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Bones and fractures
Published in Henry J. Woodford, Essential Geriatrics, 2022
Vertebral fractures most commonly occur in the low thoracic to upper lumbar region. They are defined as loss of 20% of vertebral body height, or a 4 mm reduction, which is best seen on plain X-ray images. They may be asymptomatic (detected only on imaging, also termed ‘morphometric') or present as progressive spinal curvature (kyphosis), height loss (more than 2 cm in a three-year period is suggestive), chronic back pain, or acute back pain following minor trauma. MRI scanning can distinguish between acute and old fractures. Spinal cord compression can occasionally occur. Two-thirds of fractures are believed to be asymptomatic, resulting in under-diagnosis and the true prevalence being unknown. Around half of women in their 80s have been found to have some vertebral deformity.54 Underlying osteoporosis should be suspected when detecting a kyphosis clinically.
Respiratory disease
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Palliation Radiotherapy/chemotherapy may be appropriate to alleviate certain symptoms, e.g. SOB.Dexamethasone for brain metastases.Spinal cord compression: corticosteroids, radiotherapy, surgery where appropriate.Radiotherapy/chemotherapy/stenting for SVC obstruction.Symptom control: palliative care input, hospice.
Oncological emergencies
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Spinal cord compression presents with neurological symptoms of weakness and reduced or altered sensation below the site of cord damage. This is accompanied by constipation and hesitancy in micturition leading to urinary retention.
Extramedullary haematopoiesis in patients with transfusion dependent β-thalassaemia (TDT): a systematic review
Published in Annals of Medicine, 2022
Eihab A. Subahi, Fateen Ata, Hassan Choudry, Phool Iqbal, Mousa A. AlHiyari, Ashraf T. Soliman, Vincenzo De Sanctis, Mohamed A. Yassin
Presenting features were not specified in a majority (N = 184, 72%) of cases (including the two retrospective studies) [14,15]. In the remaining patients, the authors reported a spectrum of presentation features. Thirty-two patients presented with clinical features of spinal cord compression. We found a small number of patients with symptoms of compression compared to the total number of patients with EMH around the spine. This is mainly because, in the two retrospective studies, which had 182 patients, the patients did not have any symptoms of EMH [14,15]. Lower limb weakness was reported in 23 (9.0%) patients. Nineteen (7.5%) patients presented with local pain at the site of EMH, whereas 3 (1.18%) presented with urinary incontinence. Ten patients (4%) presented with the finding of mass, either visible or incidental, on examination or imaging (Figure 2).
A case of spontaneous spinal epidural hematoma mimicking transient ischemic attack
Published in International Journal of Neuroscience, 2022
Cong Liu, Xiuli Liu, Yan Liu, Guomei Ma, Hui Li, Jingzhe Han, Yi Xiang
At present, most scholars advocate early laminar decompression and hematoma evacuation in order to obtain neurological recovery. Even some scholars believe that surgical treatment is the preferred choice for patients with SSEH [7, 9]. Some scholars have successively reported cases of SSEH treated conservatively, most having obtained satisfactory results, but more suitable for mild patients [10]. The patient had severe neurological deficit symptoms and no signs of symptom improvement were found in a short period of time, so surgical treatment was performed. The patient had a good prognosis though it took over 24 h from onset to surgery, which should be considered to be related to the degree of early spinal cord compression and early fluctuation of symptoms. For the time interval from onset to surgery, emergency surgery within 12 h is not sure to produce good prognosis. The prognosis of SSEH is mainly related to the degree of anterior neurological dysfunction, but patients with severe neurological dysfunction may also recover after surgery.
Application of percutaneous vertebroplasty and percutaneous kyphoplasty in treating Kümmell’s patients with different stages and postural correction status
Published in Expert Review of Medical Devices, 2020
Haiming Yu, Yizhong Li, Xuedong Yao, Jinkuang Lin, Yuancheng Pan, Huafeng Zhuang, Peiwen Wang
All the patients who were diagnosed with KD were admitted between May 2010 and August 2015. A total of 19 patients (males, n = 7; females, n = 12) were enrolled in this study. They were aged from 65 to 87 years, with a mean age of 73.45 ± 5.62 years. Thirteen of the patients had a definite history of trauma (falling history, n = 9; sprain history, n = 4). The period of lumbago pain was 4 weeks to 6 months, with an average of 2.3 months. Low back pain self-mitigation occurred in 8 cases of trauma, which was the performance of KD’s typical occult, and occult duration lasted 4 weeks to 3 months (average of 5.8 weeks). In cases of recurrence of low back pain symptoms or an increase in these symptoms, patients were hospitalized. The remaining 19 cases initially had low back pain, which gradually developed into serious low back pain, with postural changes and pain in various postures (e.g. standing from a sitting position, sitting, and standing still). Conservative treatment was considered inappropriate in these cases. Among these cases, the spinal cord compression symptoms in 3 patients were manifested as decreased lower limb muscle strength and sensory disturbance. The involved vertebrae in 20 vertebrae (19 patients) were as follows: T10 vertebra (n = 1), T11 vertebra (n = 3), T12 vertebra (n = 8), L1 vertebra (n = 6), L2 vertebra (n = 1), and L2 combined with spinous process fracture (n = 1). The bone mineral density (T) was −2.8 to −6.0, with an average of −3.68.