1: Percept Mot Skills. 2002 Apr;94(2):476-8. Comment in: Percept Mot Skills. 2003 Aug;97(1):3-10. On the syndrome of the "spare limb": one case. Grossi D, Di Cesare G, Tamburro RP. Psychological Department, Second University of Naples, Italy. We describe a case of a brain-damaged patient who had a peculiar bodily illusion which could not be labelled an hallucination but seemed somatognosically and phenomenologically similar to the phantom limb without amputation. The patient, who showed left hemiplegia, felt a third upper limb (without seeing it) which he himself defined as "spare." The spare limb was not deformed; it could be moved and controlled by the patient, and there was no sensation of pain. The patient did not show psychopathological or cognitive disorders. A possible interpretation of the phenomenon is as a "phantom movement" of the paralysed limb: the mental representation of the movement of the limb was dissociated from the bodily representation of his own limb and so was still present in his consciousness despite the paralysis. Publication Types: Case Reports PMID: 12027341 [PubMed - indexed for MEDLINE] 2: Rev Neurol (Paris). 1997 Oct;153(10):587-90. [Hallucinations of supernumerary limbs, left hemineglect and hypersexuality in a case of right capsulo-lenticular hematoma] [Article in French] Donnet A, Schmitt A, Poncet M, Graziani N, Grisoli F. Service de Neurochirurgie, CHU Timone-Marseille. Following a right capsulo-lenticular hematoma, a 35-year-old man developed left sensory motor hemiplegia. Three years later, he still describes the existence of a supernumerary phantom limb. Mood disturbances, hypersexuality and attentional left hemineglect were also present. Publication Types: Case Reports English Abstract PMID: 9684023 [PubMed - indexed for MEDLINE] 3: J Neurol Neurosurg Psychiatry. 1993 Feb;56(2):159-66. Comment in: J Neurol Neurosurg Psychiatry. 1995 Sep;59(3):341-2. J Neurol Neurosurg Psychiatry. 2000 Aug;69(2):275-6. Three arms: a case study of supernumerary phantom limb after right hemisphere stroke. Halligan PW, Marshall JC, Wade DT. University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK. A case of supernumerary phantom limb is described after a haematoma within the right basal ganglia. The phantom, which persisted for many months, occurred in the context of severe left hemiplegia, sensory loss, hemianopia, and neglect. The subjective reality of this "third arm" caused the patient considerable distress, which was not ameliorated by his attempts to rationalise its existence. Although deeply confused by the phantom, the patient was otherwise fully oriented, with a high verbal IQ, and normal cognition. Two distinct formal interpretations of the phenomenon are discussed. Publication Types: Case Reports Research Support, Non-U.S. Gov't PMID: 8437005 [PubMed - indexed for MEDLINE] 4: Reg Anaesth. 1987 Oct;10(4):121-4. [Lumbar epidural hematoma and spinal abscess following peridural anesthesia] [Article in German] Sollmann WP, Gaab MR, Panning B. Neurochirurgische Klinik, Medizinische Hochschule Hannover. Epidural application of local anesthetics or opiates is commonly used for treatment of severe pain or arterial obstruction. We discuss two cases of complications following peridural anesthesia. As an acute complication, a lumbar epidural hematoma developed hours after placement of the catheter and caused sciatic pain and nearly complete paraplegia. The hemorrhage might have been promoted by heparinization. After decompressive hemilaminectomy the patient recovered but was disabled by a persistent paresis. The second patient suffered from renal failure, arterial obstruction, and phantom limb pain. A peridural catheter was kept in place for 6 weeks. Five months later the patient developed severe sciatica. Spinal computed tomography showed compression of the cauda at the L4/5 level (Fig.4) caused by an abscess that was opened and drained. After insertion of a gentamicin - PMMA - chain (Septopal), the wound healed primarily but the patient suffered from persistent pain. The incidence of vessel puncture after insertion of a peridural catheter is about 1%-10%. The risk of hemorrhage, perforation of the dura, and nerve root irritation is increased in scoliotic or elderly patients with a narrow spinal canal. Persistent pain after removal of the catheter is the most important sign. Although paraplegias following peridural catheterization can occur without anticoagulants, even low-dose heparinization is potentially dangerous. The risk of infectious complications after long-term peridural catheterization may be up to 20%. Hematogenous metastatic infection is more common in patients with malignancies or multiple risk factors than continuous immigration of bacteria. Epidural hematomas and spinal abscesses can cause disability and persistent neurological deficit in spite of aggressive surgical and antibiotic therapy. Publication Types: Case Reports English Abstract PMID: 3685476 [PubMed - indexed for MEDLINE] 5: Br J Surg. 1976 Sep;63(9):683-90. Amputation for vascular disease. Jamieson CW, Hill D. Amputation for peripheral ischaemia still has a depressingly high early and late mortality, and morbidity and the end result are usually less than satisfactory. Individual surgeons probably see too few amputees to treat them with maximal efficiency, and these patients create a large burden on beds and resources. There is room for improvement in all aspects of our management of amputees. Primary healing rates might be better with less heroic attempts to obtain a distal amputation. Sepsis is lessened by the use of prophylactic antibiotics. Tight bandaging and the intra-operative fitting of prostheses are undesirable. Simple tests of skin blood pressure may aid prediction of the degree of ischaemia at the proposed level of limb section and the chances of healing. The late mortality is high and merits study of methods designed to reduce it such as long term anticoagulation. Publication Types: Review PMID: 786427 [PubMed - indexed for MEDLINE] 6: Arch Surg. 1975 Jan;110(1):82-5. Hemipelvectomy. Douglass HO Jr, Razack M, Holyoke ED. Hemipelvectomy was performed in 50 patients with malignant neoplasms of the upper part of the thigh and pelvis. Although not technically difficult, the operation is associated with considerable blood loss. Postoperative complications are frequent, the greatest morbidity resulting from skin flap necrosis. Symptomatic phantom limb is as occasional late problem. Of 37 patients resected for cure prior to 1969, 14 were alive five or more years postoperatively. Five of these long-term survivors subsequently died of metastases. Patients with fibrosarcoma and chondrosarcoma had the best survival. Six other patients underwent palliative hemipelvectomy for intractable pain, with gratifying results. Hemipelvectomy is an important, useful operative procedure in selected patients. PMID: 46747 [PubMed - indexed for MEDLINE] 7: Orthop Clin North Am. 1972 Jul;3(2):383-95. Amputation surgery in the upper extremity. Tooms RE. PMID: 5037524 [PubMed - indexed for MEDLINE] 8: Rev Neurol (Paris). 1954;90(6):874-7. [Illusion of supplementary left arm in right parietal intracerebral hematoma.] [Article in French] POURSINES Y, ALLIEZ J, ROGER J, BONNAL J. PMID: 13237788 [PubMed - OLDMEDLINE]