1/179. Cavernous angioma of the conus medullaris as a cause of paraplegia.Cavernous angiomas of the conus medullaris are unusual lesions, representing about 3% of all intramedullary cavernomas. Most are asymptomatic. magnetic resonance imaging (MRI) is the best diagnostic tool for the detection. We report a case of a 74-year-old man who initially developed low back pain and numbness of the right leg and subsequently paraplegia, asia impairment scale 'c'. MRI revealed a cavernous angioma of the conus medullaris with perilesional oedema and signs of acute bleeding. Clinical improvement was associated with changes in the MRI.- - - - - - - - - - ranking = 1keywords = low back pain, back pain, low back, back (Clic here for more details about this article) |
2/179. osteoblastoma in lumbar vertebral body.We report a young man with low back pain suspected to have a disc protrusion. Imaging suggested a tumour of the dorsal portion of the fifth lumbar vertebral body. Operation suggested a giant-cell tumour and subsequent histology showed an osteoblastoma. All typical imaging features of osteoblastoma are demonstrated in this rather uncommon location. Contrast-enhancing bone-marrow oedema on MRI, with mild enhancement of the tumour, together with the CT appearances were the clues to the diagnosis.- - - - - - - - - - ranking = 1keywords = low back pain, back pain, low back, back (Clic here for more details about this article) |
3/179. Atypical presentation of vertebral bone metastasis from lung cancer.The authors describe a case of lung cancer in a 55-year-old man who complained of back pain. Initial isotopic bone scanning showed no abnormality, however, magnetic resonance (MRI) imaging revealed bone metastasis in thoracic vertebral bone. Even when there is no typical findings of metastasis in bone scintigraphy, MRI imaging would be useful if vertebral bone metastasis is suspected. MRI imaging is an important modality to evaluate extraosseous extension and marrow invasion of metastatic tumors.- - - - - - - - - - ranking = 0.20818465419408keywords = back pain, back (Clic here for more details about this article) |
4/179. Pilomatrix carcinoma with multiple metastases: report of a case and review of the literature.Pilomatrix carcinoma, the malignant counterpart of pilomatrixoma, is rare, with only 55 cases reported, and only four cases with visceral metastases described in the literature. Here we present a case report and a literature review on this rare tumour. A 74-year-old male with a pilomatrix carcinoma from the left temporal region presented in July 1996 and the tumour was excised. One month after diagnosis, metastases to both lungs and to a regional lymph node were found and histologically verified. The patient also developed metastases in the abdomen, back and thoracic spine. The latter resulted in spinal cord compression and paraplegia. Despite systemic chemotherapy with intravenous cisplatin and 5-fluorouracil and localised radiotherapy to the thoracic spine, progression and deterioration led to death within 3 months from time of diagnosis. Pilomatrix carcinomas are usually indolent. In our patient, however, the malignant disease progressed rapidly and it appeared to be resistant to both chemotherapy and irradiation.- - - - - - - - - - ranking = 0.012523024099481keywords = back (Clic here for more details about this article) |
5/179. multiple myeloma presenting with a paraspinal tumor and malignant effusion: case report.We describe a patient with multiple myeloma which presented as a thoracic paraspinal tumor and myelomatous pleural effusion. He had manifested a gradual onset of upper back pain with radiation to the left chest wall for 3 months. A radiographic examination showed left pleural effusion and a paraspinal tumor with rib destruction at the--left T5-6 level. Laboratory data showed anemia and a reversed serum albumin to globulin ratio. Protein electrophoresis and immunoelectrophoresis showed a monoclonal IgG-lambda chain component in the serum, urine, and pleural effusion fluid. Ultrasound-guided transthoracic mass biopsy and thoracentesis were performed for diagnosis. biopsy of the thoracic tumor showed a solid mass composed of immature plasma cells. The pleural effusion fluid contained numerous immature plasma cells. An immunophenotype study of the pleural effusion fluid revealed monoclonal plasma cells, compatible with malignant pleural effusion. A specimen of bone marrow was interpreted as typical for plasma cell myeloma. Local radiotherapy and chemotherapy with melphalan and prednisolone resulted in good partial remission with a stable condition. Later, however, the disease flared up and hyperviscosity syndrome developed with epistaxis and retinal hemorrhage. He died of sepsis about 15 months after the initial diagnosis.- - - - - - - - - - ranking = 0.20818465419408keywords = back pain, back (Clic here for more details about this article) |
6/179. A case of spinal cord compression syndrome by a fibrotic mass presenting in a patient with an intrathecal pain management pump system.A 45-year-old woman presented with increasing low back pain, progressive anesthesia in her lower extremities and difficulty ambulating. She had a history of chronic low back pain problems for which, 26 months earlier, she had an intrathecal infusion pump permanently placed for pain and spasm control. Urgent magnetic resonance imaging (MRI) of the lumbar spine revealed a mass at the site of the tip of the intrathecal catheter with high grade spinal cord compression at the level of L-1. At surgical laminectomy the compressing lesion was found to be a reactive tissue fibroma. As more patients receive these devices the physician should consider cord compression syndrome in patients presenting with symptoms of increasing low back pain, anesthesia and progressive proprioceptive loss.- - - - - - - - - - ranking = 3keywords = low back pain, back pain, low back, back (Clic here for more details about this article) |
7/179. Extraosseous extension of vertebral hemangioma, a rare cause of spinal cord compression.STUDY DESIGN: Case report. OBJECTIVE: To illustrate a rare cause of thoracic spinal cord compression, its diagnosis, and its management. SUMMARY OF BACKGROUND DATA: Asymptomatic vertebral hemangiomas are common, but extraosseous extension causing spinal cord compression with neurologic symptoms is rare, and few cases appear in the English-language literature. METHOD: A previously asymptomatic 63-year-old man sought medical attention for acute back pain and thoracic myelopathy of 6 week's duration. magnetic resonance imaging confirmed the presence of a mass in the T10 vertebral body with paravertebral and intracanalicular extension contributing to cord compression. decompression and reconstructive surgery were performed and radiotherapy administered after surgery. Preoperative angiography was not performed because of the patient's rapidly progressive neurologic deterioration and the consideration that the differential diagnosis of vertebral hemangioma was less likely. RESULTS: The diagnosis of benign capillary hemangioma was made histologically. Neurologic recovery was complete except for minor residual sensory changes in the legs. At follow-up 10 months after surgery the patient had returned to his usual active life and motor mower repairing business. CONCLUSION: Extraosseous extension of vertebral hemangiomas is a rare cause of thoracic spinal cord compression. As such, the available data are derived from reports based on series involving only a small number of cases, rather than on results of randomized controlled trials. Those causing progressive neurologic symptoms should be surgically decompressed, with the specific procedure determined by the extent and site of the lesion. Preoperative angiography is recommended, but embolization is not always necessary or even possible. Postoperative radiotherapy is recommended when tumor removal is subtotal.- - - - - - - - - - ranking = 0.20818465419408keywords = back pain, back (Clic here for more details about this article) |
8/179. Cutaneous metastasis of chordoma.BACKGROUND: Chordomas are rare neoplasms that arise from the notochord remnant. They develop in the sacrococcygeal (50%) or cervical (15%) region and are generally regarded as a locally aggressive tumor with a slow progressive growth rate and a metastatic incidence ranging from 3 to 48%. skin involvement by chordoma is rare, but can occur by direct extension, by local recurrence and by metastases. OBJECTIVE: To illustrate by a case report the clinical presentation and management of this disease. methods: We present a case of sacral chordoma with metastases over a 10-year period to the lungs, the soft tissue of the chest wall, the triceps tendon, and distant cutaneous metastases to the back and the nose. RESULTS: The cutaneous metastases were treated by excision. CONCLUSION: chordoma is a slow growing tumor of the notochord remnant that may metastasize to the skin. physicians and pathologists should be aware of this entity.- - - - - - - - - - ranking = 0.012523024099481keywords = back (Clic here for more details about this article) |
9/179. Nonconvulsive status epilepticus: the role of morphine and its antagonist.A 77-year-old woman with no history of epilepsy presented a probable nonconvulsive status epilepticus while receiving continuous intravenous morphine for back pain relating to vertebral metastasis of a malignant lymphoma. A generalized tonic-clonic seizure occurred a few minutes after injection of the morphine antagonist naloxone. No cerebral lesion was detected. This observation supports the notion of a possible pro-epileptogenic effect of opioid substances in association with metabolic and other toxic factors. Various hypotheses as to the complex actions of morphine and its antagonist in epileptogenesis are discussed.- - - - - - - - - - ranking = 0.20818465419408keywords = back pain, back (Clic here for more details about this article) |
10/179. Persistent or severe back pain and stiffness are ominous symptoms requiring prompt attention.BACKGROUND: Children with severe or persistent back pain and stiffness often have an underlying organic cause but there is a large differential diagnosis, examination may be difficult and the problem is relatively rare in general paediatric practice. These difficulties appeared to lead to delays in diagnosis and management of children with this problem. OBJECTIVES: To provide an approach to the diagnosis and management children with severe or persistent back pain or stiffness based on our clinical experience and the literature. METHODOLOGY: The case histories of 10 children with severe back pain seen by the authors over a 5-year period were reviewed. They were chosen as illustrative examples of the diagnostic and management problems and did not represent a systematic review of all cases seen by the authors over that time. RESULTS: Underlying causes included infection, inflammation, neoplasm, trauma and vascular malformation. Four of the children had spinal cord compression which required urgent decompression. There was one child with a conversion disorder but three children with organic disease were initially felt to have a conversion disorder. Investigations generally proceeded relatively slowly and the problem was not regarded as a semi-urgent situation carrying the risk of permanent paraplegia. magnetic resonance imaging (MRI) scan of the spine was the investigation of choice. CONCLUSION: Children with severe or persistent back pain and stiffness have a wide variety of underlying causes. The possibility of underlying spinal cord compression should always be considered in children with this presentation. If the diagnosis is not obvious, MRI scan of the spine should be arranged without delay.- - - - - - - - - - ranking = 1.6654772335526keywords = back pain, back (Clic here for more details about this article) |
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