Meltem Aras

Adult case of acrodysostosis with severe neurologic involvement

OBJECTIVE Acrodysostosis is a rare syndrome characterized by peripheral dysostosis, nasal hypoplasia and frequently mental retardation. Only one adult case of acrodysostosis has been reported to have neurologic symptoms. We report one further adult case of acrodysostosis with severe neurologic findings including myelopathy and spastic paraparesis due to diffuse spinal stenosis and recurrent deep vein thrombosis possibly caused by neurologic deficits. RESULTS We report a 43-year-old woman who had back and neck pain with weakness in the extremities of several years. 1~year before admission to our hospital, she had been treated with a missed diagnosis of sero (-) spondyloarthropathy but had not benefited. She became unable to walk, thereafter she underwent decompression surgery with a diagnosis of degenerative spinal stenosis. She presented at our outpatient department complaining of lowback pain and difficulty walking. She had marked facial and peripheral appearance of acrodysostosis. Spinal MRI revealed extensive spinal stenosis. A diagnosis was made through the genetic investigation, clinical and radiological findings. Spastic paraparesis were detected. There was widespread neuropathic pain. 15 days after admission, she developed swelling and redness of the left lower extremity and the venous doppler ultrasonography showed left acute and right past DVT. We treated DVT with anticoagulant therapy. Gabapentin and Baclofen were initiated for neuropathic pain and spasticity. A conventional rehabilitation program was performed. She left walking with a walker without pain and spasticity. CONCLUSIONS We would like to remind physicians to be aware of peripheral malformations as signs of skeletal dysplasias and to consider acrodysostosis in the differential diagnosis. Although it is a rare condition, if diagnosed early, possible complications can be treated and outcomes may be improved.

Spinal cord injury associated with thoracic osteoporotic fracture.

Demir SÖ, Akın C, Aras M, Köseoğlu F: Spinal cord injury associated with thoracic osteoporotic fracture. Am J Phys Med Rehabil 2007;86:242–246. This report details a case of sudden neurologic deficit attributable to acute thoracic fractures associated with senile osteoporosis. A 73-yr-old female patient with a history of occasional back pain during the past 4 mos had sudden thoracic vertebral fracture with spinal cord injury. The patient, who had a benign past medical history, had not been evaluated for osteoporosis. Thoracic spine radiographs showed a compression fracture at T8. Thoracic magnetic resonance imaging exposed a compression fracture at T7–T8. She was treated operatively. She was found to have spinal cord injury with American Spinal Injury Association classification C (T7), and she had poor sitting balance. She was discharged in a wheelchair and was administered clean intermittent catheterization every 6 hrs. Six months after discharge, she ambulated with a walker and had spontaneous micturition. Vertebral fractures are a common presentation of senile osteoporosis. The risk of neurologic impairment attributable to vertebral fracture is a rare but potentially severe complication. Besides medical therapy and suitable rehabilitation programs, surgical treatment is an integral part of the management of patients with osteoporotic vertebral fractures.

Gabapentin-Induced Urinary Incontinence: A Rare Side Effect in Patients with Neuropathic Pain

Gabapentin is a first-line agent for neuropathic pain management and has a favorable safety profile. The literature includes a few cases of gabapentin-induced incontinence, and most of them involved patients with epilepsy who were between the ages of 12 and 43 years. Herein, we present three patients with neuropathic pain due to different diagnoses, and, to our knowledge, these are the oldest reported cases of urinary incontinence caused by gabapentin therapy. A 56-year-old female patient who underwent hip arthroplasty developed a sciatic nerve injury and neuropathic pain postoperatively. Ten days after she began taking gabapentin to relieve her pain, she experienced daily urinary incontinence. In another instance, a 63-year-old female patient was diagnosed with complex regional pain syndrome, and seven days after the initiation of gabapentin therapy, urinary incontinence developed. In addition, a 66-year-old male patient with neuropathic pain due to cervical disc pathology complained of urinary incontinence after the onset of gabapentin therapy. After discontinuing this drug, the incontinence symptoms resolved in these patients on the seventh, the first, and the second days, respectively. Physicians who administer gabapentin should inform their patients about the potential risk of gabapentin-induced incontinence and its negative impact on quality of life.

Demographic and Clinical Characteristics of Patients with Breast Cancer-Related Lymphedema

Amaç: Çal›flman›n amac› onkolojik rehabilitasyon ünitemize baflvuran meme kanseri ile iliflkili lenfödemi olan hastalar›n klinik ve demografik özelliklerinin sunulmas›d›r. Gereç ve Yöntem: Elli yedi kad›n hasta de¤erlendirildi. Demografik veriler, uygulanan tedavi modaliteleri, ç›kar›lan lenf nodu say›s›, metastatik lenf nodu say›s›, patolojik tan› tipi kaydedildi. A¤r›, uyuflukluk, a¤›rl›k hissi ve fonksiyon kayb› sorguland›. Lenfödem de¤erlendirmesinde çevresel ölçüm yöntemi kullan›ld›. Evreleme yöntemine göre lenfödem s›n›fland›rmas›nda evre 1’deki hastalar bir grup oluflturacak (Grup 1, geriye dönüflümlü lenfödem, n=20) flekilde ve Evre 2 ve Evre 3’teki hastalarda birlefltirilerek bir grup oluflturacak flekilde (Grup 2, geriye dönüflümsüz lenfödem, n=37) iki grup yap›ld›. Bulgular: Hastalar›n yafl ortalamas› 50,92±10,58 y›ld›. Operasyondan sonra lenfödem oluflumuna kadar geçen süre ortalamas› 25,61±16,01 (4-72) ayd›. Hastalar›n 25’inde lenfödemli ekstremitede a¤›rl›k hissi, 27’sinde a¤r› yak›nmas›, 19’unda uyuflukluk ve 25’inde fonksiyon kayb› yak›nmas› vard›. Dört bölgedeki çevresel ölçüm de¤erleri ile beden kitle indeksi aras›nda anlaml› pozitif korelasyon saptand› (p<0,05). Sonuç: Lenfödem meme kanserli hastalarda önemli bir morbidite nedenidir. Obesite, lenfödem geliflimini kolaylaflt›ran önemli bir risk faktörüdür. Bu nedenle meme kanserli hastalar›n lenfödem konusunda bilgilendirilmesi, risk faktörlerinin belirlenmesi ve kontrol alt›na al›nmas› lenfödemin önlenmesi aç›s›ndan oldukça önemlidir. Türk Fiz T›p Rehab Derg 2010;56:124-9. Anahtar Kelimeler: Meme kanseri, lenfödem, risk faktörleri Summary