Central Pain in the Face and Head
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Intractable Vomiting and Hiccups As the Presenting Symptom of Neuromyelitis Optica
Case Report Intractable vomiting and hiccups as the presenting symptom of neuromyelitis optica Girish Baburao Kulkarni, Pradeep Kallollimath, R. Subasree, M. Veerendrakumar Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India Abstract Vomiting and hiccups can be due to peripheral or central causes. Neurological diseases causing vomiting and hiccups are due to lesions of medulla involving area postrema and nucleus tractus solitarius. Neuromyelitis optica (NMO) is one such disease which involves these structures. However refractory vomiting and hiccups as the presenting symptom of NMO is unusual. Here we report a patient with NMO in whom refractory vomiting and hiccups were the sole manifestation of the first attack. Diagnosis can be missed at this stage leading to delay in treatment and further complications. This case demonstrates the importance of considering NMO in any patient presenting with refractory vomiting and hiccups and with local and metabolic causes ruled out and linear medullary lesion on magnetic resonance imaging may indicate the diagnosis even when the classical clinical criteria are not met. Anti NMO antibody testing should be done and if positive appropriate treatment should be initiated to prevent further neurological damage. Key Words Aquaporin antibody, hiccups, intractable vomiting, neuromyelitis optica For correspondence: Dr. Girish Baburao Kulkarni, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore ‑ 560 029, Karnataka, -
Le Journal Canadien Des Sciences Neurologiques
LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUES tations of ambulatory cassette recordings, computer application edge may lead to the rapid productive careers of young clinical for data reduction and seizure and spike recognition, and the investigators and scientists being replaced sooner by the next power and pitfalls of monitoring techniques in differentiating group of young Turks. "fits from faints". Broad applications including the pre-surgical The clinical reviews of cases by Jonesco-Sisesti are painstaking, evaluation are well-covered. Although some chapters give good and it's salutary to again see the careful clinical observation descriptions of subcategories of primary generalized and com that formed the basis of modern neurology. How long has it plex partial seizures, this material is available in other more been since we saw someone recording Oppenheim's, Gordon's, general texts on epilepsy. Schaeffer's reflexes as part of the clinical examination. One Unfortunately, I feel the weaknesses outweigh the qualities must pause when reading that the "mediopublic reflex pro of the book. There should be a more clear definition of research duced a definite inferior response and a weak superior response", versus routine clinical application of the technology. Through but the pause is enjoyable as it recalls the impeccable respect out the book the value of such monitoring is repeatedly stressed, for the neurological examination prior to the age of technology. yet there are no controlled studies to support its superiority Dr. Ross was given the idea for this project may years ago by over conventional clinical and EEG evaluations. The case for the late Dr. -
Thoracic Syringomyelia in a Patient with Amyotrophic Lateral Sclerosis
International Neuropsychiatric Disease Journal 3(4): 136-140, 2015; Article no.INDJ.2015.019 ISSN: 2321-7235 SCIENCEDOMAIN international www.sciencedomain.org Thoracic Syringomyelia in a Patient with Amyotrophic Lateral Sclerosis Daniele Lo Coco1,2, Rossella Spataro2, Alfonsa Claudia Taiello2 and Vincenzo La Bella2* 1Neurology Unit, Civico General Hospital ARNAS, 90127, Palermo, Italy. 2Department of Experimental Biomedicine and Clinical Neurosciences, ALS Clinical Research Center, University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy. Authors’ contributions This work was carried out in collaboration between both authors. Authors DLC and VLB made the diagnosis and outlined the case report. Authors DLC, RS, and ACT managed the literature search and wrote the first draft of the manuscript with assistance from author VLB. All authors read and approved the final manuscript. Article Information DOI: 10.9734/INDJ/2015/17176 Editor(s): (1) Zhefeng Guo, Department of Neurology, University of California, Los Angeles, USA. Reviewers: (1) Mario Ciampolini, Università di Firenze, Department of Peiatrics, Università di Firenze, Italy. (2) Raghvendra Vijay Ramdasi, Jaslok Hospital & Research Centre, Mumbai India. Complete Peer review History: http://www.sciencedomain.org/review-history.php?iid=840&id=29&aid=8665 Received 1st March 2015 th Short Communication Accepted 20 March 2015 Published 2nd April 2015 ABSTRACT We report a patient with bulbar-onset, clinically defined, sporadic amyotrophic lateral sclerosis bearing an isolated syringomyelia of the lower thoracic portion of the spinal cord. This is a very unusual association between two rare and progressive disorders, both affecting the spinal motoneurons. Syringomyelia might have acted as a phenotypic modifier in this ALS patient. -
Outcomes in Children Undergoing Posterior Fossa Decompression And
CLINICAL ARTICLE J Neurosurg Pediatr 25:21–29, 2020 Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study *Joyce Koueik, MD, MS,1 Carolina Sandoval-Garcia, MD,1 John R. W. Kestle, MD,2 Brandon G. Rocque, MD, MS,3 David M. Frim, MD, PhD,4 Gerald A. Grant, MD,5 Robert F. Keating, MD,6 Carrie R. Muh, MD,7 W. Jerry Oakes, MD,3 Ian F. Pollack, MD,8 Nathan R. Selden, MD, PhD,9 R. Shane Tubbs, PhD, PA-C,3 Gerald F. Tuite, MD,10 Benjamin Warf, MD,11 Victoria Rajamanickam, MS,12 Aimee Teo Broman, MA,12 Victor Haughton, MD,13 Susan Rebsamen, MD,13 Timothy M. George, MD,14 and Bermans J. Iskandar, MD1 1Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin; 2Department of Neurosurgery, University of Utah, Salt Lake City, Utah; 3Department of Neurosurgery, Children’s of Alabama, Birmingham, Alabama; 4Section of Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois; 5Department of Pediatric Neurosurgery, Stanford Health Care, Palo Alto, California; 6Department of Neurosurgery, Children’s National Health System, Washington, DC; 7Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina; 8Department of Neurosurgery, UPMC Children’s Hospital of Pittsburgh, Pennsylvania; 9Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon; 10Department of Neurosurgery, Johns Hopkins All Children’s Hospital, Tampa, Florida; 11Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts; Departments of 12Biostatistics and Medical Informatics and 13Radiology, University of Wisconsin–Madison, Wisconsin; and 14Department of Neurosurgery, Dell Medical School, Austin, Texas OBJECTIVE Despite significant advances in diagnostic and surgical techniques, the surgical management of Chiari malformation type I (CM-I) with associated syringomyelia remains controversial, and the type of surgery performed is surgeon dependent. -
Caspr2 Antibodies in Patients with Thymomas
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector MALIGNANCIES OF THE THYMUS Caspr2 Antibodies in Patients with Thymomas Angela Vincent, FRCPath,* and Sarosh R. Irani, MA* neuromuscular junction. Neuromyotonia (NMT) is due to Abstract: Myasthenia gravis is the best known autoimmune disease motor nerve hyperexcitability that leads to muscle fascicula- associated with thymomas, but other conditions can be found in tions and cramps. A proportion of patients have antibodies patients with thymic tumors, including some that affect the central that appear to be directed against brain tissue-derived volt- nervous system (CNS). We have become particularly interested in age-gated potassium channels (VGKCs) that control the ax- patients who have acquired neuromyotonia, the rare Morvan disease, onal membrane potential.4,5 VGKC antibody titers are rela- or limbic encephalitis. Neuromyotonia mainly involves the periph- tively low in NMT. eral nerves, Morvan disease affects both the peripheral nervous Morvan disease is a rare condition first described in system and CNS, and limbic encephalitis is specific to the CNS. 1876 but until recently hardly mentioned outside the French Many of these patients have voltage-gated potassium channel auto- literature.6 The patients exhibit NMT plus autonomic distur- antibodies. All three conditions can be associated with thymomas bance (such as excessive sweating, constipation, and cardiac and may respond to surgical removal of the underlying tumor -
Syringomyelia in Cervical Spondylosis: a Rare Sequel H
THIEME Editorial 1 Editorial Syringomyelia in Cervical Spondylosis: A Rare Sequel H. S. Bhatoe1 1 Department of Neurosciences, Max Super Specialty Hospital, Patparganj, New Delhi, India Indian J Neurosurg 2016;5:1–2. Neurological involvement in cervical spondylosis usually the buckled hypertrophic ligament flavum compresses the implies radiculopathy or myelopathy. Cervical spondylotic cord. Ischemia due to compromise of microcirculation and myelopathy is the commonest cause of myelopathy in the venous congestion, leading to focal demyelination.3 geriatric age group,1 and often an accompaniment in adult Syringomyelia is an extremely rare sequel of chronic cervical patients manifesting central cord syndrome and spinal cord cord compression due to spondylotic process, and manifests as injury without radiographic abnormality. Myelopathy is the accelerated myelopathy (►Fig. 1). Pathogenesis of result of three factors that often overlap: mechanical factors, syringomyelia is uncertain. Al-Mefty et al4 postulated dynamic-repeated microtrauma, and ischemia of spinal cord occurrence of myelomalacia due to chronic compression of microcirculation.2 Age-related mechanical changes include the cord, followed by phagocytosis, leading to a formation of hypertrophy of the ligamentum flavum, formation of the cavity that extends further. However, Kimura et al5 osteophytic bars, degenerative disc prolapse, all of them disagreed with this hypothesis, and postulated that following contributing to a narrowing of the spinal canal. Degenerative compression of the cord, there is slosh effect cranially and kyphosis and subluxation often aggravates the existing caudally, leading to an extension of the syrinx. It is thus likely compressiononthespinalcord.Flexion–extension that focal cord cavitation due to compression and ischemia movements of the spinal cord places additional, dynamic occurs due to periventricular fluid egress into the cord, the stretch on the cord that is compressed. -
Neurosyphilis Presenting with Myelitis-Case Series and Literature Review
Neurosyphilis presenting with myelitis-Case series and literature review Yali Wu Capital Medical University Aliated Beijing Ditan Hospital https://orcid.org/0000-0002-9737-6439 Wenqing Wu ( [email protected] ) https://orcid.org/0000-0001-7428-5529 Case report Keywords: Syphilis, Neurosyphilis, Spinal cord, Magnetic resonance imaging Posted Date: April 5th, 2019 DOI: https://doi.org/10.21203/rs.2.1849/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published at Journal of Infection and Chemotherapy on February 1st, 2020. See the published version at https://doi.org/10.1016/j.jiac.2019.09.007. Page 1/9 Abstract Background Neurosyphilis is a great imitator because of its various clinical symptoms. Syphilitic myelitis is extremely rare manifestation of neurosyphilis and often misdiagnosed. However, a small amount of literature in the past described its clinical manifestations and imaging features, and there was no relevant data on the prognosis, especially the long-term prognosis. In this paper, 4 syphilis myelitis patients admitted to our hospital between July 2012 and July 2017 were retrospectively reviewed. In the 4 patients, 2 were females, and 2 were males. We present our experiences with syphilitic myelitis, discuss the characteristics, treatment and prognosis. Case presentation The diagnosis criteria were applied: (1) diagnosis of myelitis established by two experienced neurologist based on symptoms and longitudinally extensive transverse myelitis (LETM) at the cervical and thoracic levels mimicked neuromyelitis optic (NMO) on magnetic resonance imaging (MRI) ; (2) Neurosyphilis (NS) was diagnosed by positive treponema pallidum particle assay (TPPA) and toluidine red untreated serum test (TRUST) in the serum and CSF; (3) negative human immunodeciency virus (HIV). -
A Histopathological and Immunohistochemical Study of Acute and Chronic Human Compressive Myelopathy
Cellular Pathology and Apoptosis in Experimental and Human Acute and Chronic Compressive Myelopathy ROWENA ELIZABETH ANNE NEWCOMBE M.B.B.S. B.Med Sci. (Hons.) Discipline of Pathology, School of Medical Sciences University of Adelaide June 2010 A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy CHAPTER 1 INTRODUCTION 1 The term “compressive myelopathy” describes a spectrum of spinal cord injury secondary to compressive forces of varying magnitude and duration. The compressive forces may act over a short period of time, continuously, intermittently or in varied combination and depending on their magnitude may produce a spectrum varying from mild to severe injury. In humans, spinal cord compression may be due to various causes including sudden fracture/dislocation and subluxation of the vertebral column, chronic spondylosis, disc herniation and various neoplasms involving the vertebral column and spinal canal. Neoplasms may impinge on the spinal cord and arise from extramedullary or intramedullary sites. Intramedullary expansion producing a type of internal compression can be due to masses created by neoplasms or fluid such as the cystic cavitation seen in syringomyelia. Acute compression involves an immediate compression of the spinal cord from lesions such as direct trauma. Chronic compression may develop over weeks to months or years from conditions such as cervical spondylosis which may involve osteophytosis or hypertrophy of the adjacent ligamentum flavum. Compressive myelopathies include the pathological changes from direct mechanical compression at one or multiple levels and changes in the cord extending multiple segments above and below the site of compression. Evidence over the past decade suggests that apoptotic cell death in neurons and glia, in particular of oligodendrocytes, may play an important role in the pathophysiology and functional outcome of human chronic compressive myelopathy. -
ICD9 & ICD10 Neuromuscular Codes
ICD-9-CM and ICD-10-CM NEUROMUSCULAR DIAGNOSIS CODES ICD-9-CM ICD-10-CM Focal Neuropathy Mononeuropathy G56.00 Carpal tunnel syndrome, unspecified Carpal tunnel syndrome 354.00 G56.00 upper limb Other lesions of median nerve, Other median nerve lesion 354.10 G56.10 unspecified upper limb Lesion of ulnar nerve, unspecified Lesion of ulnar nerve 354.20 G56.20 upper limb Lesion of radial nerve, unspecified Lesion of radial nerve 354.30 G56.30 upper limb Lesion of sciatic nerve, unspecified Sciatic nerve lesion (Piriformis syndrome) 355.00 G57.00 lower limb Meralgia paresthetica, unspecified Meralgia paresthetica 355.10 G57.10 lower limb Lesion of lateral popiteal nerve, Peroneal nerve (lesion of lateral popiteal nerve) 355.30 G57.30 unspecified lower limb Tarsal tunnel syndrome, unspecified Tarsal tunnel syndrome 355.50 G57.50 lower limb Plexus Brachial plexus lesion 353.00 Brachial plexus disorders G54.0 Brachial neuralgia (or radiculitis NOS) 723.40 Radiculopathy, cervical region M54.12 Radiculopathy, cervicothoracic region M54.13 Thoracic outlet syndrome (Thoracic root Thoracic root disorders, not elsewhere 353.00 G54.3 lesions, not elsewhere classified) classified Lumbosacral plexus lesion 353.10 Lumbosacral plexus disorders G54.1 Neuralgic amyotrophy 353.50 Neuralgic amyotrophy G54.5 Root Cervical radiculopathy (Intervertebral disc Cervical disc disorder with myelopathy, 722.71 M50.00 disorder with myelopathy, cervical region) unspecified cervical region Lumbosacral root lesions (Degeneration of Other intervertebral disc degeneration, -
Transverse Myelitis Interagency Collaboration
SHNIC Specialized Health Needs Factsheet: Transverse Myelitis Interagency Collaboration What is it? Transverse Myelitis is a neurological disorder caused by inflammation of the spinal cord. A child will experience weakness, pain, sensory and autonomic dysfunction. Auto- nomic, involuntary activities such as breathing, digestion, heartbeat and reflexes can be affected. Symptoms can ap- pear suddenly within hours or progress over a span of sev- eral weeks. Approximately 25% of cases are children. A peak in incidence occurs between ages of 10 and 19 and females are at higher risk than men. During an inflammato- ry response the myelin, or protective fatty coating on nerve cells, is damaged or destroyed. TM can also be the first symptom to diagnose Multiple Sclerosis. What causes it? Researchers believe it is the body’s immune response, not the infection itself, that causes the inflammatory response. This indicates an auto-immune reaction, where the body attacks it’s own tissue rather than the infection, is responsible. Research has made connections to the damage of spinal nerves following a viral or bacterial infection, especially those associated with a rash. According to the National Institute of Neurologic Disorders and Stroke, infectious agents sus- pected of causing TM include Varicella zoster (the virus that causes chickenpox and shingles), Herpes simplex, Cytomegalovirus, Epstein-Barr, Influenza, Echovirus, Human immunodefi- ciency virus (HIV), Hepatitis A, and Rubella. In some cases, bacterial infections like a middle ear infection and bacterial pneumonia have also been linked. What are the symptoms? Symptoms can start slowly and progressively worsen over hours or days. Damage depends on the affected area of the spinal cord. -
Non-Commercial Use Only
Neurology International 2015; volume 7:5885 Amyotrophic lateral sclerosis: Introduction Correspondence: Marco Orsini, Programa de Pós- new perpectives and update Graduação em Ciências da Reabilitação, Praça The technological breakthrough in the field das Nações, 34, Bonsucesso, Rio de Janeiro, CEP: Marco Orsini,1,2 Acary Bulle Oliveira 3 of neurolog /neuroscience, with modern imag- 21041021, Brasil. Osvaldo J.M. Nascimento,1 , ing and genetic studies, may, sometimes, E-mail: [email protected] Carlos Henrique Melo Reis 1 make the neurologist stay away from indispen- Key words: Amyotrophic lateral sclerosis; neu- Marco Antonio Araujo Leite, 1 sable propaedeutic techniques for the correct rodegenerative diseases; diagnosis; treatment; 1 1 Jano Alves de Souza Camila, Pupe diagnosis of amyotrophic lateral sclerosis rehabilitation. Olivia Gameiro de Souza, 1 , (ALS). ALS is without doubt a disease of the Victor Hugo Bastos 4 , central nervous system (CNS), which its natu- Contributions: the authors contributed equally. Marcos R.G. de Freitas, 1 Silmar Teixeira 4 ral history is one of the darkest in neurology. A progressive, devastating and inexorable dis- Carlos Bruno 1 Eduardo, Davidovich 1 , Conflict of interest: the authors declare no poten- ease, commonly leads to death by respiratory tial conflict of interest. Benny Smidt3, , failure a few years after onset of first symp- 1Neurology Department, Universidade toms. Rowland,1 centuries ago, defines its nat- Received for publication: 25 February 2015. Federal Fluminense, Rio de Janeiro; ural history well by stating that any notifica- Accepted for publication: 15 June 2015. 2Programa de Mestrado em Ciências da tion of improvement in patients with this dis- This work is licensed under a Creative Commons ease deserves careful review, because probably Reabiitação – UNISUAM, Rio de Janeiro; Attribution NonCommercial 3.0 License (CC BY- 3Neurology Department, Universidade it is not a case of ALS. -
Topical Diagnosis in Neurology
V Preface In 2005 we publishedacomplete revision of Duus’ Although the book will be useful to advanced textbook of topical diagnosis in neurology,the first students, also physicians or neurobiologists inter- newedition since the death of its original author, estedinenriching their knowledge of neu- Professor PeterDuus, in 1994.Feedbackfromread- roanatomywith basic information in neurology,oR ers wasextremelypositive and the book wastrans- for revision of the basics of neuroanatomywill lated intonumerous languages, proving that the benefit even morefromit. conceptofthis book wasasuccessful one: combin- This book does notpretend to be atextbook of ing an integrated presentation of basic neu- clinical neurology.That would go beyond the scope roanatomywith the subject of neurological syn- of the book and also contradict the basic concept dromes, including modern imaging techniques. In described above.Firstand foremostwewant to de- this regard we thank our neuroradiology col- monstratehow,onthe basis of theoretical ana- leagues, and especiallyDr. Kueker,for providing us tomical knowledge and agood neurological exami- with images of very high quality. nation, it is possible to localize alesion in the In this fifthedition of “Duus,” we have preserved nervous system and come to adecision on further the remarkablyeffective didactic conceptofthe diagnostic steps. The cause of alesion is initially book,whichparticularly meets the needs of medi- irrelevant for the primarytopical diagnosis, and cal students. Modern medical curricula requirein- elucidation of the etiology takes place in asecond tegrative knowledge,and medical studentsshould stage. Our book contains acursoryoverviewofthe be taught howtoapplytheoretical knowledge in a major neurologicaldisorders, and it is notintended clinical settingand, on the other hand, to recognize to replace the systematic and comprehensive clinical symptoms by delving intotheir basic coverage offeredbystandardneurological text- knowledge of neuroanatomyand neurophysiology.