1.Upper Extremity Paralysis Caused by an Internal Spinal Epidural Abscess that was not Identified on Imaging
Hisashi Nishisako ; Hiraku Endou ; Yukitaka Yamasaki ; Takaaki Nemoto ; Shinichi Nakaya ; Takahide Matsuda
General Medicine 2013;14(1):57-60
We report the case of a 63-year-old male with diabetes who was diagnosed with staphylococcal bacteremia. Paralysis of the extremities (right upper, left lower) and bladder and bowel dysfunction developed 5 days after treatment initiation. Spinal magnetic resonance imaging revealed a spinal epidural abscess at the L4/5 level. Despite right upper extremity palsy, there was no visible cervical spine abscess. Emergency surgery was undertaken, which resulted in complete neurological recovery. General physicians must be aware that damage to the spinal cord can be caused not only by direct compression of an epidural abscess but also by impaired blood circulation or inflammation.
2.A Case of Slowly Progressive Insulin-dependent Diabetes Mellitus (SPIDDM) with Low Anti-GAD Antibody Titer Detected during Treatment of Organizing Pneumonia
Takehiro Kawata ; Akio Ohta ; Takaaki Nemoto ; Hisashi Nishisako ; Yukitaka Yamasaki ; Masanori Hirose ; Hiroyuki Kunishima ; Takahide Matsuda ; Yasushi Tanaka
General Medicine 2013;14(2):130-134
3.Spontaneous Low Cerebrospinal Fluid Pressure Headache Initially Misdiagnosed as a Tension-type Headache
Hisashi Nishisako ; Hiroyuki Kunishima ; Gohji Shimizu ; Yoshiyuki Naitou ; Yoko Teruya ; Masatoshi Yokokawa ; Kentaro Masui ; Masanori Hirose ; Tsubasa Sakai ; Yukitaka Yamasaki ; Tomoya Tsuchida ; Takaaki Nemoto ; Keito Torikai ; Teisuke Nakagawa ; Takahide Matsuda
General Medicine 2014;15(1):43-46
We report the case of a 34-year-old man who was initially diagnosed with a tension-type headache after complaining of a headache and nausea. His headache worsened in severity and it was exacerbated on standing in the upright position. The patient was admitted to the hospital on suspicion of spontaneous low cerebrospinal fluid (CSF) pressure headache. Gadolinium-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement, brain sagging, cerebellar tonsillar herniation, brainstem descent and a subdural hematoma. Successful emergency surgery was undertaken.
Spontaneous low CSF pressure headache syndrome is characterized by orthostatic headache, and if such a headache worsens, clinicians should consider a subdural hematoma, a life-threatening complication of this unusual disorder.