Loss Of Temperature Sensation Research Articles

Cheiro-oral-pedal syndrome of the pons and the role of imaging in diagnosis and management

The patient is a 58-year-old male who presented with chief complaints of right-sided numbness, tingling, and loss of temperature sensation in the upper and lower extremities. The patient’s symptoms began around the face and right corner of the mouth [maxillary/mandibular (V2/V3) distribution] before descending to the arm, trunk, and followed by the lower leg and foot. His home medication regimen included lisinopril, atorvastatin, long and short-acting insulin, and amlodipine. During the interview, the patient admitted to abstinence from his medications. Upon examination, the patient was found to have a loss of hot and cold touch on the right side and expressed 2+ reflexes (brisk response; normal) on both upper and lower extremities. In the initial work-up of the patient, he received a computed tomography (CT) scan which demonstrated an area of potential ischemic infarct of one of the left sided pontine perforator arteries. Immediately at that time he was given a loading dose of 325 mg aspirin and started on 81 mg daily. Because of the patient’s symptoms and risk factors, he was hospitalized for further additional work-up and eventually discharged on dual antiplatelet therapy. This case is intriguing as both neuroradiological reading and neurological examination helped with localization of the lesion and changing the treatment strategy of the patient. With a pontine perforator ischemic event, the harms of treatment with thrombolytics would have outweighed the benefits. This interprofessional work between neuroradiology, internal medicine, and neurology ensured that the patient received the best care for his specific ailments.

Combined Spinal Epidural Anaesthesia Technique with Ketamine Infusion for Emergency Laparotomy of a Known COVID-19 Case at High Altitude of 12000 Feet Above Mean Sea Level

SARS-CoV-2 is a highly infectious virus known to cause severe acute respiratory syndrome in humans known as COVID-19. It is well established that the mode of transmission is through aerosol generation. Since the invasive procedures like endotracheal intubation place the anaesthesiologist and the operating room staff highly exposed to the risk of infection it is prudent to follow regional anaesthesia technique wherever possible. The present case is of a 34-year-old COVID 19 positive male patient who underwent emergency laparotomy in a service hospital of armed forces at 12000 feet above sea level under combined spinal and epidural anaesthesia supplemented with sedation using intravenous infusion of Ketamine. After the attachment of standard ASA monitor and taking in account of baseline readings patient was administered an 18-gauge epidural secured in the T12-L1 level with the catheter was fix at 12 cm on the skin. Sub arachnoid block was administered to the patient using 2.75 ml of 0.5 % Bupivacaine (heavy) and 25 mcg of Fentanyl in L2-L3 space using a 26-gauge spinal needle in sitting position. Once the height of the block was ascertained at T6 level by loss of temperature sensation the surgery commenced. Patient was administered with 3.0 mg of Morphine in epidural space for perioperative analgesia. For allaying intraoperative discomfort patient was sedation infusion of Ketamine of 0.6mg/kg/hr to keep the Ramsay sedation score between 3-4. The intraoperative period was uneventful, and the patient did not require any supplemental analgesia during the surgery. Post operatively the patient was pain free and comfortable with no features of hypopnea, post-operative nausea vomiting and shivering and was shifted to the post-operative care unit in the covid facility of the hospital.

Intra-abdominal pressure, vertebral column length, and spread of spinal anesthesia in parturients undergoing cesarean section: An observational study.

BackgroundIn parturients with increased physiologically intra-abdominal pressure (IAP) and a short stature, a greater cephalad spread of spinal anesthesia is often observed after a fixed amount of plain bupivacaine is administered. Therefore, we designed this prospective study to test whether IAP and vertebral column length (VCL) were predictors of spinal spread in parturients undergoing a cesarean section.MethodsA total of 113 parturients, all undergoing elective cesarean sections with single-shot spinal anesthesia, were enrolled. The L3-L4 interspace was entered, and 2 mL of 0.5% plain bupivacaine was injected into the subarachnoid space. Upon loss of temperature sensation at the T4 level, IAP was measured through a bladder catheter while the patient was in the supine position with a 10°left lateral tilt. Parturient demographic variables, including age, height, weight, IAP, and VCL were recorded. Linear regressions and multiple regressions were performed to analyze the relationships between parturient variables and the spread of spinal anesthesia.ResultsA total of 109 parturients were included in the analysis. Linear regression analysis showed a significant univariate correlation of height, weight, body mass index (BMI), IAP, and VCL with cephalad spread (all P< 0.004). Multiple linear regression analysis showed that IAP and VCL were the key determinants of spinal spread (both P < 0.0001), where as exclusion of age, weight, and height did not change the result (all P> 0.209).ConclusionsOur data indicated that IAP and VCL were significant predictors of intrathecal spread of plain bupivacaine, and there was a positive association between IAP and abdominal girth in term parturients.

Type I Chiari malformation presenting orthostatic syncope who treated with decompressive surgery.

Chiari malformations are a congenital anomaly of the hindbrain. The most common, Chiari malformation type I (CM-I), is characterized by herniation of the cerebellar tonsils extending at least 3 mm below the plane of the foramen magnum. Consequently, CM-I is associated with hydrocephalus and symptoms involving compression of the cervicomedullary junction by ectopic tonsils. Several studies have reported the clinical symptoms associated with CM-I, including suboccipital headache, weakness in the upper extremities, facial numbness, loss of temperature sensation, ataxia, diplopia, dysarthria, dysphagia, vomiting, vertigo, nystagmus, and tinnitus. Syncope is one of the rarest presentations in patients with CM-I. There are many hypotheses regarding the causes of syncope in patients with CM-I; however, the mechanisms are not clearly understood. Although surgical decompression for CM-I in patients with syncope has yielded good clinical results in some studies, such cases are rarely reported. We report a case of orthostatic syncope in a patient with CM-I who was treated with surgical intervention.

Intramyometrial vasopressin as a haemostatic agent: Is it really safe?

Vasopressin when given intramyometrially during myomectomy results in good surgical haemostasis.[1,2] At the same time, there are published reports of adverse cardiac events following vasopressin injection.[3,4] Resuscitation measures following such adverse cardiac events require understanding of pharmacodynamics of vasopressin administration.[5] We present a case of successful resuscitation of complete heart block following intramyometrial vasopressin injection during myomectomy and the associated implications.

Sensory Guillain-Barré syndrome: A case report.

A 58-year-old female exhibited the onset of symmetrical sensory abnormalities of the face and extremities. The neurological examination revealed normal muscle strength with abated or absent tendon reflexes. The patient experienced symmetrical glove- and stocking-type pinprick sensations in the distal extremities and a loss of temperature sensation, but had normal proprioception and vibration senses and joint topesthesia. The lumbar puncture showed protein cell separation at the fifth week after the onset of symptoms. At the same time-point, the electrophysiological examination showed demyelination changes involving the trigeminal nerve and the somatic motor nerve. Needle electromyography revealed normal results. The clinical symptoms ceased progression at the fourth week after symptom onset, and began to improve from the sixth. This case was considered to be sensory Guillain-Barré syndrome, which was characterized by its cranial nerve involvement.

Abdominal girth, vertebral column length, and spread of spinal anesthesia in 30 minutes after plain bupivacaine 5 mg/mL.

The spread of spinal anesthesia is highly unpredictable. In patients with increased abdominal girth and short stature, a greater cephalad spread after a fixed amount of subarachnoidally administered plain bupivacaine is often observed. We hypothesized that there is a strong correlation between abdominal girth/vertebral column length and cephalad spread. Age, weight, height, body mass index, abdominal girth, and vertebral column length were recorded for 114 patients. The L3-L4 interspace was entered, and 3 mL of 0.5% plain bupivacaine was injected into the subarachnoid space. The cephalad spread (loss of temperature sensation and loss of pinprick discrimination) was assessed 30 minutes after intrathecal injection. Linear regression analysis was performed for age, weight, height, body mass index, abdominal girth, vertebral column length, and the spread of spinal anesthesia, and the combined linear contribution of age up to 55 years, weight, height, abdominal girth, and vertebral column length was tested by multiple regression analysis. Linear regression analysis showed that there was a significant univariate correlation among all 6 patient characteristics evaluated and the spread of spinal anesthesia (all P < 0.039) except for age and loss of temperature sensation (P > 0.068). Multiple regression analysis showed that abdominal girth and the vertebral column length were the key determinants for spinal anesthesia spread (both P < 0.0001), whereas age, weight, and height could be omitted without changing the results (all P > 0.059, all 95% confidence limits < 0.372). Multiple regression analysis revealed that the combination of a patient's 5 general characteristics, especially abdominal girth and vertebral column length, had a high predictive value for the spread of spinal anesthesia after a given dose of plain bupivacaine.

Analysis, Diagnosis and Prognosis of Leprosy Utilizing Fuzzy Classifier

Leprosy (Hensen&#8217;s Disease) is an infectious disease that progressively deteriorates over time and is associated with mycobacterium leprae (M.leprae). Although human-to-human transmission is the primary source of infection, three other species can carry and (rarely) transfer M.leprae to humans: chimpanzees, mangabey monkeys, and nine-banded armadillos. The early signs and symptoms of leprosy are very subtle and occur slowly (usually over years), which includes; numbness (loss of temperature sensation), skin lesions, weakness, anesthesia, paralysis, epistaxis, skin bumps, deformity (face, hand and foot), eye damage (dryness and reduced blinking), loss of digit, enlarged earlobes, conjunctivitis and Iridocyclitis. In this paper, the traditional procedure of the medical diagnosis of Leprosy employed by physicians is expressed using Fuzzy classifier. The proposed expert system eliminates uncertainty and imprecision associated with the diagnosis of Leprosy.

Comparison of Three Different Concentrations of Ropivacaine for Postoperative Patient-controlled Thoracic Epidural Analgesia After Upper Abdominal Surgery

Previous studies have reported the comparable efficacy of ropivacaine/fentanyl for patient-controlled epidural analgesia (PCEA). In our hospital, three different concentrations of ropivacaine solution (0.1%, 0.15%, 0.2%) in combination with 1 microg/mL fentanyl were available for PCEA. As some studies have reported a much higher incidence of motor block and opioid-related side effects with 0.2% ropivacaine in combination with 4 microg/mL fentanyl, it was our intent to analyze the data of our patients who had received PCEA after upper abdominal surgery. In addition to comparing the analgesic effects and the incidence of motor block and opioid-related side effects of these three different ropivacaine/fentanyl solutions, we also evaluated the workload of our pain staff. The main purpose of our study was to determine which of these three regimens of ropivacaine was most satisfactory with the least workload for the pain service staff. In total, 33 patients who had received PCEA after upper abdominal surgery were included in the analysis. The number of patients in each ropivacaine/fentanyl group was 11 (group 1, 0.1% ropivacaine; group 2, 0.15%; group 3, 0.2%). The PCEA device was programmed to deliver a patient-controlled bolus of 2 mL with a lockout time of 20 minutes and background infusion of 5 mL/hr for 72 hours. Visual analog scale (VAS) pain scores, adverse events and the extent of sensory or motor block were recorded 12, 36 and 60 hours after surgery. The total volume of analgesic solution consumed and the frequency of requisite attendance by pain service staff were also recorded. There were no differences among the three groups regarding total consumption. In group 1, VAS scores during ambulation and cough 12 hours postoperatively were significantly higher than in the other two groups (p < 0.05). There was no motor block. Four patients in group 3 suffered from loss of temperature sensation. The overall incidence of adverse events was less than 40%. Both thoracic epidural 0.15% and 0.2% ropivacaine provide effective postoperative pain control in combination with fentanyl without motor block. A 0.15% ropivacaine-1 microg/mL fentanyl solution is preferable considering the lower incidence of adverse events.

Confirmation of linkage of type 1 hereditary sensory neuropathy to human chromosome 9q22.

1) To confirm linkage of hereditary sensory neuropathy type 1 (HSN-I) to human chromosome 9q22 in a large American family of German origin. 2) To construct a yeast artificial chromosome (YAC) contig spanning the HSN-I candidate interval. 3) To investigate the HSN-I contig for potential candidate genes. HSN-I is a rare peripheral neuropathy characterized by loss of temperature sensation, ulceration and osteomyelitis of the digits, and subtle distal weakness. A gene for HSN-I has previously been mapped to human chromosome 9q22.1-q22.3 between markers D9S318 and D9S176 in an 8-cM interval in four Australian families. In a large German-American family with HSN-I, genome-wide linkage analysis was performed on 68 family members extending over five generations and including 17 affected members. Genotyping was performed with PCR, and the resulting genotypes were analyzed with two-point linkage analysis with Fastlink. A YAC contig was constructed based on the Whitehead Institute YAC contig WC9.3. Two-point linkage analysis resulted in a maximum lod score of 8.2 at theta = 0 for marker D9S1815. Haplotype analysis locates the HSN-I gene between markers D9S1797 and D9S197. Using YAC clones from the Centre d'Etude du Polymorphism Humain YAC Library, we constructed a YAC contig spanning these markers. Based on the radiation hybrid map of the human genome, we estimate that the size of this interval is less than 2,500 kb. Our study confirms linkage of a putative HSN-I gene to chromosome 9q22, considerably narrows the HSN-I locus, and provides a basis for identification of the HSN-I gene.

Combined effect of patient variables on sensory level after spinal 0.5% plain bupivacaine

The combined effect of age, weight, height, and vertebral column length (VCL) on the distribution of isobaric 0.5% bupivacaine within the subarachnoid space is unclear. The aim of the present study was to evaluate the combined influence of these patient variables on the upper sensory level and on its predictability. In 100 patients who were above the age of 49 years, the age, weight, height, VCL, body surface (BS), and body mass index (BMI) were noted. Spinal puncture and subarachnoid drug administration were standardized. Cephalad spread of spinal anaesthesia (SA) was assessed by loss of temperature sensation and pinprick discrimination 15, 30, 60, 90, and 120 min following subarachnoid injection of 18 mg of plain 0.5% bupivacaine. Linear regression analysis was performed for each of the patient variables and the cephalad segmental spread of anaesthesia. Multiple regression analysis was used to test for combined correlation between patient variables and the sensory level of SA. No linear correlation was found between the patient variables and the sensory level of anaesthesia. In contrast, multiple regression analysis revealed that age (P<0.01), weight (P<0.05), and height (P<0.01) significantly contributed to the spread of anaesthesia. A squared multiple comparison coefficient between 0.10 and 0.21, however, is an indication that the predictive value of the combined variables remained rather low. Multiple regression analysis revealed that age, weight, and height significantly correlated with the sensory level after subarachnoid injection of plain bupivacaine. The low predictive value suggests that patient factors other than age, weight, or height add to cephalad spread of SA.

Abstract of a study to measure the possible differences in the perception of pain and temperature in hemiplegic patients

Introduction: The peripheral sensations of pain and temperature are so closely linked anatomically1 that often only one is assessed during the physiotherapy examination of a neurologically impaired patient. The assumption is made that they would either both be affected or both be normal. Usually pain perception is evaluated as it is the quicker and easier of the two tests. However, could it be possible that pain sensibility be normal, yet temperature abnormal? This scenario could have dire consequences for the patient, as the therapist would neglect to warn the patient or his/her care giver of the possibility of burning themselves, for instance, when climbing into too hot a bath, or sitting too close to a heater. A pilot study investigated the validity of this assumption in subjects having sustained a cerebral vascular accident (CVA).Procedure: The pain and temperature perceptions of twenty-two acute (less than three months prior) CVA patients were assessed. Pain was assessed using the pin prick method, and temperature, using hot and cold test-tubes on both sides of the body in thirteen different areas2,3.Results :There were fifteen female and seven male subjects tested, nine of whom had right CVA's, while thirteen had sustained left CVA's. Eight of the subjects had normal sensation, and ten had both pain and temperature decreased. Four of the subjects (all left CVA's) reported a normal perception to pain, but this was decreased as compared to temperature, especially to heat.Discussion: The results were in keeping with those of Samuelsson et al4. However, the study requires more stringent inclusion criteria, for example a smaller age range as the appreciation of sensation may decrease with age, and a larger sample in order to determine the difference between left and right CVA's. Only middle cerebral artery territory strokes should be included. Unfortunately the nature of the assessment of sensation requires that the subject be able to understand the test and be able to communicate their reply, thus aphasic subjects, both receptive and expressive would have to be excluded. Follow-up studies may have to be included, as sensation perception may improve with time following a CVA1.Conclusion: Although there was not conclusive evidence these two sensations may be affected by a CVA, there were examples of when it did occur. perhaps it is incumbent on physiotherapists to warn all their clients of the possibility and consequences of a loss of temperature sensation, even if pain perception appears normal.

Evidence for segregated pain and temperature conduction within the spinothalamic tract

The lateral spinothalamic tract, located in the anterolateral quadrant of the white matter of the spinal cord, is one of the most important structures in transmitting pain within the central nervous system. It has been known for almost a century that destruction of fibers in this tract results in analgesia contralateral to the lesion. The effectiveness and clinical importance of interruption of the lateral spinothalamic tract has been proven in many studies. Today cordotomies are still a useful neurosurgical treatment modality, especially when pain can no longer be sufficiently controlled by analgesic drugs. Although analgesia on the contralateral side is the desired effect, one must also expect to cause disturbance in temperature sensation when performing a cordotomy. The authors' observations showed that after a cordotomy the dermatome level of analgesia can be variable within certain limits, which is in accordance with the literature. Surprisingly, however, the loss of temperature sensation may differ significantly from the loss of pain sensation. It was also found to be possible to perform a successful cordotomy without altering the sensation of temperature at all. This indicates that pain and temperature sensations may be conducted via separate pathways. Possible mechanisms underlying this phenomenon are discussed.