We describe the case of a 79-year-old man who presented with progressive aggravation of severe axial neck pain and fever 3 days after transurethral resection of the prostate (TURP), despite maintaining neutral neck posture during surgery. Laboratory examination revealed markedly elevated C-reactive protein levels and erythrocyte sedimentation rates. Computed tomography revealed crown-like calcifications surrounding the odontoid process. We diagnosed crowned dens syndrome (CDS) as the cause of acute-onset neck pain after TURP. The patient was treated with nonsteroidal anti-inflammatory drugs for 5 days, and his symptoms resolved completely. CDS is a rare disease characterized by calcific deposits around the odontoid process with acute onset of severe neck pain and restricted motion. Evidence of inflammation on serological testing and fever are typical of CDS. However, the prevalence and pathophysiology of CDS remain unclear. We hypothesized that systemic inflammation after prostate surgery may have induced a local inflammatory response involving calcification around the odontoid process.
Neurolymphomatosis (NL) is defined as the involvement of the peripheral nervous system in lymphocytic invasion. It is a very rare form of lymphoma that may occur as an initial presentation or recurrence. It affects various peripheral nervous structures and can therefore mimic disc-related nerve root pathology or compressive mononeuropathy. NL often occurs in malignant B-cell non-Hodgkin lymphomas. Notwithstanding its aggressiveness or intractability, NL should be discriminated from other neurologic complications of lymphoma. Herein, we present a case of primary NL as the initial presentation of diffuse large B-cell lymphoma (DLBCL) of the sciatic nerve. The patient presented with weakness and pain in his left leg but had no obvious lesion explaining the neurologic deficit on initial lumbosacral and knee magnetic resonance imaging (MRI). NL of the left sciatic nerve at the greater sciatic foramen was diagnosed based on subsequent hip MRI, electrodiagnostic test, positron emission tomography/computed tomography, and nerve biopsy findings. Leg weakness slightly improved after chemotherapy and radiotherapy. We report a case wherein NL, a rare cause of leg weakness, manifested as the initial presentation of primary DLBCL involving the sciatic nerve at the greater sciatic foramen.
Citations
Citations to this article as recorded by
Primary peripheral nerve lymphoma: a case report and literature review Di Wu, Hui Liu, Lingyu Hao, Xu Han, Sihan Wang, Yijia Xiang, Shizhu Yu, Yi Wang Neurological Sciences.2024; 45(4): 1447. CrossRef
A case report of surgical management of a solitary Non-Hodgkin's Lymphoma (NHL) arising from the proximal sciatic nerve Sivakumaran Gobinath, Ganeshamoorthy Sritharan, Subramaniam Bakeerathan, Paramanathan Shathana, Umesh Jayarajah International Journal of Surgery Case Reports.2023; 111: 108817. CrossRef
Adhesive capsulitis of the shoulder joint is a common disease characterized by pain at the insertional area of the deltoid muscle and decreased range of motion. The pathophysiological process involves fibrous inflammation of the capsule and intraarticular adhesion of synovial folds leading to capsular thickening and contracture. Regarding the multidirectional limitation of motion, a limitation in external rotation is especially prominent, which is related to not only global fibrosis but also to a localized tightness of the anterior capsule. Ultrasound and magnetic resonance imaging studies can be applied to rule out other structural lesions in the diagnosis of adhesive capsulitis. Hydraulic distension of the shoulder joint capsule provides pain relief and an immediate improvement in range of motion by directly expanding the capsule along with the infusion of steroids. However, the optimal technique for hydraulic distension is still a matter of controversy, with regards to the infusion volume and rupture of the capsule. By monitoring the real-time pressure-volume profile during hydraulic distension, the largest possible fluid volume can be infused without rupturing the capsule. The improvement in clinical outcomes is shown to be greater in capsule-preserved hydraulic distension than in capsule-ruptured distension. Moreover, repeated distension is possible, which provides additional clinical improvement. Capsule-preserved hydraulic distension with maximal volume is suggested to be an efficacious treatment option for persistent adhesive capsulitis.
Citations
Citations to this article as recorded by
Rotator Interval vs Posterior Approach Ultrasound-guided Corticosteroid Injections in Primary Frozen Shoulder: A Meta-analysis of Randomized Controlled Trials Francisco Javier Arrambide-Garza, Juventino Tadeo Guerrero-Zertuche, Neri Alejandro Alvarez-Villalobos, Alejandro Quiroga-Garza, Abraham Espinosa-Uribe, Felix Vilchez-Cavazos, Yolanda Salinas-Alvarez, Juan Antonio Rivera-Perez, Rodrigo Enrique Elizondo-Om Archives of Physical Medicine and Rehabilitation.2024; 105(4): 760. CrossRef
A prospective, randomized, blinded study on the efficacy of using corticosteroids in hydrodilatation as a treatment for adhesive capsulitis of the shoulder Joan Tomàs Gebellí-Jové, Antonio Buñuel-Viñau, Marta Canela-Capdevila, Jordi Camps, Fàtima Sabench, Petrea Iftimie-Iftimie Shoulder & Elbow.2024;[Epub] CrossRef
Pharmacoacupuncture for the Treatment of Frozen Shoulder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Ji-Ho Lee, Hyeon-Sun Park, Sang-Hyeon Park, Yun-Kyung Song, Dong-Ho Keum, Seo-Hyun Park Current Pain and Headache Reports.2024; 28(12): 1365. CrossRef
Frozen Shoulder: Diagnosis and Management Sean R. Wise, Paul Seales, Alex P. Houser, Chase B. Weber Current Sports Medicine Reports.2023; 22(9): 307. CrossRef
Ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy for treatment of frozen shoulder Huajun Xu, Yingchun Zhang, Caishan Wang Journal of Back and Musculoskeletal Rehabilitation.2022; 35(5): 1153. CrossRef
Impact of capsular preservation on patient-reported outcomes and complication rates in total hip arthroplasty using the direct anterior approach Vincent A. Stadelmann, Hannes A. Rüdiger, Selina Nauer, Michael Leunig The Bone & Joint Journal.2022; 104-B(7): 826. CrossRef
Management of Patients with Adhesive Capsulitis via Ultrasound-Guided Hydrodilatation without Concomitant Intra-Articular Lidocaine Infusion: A Single-Center Experience Yung-Chieh Chen, Shu-Huei Shen, Hong-Jen Chiou, Yung-Liang Wan Life.2022; 12(9): 1293. CrossRef
Role of Platelet-Rich Plasma in the Treatment of Adhesive Capsulitis: A Prospective Cohort Study Syed Imran Haider, Muhammad Zarak Awais, Muhammad Tahir Iqbal Cureus.2022;[Epub] CrossRef
Musculoskeletal complications in patients with diabetes mellitus Jong Han Choi, Hae-Rim Kim, Kee-Ho Song The Korean Journal of Internal Medicine.2022; 37(6): 1099. CrossRef
Comparison of the spread pattern of medial-to-lateral and lateral-to-medial rotator interval injections: A cadaveric study Benjamin J. Kozlowski, John Tran, Philip W.H. Peng, Anne M.R. Agur, Nimish Mittal Interventional Pain Medicine.2022; 1(4): 100164. CrossRef
Updates on Intra-articular Corticosteroid Injection for the Treatment of Adhesive Capsulitis Ju Heon Oh, In Ho Jung, Eun Woo Park, Jang Hyuk Cho Keimyung Medical Journal.2022; 41(2): 51. CrossRef