1/17. Idiopathic localized hydromyelia: dilatation of the central canal of the spinal cord of probable congenital origin.Three adult patients are reported with asymptomatic localized widening of the central canal of the spinal cord. These patients were followed for a period of 24 years by imaging and/or clinical history and physical examination without evidence of signs or symptoms related to the spinal cord. This condition probably represents persistence into adult life of a fetal configuration of the central canal of the spinal cord. This process may be termed "idiopathic localized hydromyelia" to distinguish it from syringomyelia secondary to such causes as Chiari malformation, trauma, infection, or neoplasm.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/17. sarcoidosis presenting as an intramedullary spinal cord lesion.OBJECTIVES: sarcoidosis affects the spinal cord in only 0.43% of patients with sarcoidosis. Usually there is systemic involvement prior to the development of cord lesions. We present a case of sarcoid isolated to the intramedullary spinal cord, which was a diagnostic and therapeutic challenge. We review the case and then present a review of the literature with an emphasis on presentation, diagnosis and treatment. methods: We have reviewed a patient who presented with an isolated sarcoid granuloma affecting the cervical spinal cord. All pertinent history and physical information was extracted from the patient's chart and through patient interview. Laboratory, radiographic and pathological investigations are presented. RESULTS AND CONCLUSIONS: Fourteen patients have been reported with isolated intramedullary spinal cord sarcoidosis. Current practice supports the role of surgery for biopsy; mainstay of treatment is corticosteroids.- - - - - - - - - - ranking = 0.10883165497842keywords = physical (Clic here for more details about this article) |
3/17. Juxtafacet cyst of the lumbar spine. Clinical, radiological and therapeutic aspects in 28 cases.OBJECT: A consecutive series of 28 "operated" juxtafacet cysts is reported. We emphasize the clinical and radiological aspects leading to diagnosis. We also discuss the results of the surgical treatment. MATERIAL AND methods: Medical information and radiological studies involving 28 patients were analyzed. Each patient has been operated on by decompressive laminectomy and resection of the cyst. The diagnosis was always confirmed by a pathological examination. The cyst most frequently occurred at the L4-L5 level (n = 18), and seldom at the L5-S1 (n - 6) or L3-L4 (n - 4) levels. RESULTS: The differential diagnosis from other pathological causes responsible for a radicular compression could not be done by physical examination. spine x-rays or myelogram were nonspecific. Computed tomography or CT-myelography could help in the diagnosis but MR imaging was the most sensitive. In our series, the respective sensitivities of these techniques are 56, 42 and 77%. The preoperative diagnosis was correct in 18 patients (64%). The cyst was sometimes adherent to the underlying dura, then significantly increasing the risk of dural tear and spinal fluid leak, especially when located at L3-L4 level. Surgical ablation lead to a complete recovery or an important improvement in 26 patients. CONCLUSIONS: The diagnosis of the juxtafacet cyst of the lumbar spine is better achieved by MRI. Surgery is the gold standard treatment, safe and long-term effective. When a total cyst removal with an internal facetectomy are performed, recurrence is exceptional.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/17. Musculoskeletal causes of chest pain.BACKGROUND: chest pain is a common presenting problem to general practitioners and accident and emergency departments. Such a symptom generates anxiety in both patients and their medical attendants, for fear that this symptom represents a life threatening event. Numerous investigations often ensue, adding to the physical and financial burden on an already stressed health system. Musculoskeletal causes of chest pain are common but frequently overlooked. OBJECTIVE: This article aims to outline some of the more common musculoskeletal problems which may present as chest pain, and to present a practical approach to their diagnosis and management. DISCUSSION: It is estimated that somewhere in the vicinity of 20-25% of noncardiac chest pain has a musculoskeletal basis. Careful history taking to identify red flag conditions differentiates those who require further investigation. Historical features suggesting a musculoskeletal cause include pain on specific postures or physical activities. A musculoskeletal diagnosis can usually be confirmed by clinical examination alone, the key to which is reproducing the patient's pain by either a movement or more specifically palpation over the structure that is the source of the pain. Confirming the diagnosis, explanation and reassurance allay anxiety. Management strategies include manual therapy, the provision of analgesia and anti-inflammatory agents, either topically, orally or by injection. Focal injection of local anaesthetic alone may also be a useful diagnostic and therapeutic tool.- - - - - - - - - - ranking = 0.21766330995685keywords = physical (Clic here for more details about this article) |
5/17. Spinal intradural endodermal cyst located anterior to the cervical spinal cord.Spinal endodermic cysts are rare and may be associated with other congenital anomalies (mediastinal cysts, bony defects of the vertebral body), derive from defective displacement of the endoderm of the intestinal tract or, more rarely, the respiratory one. The authors describe a case of endodermic cyst of the cervical spine localized anteriorly to the spinal cord. In the case we treated the patient was a 17-year-old male who presented hypostenia of the lower limbs accompanied by hyperreflexia and spasticity; physical examination was negative. MRI, CT and CT-myelography documented a well-defined mass situated anteriorly to the spinal cord at C2-C4 level. A total-body CT-scan excluded the existence of other malformations. Surgery was performed via an anterior approach and the cyst completely removed. Histological examination confirmed the endodermal nature of the cyst. At long-term follow-up examination the patient was neurologically intact. Postoperative MRI showed a small residue of the cyst wall without spinal cord compression. Endodermic spinal cysts are very rare intradural lesions, predominantly with an anterior cervical localization, which derive from misplaced embryonic and endodermic cells. In the majority of cases, clinical onset is insidious and has a discontinuous progression. The best diagnostic tool is MRI. Treatment of choice is total surgical removal or emptying of the cyst followed by fenestration.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/17. Exertional myelopathy in type 2 congenital kyphosis.STUDY DESIGN: A case of lower-extremity myelopathy induced by physical exertion in a patient with Type 2 (failure of segmentation) congenital kyphosis is reported. OBJECTIVE: To describe the uncommon presentation of neurologic sequelae in a patient with Type 2 congenital kyphosis. SUMMARY OF BACKGROUND DATA: Various reports have described neurologic sequelae in patients with Type 1 (failure of formation) congenital kyphosis. To the authors' knowledge, no case of Type 2 congenital kyphosis leading to neurologic symptoms has been reported. methods: A 17-year-old boy presented with a 3-year history of progressively worsening midthoracic back pain. During exertion, numbness developed along the posterior aspects of his legs, and he experienced a wobbly sensation in his lower extremities that prevented his participation in athletic activities. His static and dynamic neurologic examination was unremarkable. However, he developed a wide-based clumsy myelopathic gait when he was asked to run in the halls of the clinic. magnetic resonance imaging demonstrated that the spinal cord was draped over the posterior vertebral body of T10. Anterior thoracic spinal cord decompression and fusion were performed through a seventh rib thoracotomy using a structural rib graft to fill the defect. The anterior 1 cm of bone was left intact so as not to cause any additional instability. RESULTS: The patient tolerated the procedure well and had complete resolution of his exertionally dependent myelopathic symptoms. At this writing, 3 years after surgery, he is involved in the Navy ROTC program. CONCLUSIONS: Although Type 2 congenital kyphosis is a rare entity, it should be followed carefully and corrected surgically when appropriate. A history of exertional myelopathy may be an early sign of spinal cord impingement and is an indication for surgical decompression.- - - - - - - - - - ranking = 0.10883165497842keywords = physical (Clic here for more details about this article) |
7/17. Cases from the Osler Medical Service at Johns Hopkins University.A 50-year-old African American woman presented with bilateral lower extremity pain, a history of falls during the past several months, and personality and behavior changes. She had been in good health until approximately 5 months before admission, when she began to fall with increasing frequency, often while going down a flight of stairs. She described these falls as her "legs giving out" and feeling very heavy and unsteady. There was no head trauma or loss of consciousness. Her daughter noticed that her gait had become somewhat unsteady during the last several months. Her family also noted a change in her personality at this time. Previously, she had been a very tidy person who took great care with her appearance, who was working as a customer service representative. However, she had become less social and very withdrawn. She had been observed putting on dirty clothes after showering, as well as eating constantly. The patient denied any fevers, chills, night sweats, headaches, vision changes, or tinnitus. She also denied any rashes, muscle pain, or intolerance to heat or cold. There was no history of seizure disorder or depression. Her past medical history was notable only for hypertension and being a passenger in a motor vehicle crash 1 year before admission. She denied any alcohol, tobacco, or illicit drug use, and had no travel history other than coming to the united states, as she was originally from Trinidad.On physical examination, she was a moderately obese African American woman with a flat affect, psychomotor slowing, and alopecia of the scalp. She was alert and oriented to person, place, and time, but had a score of 26 out of 30 on the Mini-Mental State Examination. She lost points only for recall; she had no difficulty with serial 7s. Her cranial nerves were intact and her speech was fluent, although sparse, and she did not make any paraphasic errors. Her muscle strength was 5/5 in both the upper and lower extremities. Reflexes were 2 in the upper extremities and 1 in the lower extremities, and toes were downgoing bilaterally. She had intact sensation to light touch and pinprick, but markedly diminished proprioception of her lower extremities bilaterally. She had a wide-based gait with a positive Romberg sign and was markedly ataxic. Rectal examination yielded a positive guaiac test with brown stool, normal tone, and no masses. The remainder of the physical examination was normal.Laboratory studies revealed pancytopenia with a hematocrit of 22.7% and a mean corpuscular volume of 118.2 fL. A peripheral smear that was performed on admission, prior to transfusion, revealed macrocytic red cells and hypersegmented neutrophils.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
8/17. Intramedullary spinal tuberculoma--case report.A healthy 33-year-old man presented with an intramedullary tuberculoma of the thoracic spinal cord manifesting as a 2-month history of progressive paraparesis and sphincter dysfunction. magnetic resonance imaging showed ring enhancement of the intramedullary thoracic lesion with perifocal edema. General physical examination was unremarkable with no signs of inflammation except for a positive finding by the tuberculin skin test. Total resection of the intramedullary mass was performed through a posterior myelotomy following T11-12 laminectomy. Histological examination revealed a granulomatous lesion that contained Langhans giant cells, inflammatory cells, and caseating necrosis. Acid-fast bacilli staining of the specimens was positive, and cultures grew mycobacterium tuberculosis. Postoperatively, the paraparesis and sphincter dysfunction improved sufficiently for the patient to return to his ordinary activities. Intramedullary spinal tuberculoma is rare, but must be considered in the differential diagnosis of spinal cord compression.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/17. Ossification of the posterior atlantoaxial membrane and the transverse atlantal ligament.STUDY DESIGN: Case report. OBJECTIVE: To report a case of ossification of the posterior atlantoaxial membrane (PAAM) and ossification of the transverse ligament of the atlas (TAL). SUMMARY OF BACKGROUND DATA: Ossification of the PAAM and TAL are both very rare clinical entities. This is the first case involving ossification of both the PAAM and TAL with the development of cervical myelopathy. methods: Patient's history, physical examination, radiographic evaluation, surgical treatment, and outcome are examined. Relevant literature is also reviewed. RESULTS: The patient's neurological symptoms significantly improved after posterior decompressive surgery. CONCLUSION: Ossification of various parts of the spinal ligament have been reported previously. Among them, ossification of both the PAAM and TAL has never been reported previously and is thus extremely rare. Surgical intervention improved the neurological impairment.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/17. Superficial siderosis of the spinal cord: a rare cause of myelopathy diagnosed by MRI.Repeated bleeding into CSF spaces may cause superficial siderosis with progressive neurologic impairment. The unique physical properties of MRI provide a basis for the in vivo diagnosis of this entity.- - - - - - - - - - ranking = 0.10883165497842keywords = physical (Clic here for more details about this article) |
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