Carbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. Following are brief statements describing the motor peripheral neuropathy involved bilateral lower extremities of a patient who recovered following acute carbon monoxide poisoning. After inhalation of smoke from a fire, a 60-year-old woman experienced bilateral leg weakness without edema or injury. Neurological examination showed diplegia and deep tendon areflexia in lower limbs. There was no sensory deficit in lower extremities, and no cognitive disturbances were detected. Creatine kinase was normal. Electroneuromyogram patterns were compatible with the diagnosis of bilateral axonal injury. Clinical course after normobaric oxygen and rehabilitation therapy was marked by complete recovery of neurological disorders. Peripheral neuropathy is an unusual complication of CO intoxication. Motor peripheral neuropathy involvement of bilateral lower extremities is exceptional. Various mechanisms have been implicated, including nerve compression secondary to rhabdomyolysis, nerve ischemia due to hypoxia, and direct nerve toxicity of carbon monoxide. Prognosis is commonly excellent without sequelae. Emergency physicians should understand the possible-neurologic presentations of CO intoxication and make a proper decision regarding treatment.
Anoxia ; Axons ; Carbon Monoxide ; Carbon Monoxide Poisoning* ; Creatine Kinase ; Diagnosis ; Edema ; Emergencies ; Female ; Fires ; Humans ; Inhalation ; Ischemia ; Leg ; Lower Extremity* ; Middle Aged ; Nervous System Diseases ; Neurologic Examination ; Oxygen ; Peripheral Nerve Injuries ; Peripheral Nervous System Diseases* ; Poisoning ; Prognosis ; Rehabilitation ; Rhabdomyolysis ; Smoke ; Tendons

PURPOSE: This study was performed to examine the treatment of erectile dysfunction by use of superparamagnetic iron oxide nanoparticles-labeled human mesenchymal stem cells (SPION-MSCs) transplanted into the cavernous nerve injured cavernosa of rats as monitored by molecular magnetic resonance imaging (MRI). MATERIALS AND METHODS: Eight-week-old male Sprague-Dawley rats were divided into three groups of 10 rats each: group 1, sham operation; group 2, cavernous nerve injury; group 3, SPION-MSC treatment after cavernous nerve injury. Immediately after the cavernous nerve injury in group 3, SPION-MSCs were injected into the cavernous nerve injured cavernosa. Serial T2-weighted MRI was done immediately after injection and at 2 and 4 weeks. Erectile response was assessed by cavernous nerve stimulation at 2 and 4 weeks. RESULTS: Prussian blue staining of SPION-MSCs revealed abundant uptake of SPION in the cytoplasm. After injection of 1x10(6) SPION-MSCs into the cavernosa of rats, T2-weighted MRI showed a clear hypointense signal induced by the injection. The presence of SPION in the corpora cavernosa was confirmed with Prussian blue staining. At 2 and 4 weeks, rats with cavernous nerve injury had significantly lower erectile function than did rats without cavernous nerve injury (p<0.05). The group transplanted with SPION-MSCs showed higher erectile function than did the group without SPION-MSCs (p<0.05). The presence of SPION-MSCs for up to 4 weeks was confirmed by MRI imaging and Prussian blue staining in the corpus cavernosa. CONCLUSIONS: Transplanted SPION-MSCs existed for up to 4 weeks in the cavernous nerve injured cavernosa of rats. Erectile dysfunction recovered and could be monitored by MRI.
Animals ; Contrast Media/pharmacology ; Dextrans/*pharmacology ; Disease Models, Animal ; Drug Delivery Systems/methods ; *Erectile Dysfunction/diagnosis/etiology/therapy ; Magnetic Resonance Imaging/methods ; *Magnetite Nanoparticles ; Male ; Mesenchymal Stem Cell Transplantation/*methods ; Monitoring, Physiologic/methods ; Penis/*innervation ; *Peripheral Nerve Injuries/complications/diagnosis/physiopathology/therapy ; Rats ; Suspensions ; Treatment Outcome

Although the musculoskeletal injuries associated with break-dancing which is gaining more popularity among adolescent and young people has been reported, the report regarding a peripheral nerve injury associated with breakdance is scarce. We report a rare case of a young amateur break-dancer, 'b-boy' who suffered from a painful paresthesia in his left hand, later diagnosed as type III Guyon's canal syndrome. A 23-year-old, right handed college man presented with a tenderness over the left hypothenar eminence and painful paresthesia over the ring and little fingers of 3 months duration. He trained himself as an amateur 'b boy' break-dancer for the last 10 months. Conservative management under the diagnosis of wrist sprain before presentation did not improve his hand pain. An magnetic resonance imaging and electrodiagnostic study revealed that painful paresthesia was caused by type III Guyon's canal syndrome, and 4 weeks of corticosteroid treatment was given with resolution of pain and paresthesia.
Adolescent ; Athletic Injuries ; Diagnosis ; Fingers ; Hand ; Humans ; Magnetic Resonance Imaging ; Paresthesia ; Peripheral Nerve Injuries ; Sprains and Strains ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes* ; Wrist ; Young Adult

Neurological and vascular complications following hip arthroplasty are uncommon, and their impact ranges from transient and trivial to permanent and devastating. The proximity of neural and vascular structures makes any operation on the hip potentially hazardous. Direct or indirect injuries of these structures may occur during operative exposure and subsequent procedures. Thus, complete awareness of the anatomy of the pelvis and proximal femur is required. Peripheral nerve injuries can involve either distant sites or nerves in the immediate vicinity of the hip joint. Sciatic nerve injury is the most common nerve injury following total hip arthroplasty. Femoral nerve injury is much less common and is associated with an anterior approach. Its diagnosis is often delayed, but the prognosis is generally better than with sciatic nerve injury. The superior gluteal nerve is at risk during the direct lateral approach. Obturator nerve injury is the least common type of injury and has the least functional consequences. Vascular injuries are less common but more immediately life threatening. The mechanisms of vascular injury include occlusion associated with preexisting peripheral vascular disease and vascular injury during removal of cement during screw fixation of acetabular components, cages, or structural grafts. It is critical to avoid the anterior quadrants for acetabular screw fixation. All acetabular and femoral defects should be bone-grafted to avoid inadvertent cement migration. Following these guidelines, surgeons should be able to offer the most appropriate treatment and counseling to the patients.
Acetabulum ; Arthroplasty* ; Arthroplasty, Replacement, Hip ; Counseling ; Diagnosis ; Femoral Nerve ; Femur ; Hip Joint ; Hip* ; Humans ; Obturator Nerve ; Pelvis ; Peripheral Nerve Injuries ; Peripheral Vascular Diseases ; Prognosis ; Sciatic Nerve ; Transplants ; Vascular System Injuries

An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty.
Aneurysm, False ; Arthroplasty ; Auscultation ; Early Diagnosis ; Hematoma ; Incidence ; Knee ; Peripheral Nerve Injuries ; Popliteal Artery

OBJECTIVE: To estimate the application of prognosis evaluation of ulnar nerve injury by 1H-magnetic resonance spectroscopy (1H-MRS). METHODS: The metabolites of first dorsal interossei (FDI) of two hands from 12 healthy volunteers and 1 volunteer with complete ulnar nerve injury were detected by 1H-MRS and the data were statistically analyzed. RESULTS: For the FDI of healthy adults, the female peaks area of extra-myocellular lipids (EMCL) was higher than the male (P < 0.05); There was no significant difference in Cho, Cr and intra-myocellular lipids (IMCL) between male and female (P > 0.05); There was no significant difference in all the peaks area between the left and right hand (P > 0.05). The EMCL peak of the injury side was higher than that of the healthy side, and the area of FDI was reduced in the volunteer with ulnar nerve injury. CONCLUSION Noninvasive and quantitative detection of 1H-MRS may be valuable for prognosis evaluation of peripheral nerve injury.
Adult ; Female ; Humans ; Male ; Peripheral Nerve Injuries/diagnosis* ; Prognosis ; Proton Magnetic Resonance Spectroscopy/methods* ; Sex Distribution ; Ulnar Nerve/metabolism*

OBJECTIVE: To provide the evidences for the choice of normal reference value of nerve conduction velocity (NCV) in clinical forensic appraisal. METHODS: One hundred and fourteen cases with normal peripheral nerve and 155 cases with injured peripheral nerve were collected. The NCV of homonymous nerves in two limbs were detected. In the normal cases, the NCV of the left limbs were used as the normal reference values. The NCV of the right limbs were compared with that of left limbs, the commendatory normal reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital. In the injured cases, the results of NCV in injuried limbs were compared with the results of healthy limbs and the reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital. RESULTS: In the normal group, there was no statistical difference between the left and right limbs in NCV results of homonymous nerve (P > 0.05). The false positive rates (FPR) were 0, 11.4% and 5.2% for three choices normal reference respectively. The false negative rates (FNR) were 0, 9.7% and 12.3% for three choices normal reference in injuried group. Thee false negative cases were all slight nerve injury. CONCLUSION The reference value of self-control method could decrease the FPR of normal cases and FNR of injured cases. In clinical forensic appraisal of peripheral nerve, the nerve condition study results from healthy homonymous nerve should be regarded as the reference value at first, supplemented by reference values from clinical labs.
Adolescent ; Adult ; Electrodiagnosis/methods* ; Forearm ; Forensic Medicine ; Humans ; Median Nerve/physiology* ; Middle Aged ; Neural Conduction/physiology* ; Peripheral Nerve Injuries/diagnosis* ; Peripheral Nerves/physiology* ; Reference Values ; Ulnar Nerve/physiology* ; Young Adult

PURPOSE: In treating schwannoma patients, it is critical to determine the origin of the tumor to preserve nerve function. We evaluated the validity of preoperative imaging studies in distinguishing the neurological origin of the schwannomas of the head and neck, and the efficacy of intracapsular enucleation in preserving nerve function. MATERIALS AND METHODS: In 7 cases of schwannomas in the head and neck region, we predicted whether the tumor originated from the vagus nerve or the cervical sympathetic chain through imaging studies including computed tomography (CT) and magnetic resonance imaging (MRI). All patients were performed intracapsular enucleation, and the function of the vagus nerve and the sympathetic nerve was evaluated preoperatively and postoperatively. RESULTS: Preoperative imaging studies showed 6 cases where the tumor was located between the carotid artery and the internal jugular vein, and 1 case where the tumor was located posteriorly, displacing the carotid artery and the internal jugular vein anteriorly. At the time of operation, we confirmed schwannoma originating from the vagus nerve on the first 6 cases, and schwannoma originating from the sympathetic nervous system on the last case. All patients went through successful intracapsular enucleation, and of the seven schwannoma cases, 6 patients maintained normal postoperative neurological function (85.7%). CONCLUSION: Preoperative imaging studies offer valuable information regarding the location and origination of the tumor, and intracapsular enucleation helped us to preserve the nerve function.
Aged ; Diagnostic Imaging/methods ; Female ; Follow-Up Studies ; Head and Neck Neoplasms/complications/diagnosis/*pathology ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Neurilemmoma/complications/diagnosis/*pathology ; Peripheral Nervous System/injuries/physiology ; Sympathetic Nervous System/physiology ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; Vagus Nerve/physiology

OBJECTIVETo discuss the diagnosis and treatment of peripheral nerve injury in the earthquake.

METHODSFourteen patients with peripheral nerve injury injured in the earthquake were involved the retrospective study. All cases accepted the timely diagnosis and treatment including anastomosis and repair of the nerve and other conservative treatments. Then the therapeutic effects were observed.

RESULTSAll 14 patients got short-term follow-up and attained the improvement in their symptoms of nerve injury.

CONCLUSIONPeripheral nerve injury has a high incidence in the earthquake. Prevention is very important. The timely and effective treatment should be taken according to spot situations and traumatic conditions of casualties in earthquake.

China ; Earthquakes ; Female ; Follow-Up Studies ; Humans ; Male ; Peripheral Nerve Injuries ; Peripheral Nerves ; surgery ; Peripheral Nervous System Diseases ; diagnosis ; prevention & control ; surgery ; therapy ; Retrospective Studies

BACKGROUND: Peripheral nerve injury induces up-regulation of the calcium channel alpha2delta (alpha2delta) subunit and TRPM8 in the dorsal root ganglion (DRG) which might contribute to allodynia development. We investigated the expression of the alpha2delta subunit and TRPM8 in the DRG of sympathetically maintained pain (SMP) and sympathetic independent pain (SIP) rat model. METHODS: For the SMP model, the L5 and L6 spinal nerves were ligated tightly distal to the DRG. For the SIP model, the tibial and sural nerves were transected, while the common peroneal nerve was spared. After a 7 day postoperative period, tactile and cold allodynia were assessed using von Frey filaments and acetone drops, respectively. Expression of the alpha2delta subunit and TRPM8 in the L5 and L6 DRG were subsequently examined by a Western blot. RESULTS: There were no significant differences between the two models for the thresholds of tactile and cold allodynia. Expression of the alpha2delta subunit in the ipsilateral DRG to the injury was increased as determined on a Western blot as compared to that in the contralateral or sham-operated DRG of the SMP model, but there was no difference in expression seen with the use of the SIP model. There was no difference in the expression of TRPM8 in the ipsilateral DRG to the injury and the contralateral or sham-operated DRG of either model. CONCLUSIONS: Up-regulation of the alpha2delta subunit in injured DRG may play a role that contributes to tactile allodynia development in SMP, but not TRPM8 to cold allodynia after peripheral nerve injury.
Acetone ; Animals ; Blotting, Western ; Calcium Channels ; Cold Temperature ; Diagnosis-Related Groups ; Ganglia, Spinal ; Hyperalgesia ; Organic Chemicals ; Peripheral Nerve Injuries ; Peroneal Nerve ; Polyenes ; Postoperative Period ; Rats ; Spinal Nerve Roots ; Spinal Nerves ; Sural Nerve ; Up-Regulation