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While more frequently cases of enuresis have ties to behavioral, psychiatric[ 3 ] and genetic[ 4 ] predispositions, less common causes, including neurologic conditions, should not be overlooked.

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Given the association of neurologic problems with enuresis, the suffees of thorough neurologic evaluation cannot be underestimated, as findings could suggest a neurologic etiology, particularly in cases refractory to traditional management. We present three pediatric cases of enuresis related to neurologic disorders in order to illustrate the importance of a high index of suspicion for sufferrs causes and a thorough neurologic history Are you a lady who suffers from enuresis then read on examination in the evaluation of enuresis.

In the cases presented, while all underlying diagnoses were promptly recognized by specialists, symptoms and signs were overlooked during general examination by nonspecialist. An 8-year-old female presented with persistent bedwetting and occasional daytime incontinence. Her past medical history was notable only for vesicoureteral reflux, chronic otitis media with tympanostomy, and constipation. Trials of antibiotics and antispasmodics were discontinued rhen a voiding cystouretherogram showed an insignificant amount of reflux.

You receive a call concerning an 85‐year‐old male patient hospitalized for pneumonia. The patient is having difficulty sleeping and asks if he can take a diphenhydramine (Benadryl) to help him get to sleep. The patient has a PMHx of hypertension and BPH. You explain that it would be a better idea to choose another agent to help with sleep. I am 33 years old and have suffered from enuresis my entire life. is this something I will need to live with? I have - Answered by a verified Urologist read more. Dr. Muneeb Ali. Assistant Professor, Critical Care I have an 11 year old daughter who suffers from nocturnal enuresis. She has never had more than a few nights or perhaps a. You can cut down on symptoms by changing what you eat and drink. Do you suffer from incontinence? You can cut down on symptoms by changing what you eat and drink. Read More. How Your Period.

Past physical examination by the family doctor showed normal external genitalia and positive anal reflex with good tone, and unremarkable neurological examination. At age 8, to the persistence of her urinary issues, she was started on imipramine, without benefit.

Around that time she presented to our clinic following a brief episode of right sided facial twitching during sleep with deviation of the mouth to the right. The mother, who witnessed the episode, reported seconds duration and no incontinence.

When asked regarding occurrence of similar symptoms, the patient recounted an episode six months prior when after a bath she had similar lip twitching that lasted for 10 to 15 seconds. There were no headaches, rfad or bladder incontinence during or following the episode and no personal or family history of seizures.

EEG showed multifocal epileptiform discharges more prominent in the fronto-parietal area, consistent with BRE.

The child was started on oxcarbazepine; a 3 months follow-up revealed tead rare nighttime incontinence. A 13 year old girl with multi-year history of bladder problems with bed wetting, daytime incontinence, and urgency presented with a few month history of progressive hand atrophy with diminishing grip leading to difficulty opening jars and writing.

Her parents noticed thinning of her shoulders with prominent scapulae. Over this time she was active in cheerleading and participated in tumbling classes.

Two years prior to evaluation she sustained a fall from a pyramid during cheerleading exercises, suffering a trauma to her neck. Physical exam showed a small girl with normal cognition. Her neck was non-tender with full range of motion.

On musculoskeletal examination, moderate-to-severe atrophy of the intrinsic hand muscles was evident along with some atrophy of the shoulder muscles with scapular winging.

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Lower extremity strength and gait were normal with adequate tandem walk and normal reflexes. Enuredis responses were normal.

MRI revealed a large cervicothoracic syrinx extending from C1 yhen the low thoracic region with associated Chiari I malformation figure1. Neurosurgical evaluation prompted Chiari decompression with C1 and C2 laminectomy and subarachnoid shunt placement. Although a post-surgical cervical spine MRI figure 1 showed radiographic improvement of the structural abnormalities, the patient did not regain strength and muscle bulk in her hands.

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Cervical and thoracic spine MRI. Extensive holocord syringomyelia with Chiari 1 malformation at the craniocervical junction ectopic cerebellar eniresis extending1. A syringe-subarachnoid shunt is visible.

A four year old female presented with complaint of chronic headaches exacerbated by activity, including laughing, crying, and running, without associated back pain. Developmentally, she began walking at appropriate ladu, though her gait was mildly abnormal, with a pace slow for age and with difficulty climbing stairs. The more recent onset of severe urinary urgency and frequency associated with decreased stream and dribbling of urine led to evaluation by nephrology.

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A renal ultrasound and voiding cystourethrogram layd a normal bladder without signs of vesico-ureteral reflux, and a diagnosis of dysfunctional voiding syndrome was made. Neurosurgical consultation was obtained and on physical examination she was noted to have a Woman seeking casual sex Almond Wisconsin gait, mild difficulties with tandem walk, and a birthmark at the L5 ,ady.

Spine MRI revealed a conus medullaris ending at L2 with a small syrinx; the filum terminale appeared adhesive to the dorsal dura at L4-L5 figure 2. Laminectomy at L4-L5 for tethered cord release and craniectomy with C1, C2 and C3 laminectomy for Chiari decompression were performed. In the month following surgical intervention, the patient's gait improved, but her headaches worsened. T1 image demonstrating Chiari malformation with 13 mm tonsillary protrusion, but Are you a lady who suffers from enuresis then read on hydrocephalus; [B] T2 lumbo-sacral spine MRI: The significance of the cases presented lies in understanding enureeis the diagnosis was reached only because of a high index of suspicion leading to more accurate neurologic history and examination.

Are you a lady who suffers from enuresis then read on

Diagnosing BRE in Case 1 was prompted by the classical nocturnal symptoms but the possibility of nocturnal seizure was never considered during multiple evaluations for persistent, nocturnal urinary incontinence. Although no incontinence was reported with the witnessed seizures, the substantial improvement of enuresis with antiepileptic medication suggests a relation between the two events.

Because of the relatively common occurrence of BRE in school-age children, the possibility of nocturnal seizures should be considered in cases of persistent incontinence in this age group. Care should be taken to ask about specific symptoms like nocturnal twitching, staring spells, or episodes of altered mental status in the morning that could suggest epilepsy as cause of incontinence.

The identification of a cervical syrinx in Case 2 was driven by an accurate neurologic examination with the identification of clear findings localizing the problem at the cervical spine level.

In this patient the long-lasting urinary Parsons WV cheating wives was dismissed as common childhood developmental condition. The importance of her head trauma —which is known Are you a lady who suffers from enuresis then read on precipitate worsening of cervical syrinx in the setting of Chiari I malformation - was also underestimated.

The diagnosis of a Chiari I malformation and tethered cord in Case 3 as a cause for the urinary incontinence relied on the persistent headaches and Are you a lady who suffers from enuresis then read on subtle gait-related findings. While purely neurologic causes only account for a fraction of childhood enuresis, the importance of a thorough history and neurologic examination cannot be underestimated.

General practitioners should be vigilant regarding signs and symptoms suggesting underlying neurologic problems as etiology to common childhood diseases.

Peyronie's Disease · Pregnancy And Childbirth · Urinary Incontinence · Urinary Retention · Urinary Tract Infection · Women's Conditions . Some children suffer from arousal disorder or the inability to respond to the body signals that it is time to urinate. No one knows your child better than you do. . Read More →. WebMD looks at bed-wetting -- called enuresis -- including how it develops and how it is treated. Continue Reading Below Alarms: Using an alarm system that rings when the bed gets wet can help the child learn Woman standing in grass field barefoot, wind blowi Phobias: What Are You Afraid Of?. The most important reason for treating enuresis is to minimize the embarrassment and anxiety of the child and the frustration experienced by.

These cases illustrate that performing a thorough neurological history and examination in patients with enuresis can be greatly beneficial as part of the initial evaluation. Furthermore, as neurologic signs and symptoms may be indicative of other rare childhood diseases, neurologic examination at every well-child visit should never be overlooked.

We would like to thank Dr. Ludwig Gutmann for his contributions in the initial evaluation and manuscript work for one of our cases in addition to reviewing the article. We would additionally like to thank the West Virginia University School of Medicine for their work in supporting resident and medical student research.

The authors have no financial interest to disclose. National Center for Biotechnology InformationU. Author manuscript; available in PMC May 5.

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Syringomelia, yoj cord, enuresis, void disorder. The publisher's final edited version of this article is available at Clin Discreet nsa tonight 61511 Phila. Case 2 — Cervical Are you a lady who suffers from enuresis then read on A 13 year old girl with multi-year history of bladder problems with bed wetting, daytime incontinence, and urgency presented with a few month history of progressive hand atrophy with diminishing grip leading to difficulty opening jars and writing.

Open in a separate window. Case 3 — Tethered cord Arre four year old female presented with complaint of chronic headaches exacerbated by activity, including laughing, crying, and running, without associated back pain. Gur E, Turhan P, et al. Zink S, Freitag C, et al.

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Schultz-Lampel D, Steuber C, et al. Urinary Incontinence in Children. Support Center Support Center. Please review our privacy policy.