Home About us Contact
|
Home About us Contact | ||
|
|
||
Nerve Roots (nerve + root)
Selected AbstractsEffects of high-intensity focused ultrasound on the intervertebral disc: A potential therapy for disc herniationsJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2006Carina Forslund PhD Abstract Purpose. To determine the potential application of high-intensity focused ultrasound for the minimally invasive treatment of herniated intervertebral discs by developing a probe that produces sufficiently high temperature locally to shrink collagen fibers (65,75°C). Materials and Methods. A 5-mm ultrasound probe was produced with a geometric focal length of 15 mm. The probe produced 2.5 W of acoustic power and was operated at a frequency of 4.1 MHz. Measurements of temperature increase were performed in discs from bovine tails. In vivo experiments were performed to assess histologic changes in the disc as well as in nerve root and muscle. Results. Sufficient temperature increase to produce collagen shrinkage was observed close to the focus of the ultrasound. Temperature measurements in vertebral end plates showed a temperature increase of only 4°C after 60-second exposure of the disc. In vivo experiments revealed histologic changes in the disc consistent with collagen shrinkage, with no adverse effects seen in surrounding tissues. Conclusions. The experiments demonstrated the feasibility of high-intensity focused ultrasound in the treatment of contained herniated discs. This technique has several advantages over other thermal treatment modalities. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:330,338, 2006 [source] Pathology of lumbar nerve root compression Part 1: Intraradicular inflammatory changes induced by mechanical compressionJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2004Shigeru Kobayashi Study design: This study is to investigate the intraradicular inflammation induced by mechanical compression using in vivo model. Objectives: The relationship between the intraradicular edema and nerve fiber degeneration induced by mechanical compression was determined in the nerve root. Summary of background data: Recently some studies reported that mechanical compression increased microvascular permeability of the endoneurial capillaries and resulted in an intraradicular inflammation. These changes may be an important factor of the pathogenesis of radiculopathy. However, the natural courses of the intraradicular inflammation after mechanical compression are still poorly understood. Methods: In dogs, laminectomy was performed at L7 and the seventh nerve root was exposed to compression at 7.5 gram force (gf) clipping power. The animals were evaluated at 1 and 3 weeks after clipping. After the appropriate period of nerve root compression, Evans blue albumin (EBA) was injected intravenously. The nerve root sections were divided into two groups. The sections were used to investigate the status of the blood,nerve barrier function under the fluorescence microscope. The other sections were used for light and transmission electron microscopic study. Results: After 1 and 3 weeks, intraradicular edema was observed not only at the site of compression but also in the peripheral zone of a compressed anterior root and in the central zone of a compressed posterior root. The evidence of active Wallerian degeneration was also seen in the area of intraradicular edema. In addition, the nerve roots showing Wallerian degeneration were infiltrated by inflammatory cells, such as macrophages and mast cells. Conclusions: Inflammatory reaction, such as Wallerian degeneration, breakdown of blood,nerve barrier and appearance of macrophage, may be deeply involved in radiculitis arising from mechanical compression, and these factors seem to be important in the manifestation of radiculopathy. © 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Spinal somatosensory evoked potential evaluation of acute nerve-root injury associated with pedicle-screw placement procedures: An experimental studyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 2 2003I-Ming Jou Pedicle screws for spinal fixation risk neural damage because of the proximity between screw and nerve root. We assessed whether spinal somatosensory evoked potential (SSEP) could selectively detect pedicle-screw-related acute isolated nerve injury. Because pedicle screws are too large for a rat's spine, we inserted a K-wire close to the pedicle in 32 rats, intending not to injure the nerve root in eight (controls), and to injure the L4 or L5 root in 24. We used sciatic-nerve-elicited SSEP pre- and postinsertion. Radiologic, histologic, and postmortem observations confirmed the level and degree of root injury. Sciatic (SFI), tibial (TFI), and peroneal function indices (PFI) were calculated and correlated with changes in potential. Although not specific for injuries to different roots, amplitude reduction immediately postinsertion was significant in the experimental groups. Animals with the offending wire left in place for one hour showed a further non-significant deterioration of amplitude. Electrophysiologic changes correlated with SFI and histologic findings in all groups. SSEP monitoring provided reliable, useful diagnostic and intraoperative information about the functional integrity of single nerve-root injury. These findings are clinically relevant to acute nerve-root injury and pedicle-screw insertion. If a nerve-root irritant remains in place, a considerable neurologic deficit will occur. © 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] SURGICAL TREATMENT OF GLOSSOPHARYNGEAL NEURALGIA: A 10 YEAR EXPERIENCEJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2002F. Rychlicki First described by Weisenburg in 1910, glossopharyngeal neuralgia is paroxysmal, lighting, excruciating pain referred to the posterior lingual region, tonsillar pillar, throat, external auditory canal and pinna. It is much less frequently encountered than trigeminal neuralgia with a reported relative frequency of the order of 1%. It is often secondary to neoplastic processes of the oropharyngeal region but can also be caused by mechanical compression of abnormal vessels on the nerve root. Less frequently it is of essential or idiophatic origin. Between 1990 and 2000, operations were performed at our Institute on 3 patients, all women ranging in age from 61 to 80 years, with glossopharyngeal neuralgia. All the patients had been taking caramazepine with only temporary initial improvement and in 2 cases parenteral feeding had been necessary before admission. The first 2 patients were submitted to percutaneous thermocoagulation rhizotomy of the inferior petrous ganglion of Andersch at the jugular foramen, the third to open procedure consisting in vascular decompression of the ninth nerve in posterior fossa. The follow-up ranges from 2 to 10 years. The results were excellent or very good in all cases at the time of evaluation. The authors emphasize the role of surgical therapy in glossopharyngeal neuralgia when medical therapy fails. [source] Disc Related and Non-Disc Related Disorders of the Thoracic SpinePAIN PRACTICE, Issue 2 2001Phillip S. Sizer Jr. MEd Abstract: Different anatomical structures and pathophysiological functions can be responsible for lumbar pain, each producing a distinctive clinical profile. Pain can arise from the intervertebral disc, either acutely as a primary disc related disorder, or as result of the degradation associated with chronic internal disc disruption. In either case, greatest pain provocation will be associated with movements and functions in the sagittal plane. Lumbar pain can also arise from afflictions within the zygapophyseal joint mechanism, as a result of synovitis or chondropathy. Either of these conditions will produce the greatest pain provocation during three-dimensional movements, due to maximal stress to either the synovium or joint cartilage. Finally, patients can experience different symptoms associated with irritation to the dural sleeve, dorsal root ganglion, or chemically irritated lumbar nerve root. Differential diagnosis of these conditions requires a thorough examination and provides information that can assist the clinician in selecting appropriate management strategies. [source] An evidence-based approach to human dermatomesCLINICAL ANATOMY, Issue 5 2008M.W.L. Lee Abstract The dermatome is a fundamental concept in human anatomy and of major importance in clinical practice. There are significant variations in current dermatome maps in standard anatomy texts. The aim of this study was to undertake a systematic literature review of the available evidence for the distribution of human dermatomes. Particular emphasis was placed on the technique of ascertainment, the location and extent of each dermatome, the number of subjects studied, and methodologic limitations. Our findings demonstrate that current dermatome maps are inaccurate and based on flawed studies. After selecting the best available evidence, a novel evidence-based dermatome map was constructed. This represents the most consistent tactile dermatomal areas for each spinal dorsal nerve root found in most individuals. In addition to highlighting the orderly arrangement, areas of consistency and clinical usefulness of dermatomes, their overlap and variability deserve greater emphasis. This review demonstrates the validity of an evidence-based approach to an anatomical concept. Clin. Anat. 21:363,373, 2008. © 2008 Wiley-Liss, Inc. [source] Developmental changes in the modulation of respiratory rhythm generation by extracellular K+ in the isolated bullfrog brainstemDEVELOPMENTAL NEUROBIOLOGY, Issue 3 2003Rachel E. Winmill Abstract This study tested the hypothesis that voltage-dependent, respiratory-related activity in vitro, inferred from changes in [K+]o, changes during development in the amphibian brainstem. Respiratory-related neural activity was recorded from cranial nerve roots in isolated brainstem,spinal cord preparations from 7 premetamorphic tadpoles and 10 adults. Changes in fictive gill/lung activity in tadpoles and buccal/lung activity in adults were examined during superfusion with artificial CSF (aCSF) with [K+]o ranging from 1 to 12 mM (4 mM control). In tadpoles, both fictive gill burst frequency (fgill) and lung burst frequency (flung) were significantly dependent upon [K+]o (r2 > 0.75; p < 0.001) from 1 to 10 mM K+, and there was a strong correlation between fgill and flung (r2 = 0.65; p < 0.001). When [K+]o was raised to 12 mM, there was a reversible abolition of fictive breathing. In adults, fictive buccal frequency (fbuccal), was significantly dependent on [K+]o (r2 = 0.47; p < 0.001), but [K+]o had no effect on flung (p > 0.2), and there was no significant correlation between fbuccal and flung. These data suggest that the neural networks driving gill and lung burst activity in tadpoles may be strongly voltage modulated. In adults, buccal activity, the proposed remnant of gill ventilation in adults, also appears to be voltage dependent, but is not correlated with lung burst activity. These results suggest that lung burst activity in amphibians may shift from a "voltage-dependent" state to a "voltage-independent" state during development. This is consistent with the hypothesis that the fundamental mechanisms generating respiratory rhythm in the amphibian brainstem change during development. We hypothesize that lung respiratory rhythm generation in amphibians undergoes a developmental change from a pacemaker to network-driven process. © 2003 Wiley Periodicals, Inc. J Neurobiol 55: 278,287, 2003 [source] Sensory neuropathy in the prodromal phase of hepatitis A and review of the literatureJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2000Shamsul Islam Abstract We report an unrecognized clinical presentation of hepatitis A with unilateral peripheral acute sensory loss in the prodromal phase of the illness. Although rare, focal neurological signs are known to occur in hepatitis A before, during and after the icteric phase; a pure peripheral sensory neuropathy is distinctly uncommon. Possible lesions could include radiculopathy of the lower thoraco,lumbo,sacral dorsal nerve roots or a partial transverse myelitis of Brown-Séquad like distribution. The signs and symptoms lasted only a few days and the patient had an uneventful recovery. [source] Magnetic resonance imaging of cauda equina syndrome in long-standing ankylosing spondylitisJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2007A Arslanoglu Summary The cauda equina syndrome is an uncommon complication of long-standing ankylosing spondylitis and its aetiology is controversial. We report a case of the cauda equina syndrome, erosion of the posterior elements of the lumbar spine and traction of the lumbar nerve roots because of multiple dural diverticula in a patient with long-standing ankylosing spondylitis. Magnetic resonance imaging is valuable in excluding other spinal lesions. Extensive dural diverticula formation is characteristic of ankylosing spondylitis and has the potential to provide an early diagnosis. [source] Rapid assessment of internodal myelin integrity in central nervous system tissueJOURNAL OF NEUROSCIENCE RESEARCH, Issue 4 2010Daniel A. Kirschner Abstract Monitoring pathology/regeneration in experimental models of de-/remyelination requires an accurate measure not only of functional changes but also of the amount of myelin. We tested whether X-ray diffraction (XRD), which measures periodicity in unfixed myelin, can assess the structural integrity of myelin in fixed tissue. From laboratories involved in spinal cord injury research and in studying the aging primate brain, we solicited "blind" samples and used an electronic detector to record rapidly the diffraction patterns (30 min each pattern) from them. We assessed myelin integrity by measuring its periodicity and relative amount. Fixation of tissue itself introduced ±10% variation in periodicity and ±40% variation in relative amount of myelin. For samples having the most native-like periods, the relative amounts of myelin detected allowed distinctions to be made between normal and demyelinating segments, between motor and sensory tracts within the spinal cord, and between aged and young primate CNS. Different periodicities also allowed distinctions to be made between samples from spinal cord and nerve roots and between well-fixed and poorly fixed samples. Our findings suggest that, in addition to evaluating the effectiveness of different fixatives, XRD could also be used as a robust and rapid technique for quantitating the relative amount of myelin among spinal cords and other CNS tissue samples from experimental models of de- and remyelination. © 2009 Wiley-Liss, Inc. [source] Immunohistochemical and electron microscopic study of invasion and differentiation in spinal cord lesion of neural stem cells grafted through cerebrospinal fluid in ratJOURNAL OF NEUROSCIENCE RESEARCH, Issue 6 2002Sufan Wu Abstract Neurospheres were obtained by culturing hippocampal cells from transgenic rat fetuses (E16) expressing green fluorescent protein (GFP). The neurosphere cells were injected into the cerebrospinal fluid (CSF) through the 4th ventricle of young rats (4 weeks old) that had been given a contusion injury at T8,9 of the spinal cord. The injected neural stem cells were transported through the CSF to the spinal cord, attached to the pial surface at the lesion, and invaded extensively into the spinal cord tissue as well as into the nerve roots. The grafted stem cells survived well in the host spinal cord for as long as 8 months after transplantation. Immunohistochemical study showed that many grafted stem cells had differentiated into astrocytes at 1,4 months, and some into oligodendrocytes at 8 months postoperatively. Immunoelectron microscopy showed that the grafted stem cells were well integrated into the host tissue, extending their processes around nerve fibers in the same manner as astrocytes. In addition, grafted stem cells within nerve roots closely surrounded myelinated fibers or were integrated into unmyelinated fiber bundles; those associated with myelinated fibers formed basal laminae on their free surface, whereas those associated with unmyelinated fibers were directly attached to axons and Schwann cells, indicating that grafted stem cells behaved like Schwann cells in the nerve roots. © 2002 Wiley-Liss, Inc. [source] Effects of 5-HT2A receptor antagonist on blood flow in chronically compressed nerve rootsJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 4 2004Miho Sekiguchi Abstract Neurogenic intermittent claudication (NIC) can be caused by compression of the cauda equina by spinal stenosis and is a major clinical problem. A reduction of blood flow is an important mechanism for inducing NIC and may be caused by a vasoconstrictive effect mediated by the serotonin 5-HT2A receptor in chronic cauda equina compression lesions. This study assessed the effects of the 5-HT2A receptor antagonist on nerve vasculature in chronically compressed nerve roots. A plastic balloon was placed under the lamina of L7 and inflated to 10 mmHg and left for 1 week in several cauda equina compression models. All experimental animals received an acute administration of serotonin. One group received sarpogrelate hydrochloride (5-HT2A receptor antagonist: 5-HTRA) before administration of serotonin, and another group was administered 5-HTRA after administration of serotonin. Diameters and blood flow in the vasculature of S2 or S3 nerve roots were measured after injection of serotonin. In animals without compression of the cauda equina (sham), blood vessels contracted and the blood flow was reduced after administration of serotonin. In sham and compression animals receiving both serotonin and 5-HTRA, blood vessel diameter was not reduced and was significantly larger than that in the compression group receiving only serotonin (p < 0.05). Likewise, the blood flow was not reduced in sham and compression animals receiving serotonin and 5-HTRA and was significantly greater in the compression group treated only with serotonin. 5-HTRA inhibited vasoconstriction and the reduction of blood flow in chronically compressed nerve roots challenged with serotonin. This fact suggests that 5-HTRA might be effective at improving blood flow in chronically compressed nerve roots in patients with spinal canal stenosis and changes in circulation levels of serotonin. [source] Selective contrast enhancement of anterior spinal nerve roots on magnetic resonance imaging: a suggestive sign of Guillain,Barré syndrome and neurobrucellosisJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 3 2003Article first published online: 12 AUG 200 No abstract is available for this article. [source] Paraplegia associated with brucellosis involving the anterior lumbrosacral nerve rootsJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2003Umit Hidir Ulas Abstract We report the case of a 21-year-old man with paraplegia due to brucellosis involvement of lumbosacral anterior roots. Lumbosacral magnetic resonance imaging showed contrast enhancement of anterior roots and the anterior part of duramater. Conduction block was found at the level of the lumbosacral anterior roots by electrophysiological studies, including magnetic stimulation study. Wright agglutination, Rose Bengal tests and bacterial culture obtained from cerebrospinal fluid confirmed the diagnosis of neurobrucellosis. Oral administration of ceftriaxon with additional rifampin was effective, and after 3 months of treatment, laboratory data resolved and clinical signs partially improved. [source] Evidence for shoulder girdle dystonia in selected patients with cervical disc prolapseMOVEMENT DISORDERS, Issue 4 2002Georg Becker MD Abstract Some patients with cervical disc herniation suffer from persistent nuchal pain and muscle spasms after decompressive surgery despite the lack of clinical and radiological signs for actual spinal root compression. Sonographic examination of the brain in some of these patients showed increased echogenicity of the lentiform nuclei as described in patients with idiopathic dystonia. This has been linked to an altered Menkes protein level and copper metabolism. We suggest a relationship between persistent nuchal pain after adequate cervical disc surgery and dystonic movement disorders. Thirteen patients with persistent nonradicular nuchal pain after at least one cervical disc surgery and without evidence of continuing spinal root compression and 13 age-matched controls were included. All patients had a complete neurological examination, ultrasound, and MRI scan of the brain. In addition, Menkes protein mRNA levels of leucocytes were analyzed in patients and controls. All patients with persistent nuchal pain exhibited a constant tonic unilateral shoulder elevation associated with an ipsilateral hypertrophy of the trapezius muscle. Ultrasound examination showed an increased echogenicity of the lentiform nucleus in one patient unilaterally and in 10 patients bilaterally but in none of the controls. On MRI the T2-values of the lentiform nuclei were found to be higher in patients exhibiting a hyperechogenicity of the lentiform nuclei compared to controls (P = 0.01). In addition, Menkes protein mRNA levels were decreased in patients with cervical disc herniation (P = 0.03). Clinical, neuroimaging, and biochemical findings of this selected patient sample with chronic nuchal pain and muscle spasms after cervical disc surgery resemble alterations in patients with idiopathic cervical dystonia. This suggests a link between both disorders. A peripheral trauma to the nerve roots may precipitate dystonic movements in susceptible patients and chronic dystonic muscle contraction would account for the persistent nuchal pain. © 2002 Movement Disorder Society [source] Chronic sensorimotor polyradiculopathy with antibodies to P2: An electrophysiological and immunoproteomic analysisMUSCLE AND NERVE, Issue 1 2008Ricard Rojas-Garcia MD Abstract In this study we report a patient with chronic progressive sensory ataxia, proximal weakness, immunoglobulin M (IgM) monoclonal gammopathy, and elevated protein levels in the cerebrospinal fluid, who showed a good response to prednisone. Electrophysiological study disclosed abnormalities predominantly of late responses (F waves and H reflexes), with no evidence of demyelination in the peripheral nerves, suggesting motor and preganglionic sensory nerve roots as the site of the lesion. An immune-mediated pathogenesis was considered and, to identify possible target antigens, we performed bidimensional electrophoresis and a Western blot study. Based on the suspected lesion site, we used human anterior and posterior root extracts. We identified IgM reactivity against peripheral nerve myelin protein P2. Enzyme-linked immunosorbent assay confirmed IgM reactivity toward one synthetic peptide from P2. To our knowledge, reactivity against P2 has not been reported previously in a paraproteinemic neuropathy. Furthermore, we demonstrated that bidimensional electrophoresis and Western blot of the tissue involved, as determined by clinical and electrophysiological studies, may be useful to establish clinical,immunological correlations in paraproteinemic neuropathies. Muscle Nerve, 2008 [source] Time course of axonal regeneration in acute motor axonal neuropathyMUSCLE AND NERVE, Issue 6 2007Noriko Tamura MD Abstract Patients with acute motor axonal neuropathy (AMAN) generally recover well. We reviewed clinical and electrophysiologic recovery in 13 patients for up to 5 years. Twelve patients showed rapid recovery over 12 months, whereas in the remaining one the recovery was slow and incomplete at 5 years. In AMAN, axonal degeneration appears to develop predominantly in the motor nerve terminals, and only occasionally more proximally in the nerve roots. Nerve terminal degeneration,regeneration presumably provides a mechanism for good recovery. Muscle Nerve, 2007 [source] Lymphoma and peripheral neuropathy: A clinical reviewMUSCLE AND NERVE, Issue 3 2005John J. Kelly MD Abstract Lymphoma occasionally affects the peripheral nervous system. When it does, the diagnosis can be elusive since many patients present without known lymphoma. Most peripheral nerve complications are due to non-Hodgkin's lymphoma (NHL), which infiltrates nerves causing axonal damage. This disorder can affect nerve roots and cranial nerves, often associated with lymphomatous meningitis. NHL may also infiltrate peripheral nerves and cause plexopathy, mononeuropathy, or generalized neuropathy. These neuropathies may resemble an asymmetric mononeuropathy multiplex or a generalized disorder such as chronic inflammatory demyelinating polyradiculoneuropathy. When NHL infiltrates diffusely, the term neurolymphomatosis is used. Hodgkin's lymphoma (HL), by contrast, rarely infiltrates nerves. More often, HL causes immunological disorders of the peripheral nervous system such as inflammatory plexopathy or Guillain,Barré syndrome. Other rare lymphomas such as intravascular lymphoma and Waldenström's macroglobulinemia can also affect peripheral nerves in specific ways. In addition, other malignant and nonmalignant lymphoproliferative disorders enter into the differential diagnosis of lymphomatous neuropathy. This review discusses the multiple peripheral nerve presentations of lymphoma from the clinician's point of view and provides a guide to the evaluation and diagnosis of these uncommon, challenging disorders. Muscle Nerve, 2005 [source] The clinical features and surgical treatment of degenerative lumbar scoliosis: A review of 112 patientsORTHOPAEDIC SURGERY, Issue 3 2009Wei Liu MD Objective:, To investigate the clinical features, radiological characteristics and surgical results of degenerative lumbar scoliosis (DLS). Methods:, One hundred and twelve cases of DLS treated surgically from June 2001 to February 2006 were retrospectively reviewed for clinical features, characteristics of nerve root compression and imaging presentations. According to the preoperative clinical manifestations and imaging findings, different surgical modalities were performed, including simple nerve decompression and decompression with short or long posterior fusion (less or more than three segments, respectively). Results:, The mean age of 47 male and 65 female patients was 54.7 years. Clinical manifestations included lower back pain (76.8%), radiculopathy (79.5%) and claudication (48.2%). Plain lumbar radiograph showed right scoliosis in 87 and left scoliosis in the other 25 cases; the Cobb angle was 10°,46°; the apex of scoliosis mostly located at L3 (48.2%); L3 and L4 nerve roots were usually compressed on the concave side and L5 and S1 nerve roots on the convex side. The Cobb angle and physiologic lordosis angle of patients who underwent multi-segment (>3 segments) fusion improved to a greater extent than did that of patients who had simple decompression without fusion. A mean 5.7-year follow-up showed that the average improvement in Oswestry disability index (ODI) scores was 32.6, 26.3 and 13.5 for long segment fusion, short segment fusion and simple decompression without fusion, respectively. Conclusion:, Decompression surgery with or without fusion, the main purpose of which is to relieve nerve root compression and stabilize the spinal column, is an effective treatment for chronic DLS. The treatment should be individualized according to the patient's age, general and economic factors, severity of deformity and other coexisting lumbar degenerative disorders. [source] Herpes zoster in older adults. (Duke University Medical Center, Durham, NC) Clinical Infectious Diseases.PAIN PRACTICE, Issue 4 20011486., 2001;32:148 Herpes zoster (HZ) strikes millions of older adults annually worldwide and disables a substantial number of them via postherpetic neuralgia (PHN). Key aged-related clinical, epidemiological, and treatment features of zoster and PHN are reviewed in this article. HZ is caused by renewed replication and spread of the varicella-zoster virus (VZV) in sensory ganglia and afferent peripheral nerves in the setting of age-related, disease-related, and drug-related decline in cellular immunity to VZV. VZV-induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities in daily living, and reduced quality of life in elderly patients. Recently, attempts to reduce or eliminate HZ pain have been bolstered by the findings of clinical trials that antiviral agents and corticosteroids are effective treatment for HZ and that tricyclic antidepressants, topical lidocaine, gabapentin, and opiates are effective treatment for PHN. Although these advances have helped, PHN remains a difficult condition to prevent and treat in many elderly patients. Comment by Miles Day, M.D. This article reviews the epidemiology clinical features diagnosis and treatment of acute herpes zoster. It also describes the treatment of postherpetic neuralgia. While this is a good review for the primary care physician, the discussion for the treatment for both acute herpes zoster and postherpetic neuralgia do not mention invasive therapy. It is well documented in pain literature that sympathetic blocks with local anesthetic and steroid as well as subcutaneous infiltration of active zoster lesions not only facilitate the healing of acute herpes zoster but also prevents or helps decrease the incidence of postherpetic neuralgia. All patients who present to the primary care physician with acute herpes zoster should have an immediate referral to a pain management physician for invasive therapy. The treatment of postherpetic neuralgia is a challenging experience both for the patient and the physician. While the treatments that have been discussed in this article are important, other treatments are also available. Regional nerve blocks including intercostal nerve blocks, root sleeve injections, and sympathetic blocks have been used in the past to treat postherpetic neuralgia. If these blocks are helpful, one can proceed with doing crynourlysis of the affected nerves or also radio-frequency lesioning. Spinal cord stimulation has also been used for those patients who are refractory to noninvasive and invasive therapy. While intrathecal methylprednisolone was shown to be effective in the study quoted in this article one must be cautious not to do multiple intrathecal steroid injections in these patients. Multilple intrathecal steroid injections can lead to archnoiditis secondary to the accumulation of the steroid on the nerve roots and in turn causing worsening pain. [source] The role of pelvic traction in the management of primary monosymptomatic nocturnal enuresisBJU INTERNATIONAL, Issue 4 2002E.E.H. Hussein Mohamed Objective To determine whether pelvic traction is beneficial in children with primary nocturnal enuresis. Patients and methods There can be disproportionate growth between the spinal column and neural tube in prepubertal children. The normal elongation of the vertebral column in children during sleep could stretch the filum terminale and nerve roots, representing a minor degree of tethering that affects neural function and contributes to nocturnal enuresis. Pelvic traction induces a similar or more intense stretch while a patient is fully awake (and able to control their bladder). Releasing the potential tethering in this way, combined with conditioning therapy, could be beneficial. Fifty patients (aged 7,17 years) with monosymptomatic primary nocturnal enuresis were evaluated in a prospective study. All had 10 sessions of pelvic traction applied over 4 weeks and were followed up for 3 months afterward; no other medications were given. Results All patients had fewer wet nights, with variable degrees of success (20,80%) during and 3 months after traction. Conclusion Pelvic traction is a safe, simple, economic and effective treatment for primary monosymptomatic nocturnal enuresis. [source] A case of idiopathic spinal epidural lipomatosis presented with radicular pain caused by compression with enlarged veins surrounding nerve rootsACTA NEUROLOGICA SCANDINAVICA, Issue 4 2002M. Kawai Objective, To report a case of idiopathic spinal epidural lipomatosis (SEDL) presented with unique radicular pain most likely caused by enlarged veins surrounding nerve roots. Patient, A 26-year-old male presented with radicular pain of the right T6,T7 area. He also showed Becker's nevus in the corresponding area. CT myelography and magnetic resonance imaging revealed epidural lipomatosis posterior to T4,T8 of the spinal cord. Surgical removal of adipose tissue and a hemilaminectomy of T4,T7 were performed and resulted in relief of the radicular pain. Conclusions, Lipomatosis was histologically confirmed and surrounded by enlarged veins. These abnormally enlarged veins compressed the nerve roots and were thought to cause radicular pain. Also, Becker's nevus of this case seems to have some relationship with SEDL. [source] Augusta Déjerine-Klumpke: The first female neuroanatomistCLINICAL ANATOMY, Issue 6 2007Mohammadali M. Shoja Abstract Augusta Déjerine-Klumpke, the wife of Joseph Jules Dejerine, an eminent French neurologist, was an American and the first woman to intern in a Parisian hospital. She is known for Klumpke's radicular palsy, which is a neuropathy involving the lower nerve roots of the brachial plexus. The neuroanatomical treatise that she wrote together with her husband is considered a masterpiece. Klumpke won several awards in medical science, the first of which was in the field of anatomy when she was a student. She was a pioneer of rehabilitation therapy after spinal cord injuries and contributed much to our current knowledge of spinal cord diseases. We review the current English and French literature regarding this neuroanatomist who was the first woman to directly contribute to the writing of a neuroanatomy textbook. Clin. Anat. 20:585,587, 2007. © 2007 Wiley-Liss, Inc. [source] The posterior longitudinal ligament and peridural (epidural) membraneCLINICAL ANATOMY, Issue 6 2006Peter R. Loughenbury Abstract The posterior longitudinal ligament (PLL) is described as having deep and superficial layers, though recent studies have suggested that there may be three layers. Additional membranous structures have been reported, although there is no consensus as to their presence or morphology. The vertebral canal and dural sac were opened and the spinal nerve roots and spinal cord removed. The anterior dural ligaments were sectioned at their attachment to the PLL and the dura mater freed from the posterior surface of the vertebral bodies. The borders of the PLL were identified and the superficial and deep layers separated. The PLL is a wide band in the cervical region becoming more denticulate inferiorly, the widest parts being attached to the intervertebral discs (IVD) and adjacent vertebral body where the superficial and deep layers could not be separated. A continuous well developed peridural membrane attaching to the pedicles was present anterior to the deep PLL as well as a separate, thin, incomplete layer in 6 of 18 cadavers, covering the posterior surface of the superficial PLL. Clin. Anat. 19:487,492, 2006. © 2005 Wiley-Liss, Inc. [source] | |||||||||||||