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Cancer Journal (Sudbury, Mass.) 2012Invasion of cranial nerves and peripheral nerve roots, plexus, or nerves by non-Hodgkin lymphoma is denoted as neurolymphomatosis (NL). Four clinical patterns are... (Review)
Review
Invasion of cranial nerves and peripheral nerve roots, plexus, or nerves by non-Hodgkin lymphoma is denoted as neurolymphomatosis (NL). Four clinical patterns are recognized. Most commonly, NL presents as a painful polyneuropathy or polyradiculopathy, followed by cranial neuropathy, painless polyneuropathy, and peripheral mononeuropathy. Diagnosis of NL is challenging and requires integration of clinical information, imaging findings, and histopathologic examination of involved nerves or nonneural tissue and cerebrospinal fluid analysis. In the rare cases of primary NL, the diagnosis is often delayed. Successful therapy is contingent upon recognition of the disease and its exact neuroanatomic localization without delay. Treatment options include systemic chemotherapy and localized irradiation of bulky disease sites. Concomitant involvement of cerebrospinal fluid and systemic disease sites requires more complex regimens.
Topics: B-Lymphocytes; Cranial Nerves; Diagnosis, Differential; Humans; Lymphoma, Non-Hodgkin; Neoplasm Invasiveness; Nervous System Neoplasms; Peripheral Nerves; Polyneuropathies; Polyradiculopathy
PubMed: 23006953
DOI: 10.1097/PPO.0b013e31826c5ad5 -
American Journal of Therapeutics 2009Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows... (Comparative Study)
Comparative Study Review
Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. This review compares CSA with other anesthetic techniques and also describes the history of CSA, its clinical applications, concerns regarding neurotoxicity, and other pharmacologic implications of its use. CSA has seen a waxing and waning of its popularity in clinical practice since its initial description in 1907. After case reports of cauda equina syndrome were reported with the use of spinal microcatheters for CSA, these microcatheters were withdrawn from clinical practice in the United States but continued to be used in Europe with no further neurologic sequelae. Because only large-bore catheters may be used in the United States, CSA is usually reserved for elderly patients out of concern for the risk of postdural puncture headache in younger patients. However, even in younger patients, sometimes the unique clinical benefits and hemodynamic stability involved in CSA outweigh concerns regarding postdural puncture headache. Clinical scenarios in which CSA may be of particular benefit include patients with severe aortic stenosis undergoing lower extremity surgery and obstetric patients with complex heart disease. CSA is an underutilized technique in modern anesthesia practice. Perhaps more accurately termed fractional spinal anesthesia, CSA involves intermittent dosing of local anesthetic solution via an intrathecal catheter. Where traditional spinal anesthesia involves a single injection with a somewhat unpredictable spread and duration of effect, CSA allows titration of the block level to the patient's needs, permits a spinal block of indefinite duration, and can provide greater hemodynamic stability than single-injection spinal anesthesia.
Topics: Anesthesia, Spinal; Drug Administration Schedule; History, 20th Century; Humans; Polyradiculopathy
PubMed: 19546804
DOI: 10.1097/MJT.0b013e3181729d2a -
British Journal of Neurosurgery Oct 2016What constitutes cauda equina syndrome (CES), how it should be subclassified and how urgently to image and operate on patients with CES are all matters of debate. A... (Meta-Analysis)
Meta-Analysis Review
What constitutes cauda equina syndrome (CES), how it should be subclassified and how urgently to image and operate on patients with CES are all matters of debate. A structured review of the literature has led us to evaluate the science and to propose evidence-based guidelines for the management of CES. Our conclusions include this guidance: pain only; MRI negative - recommend: analgesia, ensure imaging complete (not just lumbar spine) adequate follow-up. Bilateral radiculopathy (CESS) with a large central disc prolapse - recommend: discuss with the patient and if for surgery, the next day (unless deteriorates to CESI in which case emergency surgery); CESI - recommend: the true emergency for surgery by day or night; a large central PLID with uncertainty as to whether CESI or CESR (e.g. catheterised prior to CESR) or where there is residual cauda equina nerve root function or early CESR - recommend: treat as an emergency by day or night. Where there has been prolonged CESR and/or no residual sacral nerve root function - recommend: treat on the following day's list.
Topics: Disease Management; Evidence-Based Medicine; Guidelines as Topic; Humans; Polyradiculopathy; Standard of Care
PubMed: 27240099
DOI: 10.1080/02688697.2016.1187254 -
Journal of Neurosurgery. Spine Jul 2009
Topics: Decompression, Surgical; Humans; Polyradiculopathy; Time Factors; Treatment Outcome; Urinary Retention
PubMed: 19569949
DOI: 10.3171/2009.2.SPINE08673L -
The British Journal of General Practice... Feb 2014
Topics: Early Diagnosis; Humans; Intervertebral Disc Displacement; Jurisprudence; Magnetic Resonance Imaging; Physical Examination; Polyradiculopathy; Postoperative Complications; Practice Guidelines as Topic; Primary Health Care; Radiography; Time Factors
PubMed: 24567588
DOI: 10.3399/bjgp14X676988 -
Practical Neurology Feb 2022Suspected cauda equina syndrome is a common presentation in emergency departments, but most patients (≥70%) have no cauda equina compression on imaging. As... (Review)
Review
Suspected cauda equina syndrome is a common presentation in emergency departments, but most patients (≥70%) have no cauda equina compression on imaging. As neurologists become more involved with 'front door' neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have other neurological causes: we discuss the differential diagnosis and how to recognise these. New data on the clinical features of patients with 'scan-negative' cauda equina syndrome suggest that the symptoms are usually triggered by acute pain (with or without root impingement) causing changes in brain-bladder feedback in vulnerable individuals, exacerbated by medication and anxiety, and commonly presenting with features of functional neurological disorder.
Topics: Cauda Equina; Cauda Equina Syndrome; Conversion Disorder; Diagnosis, Differential; Humans; Polyradiculopathy
PubMed: 34389643
DOI: 10.1136/practneurol-2020-002830 -
British Medical Journal Jul 1975
Topics: Age Factors; Humans; Muscles; Myelin Sheath; Polyradiculopathy; Prognosis
PubMed: 1148724
DOI: No ID Found -
Muscle & Nerve Jan 2021
Topics: Humans; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Polyradiculopathy
PubMed: 32970333
DOI: 10.1002/mus.27075 -
Muscle & Nerve Aug 2000A 53-year-old man developed progressive sensory disturbance and weakness in the legs, sphincter disturbance, back pain, systemic symptoms, and pancytopenia....
A 53-year-old man developed progressive sensory disturbance and weakness in the legs, sphincter disturbance, back pain, systemic symptoms, and pancytopenia. Electrophysiological tests indicated a widespread lumbosacral polyradiculopathy. Spinal magnetic resonance imaging and routine cerebrospinal fluid analysis showed minor nonspecific abnormalities. Bone marrow and liver biopsies showed hemophagocytosis; and polymerase chain reaction of cerebrospinal fluid, bone marrow, and serum suggested active infection with human herpesvirus-6. Autopsy revealed that his neurological symptoms resulted from intravascular lymphomatosis (angiotropic large cell lymphoma), a rare variant of lymphoma with predilection for the nervous system.
Topics: Diagnosis, Differential; Fatal Outcome; Herpesviridae Infections; Herpesvirus 6, Human; Humans; Lumbosacral Region; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Pancytopenia; Polyradiculopathy
PubMed: 10918273
DOI: 10.1002/1097-4598(200008)23:8<1295::aid-mus24>3.0.co;2-e -
Neurology Nov 1993
Topics: Cytomegalovirus Infections; Humans; Magnetic Resonance Imaging; Myelitis; Polyradiculopathy
PubMed: 8232976
DOI: 10.1212/wnl.43.11.2421-b