1/93. Ankylosing spondylitis and multiple sclerosis.Ankylosing spondylitis can be associated with extra-articular involvement. Besides internal and ocular complications, neurological manifestations such as single root lesions, compression of the myelum or the cauda equina syndrome have also been described. We present a patient with ankylosing spondylitis who developed a monophasic myelopathy resembling multiple sclerosis. literature data show no conclusive evidence for an increased association of ankylosing spondylitis and multiple sclerosis. However, a monophasic myelopathy may be a separate neurological manifestation associated with ankylosing spondylitis.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/93. Double spinal cord injury in a patient with ankylosing spondylitis.Ankylosing spondylitis patients are more prone to spinal fractures and these fractures commonly result in mobile nonunion. We report a patient with a 30-year history of ankylosing spondylitis who sustained double spinal cord injuries following minor trauma. The first injury occurred at the lumbar level due to pseudoarthrosis of an old fracture, and the second at the thoracic level following cardiopulmonary arrest and an episode of hypotension. The possible mechanisms of the injuries are discussed and maintaining normal blood pressure in these patients is emphasized.- - - - - - - - - - ranking = 122.45730716444keywords = fracture (Clic here for more details about this article) |
3/93. Cervical spondylarthrotic myelopathy with early onset in Down's syndrome: five cases and a review of the literature.Progressive walking difficulties and bladder dysfunction may be attributed to alzheimer disease or atlanto-axial subluxation in people with Down's syndrome (DS). The present authors describe five patients with DS suffering from the above symptoms as a result of cervical spondylarthrotic myelopathy. Clinical and radiological data were collected from all patients with DS who underwent surgery for cervical spondylarthrotic myelopathy at the Leiden University Medical Centre during the period between 1991 and 1995. Five patients with DS (four males and one female) were identified. Their mean age at diagnosis was 42 years. The main clinical features were weakness of the arms and legs, ataxic gait, hyperreflexia and bilateral Babinski signs. Radiological examination showed spondylarthrosis, compression of the spinal cord and myelomalacia. The mean delay in diagnosis was 3 years. All five individuals showed clinical stabilization after laminectomy. Cervical spondylarthrotic myelopathy seems a rather frequent disorder in DS, occurring at a relatively young age. early diagnosis may prevent irreversible neurological deficits.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
4/93. Clinics in diagnostic imaging (42). Shepherd's fracture.A 21-year-old woman presented with severe ankle pain during a soccer match. Radiographs showed a Shepherd's fracture of the talus. She responded well to conservative treatment. The imaging anatomy of the posterior talus and os trigonum is reviewed, together with radiological features of osteochondritis dissecans of the talar dome.- - - - - - - - - - ranking = 204.09551194074keywords = fracture (Clic here for more details about this article) |
5/93. Odontoid fracture complicating ankylosing spondylitis.patients with ankylosing spondylitis are prone to fractures. We describe a 32-year-old male patient with an odontoid fracture and anterior dislocation of C1 vertebra relative to C2 complicating ankylosing spondylitis. The importance and difficulties of the rehabilitation program are stressed. The role of magnetic resonance imaging and three-dimensional computerized tomography in diagnosis is emphasized.- - - - - - - - - - ranking = 244.91461432889keywords = fracture (Clic here for more details about this article) |
6/93. Slow ascending myelopathy, tetraplegia, carcinoma of the bladder and amyloidosis in a patient with ankylosing spondylitis.OBJECTIVE: We report a case of slow ascending myelopathy in a patient with ankylosing spondylitis (AS). DESIGN: Case report of a 60-year-old patient suffering from AS, who developed over a period of 39 years a slow ascending myelopathy leading to tetraplegia, squamous cell carcinoma of the bladder and amyloidosis of the small intestine secondary to neuropathic bladder and bowel. SETTING: Department and Outpatient's Department of Neurological rehabilitation Sheba Medical Center, Tel Hashomer, israel. SUBJECT: Single patient case report. Main outcome measure: Clinical follow-up of the patient between the years 1959 - 1998. RESULTS: physical examination disclosed deteriorating incomplete tetraplegia with hypotonia and hyporreflexia. Neurogenic bladder and bowel complicated to squamous cell carcinoma and amyloidosis. CONCLUSION: To our knowledge, flaccid tetraplegia associated with AS, has never been reported in the literature. The possibility of vascular compression by the ankylosed spine causing the clinical picture of flaccid tetraplegia in this patient is discussed.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
7/93. "Bamboo spine" starts to bend--something is wrong.A typical complication of ankylosing spondylitis with an atypical patient history is reported and the topic is discussed. The diagnosis of a spinal fracture may be difficult in a "bamboo spine".- - - - - - - - - - ranking = 40.819102388148keywords = fracture (Clic here for more details about this article) |
8/93. Transverse myelitis in a patient with long-standing ankylosing spondylitis.Ankylosing spondylitis is reported to involve not only the joints but other organs as well. Among these extra-articular involvements, uncommon complications associated with nervous system such as single root lesions, compression of the myelum and cauda equina syndrome have also been documented. Here we present a patient with long-standing ankylosing spondylitis who developed spastic paraparesis. Extensive study to find the cause of a spastic paraparesis failed and therefore led to the conclusion that this patient was suffering from transverse myelitis. Similar reports in the past have been attributed to an association with multiple sclerosis; however, we suggest that the findings support the diagnosis of a rare complication of ankylosing spondylitis with an unknown etiology.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
9/93. Opioids in non-cancer pain: a life-time sentence?There is continuing reluctance to prescribe strong opioids for the management of chronic non-cancer pain due to concerns about side-effects, physical tolerance, withdrawal and addiction. Randomized controlled trials have now provided evidence for the efficacy of opioids against both nociceptive and neuropathic pain. However, there is considerable variability in response rates, possibly depending on the type of pain, the type of opioid and its route of administration, the time to follow-up, compliance and the development of tolerance. Five patients were selected with nociceptive or neuropathic pain in whom other pharmacological or physical therapies had failed to provide satisfactory pain relief. They received transdermal fentanyl (starting dose 25 microg/h) for at least 6 weeks. Transdermal fentanyl dosage was titrated upwards as required. Transdermal fentanyl provided adequate pain relief in patients with nociceptive pain (diabetic ulcer, osteoporotic vertebral fracture, ankylosing spondylitis) or neuropathic pain with a nociceptive component (radicular pain due to disc protrusion, herpetic neuralgia). The duration of treatment ranged from 6 weeks to 6 months for four cases. In the case of ankylosing spondylitis, treatment was carried out for 2 years, stopped and then restarted successfully. There were no withdrawal effects or addictive behaviour on treatment cessation, regardless of duration of the treatment. In conclusion, strong opioids may provide prolonged effective pain relief in selected patients with nociceptive and neuropathic non-cancer pain. Transdermal fentanyl treatment can often be temporary and can easily be stopped following adequate pain relief without withdrawal effects or any evidence of addictive behaviour.- - - - - - - - - - ranking = 40.819102388148keywords = fracture (Clic here for more details about this article) |
10/93. A case of osteomalacia mimicking ankylosing spondylitis.A 39-year-old woman presented with symptoms of pain in the lumbar region and lower extremities. Physical findings included restricted movement of the lumbar spine, sacroiliac joint tenderness, positive Schober's test (10-12.5 cm), and bilaterally positive Mennel and Fabere tests. Although these symptoms and findings were suggestive of ankylosing spondylitis, osteomalacia was diagnosed with the appearance of multiple pseudofractures in her pelvic X-ray and laboratory abnormalities. All her symptoms and signs resolved in 6 months with vitamin d and calcium treatment.- - - - - - - - - - ranking = 40.819102388148keywords = fracture (Clic here for more details about this article) |
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