scholarly journals MRI Findings of Causalgia of the Lower Extremity Following Transsphenoidal Resection of Pituitary Tumor

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
D. Ryan Ormond ◽  
Augustine L. Moscatello ◽  
Raj Murali
Keyword(s):  
Lower Extremity ◽  
Pituitary Tumor ◽  
Common Peroneal Nerve ◽  
Lower Limbs ◽  
Neutral Position ◽  
Mri Findings ◽  
Sudomotor Activity ◽  
Pain Symptoms ◽  
The Right ◽  
Transsphenoidal Resection

Background. Causalgia is continuing pain, allodynia, or hyperalgesia after nerve injury with edema, changes in skin blood flow, or abnormal sudomotor activity. Here we report a case of lower extremity causalgia following elective transsphenoidal resection of a pituitary tumor in a young man.Clinical Presentation. A 33-year-old man with acromegaly underwent elective sublabial transsphenoidal resection of his pituitary tumor. During the three-hour surgery, the lower limbs were kept in a supine, neutral position with a pillow under the knees. The right thigh was slightly internally rotated with a tape to expose fascia lata, which was harvested to repair the sella. Postoperatively, he developed causalgia in a distal sciatic and common peroneal nerve distribution. Pain was refractory to several interventions. Finally, phenoxybenzamine improved his pain significantly.Conclusions. Malpositioning in the operating room resulted in causalgia in this young man. Phenoxybenzamine improved, and ultimately resolved, his symptoms. Improvement in his pain symptoms correlated with resolution of imaging changes in the distal sciatic and peroneal nerves on the side of injury.

scholarly journals Primary Orbital Myxoid Liposarcoma: A Case Report and Review of Literature

2013 ◽  
Vol 4 (4) ◽  
pp. 28-32
Author(s):  
Chen Niu ◽  
Netra Rana ◽  
Zhi Gang Min ◽  
Ming Zhang
Keyword(s):  
Medical Science ◽  
Myxoid Liposarcoma ◽  
Soft Tissue Tumors ◽  
Lower Limbs ◽  
Mri Findings ◽  
One Year ◽  
The Right ◽  
Ct And Mri

Liposarcomas are common malignant soft-tissue tumors, which come from primitive mesenchymal cells and differentiate into adipose tissue. These tumors are more commonly found in lower limbs and retroperitoneal region but also reported in pharynx, lung, liver, digestive tract, diaphragm, as well as in the spermatic cord. We reported a case of primary orbital myxoid liposarcoma in a 20-year-old female patient presented with a painless proptosis of the right eye. The mass was pathologically diagnosed as a myxoid liposarcoma. The tumor recurred in 9 months after surgical intervention. The second surgery was performed and followed by postoperative local radiotherapy. No recurrence has been reported after one year of follow-up. We highlighted the role of CT and MRI findings in the tumor diagnosis and the importance of local radiotherapy after surgery. Asian Journal of Medical Science, Volume-4 (2013), Pages 28-32 DOI: http://dx.doi.org/10.3126/ajms.v4i4.8311 

Electromyography of experimentally immobilized skeletal muscles in cats

1961 ◽  
Vol 200 (5) ◽  
pp. 963-967 ◽  
Author(s):  
John J. Fudema ◽  
James A. Fizzell ◽  
Edward M. Nelson
Keyword(s):  
Skeletal Muscles ◽  
Common Peroneal Nerve ◽  
Electrical Stimulus ◽  
Neutral Position ◽  
Contralateral Limb ◽  
Hind Limbs ◽  
Significant Difference ◽  
Anterior Tibial ◽  
Muscle Innervation ◽  
The Right

The hind limbs of ten cats were bilaterally immobilized by external fixation without altering skeletal muscle innervation. Bilateral immobilization was used to rule out the possible effects of reciprocal activation from a nonimmobilized contralateral limb. Limbs were fixed in a neutral position to minimize the effect of muscle spindle activation. An electromyograph with an integrator circuit was used to measure the maximum action-potential output of anterior tibial muscles of both sides. Recordings were made of the maximum integrating meter response of the muscles to a standardized supramaximal electrical stimulus applied percutaneously to the common peroneal nerve while the animals were uniformly anesthetized. Measurements were made every 4 days for a period of 101 days of immobilization. The control or normal response was represented by measurements made at the beginning of the experiment. A highly significant continuing decrease in electrical output of the skeletal muscles was seen during the course of the immobilization. No statistically significant difference was found between the response of the right and left sides.

A Man with Simultaneous Occurrence of Acute Lower Extremity Arterial Embolization and Acute Myocardial Infarction: A Case Report

2020 ◽  
Author(s):  
Liangyuan Lu ◽  
Yanyan Xue ◽  
Yalei Han ◽  
Tongxin Bao ◽  
Jing Xue ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Lower Extremity ◽  
Arterial Embolization ◽  
Lower Limbs ◽  
Simultaneous Occurrence ◽  
Arterial Embolism ◽  
Multiple Organs ◽  
History Of ◽  
The Right

Abstract Background: Spontaneous co-occurrence of acute myocardial infarction (AMI) and acute lower extremity arterial embolism (ALEAE) has rarely been reported.Case presentation: A 44-year-old male with a history of 4 years of type1 diabetes was admitted to hospital when he suddenly experienced severe pain in his right lower limb and felt tightness in the left anterior chest area. Ultrasonography revealed distal occlusion of the right superficial femoral artery. ECG showed acute anterior interstitial myocardial infarction. After conservative treatment for 2 days, the patient had severe necrosis of lower limbs and secondary injury of multiple organs. Hemodialysis and heparin anticoagulant therapy were performed before amputation. Twelve days after the operation, the patient's condition was stable and he was transferred out of ICU.Conclusions: Emergency amputation and multidisciplinary approaches may offer a chance for survival if patents lost the opportunity for early treatment.

scholarly journals A rare case of L5-S1 right severe foraminal stenosis and paramedian disc herniation result in foot drop of right lower extremity: A case report

2021 ◽  
Vol 8 (10) ◽  
pp. 623-627
Author(s):  
Ngoc Quyen Nguyen ◽  
Trong Hau Phan
Keyword(s):  
Lower Extremity ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Rare Case ◽  
Lumbar Disc ◽  
Clinical Manifestations ◽  
Foot Drop ◽  
Foraminal Stenosis ◽  
Mri Findings ◽  
The Right

Objective: the authors presented a extremely rare case of severe foraminal stenosis combined with huge lateral lumbar disc herniation  Case presentation: The authors presented a 74 – year old, male with type II chronic diabetes, had severe pain of the dermatomal distribution of L5, S1 nerve roots, and foot-drop of the right lower limb. When we evaluated the patient’s MRI, the huge paramedian disc herniation of the right L5-S1 level was seen and the right L5-S1 laminotomy and discetomy were planned for the treatment of the patient. However, the clinical symptoms were not completely correlated with that MRI findings so that, we re-checked the MRI, particularly at the lumbosacral region, and the right severe foraminal stenosis of L5-S1 level was found. The patient underwent surgery with facetectomy, transforaminal interbody fusion, and pedicle screw fixation. After the operation, the patient has quickly reduced radiating pain of the right lower extremity, although the foot-drop was not improved. Because of the huge lateral lumbar disc herniation impression, that could affect the assessing the patient’s injury correctly, leaded consequences of a missing diagnosis of foraminal stenosis and inadequate surgery method. Conclusion: It is essential to detail examination of the clinical manifestations and thorough assessment of MRI for evaluation of the correlation between the physical examination and MRI findings before making the decision of surgical method.

Antithrombotic Therapy in Lower Extremity Artery Disease

2020 ◽  
Vol 18 (3) ◽  
pp. 215-222 ◽  
Author(s):  
Mislav Vrsalovic ◽  
Victor Aboyans
Keyword(s):  
Lower Extremity ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Cardiovascular Events ◽  
Cardiovascular Outcomes ◽  
Lower Limbs ◽  
Stent Type ◽  
Increased Risk ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Lower extremity artery disease (LEAD) is a marker of a more advanced atherosclerotic process often affecting multiple vascular beds beyond the lower limbs, with a consequent increased risk for all-cause and cardiovascular mortality. Antithrombotic therapy is the cornerstone of management of these patients to prevent ischaemic cardiovascular and limb events and death. In patients with symptomatic LEAD, the efficacy of aspirin has been established long ago for the prevention of cardiovascular events. In the current guidelines, clopidogrel may be preferred over aspirin following its incremental ability to prevent cardiovascular events, while ticagrelor is not superior to clopidogrel in reducing cardiovascular outcomes. Dual antiplatelet therapy (DAPT, aspirin with clopidogrel) is currently recommended for at least 1 month after endovascular interventions irrespective of the stent type. Antiplatelet monotherapy is recommended after infra-inguinal bypass surgery, and DAPT may be considered in below-the-knee bypass with a prosthetic graft. In symptomatic LEAD, the addition of anticoagulant (vitamin K antagonists) to antiplatelet therapy increased the risk of major and life-threatening bleeding without benefit regarding cardiovascular outcomes. In a recent trial, low dose of direct oral anticoagulant rivaroxaban plus aspirin showed promising results, not only to reduce death and major cardiovascular events, but also major limb events including amputation. Yet, this option should be considered especially in very high risk patients, after considering also the bleeding risk. Despite all the evidence accumulated since >40 years, many patients with LEAD remain undertreated and deserve close attention and implementation of guidelines advocating the use of antithrombotic therapies, tailored according to their level of risk.

Neuroimaging of Children With Takayasu Arteritis

2021 ◽  
pp. 088307382199128
Author(s):  
Hafize Emine Sönmez ◽  
Ferhat Demir ◽  
Semanur Özdel ◽  
Şerife Gül Karadağ ◽  
Esra Bağlan ◽  
...  
Keyword(s):  
Takayasu Arteritis ◽  
Internal Carotid ◽  
Laboratory Data ◽  
Left Middle Cerebral Artery ◽  
Mri Findings ◽  
Cranial Mri ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
And Diffusion ◽  
Left Middle

Objective: Takayasu arteritis is a rare granulomatous chronic vasculitis that affects the aorta and its main branches. Neurologic manifestations can accompany the disease; however, there is no study on neuroimaging in children with Takayasu arteritis. Therefore, we aimed to evaluate cranial magnetic resonance imaging (MRI) in pediatric Takayasu arteritis patients. Materials and Methods: Demographic, clinical, and laboratory data were obtained retrospectively. Results: The study included 15 pediatric Takayasu arteritis patients. All patients presented with constitutional symptoms. Additionally, 6 patients suffered from headache, 2 had syncope, 1 had loss of consciousness, and 1 had convulsion. All patients underwent cranial and diffusion MRI a median 12 months after diagnosis. Cranial MRI findings were normal in 12 patients, whereas 3 patients had abnormal findings, as follows: stenosis in the M1 and M2 segments of the left middle cerebral artery (n = 1); diffuse thinning of the right internal carotid, middle cerebral, and right vertebral and basilar artery (n = 1); as a sequela, areas of focal gliosis in both the lateral ventricular and posterior periventricular regions (n = 1). Among these 3 patients, 1 had no neurologic complaints. Conclusion: Abnormal MRI findings can be observed in pediatric Takayasu arteritis patients, even those that are asymptomatic; therefore, clinicians should carefully evaluate neurologic involvement in all pediatric Takayasu arteritis patients.

scholarly journals Levator palpabrae superioris myositis as an unusual cause of unilateral ptosis—case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ahmed M. Abdrabou
Keyword(s):  
Previous History ◽  
Good Prognosis ◽  
Oculomotor Nerve Palsy ◽  
Ophthalmological Examination ◽  
Bilateral Ptosis ◽  
Mri Findings ◽  
Upper Eyelid ◽  
Unilateral Disease ◽  
The Right ◽  
Mri Study

Abstract Background Ptosis can be a manifestation of a more serious situation. Hence, the analysis of the complaint and the search for etiology are crucial in such cases. Ptosis has many causes; some of them lead to unilateral ptosis while others cause bilateral ptosis. For instance, myasthenia gravis is a cause of bilateral ptosis while oculomotor nerve palsy induces unilateral disease. Proper evaluation of the patient and identification of the cause are important to achieve accurate management and good prognosis. Case presentation A 47-year-old male patient attended the ER complaining of dropping the right eye lid of 2 days’ duration. There was no associated pain or diplopia. On examination, the extraocular muscles’ (EOM) motility was intact, normal pupil and corneal reflexes, and there was swelling of the upper eyelid. Ophthalmological examination revealed normal anterior and posterior chambers as well as the vitreous and retina. The patient had a previous history of traumatic intracranial hemorrhage that was resolved without surgical intervention. He also had diabetes mellitus and hypertension. The patient was transferred to the MRI unit to perform MRI study of the brain and orbit with MRA and IV contrast administration. MRI findings confirmed the diagnosis of LPS myositis, and the patient received medical treatment and improved. Conclusion Proper radiological diagnosis leads to accurate management and achieves rapid recovery and optimal patient care.

scholarly journals Longer T2relaxation time is a marker of hypothalamic gliosis in mice with diet-induced obesity

2013 ◽  
Vol 304 (11) ◽  
pp. E1245-E1250 ◽  
Author(s):  
Donghoon Lee ◽  
Joshua P. Thaler ◽  
Kathryn E. Berkseth ◽  
Susan J. Melhorn ◽  
Michael W. Schwartz ◽  
...  
Keyword(s):  
Relaxation Time ◽  
High Field ◽  
Relaxation Times ◽  
Quantitative Mri ◽  
Human Studies ◽  
Mri Findings ◽  
Diet Induced Obesity ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Mr Brain

A hallmark of brain injury from infection, vascular, neurodegenerative, and other disorders is the development of gliosis, which can be detected by magnetic resonance imaging (MRI). In rodent models of diet-induced obesity (DIO), high-fat diet (HFD) consumption rapidly induces inflammation and gliosis in energy-regulating regions of the mediobasal hypothalamus (MBH), and recently we reported MRI findings suggestive of MBH gliosis in obese humans. Thus, noninvasive imaging may obviate the need to assess MBH gliosis using histopathological end points, an obvious limitation to human studies. To investigate whether quantitative MRI is a valid tool with which to measure MBH gliosis, we performed analyses, including measurement of T2relaxation time from high-field MR brain imaging of mice fed HFD and chow-fed controls. Mean bilateral T2relaxation time was prolonged significantly in the MBH, but not in the thalamus or cortex, of HFD-fed mice compared with chow-fed controls. Histological analysis confirmed evidence of increased astrocytosis and microglial accumulation in the MBH of HFD-fed mice compared with controls, and T2relaxation times in the right MBH correlated positively with mean intensity of glial fibrillary acidic protein staining (a marker of astrocytes) in HFD-fed animals. Our findings indicate that T2relaxation time obtained from high-field MRI is a useful noninvasive measurement of HFD-induced gliosis in the mouse hypothalamus with potential for translation to human studies.

The Effect of Tibiotalar Fixation on Foot Biomechanics

1997 ◽  
Vol 18 (12) ◽  
pp. 792-797 ◽  
Author(s):  
Jennifer S. Wayne ◽  
Keith W. Lawhorn ◽  
Kenneth E. Davis ◽  
Karanvir Prakash ◽  
Robert S. Adelaar
Keyword(s):  
Subtalar Joint ◽  
Sagittal Plane ◽  
Lower Limbs ◽  
Coronal Plane ◽  
Neutral Position ◽  
Talonavicular Joint ◽  
Tibiotalar Joint ◽  
Contact Areas ◽  
Joint Contact ◽  
Peak Pressures

Contact areas and peak pressures in the posterior facet of the subtalar and the talonavicular joints were measured in cadaver lower limbs for both the normal limb and after fixation of the tibiotalar joint. Six joints were fixed in neutral, in 5–7° of varus and of valgus. Ten degrees of equinus angulation was also studied. Each position of fixation was tested independently. Neutral was defined as fixation without coronal or sagittal plane angulation compared with prefixation alignment of the specimen. When compared with normal unfused condition, peak pressures increased, and contact areas decreased in the subtalar joint for specimens fixed in neutral, varus, and valgus. However, the change in peak pressure for neutral fusion compared with normal control was not statistically significant ( P > 0.07). Peak pressures for varus and valgus fixation were significantly different from normal ( P < 0.001). Contact areas for all positions of fixation were significantly different from normal ( P < 0.001). Coronal plane angulation, however, also resulted in significantly lower contact areas compared with neutral fixation ( P < 0.001). Contact areas and peak pressures in the talonavicular joint did not appear to be substantially affected by tibiotalar fixation with coronal plane angulation. Equinus fixation qualitatively increased contact areas and peak pressures in the talonavicular and posterior facet of the subtalar joint. Neutral alignment of the tibiotalar joint in the coronal and sagittal planes altered subtalar and talonavicular joint contact characteristics the least compared with normal controls. Therefore, ankle fusion in the neutral position would be expected to most closely preserve normal joint biomechanics and may limit the progression of degenerative arthrosis of the subtalar joint.

Foix-Chavany-Marie syndrome caused by a disconnection between the right pars opercularis of the inferior frontal gyrus and the supplementary motor area

2012 ◽  
Vol 117 (5) ◽  
pp. 844-850 ◽  
Author(s):  
Juan Martino ◽  
Enrique Marco de Lucas ◽  
Francisco Javier Ibáñez-Plágaro ◽  
José Manuel Valle-Folgueral ◽  
Alfonso Vázquez-Barquero
Keyword(s):  
Supplementary Motor Area ◽  
Diffusion Tensor ◽  
Anterior Part ◽  
Inferior Frontal Gyrus ◽  
Motor Area ◽  
Lower Limbs ◽  
Rare Type ◽  
Orofacial Movement ◽  
Pars Opercularis ◽  
The Right

Foix-Chavany-Marie syndrome (FCMS) is a rare type of suprabulbar palsy characterized by an automaticvoluntary dissociation of the orofacial musculature. Here, the authors report an original case of FCMS that occurred intraoperatively while resecting the pars opercularis of the inferior frontal gyrus. This 25-year-old right-handed man with an incidentally diagnosed right frontotemporoinsular tumor underwent surgery using an asleep-awake-asleep technique with direct cortical and subcortical electrical stimulation and a transopercular approach to the insula. While resecting the anterior part of the pars opercularis the patient suffered sudden anarthria and bilateral facial weakness. He was unable to speak or show his teeth on command, but he was able to voluntarily move his upper and lower limbs. This syndrome lasted for 8 days. Postoperative diffusion tensor imaging tractography revealed that connections of the pars opercularis of the right inferior frontal gyrus with the frontal aslant tract (FAT) and arcuate fasciculus (AF) were damaged. This case supplies evidence for localizing the structural substrate of FCMS. It was possible, for the first time in the literature, to accurately correlate the occurrence of FCMS to the resection of connections between the FAT and AF, and the right pars opercularis of the inferior frontal gyrus. The FAT has been recently described, but it may be an important connection to mediate supplementary motor area control of orofacial movement. The present case also contributes to our knowledge of complication avoidance in operculoinsular surgery. A transopercular approach to insuloopercular gliomas can generate FCMS, especially in cases of previous contralateral lesions. The prognosis is favorable, but the patient should be informed of this particular hazard, and the surgeon should anticipate the surgical strategy in case the syndrome occurs intraoperatively in an awake patient.

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