Zoster paresis.

Herpes zoster (HZ) is essentially a viral disease of the posterior root ganglia and sensory nerve fibers, which presents clinically with vesicular eruption of the skin, radicular pain and sensory changes in the distribution of the affected ganglion. However, motor involvement can be seen as well. If classic cutaneous lesions are present, HZ-related motor paresis is easily diagnosed. Otherwise, the diagnosis may be suspicious, especially if the weakness occurs before the cutaneous lesions have appeared, or weeks after they have subsided. We present a patient with HZ-related motor paresis due to radiculopathy in the cervical segments whose motor symptoms and signs appear as major clinical features.

Nitric oxide and endothelin-1,2 in actinic keratosis and basal cell carcinoma: changes in nitric oxide/endothelin ratio.

BACKGROUND: Nitric oxide (NO) is an inorganic free radical gas which has cytostatic/cytotoxic actions in tumoral tissues, including gynecologic, breast, and colon cancer. Nitric oxide is also a multifunctional signaling molecule active in many cells of the body, including endothelial cells, macrophages, monocytes, hepatocytes, mast cells, osteoblasts, and astrocytes. Endothelin-1 (ET-1) is a 21-amino acid peptide that stimulates the proliferation of vascular smooth muscle cells, fibroblasts, and keratinocytes, and plays a role in the expression of proto-oncogenes (c-myc, c-fos), which precedes cell proliferation. Similar to NO, ET is secreted by different cell types, including macrophages, monocytes, hepatocytes, endothelial cells, vascular smooth muscle cells, and various tumor cells. Elevated ET-1 levels are observed in pulmonary, hepatocellular, and prostate cancers. Actinic keratosis (AK) and basal cell carcinoma (BCC) are common skin tumors with accentuated hyperkeratinization, hyperpigmentation, and keratinocyte proliferation. AIM: To investigate plasma NOx (nitrite/nitrate -- the end products of NO metabolism), ET, and the NOx/ET ratio in patients with AK and BCC in comparison with healthy controls. METHODS: NOx, ET, and the NOx/ET ratio were measured in 13 patients with AK, 12 patients with BCC, and in 16 healthy controls. RESULTS: Data analysis indicated a significant increase in plasma NOx, ET, and NOx/ET values in BCC patients in comparison with controls (P < 0.001, P < 0.05 and P < 0.001, respectively). Plasma ET levels in AK were also increased in comparison with controls (P < 0.001). When the two study groups (AK and BCC) were compared, a significant increase (P < 0.001) in the NOx/ET ratio in BCC was found. CONCLUSIONS: The increased plasma ET and NOx levels in AK and, especially, BCC are probably the result of and/or reason for the accentuated hyperkeratinization, hyperpigmentation, and keratinocyte proliferation. The increased production of ET and NO by keratinocytes may function as growth and cytotoxic factors and potential mitogens, and may accelerate further proliferation of these skin tumors. In addition, the increased NOx/ET ratio probably reflects a disturbed equilibrium between these two substances, leading to cell damage and tumor promotion and proliferation.

Visual evoked potentials in Parkinson's disease-correlation with clinical involvement.

A total of 18 patients with Parkinson's disease were evaluated clinically and by transient checker-board VEP study. There were significant differences between bradykinesia (P<0.01), rigidity (P<0.02), and tremor (P<0.05) subscores of the more and less severely affected sides. There were no asymmetry of VEP latency or amplitude between the more and less severely affected sides by stimulation of the corresponding eye. There were no significant correlations between the VEP latency or amplitude and any of the clinical features except the bradykinesia scores. The bradykinesia scores on the more severely involved side (r: 0.57; P=0.014) and less severely involved side (r: 0.82; P=0.00003) showed medium to high degree positive correlations with VEP amplitudes by stimulation of the corresponding eye. By studying monocular fullfield responses our data can only suggest that there is no prechiasmal asymmetry. The positive correlation between the VEP amplitude and bradykinesia score might indicate that D2 receptors dominate in the retina.

Familial cerebellar ataxia and hypogonadism associated with sensorimotor axonal polyneuropathy.

In this article, we report two siblings who have familial cerebellar ataxia and hypogonadism associated with sensorimotor axonal polyneuropathy documented by light microscopy. This combination has not been reported previously in the literature. Cerebellar ataxia and hypogonadism is reviewed according to the clinical and laboratory features of the reported cases in the literature.

Sympathetic skin response in carpal tunnel syndrome.

OBJECTIVES: Sudomotor efferent nerve fiber function was studied in carpal tunnel syndrome (CTS). METHODS: Bilateral median and ulnar sympathetic skin response (SSR) were recorded by sternal stimulation in 22 bilateral and 9 unilateral patients and compared with 21 healthy volunteers. RESULTS: There was no significant difference between median and ulnar nerve SSR latency, amplitude or area. The median nerve SSR was not different from that of the controls. The median-to-ulnar ratios of SSR parameters were not different in patients and controls. However, the median-to-ulnar ratios of SSR amplitude and area were lower than normal in 3 out of 7 patients with normal nerve conduction whereas this abnormality was found in only 4 out of 46 patients with abnormal nerve conduction. CONCLUSIONS: Normal SSR results, even in patients with complaints related to sudomotor sympathetic dysfunction, indicate that the SSR does not seem to be a sensitive diagnostic method in CTS.

Patients with urinary incontinence often benefit from surgical detethering of tight filum terminale.

We retrospectively reviewed 77 patients with a tethered spinal cord syndrome to evaluate the results of neurosurgical treatment. The patients were divided into two groups: in group 1 there were 17 patients with primary tethered cord who had normal level conus medullaris (NLCM) and normal thickness filum terminale (NTFT) with urinary incontinence, and group 2 was made up of 60 patients with secondary spinal cord tethering after a previous closure of a midline fusion defect who had a low-lying conus medullaris. Neurological examination, radiography, urodynamic tests and electrophysiological findings confirmed the diagnosis. Conventionally, tethered cord syndrome has been defined as a state in which the conus medullaris is located below the L1-2 disc space. However, in a patient with urinary incontinence and a hyperreflexive type of neurogenic bladder, in whom the conus medullaris is found to be at the normal level, there may still be cord tethering that is causing the incontinence. In this study the comparison was based on evaluation of the response to treatment and general characteristics of the syndrome in both groups of patients to draw attention to the general approach to this incapacitating mal-development.

Plasma antioxidant defense in actinic keratosis and basal cell carcinoma.

BACKGROUND: Reactive oxygen species and lipid peroxides have been implicated in the pathogenesis of a variety of diseases, particularly cancer. There may be an inverse correlation between lipid peroxidation and antioxidant defense mechanisms. The aim of this study was to investigate whether certain plasma antioxidants (ascorbic acid, alpha-tocopherol, total thiol groups, ceruloplasmin, urate, albumin and erythrocyte glutathione) are altered in actinic keratosis (AK) and basal cell carcinoma (BCC). METHODS: Plasma samples and red blood cells (RBC) of 13 patients with AK, 12 with BCC and 16 healthy controls were investigated. RESULTS: Data analysis indicates significant decrease of ascorbic acid (P < 0.001), alpha-tocopherol (P < 0.05 and P < 0.001), total thiol groups (P < 0.001), ceruloplasmin (P < 0.001 and P < 0.05), and RBC glutathione (P < 0.05) values in both AK and BCC groups compared to controls. Comparison of AK and BCC groups evidenced a significant decrease of alpha-tocopherol and RBC glutathione (P < 0.05) in BCC patient. CONCLUSION: Plasma antioxidants are decreased in the AK and BCC, probably due to the long exposure to UV irradiation which is one of the most important factors in the etiology of AK and BCC and alpha-tocopherol and RBC glutathione (P < 0.05) are most altered in BCC.

Effect of thigh flexion on somatosensory evoked potentials in meralgia paresthetica.

Standing with the thigh extended or lying still provokes and stepping or sitting relieves the symptoms in some patients with meralgia paresthetica. We performed this study to confirm this clinical feature with electrophysiological measures. Twenty-one symptomatic and 17 asymptomatic legs of 19 patients were evaluated by somatosensory evoked potential studies in both extended and flexed thigh positions. In the symptomatic group, thigh flexion significantly reduced the cortical latency. This finding is parallel with the relief of the symptoms.

Cervical osseous changes associated with vertebral artery tortuosity.

Vertebral artery tortuosity causing neural foraminal widening is a well described abnormality that should not be confused with other causes of neural foraminal enlargement, particularly on conventional roentgenograms. We, hereby, describe CT features of another cervical osseous change due to the vertebral artery tortuosity, the so called "tubular shaped vertebral artery canal", which is embedded in the vertebral body instead of causing neural foramen enlargement. Catheter and MR angiographic studies have also been performed to confirm the vertebral artery tortuosity causing the osseous changes.

Diagnostic value of electrical stimulation of lumbosacral roots in radiculopathies.

Needle electrical stimulation of the lumbosacral roots at the laminar level of the Th12-L1 or L1-2 intervertebral spaces were performed in 24 normal subjects and 58 patients with various kinds of lumbar radiculopathy (unilateral L4, L5 and S1 herniated nucleus pulposus and lumber stenosis). The root stimulation method was compared with conventional needle EMG. Lumber electrical stimulation showed root abnormalities objectively in 80% of patients while the diagnostic value of needle EMG was 65%. Therefore, electrical root stimulation is superior to routine EMG for localizing lumbar root involvement. However, the only needle EMG demonstrated the root pathology in 7 cases (12%) and single electrophysiological abnormality was found by the root stimulation in 16 cases (27%). Thus, both electrophysiological methods should be complementary to each other in evaluation of the lumbar radioculopathy.

The evaluation of late sequelae of tetanus infection.

Tetanus is still an important cause of morbidity and mortality in developing countries. Fifty two patients with tetanus were admitted within a 15 year period to our hospital, and 24 of them died. The remaining cases were called for re-evaluation 3-13 years after the infection. Only 10 cases were admitted again, and 6 of them recovered from neonatal tetanus. Their neurological examinations were unremarkable with 5 of them having mild mental retardation. Their EEG's were normal except for one case who had epileptic focus. Their visual and brainstem evoked potentials (VEP, BAEP) were measured and they were in normal ranges. Their results were compared with the results of a control group which consisted of 9 healthy children of matched age and sex.

Comparison of magnetic coil stimulation and needle electrical stimulation in the diagnosis of lumbosacral radiculopathy.

Electrical stimulation (ES) of lumbosacral nerve roots using a needle electrode inserted to the laminar level at the midline of Th12-L1 or L1-2 intervertebral interspace, was compared with magnetic stimulation using a 9-cm diameter coil (MCS) at the L3-4 or L4-5 spine levels, Compound muscle action potentials (CMAP) were superficially recorded from homologous muscles in both sides in 15 normal control subjects and in 20 patients with lumbosacral radiculopathy. Soleus muscles were used for S1, tibialis anterior (TA) for L5, and rectus femoris (RF) muscles for L4 roots. According to the clinical or radiological diagnosis (CAT, MRI and/or myelography) conventional needle EMG was capable to localise the root lesion in 16 of 20 patients (80%) and ES localised the root involvement in 18 of 20 patients (90%); the diagnostic value of MCS was lower, about 65% (13 of 20 patients). Although ES is uncomfortable and invasive, it is superior to needle EMG in localising unilateral or multiple lumbosacral root involvement. At present, MCS is not suitable for the diagnosis of lumbar radiculopathy.