Focal dystonia in musicians.

In conclusion, musicians' focal dystonia is a significant and potentially career-ending neurological condition of which physiatrists and other performing arts medicine clinicians should be aware. Pathology has been identified in the somatosensory cortex, and in the motor cortex and basal ganglia. Although advances have been made in the elucidating some of the pathologic changes in focal dystonia, better understanding is needed. Current treatments such as retraining, splinting, oral medications, and botulinum toxin injections are limited. Therefore, the ultimate goal for focal dystonia is to prevent this disabling disorder of instrumental musicians.

Vertebral augmentation complicated by perioperative addisonian crisis.

BACKGROUND: We describe a case of perioperative Addisonian crisis induced by vertebral augmentation. While several complications of vertebral augmentation have been reported previously, related to the technical procedure, to our knowledge, perioperative Addisonian crisis from vertebral augmentation has not been reported in the literature. OBJECTIVE: To report an Addisonian crisis perioperative to vertebral augmentation. DESIGN: Case report. METHOD: Retrospective case review. RESULTS: The patient had a history of adrenal insufficiency treated previously with steroids. He developed an L3 vertebral compression fracture, failed conservative therapy and was eventually referred for vertebral augmentation. Immediately after starting the procedure, the patient developed profound hypotension unresponsive to intravenous fluids and vasopressors, consistent with Addisonian crisis. After intravenous steroids had resolved the Addisonian crisis, he underwent vertebral augmentation without further complication. CONCLUSION: Addisonian crisis may be triggered by vertebral augmentation. Practitioners need to recognize immediately this potentially lethal disorder in patients with known or suspected adrenal insufficiency and treat with intravenous hydrocortisone.