Diabetes Mellitus, Obesity, Lipoprotein Disorders and other Metabolic Diseases
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
This is an unusual complication of neuropathic feet presenting as a red, hot, swollen foot with or without pain. Blood flow to the foot is increased due to autonomic neuropathy. Peripheral neuropathy may contribute to unnoticed trauma. An excessive local inflammatory response results in focal osteolysis and osteoporosis. Sustained mechanical stress deforms the foot with fracture-dislocations of forefoot bones and mid-foot collapse. Once foot deformity has occurred, the risk of foot ulceration is high and with it the risk of soft tissue and bone infection. Charcot arthropathy is often misdiagnosed as cellulitis but, if not recognized, serious complications are likely. Plain radiographs are initially normal, but later show fracture, osteolysis, new bone formation and disorganization of the joint by subluxation.MRI scans may show bone marrow oedema in the mid-foot region, but may be difficult to differentiate from osteomyelitis (Figure 11.10).
First Half of the Nineteenth Century
Arturo Castiglioni in A History of Medicine, 2019
In france, Jean Martin charcot (1825-93) was one of the greatest neurologists of his time. It was perhaps his incomparable qualities as teacher, writer, and organizer that contributed most to the great reputation of this gifted clinician, whose profundity and clarity of observation joined with an admirable originality in pathological synthesis to visualize the broad aspects of clinical symptoms. He was the creator of the greatest modern neurological clinic, and a masterly describer of many disease pictures, such as hysteria, muscular atrophy, amyotrophic lateral sclerosis, multiple sclerosis, and paralysis agitans. He was a great clinician in the broadest sense of the word, careful of the patients committed to his care, wonderfully energetic and diagnostically acute, though in his examination of hysterical patients he is now thought to have sometimes produced symptoms by the suggestive nature of his questioning. Charcot brought to his clinic at the Salpetriere a group of devoted pupils who were among the founders of modern neurology. In 1898 a monument was erected in front of this hospital in memory of one of the greatest figures in the history of French medicine. His masterly Leçons sur les -maladies du systeme nerveux (Paris, 1872-83; published in translation by the Sydenham Society, 1881) and his magnificent Iconographie de la Salpetriere (1876-80) are classics in the eloquence of their style, the value of their contents, and the clarity of their exposition.
Health and Economic Burdens of Diabetes and Its Complications
Emmanuel C. Opara, Sam Dagogo-Jack in Nutrition and Diabetes, 2019
Diabetic complications in the lower extremities are multifactorial and result from complex interplay between diabetic vasculopathy, neuropathy, structural deformity, and decreased immunity.38 Lower-limb atherosclerosis tends to occur more distally in diabetic subjects and preferentially affects the arteries below the knees.38 Ten percent to 18% of people have peripheral neuropathy at the time of their diagnosis; after 5 years of disease duration, approximately 26% have peripheral neuropathy, and at 10 years, approximately 41% have peripheral neuropathy, with at least 50% of people with diabetes eventually developing peripheral neuropathy.39 Charcot osteopathic neuropathy is a chronic condition affecting the bones, joints, and soft tissues, most commonly of the foot and ankle. It is estimated to occur in 0.4%–13% of patients with diabetes. As a result of multiple factors, including the ones mentioned above, there is also a related propensity to development of fat atrophy, callus formation, ulceration sinus tracts, and avascular necrosis of pedal bones, which can lead to cellulitis and abscess formation, and can also lead to development of worsening sequelae such as osteomyelitis and necrotizing fasciitis.38,40
Two faces of the teacher: Comparing editions of Charcot’s Leçons du mardi
Published in Journal of the History of the Neurosciences, 2022
Christopher G. Goetz, Emmanuel Drouin
Jean-Martin Charcot (1825–1893) was the premier international nineteenth-century clinical neurologist (Goetz, Bonduelle, and Gelfand 1995). His teaching sessions at the Salpêtrière Hospital in Paris drew international colleagues and students. There were two teaching formats: the formal Friday lectures and a particularly popular impromptu “show and tell” Tuesday series of case presentations. In the latter, Charcot interviewed patients, many whom he had seen that day in consultation, and unveiled diagnostic and treatment strategies in an immediate and open manner (Goetz 1987; see Figure 1). The formal Friday lectures eventually were consolidated by Désiré-Magloire Bourneville (1840–1909) into Charcot’s Complete Works (Œuvres Complètes), translated into multiple languages (Charcot, 1877–1890). The Tuesday sessions, termed the Leçons du mardi, were hand transcribed for the 1887–1888 academic year and published as a transcription lithograph, today rarely found (Charcot, 1887–1888), although a modern typeset rendition has been recently published in French (Charcot 2002).
Multi-joint Charcot arthropathy caused by cervical spondylotic myelopathy and adult degenerative scoliosis with syringomyelia: a case report
Published in British Journal of Neurosurgery, 2021
Xin Shi, Panpan Li, Lanying Wang, Jia Zhang
Charcot arthropathy is a systemic disease with pathological changes in the musculoskeletal system, characterized by the progressive development of osteoarthritis and cartilage necrosis in the joints and/or spine, which ultimately leads to joint instability, dislocation and deformity. At present, the most common causes of Charcot arthropathy are diabetes and neurosyphilis.1 In addition, it is often closely related to myelopathy, syringomyelia or idiopathic neuropathy.2,3 Although previous reports have described Charcot arthropathy related to other secondary etiology, in many cases it may still be misdiagnosed or missed due to the complexity and etiology of Charcot arthropathy. In this report, we describe the world’s first case of multi-joint Charcot arthropathy caused by CSM and ADS complicated by syringomyelia.
Jean-Martin Charcot´s medical instruments: Electrotherapeutic devices in La Leçon Clinique à la Salpêtrière
Published in Journal of the History of the Neurosciences, 2021
Francesco Brigo, Albert Balasse, Raffaele Nardone, Olivier Walusinski
Jean-Martin Charcot (1825–1893) is widely considered the father of modern neurology. The lectures he delivered at the Salpêtrière Hospital in Paris attracted a large number of visitors from all over the world (Goetz, Bonduelle, and Gelfand 1995). While working as chief of service at this hospital (1862–1893), Charcot became increasingly interested in hysteria, which he described in its various stages and forms (Bogousslavsky 2014; Bogousslavsky and Moulin 2009; Goetz, Bonduelle, and Gelfand 1995). For him, hysteria was a condition with distinctive neurologic signs but no detectable morphological lesions in the brain identified at autopsy. Charcot had initially considered hysteria as the consequence of a “dynamic lesion” (lésion fonctionnelle or lésion dynamique) of the nervous system (Goetz, Bonduelle, and Gelfand 1995). Furthermore, he vehemently rejected the equation between hysteria and simulation. Only shortly before his death, he became increasingly convinced of the importance of psychological factors in the genesis of hysteria (Bogousslavsky and Moulin 2009). Because he believed only hysterical subjects could be hypnotized, Charcot advocated the use of hypnotism for studying this phenomenon (Goetz, Bonduelle, and Gelfand 1995).
Related Knowledge Centers
- Neurology
- Anatomical Pathology
- Hypnosis
- Hysteria
- Eponym
- Psychology
- Neurosis
- Multiple Sclerosis
- Charcot'S Neurologic Triad
- Nystagmus