Non-traumatic cervical disc prolapse with spinal cord compression: an unlikely but important cause of leg and back pain
| Autor: | Mayukh Bhattacharyya, Dominic Crocombe |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Clinical Intelligence Neurological examination 03 medical and health sciences 0302 clinical medicine Spinal cord compression Back pain Medicine Humans 030212 general & internal medicine Intervertebral Disc Physical Therapy Modalities Leg medicine.diagnostic_test business.industry Emergency department Spinal cord medicine.disease Decompression Surgical Magnetic Resonance Imaging medicine.anatomical_structure Treatment Outcome Back Pain Physical therapy Sphincter medicine.symptom Differential diagnosis Family Practice business Paraplegia Spinal Cord Compression 030217 neurology & neurosurgery Intervertebral Disc Displacement |
| Zdroj: | The British journal of general practice : the journal of the Royal College of General Practitioners. 68(671) |
| ISSN: | 1478-5242 |
| Popis: | Leg pain, back pain, and unsteadiness are common presenting complaints in general practice that can represent a broad range of conditions. Rarely, they can be the first symptoms of catastrophic spinal cord lesions. This report explores a case of cervical spondylomyelopathy resulting in severe spinal cord compression and impending paraplegia that presented in the community with mild initial symptoms and no history of trauma. It is used to discuss the differential diagnosis of unsteadiness, the value of taking a patient-centred history, and the importance of safety-net advice and timely follow-up of patients with unrelenting symptoms. In addition, a format of focused neurological examination to fit within the time constraints of general practice is suggested. In patients with a typical history and positive physical signs, urgent referral to secondary care is required for further investigation and intervention to prevent life-changing damage. A previously well and active 42-year-old male presented to his GP with a 4-week history of persistent ‘burning’, ‘stretching’ pain in both thighs and vague, non-radiating lower back pain. He also complained of progressive unsteadiness on his feet. He denied any history of trauma, sphincter control remained intact, and he did not complain of upper-limb or sensory symptoms. Two weeks previously he attended the emergency department following an episode where his legs gave way. Clinical assessment at that time reported no significant neurological signs and he was discharged home for GP follow-up with regular co-codamol, diclofenac, and diazepam. Despite this, the patient’s symptoms did not improve and 4 days … |
| Databáze: | OpenAIRE |
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