Hysteria
Francis X. Dercum in 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
Philip E. Harris, Pierre-Marc G. Bouloux in Endocrinology in Clinical Practice, 2014
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.
Endoscopic and robotic thyroidectomy
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
To maintain the working space constantly during the operation time, a gasless transaxillary approach (TAA) was developed by Chung et al. in Korea, and they developed a unique external retractor that can be connected with a continuous suction line by a canal in the midline of the retractor blade [7]. This approach allows for more superior cosmetic results than other remote approaches since there are no scars on the neck or anterior chest wall. The scar is completely covered by the arm in its natural position. During this procedure, the thyroid gland is visualized laterally and the RLN and the parathyroid glands are easily identified. This remote approach offers numerous advantages, including decreased CO2-related complications, the use of conventional instruments, avoiding the dissection of strap muscle, and a wider and clearer surgical field of view by avoiding disturbance from smoke and fumes. The surgeon can preserve the sensory nerve around the anterior neck area, and postoperative hypesthesia in this region can be avoided. The most remarkable advantage of this method is that it can be focused for performance of central compartment node dissection (CCND) in malignant tumor patients. However, the contralateral region approach exhibits some difficulty and involves a widely invasive working space, which is a disadvantage. However, Chung et al. solved this problem by performing a subcapsular dissection of the anterior thyroid surface to create a working space until the contralateral lobe is exposed. Kang et al. reported the feasibility and safety of this method in 581 patients with benign nodules and thyroid cancer [10]. Hakim et al. reported long-term follow-up results of the transaxillary approach in 1085 patients, concluding that transaxillary endoscopic thyroidectomy is comparable to open thyroidectomy in terms of early surgical outcomes and complications, and it bridges the gap between conventional open surgery and robotic transaxillary thyroidectomy [29].
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
Paraneoplastic cerebellar syndromes associated with antibodies against Purkinje cells
Published in International Journal of Neuroscience, 2018
Philipp Schwenkenbecher, Lisa Chacko, Refik Pul, Kurt-Wolfram Sühs, Florian Wegner, Ulrich Wurster, Martin Stangel, Thomas Skripuletz
All 10 patients with immunohistochemically confirmed anti-Yo antibodies were female with a median age of 54 years (range 39–76 years) at presentation (Table 1). The median duration of neurological symptoms until diagnosis of a PNS was two months (range 1–7 months). Half of the patients were admitted within one month after onset of symptoms. All patients suffered from cerebellar disorder and reported gait and limb ataxia. In addition, neurological examination revealed dysarthria in eight patients of whom one also presented with dysphagia. Nystagmus was present in seven patients (horizontal gaze nystagmus in four patients, upbeat nystagmus in two patients and downbeat nystagmus in one patient). Three patients with nystagmus reported diplopia but neurological examination revealed no visible oculomotor palsy. Two patients suffered from abducens palsy and one from hemiparesis. One patient reported hypesthesia of one arm and suffered from focal motor seizures of the affected side.
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)).
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