Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jun 1993
Case ReportsCoexistence of Parkinson's disease and myasthenia gravis: a case report.
This is a report on a 62-year-old Chinese woman with Parkinson's disease (PD) for 8 years who developed myasthenia gravis (MG) in the last year. In this case, there was no adverse effect of trihexyphenidyl on MG, whereas pyridostigmine worsened the PD.
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The origin and course of the nerval innervation of the levator scapulae and rhomboid muscles was studied in four human cadavers. Special attention was given to surgical anatomy. The levator scapulae muscle receives two small segmental nerves from C3 and C4, respectively. ⋯ Paresis of one or both of these muscles was noted in 13 cases. It was concluded that the rhomboid muscle may function on a single C4 nerve supply without any loss of strength. Arguments are put forward to support the relevance of rhomboid muscle testing in the assessment of brachial plexus lesions.
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Clin Neurol Neurosurg · Jan 1993
Brachial plexus injury: deafferentation pain and dorsal root entry zone (DREZ) coagulation.
The nature of deafferentation pain in cases of brachial plexus injury is described. The natural course of the symptoms together with conservative treatment is outlined. The theoretical background of the dorsal root entry zone (DREZ) coagulation, and its clinical indications, operative techniques and results are presented.
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The main causes of brachial plexus palsies are traction, due to extreme movements, and heavy impact. In downward traction of the arm and forcible widening of the shoulder-neck angle the lesion will occur in the upper roots and trunk. Forcible upward traction will cause avulsion of T1 and C8. ⋯ Rupture of the cords and/or individual infraclavicular nerves will be produced by traction and/or forcible widening of the scapulohumeral angle. Vascular structures are subjected to the same mechanism and injuries of these structures give information about the site and severity of nerve lesions; fractures of the skull, cervical spine, clavicle, first rib or arm yield further data on the mechanism of trauma that has produced the brachial plexus palsy. Heavy impact or crush lesions are caused by direct trauma to the (supra)clavicular region and are nearly always associated with fracture of the clavicle.
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Clin Neurol Neurosurg · Jan 1992
Case ReportsPurulent meningitis due to aspergillosis in a patient with systemic lupus erythematosus.
We report a 39-year-old female patient with systemic lupus erythematosus under immunosuppressive therapy who developed persistent neutrophilic meningitis, for which no infectious agent could be identified. Intensifying the immunosuppressive therapy induced a short amelioration of the clinical picture. At autopsy, basal meningitis was found to be due to Aspergillus sp.