A Proposed Treatment Algorithm for Low Back Pain Secondary to Bertolotti's Syndrome.

BACKGROUND: Chronic low back pain is widely prevalent, and there are a range of conditions that may result in the low back pain. In general, treatment of low back pain starts with conservative management such as medications, physical therapy, and home exercise regimens. If conservative measures fail, a range of interventional techniques can be employed to manage back pain. An uncommonly recognized cause of back pain is Bertolotti's syndrome which is a result of back pain due to lumbosacral transitional vertebrae (LSTV). LSTV is a congenital abnormality either characterized by the lumbarization of the sacrum where the first sacral bone fails to fuse with the rest of the sacrum or the sacralization of the lumbar spine where the L5 vertebra fuses with the sacrum creating a longer sacrum. In many cases, the condition can be recognized by imaging techniques such as an x-ray, computed tomography, or magnetic resonance imaging. OBJECTIVES: To propose a treatment algorithm for patients with low back pain secondary to Bertolotti's syndrome. STUDY DESIGN: Case study and treatment algorithm proposal. METHODS: A treatment algorithm for patients with low back pain secondary to Bertolotti's Syndrome which involves starting with local anesthetic and steroid injection of the pseudo-articulation, followed by radiofrequency ablation of the pseudo-articulation, and then complete endoscopic resection of the pseudo joint. RESULTS: The proposed stepwise treatment guideline has the ability to diagnose Bertolotti's syndrome as the cause of low back pain and provide symptomatic relief. LIMITATIONS: Several limitations exist for the study including the fact that the algorithmic approach may not fit every patient. Additionally, there would be benefit in future research studies comparing each step of the algorithm with conservative measures to compare efficacy and long-term outcomes of the procedures. CONCLUSIONS: Our stepwise approach to diagnosing and managing the pain resulting from Bertolotti's syndrome is an effective method of treatment for the condition.

Priapism in a 28-year-old Male with Bipolar Disorder.

Priapism is a serious but rare side effect of psychiatric medications. We report the case of a 28-year-old male who has been mentally stable for a year on a combination of sertraline, olanzapine, and quetiapine. Two weeks after he was started on topiramate, the patient experienced priapism that led to a medical admission and surgical intervention. This case report suggests that topiramate might induce ischemic priapism, either directly or through interactions with other medications. Further studies are warranted to establish such a link.

Transient Global Amnesia in a 60-year-old female with Post-traumatic Stress Disorder.

This is a case report involving a 60-year-old female who developed transient global amnesia (TGA) after an emotional psychotherapy session in the framework of post-traumatic stress disorder (PTSD). She presented to the local emergency room, three days after her psychotherapist appointment, with complaints of memory impairment. She and her husband were worried about acute stroke since it was a sudden memory loss. The patient discussed with her psychotherapist a physical assault that occurred five years ago. Three days after that discussion, the patient developed the memory loss acutely. PTSD is associated with dissociative and retrograde amnesia. This case report demonstrates that PTSD can present with anterograde amnesia in the form of TGA.