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Sample records for posterior interosseous nerve

  1. Delayed diagnosed posterior interosseous nerve palsy due to intramuscular myxoma

    PubMed Central

    Kursumovic, A; Mattiassich, G; Rath, S

    2013-01-01

    We present a case of posterior interosseous nerve palsy after bowel surgery associated with intramuscular myxoma of the supinator muscle. The initial symptoms of swelling of the forearm made it difficult to distinguish the condition from extravasations after intravenous cannulation. The diagnosis was finally established with nerve conduction studies and MRI 3 months after symptom onset. The patient underwent surgery for removal of the tumour and decompression of the posterior interosseous nerve. The histological examination identified the tumour as intramuscular myxoma and the patient made a full recovery with no recurrence of the lesion until present. Every swelling on the forearm causing neurological disorders is tumour suspected and should be examined clinically as well as electrophysically and radiographically. Early surgery and nerve decompression should follow immediately after the diagnosis. In case of intramuscular myxoma, good recovery of function after surgery with low recurrence risk may be expected. PMID:23576649

  2. Neuralgic Amyotrophy Manifesting as Mimicking Posterior Interosseous Nerve Palsy.

    PubMed

    Yang, Jin Seo; Cho, Yong Jun; Kang, Suk Hyung; Choi, Eun Hi

    2015-11-01

    The upper trunk of the brachial plexus is the most common area affected by neuralgic amyotrophy (NA), and paresis of the shoulder girdle muscle is the most prevalent manifestation. Posterior interosseous nerve palsy is a rare presentation in patients with NA. It results in dropped finger on the affected side and may be misdiagnosed as entrapment syndrome or compressive neuropathy. We report an unusual case of NA manifested as PIN palsy and suggest that knowledge of clinical NA phenotypes is crucial for early diagnosis of peripheral nerve palsies. PMID:26713154

  3. Rehabilitation of Supinator Nerve to Posterior Interosseous Nerve Transfer in Individuals With Tetraplegia.

    PubMed

    Hahn, Jodie; Cooper, Catherine; Flood, Stephen; Weymouth, Michael; van Zyl, Natasha

    2016-06-01

    Despite being a routine part of the early surgical management of brachial plexus injury, nerve transfers have only recently been used as a reconstructive option for those with tetraplegia. Subsequently, there is limited published literature on the rehabilitation theories and techniques for optimizing outcomes in this population. This article seeks to address this void by presenting our centers' working model for rehabilitation after nerve transfers for individuals with tetraplegia. The model is illustrated with the example of the rehabilitation process after a supinator nerve to posterior interosseous nerve transfer. This nerve transfer reconstructs wrist, finger, and thumb extension. The topics covered in the model include the following: patient selection and presurgical planning/intervention, managing the postoperative healing phase of an individual who is wheelchair dependent, maximizing motor reeducation, increasing muscle strength, and ensuring use in functional tasks. This article provides a platform for further development and collaboration to improve the outcomes of patients who undergo nerve transfers after tetraplegia. PMID:27233591

  4. Surgical treatment of posterior interosseous nerve paralysis in a tennis player☆

    PubMed Central

    Fujioka, Hiroyuki; Tsunemi, Kenjiro; Tsukamoto, Yoshitane; Oi, Takanori; Takagi, Yohei; Tanaka, Juichi; Yoshiya, Shinichi

    2014-01-01

    We report a rare case of posterior interosseous nerve (PIN) paralysis in a tennis player. The PIN, a 2 cm section from a bifurcation point of the radial nerve, presented increased stiffness in the surgical findings and treated with free sural nerve grafting after excision of the degenerative portion of the PIN. We speculate that PIN paralysis associated with hourglass-like constriction can be caused and exacerbated by repetitive forearm pronation and supination in playing tennis. PMID:25104896

  5. McBurney's button-hole to the posterior interosseous nerve.

    PubMed

    Mylne, Miranda Layla Rosalynn; Spinner, Robert J

    2012-03-01

    McBurney's button-hole is an exposure technique for the posterior interosseous nerve quoted in Anrold Kirkpatrick Henry's famous book Extensile Exposures. This short article discusses the overlap between three historical surgeons, Thompson, Henry and McBurney to discover the meaning of the reference and technique, which is used by surgeons to this day. PMID:21688323

  6. Transient entrapment neuropathy of the posterior interosseous nerve in violin players.

    PubMed

    Maffulli, N; Maffulli, F

    1991-01-01

    Eleven white male right handed violin players complained of transient muscular deficit of the extensor compartment of the left forearm during and after prolonged playing. This was associated with paraesthesiae and pain. Relief was achieved keeping the wrist and the elbow flexed, with the supinated forearm held by the contralateral hand. An anatomical study showed changes of the relationship of the posterior interosseous nerve with its surrounding structures with pronation and supination of the forearm. On the basis of the clinical features, the anatomical studies and the response to a simple physiotherapeutic regime, it is suggested that prolonged pronation of the forearm may cause transient entrapment of the nerve. PMID:1849172

  7. Transient entrapment neuropathy of the posterior interosseous nerve in violin players.

    PubMed Central

    Maffulli, N; Maffulli, F

    1991-01-01

    Eleven white male right handed violin players complained of transient muscular deficit of the extensor compartment of the left forearm during and after prolonged playing. This was associated with paraesthesiae and pain. Relief was achieved keeping the wrist and the elbow flexed, with the supinated forearm held by the contralateral hand. An anatomical study showed changes of the relationship of the posterior interosseous nerve with its surrounding structures with pronation and supination of the forearm. On the basis of the clinical features, the anatomical studies and the response to a simple physiotherapeutic regime, it is suggested that prolonged pronation of the forearm may cause transient entrapment of the nerve. Images PMID:1849172

  8. [Posterior interosseous nerve palsy in a man in a lateral position for laparoscopic adrenalectomy--a case report].

    PubMed

    Maeda, Ryoko; Koinuma, Toshitaka; Seo, Norimasa

    2005-08-01

    A 51-year-old man with aldosteronism underwent laparoscopic left adrenalectomy. Anesthesia was induced with fentanyl 0.1 mg, propofol 140 mg and vecuronium 7 mg. Following endotracheal intubation, he was placed in a right lateral position with extension of his left side, and fixed with the Magic Bed. Canulation of the right radial artery was smoothly performed. Anesthesia was maintained with sevoflurane and thoracic epidural anesthesia (mepivacaine and ropivacaine). The operation lasted for 270 minutes and was uneventful. A few hours after surgery, he complained of inability to extend his right fingers without any sensory loss, and the local oppressive pain on his right forearm. Neurological examination revealed a posterior interosseous palsy. Symptoms improved gradually and disappeared completely in two months with the administration of vitamin B12 and physical therapy. Postoperative reproduction of the positioning of this case disclosed that the edge of the Magic Bed might potentially compress the posterior interosseous nerve at the point where the nerve is bifurcated from the radial nerve and travels within the supinator muscle going into the muscle again. This case indicated that we must be careful of nerve injuries due to devices used to maintain the patient in lateral position. PMID:16104549

  9. Case report: Double nerve transfer of the anterior and posterior interosseous nerves to treat a high ulnar nerve defect at the elbow.

    PubMed

    Delclaux, S; Aprédoaei, C; Mansat, P; Rongières, M; Bonnevialle, P

    2014-10-01

    Double neurotization of the deep branch of ulnar nerve (DBUN) and superficial branch of ulnar nerve using the anterior interosseous nerve (AIN) and the recurrent (thenar) branch of the median nerve was first described by Battiston and Lanzetta. This article details the postoperative results after 18 months of a patient who underwent this technique using the posterior interosseous nerve (PIN) instead of the recurrent branch of the median nerve for sensory reconstruction. A 35-year-old, right-handed man suffered major trauma to his right upper limb following a serious motor vehicle accident. One year later, a pseudocystic neuroma of the ulnar nerve was evident on ultrasound examination and MRI. After the neuroma had been resected, the nerve defect was estimated at 8 cm. One and a half years after the initial trauma, with the patient still at M0/S0, we transferred the AIN and PIN onto the deep and superficial branches of the ulnar nerve respectively. Nerve recovery was monitored clinically every month and by electromyography (EMG) every three months initially and then every six months. At 18 months postoperative, 5th digit abduction/adduction was 28 mm. Sensation was present at the base of the 5th digit. The patient was graded M3/S2. Clear re-innervation of the abductor digiti minimi was demonstrated by EMG (motor conduction velocity 50 m/s). Given that the ulnar nerve could not be excited at the elbow, this re-innervation had to be the result of the double nerve transfer. Neurotization of the DBUN using the AIN produces functional results as early as 1 year after surgery. Using PIN for sensory neurotization is easy to perform, has no negative consequences for the donor site, and leads to good recovery of sensation (graded as S2) after 18 months. PMID:25260763

  10. Delayed diagnosed intermuscular lipoma causing a posterior interosseous nerve palsy in a patient with cervical spondylosis: the “priceless” value of the clinical examination in the technological era

    PubMed Central

    COLASANTI, R.; IACOANGELI, M.; DI RIENZO, A.; DOBRAN, M.; DI SOMMA, L.; NOCCHI, N.; SCERRATI, M.

    2016-01-01

    Background Posterior interosseous nerve (PIN) palsy may present with various symptoms, and may resemble cervical spondylosis. Case report We report about a 59-year-old patient with cervical spondylosis which delayed the diagnosis of posterior interosseous nerve (PIN) palsy due to an intermuscular lipoma. Initial right hand paraesthesias and clumsiness, together with MR findings of right C5–C6 and C6–C7 foraminal stenosis, misled the diagnostic investigation. The progressive loss of extension of all right hand fingers brought to detect a painless mass compressing the PIN. Electrophysiological studies confirmed a right radial motor neuropathy at the level of the forearm. Results Surgical tumor removal and nerve decompression resulted in a gradual motor deficits recovery. Conclusions A thorough clinical examination is paramount, and electrophysiology may differentiate between cervical and peripheral nerve lesions. Ultrasonography and MR offer an effective evaluation of lipomas, which represent a rare cause of PIN palsy. Surgical decompression and lipoma removal generally determine excellent prognoses, with very few recurrences. PMID:27142825

  11. Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources

    PubMed Central

    Tiengo, Cesare; Lombardi, Matteo; Bassetto, Franco

    2016-01-01

    Purpose: The reverse posterior interosseous artery flap has several advantages, not sacrificing any major blood vessel, but its relatively short pedicle limits the use to cover defects up to the metacarpophalangeal joint. Our purpose is to demonstrate that the ligature of the anterior interosseous artery (AIA), proximal to the communicating branch with the posterior interosseous artery, leads to an improved flap rotation arch, preserving both vascular sources. Methods: Sixteen fresh cadavers with latex perfusion were analyzed before and after our technique of elongation, and the so-obtained measures were standardized in “percentage of elongation of the pedicle.” Eight patient with the loss of substance at the dorsal aspect of the hand have been treated with this technique, and results were evaluated in terms of flap survival and complication rates. Results: The medium length of the pedicle in the normal flap was 10.8 cm, and after the section of the AIA, the medium length of the pedicle was 13.6 cm with a medium increase of 2.8 cm. It means a medium increase of 24% of the length of the pedicle. In all patients treated, full coverage of the defect was obtained, and we did not experience major complications. Conclusions: This anatomical study supported by our clinical experience demonstrates that the use of the variant described above permits to reach more distal part of the hand without being afraid to stretch the pedicle because of the connection with the anastomotic arcades of the AIA at the wrist reducing the risk of ischemia of the flap. PMID:27536473

  12. Ultrasound combined with electrodiagnosis improves lesion localization and outcome in posterior interosseous neuropathy

    PubMed Central

    Wininger, Yevgeniya Dvorkin; Buckalew, Neilly A.; Kaufmann, Robert A.; Munin, Michael C.

    2016-01-01

    INTRODUCTION Posterior interosseous nerve (PIN) syndrome is a rare compression neuropathy. Electrodiagnostic studies (EDX) combined with neuromuscular ultrasound (US) enable precise lesion localization and may improve patient outcome. METHODS In 4 patients with finger extension weakness, US was used to accurately localize concentric EMG needle placement in PIN muscles and to visualize the lesion site. RESULTS EMG with US guidance showed decreased recruitment with abnormal configuration in PIN muscles. Active denervation was not always observed. US scanning demonstrated larger PIN diameter in the affected arm. All patients had surgical intervention to confirm EDX and US findings with improved outcome on follow-up. CONCLUSION These cases demonstrate the benefits of augmenting EDX with US by guiding accurate electrode localization and providing diagnostic information about lesion location. PMID:26206065

  13. Ulnar nerve motor conduction to the first dorsal interosseous muscle.

    PubMed

    Prahlow, Nathan D; Buschbacher, Ralph M

    2006-01-01

    The ulnar motor study to the abductor digiti minimi (ADM) is commonly performed, but does not test the terminal deep palmar branch of the ulnar nerve. Although damage to the ulnar nerve most often occurs at the elbow, the damage may occur elsewhere along the course of the nerve, including damage to the deep palmar branch. Ulnar conduction studies of the deep branch have been performed with recording from the first dorsal interosseous (FDI) muscle. These studies have used differing methodologies and were mostly limited by small sample size. The aim of this study was to develop a normative database for ulnar nerve conduction to the FDI. A new method of recording from the FDI was developed for this study. It utilizes recording with the active electrode over the dorsal first web space, with the reference electrode placed at the fifth metacarpophalangeal joint. This technique reliably yields negative takeoff measurements. An additional comparison was made between ulnar motor latency with recording at the ADM and with recording at the FDI. For this study, 199 subjects with no risk factors for neuropathy were tested. The latency, amplitude, area, and duration were recorded. The upper limit of normal (ULN) was defined as the 97th percentile of observed values. The lower limit of normal (LLN) was defined as the 3rd percentile of observed values. For the FDI, mean latency was 3.8 +/- 0.5 ms, with a ULN of 4.7 ms for males, 4.4 ms for females, and 4.6 ms for all subjects. Mean amplitude was 15.8 +/- 4.9 mV, with a LLN of 5.1 for all subjects. Side-to-side differences in latency to the FDI, from dominant to nondominant hands, was -0.1 +/- 0.4 ms, with a ULN of 0.8 ms. For the amplitude, up to a 52% decrease from side to side was normal. For the same-limb comparison of the FDI and ADM, the mean latency difference was 0.6 +/- 0.4 ms, with a ULN increase of 1.3 ms for latency to the ADM versus the FDI. PMID:17206927

  14. Anterior interosseous nerve syndrome diagnosis and intraoperative findings: A case report

    PubMed Central

    Aljawder, Abdulla; Faqi, Mohammed Khalid; Mohamed, Abeer; Alkhalifa, Fahad

    2016-01-01

    Introduction Anterior Interosseous Nerve (AIN) is a motor branch from the Median nerve and runs deep in the forearm along with the anterior interosseous artery. It innervates three muscles in the forearm; an isolated palsy of these muscles is known as AIN Syndrome. There are several documented causes of AIN syndrome but its pathophysiology remains unclear. Presentation of case A 48-year old male that presented with right elbow pain and inability to flex his right interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. MR images denoted mild atrophy of the radial half of the flexor digitorum profundus and the pronator quadratus. Although there were no compressing lesions identifiable on MRI, Electrodiagnostic studies suggested compression neuropathy affecting the AIN. During surgical decompression of the median nerve in the proximal forearm, the operative findings were several tendinous fasciae and a tight fibrous arch of the flexor digitorum superficialis compressing the median nerve at the level of the AIN branch. Discussion Different treatment schemes with reasonable outcome have been reported. Both nonsurgical and surgical intervention have been described in most of these schemes but differed in the timing of intervention with variable outcome. Conclusion Clinical suspicion should arise in the presence of isolated paralysis of the AIN-supplied muscles. MRI and electrodiagnostic studies will confirm the diagnosis and identify the etiology. The optimal treatment of AIN syndrome has not been established. We recommend surgical intervention in confirmed AIN syndrome from compression neuropathy, refractive to conservative therapy. PMID:26921536

  15. Release of severe post-burn contracture of the first web space using the reverse posterior interosseous flap: Our experience with 12 cases.

    PubMed

    Kai, Shi; Zhao, Jingchun; Jin, Zhenghua; Wu, Weiwei; Yang, Ming; Wang, Yan; Xie, Chunhui; Yu, Jiaao

    2013-09-01

    We retrospectively assessed outcomes after treating severe contractures of the first web space from burns with the reverse posterior interosseous flaps (RPIF). Twelve consecutive patients (ages 18-58 years) with burns from 10% to 70% (mean, 30.1%) total body surface area and severe contractures of the first web space of the hand (initial thumb to index angles from 10° to 35° [mean, 23°]) underwent contracture release using the RPIF. Seventeen RPIFs were used, with sizes from 9cm×6cm to 14cm×10cm (mean area, 83.6cm(2)). The patients were followed for 5-26 months. All flaps survived completely, rapidly adapted to the recipient beds, and achieved good color and texture harmony. No early complications occurred. Fifteen donor sites were closed with skin grafts. Two donor sites were closed by direct suture. No paralysis of the posterior interosseous nerve was observed in these cases. At last follow-up the mean thumb to index angle was 78°, increasing the web length 260%. All patients regained fundamental hand functions. The RPIF is reliable and safe for releasing severe contractures of the first web space of the hand after burn, with distinct advantages over currently used alternative methods. PMID:23523223

  16. The Pronator Quadratus and Distal Anterior Interosseous Nerve: A Cadaveric Study

    PubMed Central

    Hinds, Richard M.; Gottschalk, Michael B.; Capo, John T.

    2015-01-01

    Background The pronator quadratus (PQ) muscle is an important and commonly encountered structure in surgery of the wrist. A thorough understanding of the anatomy of the PQ and the anterior interosseous nerve (AIN), which innervates the PQ, is important, particularly during distal radius fracture osteosynthesis and distal AIN transfer to deep branch of the ulnar nerve. Furthermore, there is a paucity of literature regarding sex differences in the morphology of these structures. We describe the morphology of the PQ and AIN and compare PQ and AIN findings in male and female specimens. Methods Twenty-five cadaveric upper extremities underwent loupe-aided dissection of the volar forearm with identification of the AIN and PQ. A digital photograph taken perpendicular to the volar surface of the forearm was used to measure the PQ and assess AIN morphology using ImageJ (National Institutes of Health; Bethesda, MD). Comparisons between male and female specimens were performed. Results Of the 25 specimens, 84% appeared as a single trapezoidal muscle bundle, with the remaining 16% demonstrating a double-bundle morphology. The PQ was a mean 3.8 ± 0.5 cm in radial-ulnar width and 4.6 ± 0.7 cm in proximal-distal length with a mean thickness, area, and volume of 0.6 ± 0.2 cm, 18.2 ± 4.8 cm2, and 10.5 ± 3.7 cm3, respectively. The PQ branch of the AIN was a mean 3.8 ± 1.1 cm long and had a mean diameter of 1.4 ± 0.2 mm. Male specimens demonstrated significantly greater radial-ulnar width (p = 0.005), area (p = 0.006), and volume (p = 0.033) of the PQ, as well as a greater distance from the radial styloid to the distal arborization of the AIN (p = 0.005) compared with female specimens. Conclusions The current study informs hand surgeons of the morphologic variability and sexual dimorphism of the PQ and AIN and may help guide operative planning. PMID:26261744

  17. Conservative management of posterior interosseous neuropathy in an elite baseball pitcher's return to play: a case report and review of the literature.

    PubMed

    Robb, Andrew; Sajko, Sandy

    2009-12-01

    This report documents retrospectively a case of Posterior Interosseous Neuropathy (PIN) occurring in an elite baseball pitcher experiencing a deep ache in the radial aspect of the forearm and altered sensation in the dorsum of the hand on the throwing arm during his pitching motion. The initial clinical goal was to control for inflammation to the nerve and muscle with active rest, microcurrent therapy, low-level laser therapy, and cessation of throwing. Minimizing mechanosensitivity at the common extensor region of the right elbow and PIN, was achieved by employing the use of myofascial release and augmented soft tissue mobilization techniques. Neurodynamic mobilization technique was also administered to improve neural function. Implementation of a sport specific protocol for the purposes of maintaining throwing mechanics and overall conditioning was utilized. Successful resolution of symptomatology and return to pre-injury status was achieved in 5 weeks. A review of literature and an evidence-based discussion for the differential diagnoses, clinical examination, diagnosis, management and rehabilitation of PIN is presented. PMID:20037695

  18. Conservative management of posterior interosseous neuropathy in an elite baseball pitcher’s return to play: a case report and review of the literature

    PubMed Central

    Robb, Andrew; Sajko, Sandy

    2009-01-01

    This report documents retrospectively a case of Posterior Interosseous Neuropathy (PIN) occurring in an elite baseball pitcher experiencing a deep ache in the radial aspect of the forearm and altered sensation in the dorsum of the hand on the throwing arm during his pitching motion. The initial clinical goal was to control for inflammation to the nerve and muscle with active rest, microcurrent therapy, low-level laser therapy, and cessation of throwing. Minimizing mechanosensitivity at the common extensor region of the right elbow and PIN, was achieved by employing the use of myofascial release and augmented soft tissue mobilization techniques. Neurodynamic mobilization technique was also administered to improve neural function. Implementation of a sport specific protocol for the purposes of maintaining throwing mechanics and overall conditioning was utilized. Successful resolution of symptomatology and return to pre-injury status was achieved in 5 weeks. A review of literature and an evidence-based discussion for the differential diagnoses, clinical examination, diagnosis, management and rehabilitation of PIN is presented. PMID:20037695

  19. Imaging of Posterior Interosseous Neuropathy following Distal Biceps Repair: A Report of 3 Cases

    PubMed Central

    Fitzpatrick, Darren; Petchprapa, Catherine; Rybak, Leon

    2015-01-01

    Three cases of PIN palsy following biceps repair are presented with clinical and imaging correlation. The imaging findings in these cases will be discussed and the orthopedic literature, as regards possible surgical approaches and technical factors believed to predispose to or prevent this complication, will be reviewed. It is important for radiologists to serve as consultants in these uncommon but sometimes devastating complications, helping to quickly and accurately recognize the imaging findings corresponding to the clinical symptoms and aiding the surgeon in diagnosis and treatment by identifying the possible causes and sites of nerve compression. PMID:26770861

  20. Axillary Nerve Reconstruction: Anterior-Posterior Exposure With Sural Nerve Cable Graft Pull-Through Technique.

    PubMed

    Baltzer, Heather L; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

    2015-12-01

    Deltoid paralysis after axillary nerve injury results in limitations in shoulder function and stability. In the setting of an isolated axillary nerve injury with no clinical or electromyographic evidence of recovery that is within 6 to 9 months postinjury, the authors' preferred technique to reinnervate the deltoid is to reconstruct the axillary nerve with sural nerve grafting. Intraoperative neuromuscular electrophysiology is critical to determine the continuity of the axillary nerve before proceeding with reconstruction. The majority of the time, both an anterior and posterior incision and dissection of the axillary nerve is required to adequately delineate the zone of injury. This also ensures that both proximally and distally, uninjured axillary nerve is present before graft inset and also facilitates the ability to perform a meticulous microsurgical inset of the nerve graft posteriorly. The nerve graft must be pulled through from posterior to anterior to span the zone of injury and reconstruct the axillary nerve. Careful infraclavicular brachial plexus dissection is necessary to prevent further injury to components of the brachial plexus in the setting of a scarred bed. Patients will require postoperative therapy to prevent limitations in shoulder range of motion secondary to postoperative stiffness. This paper presents a detailed surgical technique for axillary nerve reconstruction by an anterior-posterior approach with a pull-through technique of a sural nerve cable graft. PMID:26524659

  1. ISOLATED NERVE ENDINGS (NEUROSECRETOSOMES) FROM THE POSTERIOR PITUITARY

    PubMed Central

    Bindler, Elliot; Labella, Frank S.; Sanwal, Madhu

    1967-01-01

    Subcellular fractions of the bovine posterior pituitary, including one composed almost exclusively of pinched-off nerve endings (neurosecretosomes), were characterized electron microscopically, hormonally, and enzymically. 15% of the nerve terminals in the gland were isolated as neurosecretosomes, as estimated from determinations of lactic dehydrogenase, a soluble, cytoplasmic enzyme. Neurosecretosomes were subdivided into three fractions by density-gradient centrifugation. The three subfractions, each shown to be nearly homogeneous populations of neurosecretosomes by means of electron microscopic and enzymic criteria, differed from each other in their vasopressin/oxytocin (VP/OT) ratios. The VP/OT ratio increased from the lightest to the densest fraction, indicating that VP is localized to denser and OT to lighter neurosecretosomes; similar results have been obtained previously for subfractions of neurosecretory granules (NSG). No morphological differences were apparent in neurosecretosomes among the three subfractions. Although complete separation of VP and OT was not achieved, the findings suggest that VP and OT are each stored in a different species of nerve ending and support the hypothesis that a given neurosecretory cell synthesizes, stores, and secretes only one of the peptide hormones. Microvesicles, 40–80 mµ diameter and contained in typical neurosecretory cell terminals, are believed to be degradation products of membrane ghosts of depleted NSG; electron micrographs indicative of this transformation are presented. A fraction rich in microvesicles, but containing some NSG membranes, was prepared by density-gradient centrifugation of an osmolysate of neurosecretosomes. Smaller, apparently nonneurosecretory nerve endings, lacking NSG but filled with small vesicles, are occasionally seen in sections from whole gland. The vesicles in these atypical posterior pituitary nerve endings may be true neurohumor-containing, "synaptic" vesicles. PMID:6040535

  2. Multiple cytosolic calcium buffers in posterior pituitary nerve terminals.

    PubMed

    McMahon, Shane M; Chang, Che-Wei; Jackson, Meyer B

    2016-03-01

    Cytosolic Ca(2+) buffers bind to a large fraction of Ca(2+) as it enters a cell, shaping Ca(2+) signals both spatially and temporally. In this way, cytosolic Ca(2+) buffers regulate excitation-secretion coupling and short-term plasticity of release. The posterior pituitary is composed of peptidergic nerve terminals, which release oxytocin and vasopressin in response to Ca(2+) entry. Secretion of these hormones exhibits a complex dependence on the frequency and pattern of electrical activity, and the role of cytosolic Ca(2+) buffers in controlling pituitary Ca(2+) signaling is poorly understood. Here, cytosolic Ca(2+) buffers were studied with two-photon imaging in patch-clamped nerve terminals of the rat posterior pituitary. Fluorescence of the Ca(2+) indicator fluo-8 revealed stepwise increases in free Ca(2+) after a series of brief depolarizing pulses in rapid succession. These Ca(2+) increments grew larger as free Ca(2+) rose to saturate the cytosolic buffers and reduce the availability of Ca(2+) binding sites. These titration data revealed two endogenous buffers. All nerve terminals contained a buffer with a Kd of 1.5-4.7 µM, and approximately half contained an additional higher-affinity buffer with a Kd of 340 nM. Western blots identified calretinin and calbindin D28K in the posterior pituitary, and their in vitro binding properties correspond well with our fluorometric analysis. The high-affinity buffer washed out, but at a rate much slower than expected from diffusion; washout of the low-affinity buffer could not be detected. This work has revealed the functional impact of cytosolic Ca(2+) buffers in situ in nerve terminals at a new level of detail. The saturation of these cytosolic buffers will amplify Ca(2+) signals and may contribute to use-dependent facilitation of release. A difference in the buffer compositions of oxytocin and vasopressin nerve terminals could contribute to the differences in release plasticity of these two hormones. PMID:26880753

  3. Ultrasound in Dual Nerve Impairment after Proximal Radial Nerve Lesion

    PubMed Central

    Lämmer, Alexandra B; Schwab, Stefan; Schramm, Axel

    2015-01-01

    Introduction Sonography in classical nerve entrapment syndromes is an established and validated method. In contrast, few publications highlight lesions of the radial nerve, particularly of the posterior interosseus nerve (PIN). Method Five patients with a radial nerve lesion were investigated by electromyography, nerve conduction velocity and ultrasound. Further normative values of 26 healthy subjects were evaluated. Results Four patients presented a clinical and electrophysiological proximal axonal radial nerve lesion and one patient showed a typical posterior interosseous nerve syndrome (PINS). The patient with PINS presented an enlargement of the PIN anterior to the supinator muscle. However four patients with proximal lesions showed an unexpected significant enlargement of the PIN within the supinator muscle. Conclusion High-resolution sonography is a feasible method to demonstrate the radial nerve including its distal branches. At least in axonal radial nerve lesions, sonography might reveal abnormalities far distant from a primary proximal lesion site clearly distinct from the appearance in classical PINS. PMID:25992766

  4. Complete Oculomotor Nerve Palsy Caused by Direct Compression of the Posterior Cerebral Artery.

    PubMed

    Jo, Yoon-Sik; Kim, Shin Kyoung; Kim, Dae Ho; Kim, Jae-Hwan; Na, Sang-Jun

    2015-07-01

    Oculomotor nerve palsy frequently occurs because of external compression by an internal carotid-posterior communicating artery aneurysm and diabetes mellitus. In addition, pontine infarction, cavernous sinus tumors, demyelinating disease, and autoimmune disorder are well-known causes of oculomotor nerve palsy. However, cases of complete oculomotor nerve palsy by neurovascular conflicts presented with a sudden onset of clinical symptoms are extremely rare. We experienced a rare case of complete oculomotor nerve palsy because of direct vascular compression of the oculomotor nerve by the posterior cerebral artery. PMID:25939862

  5. Unilateral abducens and bilateral facial nerve palsies associated with posterior fossa exploration surgery

    PubMed Central

    Khalil, Ayman; Clerkin, James; Mandiwanza, Tafadzwa; Green, Sandra; Javadpour, Mohsen

    2016-01-01

    Multiple cranial nerves palsies following a posterior fossa exploration confined to an extradural compartment is a rare clinical presentation. This case report describes a young man who developed a unilateral abducens and bilateral facial nerve palsies following a posterior fossa exploration confined to an extradural compartment. There are different theories to explain this presentation, but the exact mechanism remains unclear. We propose that this patient cranial nerve palsies developed following cerebrospinal fluid (CSF) leak, potentially as a consequence of rapid change in CSF dynamics. PMID:26951144

  6. Unilateral abducens and bilateral facial nerve palsies associated with posterior fossa exploration surgery.

    PubMed

    Khalil, Ayman; Clerkin, James; Mandiwanza, Tafadzwa; Green, Sandra; Javadpour, Mohsen

    2016-01-01

    Multiple cranial nerves palsies following a posterior fossa exploration confined to an extradural compartment is a rare clinical presentation. This case report describes a young man who developed a unilateral abducens and bilateral facial nerve palsies following a posterior fossa exploration confined to an extradural compartment. There are different theories to explain this presentation, but the exact mechanism remains unclear. We propose that this patient cranial nerve palsies developed following cerebrospinal fluid (CSF) leak, potentially as a consequence of rapid change in CSF dynamics. PMID:26951144

  7. Intraoperative Cranial Nerve Monitoring During Posterior Skull Base Surgery

    PubMed Central

    Kartush, Jack M.; LaRouere, Michael J.; Graham, Malcolm D.; Bouchard, Kenneth R.; Audet, Blaise V.

    1991-01-01

    Intraoperative monitoring of neurophysiologic function is rapidly evolving as an important adjunct during skull base surgery to reduce the incidence of neurologic deficit. Facial nerve monitoring is an excellent model, since electrical and mechanical evoked potentials can be directly presented to the surgeon in real-time through an acoustic loudspeaker display. The lower cranial nerves may also be monitored using similar electromyographic techniques. Auditory system monitoring is more difficult due to the low amplitude response that requires averaging and filtering to extract the evoked potential. In conjunction with auditory monitoring, improved hearing preservation may be further enhanced by concomitant facial nerve monitoring, since the surgeon is alerted to traumatic manipulations that may affect both facial and cochlear nerves. Techniques and interpretative issues are presented to maximize the efficacy and safety of cranial nerve monitoring. ImagesFigure 1Figure 2Figure 3Figure 5 PMID:17170827

  8. Topography of human ankle joint: focused on posterior tibial artery and tibial nerve.

    PubMed

    Kim, Deog-Im; Kim, Yi-Suk; Han, Seung-Ho

    2015-06-01

    Most of foot pain occurs by the entrapment of the tibial nerve and its branches. Some studies have reported the location of the tibial nerve; however, textbooks and researches have not described the posterior tibial artery and the relationship between the tibal nerve and the posterior tibial artery in detail. The purpose of this study was to analyze the location of neurovascular structures and bifurcations of the nerve and artery in the ankle region based on the anatomical landmarks. Ninety feet of embalmed human cadavers were examined. All measurements were evaluated based on a reference line. Neurovascular structures were classified based on the relationship between the tibial nerve and the posterior tibial artery. The bifurcation of arteries and nerves were expressed by X- and Y-coordinates. Based on the reference line, 9 measurements were examined. The most common type I (55.6%), was the posterior tibial artery located medial to the tibial nerve. Neurovascular structures were located less than 50% of the distance between M and C from M at the reference line. The bifurcation of the posterior tibial artery was 41% in X-coordinate, -38% in Y-coordinate, and that of the tibial nerve was 48%, and -10%, respectively. Thirteen measurements and classification showed statistically significant differences between both sexes (P<0.05). It is determined the average position of neurovascular structures in the human ankle region and recorded the differences between the sexes and amongst the populations. These results would be helpful for the diagnosis and treatment of foot pain. PMID:26140224

  9. Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord.

    PubMed

    Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio

    2016-01-01

    OBJECT Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was 26 years and the average time between accident and surgery was 6 months. Sural nerve graft length averaged 12 cm. Recovery was scored according to the British Medical Research Council (BMRC) scale, which ranges from M0 to M5 (normal muscle strength). RESULTS After grafting, all 7 patients with an elbow extension palsy recovered elbow extension, scoring M4. Six of the 13 recovered M4 wrist extension, 6 had M3, and 1 had M2. Thumb and finger extension was scored M4 in 3 patients, M3 in 2, M2 in 2, and M0 in 6. CONCLUSIONS The authors consider levels of strength of M4 for elbow and wrist extension and M3 for thumb and finger extension to be good results. Based on these criteria, overall good results were obtained in only 5 of the 13 patients. In proximal radial nerve lesions, the authors now advocate combining nerve grafts with nerve or tendon transfers to reconstruct wrist, thumb, and finger extension. PMID:26274998

  10. The effect of preemptive pudendal nerve block on pain after anterior and posterior vaginal repair

    PubMed Central

    Rouholamin, Safoura; Jabalameli, Mitra; Mostafa, Abedi

    2015-01-01

    Introduction: Anterior and posterior vaginal repair (APR) is a common surgery for women with prolapse of pelvic organs which creates post-operative pain because of damage of tissues that we should manage and control this pain. For this purpose, this study was conducted in order to evaluate the effect of preemptive pudendal nerve block on post-operative pain in anterior and posterior vaginal wall repair. Materials and Methods: In a double-blinded clinical trial study, 60 women candidates of APR were randomly divided to two groups. In both of them was injected 0.3 cc/kg bupivacaine 0.25% for the intervention group or normal saline for the control group in pudendal nerve tract with the guide of nerve stimulator. A visual analog scale was used to measure pain during the first 48 h after the surgery. Data were analyzed by repeated measures analysis of variance (ANOVA). Results: Compared with the intervention group, the control group experienced greater pain during rest and walking. There were significant differences between the two groups from the first post-operative hour (P = 0.003) until 48 h after the operation (P = 0.021). Furthermore, the mean ± SD values of pain in the sitting position was not significantly different between control and intervention groups at the same time (P = 0.340). Conclusion: Preemptive pudendal nerve block can reduce post-operative pain score in anterior and posterior vaginal wall repair and this method was suggested in anterior and posterior vaginal wall repair. PMID:26380238

  11. Microvascular decompression of the posterior inferior cerebellar artery for intermediate nerve neuralgia

    PubMed Central

    Schroeder, Humberto Kluge; Neville, Iuri Santana; de Andrade, Daniel Ciampi; Lepski, Guilherme Alves; Teixeira, Manoel Jacobsen; Duarte, Kleber Paiva

    2015-01-01

    Background: Intermediate nerve neuralgia (INN) is an extremely rare craniofacial pain disorder mainly caused by neurovascular compression. Case Description: We present the case of a 48-year-old female with a 20-month history of intractable paroxysmal INN on the right side. The patient described feeling paroxysmal pain in her auditory canal, pinna, deep in the jaw, and adjacent retromastoid area on the right side. She described the pain as being like a burning sensation. Magnetic resonance imaging showed the right posterior cerebellar artery crossing the cerebellopontine cistern in close contact with the right VII and VIII nerves. Surgical exploration via retromastoid craniotomy revealed vascular compression of the intermediate nerve by the posterior cerebellar artery. We therefore performed microvascular nerve decompression to relieve pain, and the patient remained pain-free at the 6-month follow-up visit. Conclusion: INN should be considered as a differential diagnosis in cases with atypical facial neuralgia, and microvascular decompression is an effective treatment option that can provide optimal pain relief. PMID:25883844

  12. Resolution of third nerve palsy despite persistent aneurysmal mass effect after flow diversion embolization of posterior communicating artery aneurysms.

    PubMed

    Binyamin, Tamar R; Dahlin, Brian C; Waldau, Ben

    2016-09-01

    Posterior communicating artery (PCOM) aneurysms may cause third nerve palsies. The optimal treatment with clipping versus coiling remains controversial. Here we report on two cases of resolution of third nerve palsy after flow diversion embolization of large and giant PCOM aneurysms without adjuvant coil placement. The resolution of third nerve palsy was not preceded by significant shrinkage of the aneurysmal sac on MRI. However, one patient showed resolution of T2-weighted signal abnormalities in the midbrain and mesial temporal lobe despite a similar size of the aneurysm. Therefore, flow diversion embolization of a PCOM aneurysm may resolve oculomotor nerve palsies through decreasing arterial pulsations against the nerve or midbrain. PMID:27183957

  13. Fascicular Involvement of the Posterior Tibial Nerve as a Result of Perineural Ganglion Cyst at the Posterior Tibial Nerve in the Calf: A Case Report and Review of Literature.

    PubMed

    Patel, Chilvana; Vishnubhakat, Surya Murthy; Narayan, Raj

    2015-12-01

    We report a 19-year-old woman with a 6-month history of nontraumatic left foot numbness associated with intermittent weakness. Nerve conduction studies and electromyography localized the lesion to the posterior tibial nerve, below the innervation to the soleus and medial gastrocnemius muscles. MRI of the left leg revealed a multiloculated cystic collection near the proximal tibiofibular joint. Surgical excision and pathology confirmed the diagnosis of a ganglion cyst, in an atypical location distal to the popliteal fossa. We believe this is the first reported case of fascicular posterior tibial nerve involvement by a ganglion cyst in the calf. PMID:26583496

  14. Sequential-digital image correlation for mapping human posterior sclera and optic nerve head deformation.

    PubMed

    Pyne, Jeffrey D; Genovese, Katia; Casaletto, Luciana; Vande Geest, Jonathan P

    2014-02-01

    Optic nerve head (ONH) deformations may be involved in the onset or further development of glaucoma, including in patients with relatively normal intraocular pressures (IOPs). Characterizing posterior scleral deformations over physiological pressures may provide a better understanding of how changes in IOP lead to changes in the mechanical environment of the ONH and possibly retinal ganglion cell death. Pressure inflation measurement test protocols are commonly used to measure deformation of the peripapillary sclera with full-field noncontact optical methods. The purpose of this work was to develop and validate a new sequential 3D digital image correlation (S-DIC) approach for quantification of posterior scleral pressure induced deformation that improves z (in-depth) resolution of the DIC measurement without losing in-plane sensitivity, while also being able to contour and map deformations of the complex-shaped ONH. Our approach combines two orthogonal axes of parallax with standard 3D DIC methods using a single high-resolution camera. The enhanced capabilities of S-DIC with respect to standard 3D DIC has been demonstrated by carrying out a complete benchmark for shape, deformation, and strain measurement on an object of known complex geometry. Our S-DIC method provided a reconstruction accuracy of 0.17% and an uncertainty in z-position measurement of 8 μm. The developed methodology has also been applied to a human posterior scleral shell, including the full peripapillary sclera and optic nerve. The relatively inexpensive S-DIC approach may provide new information on the biomechanical deformations of the optic nerve head and, thus, the death of retinal ganglion cells in primary open angle glaucoma. PMID:24337344

  15. Recovery of Third Nerve Palsy after Endovascular Packing of Internal Carotid-Posterior Communicating Artery Aneurysms

    PubMed Central

    Mavilio, N.; Pisani, R.; Rivano, C.; Testa, V.; Spaziante, R.; Rosa, M.

    2000-01-01

    Summary Endovascular packing of intracranial aneurysm with preservation of the parent vessel has become in many cases a valid alternative to surgical clipping. Regression of oculomotor disorders after clipping of internal carotid-posterior communicating artery (ICA-PCoA) aneurysms has been well assessed. This report focuses on the reversal of third nerve palsy after endovascular packing of ICA-PCoA aneurysms. To this end, clinical appearances, neuroradiological features, and endovascular interventional procedures of six treated patient are reported and discussed in the light of the very few previous case observations found in the literature. Results indicate that endovascular packing of ICA-PCoA aneurysms may produce effective recovery of correlated third nerve dysfunction. PMID:20667199

  16. Histochemical study of posterior cricoarytenoid muscle reinnervation by a nerve-muscle pedicle in the cat.

    PubMed

    Fata, J J; Malmgren, L T; Gacek, R R; Dum, R; Woo, P

    1987-01-01

    Reinnervation of the posterior cricoarytenoid (PCA) muscle with a nerve-muscle pedicle (NMP) has been proposed for patients with bilateral abductor vocal cord paralysis. Since its success has been controversial, a glycogen depletion histochemical technique was used to examine reinnervation. An ansa cervicalis NMP was implanted into the denervated PCA in nine cats. Eight months later, vocal cord activity was evaluated. The NMP nerve was stimulated extensively in seven cats (experimental group). Optical densities of NMP-supplied PCA muscle fibers from experimental and control groups were compared to detect differences in glycogen content. The results demonstrated quantitative evidence of reinnervation in two experimental animals. Electrical stimulation of the NMP produced abduction in one of these two animals, but was never observed during spontaneous respiration or airway occlusion. These observations indicate that reinnervation can occur but abduction requires electrical stimulation. The NMP technique may be more successful with an electrical pacer. PMID:3674642

  17. Iatrogenic posterior tibial nerve division during a combined anterior ankle arthroscopy with an additional posterolateral portal.

    PubMed

    Abdul-Jabar, Hani B; Bhamra, Jagmeet; Quick, Tom J; Fox, Michael

    2016-01-01

    Ankle arthroscopy is an important diagnostic and therapeutic technique in the management of ankle disorders. Nowadays ankle arthroscopy provides good to excellent results (up to 90%) in the treatment of certain intra-articular disorders. Due to the superficial location of ankle joint and the abundance of overlying neurovascular structures, complications reported in ankle arthroscopy are greater than those reported in other joints. We present the first reported case of a complete division of the posterior tibial nerve during an anterior ankle arthroscopy combined with an additional posterolateral portal. This was due to a poorly controlled use of the arthroscopic instruments. PMID:27197613

  18. Iatrogenic posterior tibial nerve division during a combined anterior ankle arthroscopy with an additional posterolateral portal

    PubMed Central

    Abdul-Jabar, Hani B; Bhamra, Jagmeet; Quick, Tom J; Fox, Michael

    2016-01-01

    Ankle arthroscopy is an important diagnostic and therapeutic technique in the management of ankle disorders. Nowadays ankle arthroscopy provides good to excellent results (up to 90%) in the treatment of certain intra-articular disorders. Due to the superficial location of ankle joint and the abundance of overlying neurovascular structures, complications reported in ankle arthroscopy are greater than those reported in other joints. We present the first reported case of a complete division of the posterior tibial nerve during an anterior ankle arthroscopy combined with an additional posterolateral portal. This was due to a poorly controlled use of the arthroscopic instruments. PMID:27197613

  19. [Anesthetic Management Using Frontal Nerve, Greater Occipital Nerve, and Superficial Cervical Plexus Block for Posterior Cervical Spinal Fusion in a Patient with Athetoid Cerebral Palsy].

    PubMed

    Matsunami, Sayuri; Komasawa, Nobuyasu; Fujiwara, Shunsuke; Fujitate, Yasutaka; Soen, Masako; Minami, Toshiaki

    2015-05-01

    Here, we report successful anesthetic management of posterior cervical spinal fusion utilizing block of the frontal nerve, the greater occipital nerve, and the superficial cervical plexus in a patient with athetoid cerebral palsy. A 69-year-old woman (height 157 cm; weight 33 kg) with athetoid cerebral palsy was scheduled to undergo posterior cervical spinal fusion for cervical spondylotic myelopathy. After induction of general anesthesia, we performed tracheal intubation using the Pentax-AWS Airwayscope with a thin Intlock. After tracheal intubation, we used ropivacaine for the frontal nerve, greater occipital nerve, and superficial cervical plexus block. Anesthetic maintenance was performed with total intravenous anesthesia utilizing propofol and remifentanil. Continuous administration of dexmedetomidine was started during operation. Following surgery, smooth spontaneous ventilation was observed following uneventful extubation. No significant pain and no athetoid movement were observed under continuous administration of dexmedetomidine. PMID:26422967

  20. Biomechanical Contributions of Posterior Deltoid and Teres Minor in the Context of Axillary Nerve Injury: A Computational Study

    PubMed Central

    Crouch, Dustin L.; Plate, Johannes F.; Li, Zhongyu; Saul, Katherine R.

    2013-01-01

    Purpose To determine if transfer to only the anterior branch of the axillary nerve will restore useful function following axillary nerve injury with persistent posterior deltoid and teres minor paralysis. Methods We used a computational musculoskeletal model of the upper limb to determine the relative contributions of posterior deltoid and teres minor to maximum joint moment generated during a simulated static strength assessment and to joint moments during 3 sub-maximal shoulder movements. Movement simulations were performed with and without simulated posterior deltoid and teres minor paralysis to identify muscles which may compensate for their paralysis. Results In the unimpaired limb model, teres minor and posterior deltoid accounted for 16% and 14% of the total isometric shoulder extension and external rotation joint moments, respectively. During the 3 movement simulations, posterior deltoid produced as much as 20% of the mean shoulder extension moment, while teres minor accounted for less than 5% of the mean joint moment in all directions of movement. When posterior deltoid and teres minor were paralyzed, the mean extension moments generated by the supraspinatus, long head of triceps, latissimus dorsi, and middle deltoid increased to compensate. Compensatory muscles were not fully activated during movement simulations when posterior deltoid and teres minor were paralyzed. Conclusions Reconstruction of the anterior branch of the axillary nerve only is an appropriate technique for restoring shoulder abduction strength following isolated axillary nerve injury. When shoulder extension strength is compromised by extensive neuromuscular shoulder injury, reconstruction of both the anterior and posterior branches of the axillary nerve should be considered. Clinical Relevance By quantifying the biomechanical role of muscles during sub-maximal movement, in addition to quantifying muscle contributions to maximal shoulder strength, we can inform pre-operative planning and

  1. Unusual Origin of a Double Upper Subscapular Nerve from the Suprascapular Nerve and the Posterior Division of the Upper Trunk of the Brachial Plexus: A Case Report

    PubMed Central

    Koutsouflianiotis, Konstantinos; Iliou, Kalliopi; Bitsis, Theodosios; Kitsoulis, Panagiotis

    2016-01-01

    A double upper subscapular nerve on the right side was detected in a male cadaver, with the proximal one arising from the suprascapular nerve and the distal one from the posterior division of the upper trunk of the brachial plexus. Both of them penetrated and supplied the uppermost portion of the right subscapularis muscle. That anatomic variation was associated with a median nerve formed by two lateral roots. The origin and pattern of the upper subscapular nerve displays high variability, however the presented combination of the variable origin of a double upper subscapular nerve has rarely been described in the literature. The knowledge of such an anatomic variation is essential for the surgeon operating in the region especially in instances of brachial plexus’ repair after any traumatic injury. Moreover, the awareness of the precise origin and topography of these nerves is important for the physician attempting to block these nerves or utilizing these nerves as grafts for neurotization of adjacent damaged nerves of the brachial plexus. PMID:27504272

  2. Unusual Origin of a Double Upper Subscapular Nerve from the Suprascapular Nerve and the Posterior Division of the Upper Trunk of the Brachial Plexus: A Case Report.

    PubMed

    Paraskevas, George; Koutsouflianiotis, Konstantinos; Iliou, Kalliopi; Bitsis, Theodosios; Kitsoulis, Panagiotis

    2016-06-01

    A double upper subscapular nerve on the right side was detected in a male cadaver, with the proximal one arising from the suprascapular nerve and the distal one from the posterior division of the upper trunk of the brachial plexus. Both of them penetrated and supplied the uppermost portion of the right subscapularis muscle. That anatomic variation was associated with a median nerve formed by two lateral roots. The origin and pattern of the upper subscapular nerve displays high variability, however the presented combination of the variable origin of a double upper subscapular nerve has rarely been described in the literature. The knowledge of such an anatomic variation is essential for the surgeon operating in the region especially in instances of brachial plexus' repair after any traumatic injury. Moreover, the awareness of the precise origin and topography of these nerves is important for the physician attempting to block these nerves or utilizing these nerves as grafts for neurotization of adjacent damaged nerves of the brachial plexus. PMID:27504272

  3. Superficial Ulnar Artery Associated with Anomalous Origin of the Common Interosseous and Ulnar Recurrent Arteries

    PubMed Central

    Pamidi, Narendra; Nayak, Satheesha B; Jetti, Raghu; Thangarajan, Rajesh

    2016-01-01

    Occurrence of vascular variations in the upper limb is not uncommon and is well described in the medical literature. However, occurrence of superficial ulnar artery associated with unusual origin of the common interosseous and ulnar recurrent arteries is seldom reported in the literature. In the present case, we report the anomalous origin of common trunk of common interosseous, anterior and posterior ulnar recurrent arteries from the radial artery, in a male cadaver. Further, ulnar artery had presented superficial course. Knowledge of anomalous arterial pattern in the cubital fossa reported here is clinically important during the angiographic procedures and plastic surgeries. PMID:27437201

  4. Superficial Ulnar Artery Associated with Anomalous Origin of the Common Interosseous and Ulnar Recurrent Arteries.

    PubMed

    Sirasanagandla, Srinivasa Rao; Pamidi, Narendra; Nayak, Satheesha B; Jetti, Raghu; Thangarajan, Rajesh

    2016-05-01

    Occurrence of vascular variations in the upper limb is not uncommon and is well described in the medical literature. However, occurrence of superficial ulnar artery associated with unusual origin of the common interosseous and ulnar recurrent arteries is seldom reported in the literature. In the present case, we report the anomalous origin of common trunk of common interosseous, anterior and posterior ulnar recurrent arteries from the radial artery, in a male cadaver. Further, ulnar artery had presented superficial course. Knowledge of anomalous arterial pattern in the cubital fossa reported here is clinically important during the angiographic procedures and plastic surgeries. PMID:27437201

  5. Surgical anatomy of the radial nerve at the elbow.

    PubMed

    Artico, M; Telera, S; Tiengo, C; Stecco, C; Macchi, V; Porzionato, A; Vigato, E; Parenti, A; De Caro, R

    2009-02-01

    An anatomical study of the brachial portion of the radial nerve with surgical implications is proposed. Thirty specimens of arm from 20 fresh cadavers (11 male, 9 female) were used to examine the topographical relations of the radial nerve with reference to the following anatomical landmarks: acromion angle, medial and lateral epicondyles, point of division between the lateral and long heads of the triceps brachii, lateral intermuscular septum, site of division of the radial nerve into its superficial and posterior interosseous branches and entry and exit point of the posterior interosseous branch into the supinator muscle. The mean distances between the acromion angle and the medial and lateral levels of crossing the posterior aspect of the humerus were 109 (+/-11) and 157 (+/-11) mm, respectively. The mean length and calibre of the nerve in the groove were 59 (+/-4) and 6 (+/-1) mm, respectively. The division of the lateral and long heads of the triceps was found at a mean distance of 126 (+/-13) mm from the acromion angle. The mean distances between the lateral point of crossing the posterior aspect of the humerus and the medial and lateral epicondyles were 125 (+/-13) and 121 (+/-13) mm, respectively. The mean distance between the lateral point of crossing the posterior aspect of the humerus and the entry point in the lateral intermuscular septum (LIS) was 29 (+/-6) mm. The mean distances between the entry point of the nerve in the LIS and the medial and lateral epicondyles were 133 (+/-14) and 110 (+/-23) mm, respectively. Our study provides reliable and objective data of surgical anatomy of the radial nerve which should be always kept in mind by surgeons approaching to the surgery of the arm, in order to avoid iatrogenic injuries. PMID:18795220

  6. Extensive molecular differences between anterior- and posterior-half-sclerotomes underlie somite polarity and spinal nerve segmentation

    PubMed Central

    Hughes, Daniel ST; Keynes, Roger J; Tannahill, David

    2009-01-01

    Background The polarization of somite-derived sclerotomes into anterior and posterior halves underlies vertebral morphogenesis and spinal nerve segmentation. To characterize the full extent of molecular differences that underlie this polarity, we have undertaken a systematic comparison of gene expression between the two sclerotome halves in the mouse embryo. Results Several hundred genes are differentially-expressed between the two sclerotome halves, showing that a marked degree of molecular heterogeneity underpins the development of somite polarity. Conclusion We have identified a set of genes that warrant further investigation as regulators of somite polarity and vertebral morphogenesis, as well as repellents of spinal axon growth. Moreover the results indicate that, unlike the posterior half-sclerotome, the central region of the anterior-half-sclerotome does not contribute bone and cartilage to the vertebral column, being associated instead with the development of the segmented spinal nerves. PMID:19463158

  7. Magnetoneurographic registration of propagating magnetic fields in the lumbar spine after stimulation of the posterior tibial nerve

    NASA Astrophysics Data System (ADS)

    Klein, Anita; van Leeuwen, Peter; Hoormann, Jörg; Grönemeyer, Dietrich

    2006-06-01

    Stimulation of the posterior tibial nerve has been associated with different somatosensory evoked potentials (SEP) recorded along the spine and thorax. The aim of this study was to register and describe the magnetic fields corresponding to different components of spinal SEP after stimulation of tibial nerves. In nine healthy subjects, right and left posterior tibial nerves were transcutaneously electrostimulated at the ankles. Neuromagnetic fields were registered over a circular 800 cm2 area of the lumbosacral spine using a 61-channel biomagnetometer. Magnetic field maps were constructed and examined visually for dipolar patterns. Equivalent current dipoles (ECD) were calculated for each somatosensory evoked field (SEF) using a least-squares fit in a spherical model. In seven subjects dipolar SEF were detected over the lower back at two separate latencies and locations and propagating ECD could be localized. Both the first and second components found agreed anatomically and functionally with respect to propagation in the underlying nerve fibers. It was possible to record and identify SEF which correspond to the SEP described in the literature. Dipole localization based on an equivalent current dipole model allowed a basic evaluation of the plausibility of the measurements with respect to the processes being examined.

  8. Hemodynamic and morphological characteristics of unruptured posterior communicating artery aneurysms with oculomotor nerve palsy.

    PubMed

    Lv, Nan; Yu, Ying; Xu, Jinyu; Karmonik, Christof; Liu, Jianmin; Huang, Qinghai

    2016-08-01

    OBJECT Unruptured posterior communicating artery (PCoA) aneurysms with oculomotor nerve palsy (ONP) have a very high risk of rupture. This study investigated the hemodynamic and morphological characteristics of intracranial aneurysms with high rupture risk by analyzing PCoA aneurysms with ONP. METHODS Fourteen unruptured PCoA aneurysms with ONP, 33 ruptured PCoA aneurysms, and 21 asymptomatic unruptured PCoA aneurysms were included in this study. The clinical, morphological, and hemodynamic characteristics were compared among the different groups. RESULTS The clinical characteristics did not differ among the 3 groups (p > 0.05), whereas the morphological and hemodynamic analyses showed that size, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, normalized wall shear stress (WSS), and percentage of low WSS area differed significantly (p < 0.05) among the 3 groups. Furthermore, multiple comparisons revealed that these parameters differed significantly between the ONP group and the asymptomatic unruptured group and between the ruptured group and the asymptomatic unruptured group, except for size, which differed significantly only between the ONP group and the asymptomatic unruptured group (p = 0.0005). No morphological or hemodynamic parameters differed between the ONP group and the ruptured group. CONCLUSIONS Unruptured PCoA aneurysms with ONP demonstrated a distinctive morphological-hemodynamic pattern that was significantly different compared with asymptomatic unruptured PCoA aneurysms and was similar to ruptured PCoA aneurysms. The larger size, more irregular shape, and lower WSS might be related to the high rupture risk of PCoA aneurysms. PMID:26636379

  9. Somatosensory evoked potentials in cervical spondylosis. Correlation of median, ulnar and posterior tibial nerve responses with clinical and radiological findings.

    PubMed

    Yu, Y L; Jones, S J

    1985-06-01

    Somatosensory evoked potentials (SEPs) following median, ulnar and tibial nerve stimulation were recorded from sites over the shoulders, neck and scalp in 34 patients with cervical spondylosis. Twenty control subjects were matched for sex and age. Detailed clinical and radiological data were assembled, with particular attention to the sensory modalities impaired and the locus and severity of cord compression. The patients were divided clinically into 4 groups: combined myelopathy and radiculopathy (6 cases), myelopathy alone (15), radiculopathy (6) and neck pain (7). Four cases are described in detail. SEP abnormalities were strongly correlated with clinical myelopathy, but not with radiculopathy. Median and ulnar nerve responses were less often affected than tibial, even with myelopathy above C6 level. Tibial nerve SEP abnormalities were strongly correlated with posterior column signs on the same side of the body, but not with anterolateral column sensory signs. In myelopathy cases, the SEP examination appeared to be more sensitive to sensory pathway involvement than clinical sensory testing. SEP abnormalities were infrequent in cases of radiculopathy and neck pain, bearing no relation to the clinical locus of root lesions. Abnormal SEPs consistent with subclinical posterior column involvement, however, were recorded in 1 patient with radiculopathy and 2 with neck pain. Follow-up recordings made postoperatively in 7 myelopathy cases reflected the clinical course (improvement, deterioration or no change) in 4, but failed to reflect improvement in 3. The correlation of SEP findings with radiological data was generally poor. SEP abnormalities were detected in 6 out of 8 patients with clinical myelopathy but no radiological evidence of posterior cord compression, suggesting that impairment of the blood supply may be an important factor contributing to cord damage. An application for SEPs in the clinical management of cervical spondylosis may lie in the detection of

  10. False aneurysm of the interosseous artery and anterior interosseous syndrome - an unusual complication of penetrating injury of the forearm: a case report

    PubMed Central

    2009-01-01

    Background Palsies involving the anterior interosseous nerve (AIN) comprise less than 1% of all upper extremity nerve palsies. Objectives This case highlights the potential vascular and neurological hazards of minimal penetrating injury of the proximal forearm and emphasizes the phenomenon of delayed presentation of vascular injuries following seemingly obscure penetrating wounds. Case Report We report a case of a 22-year-old male admitted for a minimal penetrating trauma of the proximal forearm that, some days later, developed an anterior interosseous syndrome. A Duplex study performed immediately after the trauma was normal. Further radiologic investigations i.e. a computer-tomographic-angiography (CTA) revealed a false aneurysm of the proximal portion of the interosseous artery (IA). Endovascular management was proposed but a spontaneous rupture dictated surgical revision with simple excision. Complete neurological recovery was documented at 4 months postoperatively. Conclusions/Summary After every penetrating injury of the proximal forearm we propose routinely a detailed neurological and vascular status and a CTA if Duplex evaluation is negative. PMID:20034382

  11. Isolated nerve endings (neurosecretosomes) from the posterior pituitary. Partial separation of vasopressin and oxytocin and the isolation of microvesicles.

    PubMed

    Bindler, E; Labella, F S; Sanwal, M

    1967-07-01

    Subcellular fractions of the bovine posterior pituitary, including one composed almost exclusively of pinched-off nerve endings (neurosecretosomes), were characterized electron microscopically, hormonally, and enzymically. 15% of the nerve terminals in the gland were isolated as neurosecretosomes, as estimated from determinations of lactic dehydrogenase, a soluble, cytoplasmic enzyme. Neurosecretosomes were subdivided into three fractions by density-gradient centrifugation. The three subfractions, each shown to be nearly homogeneous populations of neurosecretosomes by means of electron microscopic and enzymic criteria, differed from each other in their vasopressin/oxytocin (VP/OT) ratios. The VP/OT ratio increased from the lightest to the densest fraction, indicating that VP is localized to denser and OT to lighter neurosecretosomes; similar results have been obtained previously for subfractions of neurosecretory granules (NSG). No morphological differences were apparent in neurosecretosomes among the three subfractions. Although complete separation of VP and OT was not achieved, the findings suggest that VP and OT are each stored in a different species of nerve ending and support the hypothesis that a given neurosecretory cell synthesizes, stores, and secretes only one of the peptide hormones. Microvesicles, 40-80 mmicro diameter and contained in typical neurosecretory cell terminals, are believed to be degradation products of membrane ghosts of depleted NSG; electron micrographs indicative of this transformation are presented. A fraction rich in microvesicles, but containing some NSG membranes, was prepared by density-gradient centrifugation of an osmolysate of neurosecretosomes. Smaller, apparently nonneurosecretory nerve endings, lacking NSG but filled with small vesicles, are occasionally seen in sections from whole gland. The vesicles in these atypical posterior pituitary nerve endings may be true neurohumor-containing, "synaptic" vesicles. PMID:6040535

  12. Transient long thoracic nerve injury during posterior spinal fusion for adolescent idiopathic scoliosis: A report of two cases.

    PubMed

    Tsirikos, Athanasios I; Al-Hourani, Khalid

    2013-11-01

    We present the transient long thoracic nerve (LTN) injury during instrumented posterior spinal arthrodesis for idiopathic scoliosis. The suspected mechanism of injury, postoperative course and final outcome is discussed. The LTN is susceptible to injury due to its long and relatively superficial course across the thoracic wall through direct trauma or tension. Radical mastectomies with resection of axillary lymph nodes, first rib resection to treat thoracic outlet syndrome and cardiac surgery can be complicated with LTN injury. LTN injury producing scapular winging has not been reported in association with spinal deformity surgery. We reviewed the medical notes and spinal radiographs of two adolescent patients with idiopathic scoliosis who underwent posterior spinal arthrodesis and developed LTN neuropraxia. Scoliosis surgery was uneventful and intraoperative spinal cord monitoring was stable throughout the procedure. Postoperative neurological examination was otherwise normal, but both patients developed winging of the scapula at 4 and 6 days after spinal arthrodesis, which did not affect shoulder function. Both patients made a good recovery and the scapular winging resolved spontaneously 8 and 11 months following surgery with no residual morbidity. We believe that this LTN was due to positioning of our patients with their head flexed, tilted and rotated toward the contralateral side while the arm was abducted and extended. The use of heavy retractors may have also applied compression or tension to the nerve in one of our patients contributing to the development of neuropraxia. This is an important consideration during spinal deformity surgery to prevent potentially permanent injury to the nerve, which can produce severe shoulder dysfunction and persistent pain. PMID:24379470

  13. Vagal and sympathetic nerve activities influenced by posterior cerebral circulation in rabbits.

    PubMed

    Yamamoto, K; Kubo, T; Matsunaga, T

    1993-01-01

    Vagal and sympathetic nervous activities in the rabbit were recorded while vertebral blood flow was partially blocked by the injection of adenosine 5'-diphosphate (ADP; platelet aggregator). When a small dose of ADP (0.2 mg/kg) was administered into a unilateral vertebral artery, sympathetic nerve (SN) activity increased, and its magnitude was inversely correlated with the extent of the decrease in blood pressure (BP). A larger dose (2 mg/kg) of ADP suppressed SN activity on the injected side, whereas the change was small on the non-injected side. Vagal nerve (VN) activity showed a monophasic excitatory response on both sides, although the change was larger on the injected than on the non-injected side. As a result, asymmetry in autonomic nerve activity was more distinct in SN than in VN. The present study demonstrated that asymmetry of autonomic nervous function can result from changes in blood flow in the cerebellum and brainstem. PMID:8256597

  14. Intrasubstance Schwannoma of Posterior Tibial Nerve Presenting as Lumbo-Sacral Radiculopathy

    PubMed Central

    Banshelkikar, Santosh; Nistane, Pruthviraj

    2015-01-01

    Introduction: Peripheral nerve tumours are rarely acknowledged as a cause of radiating pain in lower limbs and suspicion is almost always pointed towards lumbo-sacral causes. Schwannomas are tumours of peripheral nerve sheaths occurring anywhere along the peripheral nervous system. Often it can produce symptoms, which can be misleading in cases where obvious swelling is not present. The diagnosis may therefore be delayed by several years of emergence of symptoms. Very few such cases have been reported previously and none of them had an intrasubstance location of the tumour as in our case. Case Report: We present a case of a middle aged female patient presenting with radiating pain in left lower limb, which was diagnosed and treated as lumbo-sacral radiculopathy for five years before an obvious swelling appeared, which on further investigations led to diagnosis of schwannoma of tibial nerve. Intraoperatively, the schwannoma was found to be intrasubstance in location which has never been reported in the past literatures making its excision, without damaging the conducting elements, a challenge. Conclusion: The possibility of peripheral nerve tumour should always be kept in mind while dealing with long standing cases diagnosed as radiculopathy and which do not get better with treatment on similar lines. A thorough clinical examination of the entire limb including Tinel’s sign can clinch the diagnosis earlier in cases where obvious swelling is not present. Even unusual presentations, as in our case, can be dealt surgically with good results. PMID:27299039

  15. Clinical Outcomes following median to radial nerve transfers

    PubMed Central

    Ray, Wilson Z.; Mackinnon, Susan E.

    2010-01-01

    Purpose In this study the authors evaluate the clinical outcomes in patients with radial nerve palsy who underwent nerve transfers utilizing redundant fascicles of median nerve (innervating the flexor digitorum superficialis and flexor carpi radialis muscles) to the posterior interosseous nerve and the nerve to the extensor carpi radialis brevis. Methods A retrospective review of the clinical records of 19 patients with radial nerve injuries who underwent nerve transfer procedures using the median nerve as a donor nerve were included. All patients were evaluated using the Medical Research Council (MRC) grading system. Results The mean age of patients was 41 years (range 17 – 78 years). All patients received at least 12 months of follow-up (20.3 ± 5.8 months). Surgery was performed at a mean of 5.7 ± 1.9 months post-injury. Post-operative functional evaluation was graded according to the following scale: grades MRC 0/5 - MRC 2/5 were considered poor outcomes, while MRC of 3/5 was a fair result, MRC grade 4/5 was a good result, and grade 4+/5 was considered an excellent outcome. Seventeen patients (89%) had a complete radial nerve palsy while two patients (11%) had intact wrist extension but no finger or thumb extension. Post-operatively all patients except one had good to excellent recovery of wrist extension. Twelve patients recovered good to excellent finger and thumb extension, two patients had fair recovery, five patients had a poor recovery. Conclusions The radial nerve is a commonly injured nerve, causing significant morbidity in affected patients. The median nerve provides a reliable source of donor nerve fascicles for radial nerve reinnervation. This transfer was first performed in 1999 and evolved over the subsequent decade. The important nuances of both surgical technique and motor re-education critical for to the success of this transfer have been identified and are discussed. PMID:21168979

  16. Greater auricular nerve palsy after arthroscopic anterior-inferior and posterior-inferior labral tear repair using beach-chair positioning and a standard universal headrest.

    PubMed

    LaPrade, Christopher M; Foad, Abdullah

    2015-04-01

    Shoulder arthroscopy is a common treatment for numerous different pathologies. An iatrogenic nerve injury that occurs during shoulder arthroscopy is more common than previously recognized. However, though many nerve pathologies are increasingly being recognized, reported cases of greater auricular nerve injury are limited. For instance, a case of greater auricular nerve palsy was reported in only 2 series that used a horseshoe headrest. One set of authors discontinued and recommended against use of this headrest, and the other recommended a headrest redesign. Here we report on a case of greater auricular nerve palsy that occurred after the patient's anterior-inferior and posterior-inferior labral tear was arthroscopically repaired using beach-chair positioning and a standard universal headrest. The palsy resulted in numbness and dysesthesia, which lessened gradually over 3 months after surgery and was completely resolved by 6 months. PMID:25844590

  17. High Median Nerve Injuries.

    PubMed

    Isaacs, Jonathan; Ugwu-Oju, Obinna

    2016-08-01

    The median nerve serves a crucial role in extrinsic and intrinsic motor and sensory function to the radial half of the hand. High median nerve injuries, defined as injuries proximal to the anterior interosseous nerve origin, therefore typically result in significant functional loss prompting aggressive surgical management. Even with appropriate recognition and contemporary nerve reconstruction, however, motor and sensory recovery may be inadequate. With isolated persistent high median nerve palsies, a variety of available tendon transfers can improve key motor functions and salvage acceptable use of the hand. PMID:27387077

  18. Management of Limited Vertical Bone Height in the Posterior Mandible: Short Dental Implants Versus Nerve Lateralization With Standard Length Implants.

    PubMed

    Dursun, Erhan; Keceli, Huseyin Gencay; Uysal, Serdar; Güngör, Hamiyet; Muhtarogullari, Mehmet; Tözüm, Tolga Fikret

    2016-05-01

    Inferior alveolar nerve lateralization (IANL) and short dental implants (SDI) are 2 viable implant-based treatment approaches in the presence of atrophied posterior mandible. Despite the risks of dysfunction, infection, and pathologic fractures in IANL, it becomes possible to place standard implants. The purpose of this study was to compare SDI and IANL approaches from clinical and radiographic aspects. Fifteen subjects having unilateral atrophic mandibles were allocated to SDI and IANL treatment groups. Following surgical procedures, early postoperative complications, implant survival, and periimplant clinical and radiographic parameters including probing pocket depth, attachment level, keratinized tissue amount, vertical tissue recession, and marginal bone loss were recorded at baseline and 1-year after prosthetic rehabilitation. In both groups, no implant was lost. Except usual postoperative complications, 2 patients had transient paraesthesia after IANL. According to time-dependent evaluation, both groups showed significant increase in probing pocket depth and attachment level at 1-year follow-up compared with baseline (P < 0.05). Except a slight but significant increase in mesial surface of SDI group (P < 0.05), no remarkable time-dependent change was identified in vertical tissue recession. Keratinized tissue amount did not exhibit any inter- or intragroup difference during whole study period. Marginal bone loss did not show any difference between IANL and SDI groups at follow-up. SDI placement or standard length implant placement with IANL can be considered promising alternatives in the treatment of atrophic mandibular posterior regions. However, SDI may be preferred in terms of lower complication risk. PMID:26999693

  19. A variant extensor indicis muscle and the branching pattern of the deep radial nerve could explain hand functionality and clinical symptoms in the living patient

    PubMed Central

    Kumka, Myroslava

    2015-01-01

    The purpose of this study is to document the topographic anatomy of an extensor indicis (EI) muscle with a double tendon and the associated distribution of the deep branch of the radial nerve (DBRN). Both EI tendons were positioned deep to the tendons of the extensor digitorum as they traversed the dorsal osseofibrous tunnel. They then joined the medial slips of the extensor expansion of the second and third digits. In all other dissected forearms, a tendon of the EI muscle joined the medial slip of the extensor expansion to the index finger. The DBRN provided short branches to the superficial extensor muscles, long branches to the abductor pollicis longus and extensor pollicis brevis muscles, and terminated as the posterior interosseous nerve. Descending deep to the extensor pollicis longus muscle, the posterior interosseous nerve sent branches to the extensor pollicis brevis and EI muscles. Understanding of the topographic anatomy of an EI with a double tendon, and the associated distribution of the DBRN, may contribute to accurate diagnosis and treatment of hand lesions. PMID:25729087

  20. Posterior Tibial Tendon Transfer.

    PubMed

    Shane, Amber M; Reeves, Christopher L; Cameron, Jordan D; Vazales, Ryan

    2016-01-01

    When performed correctly with the right patient population, a tibialis posterior muscle/tendon transfer is an effective procedure. Many different methods have been established for fixating the tendon, each of which has its' own indications. Passing through the interosseous membrane is the preferred and recommended method and should be used unless this is not possible. Good surgical planning based on patient needs and expectations, along with excellent postoperative care including early range of motion and physical therapy minimizes risk of complications and allows for the optimal outcome to be achieved. PMID:26590722

  1. Case of Behçet's disease complicated by oculomotor nerve palsy associated with internal carotid artery-posterior communicating artery aneurysm.

    PubMed

    Yamaoka, Toshifumi; Murota, Hiroyuki; Katayama, Ichiro

    2015-03-01

    Behçet's disease (BD) is a relapsing systemic inflammatory disorder of unknown etiology involving systemic vasculitis. Vasculitis in BD results from the involvement of arteries, veins and blood vessels of all sizes, which leads to the three major manifestations of this condition: venous occlusion, arterial occlusion and aneurysm formation. Therefore, whole-body vascular involvement should always be considered in BD patients. Here, we describe the first appearance of an internal carotid-posterior communicating artery aneurysm, resulting in complete oculomotor nerve palsy in a BD patient. A 44-year-old Japanese man suffered from recurrent episodes of erythema nodosum that had presented on the lower extremities for the past 2 years. His condition was diagnosed as an incomplete type of BD based on relapsing oral and genital ulcers, skin eruptions, such as erythema nodosum and folliculitis, a positive pathergy test and systemic arthralgia. Ten years after his initial clinical presentation, he had manifestations of right-sided ptosis and cyclic dull pain in his right temporal region. Magnetic resonance imaging and angiography revealed a right internal carotid artery-posterior communicating artery aneurysm. Although oculomotor nerve palsy associated with internal carotid artery-posterior communicating artery aneurysm in a BD patient has not been reported previously, our report highlights the fact that this abnormal manifestation should be considered in those with vasculo-BD. PMID:25573207

  2. The retinoic acid signaling pathway regulates anterior/posterior patterning in the nerve cord and pharynx of amphioxus, a chordate lacking neural crest

    NASA Technical Reports Server (NTRS)

    Escriva, Hector; Holland, Nicholas D.; Gronemeyer, Hinrich; Laudet, Vincent; Holland, Linda Z.

    2002-01-01

    Amphioxus, the closest living invertebrate relative of the vertebrates, has a notochord, segmental axial musculature, pharyngeal gill slits and dorsal hollow nerve cord, but lacks neural crest. In amphioxus, as in vertebrates, exogenous retinoic acid (RA) posteriorizes the embryo. The mouth and gill slits never form, AmphiPax1, which is normally downregulated where gill slits form, remains upregulated and AmphiHox1 expression shifts anteriorly in the nerve cord. To dissect the role of RA signaling in patterning chordate embryos, we have cloned the single retinoic acid receptor (AmphiRAR), retinoid X receptor (AmphiRXR) and an orphan receptor (AmphiTR2/4) from amphioxus. AmphiTR2/4 inhibits AmphiRAR-AmphiRXR-mediated transactivation in the presence of RA by competing for DR5 or IR7 retinoic acid response elements (RAREs). The 5' untranslated region of AmphiTR2/4 contains an IR7 element, suggesting possible auto- and RA-regulation. The patterns of AmphiTR2/4 and AmphiRAR expression during embryogenesis are largely complementary: AmphiTR2/4 is strongly expressed in the cerebral vesicle (homologous to the diencephalon plus anterior midbrain), while AmphiRAR expression is high in the equivalent of the hindbrain and spinal cord. Similarly, while AmphiTR2/4 is expressed most strongly in the anterior and posterior thirds of the endoderm, the highest AmphiRAR expression is in the middle third. Expression of AmphiRAR is upregulated by exogenous RA and completely downregulated by the RA antagonist BMS009. Moreover, BMS009 expands the pharynx posteriorly; the first three gill slit primordia are elongated and shifted posteriorly, but do not penetrate, and additional, non-penetrating gill slit primordia are induced. Thus, in an organism without neural crest, initiation and penetration of gill slits appear to be separate events mediated by distinct levels of RA signaling in the pharyngeal endoderm. Although these compounds have little effect on levels of AmphiTR2/4 expression, RA

  3. Identification of the Bony Canal of the Posterior Superior Alveolar Nerve and Artery in the Maxillary Sinus: Tomographic, Radiographic, and Macroscopic Analyses

    PubMed Central

    German, Iris Jasmin Santos; Buchaim, Daniela Vieira; Andreo, Jesus Carlos; Shinohara, Elio Hitoshi; Capelozza, Ana Lúcia Alvares; Shinohara, Andre Luis; Pereira, Mizael; Buchaim, Rogerio Leone

    2015-01-01

    The aim of this study was to identify the shape and route of the bony canal of the posterior superior alveolar artery (PSAA) and posterior superior alveolar nerve (PSAN) using different identification methods, including computed tomography (CT), panoramic radiograph, and macroscopic evaluation (corpse and dry skull). Twenty-four patients were analyzed by CT and panoramic and posterior anterior (PA) radiographs; additionally, 90 dry skulls and 21 dissected anatomical specimens were examined. Three-dimensional-CT revealed that the lateral wall of the maxillary sinus resembled a tunnel format in 60% of the treated patients. Out of all 24 patients, the panoramic radiograph identified the bony canal in only one patient; whereas the PA radiograph identified it in 80% of the patients. The dry skulls showed tunnellike routes of the PSAA and PSAN in 65% of the cases. Moreover, the pathway was also visibly observed in the dissected anatomical specimens as a straight shape in 85% of the cases. Thus, our results demonstrated that the most common shape of the bony canal of the PSAA and PSAN is the tunnel format with a straight route by 3D-CT, posterior anterior radiography, and macroscopic evaluation. However, in the panoramic radiographs, it was difficult to identify this canal. PMID:25861685

  4. The role of the interosseous membrane on tibiofibular weightbearing.

    PubMed

    Skraba, J S; Greenwald, A S

    1984-01-01

    Three in vitro, strain gauge instrumented lower legs were loaded in positions ranging from 10 degrees dorsiflexion to 10 degrees plantarflexion with loads corresponding to those seen in normal gait. The interosseous membrane was found to play a critical role in the load-sharing ability of the fibula. After incision of the membrane, fibular strains decreased to essentially zero, thus supporting the hypothesis that the interosseous membrane acts as a conduit for stress transmission to the fibula. An intact membrane keeps the fibula active during the loads and motions of normal gait. PMID:6735287

  5. Alternative to the inferior alveolar nerve block anesthesia when placing mandibular dental implants posterior to the mental foramen.

    PubMed

    Heller, A A; Shankland, W E

    2001-01-01

    Local anesthesia block of the inferior alveolar nerve is routinely taught throughout dental education. This commonly used technique eliminates all somatosensory perception of the mandible, mandibular teeth, floor of the mouth, ipsilateral tongue, and all but the lateral (buccal) gingivae. Generally, the dentist or surgeon desires these structures to be anesthetized. However, in the placement of mandibular implants, it may be useful for the patient to be able to sense when the inferior alveolar nerve is in danger of being damaged, possibly producing permanent paresthesia. In this article, the technique of mandibular infiltration prior to mandibular implant placement in the mandible is discussed. PMID:12500871

  6. Lack of effect of tetrodotoxin and of an extract from the posterior salivary gland of the blue-ringed octopus following injection into the octopus and following application to its brachial nerve.

    PubMed

    Flachsenberger, W; Kerr, D I

    1985-01-01

    Lack of effect of tetrodotoxin and of an extract from the posterior salivary gland of the blue-ringed octopus following injection into the octopus and following application to its brachial nerve. Toxicon 23, 997-999, 1985. Injections of the blue-ringed octopus salivary gland extract and tetrodotoxin into the blue-ringed octopus have no ill-effect on the animals. Similarly, in vitro nerve preparations from the animal were not affected by these materials although they are both extremely potent on bioelectrically excitable preparations from other species. PMID:3006286

  7. Anterior and Posterior Optic Nerve Head Blood Flow in Nonhuman Primate Experimental Glaucoma Model Measured by Laser Speckle Imaging Technique and Microsphere Method

    PubMed Central

    Wang, Lin; Cull, Grant A.; Piper, Chelsea; Burgoyne, Claude F.; Fortune, Brad

    2012-01-01

    Purpose. To characterize optic nerve head (ONH) blood flow (BF) changes in nonhuman primate experimental glaucoma (EG) using laser speckle flowgraphy (LSFG) and the microsphere method and to evaluate the correlation between the two methods. Methods. EG was induced in one eye each of 9 rhesus macaques by laser treatment to the trabecular meshwork. Prior to lasering and following onset of intraocular pressure (IOP) elevation, retinal never fiber layer thickness (RNFLT) and ONH BF were measured biweekly by spectral-domain optical coherence tomography and LSFG, respectively, until RNFLT loss was approximately 40% in the EG eye. Final BF was measured by LSFG and by the microsphere method in the anterior ONH (MS-BFANT), posterior ONH (MS-BFPOST), and peripapillary retina (MS-BFPP). Results. Baseline RNFLT and LSFG-BF showed no difference between the two eyes (P = 0.69 and P = 0.43, respectively, paired t-test). Mean (±SD) IOP was 30 ± 6 mm Hg in EG eyes and 13 ± 2 mm Hg in control eyes (P < 0.001). EG eye RNFLT and LSFG-BF were reduced by 42 ± 16% (P < 0.0001) and 22 ± 13% (P = 0.003), respectively, at the final time point. EG eye MS-BFANT, MS-BFPOST, and MS-BFPP were reduced by 41 ± 17% (P < 0.001), 22 ± 34% (P = 0.06), and 30 ± 12% (P = 0.001), respectively, compared with the control eyes. Interocular ONH LSFG-BF differences significantly correlated to that measured by the microsphere method (R2 = 0.87, P < 0.001). Conclusions. Chronic IOP elevation causes significant ONH BF decreases in the EG model. The high correlation between the BF reduction measured by LSFG and the microsphere method provides evidence that the LSFG is capable of assaying BF for a critical deep ONH region. PMID:23169886

  8. Scapholunate Interosseous Ligament Anatomy and Biomechanics.

    PubMed

    Rajan, Prashant V; Day, Charles S

    2015-08-01

    Injury to the scapholunate interosseous ligament is one of the most common causes of carpal instability and can impart considerable compromise to the patient's hand function. However, the management of scapholunate ligament injuries remains a dynamic concept, especially with regard to the multitude of options and techniques that exist for its surgical treatment. We present a thorough review of scapholunate anatomy and morphology, and the role of the scapholunate articulations in the kinetics and pathomechanics of wrist instability. We also review the current literature on the biomechanical properties of the scapholunate ligament and its subcomponents. A sound understanding of the anatomy and biomechanics of the scapholunate ligament can clarify its instability and may better orient current reconstructive procedures or pioneer better future techniques. PMID:26143029

  9. Diagnostic Value of the Second Lumbrical-Interosseous Distal Motor Latency Comparison Test in Severe Carpal Tunnel Syndrome

    PubMed Central

    Lee, SangHun; Kim, DongHyun; Cho, Hee-Mun; Nam, Ho-Sung

    2016-01-01

    Objective To examine the usefulness of the second lumbrical-interosseous (2L-INT) distal motor latency (DML) comparison test in localizing median neuropathy to the wrist in patients with absent median sensory and motor response in routine nerve conduction studies. Methods Electrodiagnostic results from 1,705 hands of patients with carpal tunnel syndrome (CTS) symptoms were reviewed retrospectively. All subjects were evaluated using routine nerve conduction studies: median sensory conduction recorded from digits 1 to 4, motor conduction from the abductor pollicis brevis muscle, and the 2L-INT DML comparison test. Results Four hundred and one hands from a total of 1,705 were classified as having severe CTS. Among the severe CTS group, 56 hands (14.0%) showed absent median sensory and motor response in a routine nerve conduction study, and, of those hands, 42 (75.0%) showed an abnormal 2L-INT response. Conclusion The 2L-INT DML comparison test proved to be a valuable electrodiagnostic technique in localizing median mononeuropathy at the wrist, even in the most severe CTS patients. PMID:26949669

  10. Ulnar Nerve Tendon Transfers for Pinch.

    PubMed

    Cook, Shane; Gaston, R Glenn; Lourie, Gary M

    2016-08-01

    Power and tip pinch are an integral part of intrinsic hand function that can be significantly compromised with dysfunction of the ulnar nerve. Loss of power pinch is one component that can significantly affect an individual's ability to perform simple daily tasks. Tip pinch is less affected, as this task has significant contributions from the median nerve. To restore power pinch, the primary focus must be on restoring the action of the adductor pollicis primarily, and if indicated the first dorsal interosseous muscle and flexor pollicis brevis. PMID:27387080

  11. Task-dependent changes in the size of response to magnetic brain stimulation in human first dorsal interosseous muscle.

    PubMed Central

    Datta, A K; Harrison, L M; Stephens, J A

    1989-01-01

    1. Electromyographic responses have been recorded from human first dorsal interosseous muscle (FDI) in response to magnetic and transcutaneous electrical stimulation of the brain. 2. Following magnetic but not electrical stimulation of the brain, the recorded EMG response was larger when FDI was active during voluntary isometric index finger abduction than during a power grip. 3. In the same experiment, cutaneous reflex responses have been recorded from FDI following electrical stimulation of the digital nerves. The long-latency excitatory component at about 60 ms (E2) was larger when recorded during voluntary finger abduction than during a power grip. This difference in size of E2 with task bore no simple relationship to the difference in size with task of the motor response to magnetic brain stimulation. 4. The results are discussed in relation to the presumed site of action of magnetic and electrical brain stimulation. It is concluded that the results may best be interpreted by assuming a higher level of cortical activity during a voluntary index finger abduction than during a grip and that this could in part explain the task-dependent changes in the long-latency response to cutaneous stimulation. PMID:2621614

  12. Chronic desmitis and enthesiophytosis of the radio-ulnar interosseous ligament in a dog.

    PubMed

    Deffontaines, Jean-Baptiste; Lussier, Bertrand; Bolliger, Christian; Bédard, Agathe; Doré, Monique; Blevins, William E

    2016-05-01

    A 10-year-old golden retriever dog was presented for chronic right forelimb lameness associated with a painful swelling at the lateral aspect of the proximal ulna. Proximal ulnar ostectomy and stabilization resulted in a good clinical outcome. The proposed diagnosis is chronic desmitis and enthesiophytosis of the radio-ulnar interosseous ligament. PMID:27152034

  13. Pseudoaneurysm of the Posterior Tibial Artery After Posterior Tibial Tendon Transfer.

    PubMed

    Elabdi, Monsef; Roukhsi, Redouane; Tijani, Youssef; Chtata, Hassan; Jaafar, Abdeloihab

    2016-01-01

    Pseudoaneurysm of the posterior tibial artery is an uncommon condition that, left untreated, can lead to hemorrhage, thrombosis, or emboli. We present the case of a 54-year-old male who developed pseudoaneurysm of the posterior tibial artery 4 months after undergoing tibialis posterior tendon transfer for management of peroneal nerve palsy, which had developed as a complication of hip arthroplasty. PMID:26972754

  14. [Anatomical variants of the medial calcaneal nerve and the Baxter nerve in the tarsal tunnel].

    PubMed

    Martín-Oliva, X; Elgueta-Grillo, J; Veliz-Ayta, P; Orosco-Villaseñor, S; Elgueta-Grillo, M; Viladot-Perice, R

    2013-01-01

    The tarsal tunnel is composed of the posterior border of the medial malleoulus, the posterior aspect of the talus and the medial aspect of the calcaneus. The medial calcaneal nerve emerges from the posterior aspect of the posterior tibial nerve in 75% of cases and from the lateral plantar nerve in the remaining 25%. Finally, the medial calcaneal nerve ends as a single terminal branch in 79% of cases and in numerous terminal branches in the remaining 21%. To describe the anatomical variants of the posterior tibial nerve and its terminal branches. To describe the steps for tarsal tunnel release. To describe Baxter nerve release. The anatomical variants of the posterior tibial nerve and its terminal branches within the tarsal tunnel were studied. Then the Lam technique was performed; it consists of: 1) opening of the laciniate ligament, 2) opening of the fascia over the abductor hallucis muscle, 3) exoneurolysis of the posterior tibial nerve and its terminal branches, identifying the emergence and pathway of the medial calcaneal branch, the lateral plantar nerve and its Baxter nerve branch and the medial plantar nerve. Baxter nerve was found in 100% of cases. In 100% of cases in our series the nerve going to the abductor digiti minimi muscle of the foot was found; 87.5% of cases had two terminal branches. The dissections proved that a crucial step was the release of the distal tarsal tunnel. PMID:24701749

  15. Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder

    PubMed Central

    Kızılyel, Sadık; Karakeçi, Ahmet; Ozan, Tunç; Ünüş, İhsan; Barut, Osman; Onur, Rahmi

    2015-01-01

    Objective To evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS), either alone or combined with an anticholinergic agent, in treating patients with an overactive bladder (OAB) in whom previous conservative treatment failed. Material and methods In this study, we included a total of 30 female patients with OAB in whom all conventional therapies failed between January 2010 and April 2011. Patients were randomly divided into three groups: Group 1, PTNS group; Group 2, patients receiving an anticholinergic agent; and Group 3, patients receiving both PTNS and anticholinergic agent. PTNS treatment continued for 12 weeks with each session lasting 30 min. Results All parameters of the bladder diary significantly improved in all groups (p<0.05). Similarly, all scores measured by questionnaires (UDI-6, IIQ-7, and OABSS) revealed significant improvements in all groups. When the improvements in symptoms were compared among the groups, there was a statistically significantly higher improvement in groups 1 and 3 than in Group 2. Conclusion PTNS is a safe, simple, and minimally invasive treatment modality in patients with OAB, and it may be suggested either alone or in combination with anticholinergics when conventional treatments fail. PMID:26623150

  16. Posterior Cervical Foraminotomy: Indications, Technique, and Outcomes.

    PubMed

    Dodwad, Shah-Jahan M; Dodwad, Shah-Nawaz M; Prasarn, Mark L; Savage, Jason W; Patel, Alpesh A; Hsu, Wellington K

    2016-06-01

    Cervical radiculopathy presents with upper extremity pain, decreased sensation, and decreased strength caused by irritation of specific nerve root(s). After failure of conservative management, surgical options include anterior cervical decompression and fusion, disk arthroplasty, and posterior cervical foraminotomy. In this review, we discuss indications, techniques, and outcomes of posterior cervical laminoforaminotomy. PMID:27187617

  17. Differential Diagnosis and Intervention of Proximal Median Nerve Entrapment: A Resident's Case Problem.

    PubMed

    Bair, Marcus R; Gross, Michael T; Cooke, Jennifer R; Hill, Carla H

    2016-09-01

    Study Design Resident's case problem. Background Entrapment neuropathies represent a diagnostic challenge and require a comprehensive understanding of the nerve's path and the anatomical structures that may cause compression of the nerve. This resident's case problem details the evaluation and differential diagnosis process for median nerve entrapment resulting from forceful and repetitive pronation/supination motions. Diagnosis Median nerve compression syndromes include pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. A cluster of clinical special tests were performed to determine the anatomical site of median nerve entrapment. Based on the patient's history and clinical test results, a diagnosis of pronator syndrome was determined. Provocation testing specific to pronator syndrome assisted with further localizing the site of entrapment to the pronator teres muscle, which guided effective management strategies. Discussion This resident's case problem illustrates the importance of detailed anatomical knowledge and a differential diagnostic process when evaluating a patient with signs and symptoms of an entrapment neuropathy of the median nerve. Electrodiagnostic studies are useful in ruling out carpal tunnel and anterior interosseous nerve syndromes, but are often inconclusive in cases of pronator syndrome. Therefore, a diagnosis of pronator syndrome in this case problem was based on a detailed understanding of median nerve anatomy, potential sites of compression, and unique clinical features associated with this condition. Level of Evidence Differential diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(9):800-808. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6723. PMID:27494058

  18. Inferior alveolar nerve repositioning.

    PubMed

    Louis, P J

    2001-09-01

    Nerve repositioning is a viable alternative for patients with an atrophic edentulous posterior mandible. Patients, however, should be informed of the potential risks of neurosensory disturbance. Documentation of the patient's baseline neurosensory function should be performed with a two-point discrimination test or directional brush stroke test preoperatively and postoperatively. Recovery of nerve function should be expected in 3 to 6 months. The potential for mandibular fracture when combining nerve repositioning with implant placement also should be discussed with the patient. This can be avoided by minimizing the amount of buccal cortical plate removal during localization of the nerve and maintaining the integrity of the inferior cortex of the mandible. Additionally, avoid overseating the implant, thus avoiding stress along the inferior border of the mandible. The procedure does allow for the placement of longer implants, which should improve implant longevity. Patients undergoing this procedure have expressed overall satisfaction with the results. Nerve repositioning also can be used to preserve the inferior alveolar nerve during resection of benign tumors or cysts of the mandible. This procedure allows the surgeon to maintain nerve function in situations in which the nerve would otherwise have to be resected. PMID:11665379

  19. Proximal Sciatic Nerve Intraneural Ganglion Cyst

    PubMed Central

    Swartz, Karin R.; Wilson, Dianne; Boland, Michael; Fee, Dominic B.

    2009-01-01

    Intraneural ganglion cysts are nonneoplastic, mucinous cysts within the epineurium of peripheral nerves which usually involve the peroneal nerve at the knee. A 37-year-old female presented with progressive left buttock and posterior thigh pain. Magnetic resonance imaging revealed a sciatic nerve mass at the sacral notch which was subsequently revealed to be an intraneural ganglion cyst. An intraneural ganglion cyst confined to the proximal sciatic nerve has only been reported once prior to 2009. PMID:20069041

  20. The biomechanical and functional relationships of the proximal radioulnar joint, distal radioulnar joint, and interosseous ligament.

    PubMed

    Malone, P S C; Cooley, J; Morris, J; Terenghi, G; Lees, V C

    2015-06-01

    This biomechanical study assessed integrated function of the proximal radioulnar joint (PRUJ), interosseous ligament (IOL), and distal radioulnar joint (DRUJ). Tekscan™ pressure sensors were inserted into the DRUJ and PRUJ of 15 cadaveric specimens. MicroStrain(®) sensors were mounted onto the IOL on nine of these specimens. A customized biomechanical jig was used to apply axial loads and take measurements through pronosupination. The PRUJ, IOL, and DRUJ were shown to function as an integrated osseoligamentous system distributing applied load. The PRUJ has transmitted pressure profiles similar to those of the DRUJ. Different IOL components support loading at different stages of pronosupination. The IOL is lax during pronation. Mid-IOL tension peaks in the midrange of forearm rotation; distal-IOL tension peaks in supination. Axial loading consistently increases IOL strain in a non-linear fashion. There are clinical implications of this work: disease or surgical modification of any of these structures may compromise normal biomechanics and function. PMID:24835480

  1. Nerve biopsy

    MedlinePlus

    Nerve biopsy may be done to help diagnose: Axon degeneration (destruction of the axon portion of the nerve cell) Damage to the ... Demyelination Inflammation of the nerve Leprosy Loss of axon tissue Metabolic neuropathies Necrotizing vasculitis Sarcoidosis

  2. Pinched Nerve

    MedlinePlus

    ... Enhancing Diversity Find People About NINDS NINDS Pinched Nerve Information Page Table of Contents (click to jump ... being done? Clinical Trials Organizations What is Pinched Nerve? The term "pinched nerve" is a colloquial term ...

  3. Distal tibial interosseous osteochondroma with impending fracture of fibula – a case report and review of literature

    PubMed Central

    2009-01-01

    Osteochondromas arising from the interosseous border of the distal tibia and involving distal fibula are uncommon. We present a 16 year old young boy with an impending fracture, erosion and weakness of the distal fibula, secondary to an osteochondroma arising from the distal tibia. Early excision of this deforming distal tibial osteochondroma avoided the future risk of pathological fracture of the distal fibula, ankle deformities and syndesmotic complications. PMID:19187551

  4. Aberrant regeneration in idiopathic oculomotor nerve palsy: case report.

    PubMed

    Laguna, J F; Smith, M S

    1980-06-01

    Aberrant regeneration of the oculomotor nerve usually follows injury to the nerve by posterior communicating arty aneurysms or trauma. A case of idiopathic third nerve palsy with pupillary involvement occurred in an otherwise healthy 38-year-old man. Follow-up examination 32 months later showed evidence of oculomotor function with aberrant regeneration. PMID:7381547

  5. Expression of extracellular matrix molecules typical of articular cartilage in the human scapholunate interosseous ligament

    PubMed Central

    Milz, S; Aktas, T; Putz, R; Benjamin, M

    2006-01-01

    The scapholunate interosseous ligament (SLIL) connects the scaphoid and lunate bones and plays a crucial role in carpal kinematics. Its rupture leads to carpal instability and impairment of radiocarpal joint function. As the ligament is one of the first structures affected in rheumatoid arthritis, we conducted an immunohistochemical study of cadaveric tissue to determine whether it contains known autoantigens for rheumatoid arthritis. We immunolabelled the ligament from one hand in 12 cadavers with monoclonal antibodies directed against a wide range of extracellular matrix (ECM) molecules associated with both fibrous and cartilaginous tissues. The labelling profile has also enabled us to comment on how the molecular composition of the ligament relates to its mechanical function. All regions of the ligament labelled for types I, III and VI collagens, chondroitin 4 and 6 sulphates, keratan sulphate, dermatan sulphate, versican, tenascin and cartilage oligomeric matrix protein (COMP). However, both entheses labelled strongly for type II collagen, aggrecan and link protein and were distinctly fibrocartilaginous. In some regions, the ligament attached to bone via a region of hyaline cartilage that was continuous with articular cartilage. Labelling for cartilage molecules in the midsubstance was most evident dorsally. We conclude that the SLIL has an ECM which is typical of other highly fibrocartilaginous ligaments that experience both tensile load and shear. The presence of aggrecan, link protein, COMP and type II collagen could explain why the ligament may be a target for autoantigenic destruction in some forms of rheumatoid arthritis. PMID:16761970

  6. Interstitial fluid flow: simulation of mechanical environment of cells in the interosseous membrane

    NASA Astrophysics Data System (ADS)

    Yao, Wei; Ding, Guang-Hong

    2011-08-01

    In vitro experiments have shown that subtle fluid flow environment plays a significant role in living biological tissues, while there is no in vivo practical dynamical measurement of the interstitial fluid flow velocity. On the basis of a new finding that capillaries and collagen fibrils in the interosseous membrane form a parallel array, we set up a porous media model simulating the flow field with FLUENT software, studied the shear stress on interstitial cells' surface due to the interstitial fluid flow, and analyzed the effect of flow on protein space distribution around the cells. The numerical simulation results show that the parallel nature of capillaries could lead to directional interstitial fluid flow in the direction of capillaries. Interstitial fluid flow would induce shear stress on the membrane of interstitial cells, up to 30 Pa or so, which reaches or exceeds the threshold values of cells' biological response observed in vitro. Interstitial fluid flow would induce nonuniform spacial distribution of secretion protein of mast cells. Shear tress on cells could be affected by capillary parameters such as the distance between the adjacent capillaries, blood pressure and the permeability coefficient of capillary's wall. The interstitial pressure and the interstitial porosity could also affect the shear stress on cells. In conclusion, numerical simulation provides an effective way for in vivo dynamic interstitial velocity research, helps to set up the vivid subtle interstitial flow environment of cells, and is beneficial to understanding the physiological functions of interstitial fluid flow.

  7. Nerve biopsy

    MedlinePlus

    ... Loss of axon tissue Metabolic neuropathies Necrotizing vasculitis Sarcoidosis Risks Allergic reaction to the local anesthetic Discomfort ... Neurosarcoidosis Peripheral neuropathy Primary amyloidosis Radial nerve dysfunction Sarcoidosis Tibial nerve dysfunction Update Date 6/1/2015 ...

  8. Nerve conduction

    MedlinePlus Videos and Cool Tools

    ... the spinal cord to muscles and sensory receptors. A peripheral nerve is composed of nerve bundles (fascicles) ... two neurons, it must first be converted to a chemical signal, which then crosses a space of ...

  9. Imaging the posterior mediastinum: a multimodality approach

    PubMed Central

    Occhipinti, Mariaelena; Heidinger, Benedikt H.; Franquet, Elisa; Eisenberg, Ronald L.; Bankier, Alexander A.

    2015-01-01

    The posterior mediastinum contains several structures that can produce a wide variety of pathologic conditions. Descending thoracic aorta, esophagus, azygos and hemiazygos veins, thoracic duct, lymph nodes, adipose tissue, and nerves are all located in this anatomical region and can produce diverse abnormalities. Although chest radiography may detect many of these pathologic conditions, computed tomography and magnetic resonance are the imaging modalities of choice for further defining the relationship of posterior mediastinal lesions to neighboring structures and showing specific imaging features that narrow the differential diagnosis. This review emphasizes modality-related answers to morphologic questions, which provide precise diagnostic information. PMID:25993732

  10. Imaging the posterior mediastinum: a multimodality approach.

    PubMed

    Occhipinti, Mariaelena; Heidinger, Benedikt H; Franquet, Elisa; Eisenberg, Ronald L; Bankier, Alexander A

    2015-01-01

    The posterior mediastinum contains several structures that can produce a wide variety of pathologic conditions. Descending thoracic aorta, esophagus, azygos and hemiazygos veins, thoracic duct, lymph nodes, adipose tissue, and nerves are all located in this anatomical region and can produce diverse abnormalities. Although chest radiography may detect many of these pathologic conditions, computed tomography and magnetic resonance are the imaging modalities of choice for further defining the relationship of posterior mediastinal lesions to neighboring structures and showing specific imaging features that narrow the differential diagnosis. This review emphasizes modality-related answers to morphologic questions, which provide precise diagnostic information. PMID:25993732

  11. [Inferior alveolar nerve repositioning in implant surgery].

    PubMed

    Ardekian, L; Salnea, J; Abu el-Naaj, I; Gutmacher, T; Peled, M

    2001-04-01

    Severe resorption of the posterior mandible possesses one of the most difficult restorative challenges to the implant surgery today. This resorption may prevent the placement of dental implants without the potentially damage to the inferior alveolar nerve. To create the opportunity of insertion dental implants of adequately length in those cases, the technique of nerve repositioning has been advocated. The purpose of this article is to describe two cases of nerve repositioning combined with placement of dental implants. Both cases showed appropriate postoperative healing without damage to the inferior alveolar nerve. The inferior alveolar nerve repositioning technique seems to be an acceptable alternative to augmentation procedure prior to dental implants placement in cases exhibiting atrophic posterior mandibular ridges. PMID:11494807

  12. Transfibular excision of distal tibial interosseous osteochondroma with reconstruction of fibula using Sofield's technique – A case report

    PubMed Central

    Thakur, Gopa Bandhu; Jain, Mantu; Bihari, Amar Jyoti; Sriramka, Bhavna

    2012-01-01

    Osteochondromas arising from the interosseous border of the distal tibia and involving distal fibula are uncommon. Considering its proximity to the ankle joint, early excision of this deforming distal tibial osteochondroma is done to avoid the future risk of pathological fracture of the distal fibula, ankle deformities and syndesmotic complications. We present a 16-year-old young girl with thinning and deformed distal fibula, secondary to an osteochondroma arising from the distal tibia which was managed with transfibular excision of mass and reconstruction of distal fibula using square nail by shoefields technique. PMID:26403450

  13. Nerve Retraction During Inferior Alveolar Nerve Repositioning Procedure: A New Simple Method and Review of the Literature.

    PubMed

    Hassani, Ali; Saadat, Sarang; Moshiri, Roya; Shahmirzad, Solaleh; Hassani, Amin

    2015-07-01

    Nerve repositioning surgery is one of the treatments chosen for the patients with edentulous posterior atrophic mandible. Like any other treatments, this therapy has its advantages and disadvantages, indications and contraindications. The most important complication of this procedure is neurosensory disturbance. This problem may occur at different stages of the treatment. One common time when nerve damage happens is when the nerve is located outside the canal and drilling and insertion of the implant are performed. Accordingly, this report describes a simple and feasible method to retract and protect nerves outside the canal during the treatment of nerve transposition. This will reduce the risk of nerve damage. PMID:24344674

  14. Iodine-125 radiation of posterior uveal melanoma

    SciTech Connect

    Packer, S.

    1987-12-01

    Twenty-eight cases of posterior choroidal melanoma were treated with iodine-125 in gold eye plaques. Eleven cases were located within 3.0 mm of the optic nerve (group A), nine were within 3.0 mm of the fovea (group B), and eight were within 3.0 mm of the optic nerve and fovea (group C). The mean follow-up of group A was 46.3 months; group B, 25.5 months; and group C, 42.7 months. Complications included macular edema, cataract and tumor growth. Visual acuity remained within two lines of that tested preoperatively for 4 of 11 patients in group A, 4 of 9 in group B, and 5 of 8 in group C. These results with iodine-125 suggest it as an appropriate treatment for patients with choroidal melanoma located near optic nerve and/or macula.

  15. Surface electromyogram analysis of the direction of isometric torque generation by the first dorsal interosseous muscle

    NASA Astrophysics Data System (ADS)

    Zhou, Ping; Suresh, Nina L.; Zev Rymer, William

    2011-06-01

    The objective of this study was to determine whether a novel technique using high density surface electromyogram (EMG) recordings can be used to detect the directional dependence of muscle activity in a multifunctional muscle, the first dorsal interosseous (FDI). We used surface EMG recordings with a two-dimensional electrode array to search for inhomogeneous FDI activation patterns with changing torque direction at the metacarpophalangeal joint, the locus of action of the FDI muscle. The interference EMG distribution across the whole FDI muscle was recorded during isometric contraction at the same force magnitude in five different directions in the index finger abduction-flexion plane. The electrode array EMG activity was characterized by contour plots, interpolating the EMG amplitude between electrode sites. Across all subjects the amplitude of the flexion EMG was consistently lower than that of the abduction EMG at the given force. Pattern recognition methods were used to discriminate the isometric muscle contraction tasks with a linear discriminant analysis classifier, based on the extraction of two different feature sets of the surface EMG signal: the time domain (TD) feature set and a combination of autoregressive coefficients and the root mean square amplitude (AR+RMS) as a feature set. We found that high accuracies were obtained in the classification of different directions of the FDI muscle isometric contraction. With a monopolar electrode configuration, the average overall classification accuracy from nine subjects was 94.1 ± 2.3% for the TD feature set and 95.8 ± 1.5% for the AR+RMS feature set. Spatial filtering of the signal with bipolar electrode configuration improved the average overall classification accuracy to 96.7 ± 2.7% for the TD feature set and 98.1 ± 1.6% for the AR+RMS feature set. The distinct EMG contour plots and the high classification accuracies obtained from this study confirm distinct interference EMG pattern distributions as a

  16. Abducens nerve palsy after schwannoma resection.

    PubMed

    Bobbio, Antonio; Hamelin-Canny, Emelyne; Roche, Nicolas; Taillia, Herve; Alifano, Marco

    2015-02-01

    Tumors of the posterior mediastinum are mostly neurogenic and could involve the intervertebral foramen and the medullary canal. We describe the case of a patient who underwent surgery for a nerve sheet tumor originating at the level of the right second neural root. Resection was associated with an incidental dural tear and cerebrospinal fluid leak that was promptly repaired. One week after surgery, horizontal diplopia occurred. A palsy of the left abducens nerve secondary to intracranial hypotension was diagnosed. We present the pathogenic cascade leading to this ocular complication after posterior mediastinal surgery. The surgical techniques to prevent this complication are discussed. PMID:25639411

  17. Neurothekeoma in the Posterior Fossa: Case Report and Literature Review

    PubMed Central

    Alexandru, Daniela; Satyadev, Radha; So, William

    2012-01-01

    Neurothekeoma is a benign nerve sheath tumor, also known as nerve sheath myxoma. It arises from the cutaneous nerves of the head and neck region. In certain cases, neurothekeoma has been reported in the breast, oral cavity, tongue, maxilla, and spinal intradural space. Intracranial neurothekeoma, however, is an extremely rare entity, with only three cases reported in the literature: one in the parasellar region, one in the deep white matter, and another one in the cerebellopontine angle. We present the case of a 40-year-old man with a very large neurothekeoma present in the posterior fossa who had no neurologic deficit on presentation. PMID:23012602

  18. Role of posterior hypothalamus in hypobaric hypoxia induced pulmonary edema.

    PubMed

    Sharma, R K; Choudhary, R C; Reddy, M K; Ray, A; Ravi, K

    2015-01-01

    To investigate the role of posterior hypothalamus and central neurotransmitters in the pulmonary edema due to hypobaric hypoxia, rats were placed in a high altitude simulation chamber (barometric pressure-294.4 mmHg) for 24 h. Exposure to hypobaric hypoxia resulted in increases in mean arterial blood pressure, renal sympathetic nerve activity, right ventricular systolic pressure, lung wet to dry weight ratio and Evans blue dye leakage. There was a significant attenuation in these responses to hypobaric hypoxia (a) after lesioning posterior hypothalamus and (b) after chronic infusion of GABAA receptor agonist muscimol into posterior hypothalamus. No such attenuation was evident with the chronic infusion of the nitric oxide donor SNAP into the posterior hypothalamus. It is concluded that in hypobaric hypoxia, there is over-activity of posterior hypothalamic neurons probably due to a local decrease in GABA-ergic inhibition which increases the sympathetic drive causing pulmonary hypertension and edema. PMID:25448396

  19. Arthroscopic approach to the posterior compartment of the knee using a posterior transseptal portal

    PubMed Central

    Ohishi, Tsuyoshi; Takahashi, Masaaki; Suzuki, Daisuke; Matsuyama, Yukihiro

    2015-01-01

    Arthroscopic surgery of the posterior compartment of the knee is difficult when only two anterior portals are used for access because of the inaccessibility of the back of the knee. Since its introduction, the posterior transseptal portal has been widely employed to access lesions in the posterior compartment. However, special care should be taken to avoid neurovascular injuries around the posteromedial, posterolateral, and transseptal portals. Most importantly, popliteal vessel injury should be avoided when creating and using the transseptal portal during surgery. Purpose of the present study is to describe how to avoid the neurovascular injuries during establishing the posterior three portals and to introduce our safer technique to create the transseptal portal. To date, we have performed arthroscopic surgeries via the transseptal portal in the posterior compartments of 161 knees and have not encountered nerve or vascular injury. In our procedure, the posterior septum is perforated with a 1.5-3.0-mm Kirschner wire that is protected by a sheath inserted from the posterolateral portal and monitored from the posteromedial portal to avoid popliteal vessel injury. PMID:26301179

  20. [Posterior capsule opacification].

    PubMed

    Milazzo, S; Grenot, M; Benzerroug, M

    2014-12-01

    Posterior capsule opacification (PCO) is the most common complication after cataract surgery, with an incidence of 30%. It tends to be considered a normal event in the natural history of cataract surgery. Better understanding of its pathophysiology and advancement of intraocular lens material and design along with the improvement of phacoemulsification technique have contributed to decrease the incidence of PCO. Although treatment by Nd: YAG laser posterior capsulotomy is quick and non-invasive, the opening of the posterior capsule may be associated with numerous complications. Prevention remains the best measure for controlling this pathology. PMID:25455552

  1. Massive exophytic malignant peripheral nerve sheath tumor.

    PubMed

    Khorsand, Derek; Porrino, Jack; Flaherty, Erin; Bandhlish, Anshu; Davidson, Darin

    2016-06-01

    We present a case of a solitary neurofibroma involving the right posterior shoulder of a 69-year-old man with degeneration into a massive, malignant peripheral nerve sheath tumor measuring more than 3 times the average reported size. The radiographic, magnetic resonance imaging, and computed tomographic features are compared with the gross appearance and pathology. PMID:27257459

  2. Posterior fossa tumor

    MedlinePlus

    ... of the posterior fossa, it can block the flow of spinal fluid and cause increased pressure on the brain and ... the cancer early. A total blockage in the flow of spinal fluid can be life threatening. If tumors are found ...

  3. Posterior Tibial Tendon Dysfunction

    MedlinePlus

    ... when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be ... repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time. ...

  4. Posterior ankle impingement syndrome.

    PubMed

    Maquirriain, Javier

    2005-10-01

    Posterior ankle impingement syndrome is a clinical disorder characterized by posterior ankle pain that occurs in forced plantar flexion. The pain may be acute as a result of trauma or chronic from repetitive stress. Pathology of the os trigonum-talar process is the most common cause of this syndrome, but it also may result from flexor hallucis longus tenosynovitis, ankle osteochondritis, subtalar joint disease, and fracture. Patients usually report chronic or recurrent posterior ankle pain caused or exacerbated by forced plantar flexion or push-off maneuvers, such as may occur during dancing, kicking, or downhill running. Diagnosis of posterior ankle impingement syndrome is based primarily on clinical history and physical examination. Radiography, scintigraphy, computed tomography, and magnetic resonance imaging depict associated bone and soft-tissue abnormalities. Symptoms typically improve with nonsurgical management, but surgery may be required in refractory cases. PMID:16224109

  5. Trigeminal neuralgia secondary to posterior fossa tumor.

    PubMed

    Agrawal, Mamta; Agrawal, Vikrant; Agrawal, Rajiv; Pramod, D S R

    2010-01-01

    Trigeminal neuralgia (TN) is by no means an uncommon entity presenting as typical or atypical pain syndrome with a standard treatment protocol consisting of medical and surgical therapies. The diagnosis of TN is mainly dependent on the characteristics of symptoms conveyed by the patient and the clinical presentation. Careful history taking, proper interpretation of the signs and symptoms and cranial nerve assessment are necessary for proper diagnosis. Here, we report a case of TN, treated for dental problems and then for neuralgia with only short-term relief. Subsequently, the patient underwent neuroimaging and was found to be having an uncommon space-occupying lesion in the posterior cranial fossa. PMID:22442556

  6. Optic nerve atrophy

    MedlinePlus

    Optic nerve atrophy is damage to the optic nerve. The optic nerve carries images of what the eye sees to ... problem most often affects older adults. The optic nerve can also be damaged by shock, toxins, radiation, ...

  7. Peripheral Nerve Disorders

    MedlinePlus

    ... spinal cord. Like static on a telephone line, peripheral nerve disorders distort or interrupt the messages between the brain ... body. There are more than 100 kinds of peripheral nerve disorders. They can affect one nerve or many nerves. ...

  8. Nerve biopsy (image)

    MedlinePlus

    Nerve biopsy is the removal of a small piece of nerve for examination. Through a small incision, a sample ... is removed and examined under a microscope. Nerve biopsy may be performed to identify nerve degeneration, identify ...

  9. Bilateral posterior sternoclavicular dislocation.

    PubMed

    Baumann, Matthias; Vogel, Tobias; Weise, Kuno; Muratore, Tim; Trobisch, Per

    2010-07-01

    Posterior sternoclavicular dislocations are a rare injury, representing <5% of all sternoclavicular dislocations and 1 in 1600 shoulder girdle injuries. Proper imaging with computed tomography and prompt diagnosis are essential steps in preventing potentially lethal complications observed in approximately 3% of all posterior sternoclavicular dislocations. Surgical treatment is necessary if closed reduction fails. With the medial clavicular epiphysis being the last to close (between ages 22 and 25), children and adolescents typically present with epiphyseal fractures rather than joint dislocations. If closed reduction fails, open reduction and internal fixation (ORIF) should be considered in fractures, whereas complex reconstructions with tendon graft procedures have been recommended for joint dislocations. This article presents a case of a traumatic bilateral posterior sternoclavicular dislocation due to an epiphyseal fracture in a 15-year-old boy. To our knowledge, this is the first reported case of a bilateral posterior sternoclavicular dislocation. Attempted closed reduction failed with redislocation after 2 days. The patient subsequently required ORIF. This article describes our technique with anterior retraction of the medial clavicle, closure of the posterior periosteum, and ORIF using nonabsorbable sutures. Postoperative shoulder mobilization was started on day 1. At final follow-up, the patient was completely asymptomatic. PMID:20608625

  10. "Zone of vulnerability" for radial nerve injury: anatomic study.

    PubMed

    Ashfaq Hasan, S; Rauls, Russell B; Cordell, Cari L; Bailey, Mark S; Nguyen, Thao

    2014-01-01

    The authors of this study sought improved understanding of the radial nerve course through the brachium and hypothesized that the most proximal aspect of the triceps tendon (PATT) serves as a useful superficial landmark for localizing the nerve. It was also hypothesized that a poorly appreciated area of vulnerability for nerve injury exists where the radial nerve runs along the lateral cortex of the humerus proximal to its transit through the lateral intermuscular septum (LIMS). The authors assessed 33 fresh-frozen cadaveric specimens. A 6.7-cm span of the nerve lies directly on the periosteum of the humerus before piercing the LIMS. The proximal 4.6~cm abuts the posterior cortex. The final 2.1~cm just proximal to the LIMS runs along the lateral cortex. The nerve at the posterior midline of the humerus is 2.3~cm proximal to the level of the PATT. The radial nerve lies directly on the lateral humeral cortex for 2~cm proximal to its transit through the LIMS. The PATT appears to be a consistent and practical superficial landmark to determine the location of the radial nerve from a posterior approach. PMID:24875341

  11. Tibialis Posterior Tendon Entrapment Within Posterior Malleolar Fracture Fragment.

    PubMed

    Fantry, Amanda; Lareau, Craig; Vopat, Bryan; Blankenhorn, Brad

    2016-01-01

    Management of posterior malleolus fractures continues to be controversial, with respect to both need for fixation and fixation methods. Fixation methods include an open posterior approach to the ankle as well as percutaneous reduction and fixation with or without arthroscopy for visualization of the articular surface. Plain radiographs are unreliable in identifying fracture pattern and intraoperative reduction, making arthroscopy a valuable adjunct to posterior malleolus fracture management. In this article, we report a case of tibialis posterior tendon entrapment within a posterior malleolus fracture, as identified by arthroscopy and managed with open reduction. Tibialis posterior tendon entrapment within a posterior malleolus has not been previously reported. Ankle arthroscopy for posterior malleolus fractures provides an opportunity to identify soft-tissue or tendinous entrapment, articular surface reduction, and articular cartilage injuries unlikely to be identified with fluoroscopy alone and should be considered in reduction and fixation of posterior malleolus fractures. PMID:26991573

  12. Ossification of the Interosseous Membrane of the Leg in a Football Player: Case Report and Review of the Literature.

    PubMed

    Postacchini, Roberto; Carbone, Stefano; Mastantuono, Marco; Della Rocca, Carlo; Postacchini, Franco

    2016-01-01

    Introduction. We report a case of ossification of the interosseous membrane (OIM) of the leg in a football player who had no history of severe local traumas. A review of the literature of the OIM of the leg in athletes was also carried out. Case Report. A 38-year-old Caucasian male patient complained of pain on lateral aspect of the leg when playing football. Pain progressively worsened until he had to stop the sporting activity. Radiographs, and then CT and MRI, showed OIM in the middle third of the left leg. MRI showed inflammation of tibia periosteum and bone adjacent to the ossification, which was then excised. Two months after surgery the patient returned to play football. Conclusion. A thorough analysis of the literature revealed three types of OIM of the leg in athletes. Type I usually occurs after a syndesmosis ankle sprain, Type II appears to result from a tibia fracture, and Type III, of which only one fully recorded case has been published, is probably caused, as in our patient, by repetitive minor traumas to the leg. Awareness of the existence of Type III OIM can avoid erroneous diagnoses leading to useless investigations and treatments. PMID:26881161

  13. Ossification of the Interosseous Membrane of the Leg in a Football Player: Case Report and Review of the Literature

    PubMed Central

    Postacchini, Roberto; Carbone, Stefano; Mastantuono, Marco; Della Rocca, Carlo; Postacchini, Franco

    2016-01-01

    Introduction. We report a case of ossification of the interosseous membrane (OIM) of the leg in a football player who had no history of severe local traumas. A review of the literature of the OIM of the leg in athletes was also carried out. Case Report. A 38-year-old Caucasian male patient complained of pain on lateral aspect of the leg when playing football. Pain progressively worsened until he had to stop the sporting activity. Radiographs, and then CT and MRI, showed OIM in the middle third of the left leg. MRI showed inflammation of tibia periosteum and bone adjacent to the ossification, which was then excised. Two months after surgery the patient returned to play football. Conclusion. A thorough analysis of the literature revealed three types of OIM of the leg in athletes. Type I usually occurs after a syndesmosis ankle sprain, Type II appears to result from a tibia fracture, and Type III, of which only one fully recorded case has been published, is probably caused, as in our patient, by repetitive minor traumas to the leg. Awareness of the existence of Type III OIM can avoid erroneous diagnoses leading to useless investigations and treatments. PMID:26881161

  14. Risk of Encountering Dorsal Scapular and Long Thoracic Nerves during Ultrasound-guided Interscalene Brachial Plexus Block with Nerve Stimulator

    PubMed Central

    Kim, Yeon Dong; Yu, Jae Yong; Shim, Junho; Heo, Hyun Joo

    2016-01-01

    Background Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. Methods A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded. Results Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%). Neither was encountered in 21 cases (30.4%). The average current measured immediately before the disappearance of muscle twitches was 0.44 mA and 0.50 mA at DSN and LTN, respectively. Conclusions Physicians should be cautious on the risk of injury related to the anatomical structures of nerves, including DSN and LTN, during ultrasound-guided IBPB by posterior approach. Nerve stimulator could be another option for a safer intervention. Moreover, if there is a motor response, it is recommended to select another way to secure better safety. PMID:27413483

  15. Nerve conduction velocity

    MedlinePlus

    Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve. ... normal body temperature. Being too cold slows nerve conduction. Tell your doctor if you have a cardiac ...

  16. Femoral nerve damage (image)

    MedlinePlus

    The femoral nerve is located in the leg and supplies the muscles that assist help straighten the leg. It supplies sensation ... leg. One risk of damage to the femoral nerve is pelvic fracture. Symptoms of femoral nerve damage ...

  17. Ulnar nerve damage (image)

    MedlinePlus

    The ulnar nerve originates from the brachial plexus and travels down arm. The nerve is commonly injured at the elbow because of elbow fracture or dislocation. The ulnar nerve is near the surface of the body where ...

  18. Diabetes and nerve damage

    MedlinePlus

    ... hot or cold When the nerves that control digestion are affected, you may have trouble digesting food. ... harder to control. Damage to nerves that control digestion almost always occurs in people with severe nerve ...

  19. A New Technique for Volar Capsulodesis for Isolated Palmar Scapholunate Interosseous Ligament Injuries: A Cadaveric Study and Case Report.

    PubMed

    van Kampen, Robert J; Bayne, Christopher O; Moran, Steven L

    2015-11-01

    Introduction Most surgical techniques for scapholunate interosseous ligament (SLIL) repair address only the dorsal component of the ligament, potentially leading to high surgical failure rates. We introduce a new technique to reconstruct the volar SLIL using a portion of the long radiolunate ligament (LRL). A biomechanical evaluation was performed to evaluate the rupture strength of this repair, and a subsequent anatomic study was performed to verify that this repair would not compromise the blood supply to either the scaphoid or the lunate. Methods A reconstruction of the volar SLIL was developed utilizing a lunate-based strip of the LRL. Fourteen cadaver arms were injected with red-colored epoxide and latex. The blood supply of the volar wrist capsule was dissected. The vascular supply to the ligaments, scaphoid, and lunate were investigated. The biomechanical strength of this reconstruction was tested on five cadaver arms by potting the scaphoid, lunate, and radius and subjecting the repair to a tensile load using a servohydraulic vertical displacement testing machine. Results In all arms, a branch of the radial artery or radiocarpal arch supplied the radioscapholunate ligament at the medial border of the LRL. The proximal half of the scaphoid was supplied by dorsal branches of the radial artery. In all cases, a vessel entered the lunate on its ulnar volar side, away from the repair. The average strength of the intact LRL strip was 97.4 N, and the average strength of the ligament-suture interface used for the capsulodesis was 43.5 N. Conclusion This volar approach to the SLIL does not compromise the vascularity of the scaphoid or the lunate. This approach allows the possibility of repairing or augmenting the volar SLIL. The strength of this repair appears to be less than the strength of the native SLIL. Further clinical studies are warranted. PMID:26539326

  20. [Anatomical rationale for lingual nerve injury prevention during mandibular block].

    PubMed

    Semkin, V A; Dydikin, S S; Kuzin, A V; Sogacheva, V V

    2015-01-01

    The topographic and anatomical study of lingual nerve structural features was done. It was revealed that during mandibular anesthesia possible lingual nerve injury can occur if puncture needle is lower than 1 cm. of molars occlusal surface level. The position of the lingual nerve varies withmandible movements. At the maximum open mouth lingual nerve is not mobile and is pressed against the inner surface of the mandibular ramus by the medial pterygoid muscle and the temporal muscle tendon. When closing the mouth to 1.25±0.2 cmfrom the physiological maximum, lingual nerve is displaced posteriorly from the internal oblique line of the mandible and gets mobile. On the basis of topographic and anatomic features of the lingual nervestructure the authors recommend the re-do of inferior alveolar nerve block, a semi-closed mouth position or the use the "high block techniques" (Torus anesthesia, Gow-Gates, Vazirani-Akinozi). PMID:26271698

  1. Complete Spinal Accessory Nerve Palsy From Carrying Climbing Gear.

    PubMed

    Coulter, Jess M; Warme, Winston J

    2015-09-01

    We report an unusual case of spinal accessory nerve palsy sustained while transporting climbing gear. Spinal accessory nerve injury is commonly a result of iatrogenic surgical trauma during lymph node excision. This particular nerve is less frequently injured by blunt trauma. The case reported here results from compression of the spinal accessory nerve for a sustained period-that is, carrying a load over the shoulder using a single nylon rope for 2.5 hours. This highlights the importance of using proper load-carrying equipment to distribute weight over a greater surface area to avoid nerve compression in the posterior triangle of the neck. The signs and symptoms of spinal accessory nerve palsy and its etiology are discussed. This report is particularly relevant to individuals involved in mountaineering and rock climbing but can be extended to anyone carrying a load with a strap over one shoulder and across the body. PMID:25937552

  2. Direct nerve suture and knee immobilization in 90° flexion as a technique for treatment of common peroneal, tibial and sural nerve injuries in complex knee trauma.

    PubMed

    Döring, Robert; Ciritsis, Bernhard; Giesen, Thomas; Simmen, Hans-Peter; Giovanoli, Pietro

    2012-01-01

    There are different ways to treat peripheral nerve injuries with concomitant defects in the lower extremity. One option is a direct nerve suture followed by immobilization of the knee in flexion as it is described for gunshot wounds that lead to lesions of the sciatic nerve and its terminal branches as well as isolated nerve lesions. We used this technique to treat a case of multiple nerve injuries of the lower extremity combined with a complex knee trauma including a lesion of both bones and the posterior capsule. To our knowledge, this technique has not yet been described for such a combined injury in literature. PMID:24968417

  3. Posterior dislocation of the hip while playing basketball.

    PubMed

    Tennent, T D; Chambler, A F; Rossouw, D J

    1998-12-01

    Injuries in basketball are usually to the ankles and knees. Dislocation of the hip is usually associated with severe trauma--for example, road traffic accidents. A case is reported here in which a 22 year old club basketball player slipped on landing from a jump shot, forcing him into a side splits position from which he sustained a posterior dislocation of the hip resulting in a sciatic nerve palsy. PMID:9865411

  4. Finite Element Modeling of the Posterior Eye in Microgravity

    NASA Technical Reports Server (NTRS)

    Feola, Andrew; Raykin, Julia; Mulugeta, Lealem; Gleason, Rudolph; Myers, Jerry G.; Nelson, Emily S.; Samuels, Brian; Ethier, C. Ross

    2015-01-01

    Microgravity experienced during spaceflight affects astronauts in various ways, including weakened muscles and loss of bone density. Recently, visual impairment and intracranial pressure (VIIP) syndrome has become a major concern for space missions lasting longer than 30 days. Astronauts suffering from VIIP syndrome have changes in ocular anatomical and visual impairment that persist after returning to earth. It is hypothesized that a cephalad fluid shift in microgravity may increase the intracranial pressure (ICP), which leads to an altered biomechanical environment of the posterior globe and optic nerve sheath (ONS).Currently, there is a lack of knowledge of how elevated ICP may lead to vision impairment and connective tissue changes in VIIP. Our goal was to develop a finite element model to simulate the acute effects of elevated ICP on the posterior eye and optic nerve sheath. We used a finite element (FE) analysis approach to understand the response of the lamina cribrosa and optic nerve to the elevations in ICP thought to occur in microgravity and to identify which tissue components have the greatest impact on strain experienced by optic nerve head tissues.

  5. Posterior Urethral Strictures.

    PubMed

    Gelman, Joel; Wisenbaugh, Eric S

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  6. Posterior Urethral Strictures

    PubMed Central

    Gelman, Joel; Wisenbaugh, Eric S.

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  7. Posterior Cortical Atrophy

    PubMed Central

    Crutch, Sebastian J; Lehmann, Manja; Schott, Jonathan M; Rabinovici, Gil D; Rossor, Martin N; Fox, Nick C

    2013-01-01

    Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that is characterized by a progressive decline in visuospatial, visuoperceptual, literacy and praxic skills. The progressive neurodegeneration affecting parietal, occipital and occipito-temporal cortices which underlies PCA is attributable to Alzheimer's disease (AD) in the majority of patients. However, alternative underlying aetiologies including Dementia with Lewy Bodies (DLB), corticobasal degeneration (CBD) and prion disease have also been identified, and not all PCA patients have atrophy on clinical imaging. This heterogeneity has led to diagnostic and terminological inconsistencies, caused difficulty comparing studies from different centres, and limited the generalizability of clinical trials and investigations of factors driving phenotypic variability. Significant challenges remain in identifying the factors associated with both the selective vulnerability of posterior cortical regions and the young age of onset seen in PCA. Greater awareness of the syndrome and agreement over the correspondence between syndrome-and disease-level classifications are required in order to improve diagnostic accuracy, research study design and clinical management. PMID:22265212

  8. A precise radiographic method to determine the location of the inferior alveolar canal in the posterior edentulous mandible: implications for dental implants. Part 1: Technique.

    PubMed

    Stella, J P; Tharanon, W

    1990-01-01

    In severely atrophic or osteoporotic mandibles, the location of the inferior alveolar nerve may vary considerably, both superoinferiorly and mediolaterally. A clinician's ability to reliably locate this nerve within the mandible would permit the surgical planning of implant placement in the posterior edentulous mandible. Eight edentulous cadaver mandibles were studied. A technique that precisely locates the inferior alveolar nerve within the mandible is described. The technique will aid the surgeon in planning a surgical approach to the posterior mandible with reduced risk of injury to the inferior alveolar nerve. PMID:2391135

  9. Lateralization Technique and Inferior Alveolar Nerve Transposition

    PubMed Central

    Sanches, Marco Antonio; Ramalho, Gabriel Cardoso; Manzi, Marcello Roberto

    2016-01-01

    Bone resorption of the posterior mandible can result in diminished bone edge and, therefore, the installation of implants in these regions becomes a challenge, especially in the presence of the mandibular canal and its contents, the inferior alveolar nerve. Several treatment alternatives are suggested: the use of short implants, guided bone regeneration, appositional bone grafting, distraction osteogenesis, inclined implants tangential to the mandibular canal, and the lateralization of the inferior alveolar nerve. The aim was to elucidate the success rate of implants in the lateralization technique and in inferior alveolar nerve transposition and to determine the most effective sensory test. We conclude that the success rate is linked to the possibility of installing implants with long bicortical anchor which favors primary stability and biomechanics. PMID:27433360

  10. Entrapment of middle cluneal nerves as an unknown cause of low back pain

    PubMed Central

    Aota, Yoichi

    2016-01-01

    Entrapment of middle cluneal nerves induces low back pain and leg symptoms. The middle cluneal nerves can become spontaneously entrapped where this nerve pass under the long posterior sacroiliac ligament. A case of severe low back pain, which was completely treated by release of the middle cluneal nerve, was presented. Entrapment of middle cluneal nerves is possibly underdiagnosed cause of low-back and/or leg symptoms. Spinal surgeons should be aware of this clinical entity and avoid unnecessary spinal surgeries and sacroiliac fusion. This paper is to draw attention by pain clinicians in this unrecognized etiology. PMID:27004164

  11. Entrapment of middle cluneal nerves as an unknown cause of low back pain.

    PubMed

    Aota, Yoichi

    2016-03-18

    Entrapment of middle cluneal nerves induces low back pain and leg symptoms. The middle cluneal nerves can become spontaneously entrapped where this nerve pass under the long posterior sacroiliac ligament. A case of severe low back pain, which was completely treated by release of the middle cluneal nerve, was presented. Entrapment of middle cluneal nerves is possibly underdiagnosed cause of low-back and/or leg symptoms. Spinal surgeons should be aware of this clinical entity and avoid unnecessary spinal surgeries and sacroiliac fusion. This paper is to draw attention by pain clinicians in this unrecognized etiology. PMID:27004164

  12. Clinical and electrophysiological assessment of inferior alveolar nerve function after lateral nerve transposition.

    PubMed

    Nocini, P F; De Santis, D; Fracasso, E; Zanette, G

    1999-04-01

    Inferior alveolar nerve (IAN) transposition surgery may cause some degree of sensory impairment. Accurate and reproducible tests are mandatory to assess IAN conduction capacity following nerve transposition. In this study subjective (heat, pain and tactile-discriminative tests) and objective (electrophysiological) assessments were performed in 10 patients receiving IAN transposition (bilaterally in 8 cases) in order to evaluate any impairment of the involved nerves one year post-operatively. All patients reported a tingling, well-tolerated sensation in the areas supplied by the mental nerve with no anaesthesia or burning paresthesia. Tactile discrimination was affected the most (all but 1 patient). No action potential was recorded in 4 patients' sides (23.5%); 12 sides showed a decreased nerve conduction velocity (NCV) (70.5%) and 1 side normal NCV values (6%). There was no significant difference in NCV decrease between partial and total transposition sides, if examined separately. Nerve conduction findings were related 2-point discrimination scores, but not to changes in pain and heat sensitivity. These findings show that lateral nerve transposition, though resulting in a high percentage of minor IAN injuries, as determined by electrophysiological testing, provides a viable surgical procedure to allow implant placement in the posterior mandible without causing severe sensory complaints. Considering ethical and forensic implications, patients should be fully informed that a certain degree of nerve injury might be expected to occur from the procedure. Electrophysiological evaluation is a reliable way to assess the degree of IAN dysfunction, especially if combined with a clinical examination. Intraoperative monitoring of IAN conduction might help identify the pathogenetic mechanisms of nerve injury and the surgical steps that are most likely to harm nerve integrity. PMID:10219131

  13. Suprascapular nerve entrapment at the spinoglenoid notch caused by a ganglion cyst.

    PubMed

    Rachbauer, F; Sterzinger, W; Frischhut, B

    1996-01-01

    A 34-year-old man had right infraspinatus muscle palsy and posterior aching of the shoulder caused by electromyographically confirmed suprascapular nerve entrapment. Sonography and magnetic resonance imaging revealed a cystic lesion at the spinoglenoid notch; this lesion was diagnosed as a ganglion. Operative removal led to immediate pain relief and incomplete recovery of the compressed branches of the suprascapular nerve. PMID:8742880

  14. Novel posterior fixation keratoprosthesis

    NASA Astrophysics Data System (ADS)

    Lacombe, Emmanuel

    1992-08-01

    The keratoprosthesis is the last solution for corneally blind patients that cannot benefit from corneal transplants. Keratoprostheses that have been designed to be affixed anteriorly usually necessitate multi-step surgical procedures and are continuously subjected to the extrusion forces generated by the positive intraocular pressure; therefore, clinical results in patients prove inconsistent. We proposed a novel keratoprosthesis concept that utilizes posterior corneal fixation which `a priori' minimizes the risk of aqueous leakage and expulsion. This prosthesis is implanted in a single procedure thereby reducing the number of surgical complications normally associated with anterior fixation devices. In addition, its novel design makes this keratoprosthesis implantable in phakic eyes. With an average follow-up of 13 months (range 3 to 25 months), our results on 21 cases are encouraging. Half of the keratoprostheses were implanted in severe burn cases, with the remainder in cases of pseudo- pemphigus. Good visual results and cosmetic appearance were obtained in 14 of 21 eyes.

  15. Supraclavicularis proprius muscle associated with supraclavicular nerve entrapment.

    PubMed

    Raikos, A; English, T; Agnihotri, A; Yousif, O K; Sandhu, M; Bennetto, J; Stirling, A

    2014-11-01

    Entrapment neuropathy of the supraclavicular nerve is rare and, when it occurs, is usually attributable to branching of the nerve into narrow bony clavicular canals. We describe another mechanism for entrapment of this nerve with the aberrant muscle; supraclavicularis being found during the routine dissection of an embalmed 82-year-old cadaver. Our report details a unique location for this rare muscular variation whereby the muscle fibres originated posteriorly on the medial aspect of the clavicle before forming a muscular arch over the supraclavicular nerve and passing laterally towards the trapezius and acromion. We recommend that in clinical instances of otherwise unexplained unilateral clavicular pain or tenderness, nerve compression from the supraclavicularis muscle must be borne in mind. PMID:25448916

  16. Feasibility of an endoscopic approach to the axillary nerve and the nerve to the long head of the triceps brachii with the help of the Da Vinci Robot.

    PubMed

    Porto de Melo, P M; Garcia, J C; Montero, E F de Souza; Atik, T; Robert, E-G; Facca, S; Liverneaux, P-A

    2013-09-01

    Surgery to transfer the axillary nerve and the nerve of the long head of the triceps presents two obstacles: 1) the access portals are not standardized and 2) the nerves are for their larger part approached through large incisions. The goal of this study was to explore the feasibility of an endoscopic microsurgical approach. The posterior aspect of a cadaver shoulder was approached through three communicating mini-incisions. The Da Vinci robot camera was installed on a central trocart, and the instrument arms on the adjacent trocarts. A gas insufflation distended the soft tissues up to the lateral axillary space. The branches of the axillary nerve and the nerve to the long head of the triceps brachii muscle were identified. The dissection of the axillary nerve trunk and its branches was easy. The posterior humeral circumflex veins and artery were dissected as well without any difficulty. Finding the nerve to the long head of the triceps brachii was found to be more challenging because of its deeper location. Robots properties allow performing conventional microsurgery: elimination of the physiologic tremor and multiplication of the movements. They also facilitate the endoscopic approach of the peripheral nerves, as seen in our results on the terminal branches of the axillary nerve and the nerve to the long head of the triceps brachii. PMID:23867724

  17. Lateralization of the inferior alveolar nerve with simultaneous implant placement: surgical techniques.

    PubMed

    Garg, A K; Morales, M J

    1998-01-01

    In the event of moderate to severe mandibular bone resorption posterior to the mental foramen, repositioning of the inferior alveolar nerve provides a greater amount of available bone for implant placement and reduces the risk of nerve injury. While neural paresthesia may initially occur, this altered sensation generally resolves spontaneously. Alveolar nerve repositioning may be possible in cases in which other procedures cannot be performed due to the extent of atrophy of the posterior mandibular alveolar crest. This article presents the surgical technique to achieve this objective. PMID:10093565

  18. Posterior Ankle Structure Injury During Total Ankle Replacement.

    PubMed

    Reb, Christopher W; McAlister, Jeffrey E; Hyer, Christopher F; Berlet, Gregory C

    2016-01-01

    Total ankle replacement studies have focused on reporting complications that are directly observed clinically or radiographically, including wound problems, technical errors, implant loosening, subsidence, infection, bone fractures, and heterotopic ossification. However, patients can still experience unresolved pain even when these problems have been ruled out. We initiated a study to more clearly define the relative risk of injury to the anatomic structures in the posterior ankle during total ankle replacement using a third-generation implant system. Ten fresh-frozen adult cadaveric below-the-knee specimens were positioned in the intraoperative positioning frame of an approved total ankle replacement system and adjusted to achieve proper foot alignment using fluoroscopic imaging. The relationship between the tibial cutting guide pins and the posterior neurovascular and tendon structures was measured using digital calipers. High rates of posterior structural injury were found. Nearly all proximal-medial pins encountered a posteromedial neurovascular structure, most commonly the tibial nerve. The distal-medial pins mainly encountered posteromedial tendinous structures, in particular, the flexor digitorum longus tendon. The proximal lateral pins were highly likely to encounter the Achilles tendon and the sural nerve. Our results support our hypothesis that the tibial neurovascular structures are at the greatest risk when preparing for and completing the bony resection, particularly with the medial and proximal cuts. Posterior ankle soft tissue structure injuries can occur during implantation but currently with unknown frequency and undetermined significance. Further study of posterior structural injuries could result in a more informed approach to post-total ankle replacement complications and management. PMID:27291681

  19. Gossypiboma mimicking posterior urethral stricture

    PubMed Central

    Kumar, Bindey; Kumar, Prem; Sinha, Sanjay Kumar; Sinha, Neelam; Hasan, Zaheer; Thakur, Vinit Kumar; Anand, Utpal; Priyadarshi, Rajiv Nayan; Mandal, Manish

    2013-01-01

    INTRODUCTION Foreign bodies in the urogenital tract are not uncommon. Hairpins, glass rods, umbilical tapes, ball point pen are described in lower urogenital tract. Retained gauze piece (gossypiboma) in posterior urethra may cause diagnostic dilemma. Symptoms and investigations may mimic stricture of posterior urethra. PRESENTATION OF CASE Two cases of retained gauze pieces in the urethra are described here. The micturating cystourethrogram was suggestive of posterior urethral stricture. DISCUSSION Two cases described here had retained gauze piece as a cause of filling defect and abnormal appearance in the micturating cystourethrogram. Gossypiboma may be a possibility where posterior urethral stricture are seen after previous surgery in paediatric age group. CONCLUSION In the setting of previous urogenital surgery gossypiboma should be kept in the differential diagnosis where posterior urethral stricture are seen in the paediatric age group. PMID:23500749

  20. Radiation therapy for primary optic nerve meningiomas

    SciTech Connect

    Smith, J.L.; Vuksanovic, M.M.; Yates, B.M.; Bienfang, D.C.

    1981-06-01

    Optic nerve sheath meningiomas, formerly thought to be rare, have been encountered with surprising frequency since the widespread use of computed tomography. Early diagnosis led to an enthusiastic surgical approach to these lesions, but this has been tempered by the realization that even in the best of hands, blindness followed such surgery with distressing frequency. Optic nerve sheath meningiomas may be divided into primary, secondary, and multiple meningioma groups. Five patients with primary optic nerve sheath meningiomas treated with irradiation therapy are presented in this report. Improvement in visual acuity, stabilization to increase in the visual field, and decrease in size to total regression of optociliary veins, have been documented following irradiation therapy of the posterior orbital and intracanalicular portions of the optic nerve in some of these cases. Although each patient must be carefully individualized, there is no question that visual palliation can be achieved in some cases of optic nerve sheath meningioma. Further investigation of this therapeutic modality in selected cases in advised.

  1. [Posterior reversible encephalopathy syndrome].

    PubMed

    Fischer, M; Schmutzhard, E

    2016-06-01

    Posterior reversible encephalopathy syndrome refers to a neurological disorder characterized by headache, disorders of consciousness, visual disturbances, epileptic seizures, and subcortical vasogenic edema. About two thirds of patients develop neurological symptoms, which are associated with blood pressure fluctuations. One hypothesis is that hypertensive episodes cause autoregulatory failure, and values above the upper limit of cerebral autoregulation result in a breakthrough followed by hyperperfusion and blood-brain barrier dysfunction. In another hypothesis, endothelial dysfunction triggered by numerous factors including preeclampsia, immunosuppressive agents, chemotherapeutics, sepsis, or autoimmune disorders is thought to be the key pathomechanism. Endo- or exogenic toxic agents including pharmacological substances, cytokines, or bacterial toxins are supposed to trigger endothelial activation and dysfunction resulting in the release of vasoconstrictors, pro-inflammatory mediators, and vascular leakage. Diagnosis is usually based on clinical and neuroimaging findings that frequently show a bilateral, symmetric, and parietooccipital pattern. However, the diagnosis can often only be confirmed during the course of disease after excluding important differential diagnoses. Currently, there is no specific treatment available. Lowering of arterial blood pressure and eliminating the underlying cause usually leads to an improvement of clinical and neuroradiological findings. Admission to a critical care unit is required in about 40 % of patients due to complicating conditions including status epilepticus, cerebral vasoconstriction, ischemia, or intracerebral hemorrhage. Prognosis is favorable; in the majority of patients neurological deficits and imaging findings resolve completely. PMID:27272329

  2. Nerve conduction velocity

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/003927.htm Nerve conduction velocity To use the sharing features on this page, please enable JavaScript. Nerve conduction velocity (NCV) is a test to see how ...

  3. Assessing nerves in leprosy.

    PubMed

    Garbino, José Antonio; Heise, Carlos Otto; Marques, Wilson

    2016-01-01

    Leprosy neuropathy is dependent on the patient's immune response and expresses itself as a focal or multifocal neuropathy with asymmetric involvement. Leprosy neuropathy evolves chronically but recurrently develops periods of exacerbation during type 1 or type 2 reactions, leading to acute neuropathy. Nerve enlargement leading to entrapment syndromes is also a common manifestation. Pain may be either of inflammatory or neuropathic origin. A thorough and detailed evaluation is mandatory for adequate patient follow-up, including nerve palpation, pain assessment, graded sensory mapping, muscle power testing, and autonomic evaluation. Nerve conduction studies are a sensitive tool for nerve dysfunction, including new lesions during reaction periods or development of entrapment syndromes. Nerve ultrasonography is also a very promising method for nerve evaluation in leprosy. The authors propose a composite nerve clinical score for nerve function assessment that can be useful for longitudinal evaluation. PMID:26773623

  4. Electromechanical Nerve Stimulator

    NASA Technical Reports Server (NTRS)

    Tcheng, Ping; Supplee, Frank H., Jr.; Prass, Richard L.

    1993-01-01

    Nerve stimulator applies and/or measures precisely controlled force and/or displacement to nerve so response of nerve measured. Consists of three major components connected in tandem: miniature probe with spherical tip; transducer; and actuator. Probe applies force to nerve, transducer measures force and sends feedback signal to control circuitry, and actuator positions force transducer and probe. Separate box houses control circuits and panel. Operator uses panel to select operating mode and parameters. Stimulator used in research to characterize behavior of nerve under various conditions of temperature, anesthesia, ventilation, and prior damage to nerve. Also used clinically to assess damage to nerve from disease or accident and to monitor response of nerve during surgery.

  5. Ulnar nerve damage (image)

    MedlinePlus

    ... arm. The nerve is commonly injured at the elbow because of elbow fracture or dislocation. The ulnar nerve is near ... surface of the body where it crosses the elbow, so prolonged pressure on the elbow or entrapment ...

  6. Nerve Injuries in Athletes.

    ERIC Educational Resources Information Center

    Collins, Kathryn; And Others

    1988-01-01

    Over a two-year period this study evaluated the condition of 65 athletes with nerve injuries. These injuries represent the spectrum of nerve injuries likely to be encountered in sports medicine clinics. (Author/MT)

  7. Radial nerve dysfunction (image)

    MedlinePlus

    The radial nerve travels down the arm and supplies movement to the triceps muscle at the back of the upper arm. ... the wrist and hand. The usual causes of nerve dysfunction are direct trauma, prolonged pressure on the ...

  8. Tibial nerve dysfunction

    MedlinePlus

    ... a loss of movement or sensation in the foot from damage to the tibial nerve. ... Tibial nerve dysfunction is an unusual form of peripheral ... the calf and foot muscles. A problem in function with a single ...

  9. Degenerative Nerve Diseases

    MedlinePlus

    Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many ... viruses. Sometimes the cause is not known. Degenerative nerve diseases include Alzheimer's disease Amyotrophic lateral sclerosis Friedreich's ...

  10. Radial nerve dysfunction

    MedlinePlus

    ... nerve leads to problems with movement in the arm and wrist and with sensation in the back of the arm or hand. ... to the radial nerve, which travels down the arm and controls movement of the triceps muscle at ...

  11. Rapid Visual Deterioration Caused by Posterior Fossa Arachnoid Cyst.

    PubMed

    Shin, Chang Jin; Rho, Myeongho; Won, Yu Sam; Kim, Si On

    2016-05-01

    Posterior fossa is a site next to the middle fossa where arachnoid cyst frequently occurs. Generally, most arachnoid cysts are asymptomatic and are found incidentally in most cases. Although arachnoid cysts are benign and asymptomatic lesions, patients with posterior fossa arachnoid cysts often complain of headaches, gait disturbance, and ataxia due to the local mass effects on the cerebellum. We observed a patient with a posterior fossa arachnoid cyst who had visual symptoms and a headache, but did not have gait disturbance and ataxia. We recommended an emergency operation for decompression, but the patient refused for personal reasons. After 7 days, the patient revisited our hospital in a state of near-blindness. We suspected that the arachnoid cyst induced the hydrocephalus and thereby the enlarged third ventricle directly compressed optic nerves. Compressed optic nerves were rapidly aggravated during the critical seven days; consequently, the patient's vision was damaged despite the operation. Considering the results of our case, it is important to keep in mind that the aggravation of symptoms cannot be predicted; therefore, symptomatic arachnoid cysts should be treated without undue delay. PMID:27226868

  12. Rapid Visual Deterioration Caused by Posterior Fossa Arachnoid Cyst

    PubMed Central

    Shin, Chang Jin; Rho, Myeongho; Won, Yu Sam

    2016-01-01

    Posterior fossa is a site next to the middle fossa where arachnoid cyst frequently occurs. Generally, most arachnoid cysts are asymptomatic and are found incidentally in most cases. Although arachnoid cysts are benign and asymptomatic lesions, patients with posterior fossa arachnoid cysts often complain of headaches, gait disturbance, and ataxia due to the local mass effects on the cerebellum. We observed a patient with a posterior fossa arachnoid cyst who had visual symptoms and a headache, but did not have gait disturbance and ataxia. We recommended an emergency operation for decompression, but the patient refused for personal reasons. After 7 days, the patient revisited our hospital in a state of near-blindness. We suspected that the arachnoid cyst induced the hydrocephalus and thereby the enlarged third ventricle directly compressed optic nerves. Compressed optic nerves were rapidly aggravated during the critical seven days; consequently, the patient's vision was damaged despite the operation. Considering the results of our case, it is important to keep in mind that the aggravation of symptoms cannot be predicted; therefore, symptomatic arachnoid cysts should be treated without undue delay. PMID:27226868

  13. Morphology and Functional Anatomy of the Recurrent Laryngeal Nerve with Extralaryngeal Terminal Bifurcation

    PubMed Central

    Dogan, Sami

    2016-01-01

    Anatomical variations of the recurrent laryngeal nerve (RLN), such as an extralaryngeal terminal bifurcation (ETB), threaten the safety of thyroid surgery. Besides the morphology of the nerve branches, intraoperative evaluation of their functional anatomy may be useful to preserve motor activity. We exposed 67 RLNs in 36 patients. The main trunk, bifurcation point, and terminal branches of bifid nerves were macroscopically determined and exposed during thyroid surgery. The functional anatomy of the nerve branches was evaluated by intraoperative nerve monitoring (IONM). Forty-six RLNs with an ETB were intraoperatively exposed. The bifurcation point was located along the prearterial, arterial, and postarterial segments in 11%, 39%, and 50% of bifid RLNs, respectively. Motor activity was determined in all anterior branches. The functional anatomy of terminal branches detected motor activity in 4 (8.7%) posterior branches of 46 bifid RLNs. The motor activity in posterior branches created a wave amplitude at 25–69% of that in the corresponding anterior branches. The functional anatomy of bifid RLNs demonstrated that anterior branches always contained motor fibres while posterior branches seldom contained motor fibres. The motor activity of the posterior branch was weaker than that of the anterior branch. IONM may help to differentiate between motor and sensory functions of nerve branches. The morphology and functional anatomy of all nerve branches must be preserved to ensure a safer surgery. PMID:27493803

  14. Laryngeal nerve damage

    MedlinePlus

    Laryngeal nerve damage is injury to one or both of the nerves that are attached to the voice box. ... Injury to the laryngeal nerves is uncommon. When it does occur, it can be from: A complication of neck or chest surgery (especially thyroid, lung, ...

  15. Peripapillary and Posterior Scleral Mechanics, Part I – Development of an Anisotropic Hyperelastic Constitutive Model

    PubMed Central

    Downs, J. Crawford; Burgoyne, Claude F.; Suh, J-K. Francis

    2009-01-01

    Background The sclera is the white outer shell and principal load-bearing tissue of the eye as it sustains the intraocular pressure. We have hypothesized that the mechanical properties of the posterior sclera play a significant role in, and are altered by the development of glaucoma – an ocular disease manifested by structural damage to the optic nerve head. Method of Approach An anisotropic hyperelastic constitutive model is presented to simulate the mechanical behavior of the posterior sclera under acute elevations of intraocular pressure. The constitutive model is derived from fiber-reinforced composite theory, and incorporates stretch-induced stiffening of the reinforcing collagen fibers. Collagen fiber alignment was assumed to be multi-directional at local material points, confined within the plane tangent to the scleral surface, and described by the semi-circular von-Mises distribution. The introduction of a model parameter, namely the fiber concentration factor, was used to control collagen fiber alignment along a preferred fiber orientation. To investigate the effects of scleral collagen fiber alignment on the overall behaviors of the posterior sclera and optic nerve head, finite element simulations of an idealized eye were performed. The four output quantities analyzed were the scleral canal expansion, the scleral canal twist, the posterior scleral canal deformation and the posterior laminar deformation. Results A circumferential fiber organization in the sclera restrained scleral canal expansion but created posterior laminar deformation, whereas the opposite was observed with a meridional fiber organization. Additionally, the fiber concentration factor acted as an amplifying parameter on the considered outputs. Conclusions The present model simulation suggests that the posterior sclera has a large impact on the overall behavior of the optic nerve head. It is therefore primordial to provide accurate mechanical properties for this tissue. In a companion

  16. Sciatica due to malignant nerve sheath tumour of sciatic nerve in the thigh.

    PubMed

    Sharma, R R; Pawar, S J; Mahapatra, A K; Doctor, M; Musa, M M

    2001-06-01

    Malignant peripheral nerve sheath tumour (MPNST) is a rare malignant neoplasm arising from the supportive non-neural component of the peripheral nerves. An unusual case of pain and weakness of the foot and calf muscles due to a giant MPNST of the sciatic nerve in the posterior compartment of the thigh is presented. The patient was already investigated as a case of sciatica due to a lumbar disc disease with a negative magnetic resonance imaging and then unsuccessfully operated elsewhere twice, with a misdiagnosis of tarsal tunnel syndrome. Neurosurgical referral prompted a diagnostic magnetic resonance study of the thigh, revealing the lesion, which was completely excised microsurgically with total relief in the pain and partial improvement in the weakness and sensations in the sole of the foot. PMID:11447444

  17. A precise radiographic method to determine the location of the inferior alveolar canal in the posterior edentulous mandible: implications for dental implants. Part 2: Clinical application.

    PubMed

    Stella, J P; Tharanon, W

    1990-01-01

    An analysis of implant placement in the posterior region of eight edentulous cadaver mandibles was performed. The results demonstrated that the radiographic technique developed can be employed to safely place implants adjacent to the inferior alveolar nerve in the posterior mandible by using radiographic laminography and a specially designed intraoral reference splint. PMID:2391136

  18. [Ganglia of peripheral nerves].

    PubMed

    Tatagiba, M; Penkert, G; Samii, M

    1993-01-01

    The authors present two different types of ganglion affecting the peripheral nerves: extraneural and intraneural ganglion. Compression of peripheral nerves by articular ganglions is well known. The surgical management involves the complete removal of the lesion with preservation of most nerve fascicles. Intraneural ganglion is an uncommon lesion which affects the nerve diffusely. The nerve fascicles are usually intimately involved between the cysts, making complete removal of all cysts impossible. There is no agreement about the best surgical management to be applied in these cases. Two possibilities are available: opening of the epineural sheath lengthwise and pressing out the lesion; or resection of the affected part of the nerve and performing a nerve reconstruction. While in case of extraneural ganglion the postoperative clinical evolution is very favourable, only long follow up studies will reveal in case of intraneural ganglion the best surgical approach. PMID:8128785

  19. Sensory nerve conduction in branches of common interdigital nerves: a new technique for normal controls and patients with morton's neuroma.

    PubMed

    Uludag, Burhanettin; Tataroglu, Cengiz; Bademkiran, Fikret; Uludag, Irem Fatma; Ertekin, Cumhur

    2010-06-01

    In this article, a new electrodiagnostic approach is described for patients with Morton's neuroma. The new method is based on the anatomic fact that the two branches of the common plantar interdigital nerves innervate the lateral side of one toe and the medial side the next one. This study included 20 normal subjects (aged 28-58 years, 10 men and 10 women) and 4 patients with Morton's neuroma (aged 44-52 years, 4 women). The branches of adjacent common plantar interdigital nerves that innerve one toe were stimulated superficially and separately with half of one toe covered with a piece of medical tape. The recordings were obtained on the posterior tibial nerve at the medial malleolus with needle electrodes. Thus, the difference in latencies of obtained sensory nerve action potentials on the posterior tibial nerve with needle electrode was measured. From normal subjects' data, it was determined that a latency difference value of above 0.17 milliseconds (mean +/- 2.5 SD) in one toe was abnormal. All of the patients with Morton's neuroma showed abnormal interlatency difference values. This new method, which we have developed, is more sensitive, simple to use, does not require extra equipment, and does not cause excessive pain. We suggest that interlatency difference between branches of the common plantar interdigital nerves is a useful and sensitive method for the diagnosis of Morton's neuroma. PMID:20479659

  20. Assessment of nerve morphology in nerve activation during electrical stimulation

    NASA Astrophysics Data System (ADS)

    Gomez-Tames, Jose; Yu, Wenwei

    2013-10-01

    The distance between nerve and stimulation electrode is fundamental for nerve activation in Transcutaneous Electrical Stimulation (TES). However, it is not clear the need to have an approximate representation of the morphology of peripheral nerves in simulation models and its influence in the nerve activation. In this work, depth and curvature of a nerve are investigated around the middle thigh. As preliminary result, the curvature of the nerve helps to reduce the simulation amplitude necessary for nerve activation from far field stimulation.

  1. A study of posterior column function in familial spastic paraplegia.

    PubMed Central

    Dimitrijevic, M R; Lenman, J A; Prevec, T; Wheatly, K

    1982-01-01

    A family is described in which affected members have clinical features consistent with the late onset form of Strümpell's Familial Spastic Paraplegia which is of dominant inheritance. Abnormalities in cortical somatosensory to peroneal nerve stimulation were found in all affected members of the family and in several who were clinically unaffected. In some cases responses were better defined at slow rates of stimulation. Peripheral nerve conduction velocity was normal. These changes are consistent with previous findings of degeneration in the posterior columns at necroscopy and with a dying back process in the first sensory neuron. Clinically unaffected members of the family with abnormalities in the somatosensory response may represent asymptomatic heterozygotes. PMID:7062069

  2. Endovascular coil embolization of unruptured posterior communicating artery aneurysm.

    PubMed

    Binning, Mandy; Hakma, Zakaria; Veznedaroglu, Erol

    2014-07-01

    The patient is a 60-year-old woman who presented to her primary care physician with new onset of headache. She was neurologically intact without cranial nerve deficit. An outpatient CT angiogram (CTA) revealed no subarachnoid hemorrhage, but showed a right-sided posterior communicating artery aneurysm measuring 11 mm by 10 mm. Digitally subtracted cerebral angiography confirmed these measurements and showed that the aneurysm was amenable to endovascular coil embolization. The patient underwent aneurysm coiling without complication and was discharged to home on postoperative Day 1. The video can be found here: http://youtu.be/MjOc3Zpv2K8 . PMID:24983726

  3. Typical trigeminal neuralgia associated with posterior cranial fossa tumors.

    PubMed

    Puca, A; Meglio, M

    1993-10-01

    A clinical diagnosis of typical trigeminal neuralgia does not rule out the possibility of a space-occupying lesion compressing the nerve along its course from the brainstem to Meckel's cave. 4 cases of typical trigeminal neuralgia, treated medically for several years and seen here recently before a space-occupying lesion was found in the posterior cranial fossa, point up the need for thorough neurological and neuroradiological examination of all patients with the typical symptoms. Lesion removal resulted in total relief from pain in 3 patients. In the fourth patient the pain was controlled by percutaneous surgery with thermocoagulation of the gasserian ganglion. PMID:8282526

  4. Current approach in the diagnosis and management of posterior uveitis

    PubMed Central

    Sudharshan, S; Ganesh, Sudha K; Biswas, Jyotrimay

    2010-01-01

    Posterior uveitic entities are varied entities that are infective or non-infective in etiology. They can affect the adjacent structures such as the retina, vitreous, optic nerve head and retinal blood vessels. Thorough clinical evaluation gives a clue to the diagnosis while ancillary investigations and laboratory tests assist in confirming the diagnosis. Newer evolving techniques in the investigations and management have increased the diagnostic yield. In case of diagnostic dilemma, intraocular fluid evaluation for polymerase chain testing for the genome and antibody testing against the causative agent provide greater diagnostic ability. PMID:20029144

  5. A Novel Rodent Model of Posterior Ischemic Optic Neuropathy

    PubMed Central

    Wang, Yan; Brown, Dale P.; Duan, Yuanli; Kong, Wei; Watson, Brant D.; Goldberg, Jeffrey L.

    2014-01-01

    Objectives To develop a reliable, reproducible rat model of posterior ischemic optic neuropathy (PION) and study the cellular responses in the optic nerve and retina. Methods Posterior ischemic optic neuropathy was induced in adult rats by photochemically induced ischemia. Retinal and optic nerve vasculature was examined by fluorescein isothiocyanate–dextran extravasation. Tissue sectioning and immunohistochemistry were used to investigate the pathologic changes. Retinal ganglion cell survival at different times after PION induction, with or without neurotrophic application, was quantified by fluorogold retrograde labeling. Results Optic nerve injury was confirmed after PION induction, including local vascular leakage, optic nerve edema, and cavernous degeneration. Immunostaining data revealed microglial activation and focal loss of astrocytes, with adjacent astrocytic hypertrophy. Up to 23%, 50%, and 70% retinal ganglion cell loss was observed at 1 week, 2 weeks, and 3 weeks, respectively, after injury compared with a sham control group. Experimental treatment by brain-derived neurotrophic factor and ciliary neurotrophic factor remarkably prevented retinal ganglion cell loss in PION rats. At 3 weeks after injury, more than 40% of retinal ganglion cells were saved by the application of neurotrophic factors. Conclusions Rat PION created by photochemically induced ischemia is a reproducible and reliable animal model for mimicking the key features of human PION. Clinical Relevance The correspondence between the features of this rat PION model to those of human PION makes it an ideal model to study the pathophysiologic course of the disease, most of which remains to be elucidated. Furthermore, it provides an optimal model for testing therapeutic approaches for optic neuropathies. PMID:23544206

  6. Ossification of the Posterior Petroclinoid Dural Fold: A Cadaveric Study with Neurosurgical Significance.

    PubMed

    Kimball, David; Kimball, Heather; Matusz, Petru; Tubbs, R Shane; Loukas, Marios; Cohen-Gadol, A Aaron

    2015-08-01

    Objectives The roof of the porus trigeminus, composed of the posterior petroclinoid dural fold, is an important landmark to the skull base surgeon. Ossification of the posterior petroclinoid dural fold is an anatomical variation rarely mentioned in the literature. Such ossification results in the trigeminal nerve traversing a bony foramen as it enters Meckel cave. The authors performed this study to better elucidate this anatomical variation. Design Fifteen adult cadaveric head halves were subjected to dissection of the middle cranial fossa. Microdissection techniques were used to examine the posterior petroclinoid dural folds. Skull base osteology was also studied in 71 dry human skulls with attention paid to the attachment point of the posterior petroclinoid dural folds at the trigeminal protuberances. Setting Cadaver laboratory Main Outcome Measures Measurements were made using a microcaliper. Digital images were made of the dissections. Results Completely ossified posterior petroclinoid folds were present in 20% of the specimens. Of the 142 dry skull sides examined, 9% had large trigeminal protuberances. Conclusions Based on this study, the posterior petroclinoid dural fold may completely ossify in adults that may lead to narrowing of the porus trigeminus and potential compression of the trigeminal nerve at the entrance to Meckel cave. PMID:26225315

  7. Normal threshold values for a monofilament sensory test in sural and radial cutaneous nerves in Indian and Nepali volunteers.

    PubMed

    Wagenaar, Inge; Brandsma, Wim; Post, Erik; Richardus, Jan Hendrik

    2014-12-01

    The monofilament test (MFT) is a reliable method to assess sensory nerve function in leprosy and other neuropathies. Assessment of the radial cutaneous and sural nerves, in addition to nerves usually tested, can help improve diagnosis and monitoring of nerve function impairment (NFI). To enable the detection of impairments in leprosy patients, it is essential to know the monofilament threshold of these two nerves in normal subjects. The radial cutaneous, sural, ulnar, median and posterior tibial nerves of 245 volunteers were tested. All nerves were tested at three sites on both left and right sides. Normal monofilament thresholds were calculated per test-site and per nerve. We assessed 490 radial cutaneous and 482 sural nerves. The normal monofilament was 2 g (Filament Index Number (FIN) 4.31) for the radial cutaneous and 4 g (FIN 4.56) for the sural nerve, although heavy manual laborers demonstrated a threshold of 10 g (FIN 5.07) for the sural nerve. For median and ulnar nerves, the 200 mg (FIN 3.61) filament was confirmed as normal while the 4 g (FIN 4.56) filament was normal for the posterior tibial. Age and occupation have an effect on the mean touch sensitivity but do not affect the normal threshold for the radial cutaneous and sural nerves. The normal thresholds for the radial cutaneous and sural nerves are determined as the 2 g (FIN 4.31) and the 4 g (FIN 4.56) filaments, respectively. The addition of the radial cutaneous and sural nerve to sensory nerve assessment may improve the diagnosis of patients with impaired sensory nerve function. PMID:25675652

  8. Basic study on the influence of inhibition induced by the magnetic stimulation on the peripheral nerve

    NASA Astrophysics Data System (ADS)

    Sato, Aya; Torii, Tetsuya; Iwahashi, Masakuni; Iramina, Keiji

    2015-05-01

    The purpose of this study is to analyze the inhibition mechanism of magnetic stimulation on motor function. A magnetic stimulator with a flat figure-eight coil was used to stimulate the peripheral nerve of the antebrachium. The intensity of magnetic stimulation was 0.8 T, and the stimulation frequency was 1 Hz. The amplitudes of the motor-evoked potentials (MEPs) at the abductor pollicis brevis muscle and first dorsal interosseous muscle were used to evaluate the effects of magnetic stimulation. The effects of magnetic stimulation were evaluated by analyzing the MEP amplitude before and after magnetic stimulation to the primary motor cortex. The results showed that MEP amplitude after magnetic stimulation compared with before magnetic stimulation decreased. Because there were individual differences in MEP amplitude induced by magnetic stimulation, the MEP amplitude after stimulation was normalized by the amplitude of each participant before stimulation. The MEP amplitude after stimulation decreased by approximately 58% (p < 0.01) on average compared with before stimulation. Previous studies suggested that magnetic stimulation to the primary motor cortex induced an increase or a decrease in MEP amplitude. Furthermore, previous studies have shown that the alteration in MEP amplitude was induced by cortical excitability based on magnetic stimulation. The results of this study showed that MEP amplitude decreased following magnetic stimulation to the peripheral nerve. We suggest that the decrease in MEP amplitude found in this study was obtained via the feedback from a peripheral nerve through an afferent nerve to the brain. This study suggests that peripheral excitement by magnetic stimulation of the peripheral nerve may control the central nervous system via afferent feedback.

  9. Injury to the inferior alveolar nerve during implant placement: a formula for protection of the patient and clinician.

    PubMed

    Worthington, Philip

    2004-01-01

    This article concerns the problem of nerve damage associated with implant placement in the posterior mandible. The causes are discussed, with particular emphasis on intrusion of the drill or implant into the nerve canal. Recommendations are made to help the practitioner avoid this too-common complication. PMID:15508990

  10. Axillary nerve course and position in the fetal period

    PubMed Central

    Uluer, Tuğba; Aktekin, Mustafa; Kurtoğlu, Zeliha; Buluklu, Semih; Karşıyaka, Dilan; Can, Erdem

    2015-01-01

    Objectives: To examine the fetal axillary nerve to reveal and compare its morphometric features within the second and third trimester. Methods: This study was conducted at the Anatomy Department, School of Medicine, Mersin University, Mersin, Turkey. Thirty-five fetal shoulders were studied to provide anatomic data and to describe its position with regard to certain landmarks around the shoulder. Results: The shortest distance between the axillary nerve and the glenoid labrum was found 2.27 mm and 2.89 mm in the second and third trimester fetuses, respectively. The shortest distances between the anterior and posterior acromial tips and the axillary nerve were also measured and were used with arm length measurements to define the anterior and posterior indexes. Conclusion: The indexes show that the distance between the axillary nerve and the anterior/posterior acromial tips are approximately one-fourth of the arm length in both the second and third trimester fetuses. The data presented in this study will be of use to surgeons, particularly to pediatric and orthopedic surgeons who will undertake surgical procedures in the axilla and arm in the newborn or early childhood. PMID:26492124

  11. Dual Nerve Transfers for Restoration of Shoulder Function After Brachial Plexus Avulsion Injury.

    PubMed

    Chu, Bin; Wang, Huan; Chen, Liang; Gu, Yudong; Hu, Shaonan

    2016-06-01

    The purpose of this study was to investigate the effectiveness of shoulder function restoration by dual nerve transfers, spinal accessory nerve to the suprascapular nerve and 2 intercostal nerves to the anterior branch of the axillary nerve, in patients with shoulder paralysis that resulted from brachial plexus avulsion injury. It was a retrospective analysis to assess the impact of a variety of factors on reanimation of shoulder functions with dual nerve transfers. A total of 19 patients were included in this study. Most of these patients sustained avulsions of C5, C6, and C7 nerve roots (16 patients). Three of them had avulsions of C5 and C6 roots only. Through a posterior approach, direct coaptation of the intercostal nerves and the anterior branch of the axillary nerve was performed, along with accessory nerve transfer to the suprascapular nerve. Satisfactory shoulder function recovery (93.83° of shoulder abduction and 54.00° of external rotation on average) was achieved after a 62-month follow-up. This dual nerve transfer procedure provided us with a reliable and effective method for shoulder function reconstruction after brachial plexus root avulsion, especially C5/C6/C7 avulsion. The level of evidence is therapeutic IV. PMID:26835823

  12. The Furcal Nerve Revisited

    PubMed Central

    Dabke, Harshad V.

    2014-01-01

    Atypical sciatica and discrepancy between clinical presentation and imaging findings is a dilemma for treating surgeon in management of lumbar disc herniation. It also constitutes ground for failed back surgery and potential litigations thereof. Furcal nerve (Furcal = forked) is an independent nerve with its own ventral and dorsal branches (rootlets) and forms a link nerve that connects lumbar and sacral plexus. Its fibers branch out to be part of femoral and obturator nerves in-addition to the lumbosacral trunk. It is most commonly found at L4 level and is the most common cause of atypical presentation of radiculopathy/sciatica. Very little is published about the furcal nerve and many are unaware of its existence. This article summarizes all the existing evidence about furcal nerve in English literature in an attempt to create awareness and offer insight about this unique entity to fellow colleagues/professionals involved in spine care. PMID:25317309

  13. Sciatic nerve injection injury.

    PubMed

    Jung Kim, Hyun; Hyun Park, Sang

    2014-06-11

    Nerve injury is a common complication following intramuscular injection and the sciatic nerve is the most frequently affected nerve, especially in children, the elderly and underweight patients. The neurological presentation may range from minor transient pain to severe sensory disturbance and motor loss with poor recovery. Management of nerve injection injury includes drug treatment of pain, physiotherapy, use of assistive devices and surgical exploration. Early recognition of nerve injection injury and appropriate management are crucial in order to reduce neurological deficit and to maximize recovery. Sciatic nerve injection injury is a preventable event. Total avoidance of intramuscular injection is recommended if other administration routes can be used. If the injection has to be administered into the gluteal muscle, the ventrogluteal region (gluteal triangle) has a more favourable safety profile than the dorsogluteal region (the upper outer quadrant of the buttock). PMID:24920643

  14. Isolated Posterior Fossa Involvement in Posterior Reversible Encephalopathy Syndrome

    PubMed Central

    Shimizu, Yukie; Tha, Khin Khin; Iguchi, Akihiro; Cho, Yuko; Yoshida, Atsushi; Fujima, Noriyuki; Tsukahara, Akiko; Shirato, Hiroki; Terae, Satoshi

    2013-01-01

    Summary Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible vasogenic edema affecting the subcortical white matter of bilateral occipital and parietal lobes. We describe a case of isolated posterior fossa involvement of PRES which occurred during remission induction chemotherapy for T-cell acute lymphoblastic leukemia. Both the brainstem and cerebellum were extensively involved, but the supratentorial structures were completely spared. The follow-up magnetic resonance images revealed reversibility of most lesions. The knowledge of atypical radiological features of PRES is essential for prompt diagnosis. PMID:24199811

  15. Endoscopic Facial Nerve Surgery.

    PubMed

    Marchioni, Daniele; Soloperto, Davide; Rubini, Alessia; Nogueira, João Flávio; Badr-El-Dine, Mohamed; Presutti, Livio

    2016-10-01

    Tympanic facial nerve segment surgery has been traditionally performed using microscopic approaches, but currently, exclusive endoscopic approaches have been performed for traumatic, neoplastic, or inflammatory diseases, specially located at the geniculate ganglion, greater petrosal nerve, and second tract of the facial nerve, until the second genu. The tympanic segment of the facial nerve can be reached and visualized using an exclusive transcanal endoscopic approach, even in poorly accessible regions such as the second genu and geniculate ganglion, avoiding mastoidectomy, bony demolition, and meningeal or cerebral lobe tractions, with low complication rates using a minimally invasive surgical route. PMID:27468633

  16. Multiscale computational and experimental approaches to elucidate bone and ligament mechanobiology using the ulna-radius-interosseous membrane construct as a model system.

    PubMed

    Knothe Tate, M L; Tami, A E; Netrebko, P; Milz, S; Docheva, D

    2012-01-01

    An in vivo axial loading model of the rat ulna was developed almost two decades ago. As a minimally invasive model, it lends itself particularly well for the study of functional adaptation in bone and the interosseous membrane, a ligament spanning between the radius and ulna. The objective of this paper is to review computational and experimental approaches to elucidate its applicability for the study of multiscale bone and ligament mechanobiology. Specifically, this review describes approaches, including i) measurement of strains on bone tissue surfaces, ii) development of a three-dimensional finite element (FE) mesh of a skeletally mature rat ulna, iii) parametric study of the relative influence of mechanical constants and materials properties on computational model predictions, iv) comparison of experimental and computational strain distribution data, and analysis of the radius and interosseous membrane (IOM) ligament's effect on axial load distribution through the ulna of the rat, and v) the effect of mechanical loading on transport through the IOM using different molecular weight fluorescent tagged dextrans. In the first stage of the study a computational stress analysis was performed after applying a 20 N single static load at the ulnar extremities, corresponding to values of experimental strain gauge measurements. To account for the anisotropy of the bone matrix, transverse isotraopic, elastic material properties were applied. In a parametric study, we analyzed the qualitative effect of different material properties on the global load and displacement behavior of the computational model. In a second stage, the same ulnar model used in the parametric study was extended to account for the interaction between the ulna, radius and IOM. The three-dimensional FE model of the rat forelimb confirms the influence of ulnar curvature on its deformation and underscores the influence of the radius and IOM on strain distribution through the ulna. The mode of strain, {i

  17. Study of Variations in the Branching Pattern of Lower Subscapular Nerve

    PubMed Central

    Havaldar, Pavan Prahlad

    2014-01-01

    Background: Variations in the origin of lower subscapular nerve of the posterior cord of brachial plexus are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of origin show population differences. Data from the South Indian population is scarce. Objective: To describe the variations in the origin of the lower subscapular nerve of the posterior cord of brachial plexus in the South Indian population. Materials and Methods: Forty brachial plexuses from 20 formalin fixed cadavers were explored by gross dissection. Origin and order of branching of lower subscapular nerve was recorded. Representative photographs were then taken using a digital camera (Sony Cyber shot R, W200, 7.2 Megapixels). Results: Lower subscapular nerves had origin from axillary nerve in 57.5% of specimens, in 37.5% specimens, it was originating from the posterior cord and in 5% of specimens it arose from common trunk. Conclusion: Lower subscapular nerves in studied population display a wide range of variations. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid in advertent injury. PMID:25584202

  18. Assessment of Optic Nerve Impairment in Patients with Neuromyelitis Optica by MR Diffusion Tensor Imaging

    PubMed Central

    Chen, Zhiye; Lou, Xin; Liu, Mengqi; Huang, Dehui; Wei, Shihui; Yu, Shengyuan; Ma, Lin

    2015-01-01

    Background Diffusion tensor imaging (DTI) has been used for the evaluation of the white matter integrity. In this study, we evaluated optic nerve impairment in patients with neuromyelitis optica (NMO) using DTI. Methodology/Principal Findings Optic nerve DTI were performed on 28 NMO patients and 38 normal controls. Fractional anisotropy (FA) values were measured in the anterior, middle, and posterior parts of the intraorbital optic nerve segment. For the posterior intraorbital optic nerve, FA values of BI (0.20±0.07), MI (0.24±0.16), and NA (0.25±0.14) decreased significantly compared with that of NC (0.43±0.07) (P<0.05), and ROC analysis demonstrated that the area under the curve (AUC) measurements for BI vs. NC, MI vs. NC, NA vs. NC, and NMO (including BI, MI, and NA) vs. NC were 0.99, 0.93, 0.88, and 0.96, respectively. The corresponding diagnostic sensitivities of ROC analysis were 100%, 80%, 80%, and 91%; and the specificities were 93%, 97%, 91%, and 93%. Conclusions/Significance Decreased FA value in the intraorbital optic nerve, especially in the posterior part of the nerve, was demonstrated as a characteristic MR feature for NMO-related optic nerve impairment. PMID:25962183

  19. Laparoscopic pelvic anatomy of nerve-sparing radical hysterectomy.

    PubMed

    Park, Nae Yoon; Cho, Young Lae; Park, Il Soo; Lee, Yoon Soon

    2010-03-01

    Many reports regarding nerve-sparing radical hysterectomy have been published. However, most reports have been based on systematic descriptions via laparotomy or cadaver dissection. The aim of this work was to describe the pelvic anatomy of nerve-sparing radical hysterectomy via laparoscopy, with specific focus on the inferior hypogastric plexus. This study is based on 125 patients with FIGO stage IB cervical cancer who had undergone laparoscopic nerve-sparing radical hysterectomies since 1999. The inferior hypogastric plexus was demonstrated via laparoscopy and was comprised of afferent fibers from the sacral root (S2, S3, and S4), sacral sympathetic ganglion, and hypogastric nerve, and efferent fibers forming its vesical, uterovaginal, and rectal branches. During the dissection of the posterior leaf of the vesicouterine ligament, various vesical veins were identified. If the cut edge of an inferior vesical vein was pulled medially with upward traction, the vesical branches of the inferior hypogastric plexus were exposed and these were divided into medial and lateral branches. The magnified view of laparoscopy made it possible to dissect nerves and vessels meticulously and to secure a clear resection margin during the dissection of the deep part of the cardinal ligament, uterosacral ligament, and posterior leaf of the vesicouterine ligament. PMID:20108355

  20. Rethinking "posterior" tongue-tie.

    PubMed

    Douglas, Pamela Sylvia

    2013-12-01

    Currently, many clinicians who help with breastfeeding problems are diagnosing "posterior" tongue-tie in infants and performing or referring for frenotomy. In this "Speaking Out" article, I argue that the diagnosis of "posterior" tongue-tie has successfully raised awareness of the importance of impaired tongue function in breastfeeding difficulty. However, the diagnosis of "posterior" tongue-tie also applies a reductionist, medicalized theoretical frame to the complex problem of impaired tongue function, risking unintended outcomes. Impaired tongue function arises out of multiple interacting and co-evolving factors, including the interplay between social behaviors concerning breastfeeding and mother-infant biology. Consideration of theoretical frames is vital if we are to build an evidence base through efficient use of the scarce resources available for clinical breastfeeding research and minimize unintended outcomes. PMID:24143939

  1. Posterior polar cataract: A review

    PubMed Central

    Kalantan, Hatem

    2011-01-01

    Posterior polar cataract is a rare form of congenital cataract. It is usually inherited as an autosomal dominant disease, yet it can be sporadic. Five genes have been attributed to the formation of this disease. It is highly associated with complications during surgery, such as posterior capsule rupture and nucleus drop. The reason for this high complication rate is the strong adherence of the opacity to the weak posterior capsule. Different surgical strategies were described for the handling of this challenging entity, most of which emphasized the need for gentle maneuvering in dealing with these cases. It has a unique clinical appearance that should not be missed in order to anticipate, avoid, and minimize the impact of the complications associated with it. PMID:23960967

  2. Injuries to the spinal accessory nerve: a lesson to surgeons.

    PubMed

    Camp, S J; Birch, R

    2011-01-01

    The integrity of the spinal accessory nerve is fundamental to thoracoscapular function and essential for scapulohumeral rhythm. This nerve is vulnerable along its superficial course. This study assessed the delay in diagnosis and referral for management of damage to this nerve, clarified its anatomical course and function, and documented the results of repair. From examination of our records, 111 patients with lesions of the spinal accessory nerve were treated between 1984 and 2007. In 89 patients (80.2%) the damage was iatropathic. Recognition and referral were seldom made by the surgeon responsible for the injury, leading to a marked delay in instituting treatment. Most referrals were made for painful loss of shoulder function. The clinical diagnosis is straightforward. There is a characteristic downward and lateral displacement of the scapula, with narrowing of the inferior scapulohumeral angle and loss of function, with pain commonly present. In all, 80 nerves were explored and 65 were repaired. The course of the spinal accessory nerve in relation to the sternocleidomastoid muscle was constant, with branches from the cervical plexus rarely conveying motor fibres. Damage to the nerve was predominantly posterior to this muscle. Despite the delay, the results of repair were surprising, with early relief of pain, implying a neuropathic source, which preceded generally good recovery of muscle function. PMID:21196545

  3. Bilateral Abducent Nerve Palsy After Neck Trauma: A Case Report

    PubMed Central

    Aminiahidashti, Hamed; Shafiee, Sajad; Sazegar, Mohammad; Nosrati, Nazanin

    2016-01-01

    Introduction The abducent nucleus is located in the upper part of the rhomboid fossa beneath the fourth ventricle in the caudal portion of the pons. The abducent nerve courses from its nucleus, to innervate the lateral rectus muscle. This nerve has the longest subarachnoid course of all the cranial nerves, it is the cranial nerve most vulnerable to trauma. It has been reported that 1% to 2.7% of all head injuries are followed by unilateral abducent palsy, but bilateral abducent nerve palsy is extremely rare. Case Presentation A 65-year-old woman presented to the emergency department following a motor vehicle accident. A neurological assessment showed the patient’s Glascow coma scale (GCS) to be 15. She complained of double vision, and we found lateral gaze palsy in both eyes. A hangman fracture type IIA (C2 fracture with posterior ligamentous C1 - C2 distraction) was found on the cervical CT scan. A three-month follow-up of the patient showed complete recovery of the abducent nerve. Conclusions Conservative treatment is usually recommended for traumatic bilateral abducent nerve palsy. Our patient recovered from this condition after three months without any remaining neurological deficit, a very rare outcome in a rare case. PMID:27218062

  4. Delivery of Topically Applied Calpain Inhibitory Peptide to the Posterior Segment of the Rat Eye

    PubMed Central

    Yamashita, Tetsuro; Ishiguro, Sei-ichi

    2015-01-01

    We developed an inhibitory peptide that specifically acts against mitochondrial μ-calpain (Tat-μCL, 23 amino acid, 2857.37 Da) and protects photoreceptors in retinal dystrophic rats. In the present study, we topically administered Tat-μCL to the eyes of Sprague-Dawley rats for 7 days to determine both the delivery route of the peptide to the posterior segment of the eye and the kinetics after topical application in adult rats. Distribution of the peptide was determined by immunohistochemical analysis, and enzyme-linked immune-absorbent assay was used to quantify the accumulation in the retina. Peptides were prominently detected in both the anterior and posterior segments of the eye at 1 h after the final eye drop application. Immunohistochemically positive reactions were observed in the retina, optic nerve, choroid, sclera and the retrobulbar tissues, even in the posterior portion of the eye. Immunoactivities gradually diminished at 3 and 6 h after the final eye drop. Quantitative estimations of the amount of peptide in the retina were 15.3, 5.8 and 1.0 pg/μg protein at 1, 3 and 6 h after the final instillation, respectively. Current results suggest that while the topically applied Tat-μCL peptide reaches the posterior segment of the retina and the optic nerve, the sufficient concentration (> IC50) is maintained for at least 6 h in the rat retina. Our findings suggest that delivery of topically applied peptide to the posterior segment and optic nerve occurs through the conjunctiva, periocular connective tissue, sclera and optic nerve sheath. PMID:26107400

  5. Optic Nerve Decompression

    MedlinePlus

    ... canals). The optic nerve is the “nerve of vision” and extends from the brain, through your skull, and into your eye. A ... limited to, the following: loss of vision, double vision, inadequate ... leakage of brain fluid (CSF), meningitis, nasal bleeding, infection of the ...

  6. Intraoperative vagal nerve monitoring.

    PubMed

    Leonetti, J P; Jellish, W S; Warf, P; Hudson, E

    1996-08-01

    A variety of benign and malignant neoplasms occur in the superior cervical neck, parapharyngeal space or the infratemporal fossa. The surgical resection of these lesions may result in postoperative iatrogenic injury to the vagus nerve with associated dysfunctional swallowing and airway protection. Anatomic and functional preservation of this critical cranial nerve will contribute to a favorable surgical outcome. Fourteen patients with tumors of the cervical neck or adjacent skull base underwent intraoperative vagal nerve monitoring in an attempt to preserve neural integrity following tumor removal. Of the 11 patients with anatomically preserved vagal nerves in this group, seven patients had normal vocal cord mobility following surgery and all 11 patients demonstrated normal vocal cord movement by six months. In an earlier series of 23 patients with tumors in the same region who underwent tumor resection without vagal nerve monitoring, 18 patients had anatomically preserved vagal nerves. Within this group, five patients had normal vocal cord movement at one month and 13 patients demonstrated normal vocal cord movement at six months. This paper will outline a technique for intraoperative vagal nerve monitoring utilizing transcricothyroid membrane placement of bipolar hook-wire electrodes in the vocalis muscle. Our results with the surgical treatment of cervical neck and lateral skull base tumors for patients with unmonitored and monitored vagal nerves will be outlined. PMID:8828272

  7. Distal median nerve dysfunction

    MedlinePlus

    ... Names Neuropathy - distal median nerve Images Central nervous system and peripheral nervous system References Jarvik JG, Comstock BA, Kliot M, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomized ... D. Disorders of peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, ...

  8. Robotic intercostal nerve harvest: a feasibility study in a pig model.

    PubMed

    Miyamoto, Hideaki; Serradori, Thomas; Mikami, Yoji; Selber, Jesse; Santelmo, Nicola; Facca, Sybille; Liverneaux, Philippe

    2016-01-01

    The aim of this study was to report the feasibility of robotic intercostal nerve harvest in a pig model. A surgical robot, the da Vinci Model S system, was installed after the creation of 3 ports in the pig's left chest. The posterior edges of the fourth, fifth, and sixth intercostal nerves were isolated at the level of the anterior axillary line. The anterior edges of the nerves were transected at the rib cartilage zone. Three intercostal nerve harvesting procedures, requiring an average of 33 minutes, were successfully performed in 3 pigs without major complications. The advantages of robotic microsurgery for intercostal nerve harvest include elimination of physiological tremor, free movement of joint-equipped robotic arms, and amplification of the surgeon's hand motion by as much as 5 times. Robot-assisted neurolysis may be clinically useful for intercostal nerve harvest for brachial plexus reconstruction. PMID:26207601

  9. Stereolithography for Posterior Fossa Cranioplasty

    PubMed Central

    Agner, Celso; Dujovny, Manuel; Evenhouse, Raymond; Charbel, Fady T.; Sadler, Lewis

    1998-01-01

    Posterior fossa cranioplasty has been suggested for improvement of neurological symptoms following craniectomy. However, there is no particular recommendation in the literature about techniques for prosthesis manufacture and implantation. We report our experience using rapid prototyping technology and stereolithography for pre-surgical implant design and production of cranioplasties. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5 PMID:17171056

  10. Posterior Tibial Tendon Dysfunction (PTTD)

    MedlinePlus

    ... ACFAS | Información en Español Advanced Search Home » Foot & Ankle Conditions » Posterior Tibial Tendon Dysfunction (PTTD) Text Size ... the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. ...

  11. Type 2 Superior Labral Anterior to Posterior Lesion-Related Paralabral Cyst Causing Isolated Infraspinatus Paralysis: Two Case Reports.

    PubMed

    Lee, Yong Ki; Han, Eun Young; Choi, Sung Wook; Kim, Bo Ryun; Suh, Min Ji

    2015-10-01

    Type 2 superior labral anterior to posterior (SLAP) lesion is a common cause of shoulder pain requiring surgical operation. SLAP tears are often associated with paralabral cysts, but they rarely cause nerve compression. However, we experienced two cases of type 2 SLAP-related paralabral cysts at the spinoglenoid notch which were confirmed as isolated nerve entrapment of the infraspinatus branch of the suprascapular nerve by electrodiagnostic assessment and magnetic resonance imaging. In these pathological conditions, comprehensive electrodiagnostic evaluation is warranted for confirmation of neuropathy, while surgical decompression of the paralabral cyst combined with SLAP repair is recommended. PMID:26605185

  12. Preoperative transcutaneous electrical nerve stimulation for localizing superficial nerve paths.

    PubMed

    Natori, Yuhei; Yoshizawa, Hidekazu; Mizuno, Hiroshi; Hayashi, Ayato

    2015-12-01

    During surgery, peripheral nerves are often seen to follow unpredictable paths because of previous surgeries and/or compression caused by a tumor. Iatrogenic nerve injury is a serious complication that must be avoided, and preoperative evaluation of nerve paths is important for preventing it. In this study, transcutaneous electrical nerve stimulation (TENS) was used for an in-depth analysis of peripheral nerve paths. This study included 27 patients who underwent the TENS procedure to evaluate the peripheral nerve path (17 males and 10 females; mean age: 59.9 years, range: 18-83 years) of each patient preoperatively. An electrode pen coupled to an electrical nerve stimulator was used for superficial nerve mapping. The TENS procedure was performed on patients' major peripheral nerves that passed close to the surgical field of tumor resection or trauma surgery, and intraoperative damage to those nerves was apprehensive. The paths of the target nerve were detected in most patients preoperatively. The nerve paths of 26 patients were precisely under the markings drawn preoperatively. The nerve path of one patient substantially differed from the preoperative markings with numbness at the surgical region. During surgery, the nerve paths could be accurately mapped preoperatively using the TENS procedure as confirmed by direct visualization of the nerve. This stimulation device is easy to use and offers highly accurate mapping of nerves for surgical planning without major complications. The authors conclude that TENS is a useful tool for noninvasive nerve localization and makes tumor resection a safe and smooth procedure. PMID:26420473

  13. Regeneration of posterior segments and terminal structures in the bearded fireworm, Hermodice carunculata (Annelida: Amphinomidae).

    PubMed

    Ahrens, Joseph B; Kudenov, Jerry D; Marshall, Christopher D; Schulze, Anja

    2014-10-01

    Like many other annelids, bearded fireworms, Hermodice carunculata, are capable of regenerating posterior body segments and terminal structures lost to amputation. Although previous research has examined anterior regeneration in other fireworm species, posterior regenerative ability in fireworms remains poorly studied. As the morphology of the anal lobe (a small, fleshy terminal structure of unknown function) has been used to distinguish East and West Atlantic H. carunculata populations, there is a more imminent need to understand the morphology and organization of tissues in specimens undergoing posterior regeneration, and the timeframe in which significant developmental changes occur. To further investigate this phenomenon, we amputated the posterior segments of living H. carunculata specimens collected from the Gulf of Mexico and monitored posterior regeneration over a 6-month study period. Although many aspects of posterior regeneration in H. carunculata are consistent with the findings of other annelid regeneration studies, histological analysis revealed that once formed, anal lobe morphology remains relatively unchanged at all stages of posterior regeneration; East Atlantic morphotypes were not observed in the West Atlantic specimens studied here. Additionally, we found that the ventral nerve chord, which is partially responsible for the regeneration of lost body parts in polychaete annelids, terminates within the anal lobe, suggesting that this structure may play a role in the formation of new segments. PMID:24796944

  14. Bevacizumab for the treatment of a complicated posterior melanocytoma

    PubMed Central

    Urrets-Zavalia, Julio A; Crim, Nicolas; Esposito, Evangelina; Correa, Leandro; Gonzalez-Castellanos, M Eugenia; Martinez, Dana

    2015-01-01

    Purpose To present a case of a complicated posterior melanocytoma that was successfully treated with intravitreal bevacizumab. Case report A 50-year-old Caucasian man was referred with sudden-onset metamorphopsia and decreased vision in his right eye over the course of the last 2 months. His best-corrected visual acuity was 20/80 and poorer than Jaeger 14 in the right eye, and 20/20 and Jaeger 1 in his left eye. In the right fundus, there was a melanocytic lesion occupying the inferotemporal quadrant of the optic disk, extending to the adjacent choroid inferiorly; optic nerve edema, superotemporal retinal vein dilatation, and subretinal fluid under the macula and nasal half of the posterior pole were observed, and a subretinal choroidal neovascularization complex was observed adjacent to the superotemporal margin of the optic disk, confirmed by fluorescein angiography, surrounded by a dense subretinal hemorrhage. Optical coherence tomography showed retinal edema and detachment of neurosensory retina. The patient was treated with three consecutive doses on a monthly basis of intravitreal 1.25 mg/0.05 mL bevacizumab. Visual acuity recovered rapidly, and at 4 months after treatment, it was 20/20 and Jaeger 1, with complete resolution of macular edema and subretinal fluid and hemorrhage. After 3 years of follow-up, best-corrected visual acuity remained stable, macular area was normal, and there was no evident optic nerve edema, retinal vein caliber and aspect were normal, and there was no significant change of the tumor. Fluorescein angiography only evidenced late staining of choroidal neovascularization scar, and optical coherence tomography showed a normal macular anatomy. Conclusion Intravitreal bevacizumab was effective in the treatment of choroidal neovascularization, optic nerve edema, venous dilatation, and local capillary telangiectasia, complicating an optic disk melanocytoma. PMID:25834382

  15. Avoiding injury to the inferior alveolar nerve by routine use of intraoperative radiographs during implant placement.

    PubMed

    Burstein, Jeffrey; Mastin, Chris; Le, Bach

    2008-01-01

    Injury to the inferior alveolar nerve during implant placement in the posterior atrophic mandible is a rare but serious complication. Although a preoperative computerized tomography scan can help determine the distance from the alveolar ridge to the nerve canal, variables such as magnification errors, ridge anatomy, and operator technique can increase the chance for complications. The routine use of intraoperative periapical radiographs during the drilling sequence is an inexpensive and reliable tool, allowing the operator to confidently adjust the direction and depth of the implant during placement. Most important, it helps avoid the risk of injury to the inferior alveolar nerve in cases in which there is limited vertical alveolar bone. Using this technique for 21 implants placed in the posterior atrophic mandible, with less than 10 mm of vertical bone to the inferior alveolar nerve canal, the authors observed no incidents of postoperative paresthesia. PMID:18390241

  16. Muscle fatigue increases beta-band coherence between the firing times of simultaneously active motor units in the first dorsal interosseous muscle.

    PubMed

    McManus, Lara; Hu, Xiaogang; Rymer, William Z; Suresh, Nina L; Lowery, Madeleine M

    2016-06-01

    Synchronization between the firing times of simultaneously active motor units (MUs) is generally assumed to increase during fatiguing contractions. To date, however, estimates of MU synchronization have relied on indirect measures, derived from surface electromyographic (EMG) interference signals. This study used intramuscular coherence to investigate the correlation between MU discharges in the first dorsal interosseous muscle during and immediately following a submaximal fatiguing contraction, and after rest. Coherence between composite MU spike trains, derived from decomposed surface EMG, were examined in the delta (1-4 Hz), alpha (8-12 Hz), beta (15-30 Hz), and gamma (30-60 Hz) frequency band ranges. A significant increase in MU coherence was observed in the delta, alpha, and beta frequency bands postfatigue. In addition, wavelet coherence revealed a tendency for delta-, alpha-, and beta-band coherence to increase during the fatiguing contraction, with subjects exhibiting low initial coherence values displaying the greatest relative increase. This was accompanied by an increase in MU short-term synchronization and a decline in mean firing rate of the majority of MUs detected during the sustained contraction. A model of the motoneuron pool and surface EMG was used to investigate factors influencing the coherence estimate. Simulation results indicated that changes in motoneuron inhibition and firing rates alone could not directly account for increased beta-band coherence postfatigue. The observed increase is, therefore, more likely to arise from an increase in the strength of correlated inputs to MUs as the muscle fatigues. PMID:26984420

  17. C2 nerve dysfunction associated with C1 lateral mass screw fixation.

    PubMed

    Huang, Da-geng; Hao, Ding-jun; Li, Guang-lin; Guo, Hao; Zhang, Yu-chen; He, Bao-rong

    2014-11-01

    The C1 lateral mass screw technique is widely used for atlantoaxial fixation. However, C2 nerve dysfunction may occur as a complication of this procedure, compromising the quality of life of affected patients. This is a review of the topic of C2 nerve dysfunction associated with C1 lateral mass screw fixation and related research developments. The C2 nerve root is located in the space bordered superiorly by the posterior arch of C1 , inferiorly by the C2 lamina, anteriorly by the lateral atlantoaxial joint capsule, and posteriorly by the anterior edge of the ligamentum flavum. Some surgeons suggest cutting the C2 nerve root during C1 lateral mass screw placement, whereas others prefer to preserve it. The incidence, clinical manifestations, causes, management, and prevention of C2 nerve dysfunction associated with C(1) lateral mass screw fixation are reviewed. Sacrifice of the C2 nerve root carries a high risk of postoperative numbness, whereas postoperative nerve dysfunction can occur when it has been preserved. Many surgeons have been working hard on minimizing the risk of postoperative C2 nerve dysfunction associated with C1 lateral mass screw fixation. PMID:25430709

  18. Mental nerve paresthesia secondary to initiation of endodontic therapy: a case report

    PubMed Central

    Alam, Sharique; Zia, Afaf; Khan, Masood Hasan; Kumar, Ashok

    2014-01-01

    Whenever endodontic therapy is performed on mandibular posterior teeth, damage to the inferior alveolar nerve or any of its branches is possible. Acute periapical infection in mandibular posterior teeth may also sometimes disturb the normal functioning of the inferior alveolar nerve. The most common clinical manifestation of these insults is the paresthesia of the inferior alveolar nerve or mental nerve paresthesia. Paresthesia usually manifests as burning, prickling, tingling, numbness, itching or any deviation from normal sensation. Altered sensation and pain in the involved areas may interfere with speaking, eating, drinking, shaving, tooth brushing and other events of social interaction which will have a disturbing impact on the patient. Paresthesia can be short term, long term or even permanent. The duration of the paresthesia depends upon the extent of the nerve damage or persistence of the etiology. Permanent paresthesia is the result of nerve trunk laceration or actual total nerve damage. Paresthesia must be treated as soon as diagnosed to have better treatment outcomes. The present paper describes a case of mental nerve paresthesia arising after the start of the endodontic therapy in left mandibular first molar which was managed successfully by conservative treatment. PMID:25110646

  19. Identification of facial nerve during parotidectomy: a combined anatomical & surgical study.

    PubMed

    Saha, Somnath; Pal, Sudipta; Sengupta, Moushumi; Chowdhury, Kanishka; Saha, Vedula Padmini; Mondal, Lopamudra

    2014-01-01

    To find out the most easily identifiable and anatomically consistent landmark for identification of facial nerve during parotid surgery. Ten cadaveric dissections and ten live parotid surgeries for different types of parotid tumours were done. Cadaveric dissection was performed in the Department of Anatomy and the surgeries were done in the Department of ENT and Head and Neck surgery of R. G. Kar Medical College of Kolkata. The distance of the facial nerve trunk from three most commonly used landmarks (viz., tympanomastoid suture, tragal pointer and posterior belly of digastric muscle) was measured in both cadaver and live patients. The ease of identification of the nerve trunk using each of the landmarks, particularly during live surgery was also assessed. The mean distance of the tympanomastoid suture from the facial nerve trunk was 3.5 mm (cadaver) and 3.87 mm (live surgery), the tragal pointer was found to be at a mean distance of 16.61 mm (cadaver) and 16.36 mm (live surgery) and in case of the posterior belly of digastric muscle it was 7.41 mm (cadaver) and 8.03 mm (live surgery). During live surgery the posterior belly of digastric was found to be the most easily identifiable landmark with a consistent anatomical relationship with the nerve trunk. The posterior belly of digastric muscle is the most easily identifiable and a very consistent landmark for facial nerve dissection during parotidectomy. When supplemented with the tragal pointer, accuracy in identifying the facial nerve trunk is very high, thereby avoiding inadvertent injury to the nerve trunk. PMID:24605304

  20. Radial Nerve Tendon Transfers.

    PubMed

    Cheah, Andre Eu-Jin; Etcheson, Jennifer; Yao, Jeffrey

    2016-08-01

    Radial nerve palsy typically occurs as a result of trauma or iatrogenic injury and leads to the loss of wrist extension, finger extension, thumb extension, and a reduction in grip strength. In the absence of nerve recovery, reconstruction of motor function involves tendon transfer surgery. The most common donor tendons include the pronator teres, wrist flexors, and finger flexors. The type of tendon transfer is classified based on the donor for the extensor digitorum communis. Good outcomes have been reported for most methods of radial nerve tendon transfers as is typical for positional tendon transfers not requiring significant power. PMID:27387076

  1. Peripapillary and posterior scleral mechanics--part I: development of an anisotropic hyperelastic constitutive model.

    PubMed

    Girard, Michaël J A; Downs, J Crawford; Burgoyne, Claude F; Suh, J-K Francis

    2009-05-01

    The sclera is the white outer shell and principal load-bearing tissue of the eye as it sustains the intraocular pressure. We have hypothesized that the mechanical properties of the posterior sclera play a significant role in and are altered by the development of glaucoma-an ocular disease manifested by structural damage to the optic nerve head. An anisotropic hyperelastic constitutive model is presented to simulate the mechanical behavior of the posterior sclera under acute elevations of intraocular pressure. The constitutive model is derived from fiber-reinforced composite theory, and incorporates stretch-induced stiffening of the reinforcing collagen fibers. Collagen fiber alignment was assumed to be multidirectional at local material points, confined within the plane tangent to the scleral surface, and described by the semicircular von Mises distribution. The introduction of a model parameter, namely, the fiber concentration factor, was used to control collagen fiber alignment along a preferred fiber orientation. To investigate the effects of scleral collagen fiber alignment on the overall behaviors of the posterior sclera and optic nerve head, finite element simulations of an idealized eye were performed. The four output quantities analyzed were the scleral canal expansion, the scleral canal twist, the posterior scleral canal deformation, and the posterior laminar deformation. A circumferential fiber organization in the sclera restrained scleral canal expansion but created posterior laminar deformation, whereas the opposite was observed with a meridional fiber organization. Additionally, the fiber concentration factor acted as an amplifying parameter on the considered outputs. The present model simulation suggests that the posterior sclera has a large impact on the overall behavior of the optic nerve head. It is therefore primordial to provide accurate mechanical properties for this tissue. In a companion paper (Girard, Downs, Bottlang, Burgoyne, and Suh, 2009

  2. High Ulnar Nerve Injuries: Nerve Transfers to Restore Function.

    PubMed

    Patterson, Jennifer Megan M

    2016-05-01

    Peripheral nerve injuries are challenging problems. Nerve transfers are one of many options available to surgeons caring for these patients, although they do not replace tendon transfers, nerve graft, or primary repair in all patients. Distal nerve transfers for the treatment of high ulnar nerve injuries allow for a shorter reinnervation period and improved ulnar intrinsic recovery, which are critical to function of the hand. PMID:27094893

  3. Posterior cruciate ligament of the knee (image)

    MedlinePlus

    The posterior cruciate ligament (PCL) is a powerful ligament extending from the top-rear surface of the tibia to the bottom-front surface of the femur. The ligament prevents the knee joint from posterior instability.

  4. [Blood vessel and nerve damage in total hip arthroplasty].

    PubMed

    Dietze, S; Perka, C; Baecker, H

    2014-01-01

    Blood vessel and nerve damage are uncommon complications in total hip arthroplasty (THA). With an incidence between 0.1 and 0.2 % in primary THA these complications are rare but can be serious with a high mortality risk. The individual risk is determined by multiple factors depending on the surgeon's skills, the number of previous surgeries and the approach itself. The anatomy of the defect is an essential risk factor. Some procedures, such as the use of screws for cup fixation are associated with a higher risk of vascular and neural damage. The acetabular quadrant system of the hip as described by Wasielewski et al. is a useful tool to visualize the neurovascular anatomy of the hip, to detect the safe zone and subsequently prevent complications. Sciatic nerve palsy after total hip replacement is the most common nerve damage followed by femoral nerve damage. Previous surgery, a posterior approach and excessive leg extension are the most common risk factors for nerve damage. In order to diagnose nerve palsy after orthopedic surgery an electromyogram can be of use to assess the extent and prognosis. This article focuses on vascular and neural complications after total hip arthroplasty and the options for diagnosis, treatment and prevention. PMID:24384891

  5. Bilateral posterior cerebral artery infarction.

    PubMed

    Ryan, Davinia; Murphy, Sinead M; Hennessey, Michael J

    2010-01-01

    We report the case of a 70-year-old man who presented with short-term memory impairment and a homonymous left inferior quadrantanopia secondary to simultaneous bilateral posterior cerebral artery (PCA) territory infarction. As in more than a quarter of cases of PCA infarction, no aetiological cause was identified. Unlike the transient nature of symptoms in some cases following unilateral infarction, his deficits persisted on 2-month follow-up. PMID:22798298

  6. α-Synuclein pathology in the cranial and spinal nerves in Lewy body disease.

    PubMed

    Nakamura, Keiko; Mori, Fumiaki; Tanji, Kunikazu; Miki, Yasuo; Toyoshima, Yasuko; Kakita, Akiyoshi; Takahashi, Hitoshi; Yamada, Masahito; Wakabayashi, Koichi

    2016-06-01

    Accumulation of phosphorylated α-synuclein in neurons and glial cells is a histological hallmark of Lewy body disease (LBD) and multiple system atrophy (MSA). Recently, filamentous aggregations of phosphorylated α-synuclein have been reported in the cytoplasm of Schwann cells, but not in axons, in the peripheral nervous system in MSA, mainly in the cranial and spinal nerve roots. Here we conducted an immunohistochemical investigation of the cranial and spinal nerves and dorsal root ganglia of patients with LBD. Lewy axons were found in the oculomotor, trigeminal and glossopharyngeal-vagus nerves, but not in the hypoglossal nerve. The glossopharyngeal-vagus nerves were most frequently affected, with involvement in all of 20 subjects. In the spinal nerve roots, Lewy axons were found in all of the cases examined. Lewy axons in the anterior nerves were more frequent and numerous in the thoracic and sacral segments than in the cervical and lumbar segments. On the other hand, axonal lesions in the posterior spinal nerve roots appeared to increase along a cervical-to-sacral gradient. Although Schwann cell cytoplasmic inclusions were found in the spinal nerves, they were only minimal. In the dorsal root ganglia, axonal lesions were seldom evident. These findings indicate that α-synuclein pathology in the peripheral nerves is axonal-predominant in LBD, whereas it is restricted to glial cells in MSA. PMID:26563477

  7. Spinal hemianesthesia: Unilateral and posterior

    PubMed Central

    Imbelloni, Luiz Eduardo

    2014-01-01

    The injection of a non-isobaric local anesthetic should induce a unilateral spinal anesthesia in patients in a lateral decubitus position. The posterior spinal hemianesthesia only be obtained with hypobaric solutions injected in the jackknife position. The most important factors to be considered when performing a spinal hemianesthesia are: type and gauge of the needle, density of the local anesthetic relative to the CSF, position of the patient, speed of administration of the solution, time of stay in position, and dose/concentration/volume of the anesthetic solution. The distance between the spinal roots on the right-left sides and anterior-posterior is, approximately, 10-15 mm. This distance allows performing unilateral spinal anesthesia or posterior spinal anesthesia. The great advantage of obtaining spinal hemianesthesia is the reduction of cardiovascular changes. Likewise, both the dorsal and unilateral sensory block predominates in relation to the motor block. Because of the numerous advantages of producing spinal hemianesthesia, anesthesiologists should apply this technique more often. This review considers the factors which are relevant, plausible and proven to obtain spinal hemianesthesia. PMID:25886320

  8. Degenerative Nerve Diseases

    MedlinePlus

    Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many of these diseases are genetic. Sometimes the cause is a medical ...

  9. Common peroneal nerve dysfunction

    MedlinePlus

    ... people: Who are very thin (for example, from anorexia nervosa ) Who have certain autoimmune conditions, such as ... Elsevier; 2013:chap 22. Read More Alertness - decreased Anorexia Broken bone Diabetes and nerve damage Mononeuritis multiplex ...

  10. Ulnar nerve dysfunction

    MedlinePlus

    ... pressure on the elbow An elbow fracture or dislocation Temporary pain and tingling of this nerve can ... Saunders; 2011:chap 428. Read More Broken bone Dislocation Mononeuritis multiplex Mononeuropathy Myelin Peripheral neuropathy Systemic Update ...

  11. Diabetic Nerve Problems

    MedlinePlus

    ... at the wrong times. This damage is called diabetic neuropathy. Over half of people with diabetes get ... you change positions quickly Your doctor will diagnose diabetic neuropathy with a physical exam and nerve tests. ...

  12. Ulnar nerve dysfunction

    MedlinePlus

    ... surface of the body where it crosses the elbow. The damage destroys the nerve covering ( myelin sheath) ... be caused by: Long-term pressure on the elbow An elbow fracture or dislocation Temporary pain and ...

  13. Femoral nerve dysfunction

    MedlinePlus

    Neuropathy - femoral nerve; Femoral neuropathy ... Craig EJ, Clinchot DM. Femoral neuropathy. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation . 3rd ...

  14. Diabetic Nerve Problems

    MedlinePlus

    ... the wrong times. This damage is called diabetic neuropathy. Over half of people with diabetes get it. ... change positions quickly Your doctor will diagnose diabetic neuropathy with a physical exam and nerve tests. Controlling ...

  15. Femoral nerve dysfunction

    MedlinePlus

    ... An abnormal knee reflex Smaller than normal quadriceps muscles on the front of the thigh Tests that may be done include: Electromyography ( EMG ) Nerve conduction tests ( NCV ), usually done at ...

  16. Schwannoma of Extraocular Nerves

    PubMed Central

    Niazi, Wasim; Boggan, James E.

    1994-01-01

    An unusual case of schwannoma arising from the third cranial nerve in a thirteen year old male is reported. The patient presented with paresis of the right oculomotor nerve and ipsilateral hemiparesis. The clinical features of this case are discussed and the pertinent medical literature reviewed. ImagesFigure 1p220-bFigure 2Figure 3Figure 4Figure 5Figure 6 PMID:17171175

  17. Triad of torticollis, photophobia and epiphora in a child with a posterior fossa tumor

    PubMed Central

    Buijsrogge, Michiel; Dauwe, Caroline; Delbeke, Patricia

    2014-01-01

    A 7-month-old Caucasian girl presented with an acquired, spasmodic torticollis to the right side with the head tilted downwards, photophobia and epiphora. Diagnostic work-out revealed a posterior fossa pilocytic astrocytoma. The symptoms improved after surgical resection. There is evidence of internuclear connections between cranial nerves II, V and VII acting as important mechanisms in this triad (Okamoto et al. 2010).

  18. Sural nerve defects after nerve biopsy or nerve transfer as a sensory regeneration model for peripheral nerve conduit implantation.

    PubMed

    Radtke, C; Kocsis, J D; Reimers, K; Allmeling, C; Vogt, P M

    2013-09-01

    Nerve repair after injury can be effectively accomplished by direct suture approximation of the proximal and distal segments. This is more successful if coadaptation can be achieved without tension. Currently, the gold standard repair of larger deficits is the transplantation of an autologous sensory sural nerve graft. However, a significant disadvantage of this technique is the inevitable donor morbidity (sensory loss, neuroma and scar formation) after harvesting of the sural nerve. Moreover, limitation of autologous donor nerve length and fixed diameter of the available sural nerve are major drawbacks of current autograft treatment. Another approach that was introduced for nerve repair is the implantation of alloplastic nerve tubes made of, for example, poly-L-lactide. In these, nerve stumps of the transected nerves are surgically bridged using the biosynthetic conduit. A number of experimental studies, primarily in rodents, indicate axonal regeneration and remyelination after implantation of various conduits. However, only limited clinical studies with conduit implantation have been performed in acute peripheral nerve injuries particularly on digital nerves. Clinical transfer of animal studies, which can be carefully calibrated for site and extent of injury, to humans is difficult to interpret due to the intrinsic variability in human nerve injuries. This prevents effective quantification of improvement and induces bias in the study. Therefore, standardization of lesion/repair in human studies is warranted. Here we propose to use sural nerve defects, induced due to nerve graft harvesting or from diagnostic nerve biopsies as a model site to enable standardization of nerve conduit implantation. This would help better with the characterization of the implants and its effectiveness in axonal regeneration and remyelination. Nerve regeneration can be assessed, for example, by recovery of sensation, measured non-invasively by threshold to von Frey filaments and cold

  19. Catheter-Based Transepidural Approach to Cervical and Thoracic Posterior and Perineural Epidural Spaces: A Cadaveric Feasibility Study

    PubMed Central

    Qureshi, Adnan I.; Qureshi, Mushtaq H.; Malik, Ahmed A.; Khan, Asif A.; Sohail, Amna; Saed, Aveen; Jadhav, Vikram

    2015-01-01

    BACKGROUND AND OBJECTIVES Approaching the cervical and high thoracic level epidural space through transepidural route from lumbar region represents a method to lower the occurrence of complications associated with direct approach. The authors performed a cadaveric pilot project to determine the feasibility of various catheter-based manipulation and cephalad advancement using the transepidural route. STUDY DESIGN AND METHODS Two cadavers were used to determine the following: 1. Ability to place a guide sheath over a guidewire using a percutaneous approach within the posterior lumbar epidural space; 2. The highest vertebral level catheter can be advanced within the posterior epidural space; 3. Ability to cross midline within the posterior epidural space; and 4. Ability to catheterize the perineural epidural sheaths of the nerve roots exiting at cervical and thoracic vertebral levels. RESULTS We were able to advance the catheters up to the level of cervical vertebral level of C2 within the posterior epidural space under fluoroscopic guidance from a sheath inserted via oblique parasagittal approach at the lumbar L4–L5 intervertebral space. We were able to cross midline within the posterior epidural space and catheterize multiple perineural epidural sheaths of the nerve roots exiting at cervical vertebral level of C2, C3, and C4 on ipsilateral or contralateral sides. We also catheterized multiple epidural sheaths that surround the nerve roots exiting at the thoracic vertebral level on ipsilateral or contralateral sides. CONCLUSIONS We were able to advance a catheter or microcatheter up to the cervical vertebral level within the posterior epidural space and catheterize the perineural epidural sheath of the nerve root exiting at cervical and thoracic vertebral levels. Such observations support further exploration of percutaneous catheter based transepidural approach to cervical and thoracic dorsal epidural spaces for therapeutic interventions. PMID:26060530

  20. Influence of muscle temperature during fatiguing work with the first dorsal interosseous muscle in man: a 31P-NMR spectroscopy study.

    PubMed

    Wade, A J; Broadhead, M W; Cady, E B; Llewelyn, M E; Tong, H N; Newham, D J

    2000-02-01

    Six healthy subjects rapidly lifted and lowered a small (250 g) weight with the first dorsal interosseous muscle (FDI) of one hand while the work performed was recorded continuously until fatigue (defined as losing the ability to continue lifting). Work was recorded in units of chart recorder trace displacement from baseline (centimeters) as an isotonic transducer followed the movement of the weight. In all experiments, the temperature of the hand was first adjusted by immersion in a controlled-temperature water bath. In the warmest condition, the skin surface temperature over the FDI was 30.5(0.30) degrees C [mean (SE)]. After moderate cooling, this surface temperature was 21.5(0.16) degrees C. Cooling significantly reduced the time taken to reach fatigue and more than halved the work capacity. An intermediate degree of cooling was also used in four subjects, showing that most of the effects seen were changing incrementally. Before work, and at fatigue, intracellular metabolic conditions in the FDI were studied by phosphorus nuclear magnetic resonance (31P-NMR) spectroscopy, with occlusion of the blood flow maintained during measurements. The mean intracellular pH of the FDI was also calculated. The changes observed were all consistent with the fact that intense work requires energy which must be derived largely from intracellular stores of phosphocreatine and glycogen. Less work made less demand upon reserves, and created lower concentrations of waste products and by-products. The observations did not, however, allow us to explain why fatigue occurred at a particular point or why work capacity was reduced by cooling. PMID:10638378

  1. Morphology of nerve endings in vocal fold of human newborn.

    PubMed

    Gonçalves da Silva Leite, Janaina; Costa Cavalcante, Maria Luzete; Fechine-Jamacaru, Francisco Vagnaldo; de Lima Pompeu, Margarida Maria; Leite, José Alberto Dias; Nascimento Coelho, Dulce Maria; Rabelo de Freitas, Marcos

    2016-10-01

    Sensory receptors are distributed throughout the oral cavity, pharynx, and larynx. Laryngeal sensitivity is crucial for maintaining safe swallowing, thus avoiding silent aspiration. Morphologic description of different receptor types present in larynx vary because of the study of many different species, from mouse to humans. The most commonly sensory structures described in laryngeal mucosa are free nerve endings, taste buds, muscle spindles, glomerular and corpuscular receptors. This study aimed at describing the morphology and the distribution of nerve endings in premature newborn glottic region. Transversal serial frozen sections of the whole vocal folds of three newborns were analyzed using an immuno-histochemical process with a pan-neuronal marker anti-protein gene product 9.5 (PGP 9.5). Imaging was done using a confocal laser microscope. Nerve fiber density in vocal cord was calculated using panoramic images in software Morphometric Analysis System v1.0. Some sensory structures, i.e. glomerular endings and intraepithelial free nerve endings were found in the vocal cord mucosa. Muscle spindles, complex nerve endings (Meissner-like, spherical, rectangular and growing) spiral-wharves nerve structures were identified in larynx intrinsic muscles. Nervous total mean density in vocal cord was similar in the three newborns, although they had different gestational age. The mean nerve fiber density was higher in the posterior region than anterior region of vocal cord. The present results demonstrate the occurrence of different morphotypes of sensory corpuscles and nerve endings premature newborn glottic region and provide information on their sensory systems. PMID:27619029

  2. [Biophysics of nerve excitation].

    PubMed

    Kol'e, O R; Maksimov, G V

    2010-01-01

    The studies testifying to the presence of the interrelation between the physiological functions of the organism and physical and chemical processes in nerves are discussed. Changes in some physical and chemical parameters observed both upon elicited rhythmic exaltation of nerves and during the spontaneous rhythmic activity of neurons are analyzed. Upon rhythmic exaltation, a complex of physical and chemical processes is triggered, and reversible structural and metabolic rearrangements at the subcellular and molecular levels occur that do not take place during the generation of a single action potential. Thus, only in conditions of rhythmic exaltation of a nerve, it is possible to reveal those processes that provide exaltation of nerves in the organism. The future possibilities of the investigations combining the biophysical and physiological approaches are substantiated. Characteristic changes in physicochemical parameters are observed in nerves during the generation of a series of action potentials of different frequency and duration ("frequency dependence") under normal physiological conditions, as well as in extreme situations and in nerve pathology. The structural and metabolic rearrangements are directly related to the mode of rhythmic exaltation and proceed both in the course of rhythmic exaltation and after its termination. Participation and the basic components of the nervous fulcrum (an axon, Shwan cell, myelin, subcellular organelles) in the realization of rhythmic exaltation is shown. In the coordination of all processes involved in rhythmic exaltation, the main role is played by the systems of redistribution and transport of intercellular and endocellular calcium. The idea is put forward that myelin of nerve fibers is not only an isolator, but also an "intercellular depot" of calcium and participates in the redistribution of different ions. Thus, the rhythmic excitation is of great importance in the realization of some physiological functions, the

  3. The Relationship of the Facial Nerve to the Condylar Process: A Cadaveric Study with Implications for Open Reduction Internal Fixation

    PubMed Central

    Barham, H. P.; Collister, P.; Eusterman, V. D.; Terella, A. M.

    2015-01-01

    Introduction. The mandibular condyle is the most common site of mandibular fracture. Surgical treatment of condylar fractures by open reduction and internal fixation (ORIF) demands direct visualization of the fracture. This project aimed to investigate the anatomic relationship of the tragus to the facial nerve and condylar process. Materials and Methods. Twelve fresh hemicadavers heads were used. An extended retromandibular/preauricular approach was utilized, with the incision being based parallel to the posterior edge of the ramus. Measurements were obtained from the tragus to the facial nerve and condylar process. Results. The temporozygomatic division of the facial nerve was encountered during each approach, crossing the mandible at the condylar neck. The mean tissue depth separating the facial nerve from the condylar neck was 5.5 mm (range: 3.5 mm–7 mm, SD 1.2 mm). The upper division of the facial nerve crossed the posterior border of the condylar process on average 2.31 cm (SD 0.10 cm) anterior to the tragus. Conclusions. This study suggests that the temporozygomatic division of the facial nerve will be encountered in most approaches to the condylar process. As visualization of the relationship of the facial nerve to condyle is often limited, recognition that, on average, 5.5 mm of tissue separates condylar process from nerve should help reduce the incidence of facial nerve injury during this procedure. PMID:26421016

  4. Partial oculomotor nerve palsy in a 7-year-old child

    PubMed Central

    Israni, Anil; Chakrabarty, Biswaroop; Kumar, Atin; Gulati, Sheffali

    2016-01-01

    Oculomotor nerve palsy can be due to varied causes that include diabetic neuropathy, myasthenia gravis, brainstem infarction, demyelinating conditions, and cerebral aneurysms. Among the aneurysmal causes of oculomotor nerve palsy, aneurysm of the posterior communicating artery has been observed to be the most common. Pupillary dysfunction is considered to be an important feature of aneurysmal oculomotor nerve paresis. A case of a 7-year-old boy with partial oculomotor nerve palsy with pupillary sparing is being reported here, the etiology of which is tortuous and ectatic distal internal carotid artery. This is a rare cause of oculomotor nerve paresis and to the best of our knowledge has not yet been reported in children. Ischemia rather than compression seems to be the most plausible cause in this case. PMID:27606031

  5. Partial oculomotor nerve palsy in a 7-year-old child.

    PubMed

    Israni, Anil; Chakrabarty, Biswaroop; Kumar, Atin; Gulati, Sheffali

    2016-01-01

    Oculomotor nerve palsy can be due to varied causes that include diabetic neuropathy, myasthenia gravis, brainstem infarction, demyelinating conditions, and cerebral aneurysms. Among the aneurysmal causes of oculomotor nerve palsy, aneurysm of the posterior communicating artery has been observed to be the most common. Pupillary dysfunction is considered to be an important feature of aneurysmal oculomotor nerve paresis. A case of a 7-year-old boy with partial oculomotor nerve palsy with pupillary sparing is being reported here, the etiology of which is tortuous and ectatic distal internal carotid artery. This is a rare cause of oculomotor nerve paresis and to the best of our knowledge has not yet been reported in children. Ischemia rather than compression seems to be the most plausible cause in this case. PMID:27606031

  6. Posterior ankyloglossia: a case report.

    PubMed

    Chu, Michael W; Bloom, David C

    2009-06-01

    Ankyloglossia, or tongue-tie, refers to an abnormally short lingual frenulum. Ankyloglossia is a recognized but poorly defined condition and has been reported to cause feeding difficulties, dysarthria, dyspnea, and social or mechanical problems. In infants, the most concerning symptoms are feeding difficulties and inability to breastfeed. While a recent trend toward breastfeeding has brought frenulectomy back into favor, the literature regarding treatment remains inconclusive. We report a case of posterior ankyloglossia with anterior mucosal hooding and a simple, safe, and effective way to treat it to improve breastfeeding. PMID:19303646

  7. Isolated posterior cruciate ligament calcification.

    PubMed

    Koukoulias, Nikolaos E; Papastergiou, Stergios G

    2011-01-01

    The authors present a case of calcified posterior cruciate ligament (PCL). A 61-year-old female presented in our department reporting 12 months history of knee pain that was getting worse during the night. The patient was under medication for epileptic seizure, osteoporosis and hyperthyroidism. X-rays demonstrated calcification of the PCL. CT and MRI excluded any other intra-articular and extra-articular pathology. Arthroscopic debridement of the calcium deposits was performed and the symptoms resolved immediately, while the postoperative x-rays were normal. Histological examination confirmed the calcium nature of the lesion. Two years postoperatively the patient remains asymptomatic. PMID:22669889

  8. Isolated posterior cruciate ligament calcification

    PubMed Central

    Koukoulias, Nikolaos E; Papastergiou, Stergios G

    2011-01-01

    The authors present a case of calcified posterior cruciate ligament (PCL). A 61-year-old female presented in our department reporting 12 months history of knee pain that was getting worse during the night. The patient was under medication for epileptic seizure, osteoporosis and hyperthyroidism. X-rays demonstrated calcification of the PCL. CT and MRI excluded any other intra-articular and extra-articular pathology. Arthroscopic debridement of the calcium deposits was performed and the symptoms resolved immediately, while the postoperative x-rays were normal. Histological examination confirmed the calcium nature of the lesion. Two years postoperatively the patient remains asymptomatic. PMID:22669889

  9. Injection nerve palsy

    PubMed Central

    Kakati, Arindhom; Bhat, Dhananjaya; Devi, Bhagavathula Indira; Shukla, Dhaval

    2013-01-01

    Objective: To study the clinical profile and outcome of surgery for injection nerve palsies. Materials and Methods: This is a retrospective study of patients with INP who were treated at our institute during May 2000 to May 2009. Clinical, electroneuromyography (ENMG), and operative findings were noted. Intraoperative nerve action potential monitoring was not used in any case. Outcome of patients who were followed was reviewed. Results: INP comprised 92 (11%) of 837 nerve injury patients. Seventy one patients were children less than 16 years. The nerves involved were sciatic in 80 patients, radial in 8, and others in four. Fifty seven patients had power, grade 0/5. ENMG studies revealed absent compound muscle action potential in 64 and absent sensory nerve action potential in 67 patients. Thirty nine (42.3%) of 92 patients underwent surgery. The mean duration since injury in these patients was 5.2 months (3 months to 11 months). All underwent neurolysis. Only 18 patients who underwent surgery had a follow up of more than 3 months. Ten (55.5%) patients had good or fair outcome after surgery. Except for grade of motor deficit prior to surgery, none of the variables were found to significantly affect the outcome. Conclusion: The outcome of INP is generally good and many patients recover spontaneously. The outcome of surgery is dependent on preoperative motor power. PMID:23546341

  10. ECG artefacts mimicking atrial flutter in posterior fossa surgery.

    PubMed

    Rudigwa, Priya; Elakkumanan, Lenin Babu; Rajan, Sakthi P; Prakash, M V Satya

    2015-01-01

    ECG artefacts are defined as abnormalities in the monitored ECG, which result from measurement of cardiac potentials on the body surface and are not related to the electrical activity of the heart. In the operation theatre, the use of various types of electrical equipment may interfere with ECG interpretation. We describe our experience with artefacts resembling atrial fibrillation when a nerve integrity monitoring device was used on a patient undergoing posterior fossa surgery for epidermoid tumour. These artefacts resemble serious arrhythmias and may result in unwanted interventions. To enable better identification of such artefacts, a 12-lead ECG should be considered as it will display rhythm in all the leads; while artefacts will present in only a few leads, true arrhythmia will be present in all the 12 leads. Our case report aims to increase awareness regarding ECG artefacts and to explain how to distinguish them from actual arrhythmias. PMID:26021382

  11. Peripapillary and posterior scleral mechanics--part II: experimental and inverse finite element characterization.

    PubMed

    Girard, Michaël J A; Downs, J Crawford; Bottlang, Michael; Burgoyne, Claude F; Suh, J-K Francis

    2009-05-01

    The posterior sclera likely plays an important role in the development of glaucoma, and accurate characterization of its mechanical properties is needed to understand its impact on the more delicate optic nerve head--the primary site of damage in the disease. The posterior scleral shells from both eyes of one rhesus monkey were individually mounted on a custom-built pressurization apparatus. Intraocular pressure was incrementally increased from 5 mm Hg to 45 mm Hg, and the 3D displacements were measured using electronic speckle pattern interferometry. Finite element meshes of each posterior scleral shell were reconstructed from data generated by a 3D digitizer arm (shape) and a 20 MHz ultrasound transducer (thickness). An anisotropic hyperelastic constitutive model described in a companion paper (Girard, Downs, Burgoyne, and Suh, 2009, "Peripapillary and Posterior Scleral Mechanics--Part I: Development of an Anisotropic Hyperelastic Constitutive Model," ASME J. Biomech. Eng., 131, p. 051011), which includes stretch-induced stiffening and multidirectional alignment of the collagen fibers, was applied to each reconstructed mesh. Surface node displacements of each model were fitted to the experimental displacements using an inverse finite element method, which estimated a unique set of 13 model parameters. The predictions of the proposed constitutive model matched the 3D experimental displacements well. In both eyes, the tangent modulus increased dramatically with IOP, which indicates that the sclera is mechanically nonlinear. The sclera adjacent to the optic nerve head, known as the peripapillary sclera, was thickest and exhibited the lowest tangent modulus, which might have contributed to the uniform distribution of the structural stiffness for each entire scleral shell. Posterior scleral deformation following acute IOP elevations appears to be nonlinear and governed by the underlying scleral collagen microstructure as predicted by finite element modeling. The

  12. Barriers of the peripheral nerve

    PubMed Central

    Peltonen, Sirkku; Alanne, Maria; Peltonen, Juha

    2013-01-01

    This review introduces the traditionally defined anatomic compartments of the peripheral nerves based on light and electron microscopic topography and then explores the cellular and the most recent molecular basis of the different barrier functions operative in peripheral nerves. We also elucidate where, and how, the homeostasis of the normal human peripheral nerve is controlled in situ and how claudin-containing tight junctions contribute to the barriers of peripheral nerve. Also, the human timeline of the development of the barriers of the peripheral nerve is depicted. Finally, potential future therapeutic modalities interfering with the barriers of the peripheral nerve are discussed. PMID:24665400

  13. Three variations of the laryngeal nerve in the same patient: a case report

    PubMed Central

    2011-01-01

    Introduction A non-recurrent course is a rare anatomic variation of the inferior laryngeal nerve (ILN). Bilateral extra-laryngeal bifurcation of the ILN seldom occurs before its laryngeal entry. Anastomosis between the ILN and cervical sympathetic chain is another rare anatomic feature. The prevalence of extra-laryngeal branching of the non-recurrent nerve is unknown. We present an example of triple anatomic variations of ILNs in the same patient, and also two anatomic variations in the same nerve. Case presentation A 56-year-old Caucasian man with a large toxic multi-nodular goiter was surgically treated with total thyroidectomy. Both his right and left ILNs were identified, fully exposed and preserved along their cervical courses. We discovered many variations during bilateral exploration of the two ILNs. His right ILN was non-recurrent. This non-recurrent ILN showed a terminal division before laryngeal entry. The left nerve had a usual course as a recurrent laryngeal nerve (RLN) at his tracheaesophageal groove. We also discovered bifurcation of his RLN beginning at a neurovascular (RLN and inferior thyroid artery) crossing point. Anterior and posterior branches of both nerves entered his larynx separately. The sympathetic inferior laryngeal anastomotic branch (SILAB) between the posterior branch of his left ILN and the cervical sympathetic chain was established in the distal part of the nerve before laryngeal entry. Conclusion A non-recurrent nerve and extra-laryngeal branching of the ILN are two different variations. The coincidence of a right non-recurrent ILN and bilateral bifurcation of both nerves is a very interesting feature. SILAB is a rare additional finding as a third anatomic variation in the same patient. Extra-laryngeal terminal division of a non-recurrent ILN is an extremely unusual anatomic finding. Two anatomic variations have occurred in the same nerve, like "the variation of the variation". PMID:21722360

  14. Huge interparietal posterior fontanel meningohydroencephalocele

    PubMed Central

    Dos Santos, Manuel Filipe Dias; de Santa Barbara, Rita de Cassia

    2015-01-01

    Congenital encephalocele is a neural tube defect characterized by a sac-like protrusion of the brain, meninges, and other intracranial structures through the skull, which is caused by an embryonic development abnormality. The most common location is at the occipital bone, and its incidence varies according to different world regions. We report a case of an 1-month and 7-day-old male child with a huge interparietal-posterior fontanel meningohydroencephalocele, a rare occurrence. Physical examination and volumetric computed tomography were diagnostic. The encephalocele was surgically resected. Intradural and extradural approaches were performed; the bone defect was not primarily closed. Two days after surgery, the patient developed hydrocephaly requiring ventriculoperitoneal shunting. The surgical treatment of the meningohydroencephalocele of the interparietal-posterior fontanel may be accompanied by technical challenges and followed by complications due to the presence of large blood vessels under the overlying skin. In these cases, huge sacs herniate through large bone defects including meninges, brain, and blood vessels. The latter present communication with the superior sagittal sinus and ventricular system. A favorable surgical outcome generally follows an accurate strategy taking into account individual features of the lesion. PMID:26484324

  15. Longevity of Posterior Composite Restorations

    PubMed Central

    Opdam, N.J.M.; van de Sande, F.H.; Bronkhorst, E.; Cenci, M.S.; Bottenberg, P.; Pallesen, U.; Gaengler, P.; Lindberg, A.; Huysmans, M.C.D.N.J.M.; van Dijken, J.W.

    2014-01-01

    The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years’ follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces. PMID:25048250

  16. Fibrolipomatous hamartoma of the inferior calcaneal nerve (Baxter nerve).

    PubMed

    Zeng, Rong; Frederick-Dyer, Katherine; Ferguson, N Lynn; Lewis, James; Fu, Yitong

    2012-09-01

    Fibrolipomatous hamartoma (FLH) is a rare, benign lesion of the peripheral nerves most frequently involving the median nerve and its digital branches (80 %). Pathognomonic MR features of FLH such as coaxial-cable-like appearance on axial planes and a spaghetti-like appearance on coronal planes have been described by Marom and Helms, obviating the need for diagnostic biopsy. We present a case of fibrolipomatous hamartoma of the inferior calcaneal nerve (Baxter nerve) with associated subcutaneous fat proliferation. PMID:22526881

  17. Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation.

    PubMed

    Rozand, Vianney; Grosprêtre, Sidney; Stapley, Paul J; Lepers, Romuald

    2015-01-01

    Percutaneous electrical nerve stimulation is a non-invasive method commonly used to evaluate neuromuscular function from brain to muscle (supra-spinal, spinal and peripheral levels). The present protocol describes how this method can be used to stimulate the posterior tibial nerve that activates plantar flexor muscles. Percutaneous electrical nerve stimulation consists of inducing an electrical stimulus to a motor nerve to evoke a muscular response. Direct (M-wave) and/or indirect (H-reflex) electrophysiological responses can be recorded at rest using surface electromyography. Mechanical (twitch torque) responses can be quantified with a force/torque ergometer. M-wave and twitch torque reflect neuromuscular transmission and excitation-contraction coupling, whereas H-reflex provides an index of spinal excitability. EMG activity and mechanical (superimposed twitch) responses can also be recorded during maximal voluntary contractions to evaluate voluntary activation level. Percutaneous nerve stimulation provides an assessment of neuromuscular function in humans, and is highly beneficial especially for studies evaluating neuromuscular plasticity following acute (fatigue) or chronic (training/detraining) exercise. PMID:26436986

  18. What Are Nerve Blocks for Headache?

    MedlinePlus

    ... nerve blocks for headache? Print Email What are nerve blocks for headache? ACHE Newsletter Sign up for ... entering your e-mail address below. What are nerve blocks for headache? A nerve block is the ...

  19. Posterior Cricoarytenoid Muscle Dynamics in Canines and Humans

    PubMed Central

    Chhetri, Dinesh K.; Neubauer, Juergen; Sofer, Elazar

    2015-01-01

    Objective The posterior cricoarytenoid (PCA) muscle is the sole abductor of the glottis and serves important functions during respiration, phonation, cough, and sniff. The present study examines vocal fold abduction dynamics during PCA muscle activation. Study Design Basic science study using an in vivo canine model and human subjects. Methods In four canines and five healthy humans vocal fold abduction time was measured using high speed video recording. In the canines, PCA muscle activation was achieved using graded stimulation of the PCA nerve branch. The human subjects performed coughing and sniffing tasks. High speed video and audio signals were concurrently recorded. Results In the canines the vocal fold moved posteriorly, laterally, and superiorly during abduction. Average time to reach 10%, 50% and 90% abduction was 23, 50, and 100 ms with low stimulation, 24, 58, and 129 ms with medium stimulation, and 21, 49, and 117 ms with high level stimulation. In the humans, 100% abduction times for coughing and sniffing tasks were 79 and 193 ms, respectively. Conclusion The PCA abduction times in canines are within the range in humans. The results also further support the notion that PCA muscles are fully active during cough. Level of Evidence N/A (Animal studies and basic research) PMID:24781959

  20. Optic nerve hypoplasia in children.

    PubMed Central

    Zeki, S. M.; Dutton, G. N.

    1990-01-01

    Optic nerve hypoplasia (ONH) is characterised by a diminished number of optic nerve fibres in the optic nerve(s) and until recently was thought to be rare. It may be associated with a wide range of other congenital abnormalities. Its pathology, clinical features, and the conditions associated with it are reviewed. Neuroendocrine disorders should be actively sought in any infant or child with bilateral ONH. Early recognition of the disorder may in some cases be life saving. Images PMID:2191713

  1. Minimally invasive posterior hamstring harvest.

    PubMed

    Wilson, Trent J; Lubowitz, James H

    2013-01-01

    Autogenous hamstring harvesting for knee ligament reconstruction is a well-established standard. Minimally invasive posterior hamstring harvest is a simple, efficient, reproducible technique for harvest of the semitendinosus or gracilis tendon or both medial hamstring tendons. A 2- to 3-cm longitudinal incision from the popliteal crease proximally, in line with the semitendinosus tendon, is sufficient. The deep fascia is bluntly penetrated, and the tendon or tendons are identified. Adhesions are dissected. Then, an open tendon stripper is used to release the tendon or tendons proximally; a closed, sharp tendon stripper is used to release the tendon or tendons from the pes. Layered, absorbable skin closure is performed, and the skin is covered with a skin sealant, bolster dressing, and plastic adhesive bandage for 2 weeks. PMID:24266003

  2. [An autopsy case of neuronal type Charcot-Marie-Tooth disease (HMSN type II) with nerve deafness and psychiatric symptoms].

    PubMed

    Yoshimura, I; Yoshimura, N; Hanazono, T; Usutani, S; Muramoto, Y; Fukushima, Y

    1992-06-01

    The clinical and pathological findings of a 41-year-old male patient with atypical Charcot-Marie-Tooth disease were reported. There were 3 cases of subarachnoid haemorrhage, 2 nerve deafness and 2 hereditary motor and sensory neuropathy (HMSN) in his family. He had suffered from progressive nerve deafness since 5 years old and gait disturbance since 37 years old. He had been admitted to the psychiatric hospital 3 times because of hallucinatory-delusional state and behavior abnormalities. Neurological examinations at 39 years old revealed that he had mental deterioration (IQ 66), nerve deafness, diffuse muscle atrophy, most marked distally, sensory disturbance, areflexia, positive Romberg's sign, orthostatic hypotension, dysphagia and slurred speech. MCV of median nerve was 27.8 m/sec, and SCV was not evoked. EEG revealed nonspecific dysfunction of the brain. He died of ileus-like condition at 41 years old. General autopsy showed haemorrhagic infarction of the jejunum and ileum due to compression of the superior mesenteric artery and vein by an adhesion band of connective tissue formed after previous appendectomy. Neuropathological examinations revealed axonal degeneration and loss of myelinated fibers with schwannosis of anterior and posterior spinal nerve roots as well as peripheral nerves. The posterior roots were more severely affected than the anterior ones. Ganglion cells of the posterior root ganglia showed remarkable degeneration and loss. There was severe degeneration of the posterior columns, especially in the gracilis, of the spinal cord. Nerve cells in the anterior horns and Clarke's columns also displayed conspicuous atrophy or central chromatolysis followed by gliosis. There was slight degeneration of the posterior spinocerebellar tracts.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1389565

  3. Primary Burkitt lymphoma in the posterior mediastinum.

    PubMed

    Chaari, Zied; Charfi, Slim; Hentati, Abdessalem; Ayadi, Ines; Abid, Hanene; Frikha, Imed

    2015-11-01

    A 13-year-old boy was admitted to our hospital with complaints of posterior chest pain and dyspnea. Computed tomography and magnetic resonance imaging of the chest revealed a mass in the posterior mediastinum, extending from T8 to T11 with intraspinal involvement. A percutaneous core needle biopsy confirmed the diagnosis of Burkitt lymphoma. He was treated according to the Lymphoma Malignancy B protocol 2001 arm C3, but he presented with liver and brain relapses and died 7.5 months after admission. Although lymphoma is rarely localized in the posterior mediastinum, it should be considered in the differential diagnosis of posterior mediastinal masses in children. PMID:26038605

  4. Optic Nerve Atrophy

    MedlinePlus

    ... with the occipital lobe (the part of the brain that interprets vision) like a cable wire. What is optic nerve ... nystagmus. In older patients, peripheral vision and color vision assessment ... around the brain and spinal cord (hydrocephalus) may prevent further optic ...

  5. Ischemic Nerve Block.

    ERIC Educational Resources Information Center

    Williams, Ian D.

    This experiment investigated the capability for movement and muscle spindle function at successive stages during the development of ischemic nerve block (INB) by pressure cuff. Two male subjects were observed under six randomly ordered conditions. The duration of index finger oscillation to exhaustion, paced at 1.2Hz., was observed on separate…

  6. Optic Nerve Drusen

    MedlinePlus

    ... the drusen enlarge and the overlying tissue (nerve fiber layer) thins with age, the disc drusen become more apparent. How are optic disc drusen treated? There is no treatment for drusen. In the rare cases (with choroidal neovascularization) laser treatment may be indicated. Revised March 2016 Eye ...

  7. The adductor part of the adductor magnus is innervated by both obturator and sciatic nerves.

    PubMed

    Takizawa, Megumi; Suzuki, Daisuke; Ito, Hajime; Fujimiya, Mineko; Uchiyama, Eiichi

    2014-07-01

    The hip adductor group, innervated predominantly by the obturator nerve, occupies a large volume of the lower limb. However, case reports of patients with obturator nerve palsy or denervation have described no more than minimal gait disturbance. Those facts are surprising, given the architectural characteristics of the hip adductors. Our aim was to investigate which regions of the adductor magnus are innervated by the obturator nerve and by which sciatic nerve and to consider the clinical implications. Twenty-one lower limbs were examined from 21 formalin-fixed cadavers, 18 males and 3 females. The adductor magnus was dissected and was divided into four parts (AM1-AM4) based on the locations of the perforating arteries and the adductor hiatus. AM1 was supplied solely by the obturator nerve. AM2, AM3, and AM4 received innervation from both the posterior branch of the obturator nerve and the tibial nerve portion of the sciatic nerve in 2 (9.5%), 20 (95.2%), and 6 (28.6%) of the cadavers, respectively. The double innervation in more than 90% of the AM3s is especially noteworthy. Generally, AM1-AM3 corresponds to the adductor part, traditionally characterized as innervated by the obturator nerve, and AM4 corresponds to the hamstrings part, innervated by the sciatic nerve. Here, we showed that the sciatic nerve supplies not only the hamstrings part but also the adductor part. These two nerves spread more widely than has generally been believed, which could have practical implications for the assessment and treatment of motor disability. PMID:23813615

  8. Mandibular fracture after endosseous implant placement in conjunction with inferior alveolar nerve transposition: a patient treatment report.

    PubMed

    Kan, J Y; Lozada, J L; Boyne, P J; Goodacre, C J; Rungcharassaeng, K

    1997-01-01

    A patient with a severely atrophic right posterior mandible had three endosseous implants placed in conjunction with transposition of the inferior alveolar nerve. Three weeks following implant placement surgery, the patient experienced a spontaneous fracture of the mandible involving the two anterior implants. The two implants were removed, and the fracture was treated with open reduction and fixation with titanium mesh. The fracture healed, and the posterior implant integrated. This report suggests that the buccolingual and superior-inferior position of the mandibular canal can increase the possibility of mandibular fracture by increasing the size of the buccal cortical plate that is removed to expose the nerve during surgery. PMID:9337027

  9. 3D reconstruction and heat map of porcine recurrent laryngeal nerve anatomy: branching and spatial location.

    PubMed

    Mason, Nena Lundgreen; Christiansen, Marc; Wisco, Jonathan J

    2015-01-01

    Recurrent laryngeal nerve palsy is a common post-operative complication of many head and neck surgeries. Theoretically, the best treatment to restore partial function to a damaged recurrent laryngeal nerve would be reinnervation of the posterior cricoarytenoid muscle via anastomosis of the recurrent laryngeal and phrenic nerves. The pig is an excellent model of human laryngeal anatomy and physiology but a more thorough knowledge of porcine laryngeal anatomy is necessary before the pig can be used to improve existing surgical strategies, and develop new ones. This study first identifies the three most common recurrent laryngeal nerve branching patterns in the pig. Secondly, this study presents three-dimensional renderings of the porcine larynx onto which the recurrent laryngeal nerve patterns are accurately mapped. Lastly, heat maps are presented to display the spatial variability of recurrent laryngeal nerve trunks and primary branches on each side of 15 subjects (28 specimens). We intend for this study to be useful to groups using a porcine model to study posterior cricoarytenoid muscle reinnervation techniques. PMID:27086418

  10. Mandibular fracture as a complication of inferior alveolar nerve transposition and placement of endosseous implants: a case report.

    PubMed

    Karlis, Vasiliki; Bae, Richard D; Glickman, Robert S

    2003-01-01

    Placement of endosseous implants and inferior alveolar nerve transposition is a treatment option for patients with an edentulous posterior mandible with inadequate bone height superior to the inferior alveolar canal. Complications associated with these procedures include infection, prolonged neurosensory disturbances, and/or pathologic fracture. This report presents the surgical management of a patient with a mandible fracture after inferior alveolar nerve transposition with concurrent placement of two endosseous implants. PMID:14560480