Cases reported "Radiculopathy"

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1/10. Use of cervical spine manipulation under anesthesia for management of cervical disk herniation, cervical radiculopathy, and associated cervicogenic headache syndrome.

    OBJECTIVE: To demonstrate the benefits of cervical spine manipulation with the patient under anesthesia as an approach to treating a patient with chronic cervical disk herniation, associated cervical radiculopathy, and cervicogenic headache syndrome. CLINICAL FEATURES: The patient had neck pain with radiating paresthesia into the right upper extremity and incapacitating headaches and had no response to 6 months of conservative therapy. Treatment included spinal manipulative therapy, physical therapy, anti-inflammatory medication, and acupuncture. magnetic resonance imaging, electromyography, and somatosensory evoked potential examination all revealed positive diagnostic findings. INTERVENTION AND OUTCOME: Treatment included 3 successive days of cervical spine manipulation with the patient under anesthesia. The patient had immediate relief after the first procedure. Her neck and arm pain were reported to be 50% better after the first trial, and her headaches were better by 80% after the third trial. Four months after the last procedure the patient reported a 95% improvement in her overall condition. CONCLUSION: Cervical spine manipulation with the patient under anesthesia has a place in the chiropractic arena. It is a useful tool for treating chronic discopathic disease complicated by cervical radiculopathy and cervicogenic headache syndrome. The beneficial results of this procedure are contingent on careful patient selection and proper training of qualified chiropractic physicians.
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2/10. Dural puncture and corticotherapy as risks factors for cerebral venous sinus thrombosis.

    Dural puncture with corticosteroid could be a predisposing factor for cerebral venous thrombosis (CVT). A 35-year-old woman using oral contraception was treated with corticosteroid epidural infiltration for L5 radiculalgia. The following day a postural headache developed and accidental dural puncture was suspected. Four days later, she presented with fever and consciousness impairment requiring mechanical ventilation. magnetic resonance angiography (MRA) confirmed thrombosis of the superior sagittal sinus. Recanalization was observed three weeks later and the patient fully recovered. blood tests for thrombophilia showed a moderate decrease in the C protein level (chronometric activity 44%, N = 65-130). CVT has been reported after spinal anaesthesia or peridural anaesthesia with accidental puncture. After dural puncture the decrease of cerebrospinal fluid pressure induces a rostrocaudal sagging effect with traumatic damage to the fragile venous endothelial wall, and may trigger a venous vasodilatation with resultant stasis. CVT has also been described in patients after lumbar puncture and oral corticoid treatment for multiple sclerosis and after corticosteroid intrathecal infiltration. Therefore, corticosteroids can be considered as a potential additional procoagulant stimuli.
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3/10. L5 radicular pain related to a cystic lesion of the posterior longitudinal ligament.

    A 35-year-old man with a long history of left L5 radicular pain was found to have an intraspinal cystic lesion causing radicular compression. magnetic resonance imaging demonstrated a round lesion situated in the anterior epidural space, with uniform high signal intensity on T2-weighted sequences characteristic of a cystic lesion. During surgery a liquid-containing cyst originating from the posterior longitudinal ligament was punctured and resected. The histologic aspect was that of a ganglion cyst without synovial layers. The radiologic differential diagnoses are discussed.
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4/10. electroacupuncture direct to spinal nerves as an alternative to selective spinal nerve block in patients with radicular sciatica--a cohort study.

    We applied electroacupuncture to the spinal nerve root by inserting needles under x ray imaging in three cases with radicular sciatica, as a non-pharmacological substitute for lumbar spinal nerve block. In all three cases, symptoms were markedly reduced immediately after electroacupuncture to the spinal nerve root. The sustained effect was noticeably longer than that of spinal nerve blocks previously performed, in two out of the three cases. We suggest that descending inhibitory control, inhibitory control at the spinal level, inhibition of potential activity by hyperpolarisation of nerve endings, or changes in nerve blood flow may be involved in the mechanism of the effect of electroacupuncture to the spinal nerve root. These results suggest that electroacupuncture to the spinal nerve root may be superior to lumbar spinal nerve block when it is applied appropriately in certain cases of radicular sciatica, taking into consideration patient age, severity of symptoms and duration of the disorder.
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5/10. An injection from the past: fluoroscopic evidence of remote injections of radiopaque substances.

    OBJECTIVE: Although uncommon, residual effects from contrast agents used more than 2 decades ago are possible. This case report is to alert clinicians to the implications of residual oil-based ionic contrast agents in the intrathecal space. CASE REPORT: A 70-year-old female with evidence of degenerative disc disease underwent a series of lumbar epidural steroid injections. fluoroscopy during the procedure revealed diffuse residual intrathecal iophendylate (Pantopaque) dye. We were able to demonstrate unrestricted epidural spread of 1 mL iohexol (Omnipaque 180) alongside the preexisting dye. CONCLUSIONS: The goal of this case report is to highlight the potential of residual myelographic dye to complicate interventional procedures. Such residual dye can increase the level of difficulty in performing interventional pain treatments and perhaps the rate of complications associated with epidural injections, such as dural puncture. The presence of large amounts of residual oil-based intrathecal dye can lead to erroneous interpretations of the dye patterns as intraspinal lipoma or hemorrhage. As a consequence, the patient can be submitted to unnecessary diagnostic and therapeutic interventions. In addition, concerns of worsening oil-based dye-induced arachnoiditis with the use of epidural steroid injections can complicate the treatment of patients with back pain.
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6/10. Capillary hemangioma of the cauda equina presenting with radiculopathy and papilledema.

    A 42-year-old, non-obese man with a three-month history of headache, pulsatile tinnitus, transient visual obscurations, and scintillations later developed low back pain with right lower extremity radiation. brain MRI and magnetic resonance venography were normal, but spine MRI revealed a mass in the cauda equina. Neuro-ophthalmologic examination disclosed bilateral optic disc edema with normal visual function. During spine surgery, cerebrospinal fluid, released under high pressure despite prior hyperventilation, contained a glucose level of 51 mg/dl and a protein level of 1840 mg/dl. Histologic and immunohistochemical features of the lesion were compatible with a capillary hemangioma. Although spinal cord tumors have been associated with papilledema, this is the first report of a capillary hemangioma of the cauda equina in this context. If papilledema is present, spinal cord imaging should be performed when lumbar puncture discloses unexplained protein elevation and in cases that lack clinical features typical of idiopathic intracranial hypertension.
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7/10. Facial palsy in lymphocytic meningoradiculitis (Bannwarth's syndrome).

    Four patients had unilateral or bilateral facial palsy associated with lymphocytic meningoradiculitis (Bannwarth's syndrome). diagnosis depends on a lumbar puncture, and if the characteristic CSF changes, ie, pleocytosis and elevated protein level, are found, more comprehensive investigations can be restricted in view of the favorable prognosis.
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8/10. intracranial hypertension and hiv associated meningoradiculitis.

    Two patients with meningoradiculitis associated with hiv presented with symptoms and signs of intracranial hypertension. In the patients described, the raised intracranial pressure resolved after lumbar puncture. After exclusion of opportunistic infection, such patients may be managed with therapeutic lumbar puncture alone.
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ranking = 2
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9/10. Transient paralysis associated with epidural steroid injection.

    Epidural steroid therapy is a commonly applied "conservative" therapy, but it is not inherently benign. Although arachnoiditis, infection, and meningitis have been reported, acute paraplegia has not been reported as a complication of either caudal or spinal epidural steroid injection. A unique case of transient, profound paralysis after epidural steroid injection is reported here. The procedure was carried out without fluoroscopic control and was complicated by a puncture of the thecal sack. Radiographic studies demonstrated a focal, space-occupying lesion in the spinal canal at the level corresponding to the neurologic deficit, which spontaneously resolved over the next 2-3 h. Surgical decompression was initially considered and then deferred in favor of observation. The patient recovered motor, sensory, and bowel and bladder function over the next 48 h. The period of recovery was consistent with an acute but brief compressive injury and inconsistent with an anesthetic effect. Radiographic studies suggest three possible explanations: (a) inadvertent thecal penetration during injection may have produced an atypical anesthetic block; (b) loculation of the injected fluid may have caused a transient compressive lesion; or (c) intrathecal injection may have produced an iatrogenic arachnoid cyst. Although pathologic confirmation of the cause was not possible, the potential for this alarming complication should be recognized by physicians prescribing epidural steroid therapy. We do not suggest that epidural steroid therapy is the treatment of choice for patients with multiple back operations or that it is efficacious for these patients. Our purpose is to alert surgeons and therapists to a rare but potentially devastating complication and to provide our experience in treating it.
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10/10. Ballroom dancing and cervical radiculopathy: a case report.

    Dance injuries associated with cervical radiculopathy have not been described in the literature. This report describes the case of an international-style ballroom dancer who developed a cervical radiculopathy as a result of frequent lateral rotation and hyperextension of the cervical spine during dancing. The patient's symptoms and signs suggestive of a left C7 radiculopathy were confirmed and documented by both magnetic resonance imaging and electrodiagnostic testing. The patient was treated conservatively with activity modification, nonsteroidal anti-inflammatory drugs, and alternative medicine approaches, including herbs and acupuncture. Her neck pain and cervical radicular symptoms declined in severity, but continued even 4 1/2 months after the onset of her symptoms. She did not wish to try steroids either through an oral or epidural route and refused surgical intervention. This case report illustrates an unconventional manner in which a left cervical radiculopathy was clinically produced. The neck motions and positions of frequent hyperextension and lateral rotation demonstrated by this ballroom dancer simulated a pattern and sequence of movements that promoted the development of signs and symptoms of a left cervical radiculopathy.
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