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1.
J Endod ; 46(2): 301-306, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31889582

RESUMO

The present report describes a case of permanent labiomandibular paresthesia subsequent to a root canal treatment in a molar in which a bioceramic sealer extrusion occurred. A 23-year-old black woman attended the endodontics clinic at university, complaining of loss of sensation in the mucosa and skin on the right side of her face in the lower lip region, which began after an endodontic treatment in the second lower right molar. A bioceramic sealer (MTA; Angelus, Londrina, PR, Brazil) was used to fill the canals. The periapical radiographic examination revealed an amount of extruded sealer by mesial and distal roots reaching the interior of the mandibular canal. Then, treatment with a corticosteroid and a vitamin B complex was initiated, and demarcation of the affected area was performed. One week later, paresthesia was still present in equal intensity in the affected area. Thirty-nine days elapsed after the endodontic therapy; the paresthesia continued, encompassing the same area, although with a small reduction in intensity. In the following 6 months, a very subtle decrease in intensity but not in the affected area was noticed. From 6 months to 1 year, no changes were observed. According to the patient's report, the paresthesia affected her quality of life in several aspects. The short distance between the root apices and the upper cortical bone of the mandibular canal seemed to have acted as a predisponent factor to the present long-term paresthesia. In conclusion, bioceramic sealers may also induce permanent facial paresthesia, if extruded.


Assuntos
Parestesia , Materiais Restauradores do Canal Radicular , Brasil , Feminino , Humanos , Parestesia/etiologia , Qualidade de Vida , Materiais Restauradores do Canal Radicular/efeitos adversos , Tratamento do Canal Radicular , Adulto Jovem
2.
Yakugaku Zasshi ; 140(1): 1-6, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-31902877

RESUMO

Dysesthesia is an unpleasant abnormal sensation, often accompanied by pain, paresthesia (abnormal sensation), and numbness (decrease or loss of sensation). Dysesthesia has been associated with various conditions, although its underlying mechanisms are largely unknown. This study assessed the roles of transient receptor potential ankyrin 1 (TRPA1) in dysesthesia by utilizing three animal models of dysesthesia characterized by reductions in blood flow to the skin: a transient hindlimb ischemia/reperfusion model, characterized by spontaneous licking and tactile hypoesthesia of the ischemic hindpaw; a streptozotocin-induced diabetic neuropathy model in mice, characterized by cold hypersensitivity, which is likely parallel to the reduced skin blood flow of the hindpaw; and a hindlimb ischemia model. TRPA1 inhibition or deficiency blocked spontaneous licking in the transient hindlimb ischemia/reperfusion model and cold hypersensitivity in the diabetic mouse model mice. Consistent with these results, the nocifensive behaviors induced by intraplantar injection of a TRPA1 agonist were enhanced in the diabetic neuropathy and hindlimb ischemia models. Hypoxia enhanced H2O2-induced TRPA1 responses in human TRPA1-expressing cells and cultured mouse dorsal root ganglion neurons, with this hypoxia-induced TRPA1 sensitization to H2O2 being associated with hypoxia-induced inhibition of the hydroxylation of prolyl hydroxylases. These results suggest that dysesthesia following blood flow reduction is caused by the activation of TRPA1 sensitized by hypoxia and that hypoxia-induced TRPA1 sensitization plays a pivotal role in painful dysesthesia induced by peripheral blood flow reduction.


Assuntos
Parestesia/genética , Canal de Cátion TRPA1/fisiologia , Animais , Neuropatias Diabéticas , Modelos Animais de Doenças , Humanos , Hipóxia , Parestesia/etiologia , Parestesia/fisiopatologia , Fluxo Sanguíneo Regional , Pele/irrigação sanguínea , Canal de Cátion TRPA1/metabolismo
3.
Medicine (Baltimore) ; 98(51): e18374, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860997

RESUMO

RATIONALE: Deposition of tophus is a common feature in chronic gout; however, signs and symptoms are not always well-pronounced in cases of uncommon sites. We report a rare case with a tophaceous tendonitis on the flexor hallucis longus (FHL) tendon with tarsal tunnel syndrome (TTS). This is the first surgical case of TTS by gouty tophi in FHL. PATIENT CONCERNS: A 55-year-old woman presented with a 6-month history of mild discomfort at the right foot, which gradually worsened in the past 3 weeks. The patient visited our outpatient clinic due to persistent and aggravating foot pain and swelling around the tarsal tunnel. DIAGNOSIS: The patient was diagnosed with hyperuricemia and diabetes mellitus with chronic kidney disease, and did not receive regular antigout treatments. Paresthesia was found along the distribution of medial and plantar nerve and tinel test was positive on tarsal tunnel. Biochemical examination showed she had raised serum uric acid (10.6 mg/dL) and decreased estimated glomerular filtration rate (69 mL/min/1.73 m). Conventional radiography examination showed negative pathology except soft tissue swelling. Magnetic resonance imaging revealed a fusiform mass within the FHL tendon and fluid collection around tarsal tunnel. INTERVENTIONS: Surgical exploration was performed to remove the mass. Inflammation fluid exploded out from FHL tendon sheath, which was later proven to have infiltration of monosodium urate crystal. Superficial dissection revealed a white chalky mass and posterior tibial nerve was significantly compressed by the tophus mass. OUTCOMES: The mass was removed and the symptoms were relieved at immediate postoperative period. LESSONS: A tophaceous tendonitis on FHL tendon can cause TTS and surgical decompression of the gout lesion can reduce the symptoms.


Assuntos
Gota/complicações , Síndrome do Túnel do Tarso/etiologia , Complicações do Diabetes , Feminino , Gota/diagnóstico , Gota/cirurgia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Parestesia/etiologia , Parestesia/cirurgia , Insuficiência Renal Crônica/complicações , Síndrome do Túnel do Tarso/cirurgia , Tendinopatia/etiologia , Tendinopatia/cirurgia , Tendões/diagnóstico por imagem
5.
Zhonghua Wai Ke Za Zhi ; 57(11): 878-880, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694139

RESUMO

Meralgia paresthetica (MP) after posterior spine surgery is caused by mechanical compression injury of lateral femoral cutaneous nerve, which presents as numbness or paresthesia in the confined area of the anterolateral thigh. MP after posterior spine surgery is a common postoperative complication, and the incidence is 12.7%-25.5%. Because its clinical manifestations are mild and easy to be ignored, often leading to treatment delays. This article mainly reviews the incidence, risk factors, prevention and treatment of MP after posterior spine surgery.


Assuntos
Neuropatia Femoral/terapia , Coluna Vertebral/cirurgia , Neuropatia Femoral/etiologia , Neuropatia Femoral/prevenção & controle , Humanos , Hipestesia/etiologia , Incidência , Parestesia/etiologia , Fatores de Risco
6.
Pan Afr Med J ; 34: 50, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762916

RESUMO

This study aims to evaluate the advantages of ultrasound in the diagnosis of carpal tunnel syndrome by comparing it with electroneuromyography (ENMG). We conducted a cross-sectional study over a period of 6 months. All patients underwent ultrasound with measurement of the surface of the median nerve at the entrance of the carpal tunnel and electroneuromyographic examination of both wrists. The sensitivity and specificity of ultrasound was compared to those of ENMG. The average age of patients was 49.6 years with a clear female predominance (98%). The majority of patients were housewives. Paresthesias were the most common reason for consultation in 86%. Bilateral clinical manifestation occurred in 78% of cases. ENMG showed pathological result in 89 wrists (89%). Ultrasound was abnormal in 63 wrists (63%) with a median surface area of the median nerve of 11 mm2. This study highlights an ultrasound sensitivity of 70%, a specificity of 100% with a positive predictive value (PPV) of 100% and a negative predictive value (VPN) of 29.7%. It was concluded that ultrasound has sensitivity only to carpel tunnel with severe involvement on ENMG.


Assuntos
Síndrome do Túnel Carpal/diagnóstico , Eletromiografia/métodos , Ultrassonografia/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Parestesia/etiologia , Valor Preditivo dos Testes , Punho/diagnóstico por imagem
7.
Medicine (Baltimore) ; 98(48): e17756, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31770194

RESUMO

BACKGROUND: Surgically assisted rapid maxillary expansion (SARME) generates an uncomfortable postoperative period accompanied by pain, edema, and paresthesia. There are few studies on the effect of photobiomodulation (PBM) after SARME and it was not possible to find studies on the efficacy of light emitted by diode (LED) after this type of intervention. The main objective of the study will be to evaluate the efficacy of PBM with LED in the control of pain, facial edema, paresthesia, and bone repair after SARME. METHODS: A randomized, double-blind, placebo-controlled clinical trial involving 72 participants aged from 18 to 45 years, who search the Department of Buccomaxillofacial Surgery and Traumatology of Mandaqui Hospital Complex, will be conducted. Immediately after surgeries, the participant will be inserted into the placebo or LED group. In the LED group, the participants will receive PBM with an extraoral device (660 and 850 nm with 6 J per point) and an intraoral device (660 nm with 2 J per point) and in the control group the person in charge of the application will simulate the irradiation with the devices kept off. The applications will be in the immediate postoperative period, 1, 2, 7, 14, 30, 60, 90, and 120 days after the end of the surgeries, when the evaluations will also be performed. Facial measurements, extra and intraoral sensitivity, pain and bone repair will be evaluated. Secondarily, data regarding the occurrence of headache; otalgia; nausea; bruising; nasolacrimation; epistaxis; dysphagia; systemic and superficial temperature in the operated region; use of analgesics and anti-inflammatories; anxiety and impact of oral health on the participants' quality of life will be computed. DISCUSSION: Since PBM has shown positive effects on postoperative complications of other types of oral surgery and also has a positive effect on bone repair after maxillary disjunction, surgically assisted or not, it seems clear the need to evaluate its performance regarding pain, edema, and paresthesia after these surgeries. TRIAL REGISTRATION: This protocol was registered in Clinical Trials platform (https://clinicaltrials.gov/) with the number NCT03814525, first published and last updated on January 24, 2019.


Assuntos
Edema/terapia , Terapia com Luz de Baixa Intensidade/métodos , Doenças Maxilares/terapia , Dor Pós-Operatória/terapia , Técnica de Expansão Palatina/efeitos adversos , Parestesia/terapia , Complicações Pós-Operatórias/terapia , Adolescente , Adulto , Regeneração Óssea , Método Duplo-Cego , Edema/etiologia , Feminino , Humanos , Masculino , Maxila/cirurgia , Doenças Maxilares/etiologia , Pessoa de Meia-Idade , Parestesia/etiologia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
8.
J Med Case Rep ; 13(1): 308, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615579

RESUMO

BACKGROUND: Although epithelioid hemangiomas involving bone have been described in previous case reports and case series, the effects of radiation therapy on vertebral epithelioid hemangioma has not been fully reported. Here we provide a case report of tumor response to radiation therapy in a young adult with a large epithelioid hemangioma involving the fourth lumbar vertebrae. CASE PRESENTATION: A 27-year-old Latino man with a past medical history of type 1 diabetes and a 3-year history of low back pain presented to a hospital emergency department following acute worsening of back pain. On transfer to our tertiary medical center, he described the pain as "shock-like" which originated at the lateral aspect of his right hip and radiated down to his right knee. Paresthesia was also reported along the medial aspect of his lower right leg. Imaging included a computed tomography scan and magnetic resonance imaging which revealed fourth lumbar and right iliac lytic bone lesions. Image-guided biopsies of the lytic lesions were consistent with a diagnosis of epithelioid hemangioma and radiation therapy was recommended as the primary treatment. Our patient's low back and leg pain were initially managed with acetaminophen, oxycodone, pregabalin, and lidocaine patch 5%. He noted improvement in pain after his third fraction of radiation. Pain intensity continued to decline and oxycodone was discontinued. CONCLUSIONS: This case report demonstrates an unusual etiology of back and leg pain in a young man and elucidates the palliative effects of radiation therapy for epithelioid hemangioma involving the lumbar spine.


Assuntos
Hemangioendotelioma Epitelioide/radioterapia , Vértebras Lombares/diagnóstico por imagem , Neoplasias da Coluna Vertebral/radioterapia , Adulto , Hemangioendotelioma Epitelioide/diagnóstico por imagem , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Parestesia/etiologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
9.
Rev Assoc Med Bras (1992) ; 65(9): 1201-1207, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618338

RESUMO

OBJECTIVES: Inguinal hernioplasty techniques have been improved since the first hernioplasty. Tension-free techniques that apply synthetic mesh materials, as in the Lichtenstein approach, are the gold standard. Laparoscopic hernioplasty is the strongest alternative to Lichtenstein. The superiority of laparoscopic hernioplasty over Lichtenstein is a major topic of debate. In this study, we aimed to find a conclusion to this debate by comparing our totally extraperitoneal (TEP) experiences with Lichtenstein experiences. METHODS: Patients who underwent inguinal hernioplasty at the Gulhane Training and Research Hospital from 2013 to 2018 were included in this retrospective cohort study. The sample included 96 TEP and 90 Lichtenstein patients for a total of 186 patients. The variables assessed were hospitalization duration, postoperative early visual analog scale score, chronic pain, paresthesia, recurrence, and early postoperative complications. Data were collected from patient records and via telephone questionnaire if needed. Data analysis was done by SPSS v20, using chi-square, Fisher's exact, and Mann-Whitney U tests. RESULTS: Male/female ratios were similar between the TEP and Lichtenstein groups. There was no difference in mean age between groups (p=0.1). The hospital stay was shorter (p=0.0001), and early postoperative visual analog scale score was lower in the TEP group (p=0.003). Chronic pain, paresthesia, recurrence, and early postoperative complications (hematoma, seroma, wound infection) were similar. CONCLUSIONS: TEP is superior to Lichtenstein with shorter hospitalization duration and lower rates of early postoperative pain. No difference between the two techniques was found for chronic pain. We believe that laparoscopic hernioplasty approach may be the best alternative technique for inguinal hernia repair.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/etiologia , Feminino , Seguimentos , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Parestesia/etiologia , Recidiva , Estudos Retrospectivos , Adulto Jovem
10.
Ideggyogy Sz ; 72(7-8): 273-277, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31517460

RESUMO

Cerebral cavernous malformations (CCMs) represent a relatively rare and heterogeneous clinical entity with mutations identified in three genes. Both sporadic and familial forms have been reported. We present a young female patient with episodic paresthesia and headaches, but without acute neurological deficits. Her mother had a hemorrhaged cavernoma surgically removed 21 years ago. Cranial magnetic resonance imaging revealed multiple cavernous malformations in the size of a few millimeters and the ophthalmologic exam detected retinal blood vessel tortuosity in the proband. Targeted exome sequencing analysis identified a nonsense mutation in exon 16 of the KRIT1 gene, which resulted in a premature stop codon and a truncated protein underlying the abnormal development of cerebral and retinal blood vessels. This mutation with pathogenic significance has been reported before. Our case points to the importance of a thorough clinical and molecular work up despite the uncertain neurological complaints, since life style recommendations, imaging monitoring and genetic counseling may have major significance in the long term health of the patient.


Assuntos
Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico , Proteína KRIT1/genética , Vasos Retinianos/diagnóstico por imagem , Feminino , Cefaleia/etiologia , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/genética , Humanos , Imagem por Ressonância Magnética , Mutação , Parestesia/etiologia , Linhagem , Deleção de Sequência/genética
11.
J Craniofac Surg ; 30(7): 2128-2130, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503123

RESUMO

BACKGROUND: The lag time between injury and treatment (LTIT) plays an important role in reduction of complications in mandibular fractures. The aim of this study was to measure the effect of LTIT on recovery of the inferior alveolar nerve (IAN) neurosensory disturbances (NSDs) following surgical management of mandibular body fractures. METHODS: This was a prospective cohort study. Patients who had a unilateral mandibular body fracture with paresthesia were studied. Paresthesia was evaluated by 2-point discrimination (TPD) test, brush stroke test and self-reporting before and 6 months after the surgical procedure. RESULTS: Forty-five patients were studied. There was a correlation between LTIT and TPD test result and self-reported paresthesia at 6 months, postoperatively (P = 0.001). Fifteen patients (33.3%) had complete improvement in NSD 6 months after treatments (group 1) and 30 patients (group 2) had hyposthesia (N = 17, 37.77%) and paresthesia (N = 13, 28.88%). There was a significant difference in LTIT between groups 1 and 2 at 6 months postoperatively (P = 0.001). Cox regression model demonstrated the hazard ratio increased significantly for self-reported NSD when treatment was done 10 days after trauma (P = 0.001, confidence level = 95%). CONCLUSION: It seems that conduction of open reduction with internal rigid fixation shortly after mandibular fracture may shorten the recovery time of NSDs of the IAN following mandibular body fractures.


Assuntos
Fraturas Mandibulares/cirurgia , Nervo Mandibular/cirurgia , Traumatismos do Nervo Trigêmeo/cirurgia , Adulto , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Fraturas Mandibulares/complicações , Redução Aberta/efeitos adversos , Parestesia/etiologia , Estudos Prospectivos , Traumatismos do Nervo Trigêmeo/etiologia , Adulto Jovem
12.
BMC Musculoskelet Disord ; 20(1): 431, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521138

RESUMO

BACKGROUND: Lumbar spinal stenosis (LSS) is a common spinal condition and the most frequent indication for spinal surgery in elderly people. General practitioners (GPs) are on the 1st line for its diagnosis and treatment. We aimed to assess how GPs diagnose and treat people with LSS in France. METHODS: We conducted a cross-sectional survey in a primary care setting. French GPs were selected by a random draw from the French Medical Board. The questionnaire was designed by 3 physicians specialized in physical and rehabilitation medicine and a resident in general practice. A provisional questionnaire was tested in a pilot survey of 11 French GPs. Participants' feedbacks served to build the final questionnaire. This latter was submitted by e-mail or mail to 330 GPs. GPs were surveyed about the 3 main domains relevant to the management of people with LSS in primary care: 1/ diagnosis, 2/ pharmacological treatments and 3/ non-pharmacological treatments, using self-administered open- and closed-ended questions and visual analog scales. RESULTS: Overall, 90/330 (27.3%) GPs completed the survey. 51/89 (57.3%) GPs were confident with managing people with LSS. Low back pain 51/87 (58.6%), neurogenic claudication 38/87 (43.7%) and paresthesia in the lower limbs 31/87 (35.6%) were the 3 most frequently cited clinical signs leading to the diagnosis of LSS. Improvement with lumbar flexion was mentioned by 9/87 (10.3%) GPs. 85/86 (98.8%) would consider prescribing lumbar imaging, 60/84 (71.4%) corticoid spinal injections and 42/79 (53.2%) would never prescribe lumbar flexion-based endurance training. All GPs would refer people with LSS to another specialist. CONCLUSIONS: French GPs lack confidence with diagnosing LSS and prescribing pharmacological and non-pharmacological treatments for people with LSS.


Assuntos
Clínicos Gerais/estatística & dados numéricos , Vértebras Lombares , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estenose Espinal/diagnóstico , Adulto , Estudos Transversais , Feminino , França , Humanos , Claudicação Intermitente/etiologia , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Parestesia/etiologia , Projetos Piloto , Estenose Espinal/complicações , Estenose Espinal/terapia , Inquéritos e Questionários/estatística & dados numéricos
13.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466988

RESUMO

A 40-year-old male patient presented to the emergency department with acute onset right-sided upper and lower extremity numbness/tingling over the past day. Prior to the paraesthesia onset, the patient experienced transient mild ataxia and left ocular pain with complete resolution at the time of presentation. Neurological exam revealed isolated right-sided sensory changes from his hand-to-elbow as well as foot-to-knee. No other focal neurological deficits were noted. MRI brain revealed a small left posterior infarct at the junction between the pons and midbrain. Dual-antiplatelet therapy was initiated and the patient experienced minimal paraesthesia improvement proximally over his 5-day hospital course. This case report highlights an acute brainstem stroke presenting with predominant hemisensory symptoms. Presentations of brainstem lesions can range from subtle, non-specific features to profound deficits. This case serves to emphasise the importance of performing a thorough clinical exam while maintaining a high index of suspicion for brainstem lesions.


Assuntos
Infartos do Tronco Encefálico/complicações , Tronco Encefálico/patologia , Parestesia/etiologia , Acidente Vascular Cerebral/etiologia , Doença Aguda , Adulto , Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/tratamento farmacológico , Infartos do Tronco Encefálico/patologia , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Parestesia/diagnóstico , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/uso terapêutico , Fatores de Risco , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
14.
Ann Dermatol Venereol ; 146(8-9): 585-591, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31320184

RESUMO

Sensitive skin (or reactive skin) is defined as a syndrome involving the onset of unpleasant sensations (stinging sensation, burning sensation, pain, pruritus, tingling) in response to stimuli that do not normally produce such sensations. These unpleasant sensations cannot be accounted for by lesions attributable to any specific skin disease. The skin may appear normal or erythema may be present. Sensitive skin can occur on any part of the skin but particularly affects the face. Sensitive skin is very common and affects around half of the population to different degrees. The diagnosis is based primarily on clinical examination. The physiopathology of the condition is becoming better known: it appears to be caused by hyperreactivity of the cutaneous nervous system and is associated in particular with activation of sensorial proteins present on keratinocytes and nerve endings. However, there is still no consensus regarding treatment.


Assuntos
Dor , Parestesia , Prurido , Dermatopatias , Humanos , Dor/diagnóstico , Dor/etiologia , Dor/fisiopatologia , Parestesia/diagnóstico , Parestesia/etiologia , Parestesia/fisiopatologia , Prurido/diagnóstico , Prurido/etiologia , Prurido/fisiopatologia , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Dermatopatias/fisiopatologia
15.
BMJ Case Rep ; 12(7)2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31315840

RESUMO

Paraneoplastic syndromes (PS) are a rare presentation of cancer, most commonly associated with small cell lung cancer (SCLC), breast cancer and haematologic malignancies. The diagnosis of PS is challenging because it could affect multiple organ systems and it may present before the tumour is visible by imaging. We report a malignant tumour diagnosed in a male patient who referred long-term paraesthesia and proximal muscle strength loss. After ruling out common causes of polyneuropathy, the anti-SOX1 antibody gave light to the diagnosis. A pulmonary opacity in the upper right lobe was observed in the chest X-ray and a pulmonary tumour was later confirmed by CT scan. The biopsy of the cervical lymphadenopathy determined an SCLC, which caused a PS called Lambert-Eaton myasthenic syndrome (LEMS). Our case raises awareness of a rare PS presentation, which can be diagnosed by specific antibodies, allowing early diagnosis and treatment of lung cancer.


Assuntos
Síndrome Miastênica de Lambert-Eaton/sangue , Síndromes Paraneoplásicas/diagnóstico , Parestesia/etiologia , Fatores de Transcrição SOXB1/antagonistas & inibidores , Carcinoma de Pequenas Células do Pulmão/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Autoanticorpos/sangue , Diagnóstico Diferencial , Eletromiografia/métodos , Humanos , Síndrome Miastênica de Lambert-Eaton/complicações , Síndrome Miastênica de Lambert-Eaton/diagnóstico , Masculino , Síndromes Paraneoplásicas/fisiopatologia , Fatores de Transcrição SOXB1/sangue , Biópsia de Linfonodo Sentinela/métodos , Carcinoma de Pequenas Células do Pulmão/complicações , Carcinoma de Pequenas Células do Pulmão/diagnóstico por imagem , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
16.
World Neurosurg ; 131: 62-64, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356981

RESUMO

BACKGROUND: Gunshot wounds to the spine are devastating injuries. Rarely, the bullet has been reported to migrate. Migration is associated with progressive neurologic deficits that often improve with bullet removal. The authors report a case of removal of a migrating lumbar spine bullet. This is supplemented by an operative video and a review of the literature. CASE DESCRIPTION: A 31-year-old man presented to the emergency department with multiple gunshot wounds and lower-extremity paresthesia. A ballistic injury occurred with an entry wound in the right posterior soft tissues, traversing the right paraspinal muscle and fracturing the left lumbar 5 pedicle and left lumbar 4 transverse process. The bullet was positioned within the spinal canal at the lumbar 3/4 interspace. His spinal injury was managed nonoperatively due to his traumatic injuries and findings of minimal neurologic deficit without cerebrospinal fluid leak. The patient returned to the neurosurgery clinic a year later and was found to have worsening low back pain, decreased sensation throughout the left leg, and radiating pain throughout the right leg. Imaging demonstrated the bullet had migrated caudally to the midlumbar 5 vertebral body. Given the patient's progressive symptoms and migration of the bullet fragment, informed consent was obtained for a laminectomy and removal of the intradural bullet fragment. CONCLUSIONS: Neurosurgical treatment for gunshot wounds remains controversial. Cauda equina or lumbosacral level wounds are often incomplete and may improve with surgical decompression and bullet removal. Migrating bullet fragments throughout the spine and brain lead to worsened neurologic function, which can be reversed by removal. Movement of the bullet during surgery should be expected, and intraoperative fluoroscopy and patient positioning can help to properly localize the bullet and aid in its removal.


Assuntos
Migração de Corpo Estranho/cirurgia , Vértebras Lombares/cirurgia , Canal Vertebral/cirurgia , Ferimentos por Arma de Fogo , Adulto , Migração de Corpo Estranho/complicações , Humanos , Hipestesia/etiologia , Laminectomia , Perna (Membro) , Dor Lombar/etiologia , Masculino , Dor/etiologia , Parestesia/etiologia
17.
J Craniofac Surg ; 30(4): e327-e330, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31166277

RESUMO

PURPOSE: Involvement of the inferior alveolar nerve (IAN) is important in the prognosis and treatment of gingival squamous cell carcinoma (SCC). METHODS: In this cross sectional study, patients with gingival SCC (T4a), undergoing hemimandibulectomy or subtotal hemimandibulectomy, were examined. The distance between the lesion and inferior alveolar canal (IAC) was measured, using axial computed tomography scans before resection. Following that, histopathological evaluation of IAN was conducted. The receiver operating characteristic curve was plotted to determine the association of IAN involvement in histopathological evaluation with various distances between the lesion and IAC. RESULTS: A total of 29 patients were examined in this study. The mean distance between the lesion and IAC was 9.40 ±â€Š2.21 mm. Nerve involvement was documented in 9 (45%) out of 20 males, while 11 (55%) men showed no involvement. Thirteen (44.82%) patients showed IAN involvement. The receiver operating characteristic curve demonstrated a cut-off point of 9.75 mm for the lesion-IAN distance. The possibility of IAN involvement was 23.33 times higher in patients who reported paresthesia, compared with patients without nerve involvement (odds ratio, 23.33; 95% CL; P = 0.001) CONCLUSION:: It seems that in a CT scan view, a 9.75-mm safe margin is associated with high accuracy for preserving IAN in patients with gingival SCC. Also, neurosensory disturbance can be considered a strong predictor of IAN involvement.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Gengivais/cirurgia , Nervo Mandibular/cirurgia , Tratamentos com Preservação do Órgão/métodos , Adulto , Carcinoma de Células Escamosas/patologia , Estudos Transversais , Feminino , Neoplasias Gengivais/patologia , Humanos , Masculino , Nervo Mandibular/patologia , Osteotomia Mandibular/métodos , Margens de Excisão , Parestesia/etiologia , Parestesia/cirurgia , Radiografia Panorâmica , Tomografia Computadorizada por Raios X
18.
Neurol Sci ; 40(9): 1909-1915, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31104170

RESUMO

Chronic traumatic encephalopathy (CTE) is very frequent and studied among contact sport players, above all American Football. Now, the defined diagnosis is only post-mortem and, consequently, more detailed diagnostic in-vivo instruments are needed to facilitate diagnosis and to allow a follow up. This clinical questionnaire (Trauma Questionnaire-TraQ) has been designed to investigate in parallel the traumatic load and clinical and cognitive subjective symptoms. It evaluates 4 anamnestic fields (specific sport activity, all previous pathological events, clinical manifestations compatible with TBI (traumatic brain injury) or CTE and subjective perception of personal memory efficacy with PRMQ questionnaire). The aim of TraQ questionnaire is to allow a standardized follow-up of active players and to identify subclinical disturbances that may become warnings. A pilot comparative study with TraQ on 105 subjects (75 AF players and 30 comparable people without a history of contact-sports activity) revealed that AF players have an increased amount of severe head trauma, an amplified level of subjective aggressiveness, more olfactory deficits but also more speech subjective problems, previously never related with CTE. In view of the obtained results, the TraQ seems to be useful (1) to obtain a better quantification of the traumatic load; (2) to differentiate the risk of long-term neurological consequences, allowing better management of different athletes right from the pre-symptomatic phases; (3) to manage prevention strategies if regularly applied to periodic visits to sports fitness; and (4) to identify the predisposing factors for the development of CTE and other neurological consequences of TBI with follow-up studies.


Assuntos
Traumatismos em Atletas/diagnóstico , Lesões Encefálicas Traumáticas/diagnóstico , Futebol Americano/lesões , Psicometria/instrumentação , Índice de Gravidade de Doença , Adolescente , Adulto , Agressão/fisiologia , Traumatismos em Atletas/complicações , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Lesões Encefálicas Traumáticas/complicações , Encefalopatia Traumática Crônica/complicações , Encefalopatia Traumática Crônica/diagnóstico , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Transtornos da Linguagem/diagnóstico , Transtornos da Linguagem/etiologia , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/etiologia , Parestesia/diagnóstico , Parestesia/etiologia , Projetos Piloto , Inquéritos e Questionários , Adulto Jovem
19.
J Dermatol ; 46(6): 526-530, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31106878

RESUMO

Scalp dysesthesia may be underrecognized but is an important condition which requires special management strategies. Through our case series of four patients, we have noted that patients were frequently misdiagnosed with seborrheic dermatitis and failed standard treatment. However, patients did benefit from low doses of oral pregabalin and a topical compound of amitriptyline, lidocaine and ketamine. Oral antihistamines and topical corticosteroids did not work sufficiently on their own but added value when used in conjunction with analgesic agents. Our experience and published work also suggest the association of cervical spinal changes, psychiatric disorders, and other environmental and habitual factors.


Assuntos
Analgésicos/administração & dosagem , Glucocorticoides/administração & dosagem , Antagonistas dos Receptores Histamínicos/administração & dosagem , Parestesia/diagnóstico , Administração Cutânea , Administração Oral , Idoso , Vértebras Cervicais , Dermatite Seborreica/diagnóstico , Erros de Diagnóstico , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Parestesia/tratamento farmacológico , Parestesia/etiologia , Parestesia/psicologia , Couro Cabeludo , Dermatoses do Couro Cabeludo/diagnóstico , Doenças da Coluna Vertebral/complicações , Resultado do Tratamento
20.
Rinsho Shinkeigaku ; 59(6): 349-355, 2019 Jun 22.
Artigo em Japonês | MEDLINE | ID: mdl-31142709

RESUMO

The case of a 17-year-old man with Hodgkin's lymphoma who presented with paraneoplastic sensory neuropathy is presented. The patient visited our hospital because of acute progression of dysesthesiae in the bilateral face and extremities. He also developed an ataxic gait due to decreased deep sensation. Post-contrast T1-weighted MRI showed enhancement of both trigeminal nerves and the cauda equina. Cerebrospinal fluid examination was unremarkable. Intravenous immunoglobulin therapy and subsequent steroid pulse therapy did not improve his symptoms. Laboratory data showed an elevated serum soluble interleukin-2 receptor level. His chest X-ray and CT showed enlarged lymph nodes in the mediastinum, and the histopathologic examination of a lymph node biopsy specimen showed classical Hodgkin's lymphoma. He was treated with chemotherapy. His symptoms of neuropathy improved promptly while the lymphoma was being successfully treated, and he was able to walk with a cane. The present case was characterized by paraneoplastic sensory neuropathy as the initial clinical feature in association with Hodgkin's lymphoma. It is necessary to consider a paraneoplastic neurological syndrome even in a young patient with acute/subacute sensory neuropathy. Paraneoplastic sensory neuropathy associated with Hodgkin's lymphoma could be expected to improve with oncotherapy, and examination of the malignancy and early treatment are important.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença de Hodgkin/complicações , Doença de Hodgkin/tratamento farmacológico , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/tratamento farmacológico , Polineuropatia Paraneoplásica/tratamento farmacológico , Polineuropatia Paraneoplásica/etiologia , Parestesia/tratamento farmacológico , Parestesia/etiologia , Doença Aguda , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Ataxia/tratamento farmacológico , Ataxia/etiologia , Bleomicina/administração & dosagem , Dacarbazina/administração & dosagem , Doxorrubicina/administração & dosagem , Doença de Hodgkin/diagnóstico , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias do Mediastino/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vimblastina/administração & dosagem
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