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Veterinary and Comparative Orthopaedics... May 2022The aim of this study was to review and describe cases of thoracolumbar (TL) hydrated nucleus pulposus extrusion (HNPE) diagnosed with magnetic resonance imaging and...
OBJECTIVE
The aim of this study was to review and describe cases of thoracolumbar (TL) hydrated nucleus pulposus extrusion (HNPE) diagnosed with magnetic resonance imaging and surgery, and compare them to cases of cervical (C) HNPE.
STUDY DESIGN
Retrospective, single-center study.
RESULTS
Thirty-six dogs met the inclusion criteria. Fifteen cases were C and 21 TL. Thirteen dogs were chondrodystrophic breeds, mean body weight was 13 kg, median age was 7.5 years, and 30/36 were male. Fewer dogs were chondrodystrophic in the C group compared with the TL group ( = 0.022). More than 90% had an acute onset, and strong activity was more often reported in the TL group. TL HNPE was more often painful, and extruded disc material more often lateralized ( = 0.017). Median Modified Frankel Score at presentation was 3 and 72.2% were non-ambulatory. More TL HNPE (11/21) were treated surgically compared with C HNPE (4/15). Treatment choice was correlated with spinal cord compression ( = 0.0075). Median Modified Frankel Score improved during hospitalization ( = 0.002) and there was no difference in outcome between C and TL HNPE or conservative and surgical treatment. Mean follow-up time was 33 days. All patients were ambulatory at follow-up.
CONCLUSION
This study suggests that the HNPE is not limited to the C vertebral column of dogs and can occur in the TL vertebral column as well. Dogs with TL HNPE show spinal hyperesthesia more often and extruded nucleus material is more often lateralized. Outcome is similar to what has previously been described for C HNPE.
Topics: Animals; Cartilage Diseases; Dog Diseases; Dogs; Female; Intervertebral Disc Displacement; Magnetic Resonance Imaging; Male; Nucleus Pulposus; Retrospective Studies; Spinal Cord Compression
PubMed: 35008122
DOI: 10.1055/s-0041-1740608 -
Journal of Feline Medicine and Surgery Apr 2022There is a paucity of information on feline discospondylitis. This study aimed to describe the signalment, clinical and laboratory findings, aetiological agents,...
OBJECTIVES
There is a paucity of information on feline discospondylitis. This study aimed to describe the signalment, clinical and laboratory findings, aetiological agents, treatment and outcome in cats affected by discospondylitis.
METHODS
This was a retrospective review of the medical records of cats diagnosed with discospondylitis at four referral institutions.
RESULTS
A total of 17 cats were identified. Most were domestic shorthair cats (76.5%) and male (58.8%), with a median age of 9 years (range 0.9-14) and a median duration of clinical signs of 3 weeks (range 0.3-16). All cats presented with spinal hyperaesthesia; 3/17 had pyrexia. Neurological dysfunction was found in 64.7% of cats, which was indicative of a T3-L3 or L4-S2 spinal segment, associated nerve root or associated nerve neurolocalisation. Haematology, serum biochemistry and urinalysis revealed occasional inconsistent non-specific changes. All cats underwent urine culture; 9/17 cats also had a distinct tissue cultured. Positive bacterial cultures were obtained in two cats (11.8%) for species (urine, blood and intradiscal fine-needle aspirate) and (urine); both presented with multifocal discospondylitis. Treatment was non-surgical in all cats, with sustained antibiotic therapy for a median of 3 months (range 1-9). Analgesia provided included non-steroidal anti-inflammatory drugs, alone or in combination with gabapentin. Restricted exercise was advised for a minimum of 4 weeks. Outcome information available in 12 cats was excellent in terms of pain control and neurological function in 10 cats (83.3%) at the time of stopping antibiotics. Recurrence occurred in one case, which had received a single antibiotic for 6 weeks, and relapsed 4 months after presentation. One other case failed to improve and was euthanased during the course of hospitalisation.
CONCLUSIONS AND RELEVANCE
Feline discospondylitis is uncommon and no obvious signalment predisposition was found in this study. Spinal hyperaesthesia was universally present, with neurological dysfunction also highly prevalent. Bacterial culture was unrewarding in most cases. Amoxicillin-clavulanic acid or cephalosporins are reasonable choices for first-line antibiotics. Prognosis was favourable, with no long-term evidence of recurrence in cats on sustained antibiotic therapy, for a mean duration of 3 months.
Topics: Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Discitis; Female; Hyperesthesia; Male; Retrospective Studies; Treatment Outcome
PubMed: 34100660
DOI: 10.1177/1098612X211020159 -
Pain Research & Management 2018To examine whether hypoesthesia and chronic pain are related in patients with MS.
OBJECTIVE
To examine whether hypoesthesia and chronic pain are related in patients with MS.
METHODS
Sixty-seven MS patients with pain and 80 persons without MS were included. Sensory functioning was tested by bedside neurological examination. Touch, joint position (dorsal column-medial lemniscus pathway), temperature sense, and pain (spinothalamic tract) were tested. Pain intensity was measured by the Colored Analogue Scale (CAS Intensity) and the Faces Pain Scale (FPS); pain affect was also measured by CAS Affect and Number of Words Chosen-Affective (NWC-A). Mood was assessed with the SCL-90 anxiety and depression subscales and the Beck Depression Inventory (BDI).
RESULTS
A significant negative relationship was found between pain intensity and the function of the dorsal column-medial lemniscal pathway, but not with the spinothalamic tract.
CONCLUSION
In addition to the already known relation between hyperesthesia and pain, hypoesthesia for touch and joint position also seems to be related to chronic pain in MS patients.
Topics: Adult; Analgesics; Chronic Pain; Cognition Disorders; Female; Humans; Hypesthesia; Linear Models; Male; Middle Aged; Mood Disorders; Multiple Sclerosis; Neurologic Examination; Pain Measurement; Physical Stimulation; Psychiatric Status Rating Scales; Sensation; Sensation Disorders; Statistics, Nonparametric; Visceral Afferents
PubMed: 29849839
DOI: 10.1155/2018/1924174 -
Arthritis and Rheumatism Sep 2012The modest association between radiographic joint damage and pain in osteoarthritis (OA) has led to the suggestion of facilitated central pain processing. This study...
OBJECTIVE
The modest association between radiographic joint damage and pain in osteoarthritis (OA) has led to the suggestion of facilitated central pain processing. This study evaluated the importance of ongoing tissue pathology in the maintenance of enhanced central pain processing.
METHODS
Pain assessment was performed on 48 patients with symptomatic knee OA and 21 sex- and age-matched pain-free healthy control subjects. Twenty of the OA patients subsequently underwent total knee replacement surgery and were reassessed. Pressure-pain thresholds (PPTs) were recorded using a pressure algometer (both over and distant from the knee) and a double-chamber inflatable cuff mounted around the calf. Spatial summation was assessed by relating PPTs using the dual- and single-chamber cuff. Conditioned pain modulation (CPM) was assessed by recording the increase in PPT in response to experimental arm pain.
RESULTS
PPTs at the knee and at sites away from the knee were reduced in OA patients as compared with healthy pain-free control subjects (P < 0.0001). Cuff PPTs were decreased in OA patients as compared with the healthy controls (P < 0.05), who also exhibited a greater degree of spatial summation (P < 0.05). Whereas an elevation of PPTs was noted in the healthy controls in response to experimental arm pain (P < 0.0001), no such CPM was observed in the OA patients. Following joint replacement in the OA patients, there was a reduction in the widespread mechanical hyperesthesia, along with normalization of spatial summation ratios and restoration of CPM.
CONCLUSION
The widespread hyperesthesia and enhanced spatial summation observed in OA patients imply sensitized central pain mechanisms together with the loss of CPM. Normalization of the results following joint replacement implies that these central pain processes are maintained by peripheral input.
Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Female; Humans; Hyperesthesia; Knee Joint; Male; Middle Aged; Nociceptive Pain; Osteoarthritis, Knee; Pain Measurement; Treatment Outcome
PubMed: 22421811
DOI: 10.1002/art.34466 -
Medical Acupuncture Oct 2017The great auricular nerve (GAN) provides sensory innervation to the skin around the auricle. Although disorder of this nerve has been reported, great auricular...
The great auricular nerve (GAN) provides sensory innervation to the skin around the auricle. Although disorder of this nerve has been reported, great auricular neuralgia, as reported by Blumenthal in 1992, is uncommon. The authors report a case of auricular paresthesia that responded well to electroacupuncture treatment (EAT). A man in his 60s was consulted in the clinic after a 6-month history of experiencing tingling sensations of the skin around the auricle. General degenerative deformity of the cervical spine was observed using computed radiography scans and magnetic resonance imaging; tactile hyperesthesia in the skin of the GAN area was also noted. This case was diagnosed as a disturbance of the great auricular nerve (mild neuralgia). As a potential treatment, EAT was administered near the affected nerve once per week for 6 weeks. Visual analogue scale (VAS) measurements showed a marked decrease in the severity of this patient's symptoms, and the tactile hyperesthesia in the affected area had normalized. The main complaint, auricular paresthesia, had disappeared and had not recurred according to a check-up 15 months later. EAT was effective in the current case. It is hypothesized that EAT can reduce neural sensitivity via a reflex mechanism actuated by somatosensory input.
PubMed: 29067145
DOI: 10.1089/acu.2017.1239 -
The Cochrane Database of Systematic... Apr 2014Iatrogenic injury of the inferior alveolar or lingual nerve or both is a known complication of oral and maxillofacial surgery procedures. Injury to these two branches of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Iatrogenic injury of the inferior alveolar or lingual nerve or both is a known complication of oral and maxillofacial surgery procedures. Injury to these two branches of the mandibular division of the trigeminal nerve may result in altered sensation associated with the ipsilateral lower lip or tongue or both and may include anaesthesia, paraesthesia, dysaesthesia, hyperalgesia, allodynia, hypoaesthesia and hyperaesthesia. Injury to the lingual nerve may also affect taste perception on the affected side of the tongue. The vast majority (approximately 90%) of these injuries are temporary in nature and resolve within eight weeks. However, if the injury persists beyond six months it is deemed to be permanent. Surgical, medical and psychological techniques have been used as a treatment for such injuries, though at present there is no consensus on the preferred intervention, or the timing of the intervention.
OBJECTIVES
To evaluate the effects of different interventions and timings of interventions to treat iatrogenic injury of the inferior alveolar or lingual nerves.
SEARCH METHODS
We searched the following electronic databases: the Cochrane Oral Health Group's Trial Register (to 9 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 9 October 2013) and EMBASE via OVID (1980 to 9 October 2013). No language restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Randomised controlled trials (RCTs) involving interventions to treat patients with neurosensory defect of the inferior alveolar or lingual nerve or both as a sequela of iatrogenic injury.
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures expected by The Cochrane Collaboration. We performed data extraction and assessment of the risk of bias independently and in duplicate. We contacted authors to clarify the inclusion criteria of the studies.
MAIN RESULTS
Two studies assessed as at high risk of bias, reporting data from 26 analysed participants were included in this review. The age range of participants was from 17 to 55 years. Both trials investigated the effectiveness of low-level laser treatment compared to placebo laser therapy on inferior alveolar sensory deficit as a result of iatrogenic injury.Patient-reported altered sensation was partially reported in one study and fully reported in another. Following treatment with laser therapy, there was some evidence of an improvement in the subjective assessment of neurosensory deficit in the lip and chin areas compared to placebo, though the estimates were imprecise: a difference in mean change in neurosensory deficit of the chin of 8.40 cm (95% confidence interval (CI) 3.67 to 13.13) and a difference in mean change in neurosensory deficit of the lip of 21.79 cm (95% CI 5.29 to 38.29). The overall quality of the evidence for this outcome was very low; the outcome data were fully reported in one small study of 13 patients, with differential drop-out in the control group, and patients suffered only partial loss of sensation. No studies reported on the effects of the intervention on the remaining primary outcomes of pain, difficulty eating or speaking or taste. No studies reported on quality of life or adverse events.The overall quality of the evidence was very low as a result of limitations in the conduct and reporting of the studies, indirectness of the evidence and the imprecision of the results.
AUTHORS' CONCLUSIONS
There is clearly a need for randomised controlled clinical trials to investigate the effectiveness of surgical, medical and psychological interventions for iatrogenic inferior alveolar and lingual nerve injuries. Primary outcomes of this research should include: patient-focused morbidity measures including altered sensation and pain, pain, quantitative sensory testing and the effects of delayed treatment.
Topics: Humans; Iatrogenic Disease; Lingual Nerve Injuries; Low-Level Light Therapy; Randomized Controlled Trials as Topic; Somatosensory Disorders; Time Factors; Trigeminal Nerve Injuries
PubMed: 24740534
DOI: 10.1002/14651858.CD005293.pub2 -
The Veterinary Quarterly Dec 2019Pituitary tumours are common neoplasms of the sellar region in small animals. However, detailed information regarding the spectrum and severity of possible neurological...
Pituitary tumours are common neoplasms of the sellar region in small animals. However, detailed information regarding the spectrum and severity of possible neurological signs are lacking. To retrospectively describe the neurological abnormalities in a population of dogs with a detectable pituitary mass (DPM) and relate them with the size of the mass and magnetic resonance imaging (MRI) signs of brain compression (BC). Client-owned dogs were included in the study if they had MRI showing a DPM and a detailed neurological examination. The neurological signs were evaluated in relation to the pituitary height/brain ratio (P:B ratio) and the presence/absence of brain compression. Ninety-seven dogs were enrolled. Besides abnormal mentation and behaviour (77%), gait (61%) and cranial nerve abnormalities (44%), other unreported neurological signs observed included postural abnormalities (21%), pain and/or hyperesthesia (25%) and abnormal postural and proprioceptive reactions (49%). The majority of dogs with DPM had signs of BC. The presence of a high pituitary height/brain area and BC represented a risk factor for developing mental status abnormalities. Neurological signs recorded in DPM-affected dogs include not only the typical forebrain signs but also gait disturbances and hyperesthesia. Neurological signs are positively associated with increased P:B ratio and MRI signs of brain compression.
Topics: Animals; Dog Diseases; Dogs; Euthanasia, Animal; Female; Hospitals, Animal; Italy; Male; Nervous System Diseases; Pituitary Neoplasms; Retrospective Studies
PubMed: 31112462
DOI: 10.1080/01652176.2019.1622819 -
British Journal of Anaesthesia Jan 2012Video-assisted thoracic surgery (VATS) lobectomy may potentially reduce the risk of post-thoracotomy pain syndrome (PTPS). However, it may still carry a risk of...
BACKGROUND
Video-assisted thoracic surgery (VATS) lobectomy may potentially reduce the risk of post-thoracotomy pain syndrome (PTPS). However, it may still carry a risk of intraoperative nerve damage and thereby development of PTPS. Thus, our aim was to present a detailed long-term neurophysiological characterization of PTPS after VATS.
METHODS
Quantitative sensory testing, using thermal and mechanical stimuli, was performed in 13 PTPS patients and 35 pain-free patients recruited 33 months after VATS lobectomy.
RESULTS
When comparing the operated side with the control side in PTPS patients, increased thresholds of tactile and warmth detection were observed, while in pain-free patients, increased thresholds of warmth detection, cool detection, and heat pain were demonstrated. At the anterior porthole, pain-free patients displayed increased threshold to thermal detection when compared with the control side. Only side-to-side difference for tactile detection threshold was increased in PTPS patients compared with pain-free patients. Assessment of central sensitization showed no significant differences within or between PTPS and pain-free patients nor did group comparison of area of hypo- and hyperaesthesia to cool. Anxiety and depression scores (HADS) were higher in PTPS patients, but the area of hyper- and hypoaesthesia did not differ significantly between HADS groups.
CONCLUSIONS
Increased sensory thresholds suggest nerve injury to be present on the operated side in both PTPS and pain-free patients. However, no significant quantitative differences between PTPS and pain-free patients could be found, implicating the presence of factors other than intercostal nerve injury as important for development of PTPS after VATS lobectomy.
Topics: Aged; Catastrophization; Chronic Disease; Data Interpretation, Statistical; Female; Functional Laterality; Hot Temperature; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Physical Stimulation; Pressure; Prospective Studies; Regression Analysis; Surveys and Questionnaires; Thoracic Surgery, Video-Assisted; Thoracotomy
PubMed: 21980121
DOI: 10.1093/bja/aer325 -
British Medical Journal Oct 1974
Topics: Cerebrospinal Fluid Proteins; Child; Humans; Hyperesthesia; Lymphocytes; Male; Mycobacterium tuberculosis; Polyradiculopathy; Spinal Nerve Roots; Tachycardia; Tuberculoma; Urination Disorders
PubMed: 4213228
DOI: 10.1136/bmj.4.5936.107-a -
GMS Hygiene and Infection Control 2021
PubMed: 33520602
DOI: 10.3205/dgkh000372