ABSTRACT
STUDY DESIGN: Case report. BACKGROUND/OBJECTIVE: Myasthenia gravis (MG) complicating spinal cord injury (SCI) is extremely rare. We report a patient with SCI developing MG leading to death. There are no similar articles at present on literature search. CASE REPORT: A 54-year-old man, paralysed at the T12 level (ASIA A) for 40 years, was admitted for surgical repair of his grade IV sacral pressure sore. During the admission he developed diplopia, fluctuating dysphagia and slurred speech. Elevated anti-acetylcholine receptor antibodies and single fibre electromyography confirmed the diagnosis of MG and pyridostigmine was commenced. His admission was complicated by intermittent episodes of unexplained tachycardia and tachypnoea. He succumbed following cardio respiratory within 6 weeks of admission. Post mortem examination was inconclusive of a definite cause of death. In the presence of SCI, it can be challenging to diagnose MG or its complications like myasthenic and cholinergic crisis. CONCLUSION: The case highlights the difficulty in diagnosis and management of MG in persons with SCI.
Subject(s)
Myasthenia Gravis/complications , Spinal Cord Injuries/complications , Fatal Outcome , Humans , Male , Middle AgedABSTRACT
STUDY DESIGN: A combination of review of case notes and outpatient follow-up. OBJECTIVE: To evaluate the effectiveness of the modified Girdlestones-Taylor procedure in patients with spinal cord injury (SCI). SETTING: Princess Royal Spinal Injuries Centre (PRSIC), Northern General Hospital, Sheffield, UK. METHODS: Nine patients with claw toe deformities to 27 toes were treated at the PRSIC from 1996 to 2005. After examination of their medical records, their toes were assessed for pain, residual deformity and stiffness. They were also asked to grade their satisfaction with the surgical outcome. The results were tabulated. RESULTS: The average age of our series of patients was 43.3 years. The mean time from injury to surgery was 20.4 years and the mean time from surgery to last follow-up was 37.3 months. All our patients had good to excellent results, with over 70% of the toes having excellent results. CONCLUSION: The modified Girdlestones-Taylor procedure for claw toe correction appears to be a safe and effective treatment for patients with SCI.
Subject(s)
Hammer Toe Syndrome/etiology , Hammer Toe Syndrome/surgery , Spinal Cord Injuries/complications , Adult , Aged , Female , Hammer Toe Syndrome/physiopathology , Humans , Male , Middle Aged , Spinal Cord Injuries/physiopathology , Tendon Transfer , Treatment OutcomeABSTRACT
OBJECTIVE: To highlight the importance of taking the psychological, social and biological aspects into consideration when dealing with somatic complaints of spinal cord injured patients. SETTING: Supra-regional Spinal Injury Unit in the UK. STUDY DESIGN: Case study series. MATERIAL AND METHODS: The somatic complaints of four patients with spinal cord injury were assessed and their relationship to psychological and social issues were correlated. Two patients suffered unexplained pain, another excessive spasm uncontrolled with intrathecal Baclofen pump and the fourth with several pressure sores, constipation and other physical problems. The impact of psychosocial issues on the somatic complaints were analysed. RESULTS: In all four patients the resolution of their psychosocial issues resulted in significant gains vis-à-vis their somatic complaints. CONCLUSION: Psychological and social issues of spinal injury patients could have a serious impact on the resolution of somatic complaints. It is important to take these into consideration in their treatment.
Subject(s)
Quality of Life , Sick Role , Spinal Cord Injuries/psychology , Spinal Cord Injuries/rehabilitation , Adaptation, Physiological , Adaptation, Psychological , Adult , Aged , Humans , Injury Severity Score , Male , Paraplegia , Prognosis , Psychology , Risk Assessment , Social Adjustment , Spinal Cord Injuries/diagnosisABSTRACT
UNLABELLED: We studied 695 patients with spina bifida over 16 years old. 56 of these are deceased. The cause of death of 30 of these patients could be ascertained from the records kept at the unit. The leading cause of death was renal failure secondary to complications of the renal tract (10 patients). 8 patients died due to cardiac causes and 5 due to respiratory complications. Of the remaining, 3 patients committed suicide and 1 died of malignancy. METHOD: This is a retrospective study from review of index cards. Individual case notes were scrutinised of patients who were deceased.
Subject(s)
Spinal Dysraphism/mortality , Adolescent , Adult , Cause of Death , Humans , Morbidity , Survival AnalysisABSTRACT
Lipoma of the parapharyngeal space is very rare, only three cases having been reported in the literature. A parapharyngeal space lipoma causing obstructive sleep apnoea has not been reported before. A 60-year-old man presented at the ear, nose and throat (ENT) clinic with a history of loud snoring associated with sleep apnoea secondary to a right parapharyngeal space lipoma. The causes of sleep apnoea and the radiological features of a parapharyngeal space lipoma are discussed.