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Welcome to CNS' Case of the Month Section.
The purpose of this Web area is to provide a forum for discussion and debate regarding the management of both ordinary and extraordinary cases. There are no right or wrong answers, but rather, there are various opinions on what should be the "standard of care." The answers given will be collected anonymously, and be presented in a graphical format at the end of each month. We will then see the spectrum of thought regarding the management of these patients.
We are always open to suggestions, and if you have a case and questions that you would like to have presented, please submit them to: krishna@ccf.org
Ajit Krishnaney, MD
Cleveland Clinic |
Sharad Rajpal, MD
University of Wisconsin |
Joe Cheng, MD
Vanderbilt University |
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| Case of the Month Archive |
| To view previous cases, select one from the drop-down list below!
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| April/May 2008: Middle Aged Man with Cervical Mass |
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HPI: A 65-year-old man woke up in bed 3 weeks ago having noticed bruises on his arms and was concerned that he might have hit himself against the bedpost although he does not recall exactly what happened. He did not have any neck pain at that time. About 5 days later he noticed significant neck pain associated with bilateral arm pain extending down to the level of his wrists but not into his hands. He denies any paresthesias but says that he did have them in the past which would get better with narcotics. He had a CT and MRI of his cervical spine completed and is transferred to your institution for further evaluation because of the findings (see below).
ROS: Denies any recent fevers, chills, weight loss, or travel outside the country.
FH: Mom has breast cancer.
PMH:
1. Atrial fibrillation.
2. Iliac aneurysm.
3. Aortic aneurysm.
Past Surgical History:
1. Cardiac ablations x 3.
2. Cardioversion.
3. Iliac aneurysm surgery.
4. Lumbar diskectomy and fusion.
Medications:
1. Aspirin 81 mg daily.
2. Lasix 10 mg daily.
3. Metoprolol XL 25 mg daily.
4. Coumadin 5 mg daily.
5. Diltiazem 15 mg TID.
6. Gabapentin 300 mg qhs.
7. Vicodin 1-2 tablets PRN.
Social Hx: No tobacco or alcohol use. Retired salesman.
Neurological Examination:
Afebrile. Vital signs stable. He is alert and oriented X 3.
Cranial nerves II-XII are intact.
C-collar in place; no focal tenderness of the neck.
4/5 strength in left hand grasp. Remainder of strength exam is full throughout all muscles groups in the upper limbs and bilateral lower limbs.
Normal sensation throughout upper and lower limbs bilaterally.
Reflexes 2+ throughout.
(-) Babinski/Hoffman sign.
He ambulates with slight stagger secondary to low back pain (chronic and unchanged).
Laboratory Studies:
WBC 4.3, PLT 201, ESR 33, CRP 0, INR 1.9, Ca 9.1
MRI C Spine (from outside facility).
Sagittal T2 without contrast.
Sagittal T1 with contrast.
CT C spine without contrast.
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