Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C1762617 (weakness)
 37,932 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this retrospective, consecutive case series, we report the nonsurgical and rehabilitation outcomes of consecutive patients who presented with pronounced painless weakness arising from disk extrusion. Seven consecutive patients who chose physiatric care were followed clinically, and strength return was monitored. Each presented with predominantly painless radiculopathy, functionally significant strength loss, and radiographic evidence of disk extrusion or sequestration. Each patient participated in a targeted strengthening program, and in some cases, transforaminal injection therapy was employed. Each patient demonstrated an eventual full functional recovery. In most cases, electrodiagnostic studies were performed and included a needle examination of the affected limb and compound muscle action potentials from the most clinically relevant and weakened limb muscle. The electrodiagnostic findings and, in particular, the quantitative compound muscle action potential data seemed to correlate with the timing of motor recovery. Patients with predominantly painless and significant weakness arising from disk extrusion can demonstrate successful rehabilitation outcomes. Despite a relative absence of pain, such patients can present with a more rapidly reversible neurapraxic type of weakness. The more quantitative compound muscle action potential data obtained through electrodiagnostic studies may offer the treating physician an additional means of characterizing the type of neuronal injury at play and the likelihood and timing of strength return.
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PMID:Resolution of pronounced painless weakness arising from radiculopathy and disk extrusion. 1597 90

A 55-year-old man with cervical radiculopathy (C5-C8) was referred to us following intra-arterial infusion of cisplatin (CDDP) because of a recurrent neck mass of laryngeal cancer. Three hours after the CDDP infusion, he had noticed general weakness of the left upper extremity and hypoaesthesia of the lateral side of the upper and lower arm. The next day he was diagnosed with left cervical radiculopathy of C5 to C8, which improved gradually and had resolved completely six months after the infusion. Even with proper positioning of the infusion catheter to minimize potential complications, for anatomical reasons there are always some risks of neural injury with intra-arterial infusion from branches of the subclavian artery. This procedure should be carefully indicated in the case of a large neck tumour that is perfused from the major branches of the subclavian artery.
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PMID:Cervical radiculopathy due to intra-arterial infusion of cisplatin. 1610 25

A patient with left shoulder girdle weakness secondary to herpetic myotomal paresis is reported. Needle electromyography revealed denervational discharge from the left supraspinatus, deltoid, and brachioradialis muscles, compatible with a radiculopathy that was relevant to his myotomes affected by zoster infection. The patient was managed with range-of-movement and strengthening exercises as well as pain relief for post-herpetic neuralgia. Further studies are required to determine whether antiviral treatment can limit the extent of motor deficit and hasten recovery. Zoster paresis should be one of the differential diagnoses of girdle muscle weakness.
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PMID:Herpetic shoulder paresis in a Chinese elderly patient. 1621 61

To investigate the nerve root distribution of deltoid and biceps brachii muscle, compound muscle action potentials (CMAPs) were recorded intraoperatively following nerve root stimulation in cervical spondylotic myelopathy. A total of 19 upper limbs in 12 patients aged 55-72 years (mean, 65.5 years) with cervical spondylotic myelopathy were examined. CMAPs were recorded from deltoid and biceps brachii muscle following C5 and C6 root stimulation. Although both C5 and C6 roots were innervated for deltoid and biceps brachii muscle in all subjects, the amplitude ratio of CMAPs (C5/C6) differed individually depending on the symptomatic intervertebral levels of the spinal cord. The C5 root predominantly innervated both deltoid and biceps brachii in patients with symptomatic cord lesions at the C4-C5 intervertebral level compared to patients with symptomatic cord lesions at the C5-C6 intervertebral level. Although no patients sustained postoperative radiculopathy in our study, severe weakness and unfavorable recovery are expected when the C5 root in patients with C4-C5 myelopathy is damaged. From the electrophysiological aspect, C4-C5 cord lesions are likely to be a potential risk factor for postoperative shoulder muscle weakness in patients with compressive cervical myelopathy.
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PMID:Nerve root distribution of deltoid and biceps brachii muscle in cervical spondylotic myelopathy: a potential risk factor for postoperative shoulder muscle weakness after posterior decompression. 1622 67

A 35-year-old woman, who underwent the removal of her uterus as a result of treatment for cancer of the cervix, developed weakness in the distal lower limbs after 8 months of subsequent radiation therapy. Although she could not walk because of distal dominant weakness and atrophy in the legs, no sensory disturbances were observed. An MRI scan showed gadolinium enhancement of the anterior portion of the lumbosacral roots in the cauda equina, which corresponded to her neurological symptoms. The administration of corticosteroid and warfarin dramatically alleviated her neurological symptoms, and a follow-up MRI scan one month later demonstrated a marked diminution of the gadolinium enhancement. There were only seven reports describing the abnormalities of the MRI findings, all of which noted the gadolinium enhancement of the anterior portion of the lumbosacral roots. Together with the findings in other reports, the enhancement abnormalities seem to be characteristic of post-irradiation lumbosacral radiculopathy.
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PMID:[Gadolinium enhancement of the anterior portion of the lumbosacral roots in a case of post-irradiation lumbosacral radiculopathy]. 1631 73

Epithelioid angiosarcoma of bone is a rare, high-grade lesion that is highly vascular and can be associated with a bleeding diathesis. An association has been reported in angiosarcomas in other locations with coagulopathy from tumor-related disseminated intravascular coagulopathy and fibrinolysis. The authors report the case of a rare occurrence of a primary sacral epithelioid angiosarcoma associated with a large epidural hematoma and a severe bleeding diathesis. A 25-year-old woman presented with weakness, fatigue, neck and low-back pain, and progressive left S-1 radiculopathy. Imaging studies revealed a large ventral epidural hematoma extending from the sacral region rostrally to C-2 and a vascular tumor located in the sacrum. The patient underwent a sacral laminectomy, complicated by postoperative bleeding from the wound, and required massive transfusions. Ultimately, multimodal therapy was required to obtain hemostasis, including the use of endovascular embolization, radiation therapy, and an infusion of epsilon-aminocaproic acid with heparin. This case represents the first report of a primary epithelioid angiosarcoma in the sacrum and emphasizes that the coagulopathy seen in angiosarcoma is also a feature of this epithelioid variant.
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PMID:Sacral epithelioid angiosarcoma associated with a bleeding diathesis and spinal epidural hematoma: case report. 1657 25

The goals of surgery for metastatic disease of the lumbosacral spine are to relieve compression of the thecal sac and nerve roots, to resect malignant tissue, and to create a stable reconstruction of the spine. Reconstruction of the lumbosacral junction, specifically the L-5 vertebral body, is particularly challenging because the biomechanical properties of this level differ from other areas of the spine. A 40-year-old woman with intraductal breast carcinoma that metastasized to the L-5 vertebral body presented with progressive low-back pain, right-sided L-5 radiculopathy, and weakness. Magnetic resonance imaging revealed a pathological fracture of the L-5 vertebral body with compression of the cauda equina. The L-5 posterior arch, both facet joints and pedicles, and the posterior third of the vertebral body were removed via a posterior approach. A pedicle screw fixation system was applied from L-4 to S-1. The patient was repositioned, and a transabdominal approach was used to resect the anterior two thirds of the L-5 body, which was reconstructed using an allograft bone strut. An interference bone screw was placed through the inferior aspect of the allograft and screwed into the body of S-1 to provide stability for the reconstructive graft. The patient's clinical recovery was excellent. She was ambulating without difficulty when seen at 19-month follow-up examination. Complete spondylectomy by using this novel fusion technique was efficacious in the treatment of metastatic disease to the vertebral column.
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PMID:Lumbosacral junction fixation and fusion after complete L-5 spondylectomy. Case report. 1691 5

Kidney transplantation related femoral neuropathy can mimic epidural catheter related radiculopathy in clinical presentation. Anesthesiologists should keep this possibility in mind when performing epidural anesthesia or analgesia for kidney transplantation. We present a 52-year-old male who after undergoing cadaveric kidney transplantation under general anesthesia in combination with epidural analgesia made possible by catheterization via T11-12 interspace for reinforcement of anesthesia and for postoperative patient-controlled epidural analgesia (PCEA) sustained sensory disturbance and muscle weakness of the lower limbs. These symptoms did not improve after discontinuation of the PCEA. Epidural hematoma with secondary radiculopathy was contemplated initially. Serial examinations including thoracic-lumbar CT scan, abdominal sonography, electromyogram and nerve conduction study were thus performed. The final diagnosis turned out to be surgical procedure related femoral neuropathy. We believe this is the first instance ever reported about the dilemma in making a predicative diagnosis from two conditions near akin in kidney transplantation. Accurate diagnosis made through serial image and electrophysiologic studies are essential to appropriate management.
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PMID:Epidural analgesia masked the diagnosis of femoral neuropathy following renal transplantation. 1703 7

We report on the case of a 66-year-old patient who was hospitalized because of intractable low back pain radiating into the right leg. Leg pain was accompanied by a numbness and muscle weakness which was clearly assigned to the L5 dermatome. Concerning the patient's medical history a nucleotomy L4/5 and a osteomyelofibrosis were known. MRI of the lumbar spine revealed a multisegmental stenosis which was pronounced on the level L4/5. One day after admission of the patient to the hospital a typical zoster exanthema involving the L5 dermatome appeared. Varicella-zoster virus (VZV) was detected in the fluid of the vesicular skin lesions by polymerase chain reaction. Intravenous administration of aciclovir lead to rapid decrease of pain and exanthema. A few months later the patient died because of an acute myeloid leukemia as a complication of the known osteomyelofibrosis. This case report shows that a herpes zoster infection can imitate a radicular spine syndrome usually caused by degenerative changes. Especially in immunocompromised patients, a zoster radiculitis should be included in the differential diagnosis of radiculopathy. VZV infection might also occur without skin lesions (zoster sine herpete) so that serological assays for the early detection of virus DNA can be useful.
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PMID:[Rare differential diagnosis of a radicular spine syndrome: herpes zoster radiculitis]. 1718 32

A 47-year-old male presented with painful swelling of the right calf. His medical history was negative, except for a herniation of disc LIV-V 5 years before. Physical examination revealed unilateral calf hypertrophy with moderate weakness of plantarflexion, mild paresis of dorsiflexion. Electromyography showed a peripheral neurogenic lesion in the right anterior tibial muscle, but normal findings were obtained from the unaffected quadriceps muscle. Histological examination of the right gastrocnemic muscle showed neurogenic changes with typical targetoid fibers, but no pathological changes were present in the quadriceps muscle. Chronic asymmetric spinal muscular atrophy is an infrequent neuromuscular disease and because of asymmetric appearance, it might be difficult to distinguish from other, acquired neurogenic muscle diseases such as radiculopathy caused by intervertebral disc herniation. Our case confirms that muscular hypertrophy can follow partial denervation in humans.
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PMID:Asymmetric calf hypertrophy of neurogenic origin. 1718 92


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