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Hysteria
Published in Francis X. Dercum, Rest, Suggestion, 2019
Again, when we study the symptoms of a given sensory loss closely, e.g., a hemianesthesia, we usually find that the patient does really feel, but says that he does not feel as well upon the anesthetic as upon the opposite side of the body; in other words, the symptom developed is that merely of a diminished sensation, a condition which has received the name of hypoesthesia or hypesthesia. When the test is being made, the question of itself—for the test is a question even when the physician does not ask it in words—arouses first a doubt in the patient's mind, followed immediately by a realization that the physician expects to find no feeling in the part and finally that there is no feeling. The mental phases are in rapid succession; "Do I feel it?" "I don't feel it as well as on the other side." "No, I don't feel it." In keeping with this fact, a sensory loss mild at first—a hypesthesia—frequently passes into one that is pronounced—an anesthesia. Especially is this apt to ensue in a much-examined case.
Surgical management of pituitary adenomas
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Garni Barkhoudarian, Edward R. Laws
Diplopia can occur when there is tumor involvement of the cavernous sinus. The most common finding is an abducens nerve paresis, causing lateral gaze diplopia. Oculomotor and trochlear nerve diplopia can also occur. Hemifacial hypesthesia can also occur due to trigeminal nerve-based involvement. Cavernous sinus compression or invasion is the etiology of these findings. In one series, 9 of 64 patients with pituitary macroadenomas were diagnosed with extraocular muscle weakness.118 Seven of these patients had full recovery of their diplopia at 6 months after surgery.
Pain Management and Geriatrics
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
The mechanism of pain in postherpetic neuralgia may be due to enhanced chemical and mechanical sensitivity to cytokines, prostaglandins, and catecholamines in peripheral sprouting nerve terminals as well as persistent small fiber activity in the periphery and in the dorsal root ganglia. Other mechanisms include upregulation of sodium channels in injured axons and upregulation of sympathetic neurons leading to hypersensitization. Neurologic examination determines whether there is numbness or sensory changes (hypoesthesias, dysesthesias, hyperesthesias, and allodynia). Neuropathic pain is often described as being lancinating, with a sharp, shooting, or stabbing component or burning in character, and this is true after postherpetic neuralgia. The mechanisms and treatment of neuropathic pain are discussed in detail in this volume, in Chapter 24, “Neuropathic Pain.”
True metachronous multiple spinal dural arteriovenous fistulas: case report and review of the literature
Published in British Journal of Neurosurgery, 2023
Yanming Ren, Hao Liu, Teng-Yun Chen, Jin Li
Four months after the initial surgery, the patient’s symptoms reccrred and he was unable to walk. Neurological examination revealed reduction of motor strength (Grade 3/5) and hypesthesia in both legs. Spinal MRI demonstrated edema in the spinal cord from T5 to the conus, and abnormal enhancement of perimedullary veins between T10 and L1 (Figure 2(C,D)). MR angiography (MRA) showed numerous dilated and tortuous vessels on the dorsal surface of the T10-L1 spinal levels (Figure 2(E)). A new spinal DAVF was suspected. Spinal angiography revealed a new fistula at the right L1 level with no evidence of recurrence of the previously treated left T10 DAVF (Figure 3(A)). The previous spinal angiogram was also reviewed. The right L1 artery had been successfully cannulated and no spinal DAVF was see (Figure 3(B)). Thus, the two spinal DAVFs were truely metachronous. An L1 laminotomy was done and the fistula identified and coagulated (Figure 4(A,B)). Multiple radiculomeningeal arteries on the outer layer of the dura at the fistula level were coagulated as well (Figure 4(C,D)).
Management of periocular cutaneous squamous cell carcinoma with perineural invasion: a case series and literature review
Published in Orbit, 2022
Thomas J. E. Clark, Gerald J. Harris
In the evaluation of patients with suspicious periocular cutaneous lesions, especially those overlying named branches of the trigeminal system (e.g., infraorbital, supraorbital, zygomaticotemporal, or zygomaticofacial nerves), symptoms and signs of PNI should be elicited. These include paresthesias (e.g. formication, burning, tingling, shooting/stabbing or “electric shock” sensation), frank pain, hypesthesia, anesthesia, and/or motor weakness.3,40 These queries should be made both at the initial visit and in post-treatment follow-up, since neurologic symptoms may precede visual evidence of tumor recurrence.40 It should be noted, however, that neurologic symptoms are typically late findings, since the distensibility of potential peri- and endoneural spaces generally prevents compressive effects until there has been substantial tumor expansion.3 External examination should include assessment of deep fixation to periosteum/bone and palpation of regional lymph nodes. Palpable lymphadenopathy should prompt imaging and referral to a head and neck surgeon for possible fine-needle aspiration or core biopsy. Risk factors for SCC, including history of organ transplantation, immune compromise (e.g. lymphoproliferative disorder, HIV-AIDS, pharmacologic immunosuppression), and xeroderma pigmentosum should be elicited.24
Surfer’s myelopathy: A review of etiology, pathogenesis, evaluation, and management
Published in The Journal of Spinal Cord Medicine, 2021
Jason Gandhi, Min Yea Lee, Gunjan Joshi, Sardar Ali Khan
Other signs include hypesthesia, hypoalgesia, and hyperesthesia. Between June 1998 and January 2003, nine cases of SM were reported, with an average patient age of 25, while exhibiting the aforementioned hallmark symptoms.1 In a reported case series of three patients in 2013 (24–31 years old; two male, one female),10 clinical manifestations also included bladder-bowel dysfunction with complete paraplegia (T9–12). Table 2 outlines the unique clinical presentation of gathered SM cases, a majority of which are due to surfing. Due to the likelihood of other conditions simulating SM, a proper differential diagnosis should be made while considering acute myelitis to broaden the spectrum (Table 3).6