Numb chin syndrome. / Nummen hake.

BACKGROUND: Numb chin syndrome describes sensory neuropathy characterised by numbness in the distribution of the terminal branch of the mandibular division of the trigeminal nerve. This symptom may be overlooked by patients and clinicians due to its mild nature; however, it could represent a serious underlying pathology such as inflammatory conditions or malignancy. CASE PRESENTATION: A man in his seventies presented with isolated numbness on the right side of the chin, and no other neurological or constitutional symptoms. Radiology showed a lytic mass in the right side of the mandible protruding through the mental foramen. A multidisciplinary approach revealed the cause of the patient's numb chin syndrome. INTERPRETATION: This case report illustrates clinical considerations in a patient with numb chin syndrome.

Legionella transmission from an outdoor fountain in Oslo, Norway. / Legionellose etter smitte fra fontenen på Youngstorget.

BACKGROUND: Most cases of legionellosis in Norway are acquired outside the country. This was a domestic case from an unusual source. CASE PRESENTATION: A man in his thirties was admitted with pneumonia early in the summer. He developed respiratory failure before recovering. Cultures from his lower airways grew Legionella pneumophila serogroup 1. Samples from his home and workplace did not identify Legionella. On further questioning it was discovered that the patient regularly sat beside an outdoor fountain during his breaks from work. Samples from the fountain identified high numbers of L. pneumophila serogroup 1, sequence type 256. Full genome sequencing showed that isolates from the patient and fountain were identical. The fountain used recirculated water with small amounts of chlorine. High outdoor temperatures in Oslo may have facilitated growth of Legionella in the fountain. INTERPRETATION: To our knowledge, this is the first published case of Legionella transmission from an outdoor fountain.

A woman in her fifties with left bundle branch block and recurrent arrhythmias. / En kvinne i 50-årene med venstre grenblokk og tilbakevendende arytmier.

BACKGROUND: Sarcoidosis is a multi-system inflammatory disorder resulting in the formation of non-caseating granulomas in various parts of the body. Cardiac involvement is associated with worse prognosis, probably due to the destructive effects the granulomas can have on the electrical conduction system. The diagnosis of cardiac sarcoidosis can be challenging due to the limited accuracy of various clinical criteria. CASE PRESENTATION: A woman in her fifties developed symptoms in the form of dry cough and uncharacteristic chest pain. Thorough assessment was initiated, but the true cause remained undiagnosed for several years. The patient suffered from recurrent arrythmias and eventually a weakened ventricular function and cardiac failure. A multidisciplinary approach revealed that the patient was suffering from cardiac sarcoidosis. INTERPRETATION: Cardiac sarcoidosis may initially present with mild symptoms, but left bundle branch block, total AV-block and supraventricular tachycardias, as well as weakened ventricular function, should raise suspicion of the condition. Magnetic resonance imaging and echocardiography may be of help during clinical assessment, and positron emission tomography/computed tomography and biopsy can confirm the condition.

Handgrip force steadiness in young and older adults: a reproducibility study.

BACKGROUND: Force steadiness is a quantitative measure of the ability to control muscle tonus. It is an independent predictor of functional performance and has shown to correlate well with different degrees of motor impairment following stroke. Despite being clinically relevant, few studies have assessed the validity of measuring force steadiness. The aim of this study was to explore the reproducibility of handgrip force steadiness, and to assess age difference in steadiness. METHOD: Intrarater reproducibility (the degree to which a rating gives consistent result on separate occasions) was investigated in a test-retest design with seven days between sessions. Ten young and thirty older adults were recruited and handgrip steadiness was tested at 5%, 10% and 25% of maximum voluntary contraction (MVC) using Nintendo Wii Balance Board (WBB). Coefficients of variation were calculated from the mean force produced (CVM) and the target force (CVT). Area between the force curve and the target force line (Area) was also calculated. For the older adults we explored reliability using intraclass correlation coefficient (ICC) and agreement using standard error of measurement (SEM), limits of agreement (LOA) and smallest real difference (SRD). RESULTS: A systematic improvement in handgrip steadiness was found between sessions for all measures (CVM, CVT, Area). CVM and CVT at 5% of MVC showed good to high reliability, while Area had poor reliability for all percentages of MVC. Averaged ICC for CVM, CVT and Area was 0.815, 0.806 and 0.464, respectively. Averaged ICC on 5%, 10%, and 25% of MVC was 0.751, 0.667 and 0.668, respectively. Measures of agreement showed similar trends with better results for CVM and CVT than for Area. Young adults had better handgrip steadiness than older adults across all measures. CONCLUSION: The CVM and CVT measures demonstrated good reproducibility at lower percentages of MVC using the WBB, and could become relevant measures in the clinical setting. The Area measure had poor reproducibility. Young adults have better handgrip steadiness than old adults.

Reference data on reaction time and aging using the Nintendo Wii Balance Board: A cross-sectional study of 354 subjects from 20 to 99 years of age.

BACKGROUND: Falls among older adults is one of the major public health challenges facing the rapidly changing demography. The valid assessment of reaction time (RT) and other well-documented risk factors for falls are mainly restricted to specialized clinics due to the equipment needed. The Nintendo Wii Balance Board has the potential to be a multi-modal test and intervention instrument for these risk factors, however, reference data are lacking. OBJECTIVE: To provide RT reference data and to characterize the age-related changes in RT measured by the Nintendo Wii Balance Board. METHOD: Healthy participants were recruited at various locations and their RT in hands and feet were tested by six assessors using the Nintendo Wii Balance Board. Reference data were analysed and presented in age-groups, while the age-related change in RT was tested and characterized with linear regression models. RESULTS: 354 participants between 20 and 99 years of age were tested. For both hands and feet, mean RT and its variation increased with age. There was a statistically significant non-linear increase in RT with age. The averaged difference between male and female was significant, with males being faster than females for both hands and feet. The averaged difference between dominant and non-dominant side was non-significant. CONCLUSION: This study reported reference data with percentiles for a new promising method for reliably testing RT. The RT data were consistent with previously known effects of age and gender on RT.