Ipsilateral Head Research Articles

Reconstrucción de defecto troclear lateral traumático con autoinjerto de cabeza radial

ObjectiveTo report the result of a severe articular defect secondary to a complex open fracture of the distal humerus, using the ipsilateral radial head as a bone autograft for the trochclear region as an alternative to total arthroplasty. Case reportWe describe a patient who suffered an open fracture of the elbow with bone loss in the distal humeral region and, after the initial stabilisation surgery, needed a reconstruction with an ipsilateral radial head autograft. DiscussionOpen fractures of elbow are rare. When there is a severe trochlear defect, surgical options are total elbow arthroplasty, where the short and medium term results appear to be insufficient, or elbow arthrodesis. We believe that reconstruction of the defect using an ipsilateral radial head autograft is a more functional alternative than the other procedures described. ConclusionRadial head reconstruction with ipsilateral lateral trochlear defects is a technique that, unlike fusion, preserves functionality without the problems of total elbow arthroplasty.

A wire-flooring model for inducing lameness in broilers: Evaluation of probiotics as a prophylactic treatment

Bacterial chondronecrosis with osteomyelitis (BCO) is the most common cause of lameness in commercial broilers. Bacteria entering the blood via translocation from the respiratory system or gastrointestinal tract spread hematogenously to the proximal epiphyseal-physeal cartilage of rapidly growing femora and tibiae, causing BCO. We tested the hypothesis that rearing broilers on wire flooring should increase the incidence of BCO by persistently imposing additional torque and shear stress on susceptible leg joints. We also tested the hypothesis that probiotics might attenuate bacterial translocation and thereby reduce the incidence of BCO. In 5 independent experiments using 4 commercial lines, broilers grown on wire flooring developed lameness attributable predominately to BCO. The fastest-growing birds were not necessarily the most susceptible to lameness on wire flooring, nor did the genders differ in susceptibility in the 2 experiments that included both male and female broilers. The pathogenesis of BCO is not instantaneous, and accordingly, many broilers that did not exhibit lameness, nevertheless, did possess early pathognomonic lesions. These subclinical lesions were equally likely to develop in the right or left leg. The lesion status of the proximal femoral head did not determine the lesion status of the ipsilateral or contralateral proximal tibial head and vice versa. Broilers reared on wire flooring consistently had higher incidences of lameness than hatch-mates reared on wood-shavings litter. Adding probiotics to the diet beginning at 1 d of age consistently reduced the incidence of lameness for broilers reared on wire flooring. These experiments indicate that probiotics administered prophylactically may constitute an alternative to antibiotics for reducing lameness attributable to BCO. Rearing broilers on wire flooring provides an important new research model for investigating the etiology, pathogenesis, and treatment strategies for BCO.

Coxofemoral joint tuberculosis: regarding one case

Figure 1 – Pelvic panoramic AP radiography, showing a decrease in the articular space on the right, besides a flattening of the ipsilateral femoral head. IntroductIon For centuries tuberculosis has plagued humankind1, being considered the main cause of death due to a single infectious agent in adults all over the world, according to WHO data2. This disease can take several forms, such as pulmonary, lymphatic, genitourinary, among others. One of them is osteoarticular tuberculosis, which has existed for thousands of years and still strikes children and adolescents with a stable incidence in both developed and developing countries. The osteoarticular disease constitutes 10 to 20% of extrapulmonary tuberculosis cases and 1% to 3% of all tuberculosis cases2-6. The bone impairment is predominant in the vertebral column7. As to joint impairment, it is less usual and occurs, in 50 to 73% of cases, in load-bearing joints, such as the hip and the knee8-10. The occurrence of tuberculosis in the coxofemoral joint is reported in a pediatric patient at a Teaching Hospital, showing how difficult the early diagnosis of this disease can be.

Does orbital proprioception contribute to gaze stability during translation?

Translational motion induces retinal image slip which varies with object distance. The brain must know binocular eye position in real time in order to scale eye movements so as to minimize retinal slip. Two potential sources of eye position information are orbital proprioception and an internal representation of eye position derived from central ocular motor signals. To examine the role of orbital proprioceptive information, the position of the left eye was perturbed by microstimulation of the left abducens nerve during translational motion to the right or left along the interaural axis in two rhesus macaques. Microstimulation rotated the eye laterally, activating eye muscle proprioceptors, while keeping central motor commands undisturbed. We found that microstimulation-induced eye position changes did not affect the translational VOR in the abductive (lateral rectus) direction, but it did influence the responses in the adductive (medial rectus) direction. Our findings demonstrate that proprioceptive inputs appear to be involved in the TVOR responses at least during ipsilateral head movements and proprioceptive influences on the TVOR may involve vergence-related signals to the oculomotor nucleus. However, internal representation of eye position, derived from central ocular motor signals, likely plays the dominant role in providing eye position information for scaling eye movements during translational motion, particularly in the abducent direction.

Effects of inferior oblique muscle-weakening surgery on the Bielschowsky head-tilt phenomenon in patients with superior oblique palsy habitually fixating with the paretic eye

To evaluate the usefulness of inferior oblique (IO) weakening surgery on a paretic eye for correcting vertical deviation in three positions of gaze by comparing the surgical results in 2 types of unilateral superior oblique (SO) palsy. The patients were divided into 2 groups: 27 patients fixated with the paretic eye and 61 patients fixated with the non-paretic eye (control). The former had hypotropia and the latter hypertropia. All patients underwent IO recession of the paretic eye. We compared the corrective effects, percentage changes in the decrease of vertical deviation of the primary position (PP), vertical deviation on ipsilateral head tilt, i.e., the Bielschowsky head-tilt phenomenon (BHP), and differences in vertical deviation between ipsilateral and contralateral head tilt (BHTD) relative to the preoperative values between the 2 groups. Mean percentage decrease in vertical deviation of the BHP and BHTD in the control group was larger at 3, 6, and 12months, but no significant difference was observed between the 2 groups except for the BHP at 12months (52% for case vs. 70% for control, p=0.04). IO weakening in the paretic eye was effective irrespective of the preferred eye for fixation on PP and head-tilt position.

Progressive carotid artery dissection causing tinnitus and one-sided head and neck pain

Carotid artery dissection, one of the most common causes of stroke in patients younger than 40 years of age, may develop spontaneously or after trauma. In 85% of cases, central neurological signs such as stroke, transient ischemic attack and amarozis fugax are seen, while headache and cranial nerve paralysis can be the presenting symptoms in the rest of cases. In this case report, a 35-year of age young male patient who had a progressive carotid artery dissection accompanied by complaints of left sided tinnitus and ipsilateral head and neck pain. The patient was admitted to the clinic with the diagnosis of carotid artery dissection and cerebral angiography (CA) was planned. During the CA performed the day after, three stents were placed in the dissection area. Improvement was observed in all complaints of the patient who was followed up in the clinic for 10 days. The patient was discharged in a healthy condition to return after three months for a control.

Flexor reflexes elicited by magnetic and electric stimulation of the sural nerve

Objectives: We have investigated whether magnetic stimulation of the sural nerve can evoke a flexor reflex recorded from the ipsilateral short head of the biceps femoris muscle.Methods: The sural nerve was subjected to magnetic stimulation as well as by single-pulse electrical stimulation in healthy subjects.Results: In 87% of the participants, a reflex response was elicited from the short head of biceps femoris muscle by magnetic stimulation of the sural nerve. In terms of latency and amplitude, this reflex response was similar to the flexor reflex response evoked from the same muscle by single-pulse electrical stimulation of the sural nerve.Discussion: Findings indicate that flexor reflexes can easily be evoked from the short head of the biceps femoris muscle by magnetic stimulation of the sural nerve. The late component of the flexor reflex may not only be elicited via nociceptive afferents but may also involve non-nociceptive afferents.

Mobile phones and head tumours. The discrepancies in cause-effect relationships in the epidemiological studies - how do they arise?

BackgroundWhether or not there is a relationship between use of mobile phones (analogue and digital cellulars, and cordless) and head tumour risk (brain tumours, acoustic neuromas, and salivary gland tumours) is still a matter of debate; progress requires a critical analysis of the methodological elements necessary for an impartial evaluation of contradictory studies.MethodsA close examination of the protocols and results from all case-control and cohort studies, pooled- and meta-analyses on head tumour risk for mobile phone users was carried out, and for each study the elements necessary for evaluating its reliability were identified. In addition, new meta-analyses of the literature data were undertaken. These were limited to subjects with mobile phone latency time compatible with the progression of the examined tumours, and with analysis of the laterality of head tumour localisation corresponding to the habitual laterality of mobile phone use.ResultsBlind protocols, free from errors, bias, and financial conditioning factors, give positive results that reveal a cause-effect relationship between long-term mobile phone use or latency and statistically significant increase of ipsilateral head tumour risk, with biological plausibility. Non-blind protocols, which instead are affected by errors, bias, and financial conditioning factors, give negative results with systematic underestimate of such risk. However, also in these studies a statistically significant increase in risk of ipsilateral head tumours is quite common after more than 10 years of mobile phone use or latency. The meta-analyses, our included, examining only data on ipsilateral tumours in subjects using mobile phones since or for at least 10 years, show large and statistically significant increases in risk of ipsilateral brain gliomas and acoustic neuromas.ConclusionsOur analysis of the literature studies and of the results from meta-analyses of the significant data alone shows an almost doubling of the risk of head tumours induced by long-term mobile phone use or latency.

Neck muscle responses evoked by transcranial magnetic stimulation of the human frontal eye fields

Transcranial magnetic stimulation (TMS) provides a non-invasive means of investigating brain function. Whereas TMS of the human frontal eye fields (FEFs) does not induce saccades, electrical stimulation of the monkey FEF evokes eye-head gaze shifts, with neck muscle responses evoked at stimulation levels insufficient to evoke a saccade. These animal results motivated us to examine whether TMS of the FEF (TMS-FEF) in humans evokes a neck muscle response. Subjects performed memory-guided saccades to the left or right while TMS (two pulses at 20 Hz) was delivered on 30% of trials to the left FEF coincident with saccade instruction. As reported previously, TMS-FEF decreased contralateral saccade reaction times. We simultaneously recorded the activity of splenius capitis (SPL) (an ipsilateral head turner). TMS-FEF evoked a lateralized increase in the activity of the right SPL but not the left SPL, consistent with the recruitment of a contralateral head-turning synergy. In some subjects, the evoked neck muscle response was time-locked to stimulation, whereas in others the evoked response occurred around the time of the saccade. Importantly, evoked responses were greater when TMS was applied to the FEF engaged in contralateral saccade preparation, with even greater evoked responses preceding shorter latency saccades. These results provide new insights into both the nature of TMS and the human oculomotor system, demonstrating that TMS-FEF engages brainstem oculomotor circuits in a manner consistent with a general role in eye-head gaze orienting. Our results also suggest that pairing neck muscle recordings with TMS-FEF provides a novel way of assaying the covert preparation of oculomotor plans.

Ictal head turning in frontal and temporal lobe epilepsy

To quantitatively evaluate the difference of ictal head turning movements between patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). We investigated 38 seizures of 31 patients with unilateral TLE and 22 seizures of 14 patients with unilateral FLE where head turning occurred in the seizure evolution. The head movements were defined as ipsilateral or contralateral in reference to the lateralization of the patient's focal epilepsy syndrome. Head movements were quantified by either referencing the head position with manually placed markers or by automatic detection of infrared marked reference points. The time of onset, duration, and angular speed of the head movements were computed, and interindividual and intraindividual analyses were performed. All of the TLE seizures had both contralateral and ipsilateral head turning, whereas all FLE had contralateral head turning; only 6 of 22 seizures were associated with ipsilateral head turning. Ipsilateral head turning always preceded contralateral head turning in both TLE and FLE. The head turning occurred significantly sooner after clinical seizure onset in FLE than in TLE patients (ipsilateral 0.5 vs. 16.0 s, contralateral: 4.5 vs. 21.3 s; p < 0.001). Furthermore, the duration of head turning was shorter in FLE for contralateral head turning (4.1 s) than in TLE (contralateral 6.0 s, p < 0.01); the ipsilateral head turning in the two groups did not differ (3.0 vs. 2.9 s) in duration. The angular speed of head turning did not differ for ipsilateral and for contralateral head turning in FLE and TLE. Quantitative analysis of head turning demonstrates significant differences between patients with FLE and TLE. These differences likely represent differences in spread of epileptic activity. This information may be useful in the seizure evaluation of patients considered for resective epilepsy surgery.

Dominant vertebral artery occlusion during ipsilateral head tilt

A 29-year-old man had paroxysmal vertigo, tinnitus, and visual blurring during head tilt to the left. During leftward head tilt, there was downbeat nystagmus with small leftward horizontal and torsional components (video on the Neurology ® Web site at www.neurology.org). Horizontal head rotation did …

Radiologic Findings and Outcomes of Hyoid Compression Syndrome

Radiologic Findings and Outcomes of Hyoid Compression Syndrome

Ipsilateral Tilt and Contralateral Sensory Change of Neck in Cortical Infarction

BackgroundNumerous neck muscles are involved in neck movements, and so isolated neck weakness is extremely uncommon in cerebral infarction.Case ReportWe report herein the case of a 65-year-old woman with hypertension and acute cortical infarction, presenting with ipsilateral head tilt and contralateral sensory changes in the neck and shoulder area, which has never been described before.ConclusionsTransient neck weakness and sensory deficits can occur in acute cortical infarction. The motor representation of the neck muscles can be at the same level of the cortical sensory representation, near to the level of the trunk representation, which is in contrast to Penfield's findings. Several possible mechanisms for the ipsilateral tilt are described.

The survival and functional outcome of primary bone sarcomas in distal lower extremity

To analyze the oncological and functional outcome of limb salvage in this location. From November 2003 to January 2010, 20 patients with primary malignant bone tumors of the distal lower extremity were treated. There were 15 male and 5 female, the mean age was 20 years. Among 14 patients with malignant distal tibial sarcoma, 11 patients had ankle arthrodesis reconstructed by using allograft (7 patients) or autografts (4 patients), the other 3 patients underwent below-knee amputation. Three patients with osteosarcoma of distal fibula reconstructed with ipsilateral fibular head, 3 patients with calcaneus osteosarcoma underwent total calcanectomy and reconstructed with fibular segment and iliac crest. The mean follow-up was 36.4 months. Five of 7 (71.4%) patients with allograft reconstruction were associated with delayed wound healing, however, only 1 of 10 patients with autograft had this problem (P = 0.036). One local recurrence was observed, 2 osteosarcoma patients died of disseminated disease. The estimated 2-year and 5-year overall survival for the patients with malignant tibial sarcomas were 92.9% and 79.6% respectively, for the patients with distal tibial high-grade osteosarcoma were 87.5% and 70.0% respectively. The mean functional MSTS score was 82% for limb salvage patients. The survival of patients with primary malignant bone tumor of distal lower extremity seems to be better than that of other sites. Limb salvage can provide satisfactory local control and functional results.

CASE REPORT AND CLINICAL REVIEW: Unilateral facial myokymia in a dog with an intracranial meningioma

A 23‐month‐old castrated male Cavalier King Charles spaniel was evaluated because of a 6‐month history of unusual rippling/undulating movements of the right facial muscles that were continuous and persisted during sleep.Neurological examination revealed narrowing of the right palpebral fissure and unilateral right‐sided facial myokymia that was characterised by myokymic, and to a lesser degree, neuromyotonic discharges on concentric needle electromyographic examination.After persisting unchanged for almost 2.5 years from its onset, the facial myokymia gradually disappeared over a 6‐month period concomitant with the emergence of a persistent ipsilateral facial paralysis and head tilt. At 5 years and 9 months after the first examination, signs of ipsilateral lacrimal, pharyngeal and laryngeal dysfunction became evident and the dog was euthanased. Postmortem examination identified a malignant (WHO grade III) meningioma in the right cerebellopontomedullary angle that compressed the ventrolateral cranial medulla, effaced the jugular foramen and internal acoustic meatus and extended into the facial canal of the petrous temporal bone.Novel findings were the unique observation of isolated unilateral facial myokymia preceding diagnosis of a meningioma affecting facial nerve function within the caudal cranial fossa and the remarkably long duration of neurological signs (75 months) attributable to the neoplasm.

Metaversion can reliably predict humeral head version: A computed tomography-based validation study

Circumstances occur when the determination of anatomic humeral head version is difficult. In the setting of irreparable proximal humeral fracture, there are few reliable intraoperative landmarks to determine anatomic humeral head version. This study tested our hypothesis that the metaphyseal version (metaversion) is a landmark that can assist with correct head version and used computed tomography (CT) to evaluate its reliability as a predictor of anatomic version. CT scans from 50 consecutive patients (20 women, 30 men) were examined using commercial software. Patients were a mean age of 46 years (range, 17-85 years). Exclusion criteria included previous fracture, arthritis, or humeral deformity. The metaversion and humeral head version were measured. Measurements were conducted independently by 2 surgeons blinded to the results of the other. Interobserver and intraobserver reliability was calculated using intraclass correlation. The mean difference between the metaversion and the humeral head version was 2.5° (95% confidence interval [CI], 0.9°-3.9°). The mean difference between metaversion and humeral head version was 1.8° (95% CI, 0.0°-3.6°) in women, 2.9° (95% CI, 0.6°-5.1°) in men, 2.4° (95% CI: 0.6°-4.1°) in right shoulders, and 2.5° (95% CI, -0.1° to 5.1°) in left shoulders. Interrater and intrarater reliability was excellent, 0.97 and 0.98, respectively. Proximal humeral metaphyseal version (metaversion) is an accurate predictor of ipsilateral humeral head version.

Eccentric muscle contraction and stretching evoke mechanical hyperalgesia and modulate CGRP and P2X3 expression in a functionally relevant manner

Non-invasive, movement-based models were used to investigate muscle pain. In rats, the masseter muscle was rapidly stretched or electrically stimulated during forced lengthening to produce eccentric muscle contractions (EC). Both EC and stretching disrupted scattered myofibers and produced intramuscular plasma extravasation. Pro-inflammatory cytokines (IL-1β, TNF-α, IL-6) and vascular endothelial growth factor (VEGF) were elevated in the masseter 24h following EC. At 48h, neutrophils increased and ED1 macrophages infiltrated myofibers while ED2 macrophages were abundant at 4d. Mechanical hyperalgesia was evident in the ipsilateral head 4h–4d after a single bout of EC and for 7d following multiple bouts (1 bout/d for 4d). Calcitonin gene-related peptide (CGRP) mRNA increased in the trigeminal ganglion 24h following EC while immunoreactive CGRP decreased. By 2d, CGRP-muscle afferent numbers equaled naive numbers implying that CGRP is released following EC and replenished within 2d. EC elevated P2X3 mRNA and increased P2X3 muscle afferent neuron number for 12d while electrical stimulation without muscle contraction altered neither CGRP nor P2X3 mRNA levels. Muscle stretching produced hyperalgesia for 2d whereas contraction alone produced no hyperalgesia. Stretching increased CGRP mRNA at 24h but not CGRP-muscle afferent number at 2–12d. In contrast, stretching significantly increased the number of P2X3 muscle afferent neurons for 12d. The sustained, elevated P2X3 expression evoked by EC and stretching may enhance nociceptor responsiveness to ATP released during subsequent myofiber damage. Movement-based actions such as EC and muscle stretching produce unique tissue responses and modulate neuropeptide and nociceptive receptor expression in a manner particularly relevant to repeated muscle damage.

Are there differences between cephalic and extracephalic cutaneous allodynia in migraine patients?

Cutaneous allodynia (CA), pain in response to innocuous cutaneous stimuli, is recognized as a sign of central sensitization during migraine episodes. It is either restricted within the pain area on the ipsilateral head, or extends within and outside the head. Moreover, CA can be elicited in response to thermal (heat or cold) and/or mechanical stimuli. This raises the question as to whether cephalic and extracephalic CAs share the same properties. We assessed cephalic and extracephalic CAs in migraine episodic patients using a questionnaire completed at home during migraine attacks. A total of 67 episodic migraine patients (58 women, nine men; 4013 years old) addressed all questions in the questionnaire. Forty-nine patients (73%) cited one or more allodynic symptoms during or immediately after the migraine attack. Almost all 49 patients reported cephalic CA, whereas 24 (49%) also reported extracephalic CA. Occurrence and extension of CA correlated (P = 0.005) with headache intensity. Modalities of cephalic and extracephalic CA were different (chi2 = 12.03; P = 0.002), extracephalic CA being mostly thermal (75%) whereas cephalic CA was mostly mechanical (92%). This suggests that cephalic and extracephalic CAs involve different mechanisms.

Anterior dislocation of hip with ipsilateral femoral neck and head fracture

A 70-year-old male patient presented to our emergency department with trauma left hip following a fall. Physical examination revealed external rotation, slight flexion, adduction, and shortening of the affected limb. There was a palpable fullness in the groin. Radiographic examination revealed fracture neck of femur with femoral head dislocated anteriorly and lying in the obturator foramen. There was an associated femoral head fracture with a fragment of it in the acetabulum. Although this sort of injury has been reported once, the difference in our case lies in the age of the patient; the injury complex was caused by a less severe trauma and a unique mechanism of injury. Also a modification of Brumback classification is proposed to include such fractures more specifically in order to allow comparative analysis in such rare injuries as more and more such case reports are added to literature.

Treatment of Knapp Class V superior oblique palsy with contralateral inferior rectus muscle recession

Objective: To describe the clinical features of patients with Knapp Class V superior oblique palsy (hypertropia greatest across the lower fields of gaze) and to present the results of a contralateral, adjustable, inferior rectus muscle recession procedure performed on these patients. Design: Clinical, cohort study. Participants: We retrospectively reviewed a series of 4 cases of superior oblique palsy (Knapp Class V). The patients, seen between the years 1991 and 2000, were selected from the private practice of 1 of the authors (Michael Flanders). Methods: Clinical and surgical data were extracted from the patients' records. All patients had had complete ophthalmologic and orthoptic assessments. Those included in this series had difficulty reading and compensated by lowering their chins. They had a hypertropia, which increased in downgaze, decreased in upgaze, and increased on ipsilateral head tilt. Both the ipsilateral superior oblique and inferior rectus muscles were underactive. All 4 patients underwent contralateral, adjustable, inferior rectus muscle recession. Results: The mean vertical deviation of the paretic eye preoperatively was 8.25 prism D (PD) in primary position and 20 PD in downgaze. Postoperatively it was 2 PD in primary position and 5 PD in downgaze. All patients had improved head posture and a more comfortable reading position after surgery. Mean follow-up was 6.4 years (range 1–9 years). Conclusions: Contralateral inferior rectus muscle recession is an effective treatment for visual symptoms associated with Knapp Class V superior oblique palsy.