ABSTRACT
Imaging of the lumbar spine is the most common application of magnetic resonance (MR) imaging in many radiologic practices. MR imaging has replaced computed tomography (CT) and CT myelography as the primary mode of spinal imaging and has relegated myelography to a secondary role in the evaluation of lumbar spinal disorders. At the same time, however, it has become evident that the correlation between gross anatomic findings as depicted on MR images and the clinical signs and symptoms detected by the clinician may be lacking. Defining the precise anatomic source of patients' complaints on the basis of imaging studies must be approached judiciously because a significant proportion of the population has disc disease as depicted on imaging studies, yet many have no clinical findings.
Subject(s)
Intervertebral Disc Displacement/diagnosis , Intervertebral Disc Displacement/therapy , Intervertebral Disc/pathology , Lumbar Vertebrae , Spinal Diseases/diagnosis , Spinal Diseases/therapy , Disease Progression , Diskectomy , Humans , Magnetic Resonance Imaging , Nerve Block , Prevalence , Terminology as Topic , Tomography, X-Ray ComputedABSTRACT
A case is reported that demonstrates the impact of psychological variables on a patient's reaction to stressful medical procedures. The evaluation and management of psychological variables that might have an effect on treatment outcome is discussed.
Subject(s)
Stress, Psychological , Surgical Procedures, Operative/psychology , Female , Humans , Middle Aged , Physician-Patient Relations , Treatment OutcomeABSTRACT
Vertebrobasilar infarction is a well documented complication of cervical manipulation. A commonly proposed pathogenesis is an intimal tear of the vertebral artery leading to cerebellar and other posterior fossa lesions. However, there have been no cases of thalamic infarct reported. This case demonstrates a thalamic infarction concurrent with brainstem and cerebellar infarction secondary to cervical manipulation and intimal tearing of the vertebral artery. Immediately following manipulation, the patient developed nystagmus, quadriparesis, and a speech deficit. After an aggressive course of in-patient rehabilitation, the patient progressed to a community ambulator with deficits in speech and perception. This case demonstrates one of the inherent risks associated with repetitive forceful cervical manipulation.
Subject(s)
Cerebral Infarction/etiology , Manipulation, Orthopedic/adverse effects , Thalamic Diseases/etiology , Adult , Cerebral Infarction/diagnosis , Female , Humans , Magnetic Resonance Imaging , Thalamic Diseases/diagnosis , Tomography, X-Ray Computed , Vertebral Artery/diagnostic imagingABSTRACT
The physiatrist frequently encounters gait abnormalities in his daily practice. Commonly, there is an obvious organic basis for the disturbance. However, on rare occasions, the gait abnormality is the consequence of a functional conversion reaction. This represents both a diagnostic and therapeutic dilemma, in extreme cases leading to unnecessary diagnostic tests and their associated complications and costs. Early suspicion and knowledge of functional gait disorders may expedite the correct diagnosis and the institution of appropriate therapy, shortening hospital stay and eliminating unnecessary procedures. This case study reviews two patients with unique gait disturbances-astasia abasia and camptocormia. Astasia abasia is the inability to stand or walk in the absence of other neurologic abnormalities. Camptocormia is characterized by exaggerated trunk flexion of functional etiology. Both patients demonstrated rapid resolution of symptoms after psychiatric intervention.
