Clinical medicine (London, England)
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We present the case of a man who presented with severe left lower back pain radiating to the anterior aspect of left thigh. He also had fever and headache. Due to the exquisite tenderness along the inguinal region, the possibility of a psoas abscess was considered. ⋯ It also presents with a prodrome of fever, headache, myalgia, myositis and Guillain-Barré syndrome. In a developing embryo, somites split to form dermatomes, myotomes (skeletal muscles), syndetomes (tendons and cartilage) and sclerotomes (bones). Our case illustrates that herpes zoster can involve the so called 'dermomyotome', a combination of the dermatome and myotome and result in a localised dermatomyositis.
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Spontaneous intracranial hypotension is uncommon and results from a cerebrospinal fluid (CSF) leak. We describe the case of a marathon runner who presented with postural headache attributable to CSF venous fistulation originating from a lower thoracic nerve root cyst. ⋯ With unmitigated CSF loss over the following 3 months, the patient became bedbound and developed rapidly progressive behavioural variant frontotemporal dementia. Behavioural changes were somewhat reversible on restoration of CSF volume after surgical intervention.
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We discuss the case of a 22-year-old man who presented with paraesthesia, reduced sensation and weakness in his limbs. Examination was in keeping with a myeloneuropathy. Initial investigations including vitamin B12 were unremarkable but magnetic resonance imaging of the spinal cord showed subacute combined degeneration. ⋯ Nitrous oxide use is prevalent and can have significant health effects. Many adverse effects are mediated through inactivation of vitamin B12 and can be detected by elevated homocysteine and methylmalonic acid levels. Early identification and prompt treatment are important to support neurological recovery.
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The clinical efficacy and cost-effectiveness of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke is well established, but uncertainty remains around the true cost of delivering this treatment within the NHS. The aim of this study was to establish the cost of providing MT within the hyperacute phase of care and to explore differences in resources used and costs across different neuroscience centres in the UK. ⋯ Major factors contributing to costs of MT for stroke include consumables and staff for intervention, use of general anaesthesia and ICU admissions. These findings can inform the reimbursement, provision and strategic planning of stroke services and aid future economic evaluations.