RESUMO
A spinal cord stimulator (SCS) is an intervention that has become increasingly popular due to its efficacy in treating pain. With the increasing number of SCSs implanted annually, there has been an equal increase in complications, which include infections. We present a patient who underwent an uncomplicated permanent placement of SCS and later developed worsening back pain, weakness, and fever after a mechanical fall and was subsequently found to have vertebral osteomyelitis without an identifiable infection source. While no source or definitive pathogen was discovered, if there is a concern for osteomyelitis radiographically, even in an uncommon situation when medical workup returns inconclusive, explant of the SCS is warranted.
RESUMO
Spinal cord stimulators (SCS) have been an invaluable resource in treating chronic pain pathologies such as failed back surgery syndrome, complex regional pain syndrome, neuropathic pain, and leg ischemia. Post-dural puncture headaches (PDPH) are a common phenomenon that happens when the dura is compromised. It has been seen with permanent SCS placement, but less commonly reported with SCS trail leads. We present a case of a patient who developed PDPH symptoms, not after initial trial leads placement but upon their removal. This case not only illustrates that dural compromise can occur when the placement of the leads is correct with confirmatory imaging, but also the leads themselves can contribute to masking the defect.
RESUMO
Parsonage-Turner syndrome (PTS) is a rare disease process in which one develops acute-onset shoulder pain, followed by progressive weakness of the upper arm and shoulder girdle musculature. PTS is difficult to diagnose as it mimics similar presenting pathologies, most commonly, cervical radiculopathy (CR). Clinical presentation and diagnostic tests are particularly important to identify this rare syndrome, as the treatment for similar conditions may be more invasive. We present an interesting case of a 32-year-old female with severe unilateral shoulder pain, followed by weakness of her upper extremity musculature. The etiology of her symptoms cannot be concluded for certain; however, the aim of this case report is to increase awareness of this rare but potentially debilitating syndrome while also educating providers on the importance of differentiating PTS from the more commonly diagnosed CR.
RESUMO
Proteus syndrome (PS) is a rare overgrowth disease process with only a few hundred cases being reported in the literature. Abnormal formation of the vertebral bodies causing scoliosis and spinal stenosis are common features that lead to debilitating pain in these patients. We present a case of a 35-year-old male landscaper with a history of PS causing severe scoliosis and vertebral overgrowth who underwent recurrent sets of multilevel zygapophyseal joint injections for management of his axial back pain. This case illustrates the utility of interventional spinal procedures in patients with progressive pain from PS.
RESUMO
A spinal cord stimulator (SCS) is an excellent therapeutic strategy for many refractory chronic pain cases. They have a multi-faceted effect in providing relief in such indicated cases that include complex regional pain syndrome (CRPS) or failed back surgery syndrome (FBSS). However, if a patient has chronic intractable neuropathic pain outside the standard indications for SCS, can a case be made for trialing SCS as a last resort option? We describe a case where a patient with neuropathic groin pain, refractory to numerous types of procedures and non-interventional modalities, successfully underwent SCS therapy as a last resort option.
RESUMO
PURPOSE: To summarize the clinical, radiographic, and intraoperative characteristics of isolated neurofibromas of the orbit (INFO) in the literature and report a case of INFO. METHODS: Case report and a systematic review of the literature. RESULTS: A total of 45 patients were identified from 18 previous studies. There was no sex predilection and mean ages were between 32.3 and 40.0 years with a standard deviation of 9.8 to 19.5 years, median age was 32 to 38 years with a range of 1.5 to 82 years. On CT imaging, INFO reveals homogeneous precontrast radiodensity similar to that of extraocular muscles. On MR imaging, INFO appears hypointense to orbital fat and isointense to brain on precontrast T1-weighted images. On T2-weighted images, they have been described as being predominantly hyperintense with possible hypointense intralesional islands. To the best of our knowledge, our case identifies the youngest patient with the myxoid histologic variant of INFO. CONCLUSIONS: Patients with orbital neurofibromas should be evaluated for the presence of systemic neurofibromatosis, and the plexiform variant is a commonly associated subtype. The myxoid variant can be part of a lesser known condition called NAME syndrome (nevi, atrial myxoma, myxoid neurofibroma, and ephelides) which may warrant echocardiography in patients to evaluate for associated cardiac tumors.
