Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C1762617 (weakness)
 37,932 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of a 65 year old Malay lady with long-standing diabetes mellitus, who presented to our institution with a one month history of worsening neck pain and progressive upper and lower limb weakness. She was stable despite severe hyponatraemia which was initially treated as syndrome of inappropriate anti-diuretic hormone (SIADH). This was consistent with her underlying illness which was concluded as cervical tuberculosis (TB) with spinal cord compression. She underwent decompression and bone grafting. Despite continuous treatment her serum sodium levels remained low. There were no other problems with her adrenals or thyroid. A water loading and hypertonic saline perfusion test was performed and supported the diagnosis of reset osmostat. Her serum sodium remained below the normal range and she was discharged well.
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PMID:A case of persistent hyponatraemia due to reset osmostat. 1762 70

A 39-year-old African American man with no significant past medical history presented to our hospital with right hand weakness and pain in both arms. He had no fever, neck pain, headache, dizziness, vision changes, or weakness in his lower extremities. Magnetic resonance imaging of the cervical spine showed extensive abnormal enhancement of the C7-T1 vertebral bodies as well as the prevertebral and epidural spaces. Open biopsy of the lesion showed inflammatory changes consistent with osteomyelitis. Culture of the biopsy specimen grew Group B Streptococcus (GBS). HIV ELISA and blood cultures were negative. The patient was treated with intravenous vancomycin for 6 weeks with complete resolution of symptoms. GBS classically affects newborns and pregnant females. However, the incidence of infection from this pathogen in nonpregnant adults is increasing. Vertebral osteomyelitis due to GBS in nonpregnant adults is exceedingly rare. To our knowledge, this is the first reported case of GBS cervical vertebral osteomyelitis in an adult without risk factors for invasive GBS infection. This case illustrates that GBS should be included in the differential diagnosis of pyogenic vertebral osteomyelitis, irrespective of immune status and predisposing factors.
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PMID:Vertebral osteomyelitis in a healthy young adult. 1764 54

Pigmented villonodular synovitis (PVNS) is a proliferative disorder of the synovium with a predisposition for the appendicular skeleton. Rarely PVNS can arise from the spine, where this disorder usually presents with localized or radicular pain secondary to involvement of the posterior elements. The authors report the case of an 82-year-old woman who presented with long-standing neck pain and acute upper-extremity numbness and weakness. Computed tomography imaging revealed a mixed sclerotic and lucent lesion affecting the dens and right lateral mass of C-2. There was also a pathological fracture at the base of the dens with 8 mm of anterior dens displacement. Magnetic resonance imaging demonstrated a diffusely infiltrative process that was nonenhancing. Because of instability, the patient underwent transarticular screw fixation, and a biopsy of the lesion was also performed at this time. Histopathological analysis was consistent with a diagnosis of PVNS. To the authors' knowledge, this is the first report of PVNS involving the C-2 vertebra or causing a pathological fracture.
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PMID:Pigmented villonodular synovitis associated with pathological fracture of the odontoid and atlantoaxial instability. Case report and review of the literature. 1768 68

Thoracic outlet syndrome (TOS) is a nonspecific label. When employing it, one should define the type of TOS as arterial TOS, venous TOS, or neurogenic TOS. Each type has different symptoms and physical findings by which the three types can easily be identified. Neurogenic TOS (NTOS) is by far the most common, comprising well over 90% of all TOS patients. Arterial TOS is the least common accounting for no more than 1%. Many patients are erroneously diagnosed as "vascular" TOS, a nonspecific misnomer, whereas they really have NTOS. The Adson Test of noting a radial pulse deficit in provocative positions has been shown to be of no clinical value and should not be relied upon to make the diagnosis of any of the three types. The test is normal in most patients with NTOS and at the same time can be positive in many control volunteers. Arterial TOS is caused by emboli arising from subclavian artery stenosis or aneurysms. Symptoms are those of arterial ischemia and x-rays almost always disclose a cervical rib or anomalous first rib. Venous TOS presents with arm swelling, cyanosis, and pain due to subclavian vein obstruction, with or without thrombosis. Neurogenic TOS is due to brachial plexus compression usually from scarred scalene muscles secondary to neck trauma, whiplash injuries being the most common. Symptoms include extremity paresthesia, pain, and weakness as well as neck pain and occipital headache. Physical exam is most important and includes several provocative maneuvers including neck rotation and head tilting, which elicit symptoms in the contralateral extremity; the upper limb tension test, which is comparable to straight leg raising; and abducting the arms to 90 degrees in external rotation, which usually brings on symptoms within 60 seconds.
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PMID:Diagnosis of thoracic outlet syndrome. 1782 54

The authors describe a case of osteomyelitis of the craniocervical junction caused by iatrogenic infection of the spine during corticosteroid injection therapy. This 58-year-old diabetic man presented with acute exacerbation of neck pain that had began 4 months prior to admission. He did not experience the associated fever, chills, or sweats, but he did notice transient weakness in the right upper extremity. A computed tomography (CT) scan of the cervical spine demonstrated a destructive process involving the odontoid and the left occipitocervical and atlantoaxial joints that was not present on a CT obtained 2 months earlier, just before trigger-point and left-sided C1-2 facet joint corticosteroid injections. A diagnosis of staphylococcal osteomyelitis was made, and initial treatment with external immobilization and appropriate antibiotic therapy failed to control radiographically demonstrated and clinical progression. The patient was successfully treated using staged anterior decompression and posterior instrumented fusion with prolonged antibiotic therapy. To the authors' knowledge this case is the first reported instance of iatrogenic pyogenic osteomyelitis of the craniocervical junction successfully treated with anterior decompression and delayed posterior arthrodesis.
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PMID:Iatrogenic pyogenic osteomyelitis of C-1 and C-2 treated with transoral decompression and delayed posterior occipitocervical arthrodesis. Case report. 1807 94

We reviewed 36 patients with endodermal cysts occurring at the craniocervical junction. They were aged between 3 and 66 years. Headache, motor weakness, and neck pain were commonly observed symptoms. Radiographically, T1-weighted magnetic resonance imaging of the tumours demonstrated a hypointense, isointense, or hyperintense signal according to the cystic content. In most cases, the cyst walls did not enhance after gadolinium administration. Histologically, the cysts were found to be lined by a single layer of epithelium. Histochemical and immunohistochemical studies showed that almost all were reactive to periodic acid schiff stain, epithelial membrane antigen, and carcino-embryonic antigen, but negative to glial fibrillary acidic protein. Mainly, the suboccipital approach with or without a laminectomy, or the trans-oral approach were selected for surgical excision of these tumours. In 17 of the 36 patients, total or gross total resections were performed, and subtotal resections were achieved in sixteen. Three patients developed recurrences.
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PMID:Endodermal cyst of the cranio-cervical junction. 1821 42

A 73-year-old woman suffered from neck pain, progressive m tor weakness and sensory disturbance in all extremities. Neuroradiological studies revealed a retro-odontoid mass with posterior compression of the upper cervical spinal cord. Decompression of the mass was performed via a postero-lateral transdural approach, and the patient exhibited marked improvement of the symptoms. Histological examination revealed that the mass was composed of degenerative cartilaginous tissue, consistent with disc material, but the lesion was not neoplastic. Retro-odontoid disc herniation causing cervical myelopathy is very rare. We primarily discuss the surgical management of retro-odontoid disc herniation.
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PMID:[Retro-odontoid disc herniation extracted using the posterior-lateral transdural approach: case report]. 1823 22

Chondromyxoid fibroma is a rare benign bone tumor representing less than 0.5% of all bone tumors. It commonly involves the long tubular bones. Involvement of the spine is rare. A 35-year-old man presented with history of neck pain, restriction of neck movements, pain and numbness along the medial aspect of the left forearm and weakness with wasting of the left hand. A presumptive diagnosis of a bony tumor such as an aneurysmal bone cyst or a giant cell tumor involving the seventh vertebral body was made on plain X-rays, MRI and bone scan. He underwent C7 central corpectomy, incomplete intralesional curettage with iliac bone grafting and C6 to T1 interspinous wiring. The histological diagnosis was chondromyxoid fibroma. On eight years' follow-up, CT scan showed no progression of the tumor with good alignment and fusion of the graft at the site of the corpectomy. The authors conclude that corpectomy and iliac bone grafting for chondromyxoid fibroma has a good outcome on long-term follow-up.
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PMID:Chondromyxoid fibroma of the seventh cervical vertebra. 1831 Aug 48

We report the case of a 40-year-old woman suffering from neck pain due to mild cervical spine injury. During conventional faceted infiltration therapy with crystalline steroids, the patient developed weakness in both arms and paresthesia of the left arm. While the weakness resolved within a few seconds, a mild deficit in motor coordination and paresthesia of the left arm were still present after 2 months. T2-weighted magnetic resonance imaging of the cervical spine depicted a small hyperintense lesion at the C6 level most likely reflecting embolic infarction due to injection of crystalline steroids into a myelon-feeding artery, which has of late repeatedly been reported. We discuss potential pathomechanisms of this very rare complication and give a review of the literature.
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PMID:[Acute spinal cord ischemia following deep injection therapy of the neck]. 1839 2

A 40-year-old man was admitted to our department, because of sudden onset of dysphagia, hoarseness, left neck pain and headache. There were no skin lesions. On neurological examination, there were paralysis of the left soft palate and constrictor muscles of the pharynx, weakness of the left sternocleidomastoid and left upper trapezius. In cerebrospinal fluid (CSF) examination, cell count and protein concentration were elevated. Antibody titer to varicella zoster virus (VZV) was elevated in both the serum and CSF. And VZV-DNA was detected by PCR from CSF. Gd enhanced MRI showed the nodular lesion at the left jugular foramen. The diagnosis of Vernet's syndrome (VS) associated with VZV infection was made. The patient's symptoms were immediately improved with 30 mg of prednisone and 3 g of varaciclovir daily for 14 days. Only a few cases of VS due to VZV have been reported previously. Our case is the first case that detected VZV-DNA in CSF by PCR.
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PMID:A case of Vernet syndrome with varicella zoster virus infection. 1845 82


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