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J Neurol Sci 2019 Apr 13;401:17-18. Epub 2019 Apr 13.

Children's Hospital of Wisconsin and the Medical College of Wisconsin, USA.

Stereotact Funct Neurosurg 2019 Apr 4:1-6. Epub 2019 Apr 4.

Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA,

Background: Spinal cord stimulation (SCS) is a well-established therapy for chronic pain syndromes, with growing applicability to other conditions. Restless legs syndrome (RLS) is a widespread, chronic movement disorder managed primarily and incompletely by medication, and its etiology can be classified as idiopathic or secondary.

Methods: Three patients underwent SCS implantation for chronic back and/or leg pain with concomitant targeting of RLS: (1) a 34-year-old man with sporadic RLS symptoms that strongly intensified after military-related spinal fractures, (2) a 54-year-old man with RLS likely secondary to meralgia paresthetica, and (3) a 42-year-old man with low back and right lower extremity pain after a military motor vehicle accident. Read More

N Z Vet J 2019 Apr 1:1-10. Epub 2019 Apr 1.

b Faculty of Veterinary and Agricultural Sciences , University of Melbourne , Werribee , Victoria , Australia.

Case History: Dairy cows recumbent following calving on farms in South Gippsland, Australia were examined during two 3-month seasonal calving periods in 2011 and 2012 as part of a larger study of 218 recumbent cows. A cohort of 104 cows diagnosed with calving paralysis following dystocia was derived from the larger group, which were examined with 3 days of becoming recumbent. A thorough medical and musculoskeletal clinical examination was performed on each cow including flexor-withdrawal and patellar reflex tests, and postural assessment in the lifted position, unless the facilities were not available. Read More

Obstet Gynecol 2019 Apr;133(4):666-668

Division of Urogynecology, Department of Obstetrics & Gynecology, State University of New York, Upstate Medical University, Syracuse, New York.

Background: Candy cane stirrups are widely used for vaginal surgery because they provide sufficient operating space. When placed in the standard perpendicular alignment, however, these stirrups cause excessive flexion, abduction, and external rotation of the thigh, which may injure the femoral, lateral femoral cutaneous, sciatic, and common peroneal nerves.

Technique: We corrected this deficiency by positioning the stirrups parallel to the operating table, just above and tilting slightly toward its lower break. Read More

World J Clin Cases 2019 Feb;7(4):494-499

The Center for Pediatric Liver Diseases, Children's Hospital of Fudan University, Shanghai 201102, China.

Background: Pediatric recurrent acute liver failure (RALF) with recovery between episodes is rare. Causes include autoimmune disease, which may flare and subside; intermittent exposure to toxins, as with ingestions; and metabolic disorders, among them the fever-associated crises ascribed to biallelic mutations in , with RALF beginning in infancy. disease manifest with RALF, as known to date, includes central and peripheral neurologic and muscular morbidity (hepatocerebellar neuropathy syndrome). Read More

Cureus 2018 Nov 28;10(11):e3652. Epub 2018 Nov 28.

Neurosurgery, Columbia University, New York, USA.

Injury to the lateral femoral cutaneous nerve (LFCN) from compression or entrapment may result in meralgia paresthetica, a painful mononeuropathy of the anterolateral thigh. Surgical decompression of the LFCN may provide relief when conservative management fails. However, the considerable anatomic variability of this nerve may complicate surgical localization and thus prolong operative time. Read More

Med Clin North Am 2019 Mar 3;103(2):371-382. Epub 2018 Dec 3.

Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.

Entrapment neuropathies in the lower limbs are a common neurologic problem and may present in any medical setting. Accurate identification and management of these nerve palsies can prevent pain, sensory loss, incoordination, and muscle weakness that may significantly affect a patient's functional mobility. In this article, the authors focus on the cause, signs and symptoms, diagnosis, and treatment of select entrapment neuropathies of the lower extremity, including palsies of the common peroneal, lateral femoral cutaneous, femoral, and posterior tibial nerves. Read More

Actas Dermosifiliogr 2018 Dec 24. Epub 2018 Dec 24.

Servicio de Neurología, Complejo Hospitalario Universitario de Ferrol, SERGAS, Ferrol, A Coruña, España.

Clin Calcium 2019;29(1):51-56

Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine, Tokyo, Japan.

Diabetes mellitus causes hyperglycemia due to resistance to insulin action in peripheral organs in addition to progressive loss of β-cell function, thus it is involved in the development and progression of diabetic microangiopathy(retinopathy, nephropathy, and neuropathy). In addition, abnormalities of bone metabolism is regarded as a chronic complication related to both type 1 diabetes and type 2 diabetes. Accumulating evidence suggests that type 1 diabetes patients had decreased bone mineral density(BMD)and the fracture risk in the femoral neck is markedly higher, when compared to non-diabetic patients. Read More

J Orthop Case Rep 2018 May-Jun;8(3):55-57

Department of Orthopaedics, Louis A Johnson VA Medical Center, Clarksburg, West Virginia, USA.

Introduction: Retroperitoneal hemorrhage has been sparsely reported with warfarin therapy. In this paper, we describe a case of spontaneous retroperitoneal hematoma causing femoral neuropathy following treatment with low molecular weight heparin.

Case Report: A 65-year-old gentleman had presented with acute onset left-sided thigh pain, paraesthesia, and weakness along with lower backache. Read More

Acta Neurochir (Wien) 2019 Feb 17;161(2):263-269. Epub 2018 Dec 17.

Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.

Background: In patients with persistent symptoms of meralgia paresthetica, a neurectomy of the lateral femoral cutaneous nerve (LFCN) can be performed to alleviate pain symptoms. The neurectomy procedure can be performed either as a primary procedure or after failure of a previously performed neurolysis or decompression of the LFNC (secondary neurectomy). The goal of the present study was to quantify the histopathologic changes inside the LFCN obtained from patients with persistent symptoms of meralgia paresthetica, and specifically to compare to what extend these changes are present after primary versus secondary neurectomy. Read More

J Spine Surg 2018 Sep;4(3):610-615

Department of Neurosurgery, School of Medicine, University of Thessaly, Larissa, Greece.

Background: Surgical treatment of adult degenerative scoliosis (DS) always remains a challenge and often necessitates complex multilevel surgery via traditional open approaches. However, the severity of the procedure, in association with the fact that many of these patients are at an advanced age with several comorbidities, results in high rate of complications. Therefore, during the last decade, minimally invasive procedures have gained a place in the treatment of this pathology. Read More

J Neurosurg 2018 Dec 1:1-9. Epub 2018 Dec 1.

1Leiden University Medical Center, and.

OBJECTIVEThe results of lateral femoral cutaneous nerve (LFCN) decompression to treat idiopathic meralgia paresthetica (iMP) vary widely. Techniques to decompress the LFCN differ, which may affect outcome, but in MP it is unknown to what extent. The authors present a new technique using dynamic decompression and discuss the outcomes. Read More

J Neurosurg 2018 Dec 1:1-9. Epub 2018 Dec 1.

2Department of Anatomy and.

OBJECTIVEMeralgia paresthetica is commonly caused by mechanical entrapment of the lateral femoral cutaneous nerve (LFCN). The entrapment often occurs at the site where the nerve exits the pelvis. Its optimal surgical management remains to be established, partly because the fine architecture of the fascial planes around the LFCN has not been elucidated. Read More

Orthopedics 2019 Mar 13;42(2):e273-e275. Epub 2018 Dec 13.

Femoral nerve palsy with concomitant patellar dislocation is a rare clinical entity that has not previously been well documented. The authors present the case of a 16-year-old female ballet dancer who sustained a patellar dislocation with concomitant femoral nerve palsy. She experienced muscle weakness after the initial injury and developed neuropathic symptoms through the anterior left thigh. Read More

J Neuroimaging 2019 Mar 23;29(2):268-271. Epub 2018 Nov 23.

Department of Neurology, University of Illinois and Mercyhealth, Rockford, IL.

Background And Purpose: Although femoral neuropathy is recognized as an adverse consequence following transfemoral neuroendovascular procedures, no reliable estimates are available. We analyzed data from a prospective registry to ascertain the frequency and characteristics of femoral neuropathy following transfemoral neuroendovascular procedures.

Methods: Consecutive patients who underwent neuroendovascular procedures through the transfemoral route were included. Read More

J Surg Case Rep 2018 Nov 15;2018(11):rjy309. Epub 2018 Nov 15.

Department of Surgery, Holroyd Private Hospital, 123 Chetwynd Road, Guildford NSW 2161, Australia.

We report an unusual and rare complication of transient femoral nerve neuropathy secondary to a large haematoma after medial thigh lift surgery. This has never been previously reported in the literature in association with this procedure. It is prudent to raise awareness that such a significant complication, although rare, can occur even with such a benign procedure, and that it is readily reversible with prompt recognition and early treatment. Read More

Br J Neurosurg 2018 Nov 19:1-4. Epub 2018 Nov 19.

c Department of Neurosurgery , Eskisehir State Hospital , Eskisehir , Turkey.

Background: Meralgia paresthetica is an entrapment neuropathy of the lateral femoral cutaneous nerve that may cause paresthesias, pain, and sensory loss of the anterior and lateral thigh. Treatment is primarily medical. Surgery is an option for patients who do not respond to medical treatments. Read More

Rozhl Chir Spring 2018;97(6):286-290

Meralgia paresthetica is a compression neuropathy of the lateral femoral cutaneous nerve. Despite its rarity, it is the most common nerve entrapment of the lower limbs. It produces similar symptoms as those associated with the more common L4 or L5 radiculopathy. Read More

Cardiovasc Revasc Med 2018 Oct 25. Epub 2018 Oct 25.

Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA, United States of America; Tufts University School of Medicine, MA, United States of America.

Background: The radial artery is the access of choice in many catheterization labs around the world due to its proven benefits over the femoral artery access. There has been growing interest in the left radial artery. We sought to evaluate the feasibility, safety and complication rates of the left distal radial artery (ldTRA) access for cardiac catheterization. Read More

Phys Sportsmed 2018 Nov 5:1-7. Epub 2018 Nov 5.

f Department of Neurological Surgery , Stanford University , Stanford , CA , USA.

Introduction: Sports surveillance databases provide valuable information regarding common ailments, yet fewer studies have focused on more rare peripheral nerve injuries. Our objective was to characterize peripheral nerve injuries in high school athletics with respect to incidence, time loss, mechanism, and diagnoses.

Methods: Sport-related nerve injury data on high school athletes were collected during the 2005/2006 through 2015/2016 academic years via the High School Reporting Information Online (RIO) database. Read More

BMJ Case Rep 2018 Oct 21;2018. Epub 2018 Oct 21.

Goulburn Valley Health, Shepparton, Victoria, Australia.

JAMA Neurol 2019 Jan;76(1):109-110

Department of Neurology, Concord Hospital, Concord, Australia.

Acta Orthop 2018 Dec 1;89(6):696-698. Epub 2018 Oct 1.

a Department of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal , Hôpital Maisonneuve Rosemont . Montréal , Québec ;

Pediatr Med Chir 2018 Sep 26;40(2). Epub 2018 Sep 26.

Clinical Surgical Department, Diagnostic and Pediatric Sciences, Locomotor System Diseases Unit, University of Pavia, Pavia.

A 4 months and half female child come to our attention for congenital dislocation of the left hip, previously treated in another hospital with abduction bracing, without satisfactory results. After progressive longitudinal bilateral traction, closed reduction under general anesthesia was performed and a spica cast was applied in the so-called human position. The patients remained in the spica cast for 6 weeks and then the plaster cast was renewed in narcosis for another 6 weeks. Read More

Circ J 2018 Oct 22;82(11):2736-2744. Epub 2018 Sep 22.

Keele Cardiovascular Research Group, Keele University.

Background: We systematically reviewed the available literature on limb dysfunction after transradial access (TRA) or transfemoral access (TFA) cardiac catheterization. Methods and Results: MEDLINE and EMBASE were searched for studies evaluating any transradial or transfemoral procedures and limb function outcomes. Data were extracted and results were narratively synthesized with similar treatment arms. Read More

J Pediatr Orthop 2019 Jan;39(1):e39-e43

Department of Orthopaedics, University of British Columbia.

Background: Infants with dislocated irreducible (D/I) hips can be substantially harder to treat than infants with dislocated but reducible hips. The purpose of this study was to compare treatment methods and outcomes for infants with D/I hips in order to optimize management of this difficult patient cohort.

Methods: A multicenter prospective hip dysplasia study database was analyzed from 2010 to 2016. Read More

J Surg Case Rep 2018 Sep 6;2018(9):rjy171. Epub 2018 Sep 6.

Department of Orthopaedics, Emory University, 59 Executive Park Drive South, Atlanta, GA 30329, USA.

The popularity of the direct anterior approach for total hip arthroplasty (THA) has dramatically increased in recent years. Many patients request this muscle sparing approach for the theorized benefits of quicker recovery and reduced post-operative pain. Femoral nerve injury is a rare, yet serious complication following the anterior approach for THA. Read More

Am J Case Rep 2018 Sep 12;19:1083-1086. Epub 2018 Sep 12.

Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama City, Okayama, Japan.

BACKGROUND Subperiosteal hematoma (SPH) of the iliac bone is an extremely uncommon clinical entity that occurs mostly in young patients with a history of a recent fall or sports-related injury. Patients usually complain of severe hip pain after a fall, mimicking femoral neck fracture. CASE REPORT An 18-year-old female was transported to our hospital complaining of pain in her left hip after falling on her buttocks while engaging in martial arts. Read More

Acta Neurochir (Wien) 2018 Nov 10;160(11):2225-2227. Epub 2018 Sep 10.

Department of Neurosurgery, The George Washington University, 2150 Pennsylvania Avenue, NW, Suite 7-412, Washington, DC, 20037, USA.

Diabetic lumbosacral radiculoplexus neuropathy is often confused with radiculopathy in the context of spinal degenerative disc disease including spinal stenosis. Accuracy in diagnosis may prevent unnecessary interventional procedures including selective nerve root blocks or epidural steroid injections or even surgery in selected cases. Our patient with known diabetes and lumbar disc disease presented with acute onset of pain in L5-S1 distribution of the left lower extremity. Read More

Pediatr Int 2018 Aug;60(8):755-756

Department of Orthopedics, Kobe Central Hospital, Kobe, Japan.

Medicine (Baltimore) 2018 Aug;97(33):e11914

Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University, Salzburg, Austria.

Meralgia paresthetica (MP) is a rare lateral femoral cutaneous nerve-(LFCN)-mononeuropathy. Treatment for this disorder includes conservative and operative approaches; the latter is considered if conservative therapy fails. The most commonly used surgical approaches are decompression/neurolysis and avulsion/neurectomy. Read More

BMJ Case Rep 2018 Jul 25;2018. Epub 2018 Jul 25.

Department of Anaesthesiology, erasmusMC, Rotterdam, The Netherlands.

A 68-year-old man classified as III on the American Society of Anaesthesiologists (ASA) physical status classification system, with a high-grade papillary urothelial cell carcinoma of the left distal ureter, underwent open retroperitoneal distal ureterectomy followed by a ureteroneocystostomy with a vesico-psoas hitch. Postoperatively, the patient complained of left proximal lower limb weakness, severe pain and hypaesthesia of the ventral left thigh suggestive of femoral neuropathy. After excluding common causes for postsurgical pain, a surgical re-exploration was eventually performed during which the sutures used in the vesicopexy were removed, resulting in almost complete resolution of the symptoms. Read More

World Neurosurg 2018 Oct 11;118:e659-e665. Epub 2018 Jul 11.

Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.

Objective: Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) caused by compression around the inguinal ligament. We report a surgical alternative for the treatment of meralgia paresthetica under local anesthesia and its outcomes.

Methods: We operated on 12 patients with unilateral meralgia paresthetica whose age at surgery ranged from 62 to 75 years. Read More

Korean J Pain 2018 Jul 2;31(3):215-220. Epub 2018 Jul 2.

Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Meralgia paresthetica (MP) is a sensory mononeuropathy, caused by compression of the lateral femoral cutaneous nerve (LFCN) of thigh. Patients refractory to conservative management are treated with various interventional procedures. We report the first use of extended duration (8 minutes) pulsed radiofrequency of the LFCN in a case series of five patients with refractory MP. Read More

Diabet Med 2018 11 20;35(11):1596-1604. Epub 2018 Aug 20.

Steno Diabetes Centre Copenhagen, Gentofte, Denmark.

Aim: To investigate the association between cardiovascular autonomic neuropathy and bone metabolism in people with Type 1 diabetes.

Methods: We assessed cardiovascular autonomic neuropathy in 329 people with Type 1 diabetes according to heart rate response to deep breathing, to standing and to the Valsalva manoeuvre, and 2-min resting heart rate. More than one pathological non-resting test was defined as cardiovascular autonomic neuropathy. Read More

J Korean Neurosurg Soc 2018 Jul 1;61(4):509-515. Epub 2018 Jul 1.

Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea.

Objective: In Asians, kneeling and squatting are the postures that are most often induce common peroneal neuropathy. However, we could not identify a compatible compression site of the common peroneal nerve (CPN) during hyper-flexion of knees. To evaluate the course of the CPN at the popliteal area related with compressive neuropathy using magnetic resonance imaging (MRI) scans of healthy Koreans. Read More

Musculoskelet Sci Pract 2018 10 23;37:58-63. Epub 2018 Jun 23.

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. Electronic address: https://twitter.com/michelcoppie.

Background: Neurodynamic assessment and management are advocated for femoral nerve pathology. Contrary to neurodynamic techniques for other nerves, there is limited research that quantifies femoral nerve biomechanics.

Objectives: To quantify longitudinal and transverse excursion of the femoral nerve during knee and neck movements. Read More

Ann Rehabil Med 2018 Jun 27;42(3):488-493. Epub 2018 Jun 27.

Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea.

Compressive femoral neuropathy is a disabling condition accompanied by difficulty in hip flexion and knee extension. It may result from retroperitoneal hematoma or bleeding, or from complications associated with pelvic, hip surgery, and renal transplants. A 55-year-old female with autosomal dominant polycystic kidney disease presented with proximal muscle weakness in lower extremities. Read More

BMJ Case Rep 2018 Jun 21;2018. Epub 2018 Jun 21.

Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia.

Paralysis of the femoral nerve secondary to iliopsoas haematoma is a rare post-traumatic complication. Because of the large differential diagnosis, a high level of suspicion is required for its early recognition. Treatment modalities are controversial due to the rarity of this entity. Read More

BMJ Case Rep 2018 Jun 6;2018. Epub 2018 Jun 6.

Department of Internal Medicine, University of Florida Health, Jacksonville, Florida, USA.

A 33-year-old woman with history of HIV presented with 4 months of gradually progressing right hip pain and was found to have avascular necrosis (AVN) of both femoral heads. She had no other risk factors for AVN including sickle cell disease, systemic lupus erythematosus, prolonged steroid used or trauma. She initially failed conservative management and ultimately had bilateral hip core decompressions. Read More

Pain Physician 2018 05;21(3):E225-E234

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Korea.

Background: Recently, clinicians have been applying pulsed radiofrequency (PRF) stimulation on various peripheral nerves to manage patients' peripheral neuropathic pain.

Objectives: To review the literature on the use and efficacy of PRF for controlling peripheral neuropathic pain.

Study Design: This is a narrative review of relevant articles on the effectiveness of PRF for peripheral neuropathic pain. Read More

Clin Imaging 2018 Sep - Oct;51:209-212. Epub 2018 May 29.

McMaster University, St. Joseph's Healthcare Hamilton, Dept. of Diagnostic Imaging, 50 Charlton Ave. E., Hamilton, ON L8N 4A6, Canada. Electronic address:

We present an unusual case of sartorius muscle tear presenting as acute meralgia paresthetica. A healthy 67-year old male was referred to our department with a one-week history of pain, numbness and bruising over his hip and anterolateral thigh. Extended ultrasound assessment revealed an intramuscular tear of sartorius, with acute hematoma surrounding the adjacent lateral femoral cutaneous nerve. Read More

J Arthroplasty 2018 09 24;33(9):2919-2926.e1. Epub 2018 Apr 24.

Emory University School of Medicine, Atlanta, Georgia.

Background: Direct anterior total hip arthroplasty (THA) is an increasingly utilized and patient-requested approach for arthroplasty carrying a unique set of complications. Injury to the lateral femoral cutaneous nerve (LFCN) can have a wide range of clinical symptoms ranging from hypesthesia to painful paresthesia. Long-term effects of this injury have not been well studied. Read More

Rev Esp Cir Ortop Traumatol 2018 Sep - Oct;62(5):322-327. Epub 2018 May 26.

Cirugía de Preservación y Artroscopia de Cadera, Pontificia Universidad Javeriana Cali, Centro Médico Imbanaco, Cali, Colombia.

Introduction: Deep gluteal syndrome (DGS) is characterized by compression, at extra-pelvic level, of the sciatic nerve within any structure of the deep gluteal space. The objective was to evaluate the clinical results in patients with DGS treated with endoscopic technique.

Methods: Retrospective study of patients with DGS treated with an endoscopic technique between 2012 and 2016 with a minimum follow-up of 12 months. Read More

Cureus 2018 Mar 27;10(3):e2375. Epub 2018 Mar 27.

Cardiology, Division of Cardiology, East Tennessee State University, Johnson City, USA.

Femoral artery pseudoaneurysm (FAP) is a common complication associated with left heart cardiac catheterization. FAP is a pulsatile encapsulated mass usually formed three to seven days after removal of the arterial sheath post cardiac catheterization. Usually, FAP is asymptomatic. Read More

World Neurosurg 2018 Jul 3;115:274-276. Epub 2018 May 3.

Department of Neurosurgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.

Background: We report a surgical case of entrapment neuropathy of lateral femoral cutaneous nerve (LFCN) with anatomical variation.

Case Description: This 53-year-old man had a 10-year history of paresthesia and pain in the right anterolateral thigh exacerbated by prolonged standing and walking. His symptoms improved completely but transiently by LFCN block. Read More

J Arthroplasty 2018 09 10;33(9):2912-2918. Epub 2018 Apr 10.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.

Background: Neuropathic (Charcot) arthropathy of the hip is rare but can lead to joint destruction, bone loss, and dysfunction. While total hip arthroplasty (THA) may be considered a treatment option, only very limited data in the form of case reports are available on the results of THA. The goal of this study was to analyze the outcomes of primary THA for Charcot arthropathy with emphasis on implant survivorship, complications, and clinical outcomes. Read More

J Neurol 2018 Jun 25;265(6):1454-1462. Epub 2018 Apr 25.

Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", University of Cantabria, and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.

The aim of this study was to describe five patients with cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) with chronic cough and preserved limb muscle stretch reflexes. All five patients were in the seventh decade of age, their gait imbalance having been initiated in the fifth decade. In four patients cough antedated gait imbalance between 15 and 29 years; cough was spasmodic and triggered by variable factors. Read More