Very unusual cases of buttock and radiating lower extremity pain- examples

-

1. You JS reported a case of lumbosacral plexopathy caused by an isolated aneurysm in the common iliac artery.
S/S: a. The patient presented with low back and buttock pain radiating to the right leg and numbness in the L5 and S1 dermatomes.
Investigations: CT scan (abdomen)
2. Kakutani K reported radiculopathy due to malignant melanoma in the sacrum.
S/S: 52-year-old man who was admitted with increasing lower back, left buttock, and left lower extremity pain, and dysuria consistent with S1 radiculopathy
Investigations: Plain radiograph, CT scan, and MRI revealed a destructive lesion in the sacrum and left ilium, which infiltrated the spinal canal and sacroiliac joint. This case was also immunoreactive for HMB-45.
Caution: The incidence of primary melanoma is increasing faster than any other cancer. Melanoma is an interesting tumor, showing the appearance of metastasis without any trace of its primary lesion. The authors claim that malignant melanoma in the sacrum is a very rare case & S1 radiculopathy is reported for the first time
3. Perez A reported Infective Pyogenic Sacroiliitis.
S/S: a 4-year-old boy had a symptom triad of fever, buttock pain, and limping gait.
Investigations: MRI, Bone scan, blood & serum analyses for infection
Caution: extremely rare manifestations with nonspecific clinical presentation such as above; only 4 pneumococcal cases of infections are only reported. The therapeutic principles used in other osteoarticular infections.



Comments

Post a Comment

Popular posts from this blog

Entrapment of medial calcaneal nerve (MCN)

-
Image
Peripheral nerve entrapment is a rare, but important, cause of foot and ankle pain that often is underdiagnosed and mistreated. A peripheral nerve may become entrapped anywhere along its course, but certain anatomic locations are characteristic (2). The medial calcaneal nerve (MCN) The Tibial nerve is called the planter nerve in the sole. The tibial nerve passes to the sole of the foot takes a turn on the medial side of the calcaneum is called MCN. The medial calcaneal nerve arises from tibial nerve of the inner side of the ankle, perforates the laciniate ligament, travels downwards passing below the bony projection on the inner side of the ankle, and supplies the skin over the medial aspect of the heel. Hence it is the most important nerve for heel sensations. MCN have 2 branches. The anterior branch dominate the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominate the sensation of the posterior an...
Read more

Differential diagnosis of Anatomic (Radial) snuffbox pain: It is not always DeQuervain’s tenosynovitis.

-
Image
Tendon, Bone & Ligament causes: 1. DeQuervain’s tenosynovitis: Swelling of tendon of APL (Abductor pollicis longus) & extensor pollicis brevis at lateral wrist near anatomic snuff box.  The primary complaint is radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb. The pain has been described as a “constant aching, burning, pulling sensation." Pain is often aggravated by repetitive lifting, gripping, or twisting motions of the hand. Swelling in the anatomical snuff box, tenderness at the radial styloid process, decreased CMC abduction ROM of the 1st digit, palpable thickening of the extensor sheaths of the 1st dorsal compartment and crepitus of the tendons moving from the extensor sheath may be found upon examination. Other possible findings include weakness and paresthesia in the hand. Finkelstein’s diagnostic test will present positive provoking the patient’s symptoms. If left untreated, the inflammation and progressive narro...
Read more

Chronic fatigue syndrome

-
Introduction: Severe fatigue is a common complaint among patients. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome (CFS) should be considered. According to Centers for Disease Control and Prevention (CDC, USA) Chronic fatigue syndrome (CFS) currently is defined as: (1) fatigue of at least 6 months' duration, seriously interfering with the patient's life; and (2) without evidence of various organic or psychiatric illnesses that can produce chronic fatigue. The World Health Organization classifies myalgic encephalomyelitis/chronic fatigue syndrome (ME/cfs) as a nervous system disease. Together with other diseases under the G93 heading, ME/cfs shares a triad of abnormalities involving elevated oxidative and nitrosative stress (O&NS), activat...
Read more