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1.
World Neurosurg ; 133: e62-e67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31442648

RESUMO

OBJECTIVE: Microvascular decompression (MVD) has been widely accepted for treating hemifacial spasm (HFS) and glossopharyngeal neuralgia (GN); an effective surgical treatment of coexistent HFS and GN still remains to be determined, however. In this paper we discuss the operative strategy of MVD for patients with coexistent HFS and GN. METHODS: This was a retrospective study. All cases of HFS with or without GN at China-Japan Friendship Hospital from January 2014 to June 2016 have been included. All patients underwent MVD and have been followed up for an average of 1.5 years. RESULTS: A total of 5375 cases of HFS were included, wherein 8 cases coexist with GN. Eight patients had same offending vessel(s) compressing the root entry zone of glossopharyngeal nerve and facial nerve. Posterior inferior cerebellar artery was identified as at least 1 of the offending arteries in all 8 patients. After MVD, spasm ceased in all 8 cases, with 7 cases ceasing immediately and 1 within 2 months. Pain disappeared also in all cases, with 7 cases immediately and 1 case after 4 days. No recurrence or complication was observed during the follow-ups. CONCLUSIONS: HFS combined with ipsilateral GN was rare. MVD could be performed to effectively relieve nerve root compression and associated symptoms for coexistent HFS and GN. Sufficient exposure of root entry zones of both nerves and fully decompression of offending blood vessels and exploratory sequences of different nerve roots are critical points for improving operative effect and reducing complications.


Assuntos
Doenças do Nervo Glossofaríngeo/cirurgia , Espasmo Hemifacial/cirurgia , Cirurgia de Descompressão Microvascular , Síndromes de Compressão Nervosa/cirurgia , Adulto , Nervo Facial/fisiopatologia , Feminino , Seguimentos , Nervo Glossofaríngeo/fisiopatologia , Doenças do Nervo Glossofaríngeo/fisiopatologia , Espasmo Hemifacial/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
2.
Muscle Nerve ; 60(3): 250-253, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31294855

RESUMO

INTRODUCTION: Suprascapular neuropathy (SSN) is rare, with an estimated prevalence of 4.3% in patients with shoulder pain. METHODS: This retrospective chart review included patients with SSN seen during a 16-year period. Demographics and clinical information were recorded. Descriptive statistics, including percentages, means, and standard deviations, were computed for the variables of interest for all patients. RESULTS: Of 87 patients included in this study, trauma (n = 27) was the most common cause of SSN, followed by neuralgic amyotrophy (n = 21). Fifty-seven patients had isolated SSN. Others had SSN associated with axillary neuropathy (23 patients), brachial plexopathy (3 patients), and long thoracic, radial, or spinal accessory neuropathy (1 patient each). DISCUSSION: SSN is commonly associated with axillary neuropathy. Trauma remains the most common cause of SSN. Electrodiagnostic findings aid in the initial diagnosis and may indicate the need for close clinical follow-up based on the severity of the axonal injury.


Assuntos
Axila/fisiopatologia , Neuropatias do Plexo Braquial/fisiopatologia , Síndromes de Compressão Nervosa/fisiopatologia , Dor de Ombro/etiologia , Adulto , Neurite do Plexo Braquial/complicações , Neurite do Plexo Braquial/fisiopatologia , Neuropatias do Plexo Braquial/complicações , Neuropatias do Plexo Braquial/diagnóstico , Eletromiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Dor de Ombro/diagnóstico , Dor de Ombro/fisiopatologia , Adulto Jovem
3.
Clin Plast Surg ; 46(3): 285-293, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103073

RESUMO

Nerve compression occurs in fibro-osseous tunnels as the nerves cross joints. The pathology involves traction and adhesion, aside from compression. This can occur at multiple sites along the course of the nerve. Regardless of level, clinical assessment is standard and a systematic approach to uncover all sites of compression is advised. Evolution of management for carpal tunnel and cubital tunnel syndrome is reviewed with an emphasis on natural history and nonsurgical treatment, which are not commonly discussed. Treatment is multimodal and the systemic factors that contribute to nerve dysfunction should also be addressed.


Assuntos
Síndromes de Compressão Nervosa , Síndrome do Túnel Carpal/terapia , Síndrome do Túnel Ulnar/terapia , Humanos , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/terapia
4.
J Bone Joint Surg Am ; 101(6): 523-530, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30893233

RESUMO

BACKGROUND: Peripheral nerve compression and entrapment can be debilitating. Using a validated animal model of peripheral nerve compression, we examined the utility of 2 drugs approved for other uses in humans, 4-aminopyridine (4-AP) and erythropoietin (EPO), as treatments for surgically induced ischemia and as adjuvants to surgical decompression. METHODS: Peripheral nerve compression was induced in wild-type mice by placing an inert silicone sleeve around the sciatic nerve. Decompression surgery was performed at 6 weeks with mice receiving 4-AP, EPO, or saline solution either during and after compression or only after decompression. A nerve conduction study and morphometric analyses were performed to compare the extent of the injury and the efficacy of the therapies, and the findings were subjected to statistical analysis. RESULTS: During peripheral nerve compression, there was a progressive decline in nerve conduction velocity compared with that in sham-treatment animals, in which nerve conduction velocity remained normal (∼55 m/s). Mice treated with 4-AP or EPO during the compression phase had significantly smaller declines in nerve conduction velocity and increased plateau nerve conduction velocities compared with untreated controls (animals that received saline solution). Histomorphometric analyses of newly decompressed nerves (i.e., nerves that underwent decompression on the day that the mouse was sacrificed) revealed that both treated groups had significantly greater proportions of large (>5-µm) axons than the untreated controls. Following surgical decompression, all animals recovered to a normal baseline nerve conduction velocity by day 15; however, treatment significantly accelerated improvement (in both the 4-AP and the EPO group), even when it was only started after decompression. Histomorphometric analyses at 7 and 15 days following surgical decompression revealed significantly increased myelin thickness and significantly greater proportions of large axons among the treated animals. CONCLUSIONS: Both the 4-AP and the EPO-treated group demonstrated improvements in tissue architectural and electrodiagnostic measurements, both during and after peripheral nerve compression, compared with untreated mice. CLINICAL RELEVANCE: Peripheral nerve decompression is one of the most commonly performed procedures in orthopaedic surgery. We believe that there is reason for some optimism about the translation of our findings to the clinical setting. Our findings in this murine model suggest that 4-AP and EPO may lessen the effects of nerve entrapment and that the use of these agents after decompression may speed and perhaps otherwise optimize recovery after surgery.


Assuntos
4-Aminopiridina/uso terapêutico , Epoetina alfa/uso terapêutico , Hematínicos/uso terapêutico , Síndromes de Compressão Nervosa/terapia , Bloqueadores dos Canais de Potássio/uso terapêutico , Neuropatia Ciática/terapia , Animais , Descompressão Cirúrgica , Modelos Animais de Doenças , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Síndromes de Compressão Nervosa/fisiopatologia , Condução Nervosa/fisiologia , Neuropatia Ciática/fisiopatologia
5.
Med Clin North Am ; 103(2): 357-370, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30704687

RESUMO

Upper extremity entrapment neuropathies are common and can cause pain, sensory loss, and muscle weakness that lead to functional disability. In this article, the authors review common entrapment neuropathies of the upper extremities, including median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, and radial neuropathy. The authors discuss the pathophysiology of nerve compression and typical etiologies, as well as strategies for differentiating between common mimics such as cervical radiculopathy and for selecting between various treatment modalities.


Assuntos
Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/terapia , Exame Neurológico , Síndrome do Túnel Carpal/diagnóstico , Diagnóstico Diferencial , Eletrodiagnóstico , Humanos , Síndromes de Compressão Nervosa/fisiopatologia , Paralisia/diagnóstico , Paralisia/terapia , Extremidade Superior
6.
Ann Vasc Surg ; 57: 275.e9-275.e12, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30711499

RESUMO

We present the case of an 89-year-old man with 3-month history of hoarseness and no other significant clinical manifestations. Flexible laryngoscopy revealed a paralyzed left vocal cord, and contrast-enhanced computed tomography showed a thoracic dissecting aortic aneurysm of the distal aortic arch and proximal descending aorta. The aortic aneurysm was repaired through implantation of an endovascular stent graft, and the patient was discharged uneventfully after a week. The false lumen was completely thrombosed, and the patient had a partial resolution of hoarseness at the 1-year follow-up.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Rouquidão/etiologia , Síndromes de Compressão Nervosa/etiologia , Nervo Laríngeo Recorrente/fisiopatologia , Prega Vocal/inervação , Idoso de 80 Anos ou mais , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Rouquidão/fisiopatologia , Humanos , Laringoscopia , Masculino , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Desenho de Prótese , Recuperação de Função Fisiológica , Stents , Síndrome , Resultado do Tratamento , Voz
8.
J Sport Rehabil ; 28(3): 219-228, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29364045

RESUMO

CONTEXT: Isolated infraspinatus atrophy (IIA) is a common condition among overhead activity athletes, which affects the hitting shoulder and is caused by suprascapular nerve injury. The loss of infraspinatus function could lead to altered activity of the glenohumeral and scapulothoracic (ST) muscles and compromise the optimal shoulder function. OBJECTIVE: To assess the surface electromyographic (sEMG) activity patterns, relationships, and response latencies of relevant shoulder girdle muscles in professional volleyball players with IIA and in healthy control players. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-four male professional volleyball players (12 players with diagnosed IIA and 12 healthy players) recruited from local volleyball teams. INTERVENTION(S): sEMG activity of anterior, middle, and posterior deltoid; upper, middle, and lower trapezius; and serratus anterior (SA) was recorded and evaluated during a movement of shoulder abduction in the scapular plane, monitored with an optoelectronic motion capture system. MAIN OUTCOME MEASURE(S): sEMG activity, relationships, and response latencies of the selected muscles were analyzed with analysis of variance models to highlight statistical differences within and between groups. RESULTS: Athletes with IIA demonstrated significant higher deltoid and trapezius muscles activity and lower SA activity compared with the contralateral shoulder and healthy athletes. The shoulder with IIA also showed a higher activity ratio between the upper trapezius and other ST muscles in addition to anticipated activation of the upper trapezius and delayed activation of the SA, with regard to the onset of shoulder movement. CONCLUSIONS: This study highlighted altered shoulder muscle activity levels, ST muscles imbalances, and abnormal ST recruitment patterns in the hitting shoulder of professional volleyball players with IIA, secondary to suprascapular nerve neuropathy. Such shoulder girdle muscles' impairments may compromise the optimal scapulohumeral rhythm and function, increasing the risk of acute and overuse shoulder injuries.


Assuntos
Traumatismos em Atletas/fisiopatologia , Músculo Deltoide/fisiopatologia , Atrofia Muscular , Lesões do Ombro/fisiopatologia , Músculos Superficiais do Dorso/fisiopatologia , Adulto , Atletas , Estudos Transversais , Eletromiografia , Humanos , Masculino , Síndromes de Compressão Nervosa/fisiopatologia , Escápula , Voleibol , Adulto Jovem
9.
Disabil Rehabil ; 41(8): 991-993, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29216768

RESUMO

PURPOSE: To describe the clinical manifestation and the treatment of complex regional pain syndrome type II in childhood. METHODS: Using information on the symptoms, diagnosis, rehabilitation and outcome of a young patient with complex regional pain syndrome type II. RESULTS: A 9-year -old girl had severe pain in the region of the left foot, signs of a common fibular nerve entrapment, hyperalgesia not limited to the distribution of the injured nerve, weakness and temperature asymmetry unknown origin. She consulted few doctor's before she was given the right diagnosis of complex regional pain syndrome type II. Following the diagnosis the treatment started, it included intensive physiotherapy, electrical therapy and also supportive psychological therapy. Half a year later, the patient was free of the daily pain and returned to all physical activity without any restrictions. CONCLUSIONS: The case report illustrates that peripheral nerve compression or injuries specifically, complex regional pain syndrome type II, should be taken into consideration when evaluating children with weakness and pain of the lower or upper limb. Implication of rehabilitation Raising the awareness of complex regional pain syndrome in the childhood is essential for an early diagnosis and appropriate treatment. The treatment options include early and adequate pain management inclusive electrical therapy and physiotherapy. Psychological therapy helps to avoid psychological stress reaction and the disease negative impact on the child's education and sports and the family social life.


Assuntos
Síndromes da Dor Regional Complexa , Terapia por Estimulação Elétrica/métodos , , Modalidades de Fisioterapia , Técnicas Psicológicas , Criança , Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/fisiopatologia , Síndromes da Dor Regional Complexa/psicologia , Síndromes da Dor Regional Complexa/reabilitação , Exercício , Feminino , Pé/inervação , Pé/fisiopatologia , Humanos , Hiperalgesia/diagnóstico , Hiperalgesia/etiologia , Hiperalgesia/terapia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/terapia , Medição da Dor/métodos , Resultado do Tratamento
10.
J Vasc Access ; 20(2): 226-228, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30073904

RESUMO

INTRODUCTION:: Insertion of central catheters in peripheral vessels is a common procedure performed for a variety of indications, including parenteral nutrition. Hyperemesis gravidarum may require parenteral nutrition in exceptional situations. Although globally safe, insertion of peripherally inserted central catheters (PICCs) can lead to complications. CASE REPORT:: We describe a case of a pregnant woman who required parenteral nutrition and underwent an unsuccessful PICC insertion attempt resulting in arterial puncture, and who 34 days later presented with right upper limb paresthesia. A pseudoaneurysm with nerve compression was diagnosed and treated by open surgery, without maternal or fetal complications. CONCLUSION:: We recommend active surveillance ultrasound (e.g. in the first 24-48 h) of unsuccessful PICC insertion attempts, because late complications may occur and require invasive procedures for treatment.


Assuntos
Artéria Braquial/lesões , Neuropatias do Plexo Braquial/etiologia , Cateterismo Periférico/efeitos adversos , Hiperêmese Gravídica/terapia , Síndromes de Compressão Nervosa/etiologia , Nutrição Parenteral , Lesões do Sistema Vascular/etiologia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Artéria Braquial/diagnóstico por imagem , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/fisiopatologia , Feminino , Humanos , Hiperêmese Gravídica/diagnóstico , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Gravidez , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal/métodos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Adulto Jovem
11.
Neurosurgery ; 84(2): 404-412, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29529303

RESUMO

BACKGROUND: Several hypotheses have been proposed for the pathophysiology of suprascapular nerve (SSN) palsy, including compression, traction, and nerve inflammation. OBJECTIVE: To provide insight into the pathophysiology of isolated nontraumatic SSN palsy by performing critical reinterpretations of electrodiagnostic (EDX) studies and magnetic resonance (MR) images of patients with such diagnosis. METHODS: We retrospectively reviewed all patients referred to our institution for the past 20 yr with a diagnosis of nontraumatic isolated suprascapular neuropathy who had an upper extremity EDX study and a shoulder or brachial plexus MR scan. Patient charts were reviewed to analyze their initial clinical examination, and their original EDX study and MR images were reinterpreted by an experienced neurologist and a musculoskeletal radiologist, respectively, both blinded from the authors' hypothesis and from each other's findings. RESULTS: Fifty-nine patients were included. Fifty of them (85%) presented with at least 1 finding that was inconsistent with an isolated SSN palsy. Forty patients (68%) had signs on physical examination beyond the SSN distribution. Thirty-one patients (53%) had abnormalities on their EDX studies not related to the SSN. Twenty-two patients (37%) had denervation atrophy in other muscles than the spinati, or neural hyperintensity in other nerves than the SSN on their MR scans, without any evidence of SSN extrinsic compression. CONCLUSION: The great majority of patients with presumed isolated SSN palsy had clinical, electrophysiological, and/or imaging evidence of a more diffuse pattern of neuromuscular involvement. These data strongly support an inflammatory pathophysiology in many cases of "isolated" SSN palsy.


Assuntos
Neuropatias do Plexo Braquial/fisiopatologia , Paralisia/fisiopatologia , Adulto , Neuropatias do Plexo Braquial/etiologia , Eletrofisiologia , Feminino , Humanos , Inflamação/complicações , Inflamação/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/fisiopatologia , Paralisia/etiologia , Estudos Retrospectivos , Adulto Jovem
12.
Ann Vasc Surg ; 57: 48.e13-48.e17, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30218834

RESUMO

Perforation of inferior vena cava (IVC) filter struts is a common incidental finding on postoperative computed tomography (CT) scans that is not associated with bleeding or major complications. However, in rare circumstances, it can be associated with hemorrhage requiring immediate removal. We present a case of a 62-year-old man who developed abdominal pain and right lower extremity weakness 2 weeks after treatment of a pulmonary embolism with IVC filter placement and anticoagulation. A CT scan revealed a large right-sided retroperitoneal hematoma with active extravasation from the IVC filter struts that had perforated the IVC wall. He underwent a hybrid operation with endovascular retrieval of the IVC filter and concomitant IVC primary repair combined with evacuation of the hematoma, causing nerve compression. Postoperatively, he regained normal sensory and motor function. Perforation of IVC filter struts is usually asymptomatic, but in rare circumstances, it can cause hemorrhage requiring immediate removal and IVC repair. Surgical intervention is indicated in the setting of a large hematoma with nerve or vessel compression and may require a combined endovascular and open approach.


Assuntos
Hematoma/etiologia , Extremidade Inferior/inervação , Debilidade Muscular/etiologia , Síndromes de Compressão Nervosa/etiologia , Lesões do Sistema Vascular/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/lesões , Angiografia por Tomografia Computadorizada , Remoção de Dispositivo/métodos , Procedimentos Endovasculares , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Flebografia/métodos , Espaço Retroperitoneal , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
13.
Ann Anat ; 221: 173-178, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30248401

RESUMO

BACKGROUND: The variable of the suprascapular notch (SSN) is a common cause in suprascapular nerve (SN) entrapment. Hence, knowledge of SSN variations may be predictive valuable for the predisposition to compression of SN. The aim of this study was to propose the classification of SSN in Chinese population and took this complex morphology into account. MATERIAL AND METHODS: 308 human dry scapulae were analyzed thoroughly and systematically in this study. Morphological variations of the SSN were observed by visual inspection and the classification of SSN was determined by geometrical measurements. Then measurement results were averaged and recorded. RESULTS: Chinese dry scapulae were measured, we found seven types of SSN. Type Ⅰ (√, 44.8%) was the most common, followed by type Ⅱ (U, 41.9%) to Ⅶ (double O, 0.6%). Right scapulae were larger in depth of SSN and thickness of A and C. Type Ⅶ (double O) had the deepest SSN and type Ⅰ (√) was widest among five types. For BC, type Ⅰ (√) was shorter than type Ⅲ (V). For thickness of A, type Ⅶ (double O) was greater than type Ⅰ (√). For thickness of C, type Ⅰ (√) and type Ⅱ (U) were shorter than type Ⅲ (V). There were no significant differences in other measurements between types and sides of body. Seven types of SSN in Chinese population were defined in our study. CONCLUSION: These anatomical variations of the SSN may improve the diagnostic rate and success rate of the surgical for the suprascapular nerve entrapment.


Assuntos
Síndromes de Compressão Nervosa/fisiopatologia , Escápula/anatomia & histologia , Articulação do Ombro/anatomia & histologia , Grupo com Ancestrais do Continente Asiático , China , Feminino , Humanos , Masculino , Síndromes de Compressão Nervosa/genética , Escápula/inervação , Articulação do Ombro/inervação
14.
Laryngoscope ; 129(9): 2105-2111, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30582168

RESUMO

OBJECTIVE: We report an association between lower cranial nerve (CN IX/X) vascular compression at the brainstem with laryngeal symptoms utilizing a stepwise algorithm that systematically evaluates and eliminates all other common etiologies. Our experiences with retromastoid craniectomy with lower cranial nerve (LCN) decompression versus non-neurosurgical treatments are detailed. STUDY DESIGN: Retrospective chart review at a tertiary care academic medical center with follow-up telephone survey. METHODS: Baseline demographics, clinical characteristics, quality-of-life surveys, and treatment outcomes were recorded for patients with laryngeal symptoms associated with LCN compression at the brainstem. RESULTS: Forty-nine patients demonstrated LCN compression at the brainstem on imaging and presented with chief complaints of dysphonia (25 of 49, 51%), chronic cough (19 of 49, 39%), dysphoric breathing (3 of 49, 6%), and dysphagia (2 of 49, 4%). Poor initial scores were noted for Voice-Related Quality of Life (V-RQOL), Reflux Symptom Index, and Glottal Closure Index. Twenty-four patients underwent LCN decompression, of which 21 of 24 (88%) reported partial, near-complete, or complete improvement. Major perioperative complications occurred in four of 24 patients (17%). Patients who had undergone decompression were more likely to obtain complete/near-complete symptom resolution (10 of 24 patients, 42%) compared to those undergoing conservative treatments (2 of 25 patients, 8%) (P = 0.02). V-RQOL scores improved more in surgical patients [mean change score, 33.0 (standard deviation [SD], 31.2) than nonsurgical patients (mean change score 9.6, SD 20.9) (P = 0.03) (mean follow-up 3.0 years, SD 2.0). CONCLUSION: Lower cranial nerve compression at the brainstem should be considered when all other etiologies are excluded. Retromastoid craniectomy with LCN decompression demonstrates an acceptable safety profile. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:2105-2111, 2019.


Assuntos
Tronco Encefálico/irrigação sanguínea , Nervo Glossofaríngeo/fisiopatologia , Doenças da Laringe/fisiopatologia , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/cirurgia , Nervo Vago/fisiopatologia , Idoso , Tronco Encefálico/diagnóstico por imagem , Descompressão Cirúrgica , Feminino , Humanos , Doenças da Laringe/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico por imagem , Complicações Pós-Operatórias , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
15.
J Med Case Rep ; 12(1): 343, 2018 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-30449285

RESUMO

BACKGROUND: Synovial osteochondromatosis, a benign tumor consisting of cartilage and bone, generally presents as multiple osteochondral or chondral nodules. Peripheral nerve palsy caused by synovial osteochondromatosis is rare. Three-dimensional reconstruction based on magnetic resonance imaging shows the specific shape and location of the tumor and its relation to the nerve. CASE PRESENTATION: We describe a case of posterior interosseous nerve palsy caused by synovial osteochondromatosis of the elbow in a 66-year-old Japanese man. A three-dimensional reconstructed image based on magnetic resonance imaging was used to determine the location and shape of the giant tumor, which was composed of bone and cartilage. After surgical resection of the giant tumor and neurolysis of the posterior interosseous nerve, he fully recovered from nerve palsy 9 months postoperatively. There was no recurrence of the lesion 1 year postoperatively. CONCLUSION: Synovial osteochondromatosis that causes posterior interosseous nerve palsy has a characteristic morphology and location, that is, a giant tumor located anterior to the humeroradial joint, as revealed by three-dimensional magnetic resonance image reconstruction.


Assuntos
Condromatose Sinovial/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Imagem Tridimensional , Imagem por Ressonância Magnética , Síndromes de Compressão Nervosa/diagnóstico por imagem , Recuperação de Função Fisiológica/fisiologia , Idoso , Condromatose Sinovial/complicações , Condromatose Sinovial/fisiopatologia , Condromatose Sinovial/cirurgia , Articulação do Cotovelo/cirurgia , Humanos , Masculino , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/cirurgia , Procedimentos Neurocirúrgicos/métodos , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
16.
Ann Plast Surg ; 81(6): 682-687, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30285992

RESUMO

BACKGROUND: Diabetic rats are more sensitive to nerve entrapment. This study was conducted to evaluate nerve function and histological changes in diabetic rats after nerve compression and subsequent decompression. METHODS: A total of 35 Wistar rats were included. The experimental group was divided into diabetic sciatic nerve compression group (DSNC, n = 5) and diabetic sciatic nerve decompression group (DSND, n = 20). The DSNC model was created by wrapping a silicone tube circumferentially around the nerve for 4 weeks, and then the DSND group accepted nerve decompression and was followed up to 12 weeks. The DSND group was equally divided into DSND 3 weeks (DSND3), 6 weeks (DSND6), 9 weeks (DSND9), and 12 weeks (DSND12) groups. Five rats were taken as normoglycemic control group (CR, n = 5), and another 5 rats as diabetic control group (DM, n = 5). The mechanical hyperalgesia of rats was detected by Semmes-Weinstein nylon monofilaments (SWMs) and by motor nerve conduction velocity (MNCV). These 2 physiological indicators and histology of sciatic nerves were compared among different groups. RESULTS: The SWM measurements improved toward normal values after decompression. The SWM value was significantly lower (more normal) in the DSNC groups than in the DSND group (P < 0.05). The MNCV was 53.7 ± 0.8 m/s in the CR group, whereas it was 28.4 ± 1.0 m/s in the DSNC group (P < 0.001). Six weeks after decompression, the MNCV was significantly faster than that in the DSNC group (P < 0.001). Histological examination demonstrated chronic nerve compression, which responded toward normal after decompression, but with degree of myelination never recovering to normal. CONCLUSIONS: Chronic compression of the diabetic sciatic nerve has measureable negative effects on sciatic nerve motor nerve function, associated with a decline of touch/pressure threshold and degeneration of myelin sheath and axon. Nerve decompression surgery can reverse these effects and partially restore nerve function.


Assuntos
Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/cirurgia , Nervo Isquiático/fisiopatologia , Nervo Isquiático/cirurgia , Animais , Descompressão Cirúrgica , Diabetes Mellitus Experimental , Eletrofisiologia , Masculino , Condução Nervosa , Procedimentos Neurocirúrgicos , Distribuição Aleatória , Ratos , Ratos Wistar
18.
Einstein (Sao Paulo) ; 16(3): eAO4206, 2018 Sep 17.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30231143

RESUMO

OBJECTIVE: To evaluate the effects of right sciatic nerve compression and cryotherapy on muscle tissue. METHODS: We used 42 male Wistar rats, subdivided in the following Groups Control, Injury 3, Injury 8 and Injury 15 submitted to nerve compression and euthanized in the 3rd, 8th and 15th day after surgery. The Cryotherapy Injury 3 was entailed treatment with cryotherapy by immersion of the animal in recipient for 20 minutes during 1 day, then animals were euthanized at the 3rd day after surgery, and the Cryotherapy Injury 8 and the Cryotherapy Injury 15 was treated for 6 days, and euthanized at the 8th and 15th day after surgery. Functional evaluation was performed by the grasping strength of the right pelvic limb. The right tibialis anterior muscles were evaluated for mass, smaller diameter and cross-sectional area. In the Cryotherapy Injury 8 and the Cryotherapy Injury 15 groups, the hydroxyproline was dosed in the right soles. RESULTS: In the compression there was a significant difference in the Injury Groups compared with the Control Group (p<0.05). In the smaller diameter, the compression in Control Group was higher than Injury 8 (p=0.0094), Injury 15 (p=0.002) and Cryotherapy Injury 15 (p<0.001) groups. The comparison between groups with euthanasia in the same post-operative period, a significant difference (p=0.0363) was seen in day 8th after surgery, and this result in Cryotherapy Injury Group was greater than Injury Group. In the fiber area, Control Group was also higher than the Injury 8 (p=0.0018), the Injury 15 (p<0.001) and the Cryotherapy Injury 15 (p<0.001). In hydroxyproline, no significant difference was seen between groups. CONCLUSION: Nerve damage resulted in decreased muscle strength and trophism, the cryotherapy delayed hypotrophy, but this effect did not persist after cessation of treatment.


Assuntos
Crioterapia/métodos , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/terapia , Nervo Isquiático/patologia , Neuropatia Ciática/patologia , Neuropatia Ciática/terapia , Animais , Modelos Animais de Doenças , Hipertrofia/fisiopatologia , Masculino , Debilidade Muscular/fisiopatologia , Síndromes de Compressão Nervosa/fisiopatologia , Distribuição Aleatória , Ratos Wistar , Valores de Referência , Reprodutibilidade dos Testes , Nervo Isquiático/fisiopatologia , Nervo Isquiático/cirurgia , Neuropatia Ciática/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
19.
World Neurosurg ; 120: 112-116, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30172973

RESUMO

BACKGROUND: The purpose of this paper is to underline that the association of physical examination, electrophysiology, and ultrasound was crucial in identifying the correct disease and atypical characteristics of its presentation, in turn, providing proper information for both surgical treatment and a rehabilitation program. Fibular nerve compression is a common finding in the adult population, and it is more frequent at the fibular head. The clinical picture may be characterized by motor and/or sensory deficits. The same symptoms may sometimes be suggestive of root impairment. CASE DESCRIPTION: We report the case of a 39-year-old man who came to our laboratory with a diagnosis of multimetameric lumbosacral radiculopathy. The patient reported a history of ankle numbness and transient foot drop. Neurophysiologic examination showed peripheral axonal damage at tibialis anterior and lateral gastrocnemius muscles. A nerve ultrasound showed the presence of a conflict between a fibular exostosis and the fibular nerve. Furthermore, the fibular nerve presented an anatomic variation supplying the lateral gastrocnemius muscle. CONCLUSIONS: Ultrasound was crucial in recognizing the cause of the atypical presentation and avoiding a misdiagnosis. Also, it allowed the identification of the appropriate treatment and rehabilitation, as well as preventing irreversible nerve damage. As a result, critical information was presented to the surgeon for surgical treatment.


Assuntos
Eletromiografia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/etiologia , Nervo Fibular/patologia , Ultrassonografia , Adulto , Variação Anatômica , Humanos , Masculino , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/cirurgia , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/fisiopatologia
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