1/13. Acute flank pain: an unusual presentation of a spinal AVM.The authors report the case of a 6-year-old boy with a spinal cord arteriovenous malformation (AVM) who presented with acute flank pain and a delayed onset of paraplegia. An early diagnosis of a spinal cord AVM was made difficult by the absence of neurological findings on initial evaluation. Included is a description of his clinical course, and the presentation of spinal AVMs to the emergency physician is discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/13. Asymmetric flaccid paralysis: a neuromuscular presentation of west nile virus infection.The neuromuscular aspects of west nile virus (WNV) infection have not been characterized in detail. We have studied a group of six patients with proven WNV infection. All cases presented with acute, severe, asymmetric, or monolimb weakness, with minimal or no sensory disturbance after a mild flu-like prodrome. Four cases also had facial weakness. Three of our cases had no encephalitic signs or symptoms despite cerebrospinal fluid pleocytosis. Electrophysiological studies showed severe denervation in paralyzed limb muscles, suggesting either motor neuron or multiple ventral nerve root damage. This localization is supported further by the finding of abnormal signal intensity confined to the anterior horns on a lumbar spine magnetic resonance imaging. Muscle biopsies from three patients showed scattered necrotic fibers, implicating mild direct or indirect muscle damage from the WNV infection. In summary, we describe a group of patients with acute segmental flaccid paralysis with minimal or no encephalitic or sensory signs. We have localized the abnormality to either the spinal motor neurons or their ventral nerve roots. It will be important for physicians to consider WNV infection in patients with acute asymmetric paralysis with or without encephalitic symptoms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/13. Emergency department presentations of transverse myelitis: two case reports.Transverse myelitis, a diagnosis that may be made in the emergency department (ED) by emergency physicians, can be difficult to diagnose because of its variable signs and symptoms and its poorly understood pathogenesis. In this article, we recount 2 cases of transverse myelitis to demonstrate its presentation, diagnosis, and management in the ED.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/13. Conversion reactions in pediatric athletes.We report five children and adolescents who displayed a conversion reaction in response to stresses induced by athletic competition. Failure to make proper diagnosis led to additional physician referral, needless testing, rehabilitation, or orthotic management. patients are characterized as high achievers who are frequently younger than peers in the sport. Conversation between child and physician identified the source of conflict in four patients. Physical therapy helps resolve symptoms associated with an acute episode and facilitates transition into psychotherapy. psychotherapy is recommended only for patients with persistent maladaptive behavior.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/13. Endemic fluorosis with spinal cord compression. A case report and review.We report a case of spinal cord compression in a Mexican immigrant due to vertebral osteosclerosis from chronic fluoride intoxication. Endemic fluorosis is acquired through drinking water. groundwater sources with high fluoride content occur worldwide. The epidemiology, metabolism, and clinical features of fluorosis are reviewed. Greater physician awareness of this entity is important to identify correctly patients with this unusual and potentially devastating clinical disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/13. Scuba diving: taking the wheelchair out of wheelchair sports.In the past, physicians prohibited patients with neuromuscular disease or disability from participating in scuba diving. This report highlights the opportunities that self-contained underwater breathing apparatus (scuba) affords to physically handicapped individuals, to move without assistive devices in a gravity-free environment. The experience of a person with T10 paraplegia is used to illustrate the applicability of a new system of evaluation, training, and certification for scuba diving to patients with a wide variety of disabilities, such as paraplegia, quadriplegia, amputation, cerebral palsy, and poliomyelitis. This review also discusses equipment needs, potential risks, and safety precautions. physicians are encouraged to support those handicapped individuals who choose to explore the submerged two thirds of our planet for its recreational as well as its potential vocational opportunities.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/13. Self-directed EMG training for the control of pain and spasticity in paraplegia: a case study.A 25-year-old paraplegic woman was able to gain control of her debilitating leg and bladder spasms and abdominal pain using self-directed EMG biofeedback. The case is significant in that she previously had only cursory exposure to biofeedback as an undergraduate student and received only minimal support and direction from an instructor. She proceeded through daily home practice using a borrowed EMG unit and audiotapes from Lester Fehmi's Open Focus series. Records were kept of the frequency and intensity of her pain and spasms, as well as the frequency and procedures of her home practice. She also maintained a record of specific psychosocial events in her life, which, over time, showed a strong, consistent pattern of influence on the recurrence and severity of her symptoms. The woman's physician declared her medical progress remarkable and encouraged her biofeedback work. At 2-year follow-up, she remains virtually symptom- and medication-free. Her successful biofeedback training program provides support for the value of client-directed biofeedback in selected cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/13. paraplegia associated with epidural anesthesia.Spinal anesthesia has lost its popularity among physicians due to rare occurrences of paraplegia that have precipitated lawsuits, with staggering judgments in favor of claimants. Epidural block has now become a popular alternative because some believe it cannot cause paraplegia; however, paraplegia is as prevalent after induction of epidural anesthesia as after spinal anesthesia. arachnoiditis has been incriminated as the causative agent when paraplegia has followed spinal anesthesia. arachnoiditis is also a causative factor when paraplegia follows epidural block. Cord compression and anterior spinal artery syndrome have also been associated with paraplegia after epidural block though they have not been a problem with spinal block.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/13. epidural abscess, vertebral destruction, and paraplegia caused by extending infection from an aspergilloma.An aspergilloma developed in a lung cyst in a 53-year-old man. aspergillus infection then contiguously spread to the epidural space, causing an abscess, vertebral destruction, and paraplegia at the level of T4. Chronic alcoholism, liver cirrhosis, and corticosteroid treatment may have been predisposing factors in this patient. Although aspergillus epidural abscess has been described infrequently, this complication has not been described in association with an aspergilloma. Symptoms, signs, or roentgenographic or laboratory findings suggestive of vertebral or meningeal pathologic lesions in patients with aspergilloma should alert the physician to the possibility of contiguous spread of infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/13. Some experience with paraplegia in a small hospital in nepal.paraplegia is a common problem in developing countries. They are the most pitiable group of cases seen, but they can all be offered some help, however limited one's resources. The main causes are Potts disease, arachnoiditis, tropical spastic paraplegia, trauma, lathyrism and cord compression. The usual trauma is falling from trees and the use of trained monkeys to gather leaves and nuts whilst humorous should not be dismissed. The author saw some 35 cases of paraplegia, of which four are described--two good results and two bad. The physician going to a developing country is advised to prepare himself for the care of these cases and to be prepared to motivate staff, patients and relatives. He will find local medical assistants are kind and enthusiastic and rapidly acquire the necessary skills. Nearly all cases should receive a simple and inexpensive anti-tuberculous regime, vitamins and a very generous diet. Necessary equipment required for the home should be locally made and nothing requiring more than simple maintenance should be used.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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