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Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis that presents with palpable purpura. The most common identified triggers of LCV are infection or exposure to a new medication. Herpes zoster (HZ) occurs as a result of the reactivation of the varicella-zoster virus (VZV). VZV is able to infect endothelial cells directly, producing a spectrum of vasculitides, including that of large and medium vessels. We report a case of a patient with synchronous HZ infection and segmental small-vessel vasculitis.

Herpes simplex infection (HSV) is a common infectious disease, which the main clinical manifestations are mucocutaneous infection. Extragenital infections are reported in both type 1 and type 2 of herpes simplex virus. We report a case of a 33-year-old female with recurrent extragenital HSV type 2 infection on the right medial wrist. The patient had history of the previous infection site locating on the right posterior deltoid however both of two sites are the same dermatomal distribution. This report demonstrates the recurrent herpes simplex infection can develop in another area of the dermatomal distribution.

We reported a patient who presented with analgesia and thermanaesthesia from the face to T4 dermatome on the contralateral side to the lesion due to infarction of the dorsal tegmentum of the caudal pons, which was inconsistent with classical dorsolateral pontine infarction. We speculated that the lesion affected the trigeminothalamic tract deriving from the second-order neurons on the contralateral side and partial lateral spinothalamic tracts carrying pain and temperature sensation above T4 dermatome, while the spinal trigeminal tract and its nucleus on the ipsilateral side and other parts of lateral spinothalamic tracts were spared. This case showed the atypical presentations of dorsolateral pontine infarction and may provide clinicians with new diagnostic ideas., Neuroscience; Neurology; Public health; Nervous system; Clinical research; Pontine infarction; Uncrossed sensory symptomatology; Segmental sensory disturbance.

Background and objectives: The manufacture of minimally traumatic needles and synthesis of pharmacological adjuncts with safe and effective action on inhibitory and neuromodulatory synapses distributed along the nociceptive pathways were crucial for a new expansion phase of spinal anesthesia. The objectives of this paper are present our clinical experience with 1330 lumbar spinal anesthesia performed with purposeful nociceptive blockade of the thoracic and cervical spinal nerves corresponding to dermatomes C4 or C3; warn about the method pathophysiological risks, and emphasize preventive standards for the safe application of the technique. Content: Review of the historical background and anatomical spinal anesthesia with cervical levels of analgesia. Description of the technique used in our institution; population anesthetized; and surgery performed with the described method. Critical exposition of the physiological, pathophysiological, and clinical effects occurred and registered during anesthesia-surgery and postoperative period. Conclusion: Spinal anesthesia with nociceptive blockade to dermatome C4, or C3, is an effective option for surgery on somatic structures distal to the metamer of the third cervical spinal nerve, lasting no more than four or five hours. The method safety depends on the unrestricted respect for the essential rules of proper anesthesia. Resumo: Justificativa e objetivos: A fabricação de agulhas minimamente traumáticas e a síntese de coadjuvantes farmacológicos com ação efetiva e segura nas sinapses inibitórias e neuromoduladoras distribuídas ao longo das vias nociceptivas foram determinantes para uma nova fase de expansão da anestesia subaracnoidea. Os objetivos deste artigo são: apresentar a experiência clínica dos autores com a realização de 1.330 Raquianestesias lombares com bloqueio nociceptivo proposital dos nervos espinhais torácicos e cervicais até os dermátomos correspondentes a C4 ou C3; alertar sobre os riscos fisiopatológicos do método e enfatizar as normas preventivas para a realização da técnica com segurança. Conteúdo: Revisão dos fundamentos históricos e anatomofuncionais da anestesia subaracnoidea com níveis cervicais de analgesia. Descrição da técnica utilizada em nossa instituição; da população anestesiada e das cirurgias realizadas com o método descrito. Exposição crítica dos efeitos fisiológicos, clínicos e fisiopatológicos ocorridos e registrados durante o ato anestésico-cirúrgico e no período pós-operatório. Conclusão: A Raquianestesia com bloqueio nociceptivo até o dermátomo de C4, ou de C3 é uma opção efetiva para cirurgias sobre estruturas somáticas distais ao metâmero do terceiro nervo espinhal cervical com duração não superior a 4 ou 5 horas. A segurança do método depende do respeito irrestrito às regras essenciais da correta prática anestésica. Keywords: Spinal anesthesia, Plastic surgery, Complications, Prevention, Treatment, Palavras-chave: Raquianestesia, Cirurgia plástica, Intercorrências, Prevenção, Tratamento

The zosteriform pattern is an infrequent cutaneous finding in oncologic patients who have a skin metastasis from a different primary source. Herein we report a case of adenocarcinoma of the lung which presented with zoster-like lesions along the thoracic dermatome. The histopathology indicated a metastatic neoplasm with variable glandular formations. Immunohistochemistry results pointed to the diagnosis of metastasized lung cancer. We suggest physicians should consider this rare diagnosis when experiencing similar cases.

Background: Although cervical vagus nerve stimulation is effective for reducing infarct volume in rats, it is not feasible for acute human stroke as it requires surgical incision of the neck. We hypothesized that stimulation of the dermatome in the external ear innervated by the vagus nerve (auricular vagus nerve stimulation; aVNS) reduces infarct volume after transient focal ischemia in rats. Methods: Animals were randomized to active aVNS or sham stimulation. For aVNS, electrical stimulation of the left cavum concha (1 h duration) using percutaneous needles was initiated 30 min after induction of ischemia. Behavioral and tissue outcome were measured 24 h after induction of ischemia. In a separate experimental dataset, c-Fos immunohistochemistry was performed to identify the brain regions activated after the stimulation. Results: Stimulation of the left cavum concha resulted in bilateral c-Fos staining in the nuclei tractus solitarii and the loci coerulei in all animals. There was no c-Fos staining in any part of the brainstem in sham control animals. The mean infarct volume (SD) as calculated by indirect method was 44.20 ± 7.58% in controls and 31.65 ± 9.67% in treated animals (P

Objective The purpose of this case report is to describe the diagnostic imaging features of redundant nerve roots caused by chronic lumbar degenerative canal stenosis (CLDCS). Clinical Features A 56-year-old male presented with severe low back pain. He experienced pain during minimal active lumbar range of motion. The patient demonstrated weakness of the right iliopsoas and hypoesthesia of the L-2 dermatome. A working diagnosis of CLDCS was established. The patient's worsening severe low back pain warranted magnetic resonance imaging of the lumbar spine, which was performed for further evaluation. Magnetic resonance imaging demonstrated disk protrusion and canal stenosis with tortuosity of the cauda equina consistent with redundant nerve root appearance. Intervention and Outcome The patient was treated with chiropractic flexion distraction, which was followed by a course of acupuncture and spinal manipulation. The patient self-discharged following clinical improvement. Conclusions This case demonstrated CLDCS with associated redundant nerve roots. Conservative treatment included chiropractic diversified lumbar spinal manipulation, acupuncture, and electrical stimulation. The patient self-discharged following clinical improvement in 3 months.

Percutaneous electrical neurostimulation (PENS) of dermatome T6 is a promising therapy for weight loss. The participants underwent one 30-minute session every week for 12 consecutive weeks. It has been demonstrated as a useful means to significantly reduce the weight of mildly to moderately obese patients, and for many, to achieve their normal weight. The effect of this therapy does not end after completing the final stimulation; its anorexygenic effect continues for at least 3 months more. PENS of dermatome T6 must always be combined with a hypocaloric diet, and it is important that a dietitian monitor the process so that patients acquire healthy alimentary habits and avoid regaining weight once the effect tapers off. Preliminary results suggest that the effect of appetite reduction is mediated by a reduction in plasma levels of ghrelin.

The dorsal root ganglion (DRG), frequently called spinal ganglion, is an accumulation of cell bodies of primary sensory neurons. The central and peripheral processes of these somatic and visceral cell bodies constitute the sensory connection between periphery and spinal cord.

Introduction Exclusive involvement of herpes zoster (HZ) in the follicular epithelium occurs rarely and lacks the typical cutaneous and histopathologic findings associated with herpesvirus. We describe a patient who underwent adjuvant chemotherapy for pancreatic cancer and subsequently had a nonvesicular rash for several weeks, ultimately proving to be herpetic zoster folliculitis. Case report A 78-year-old man with adenocarcinoma of the tail of the pancreas treated with surgical resection and 1 round of adjuvant chemotherapy with gemcitabine, docetaxel, and capecitabine presented with a 3-week history of a right leg rash. He first noticed the rash 5 days after the initiation of his chemotherapy. It initially appeared on his middorsal foot, and over the next couple weeks progressed proximally along the anteromedial leg to the distal knee and medial thigh. It was not painful and was minimally pruritic. Two and a half weeks after the onset of his rash, a fever to 38.5°C developed along with back pain. At this time, he had a nondiagnostic skin biopsy by an outside dermatologist and was given diphenhydramine and topical hydrocortisone with no improvement in his rash. He also had an abdominal computed tomography (CT) performed at an outside hospital, which found a left upper quadrant fluid collection. He was subsequently admitted to Columbia Presbyterian Medical Center for evaluation. On our examination, he had purpuric patches and edematous, purpuric papules along the right dorsal foot, extending proximally up the right anteromedial leg (Fig 1). He also had a few faint pink papules along the right hip and superior buttock (Fig 2). There were no vesicles. A comprehensive metabolic panel and liver function test results were normal. Noted were a leukocytosis level of 14,400/μL with 76% neutrophils and 1% bands, an elevated lipase level of 194 U/L (3-43 U/L), and an amylase level of 95 U/L (20-96 U/L). A CT scan of the abdomen confirmed an 8.0- × 7.0-cm fluid collection of the left upper quadrant of the abdomen. A skin biopsy of the right anteromedial leg found only alteration of the basal layer epidermis with a perivascular mononuclear cell infiltrate and extravasated erythrocytes. However, deeper sections had necrotic keratinocytes and multinucleated epithelial-type giant cells with ground-glass nuclei restricted to the follicular epithelium, confirming a diagnosis of follicular herpetic infection (Fig 3, A and B). A diagnosis of HZ in the L4 and L5 dermatomes was made, and the eruption promptly resolved with a 7-day course of valganciclovir (1-g tablet 3 times a day).

Weakness and numbness occur in a variety of patterns that reflect injury to different parts of the central and peripheral nervous system. Progressive symptoms most often signify an underlying structural or degenerative problem. Familiarity with the major descending motor and ascending sensory tracts of the central nervous system, as well as radicular (dermatome and myotome) and peripheral nerve anatomy, is essential. Damage to these tracts and nerve fibers produces characteristic clinical symptoms and signs. Imaging, when used in a hypothesis-driven way, can be a valuable adjunct to the clinical history and physical examination. One of the most useful aspects of imaging is that it allows for differentiation of edema and inflammation from gliosis and atrophy, both of which can be associated with progressive weakness or numbness. Compression of nervous system structures by nonnervous system tissue can also be easily detected. The spectrum of diseases and imaging abnormalities associated with progressive weakness and numbness is highlighted in this review via a series of illustrative cases. In each case, anatomic localization and the key imaging findings are emphasized.

In the present study, we investigated whether dynamic and static allodynia would be developed in the affected dermatome in murine models of herpetic pain and postherpetic neuralgia and pharmacologically characterized the allodynia. Inoculation with herpes simplex virus type-1 on the femur induced skin lesions in the dermatome including the plantar region of the hind paw from day 5 to day 21 after inoculation. Dynamic allodynia became apparent in the hind paw from day 3 to at least day 42. Static allodynia was not obvious during the stage of herpetic pain and gradually increased after the lesion healing. Mexiletine hydrochloride (30 mg/kg, p.o.) and ketamine hydrochloride (50 mg/kg, i.p.) produced a moderate attenuation of static but not dynamic allodynia. Diclofenac sodium (50 mg/kg, i.p.) did not affect both static and dynamic allodynia. Gabapentin (30 mg/kg, p.o.) markedly inhibited both static and dynamic allodynia. Developmental and pharmacological differences between static and dynamic allodynia suggest that independent mechanisms are responsible for dynamic and static allodynia. This murine model may be useful for the study of the mechanisms of dynamic allodynia of herpetic pain or postherpetic neuralgia and the development of new analgesics effective against the dynamic allodynia. Keywords:: dynamic and static allodynia, herpes simplex virus type-1, herpetic pain, postherpetic neuralgia, dorsal root ganglion

All neurons’ cell bodies are a part of a ganglion. Whether motor or sensory, the cell bodies of multiple neurons conglomerate to form ganglia throughout the human nervous system. The cell bodies of sensory nerves originating from the spinal cord may be located in dorsal root ganglia. For each spinal nerve level, there exists a pair of dorsal root ganglia containing the cell bodies of the neurons responsible for the respective dermatome. Thus, it comes as no surprise when pathological conditions impair the ganglion, an ipsilateral distribution symptomology may be noted. Within this chapter, we cover the individual dorsal root ganglion layers and the neuropathology that may afflict them.

A dermatome is an area of skin innervated by a single dorsal nerve root. As demonstrated by many current textbooks, different authors provide different boundaries for the dermatomes. This variation may result from the different methods used over the years to investigate the dermatomes. In this chapter, we explore the history of dermatome mapping from its inception to now.

This chapter provides a brief description of the general map of each dermatome. We discuss the variability that exists in the creation of dermatomal maps and provide explanations for these variations. Foerster’s, Head and Campbell’s, and Keegan and Garrett’s dermatome maps are discussed along with the Lee’s evidence-based dermatome map.

Publisher Summary This chapter describes the anatomy of the dorsal and ventral roots and spinal nerves. The spinal nerves transmit sensory information from the target organs to the central nervous system, and send motor commands from the central nervous system to muscles and target organs. Along the entire length of the spinal cord, spinal nerves arise at regular intervals and leave the vertebral column between the adjacent vertebrae through the intervertebral foramina. Each spinal nerve is attached to the spinal cord by a ventral (anterior) and a dorsal (posterior) root. The ventral and dorsal roots join together and form the spinal nerve at each segmental level. The spinal nerve runs from the lateral aspect of the dural sac to the intervertebral foramen in a tubular canal of variable length; this canal is named the nerve root canal. Each ventral root (also named the anterior root, radix anterior, radix ventralis, or radix motoria) is attached to the spinal cord by a series of rootlets that emerge from the ventrolateral sulcus of the spinal cord. Each dorsal spinal root bears an ovoid swelling named the dorsal root (spinal) ganglion (DRG). A dermatome is the area of skin supplied by a single spinal nerve. Dermatomes have a segmental distribution represented as narrow bands of skin running almost horizontally along the trunk in a regular fashion.

Publisher Summary This chapter describes the dermatomal somatosensory evoked potentials (DSEPs) as a means to assess segmental-level function of the spinal cord in both the clinical and the operating room settings. The technique is based on the concept that each spinal nerve innervates a well-defined area of skin called a dermatome. The chapter focuses on a description of the DSEP technique, its application in the operating room, and a discussion of the factors that may affect DSEP acquisition. It discusses that DSEPs were developed as a refinement of mixed nerve somatosensory evoked potentials (SEPs). It has long been recognized that nerve fibers from mixed nerves, such as median, ulnar, or tibial nerves enter the spinal canal over several nerve roots. An underlying assumption of the technique is that electrical stimulation of the skin may be done so that the ascending afferent activity is mostly confined to a single sensory nerve root. The chapter also reviews that DSEPs have been recorded clinically from all segmental levels from cervical to sacral levels. Most studies have focused on the cervical or lumbar levels.

Publisher Summary This chapter discusses somite strips—an embryo fillet preparation. Somite strips can be used to study somitic guidance cues at the cellular and molecular levels. This assay confers the benefits of studying a semi-intact system in a culture setting. It is a hybrid in vivo–in vitro assay that exposes anterior and posterior sclerotomes to view and yet retains in culture both the segmental architecture and typical molecular characteristics, such as differential binding to peanut agglutinin lectin. Anatomical studies have shown that differences between anterior and posterior somites guide axons and neural crest cells, both of which traverse anterior but not posterior somites to form segmental arrays corresponding to the segmentally repeated somites. The somitic tissue responsible for the permissive and inhibitory subdivisions is the sclerotome; the dermatome and the myotome are not essential for segmental outgrowth patterns. However, although it is known which tissues carry the guidance cues, the molecules or the cellular interactions that mediate the responses to these tissues have yet to be identified.

Publisher Summary This chapter presents an overview of somatosensory and motor evoked potentials. The application of somatosensory evoked potential (SSEP) is a natural extension of the electrodiagnostic medical examination. SSEP testing provides a window for exploring portions of the nervous system that are difficult to study by electromyographic (EMG) and nerve conduction methods. When an appropriate peripheral nerve or dermatome is stimulated, an SSEP is generated along the neuroaxis progressing to a specific topography in the cortex. These potentials are made up of various components that occur at different latencies. Ideally, the components are labeled according to polarity and latency. In most instances, the mean latency of a particular component is used to identify the potential, no matter what the absolute latency for a given subject. A variety of electrodes can be used to record SSEPs. Gold or silver-silver chloride EEG cup electrodes are preferred to platinum needle or clip EEG electrodes because of their lower impedance. Needle and clip electrodes, on the other hand, are quicker to place and secure, particularly in the intraoperative setting.

This chapter discusses the structure and function of the spinal nerves. There are 31 pairs of spinal nerves that leave the spinal cord from each side through the openings or foramina between the vertebrae. There are eight pairs of cervical nerves, twelve pairs of thoracic, five pairs of lumbar, five pairs of sacral, and one coccygeal nerve. Apart from the cervical nerves, the number of nerves corresponds with the number of vertebrae. As the spinal nerves leave the spinal cord, some of them group together to form plexuses, where the nerve fibers recombine to follow the most direct route. The first four cervical nerves form the cervical plexus, supplying the head and neck. The remainder of the cervical nerves and the first thoracic form the brachial plexus, supplying the arms. The lumbar plexus consists of the first four lumbar nerves which supply the front of the leg. The last two lumbar nerves and the first three sacral nerves form the sacral plexus supplying the buttocks and the back of the legs. The thoracic nerves do not form a plexus, but just encircle the chest in bands supplying the adjacent areas of skin and muscle. Individual spinal nerves receive sensation from a specific area of skin which is called a dermatome.