1/8. Spinal epidural haematoma as a result of warfarin/fluconazole drug interaction.This is the first reported case in the emergency medicine literature of a drug interaction between warfarin and fluconazole. We present a case of spinal epidural haematoma and summarize four other case reports reported elsewhere from 1988 to 1996. We admonish emergency physicians to be aware of this dangerous drug combination. warfarin and fluconazole are frequently encountered drugs in the emergency department and thus any interaction between these drugs is of considerable importance.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Atypical presentation of intramedullary spinal cord lesion.We report a patient who presented with atypical clinical manifestations including worsening abdominal pain from an intramedullary spinal cord lesion. It is important to consider non-abdominal causes of abdominal pain for patients with an atypical presentation. The described case demonstrates the challenges facing the physician with the early diagnosis of acute abdominal pain. spinal cord lesions, although uncommon, remain a potentially disabling and life-threatening cause of abdominal pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Complications of chiropractic treatment for back pain.back pain often causes patients great despair, and they expect the primary care physician or orthopedic surgeon to provide a quick, simple solution. rest and analgesia are the most commonly prescribed treatments, and muscle relaxants, heat, traction, and physiotherapy are also used. If these treatments do not help, the patient may search for relief through faith healing, acupuncture, chiropractic treatment, or other nonconventional forms of treatment. Although chiropractic treatment is a popular alternative, its long-term effect is questionable and the medical literature contains numerous reports of patients whose condition worsened as a result of it. physicians should be aware of the dangers of chiropractic treatment, particularly in patients with severe spondylitic changes, osteoporosis, fractures, tumors, ankylosing spondylitis, infections, or signs of nerve root pressure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. An unusual case of gastric carcinoma initially presenting bone metastasis and later transverse myelopathy.A 44-year-old man with Borrmann type III gastric carcinoma initially presenting bone metastasis and later transverse myelopathy is reported. Chest and skull roentgenograms showed multiple punched-out lesions. A bone scintigram showed multiple abnormal uptake. Histological examinations of biopsy and autopsy materials revealed signet-ring cell carcinoma of the stomach. Disseminated carcinomatosis of the bone marrow was ruled out histologically and neither microangiopathic hemolytic anemia nor disseminated intravascular coagulopathy was observed. Because this patient with bone metastasis did not have metastasis to the liver and lungs we propose that a nonportal route through the vertebral venous plexus might be an alternative to the portal route of bone metastasis from gastric carcinoma. During the last 20 years, only 10 such cases including this one have been reported in japan. Their prognosis was quite poor and in most of them the malignancy was either undifferentiated adenocarcinoma or signet-ring cell carcinoma. If a bone metastasis is found as the initial sign, physicians should keep in mind that the primary lesion might be in the stomach, or in the thyroid, kidney, lung or prostate as another point of search.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Spinal syphilis: the problem of fluorescent treponemal antibody in the cerebrospinal fluid.Spinal manifestations of syphilis are now uncommon. Three adults with presumptive nontabetic spinal syphilis are presented. This paper should serve as a reminder to physicians that cases of late syphilis continue to occur and may be manifested as obscure spinal syndromes and be misdiagnosed unless the possibility of syphilis is constantly kept in mind. Some of the clinical dilemmas associated with the reactivity of fluorescent treponemal antibody in the cerebrospinal fluid are discussed,- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Posttraumatic cystic myelopathy in motor incomplete quadriplegia presenting as progressive orthostasis.A 20-year-old man sustained a C7 burst fracture in a motor vehicle accident. Initial neurologic examination showed sensory incomplete C7 quadriplegia. Seventeen days postinjury anterior C7 body excision with bony fusion was performed. Postoperatively, his sensation improved. He first voluntarily moved the lower extremities at seven weeks. Eight months postinjury he could ambulate independently with forearm crutches for 500 feet. Eleven months postinjury he complained of headache and fatigability. Examination demonstrated orthostatic hypotension which became severe after walking 40 feet. In spite of salt loading, ephedrine, fludrocortisone, and compression garments, he became increasingly disabled by fatigability and orthostatic hypotension. Consequently, he could not ambulate regularly. Twenty-two months postinjury metrizamide myelogram showed widening of the spinal cord at C7. Following the myelogram CT showed a small cyst filled with contrast material. The patient underwent surgical decompression of the spinal cord cyst with placement of a drain from the cyst to the subarachnoid space. Postoperatively, he noted improvement of fatigability and was able to ambulate 500 feet without symptomatic orthostasis. Posttraumatic cystic myelopathy is increasingly recognized as a late complication of traumatic spinal cord injury. Presenting symptoms are usually pain and neurologic deterioration. Progressive loss of sympathetic nervous system function with severely symptomatic orthostatic hypotension should also alert physicians to consider this diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Bilateral epidural empyemas in an adolescent.Epidural empyema is an unusual cause of headache that may be encountered in the emergency department. The collection of suppurative fluid usually results from local spread of sinusitis, although many other predisposing factors have also been described. patients with epidural empyema usually present with nonspecific cephalalgia that may be accompanied by fever and leukocytosis but is unlikely to be associated with focal neurological findings. The case of an adolescent who presented to our emergency department twice in 6 days with persistent headache is reported; cranial computed tomography performed on the second visit demonstrated bilateral epidural empyema. This entity is uncommon, but may certainly be encountered by the emergency physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Spinal epidural abscess. Optimizing patient care.The medical literature regarding spinal epidural abscess has two common threads: reports of poor prognosis and appeals for rapid treatment. Spinal epidural abscess is a difficult diagnosis to make because of its rarity--many physicians will never see a case during their careers. Among all patients admitted to hospitals, the incidence is approximately one to two cases per 10,000. Only increased awareness and swift management of spinal epidural abscess will improve outcome. Our goal through this report is to enhance the recognition and treatment of spinal epidural abscess. We present 28 new cases of spinal epidural abscess, giving special attention to the peculiarities of the disease; we compile and analyze comprehensive data from cases from literature; and finally, we present the results of 16 retrospective personal interviews of infected patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |