Over a period of 12 years, 80 patients underwent ventricular shunting for normal pressure hydrocephalus. Three developed sixth cranial nerve palsy in the first two weeks after surgery. This uncommon complication is usually transitory following the same pattern of abducens palsy after lumbar puncture or spinal anesthesia. Traction on the nerve with local ischemia has been involved as the responsible mechanism in both instances. RESUME: Paralysie du droit externe de I'oeil a la suite d'une derivation pour hydrocephalic. Sur une periode de 12 ans, 80 patients ont subi une derivation ventriculaire pour une hydrocephalic normotensive. Trois ont developpe une paralysie du sixieme nerf cranien dans les deux premieres semaines apres la chirurgie. Cette complication pcu frequente est habituellement transitoire et evolue comme la paralysie du droit externe survenant apres une ponction lombaire ou une anesthesie spinale. Une traction du nerf accompagnee d'ischemie locale a ete invoquee comme etant le mechanisme responsable dans les deux cas.Can. J. Neurol. Sci. 1993: 20: 123-125 The causes of abducens palsy are multiple and have been described before in the medical literature.1 -2 Nevertheless, its occurrence after ventricular shunting for normal pressure hydrocephalus (NPH) is so unusual that it deserves special attention.
CASE REPORTS
Patient 1A 69-year-old male presented with a 4-year history of unsteady gait, progressive memory impairment and recent onset of urinary incontinence. On examination there was difficulty recalling current events, gait apraxia and hyperreflexia of the lower extremities. Computerized tomography (CT) of the brain demonstrated ventricular dilatation. The results of an isotope cisternogram and lumbar subarachnoid infusion test suggested a diagnosis of NPH. A ventriculoatrial shunt was placed and the opening pressure was 18 cm of CSF. A Pudenz valve with a closing pressure of 5 cm of H 2 0 was used. Postoperative CT scan showed marked decrease in the ventricular size and brain atrophy.Nine days after surgery the patient complained of nausea and headache followed by double vision when looking towards the right side. The right eye had limited abduction consistent with a sixth nerve palsy. Two days later the headache and nausea disappeared; however the right abducens palsy persisted for nine weeks. His gait, urinary incontinence, and memory improved gradually.
Patient 2A 69-year-old priest with a five-year history characterized by difficulty walking and progressive memory loss was admitted to our institution. Physical examination revealed minimal impairment of recent memory and an abnormal gait characterized by a wide base with short, unsteady steps. The lone was increased in the lower extremities with associated hyperreflexia. CT scan of the brain showed ventricular dilatation. Magnetic resonance imaging (MRI) disclosed a smooth, hyperintense border around the ventricjes and marked signal loss in the aqueduct. MRI cine was compatible with NPH. A lumbar puncture was not done as part of h...
Introduction Pelvic floor myalgia is a common cause and contributor to chronic pelvic pain [Neurourol Urodyn 4:984-1008 (2017)]. The purpose of this study was to compare in-person versus video-based teaching methods of a comprehensive assessment of the pelvic floor musculature on a pelvic model. Methods A randomized controlled trial of 46 participants was conducted. The participants were randomized into two groups. Both groups were taught by the same pelvic floor physiotherapist using two different teaching methods on a pelvic model. Group 1 watched an instructional video, whereas group 2 had in-person training. Both groups underwent pre-and post-training assessments consisting of a written examination and an Objective Structured Clinical Examination (OSCE). Primary outcome measure was the change in participants' pre-and post-training assessment scores. Secondary outcome measures were perceived changes in both participants' comfort level in performing pelvic floor examination and applicability of the training program to clinical practice. Results There was no statistically significant difference between the teaching methods in the degree of improvement of the participants' mean written assessment scores (p = 0.58), OSCE scores (p = 0.15), and perceived comfort level (p = 0.19). Participants' mean pre-and post-assessment scores improved significantly (p < 0.001). Participants reported the training program to be applicable towards their clinical practice. Conclusions This study demonstrates that learners' assessment of pelvic floor musculature can be enhanced using varied teaching methods on a pelvic model. Keywords Chronic pelvic pain. Pelvic model. Pelvic floor musculature. Teaching methods. Video-based teaching. In-person teaching Abbreviations ANOVA Analysis of variance OSCE Objective structured clinical examination PFM Pelvic floor myalgia
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