Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Arthritis, Psoriatic/drug therapy , Colitis/chemically induced , Ileitis/chemically induced , Vasculitis, Leukocytoclastic, Cutaneous/chemically induced , C-Reactive Protein/analysis , Colitis/diagnostic imaging , Diarrhea/chemically induced , Female , Humans , IgA Vasculitis/chemically induced , Ileitis/diagnostic imaging , Middle Aged , Necrosis , Skin/pathology , Tomography, X-Ray Computed , Vasculitis, Leukocytoclastic, Cutaneous/diagnosisABSTRACT
Radionuclide bone scanning was proven effective many years ago. Its main advantages are good sensitivity, limited radiation exposure, and noninvasiveness. However, increased radionuclide uptake by a lesion is not specific, and differentiating malignant from nonmalignant disorders may therefore be difficult. An additional structural imaging study is often needed to establish the final diagnosis. Furthermore, the limited resolution of radionuclide bone scanning images does not allow accurate localization of the lesions. Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) provides both structural and functional information. SPECT/CT has been proven useful for interpreting radionuclide bone scan results in patients with bone malignancies, showing far better specificity than planar imaging or SPECT alone, most notably in the evaluation of spinal abnormalities. SPECT/CT provides an accurate evaluation of the site of the lesions and also supplies other information that can be useful in nonmalignant conditions such as injuries, infections, and degenerative disease. Nevertheless, there are only a few published studies on the usefulness of SPECT/CT in nonmalignant conditions. However, SPECT/CT is only starting to become available and may become a routine investigation for a number of rheumatic disorders.
Subject(s)
Bone Diseases/diagnostic imaging , Tomography, Emission-Computed, Single-Photon/methods , Tomography, X-Ray Computed/methods , Aged , Bone Neoplasms/diagnostic imaging , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Neoplasm Metastasis/diagnostic imaging , Osteoarthritis/diagnostic imaging , RadioisotopesABSTRACT
Tonic dystonia is an underrecognized complication of reflex sympathetic dystrophy syndrome (RSDS) characterized by an increase in muscle tone at the site of injury. Case-reports.- We describe five cases of tonic dystonia complicating RSDS of the lower extremity. There were four women and one man, with a mean age of 52 years. In addition to the typical features of RSDS, the patients had fixed equinovarus of the foot with hyperextension or hyperflexion of the great toe. In two patients, examination after spinal anesthesia showed that the deformity was reducible. Spontaneous resolution of the dystonia occurred in one patient. Another patient failed to experience meaningful improvement after a motor block followed by botulinic toxin injections. In two patients, the same treatment was followed by a slight improvement. Treatment options are still being evaluated in the last patient. Discussion.- Tonic dystonia is an underrecognized complication of RSDS that often develops after a minor injury yet causes prolonged pain and disability. Spread of the dystonia to other sites is not infrequent. The underlying mechanisms remain unclear but may involve dysfunction of the central or peripheral nervous system or psychogenic factors. Suggested treatments include motor block, intrathecal baclofen, sympathetic block, and sympathectomy. However, none of these treatments has been proved effective. Conclusion.- The five cases described here provide useful information on RSDS-associated tonic dystonia, a condition that runs a protracted course and remains difficult to manage.
