal Ganglion Cells/physiology , Sensitivity and Specificity , Severity of Illness Index , Visual Field Tests/methods , Visual Fields/physiologySubject(s)
Cerebellar Diseases/complications , Cerebellum/blood supply , Cerebral Arterial Diseases/complications , Nerve Compression Syndromes/complications , Oculomotor Nerve Diseases/etiology , Cerebellar Diseases/diagnosis , Cerebral Angiography , Cerebral Arterial Diseases/diagnosis , Chronic Disease , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nerve Compression Syndromes/diagnosis , Oculomotor Nerve Diseases/diagnosisABSTRACT
PURPOSE: To correlate visual field sensitivity (VFS) loss on standard automated perimetry (SAP) and quadrantic macular thickness on optical coherence tomography (OCT) in patients with permanent temporal hemianopia from chiasmal compression. METHODS: Forty eyes from 40 patients with chiasmal compression and 40 healthy eyes were submitted to standard automated perimetry and Stratus-OCT scanning. Raw data of the fast macular thickness scanning protocol were exported and macular thickness measurements were recorded and averaged for each quadrant and half of the central area. The correlation between visual field sensitivity loss and optical coherence tomography measurements was tested with Pearson's correlation coefficients and with linear regression analysis. RESULTS: A significant association was found between each macular thickness parameter and the corresponding central VF mean sensitivity. The strongest association was observed between superonasal macular thickness and the inferotemporal mean defect measured both in decibel (R=0.47; p=0.001) and in 1/Lambert (R=0.59; p<0.0001) units. CONCLUSION: Stratus-OCT-measured macular thickness was topographically related with visual field sensitivity loss in patients with temporal hemianopia from chiasmal compression. Such measurements could prove clinically useful in the diagnosis and follow-up of patients with chiasmal compression. ClinicalTrial.gov identifier number: NCT0039122.
OBJETIVO: Avaliar a correlação entre o defeito de campo visual ao exame de perimetria computadorizada e a espessura macular quadrântica ao exame de tomografia de coerência óptica (OCT) em pacientes com hemianopsia temporal permanente causada por compressão quiasmática. MÉTODOS: Quarenta olhos de 40 pacientes com compressão quiasmática e 40 olhos de 40 indivíduos controles foram submetidos aos exames de perimetria computadorizada e tomografia de coerência óptica. Dados não processados foram exportados e as medidas de espessura macular foram calculadas para cada quadrante e metade da área macular central. A correlação entre o defeito campimétrico e as medidas de espessura macular foi avaliada por coeficiente de correlação de Pearson e por análise de regressão linear. RESULTADOS: Associação significante foi encontrada entre os parâmetros de espessura macular e seus respectivos defeitos campimétricos. A correlação mais forte foi encontrada entre o parâmetro espessura macular nasal superior e o defeito campimétrico médio temporal inferior medido em decibel (R=0,47; p=0,001) e em 1/Lambert (R=0,59; p<0,0001). CONCLUSÃO: Medidas de espessura macular avaliada através da tomografia de coerência óptica foi topograficamente relacionada ao defeito campimétrico em pacientes com hemianopsia temporal por compressão quiasmática. Estas medidas podem provar a importância clínica no diagnóstico e seguimento dos pacientes com compressão quiasmática. ClinicalTrial.gov identifier number: NCT0039122.
Subject(s)
Adult , Female , Humans , Male , Hemianopsia/physiopathology , Macula Lutea/pathology , Nerve Compression Syndromes/complications , Optic Chiasm/pathology , Visual Fields/physiology , Epidemiologic Methods , Hemianopsia/etiology , Hemianopsia/pathology , Tomography, Optical CoherenceSubject(s)
Humans , Male , Middle Aged , Cerebellar Diseases/complications , Cerebellum/blood supply , Cerebral Arterial Diseases/complications , Nerve Compression Syndromes/complications , Oculomotor Nerve Diseases/etiology , Cerebral Angiography , Chronic Disease , Cerebellar Diseases/diagnosis , Cerebral Arterial Diseases/diagnosis , Magnetic Resonance Imaging , Nerve Compression Syndromes/diagnosis , Oculomotor Nerve Diseases/diagnosisABSTRACT
Headache is one of the most common types of recurrent pain in medical practice. Although nearly everyone has occasional headaches, there are well-defined headache disorders that vary in incidence and prevalence. Among the unusual headache syndromes, headache due to external compression is a poorly studied headache considered to arise as a result of continued stimulation of cutaneous nerves by the application of pressure over the scalp or forehead. The wearing of bands around the head, specifically goggles (such as those worn for swimming), tight hats, or even professional helmets have been described as causative factors. The pain is often constant and more severe at the location where the object is pressing the head. In predisposed patients (ie, those with migraine), external compression may lead to a more severe migrainous headache if the stimulus is prolonged. The mechanism responsible is the compression of trigeminal or occipital nerves branches. The headache resolves after pressure is relieved, or is prevented by avoiding the precipitating cause. Drugs are rarely used.
Subject(s)
Eye Protective Devices/adverse effects , Head Protective Devices/adverse effects , Headache/diagnosis , Headache/etiology , Pressure/adverse effects , Animals , Headache/prevention & control , Humans , Nerve Compression Syndromes/complications , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/prevention & controlABSTRACT
PURPOSE: To correlate visual field sensitivity (VFS) loss on standard automated perimetry (SAP) and quadrantic macular thickness on optical coherence tomography (OCT) in patients with permanent temporal hemianopia from chiasmal compression. METHODS: Forty eyes from 40 patients with chiasmal compression and 40 healthy eyes were submitted to standard automated perimetry and Stratus-OCT scanning. Raw data of the fast macular thickness scanning protocol were exported and macular thickness measurements were recorded and averaged for each quadrant and half of the central area. The correlation between visual field sensitivity loss and optical coherence tomography measurements was tested with Pearson's correlation coefficients and with linear regression analysis. RESULTS: A significant association was found between each macular thickness parameter and the corresponding central VF mean sensitivity. The strongest association was observed between superonasal macular thickness and the inferotemporal mean defect measured both in decibel (R=0.47; p=0.001) and in 1/Lambert (R=0.59; p<0.0001) units. CONCLUSION: Stratus-OCT-measured macular thickness was topographically related with visual field sensitivity loss in patients with temporal hemianopia from chiasmal compression. Such measurements could prove clinically useful in the diagnosis and follow-up of patients with chiasmal compression. ClinicalTrial.gov identifier number: NCT0039122.
Subject(s)
Hemianopsia/physiopathology , Macula Lutea/pathology , Nerve Compression Syndromes/complications , Optic Chiasm/pathology , Visual Fields/physiology , Adult , Epidemiologic Methods , Female , Hemianopsia/etiology , Hemianopsia/pathology , Humans , Male , Tomography, Optical CoherenceABSTRACT
PURPOSE: To evaluate the relationship between pattern electroretinogram (PERG) amplitude, macular and retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT), and visual field (VF) loss on standard automated perimetry (SAP) in eyes with temporal hemianopia from chiasmal compression. METHODS: Forty-one eyes from 41 patients with permanent temporal VF defects from chiasmal compression and 41 healthy subjects underwent transient full-field and hemifield (temporal or nasal) stimulation PERG, SAP and time domain-OCT macular and RNFL thickness measurements. Comparisons were made using Student's t-test. Deviation from normal VF sensitivity for the central 18 degrees of VF was expressed in 1/Lambert units. Correlations between measurements were verified by linear regression analysis. RESULTS: PERG and OCT measurements were significantly lower in eyes with temporal hemianopia than in normal eyes. A significant correlation was found between VF sensitivity loss and full-field or nasal, but not temporal, hemifield PERG amplitude. Likewise a significant correlation was found between VF sensitivity loss and most OCT parameters. No significant correlation was observed between OCT and PERG parameters, except for nasal hemifield amplitude. A significant correlation was observed between several macular and RNFL thickness parameters. CONCLUSIONS: In patients with chiasmal compression, PERG amplitude and OCT thickness measurements were significant related to VF loss, but not to each other. OCT and PERG quantify neuronal loss differently, but both technologies are useful in understanding structure-function relationship in patients with chiasmal compression. (ClinicalTrials.gov number, NCT00553761).