1/20. Spinal subdural hematoma: a rare complication of lumbar puncture. Case report and review of the literature.Spinal subdural hematoma, though rare, is an established complication of lumbar puncture. A young man with persistent back and neck pain after a traumatic lumbar puncture for the diagnosis of lymphocytic meningitis is presented. A diagnosis of spinal subdural hematoma at T2 to T8 levels without significant spinal cord compression was confirmed by magnetic resonance imaging. Symptoms resolved after one month of analgesics and muscle relaxants.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/20. Horner's syndrome and dissection of the internal carotid artery after chiropractic manipulation of the neck.PURPOSE: To report a case of Horner's syndrome and dissection of the internal carotid artery after chiropractic manipulation of the neck. methods: Case report. A 44-year-old woman with no prior ocular or vascular history presented with severe right-sided head and neck pain, ptosis, and miosis following chiropractic treatment for a strained right shoulder muscle. RESULTS: magnetic resonance angiography of the neck and brain revealed a dissection of the right internal carotid artery as well as a suggestion of subtle dissection in the right vertebral artery. No significant brain abnormalities were noted on magnetic resonance imaging. Pharmacological testing was consistent with preganglionic oculosympathetic damage. CONCLUSION: Acute, painful Horner's syndrome as a manifestation of vascular dissection may be associated with chiropractic manipulation of the neck.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
3/20. ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy.OBJECTIVE: To determine feasibility of ultrasonography in detecting the normal accessory nerve as well as pathologic changes in cases of accessory nerve palsy. methods: Four patients with accessory nerve palsy were investigated by ultrasonography. Three cases of accessory nerve palsy after lymph node biopsy and neck dissection were primarily diagnosed on the basis of ultrasonography using a 5- to 12-MHz linear transducer. In addition, we performed ultrasonography in 3 cadaveric specimens to show the feasibility of detecting the accessory nerve. RESULT: Nerve transection (n = 2), scar tissue (n = 1), and atrophy of the trapezius muscle (n = 4) were confirmed by electroneurographic testing and surgical nerve inspection. In 1 case in which a patient had a whiplash injury with accessory nerve palsy, ultrasonography showed atrophy of the trapezius muscle with a normal nerve appearance. CONCLUSIONS: ultrasonography allows visualization of the normal accessory nerve as well as changes after accessory nerve palsy.- - - - - - - - - - ranking = 2keywords = muscle (Clic here for more details about this article) |
4/20. Ankylosing spondylitis manifested by spontaneous anterior atlantoaxial subluxation.The onset of ankylosing spondylitis is usually characterized by lower back pain and stiffness in young adults; early diagnosis is not easy, but the disease is generally identified within a few years of onset. Anterior atlantoaxial subluxation may occur in the late stage of ankylosing spondylitis, but early spontaneous subluxation is rarely seen. We present a case of ankylosing spondylitis with an initial symptom of neck pain, rather than lower back pain, due to spontaneous anterior atlantoaxial subluxation. After medical and surgical intervention, except for limited range of motion, the patient experienced neither neck pain nor weakness of his left limbs during the next 8 mo of follow-up.- - - - - - - - - - ranking = 0.075643358924494keywords = limb (Clic here for more details about this article) |
5/20. Chronic spontaneous spinal epidural hematoma -- a rare cause of cervical myelopathy.Spontaneous spinal epidural hematoma (SSEH) is a rare entity. SSEH occurring anterior to the spinal cord in the cervical region with spontaneous improvement is even more rare. One such rare case is reported. A 19-year-old male presented with a 2-month history of neck pain and weakness of the upper and lower limbs without sensory deficit. magnetic resonance imaging (MRI) showed features of anteriorly located cervical epidural hematoma. As the patient had started improving by the time he sought neurosurgical consultation, he was treated conservatively, and he improved over a period of 2 months. This case illustrates that, though rare, chronic spontaneous spinal epidural hematoma should be entertained in the differential diagnosis of cervical cord compression. Spontaneous resolution of spinal epidural hematomas is known to occur, and in properly selected cases, surgical intervention may not always be necessary.- - - - - - - - - - ranking = 0.075643358924494keywords = limb (Clic here for more details about this article) |
6/20. Vectored upper cervical manipulation for chronic sleep bruxism, headache, and cervical spine pain in a child.OBJECTIVE: To discuss the management of chronic sleep bruxism in a 6-year old girl. Clinical features The patient had morning headaches and cervical spine pain. Due to abnormal tooth wear, bruxism had been previously diagnosed and was verified by observation during sleep. She also had abnormal postural and palpatory findings, indicating upper cervical joint dysfunction. Intervention and outcome Bilateral rotary cervical stretching/mobilization and a vectored high-velocity, low-amplitude adjustment were performed in the upper cervical spine, using the atlas transverse process as the contact point. There was complete relief of the chronic subjective symptoms concomitant with remission of the objective signs of joint dysfunction. CONCLUSIONS: Cervical, particularly upper cervical, spine muscle-joint dysfunction should be considered as a potential etiology in chronic childhood sleep bruxism.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
7/20. Severe coronary artery disease presenting with a chief complaint of cervical pain.We present the case of a 49-yr-old man with cervical pain of 14 wk of duration. physical examination and magnetic resonance imaging of the cervical spine demonstrated no neurologic abnormality or corroborative pathology. cardiac catheterization demonstrated advanced multivessel disease. The patient underwent successful coronary bypass grafting and was symptom free 12 mo later. spine practitioners are often consulted by the medical community to determine if a patient's limb or chest complaints might be caused by a spinal pain generator. This atypical case reminds us of the overlap between cardiac and cervical symptom referral. A patient with critical cardiac ischemia can present with predominant cervical complaints.- - - - - - - - - - ranking = 0.075643358924494keywords = limb (Clic here for more details about this article) |
8/20. Extramedullary sarcoid lesion mimicking intraspinal tumor.BACKGROUND CONTEXT: Spinal sarcoidosis is rare. Most spinal sarcoid lesions are intramedullary, and only three cases of extramedullary sarcoid lesions have been reported. PURPOSE: To describe a case of an extramedullary sarcoid lesion in a patient that did not have systemic involvement and to review the literature of spinal sarcoidosis. STUDY DESIGN/SETTING: Case report and review of the literature. PATIENT SAMPLE: Case report. OUTCOME MEASURES: Report of resolution of symptoms. methods/DESCRIPTION:The patient was a 33-year-old woman who had neck pain and pain radiating to the right scapula area and down the right arm into her hand and wrist. She also complained of numbness, tingling, muscle spasms and tremors, and had difficulty with writing. magnetic resonance imaging showed a mass that was extramedullary in the right lateral aspect of the spinal canal at the level of C5 and extending into the right C5-6 neuroforamen. Admitting diagnosis of neurofibroma was made. The patient underwent C4, C5 and C6 laminoplasty and gross total resection of an intradural extramedullary tumor. The lesion encroached on the neuroforamen on the right side involving the C6 nerve root, was grossly adherent to some of the rootlets and looked like a Schwannoma. Gross total resection of the tumor was performed. Pathological examination of the specimen showed a noncaseating granulomatosis consistent with sarcoid. Postoperative testing did not reveal systemic involvement of sarcoidosis. The patient was treated with corticosteroids. RESULTS: The patient made a satisfactory recovery, returned to work full-time, and had no complaints of neurological symptoms. CONCLUSIONS: An extramedullary sarcoid lesion is rare. Unlike intramedullary sarcoid lesions, it can be totally removed. If no systemic sarcoidosis is present, the patient can have a satisfactory recovery.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
9/20. Unilateral compression neuropathy of the hypoglossal nerve due to head suspension orthosis in mitochondriopathy.An 85-year-old woman with multisystem mitochondriopathy experienced tension headache, cervical pain, torque head-posture, and vertigo since 1980 for which she was continuously wearing a head-suspension-orthosis- since 1990. Since 1996 she developed severe left-sided weakness and wasting of the tongue. Needle-EMG of the left genioglossus muscle revealed abnormal spontaneous activity and reduced interference-pattern. No morphological alterations in the anatomical course of the hypoglossal nerve were found. Severe, unilateral weakness and wasting of the tongue was interpreted due to chronic compression of the hypoglossal nerve by long-standing use of a head-suspension-orthosis for cervical pain from cervical muscle weakness and resulting spinal degeneration.- - - - - - - - - - ranking = 2keywords = muscle (Clic here for more details about this article) |
10/20. A clinical and pharmacologic review of skeletal muscle relaxants for musculoskeletal conditions.Muscle strains and other musculoskeletal disorders (MSDs) are a leading cause of work absenteeism. Muscle pain, spasm, swelling, and inflammation are symptomatic of strains. The precise relationship between musculoskeletal pain and spasm is not well understood. The dictum that pain induces spasm, which causes more pain, is not substantiated by critical analysis. The painful muscle may not show EMG activity, and when there is, the timing and intensity often do not correlate with the pain. Clinical and physiologic studies show that pain tends to inhibit rather than facilitate reflex contractile activity. The decision to treat and choice of therapy are largely dictated by the duration, severity of symptoms, and degree of dysfunction. Trigger point injections are sometimes used with excellent results in the treatment of muscle spasm in myofacial pain and low-back pain. NSAIDs are used with much greater frequency than oral skeletal muscle relaxants (SMRs) or opioids in the treatment of acute MSDs. Unfortunately, remarkably little sound science guides the choice of drug for the treatment of acute, uncomplicated MSDs, and the evaluation of efficacy of one agent over another is complicated by numerous factors. Only a limited number of high-quality, randomized, controlled trials (RCTs) provide evidence of the effectiveness of NSAIDs or SMRs in the treatment of acute, uncomplicated MSDs. The quality of design, execution, and reporting of trials for the treatment of MSDs needs to be improved. The combination of an SMR and an NSAID or COX-2 inhibitor or the combination of SMR and tramadol/acetaminophen is superior to single agents alone.- - - - - - - - - - ranking = 7keywords = muscle (Clic here for more details about this article) |
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