1/7. An integrated medical and psychiatric approach to conversion symptoms in a four-year-old.conversion disorder is a challenging diagnosis in children and adolescents. Medical and psychiatric diagnoses need to be evaluated both separately and in relation to each other. This case highlights both the diagnostic criteria for a conversion disorder in a young child and the need for an integrated medical and psychiatric approach by physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Cervical epidural abscess in an afebrile patient: a case report.OBJECTIVE: The aim of the study was to discuss a case of cervical epidural abscess and present the clinical features and diagnosis of this disorder. CLINICAL FEATURES: A 52-year-old man had severe neck pain for 1 week. He had a long history of chronic recurrent neck pain, including 2 previous neck surgeries. He was afebrile on each visit, but developed rapid onset of motor loss, which necessitated immediate magnetic resonance imaging referral. The patient died in the magnetic resonance imaging tube. INTERVENTION AND OUTCOME: Because of the aggressive nature of the infection, causing death only 1 week after the initial onset of symptoms, there was no opportunity to institute treatment of the abscess. CONCLUSION: Spinal epidural abscess is a relatively rare but potentially life-threatening disorder in which the most common initial symptom is spinal pain. Because of this, patients with early spinal epidural abscess will often consult a chiropractic physician or other primary contact spine specialist. It is important for clinicians to be alert to the diagnostic features of spinal epidural abscess so that early treatment can be instituted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. behavior modification of abnormal gait and chronic pain secondary to somatization disorder.An interdisciplinary team, which included a physiatrist, psychologist, physical therapist, occupational therapist, social worker, and nursing staff, undertook the treatment of a 33-year-old woman with a 16-year history of gait problems and multiple somatic complaints. Previously, she had been followed by a number of physicians and had undergone both invasive and noninvasive diagnostic procedures as well as several surgical procedures. After limited response to such treatment, she was referred to the outpatient PM&R clinic for evaluation. Physical and psychologic study led to a primary diagnosis of somatization disorder, leading to inpatient treatment which combined a systematic gait-training program, withdrawal of reinforcement for maladaptive disability-related behavior, and reinforcement of increases in normal activities. The patient attained all of the goals in her program in 11 weeks.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. masturbation mimicking paroxysmal dystonia or dyskinesia in a young girl.We present the case of a young girl with periodic posturing during masturbation. The child had been evaluated by several physicians and underwent numerous diagnostic tests before the spells were seen by a physician and determined to be self-stimulatory and not paroxysmal dystonia. masturbation is a normal and common behavior in young children and should be recognized as such. Failure to recognize this behavior can lead to unnecessary and invasive testing.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/7. Acute hemorrhagic leukoencephalitis: a cause of acute brainstem dysfunction.A 37-year-old female physician was admitted to the hospital with severe headache, facial and hand paresthesias, dysarthria, and ataxia. neurologic examination disclosed signs of brain stem dysfunction. There was rapid neurologic deterioration, and she died in 28 hours. Postmortem studies showed the characteristic features of acute hemorrhagic leukoencephalitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. serotonin syndrome complicating migraine pharmacotherapy.serotonin syndrome, a condition with numerous clinical neurological manifestations, is the result of central serotonergic hyperstimulation. Features of the syndrome include mental status and behavioral changes (agitation, excitement, hypomania, obtundation), motor system involvement (myoclonus, hemiballismus, tremor, hyperreflexia, motor weakness, dysarthria, ataxia) and autonomic symptoms (fever, chills, diarrhea). serotonin syndrome has been reported exclusively in patients on medications for psychiatric illness and Parkinsonism, despite the fact that the putative action of many antimigraine agents also involves the serotonin system. We herein report six patients with migraine who developed symptoms suggestive of the serotonin syndrome. Five were taking one or more serotomimetic agents for migraine prophylaxis (sertraline, paroxetine, lithium, imipramine, amitriptyline). In each case the symptoms and signs developed in close temporal proximity with use of a migraine abortive agent known to interact with serotonin receptors. In three instances the agent was subcutaneous sumatriptan and, in three, intravenous dihydroergotamine. In each instance the symptoms were transient and there was full recovery. With the ever increasing use of migraine medications active at serotonin receptor sites, cases of serotonin syndrome will likely occur more frequently. It is important that physicians treating migraine are aware of the serotonin syndrome and are able to recognize its varying presentations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Difficulty walking. A presentation of idiopathic juvenile osteoporosis.Idiopathic juvenile osteoporosis is a rare condition that may present as difficulty walking. Difficulty walking represents a challenging differential diagnosis in pediatrics. Diagnostic studies are usually oriented to rule out neuromuscular etiologies or, once organic causes have been reasonably discarded, conversion disorders. We describe 2 patients who presented with difficulty or inability to walk due to idiopathic juvenile osteoporosis, a rare disease unfamiliar to most physicians. However, early diagnosis in patients can avoid extensive testing and prolonged hospitalizations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |