Tabes dorsalis

a slow degeneration of the sensory neurons that carry information due to demyelination. The degenerating nerves are in the dorsal columns.

Etiology:

untreated Treponema pallidum, syphilis, infection

Ehlers-Danlos Syndrome (EDS)

genetic disorder that results in a defect in collagen synthesis. The severity may range from mild to life-threatening. Common symptoms include extremely flexible joints, eye lens dislocation, and bone deformities. Joints have a high tendency to dislocate.

Chondromalacia

Abnormal softening or degeneration of cartilage.

May present as wearing away of the articular cartilage, common in the knee joint on the underside of the patella.

Myxoid Liposarcoma

A subtype of liposarcoma,  is a malignant tumor that arises in fat cells in deep soft tissue.

Myxoid liposarcomas occur most commonly in the lower extremity, particularly the thigh.

Liposarcomas originate from primitive mesenchymal cells rather than from mature fat cells.

At histologic analysis, they can be classified as well-differentiated, myxoid, pleomorphic, or round cell

abnormalities occur in myxoid liposarcoma, depending on:

• the amount of fat and myxoid material
• the degree of cellularity and vascularity
• the presence of necrosis.
• Most myxoid liposarcomas have lacy or linear, amorphous foci of fat.

Dx:

• MRI
• CT

A myxoid liposarcoma that contains abundant water can mimic a cystic lesion, producing diagnostic confusion. Myxoid liposarcomas must be differentiated from cystic lesions because the former can be limb threatening.

Prognosis

• varies with the histologic subtype.
• The well-differentiated variant is considered a low-grade malignancy
• the pleomorphic and round cell types are regarded as highly malignant tumors with a tendency toward local recurrence and metastasis.

Mi-Sook Sung, Heong S. Kang, Jin S. Suh, Jung H. Lee, Jeong M. Park, Jee Y. Kim, and Hae G. Lee. 2000. Mxoid Liposarcoma: Appearance at MR imaging with hisotlogic correlation. Radiographics. 20: 1007-1019.

http://radiographics.rsna.org/content/20/4/1007.full

Rhabdomyolysis

Rhabdomyolysis is the rapid breakdown (lysis) of skeletal muscle tissue (rhabdomyo) due to injury to muscle tissue. The muscle damage may be caused by physical (e.g., crush injury), chemical, or biological factors. This condition may lead to renal failure.

Etiology:

Multiple Sclerosis and Amyloid Lateral Sclerosis Comparison

 

Feature	Multiple Sclerosis	Amyloid Lateral Sclerosis
Disease	Affects motor and sensory neurons	Affects motor neurons/ Sensory and cognition not affected
Incidence	Higher in women	Higher in men
Genetics	Mutation in the MHC portions of chromosomes on the HLA regions of the genes	Mutation of the SOD1 gene on chromosome 21
Pathophysiology	Neural demylination and Death of oligodenrocytes producing myelin	Superoxide dismutase gene that neutralizes harmful free radicals is mutated
Manifestations Signs and Symptoms	Depends on the region and extent of neural demylination. Paresthesia (burning, tingling sensation) fatigue decreased muscle strength and coordination gait affected visual impairment bowel and bladder dysfunction	Weakness fascication (muscle twitch) muscle atrophy dysphagia dysarthria
Diagnostics	MRI for plaques. Assay for presence of protein in CSF indiciative of: compromised blood brain barrier autoimmune damage occurance inflammatory processes	electromyography

Torticollis

Inclination of the head to affected side in which sternocleidomastoid muscle is contracted.

A stiff neck caused by spasms of the neck muscles drawing the head to one side with the chin pointed to the other side. a condition of twisting of the neck that causes the head to rotate and tilt on an angle.

 

Etiology:

may be congenital or acquired.

Congenital Torticollis:

• Unclear in Congenital muscular torticollis results when the sterno-mastoid muscle (ie, the strap that runs from beneath the angle of the jaw to the base of the neck above the collar bone) is shortened or tightened on one side.
• Birth trauma or intrauterine malposition is also considered to cause damage to the sternocleidomastoid muscle in the neck. This results in a shortening or excessive contraction of the sternocleidomastoid muscle, often with limited range of motion in both rotation and lateral bending. The head is typically tilted in lateral bending toward the affected muscle and rotated toward the opposite side.

 

Acquired Torticollis:

Trauma to the neck can cause atlantoaxial rotatory subluxation, in which the two vertebrae closest to the skull slide with respect to each other, tearing stabilizing ligaments; this condition is treated with traction to reduce the subluxation, followed by bracing or casting until the ligamentous injury heals.

Tumors of the skull base (posterior fossa tumors) can compress the nerve supply to the neck and cause torticollis, and these problems must be treated surgically.

Infections in the posterior pharynx can irritate the nerves supplying the neck muscles and cause torticollis, and these infections may be treated with antibiotics if they are not too severe, but could require surgical debridement in intractable cases.

Ear infections and surgical removal of the adenoids can cause an entity known as Grisel’s Syndrome, a subluxation of the upper cervical joints, mostly the atlantoaxial joint, due to inflammatory laxity of the ligaments caused by an infection. This bridge must either be broken through manipulation of the neck, or surgically resected.

The use of certain drugs, such as  antipsychotics, can cause torticollis.

Treatment:

1) Low-impact exercise to increase strong form neck stability. Gentle range of motion exercises
2) Chiropractic manipulation of the neck.
3) Extended heat application.
4)  Massage.

5) Surgery

6) Neck brace support or immobilization

Perry, A, G, Potter, P, A, Ross-Kerr, J, C and Wood, M, J. 2006. Canadian fundamentals of nursing. 3^rded. Toronto: Elselvier