Joint, bone, spine : revue du rhumatisme
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Fibromyalgia, a syndrome characterized by widespread pain and diffuse tenderness, is considered a multifactorial disorder. Central nervous system sensitization is a major pathophysiological aspect of fibromyalgia, while various external stimuli such as infection, trauma and stress may contribute to development of the syndrome. In addition, current evidence points towards the existence of a genetic basis for fibromyalgia and information has been accumulated regarding the role of a number of candidate genes in fibromyalgia pathogenesis. In the present review, we have summarized the clinical manifestations of fibromyalgia, as well as the necessary laboratory workup; subsequently we have attempted to cover various aspects of pathogenesis with special emphasis on the genetic aspects currently uncovered.
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Case Reports
Acute spontaneous spinal subdural hematoma in a patient with bilateral incarcerated inguinal hernia.
Acute spinal subdural hematoma is an infrequent and devastating condition that occurs mostly in patients with coagulopathy or receiving anticoagulants. It may also develop after trauma, spinal surgery or iatrogenically (lumbar puncture and/or spinal anaesthesia). Spinal vascular malformations or spinal tumours can also be the origins of subdural hematomas. However, acute spinal subdural hematomas, which are not associated with these risk factors, are seen even more infrequently. In this report, we have described a case of spontaneous acute spinal subdural hematoma that occurred in a patient with bilateral incarcerated inguinal hernia and discussed the possible pathomechanisms. ⋯ Acute spinal subdural hematoma is an emergency condition in case of neurological compromise. Urgent surgical evacuation of hematoma results in good outcome. In the case of unidentified etiologies, the conditions that could play a role in increased intraabdominal and/or intrathoracic pressure should be considered always.