1/16. midodrine hydrochloride and the treatment of orthostatic hypotension in tetraplegia: two cases and a review of the literature.STUDY DESIGN: A report of two cases of orthostatic hypotension in acute tetraplegia that were resistant to classic treatment interventions. OBJECTIVE: To discuss the use of midodrine hydrochloride for the treatment of orthostatic hypotension in early tetraplegia. SETTING: Department of rehabilitation medicine, The University of texas health science Center at San Antonio, texas, USA. methods: Presentation of two cases. RESULTS: midodrine hydrochloride successfully treated two cases of orthostatic hypotension that had been refractory to classic treatment interventions. CONCLUSION: midodrine hydrochloride should be included in the armamentarium of the physician treating orthostatic hypotension in spinal cord injury.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/16. milk of calcium in the inferior calyx of a hydronephrotic kidney in a tetraplegic patient - a diagnosis to be made before scheduling for extracorporeal shock wave lithotripsy.STUDY DESIGN: A Case Report of renal milk of calcium in a tetraplegic subject. OBJECTIVES: To increase the awareness of renal milk of calcium in spinal cord injury (SCI) physicians. Renal milk of calcium contains a colloidal suspension of calcium crystals. Since upright views of the kidneys are not performed in tetraplegic subjects, the renal milk of calcium may be misinterpreted as renal lithiasis by routine radiography taken in supine position. SETTING: Regional spinal injuries Centre, Southport, england. METHOD: In a 41-year-old male with traumatic tetraplegia, X-ray of abdomen in supine position showed multiple opacities in the region of the left kidney. These radio opaque shadows were interpreted as renal calculi. Subsequently, computed tomography (CT) of the kidneys was performed. RESULTS: CT confirmed the presence of calculi in the mid-polar calyx. However, the density situated in the inferior calyx of the hydronephrotic left kidney exhibited a horizontal upper edge. This specific radiological finding as observed in the CT of kidneys, provided the clue to the presence of milk of calcium in the inferior calyx of the hydronephrotic left kidney. CONCLUSION: As plain film of the abdomen in standing position is not performed in SCI patients, physicians caring for SCI patients should have a high index of suspicion for renal milk of calcium. Prompt diagnosis of renal milk of calcium will help to avoid unnecessary surgery, or extracorporeal shock wave lithotripsy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/16. Cervical spine injuries in the athlete.Special considerations must be brought into play when the physician is consulted about when to allow an athlete to return to play following injury. This is especially true for brain and spinal cord injury. Although it is generally best to be on the conservative side, being too reticent about allowing any athlete to return may be very detrimental to the athlete and/or the entire team. Therefore, it behooves the sports physician to be circumspect with regard to not only the type of injury the athlete has suffered but also the nature, duration, and the repetitive aspects of the trauma along with the inherent strengths of any player. This article will provide the sports physician with criteria for making sound decisions regarding return to competition after cervical spine injury and "functional" cervical spinal stenosis.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
4/16. Intrathecal baclofen withdrawal mimicking sepsis.baclofen (Lioresal) is a drug of choice to treat spasticity and is increasingly being administered intrathecally via an implantable pump in cases refractory to oral therapy. Emergency physicians will likely treat patients with baclofen withdrawal or overdose as this treatment becomes more widespread. The syndrome of baclofen withdrawal presents with altered mental status, fever, tachycardia, hypertension or hypotension, seizures, and rebound spasticity, and may be fatal if not treated appropriately. baclofen withdrawal may mimic other diseases including sepsis, meningitis, autonomic dysreflexia, malignant hyperthermia, or neuroleptic malignant syndrome. Treatment consists of supportive care, reinstitution of baclofen, benzodiazepines, and diagnosis and eventual repair of intrathecal pump and catheter malfunction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/16. Current thinking: return to play and transient quadriplegia.athletes that participate in contact and collision sports assume risk of serious injury each time they take the field. For those athletes that have sustained an episode of transient quadriplegia, the decision of whether to return to competition can be a difficult one. Some athletes, realizing how close they may have come to permanent injury, may decide that further participation is not in their best interest. Others may be somewhat undecided, and some may want to return at all costs. As the treating physician, the goal is to identify those athletes who after a single episode of transient quadriplegia are at increased risk for further injury and consequently should discontinue participation in contact sports. Factors that may contribute to that determination include mechanism of injury, prior history of neurologic symptoms or injury, and anatomic features that may predispose to further injury such as disc herniation, fracture, or cervical stenosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/16. autonomic dysreflexia triggered by an unstable lumbar spine in a quadriplegic patient.A 40 year-old man with C5 complete quadriplegia, had L2-L3 pyogenic spondylitis treated with debridement and fusion of the lumbar spine with left iliac bone graft. Three months later he developed symptoms of autonomic dysreflexia, including headache, cold sweating, and hypertension whenever he was in an upright position. These symptoms resolved after lying down. Roentgenograms of the lumbar spine revealed absorption of the bone graft at the L2-L3 level. A spinal stabilization procedure was done after eight weeks of antibiotic therapy under the impression of unstable spine caused by pyogenic spondylitis. Symptoms were relieved immediately following the surgery. This report may be helpful for physicians caring for quadriplegic patients with autonomic dysreflexia induced by an unstable spine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/16. Quadriparesis due to intraspinal cyst after failed posterior occipitocervical fusion in a patient with athetoid cerebral palsy.STUDY DESIGN: A case report and review of the literature are presented. OBJECTIVES: To describe the clinical course and treatment of a patient with athetoid cerebral palsy who had quadriparesis due to an intraspinal cyst, following a failed occipitocervical fusion using sublaminar wires and rods. SUMMARY OF BACKGROUND DATA: Intraspinal cyst as a cause of quadriparesis in a patient with athetoid cerebral palsy is extremely rare. To our knowledge, there have been no publications on this issue. methods: A 60-year-old man with athetoid cerebral palsy and a history of posterior occipitocervical fusion presented with quadriparesis. Salvage surgery for cervical myelopathy and pseudarthrosis was performed with laminectomy and rearthrodesis using the pedicle screw system. An intraspinal cyst was identified as the main cause of the paraparesis. RESULTS: Solid bony fusion and the improvement of paraparesis were achieved 2 years and 1 month after the surgery. He is now able to feed himself and to walk with a cane, both without assistance. CONCLUSION: A physician managing patients with athetoid cerebral palsy should always be aware that an intraspinal cyst in the cervical spine may be the cause of cervical myelopathy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/16. Simultaneous gastropleural and gastrocolic fistulae in a quadriplegic male.A 56-year-old, quadriplegic man presented to a physician's office with a large, left pleural effusion. He subsequently was found to have a gastropleural and gastrocolic fistula. These two very rare complications of benign peptic ulcer disease are discussed with special reference to patients with profoundly altered sensation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/16. Locked-in syndrome: report of a case.Locked-in syndrome is a unique clinical condition associated with ventral pontine lesions. The locked-in state is characterized by tetraplegia and mutism with maintenance of alertness as well as vertical eye movements and eye blinking, by which communication is possible. A case of locked-in syndrome in a 58-year-old man that demonstrates the clinical manifestations of the disorder is reported. Unless the physician is familiar with the signs and symptoms of the locked-in syndrome, the diagnosis may be missed and the patient may erroneously be considered comatose.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/16. Preterm labor in the quadriplegic parturient.The occurrence of preterm labor is not uncommon in the pregnant quadriplegic. early diagnosis is hampered by the inability of most quadriplegics to sense uterine contractions in the usual way. A patient we recently treated for preterm labor learned to recognize contractions by the associated symptoms of autonomic hyper-reflexia: flushing, headache, and piloerection. Tocolytic therapy was successful and a favorable neonatal outcome occurred. Increased awareness by the physician and the pregnant quadriplegic patient is encouraged so that symptoms of autonomic hyper-reflexia may be recognized as potentially indicative of uterine contractions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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