The Experts below are selected from a list of 294 Experts worldwide ranked by ideXlab platform
Helmut Kerl - One of the best experts on this subject based on the ideXlab platform.
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itch skin lesions and a Stiff Neck
The Lancet, 2007Co-Authors: Thomas Wiesner, Bernd Leinweber, Stefan Quasthoff, Baerbel Unger, Peter Komericki, Stefan Hoedl, Helmut KerlAbstract:In January, 2007, a 36-year-old man presented to his derma tologist, with a 3-month history of constant itching of his head, Neck, shoulders, and upper limbs. The itch had become so intense that it disturbed the patient’s sleep; it had a burning character, especially when the patient was wearing clothes. Treatment with topical cortico steroids and oral antihistamines produced no improve ment. The patient took no other regular medications, except occa sional nonsteroidal anti-infl ammatory drugs to relieve inter mittent Neck pain: he had a 2-year history of Neck pain and Stiff ness. After 1 month, during which the itch contin ued to worsen, the patient was referred to us for further investigation. Physical examination showed slight redness of the aff ected skin, as well as excoriated fl at papules and erosions on the Neck and forearms (fi gure). These signs were considered to be caused by rubbing and scratching. The results of blood tests, including a full blood count, plasma glucose, renal and liver function tests, and infl ammatory markers were all unremarkable. The association of Neck pain, cervical Stiff ness, and itch localised to areas supplied by the cervical spinal cord, pointed to a neurological cause for the itch. Neurological examination revealed abnormalities of both arms, particularly severe distally and in the right arm: hypoaesthesia, paraesthesia, muscle weakness, and reduced refl exes. Electromyography and nerve conduction tests showed an axonal injury, at the levels of the fi fth and sixth cervical roots. Further sensory testing revealed complete loss of heat sensation, and reduced vibration sense, in the index fi ngers of both hands, corresponding to the sixth cervical root. The symmetrical loss of motor and sensory function led us to suspect a lesion of the cervical spinal cord, aff ecting most or all of its width. Cervical MRI showed a lesion extending from the level of the fi rst to the seventh cervical vertebra, with prominent perifocal oedema. The lesion was excised by a decom pressive laminectomy, and was found to be an ependymoma on histopathological analysis. Irritation of the spinal cord, during the operation, caused weakness of all the patient’s limbs. This weakness decreased during residential rehabilitation; by April, 2007, the patient had regained most of his strength and coordination. The itch was no longer present. In May, 2007, the patient started to receive radiotherapy, to ensure that the tumour was eradicated. Sadly, he then developed a fi stula extending from the spinal cord to the skin—through which cerebrospinal fl uid leaked—and a subse quent infection of the fi stula and the surrounding tissue, though not of the spinal cord itself. The cord was seen on MRI to be oedematous. When last seen, in May, 2007, the patient had severe neurological defi cits—although, ironically, no itch. Itch can be classifi ed into four types: pruritoceptive, psychogenic, neurogenic, and neuropathic. 1
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Itch, skin lesions—and a Stiff Neck
The Lancet, 2007Co-Authors: Thomas Wiesner, Bernd Leinweber, Stefan Quasthoff, Baerbel Unger, Peter Komericki, Stefan Hoedl, Helmut KerlAbstract:In January, 2007, a 36-year-old man presented to his derma tologist, with a 3-month history of constant itching of his head, Neck, shoulders, and upper limbs. The itch had become so intense that it disturbed the patient’s sleep; it had a burning character, especially when the patient was wearing clothes. Treatment with topical cortico steroids and oral antihistamines produced no improve ment. The patient took no other regular medications, except occa sional nonsteroidal anti-infl ammatory drugs to relieve inter mittent Neck pain: he had a 2-year history of Neck pain and Stiff ness. After 1 month, during which the itch contin ued to worsen, the patient was referred to us for further investigation. Physical examination showed slight redness of the aff ected skin, as well as excoriated fl at papules and erosions on the Neck and forearms (fi gure). These signs were considered to be caused by rubbing and scratching. The results of blood tests, including a full blood count, plasma glucose, renal and liver function tests, and infl ammatory markers were all unremarkable. The association of Neck pain, cervical Stiff ness, and itch localised to areas supplied by the cervical spinal cord, pointed to a neurological cause for the itch. Neurological examination revealed abnormalities of both arms, particularly severe distally and in the right arm: hypoaesthesia, paraesthesia, muscle weakness, and reduced refl exes. Electromyography and nerve conduction tests showed an axonal injury, at the levels of the fi fth and sixth cervical roots. Further sensory testing revealed complete loss of heat sensation, and reduced vibration sense, in the index fi ngers of both hands, corresponding to the sixth cervical root. The symmetrical loss of motor and sensory function led us to suspect a lesion of the cervical spinal cord, aff ecting most or all of its width. Cervical MRI showed a lesion extending from the level of the fi rst to the seventh cervical vertebra, with prominent perifocal oedema. The lesion was excised by a decom pressive laminectomy, and was found to be an ependymoma on histopathological analysis. Irritation of the spinal cord, during the operation, caused weakness of all the patient’s limbs. This weakness decreased during residential rehabilitation; by April, 2007, the patient had regained most of his strength and coordination. The itch was no longer present. In May, 2007, the patient started to receive radiotherapy, to ensure that the tumour was eradicated. Sadly, he then developed a fi stula extending from the spinal cord to the skin—through which cerebrospinal fl uid leaked—and a subse quent infection of the fi stula and the surrounding tissue, though not of the spinal cord itself. The cord was seen on MRI to be oedematous. When last seen, in May, 2007, the patient had severe neurological defi cits—although, ironically, no itch. Itch can be classifi ed into four types: pruritoceptive, psychogenic, neurogenic, and neuropathic. 1
Akira Eboshida - One of the best experts on this subject based on the ideXlab platform.
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association of perceived stress and Stiff Neck shoulder with health status multiple regression models by gender
Hiroshima journal of medical sciences, 2006Co-Authors: Tomoaki Kimura, Yasutami Tsuda, Seiya Uchida, Akira EboshidaAbstract:It is well known that psychological stress affects health status. Stiff Neck and shoulder in a broad sense is one of the major somatic complaints among Japanese. The objective was to determine how much perceived stress and Stiff Neck/shoulder are associated with health-related quality of life (HRQoL) by gender. Participants (n = 512) completed the Japanese version of Perceived Stress Scale, the SF-8 Japanese version and original questions on perceived Stiff Neck/shoulder. Muscle hardness around the shoulder also was measured with the muscle tension meter. The multiple regression model of the men demonstrated that perceived stress was associated with not only the mental component summary (MCS) (beta: -0.494), but also the physical component summary (PCS) (beta = -0.319) of the SF-8. Although, in the model of the women, perceived stress was also associated with MCS (beta: -0.632) more than in that of the men, Stiff Neck/shoulder and age group (beta: -0.231; -0.268, respectively), but not stress, were related to PCS. The subjective Neck/shoulder Stiffness was hardly correlated with the objective shoulder muscle hardness. This study revealed the associations between perceived stress, Stiff Neck/shoulder and HRQoL, and their difference by gender. The hypothesis of gender differences was discussed with a focus on kind of stressors, perception of stress, admission of negative symptoms and cause of Stiff Neck/shoulder.
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Association of Perceived Stress and Stiff Neck/Shoulder with Health Status : Multiple Regression Models by Gender
Hiroshima journal of medical sciences, 2006Co-Authors: Tomoaki Kimura, Yasutami Tsuda, Seiya Uchida, Akira EboshidaAbstract:It is well known that psychological stress affects health status. Stiff Neck and shoulder in a broad sense is one of the major somatic complaints among Japanese. The objective was to determine how much perceived stress and Stiff Neck/shoulder are associated with health-related quality of life (HRQoL) by gender. Participants (n = 512) completed the Japanese version of Perceived Stress Scale, the SF-8 Japanese version and original questions on perceived Stiff Neck/shoulder. Muscle hardness around the shoulder also was measured with the muscle tension meter. The multiple regression model of the men demonstrated that perceived stress was associated with not only the mental component summary (MCS) (beta: -0.494), but also the physical component summary (PCS) (beta = -0.319) of the SF-8. Although, in the model of the women, perceived stress was also associated with MCS (beta: -0.632) more than in that of the men, Stiff Neck/shoulder and age group (beta: -0.231; -0.268, respectively), but not stress, were related to PCS. The subjective Neck/shoulder Stiffness was hardly correlated with the objective shoulder muscle hardness. This study revealed the associations between perceived stress, Stiff Neck/shoulder and HRQoL, and their difference by gender. The hypothesis of gender differences was discussed with a focus on kind of stressors, perception of stress, admission of negative symptoms and cause of Stiff Neck/shoulder.
Thomas Wiesner - One of the best experts on this subject based on the ideXlab platform.
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itch skin lesions and a Stiff Neck
The Lancet, 2007Co-Authors: Thomas Wiesner, Bernd Leinweber, Stefan Quasthoff, Baerbel Unger, Peter Komericki, Stefan Hoedl, Helmut KerlAbstract:In January, 2007, a 36-year-old man presented to his derma tologist, with a 3-month history of constant itching of his head, Neck, shoulders, and upper limbs. The itch had become so intense that it disturbed the patient’s sleep; it had a burning character, especially when the patient was wearing clothes. Treatment with topical cortico steroids and oral antihistamines produced no improve ment. The patient took no other regular medications, except occa sional nonsteroidal anti-infl ammatory drugs to relieve inter mittent Neck pain: he had a 2-year history of Neck pain and Stiff ness. After 1 month, during which the itch contin ued to worsen, the patient was referred to us for further investigation. Physical examination showed slight redness of the aff ected skin, as well as excoriated fl at papules and erosions on the Neck and forearms (fi gure). These signs were considered to be caused by rubbing and scratching. The results of blood tests, including a full blood count, plasma glucose, renal and liver function tests, and infl ammatory markers were all unremarkable. The association of Neck pain, cervical Stiff ness, and itch localised to areas supplied by the cervical spinal cord, pointed to a neurological cause for the itch. Neurological examination revealed abnormalities of both arms, particularly severe distally and in the right arm: hypoaesthesia, paraesthesia, muscle weakness, and reduced refl exes. Electromyography and nerve conduction tests showed an axonal injury, at the levels of the fi fth and sixth cervical roots. Further sensory testing revealed complete loss of heat sensation, and reduced vibration sense, in the index fi ngers of both hands, corresponding to the sixth cervical root. The symmetrical loss of motor and sensory function led us to suspect a lesion of the cervical spinal cord, aff ecting most or all of its width. Cervical MRI showed a lesion extending from the level of the fi rst to the seventh cervical vertebra, with prominent perifocal oedema. The lesion was excised by a decom pressive laminectomy, and was found to be an ependymoma on histopathological analysis. Irritation of the spinal cord, during the operation, caused weakness of all the patient’s limbs. This weakness decreased during residential rehabilitation; by April, 2007, the patient had regained most of his strength and coordination. The itch was no longer present. In May, 2007, the patient started to receive radiotherapy, to ensure that the tumour was eradicated. Sadly, he then developed a fi stula extending from the spinal cord to the skin—through which cerebrospinal fl uid leaked—and a subse quent infection of the fi stula and the surrounding tissue, though not of the spinal cord itself. The cord was seen on MRI to be oedematous. When last seen, in May, 2007, the patient had severe neurological defi cits—although, ironically, no itch. Itch can be classifi ed into four types: pruritoceptive, psychogenic, neurogenic, and neuropathic. 1
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Itch, skin lesions—and a Stiff Neck
The Lancet, 2007Co-Authors: Thomas Wiesner, Bernd Leinweber, Stefan Quasthoff, Baerbel Unger, Peter Komericki, Stefan Hoedl, Helmut KerlAbstract:In January, 2007, a 36-year-old man presented to his derma tologist, with a 3-month history of constant itching of his head, Neck, shoulders, and upper limbs. The itch had become so intense that it disturbed the patient’s sleep; it had a burning character, especially when the patient was wearing clothes. Treatment with topical cortico steroids and oral antihistamines produced no improve ment. The patient took no other regular medications, except occa sional nonsteroidal anti-infl ammatory drugs to relieve inter mittent Neck pain: he had a 2-year history of Neck pain and Stiff ness. After 1 month, during which the itch contin ued to worsen, the patient was referred to us for further investigation. Physical examination showed slight redness of the aff ected skin, as well as excoriated fl at papules and erosions on the Neck and forearms (fi gure). These signs were considered to be caused by rubbing and scratching. The results of blood tests, including a full blood count, plasma glucose, renal and liver function tests, and infl ammatory markers were all unremarkable. The association of Neck pain, cervical Stiff ness, and itch localised to areas supplied by the cervical spinal cord, pointed to a neurological cause for the itch. Neurological examination revealed abnormalities of both arms, particularly severe distally and in the right arm: hypoaesthesia, paraesthesia, muscle weakness, and reduced refl exes. Electromyography and nerve conduction tests showed an axonal injury, at the levels of the fi fth and sixth cervical roots. Further sensory testing revealed complete loss of heat sensation, and reduced vibration sense, in the index fi ngers of both hands, corresponding to the sixth cervical root. The symmetrical loss of motor and sensory function led us to suspect a lesion of the cervical spinal cord, aff ecting most or all of its width. Cervical MRI showed a lesion extending from the level of the fi rst to the seventh cervical vertebra, with prominent perifocal oedema. The lesion was excised by a decom pressive laminectomy, and was found to be an ependymoma on histopathological analysis. Irritation of the spinal cord, during the operation, caused weakness of all the patient’s limbs. This weakness decreased during residential rehabilitation; by April, 2007, the patient had regained most of his strength and coordination. The itch was no longer present. In May, 2007, the patient started to receive radiotherapy, to ensure that the tumour was eradicated. Sadly, he then developed a fi stula extending from the spinal cord to the skin—through which cerebrospinal fl uid leaked—and a subse quent infection of the fi stula and the surrounding tissue, though not of the spinal cord itself. The cord was seen on MRI to be oedematous. When last seen, in May, 2007, the patient had severe neurological defi cits—although, ironically, no itch. Itch can be classifi ed into four types: pruritoceptive, psychogenic, neurogenic, and neuropathic. 1
Jiang Qian - One of the best experts on this subject based on the ideXlab platform.
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september 2004 a 6 year old girl with headache and Stiff Neck
Brain Pathology, 2006Co-Authors: Qing Li, Xiao He Yang, Jiang QianAbstract:CASE OF THE MONTH: ABSTRACT September 2004. Free-living amebas in the genera Naegleria, Acanthamoeba and Balamuthia are known to cause CNS infections. Here we report a case of fatal granulomatous amebic meningoencephalitis (GAE) caused by Balamuthia mandrillaris in a 6-year-old previously healthy girl who presented with headache and Stiff Neck. She was treated medically for brain abscess after a CT scan identified a ring-enhancing lesion in the right temporo-parietal area. A brain biopsy showed necrosis and granulomatous inflammation. Subsequently, multiple new lesions appeared in the brain bilaterally. A second brain biopsy revealed viable amebic trophozoites that were most abundant in perivascular spaces, accompanied by neutrophils, macrophages and eosinophils. Immunofluorescence study confirmed the amoeba as Balamuthia mandrillaris. This case demonstrates that making diagnosis of GAE pre-mortem requires a high index of suspicion. Amebic infection should be included in the differential diagnosis of any granulomatous lesion in CNS; and careful search for amebic parasites should be carried out especially when necrosis predominates in the pathological material.
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SEPTEMBER 2004: A 6‐YEAR‐OLD GIRL WITH HEADACHE AND Stiff Neck
Brain Pathology, 2006Co-Authors: Qing Li, Xiao He Yang, Jiang QianAbstract:CASE OF THE MONTH: ABSTRACT September 2004. Free-living amebas in the genera Naegleria, Acanthamoeba and Balamuthia are known to cause CNS infections. Here we report a case of fatal granulomatous amebic meningoencephalitis (GAE) caused by Balamuthia mandrillaris in a 6-year-old previously healthy girl who presented with headache and Stiff Neck. She was treated medically for brain abscess after a CT scan identified a ring-enhancing lesion in the right temporo-parietal area. A brain biopsy showed necrosis and granulomatous inflammation. Subsequently, multiple new lesions appeared in the brain bilaterally. A second brain biopsy revealed viable amebic trophozoites that were most abundant in perivascular spaces, accompanied by neutrophils, macrophages and eosinophils. Immunofluorescence study confirmed the amoeba as Balamuthia mandrillaris. This case demonstrates that making diagnosis of GAE pre-mortem requires a high index of suspicion. Amebic infection should be included in the differential diagnosis of any granulomatous lesion in CNS; and careful search for amebic parasites should be carried out especially when necrosis predominates in the pathological material.
Tomoaki Kimura - One of the best experts on this subject based on the ideXlab platform.
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association of perceived stress and Stiff Neck shoulder with health status multiple regression models by gender
Hiroshima journal of medical sciences, 2006Co-Authors: Tomoaki Kimura, Yasutami Tsuda, Seiya Uchida, Akira EboshidaAbstract:It is well known that psychological stress affects health status. Stiff Neck and shoulder in a broad sense is one of the major somatic complaints among Japanese. The objective was to determine how much perceived stress and Stiff Neck/shoulder are associated with health-related quality of life (HRQoL) by gender. Participants (n = 512) completed the Japanese version of Perceived Stress Scale, the SF-8 Japanese version and original questions on perceived Stiff Neck/shoulder. Muscle hardness around the shoulder also was measured with the muscle tension meter. The multiple regression model of the men demonstrated that perceived stress was associated with not only the mental component summary (MCS) (beta: -0.494), but also the physical component summary (PCS) (beta = -0.319) of the SF-8. Although, in the model of the women, perceived stress was also associated with MCS (beta: -0.632) more than in that of the men, Stiff Neck/shoulder and age group (beta: -0.231; -0.268, respectively), but not stress, were related to PCS. The subjective Neck/shoulder Stiffness was hardly correlated with the objective shoulder muscle hardness. This study revealed the associations between perceived stress, Stiff Neck/shoulder and HRQoL, and their difference by gender. The hypothesis of gender differences was discussed with a focus on kind of stressors, perception of stress, admission of negative symptoms and cause of Stiff Neck/shoulder.
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Association of Perceived Stress and Stiff Neck/Shoulder with Health Status : Multiple Regression Models by Gender
Hiroshima journal of medical sciences, 2006Co-Authors: Tomoaki Kimura, Yasutami Tsuda, Seiya Uchida, Akira EboshidaAbstract:It is well known that psychological stress affects health status. Stiff Neck and shoulder in a broad sense is one of the major somatic complaints among Japanese. The objective was to determine how much perceived stress and Stiff Neck/shoulder are associated with health-related quality of life (HRQoL) by gender. Participants (n = 512) completed the Japanese version of Perceived Stress Scale, the SF-8 Japanese version and original questions on perceived Stiff Neck/shoulder. Muscle hardness around the shoulder also was measured with the muscle tension meter. The multiple regression model of the men demonstrated that perceived stress was associated with not only the mental component summary (MCS) (beta: -0.494), but also the physical component summary (PCS) (beta = -0.319) of the SF-8. Although, in the model of the women, perceived stress was also associated with MCS (beta: -0.632) more than in that of the men, Stiff Neck/shoulder and age group (beta: -0.231; -0.268, respectively), but not stress, were related to PCS. The subjective Neck/shoulder Stiffness was hardly correlated with the objective shoulder muscle hardness. This study revealed the associations between perceived stress, Stiff Neck/shoulder and HRQoL, and their difference by gender. The hypothesis of gender differences was discussed with a focus on kind of stressors, perception of stress, admission of negative symptoms and cause of Stiff Neck/shoulder.
