Back pain, fever and stiffness: Difference between revisions
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! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease | |||
! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation | |||
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments | |||
|- | |||
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms | |||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging | |||
|- | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Headache | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Nausea and vomiting | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Syncopy | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Motor weakness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Sensory deficit | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pulse Deficit | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Heart Murmur | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel or bladder dysfunction | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome | |||
|- | |||
! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Neurological | |||
![[Arachnoiditis]]<ref name="pmid10665863">{{cite journal |vauthors=Ozateş M, Kemaloglu S, Gürkan F, Ozkan U, Hoşoglu S, Simşek MM |title=CT of the brain in tuberculous meningitis. A review of 289 patients |journal=Acta Radiol |volume=41 |issue=1 |pages=13–7 |date=January 2000 |pmid=10665863 |doi= |url=}}</ref> | |||
|Acute | |||
|Hours | |||
|Dull aching pain | |||
|Head, neck and back | |||
| +/- | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
| +/- | |||
|<nowiki>+/-</nowiki> | |||
| +/- | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|CSF | |||
* Elevated protein with normal or low [[glucose]] | |||
Culture and sensitivity | |||
* May be due to [[TB]] or [[Meningitis]] | |||
Nucleic acid tests | |||
* Helpful in tuberculous [[meningitis]] | |||
|Radiography | |||
* Thickened nerve roots | |||
[[CT]] | |||
* Narrowing of subarachnoid space | |||
* Irregular collections of contrast material | |||
* Thickened nerve roots | |||
[[MRI]] | |||
* Study of choice shows indistinct cord outline | |||
| | |||
* Usually caused by [[meningitis]] or [[TB]] | |||
|- | |||
|- | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease | |||
! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation | |||
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments | |||
|- | |||
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms | |||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging | |||
|- | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Headache | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Nausea and vomiting | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Syncopy | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Motor weakness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Sensory deficit | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pulse Deficit | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Heart Murmur | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel or bladder dysfunction | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome | |||
|- | |||
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Bone | |||
|- | |||
![[Osteomyelitis|Chronic recurrent focal osteomyelitis]]<ref name="pmid15276398">{{cite journal |vauthors=Lew DP, Waldvogel FA |title=Osteomyelitis |journal=Lancet |volume=364 |issue=9431 |pages=369–79 |date=2004 |pmid=15276398 |doi=10.1016/S0140-6736(04)16727-5 |url=}}</ref><ref name="pmid9431368">{{cite journal |vauthors=Mader JT, Shirtliff M, Calhoun JH |title=Staging and staging application in osteomyelitis |journal=Clin. Infect. Dis. |volume=25 |issue=6 |pages=1303–9 |date=December 1997 |pmid=9431368 |doi= |url=}}</ref><ref name="pmid9077380">{{cite journal |vauthors=Lew DP, Waldvogel FA |title=Osteomyelitis |journal=N. Engl. J. Med. |volume=336 |issue=14 |pages=999–1007 |date=April 1997 |pmid=9077380 |doi=10.1056/NEJM199704033361406 |url=}}</ref> | |||
|Chronic | |||
|Years | |||
|Dull aching pain | |||
|Local | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
| - | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|[[CBC]] | |||
*[[Leukocytosis]] and left shift | |||
[[ESR]] | |||
* Elevated | |||
[[CRP]] | |||
* Elevated | |||
[[Procalcitonin]] | |||
* Elevated | |||
Culture and sensitivity | |||
* To identify causative agent | |||
|Radiography | |||
* Demonstrates endosteal or medullary lesion | |||
* Sequestration and cavity formation | |||
MRI | |||
*[[Bone marrow]] abnormalities and lytic changes | |||
CT | |||
* Articular and periarticular involvement | |||
Ultrasound | |||
* Soft tissue abnormalities | |||
Nuclear imaging | |||
* Loss of [[bone density]] | |||
| | |||
*Acute presentation is often seen in children and is associated with gait abnormalities | |||
|- | |||
!Sacroilitis<ref name="pmid17117004">{{cite journal |vauthors=Foley BS, Buschbacher RM |title=Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment |journal=Am J Phys Med Rehabil |volume=85 |issue=12 |pages=997–1006 |date=December 2006 |pmid=17117004 |doi=10.1097/01.phm.0000247633.68694.c1 |url=}}</ref><ref name="pmid6600615">{{cite journal |vauthors=Carette S, Graham D, Little H, Rubenstein J, Rosen P |title=The natural disease course of ankylosing spondylitis |journal=Arthritis Rheum. |volume=26 |issue=2 |pages=186–90 |date=February 1983 |pmid=6600615 |doi= |url=}}</ref> | |||
|Acute or chronic | |||
|Variable | |||
|Dull aching or throbbing | |||
|Hips and legs | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|CBC | |||
*May demonstrate [[leukocytosis]] | |||
ESR | |||
*May be elevated | |||
CRP | |||
*May be elevated | |||
Procalcitonin | |||
*May be elevated | |||
Culture and sensitivity | |||
*To identify causative agent | |||
|MRI | |||
*Narrowing of joint space and low signalling indicates edema | |||
CT | |||
*Detects lesions earlier than radiography, demonstrates hypodensity of joint space and destruction of articular surface | |||
Radiography | |||
*Joint space narrowing with destruction of joint space | |||
Nuclear imaging | |||
*Focal uptake of gallium-67 and technetium-99m in area of destruction | |||
| | |||
*Most likely due to hematogenous spread of organism | |||
|- | |||
![[Vertebral osteomyelitis]]<ref name="pmid11515764">{{cite journal |vauthors=Beronius M, Bergman B, Andersson R |title=Vertebral osteomyelitis in Göteborg, Sweden: a retrospective study of patients during 1990-95 |journal=Scand. J. Infect. Dis. |volume=33 |issue=7 |pages=527–32 |date=2001 |pmid=11515764 |doi= |url=}}</ref><ref name="pmid370121">{{cite journal |vauthors=Digby JM, Kersley JB |title=Pyogenic non-tuberculous spinal infection: an analysis of thirty cases |journal=J Bone Joint Surg Br |volume=61 |issue=1 |pages=47–55 |date=February 1979 |pmid=370121 |doi= |url=}}</ref><ref name="pmid1775852">{{cite journal |vauthors=McHenry MC, Rehm SJ, Krajewski LP, Duchesneau PM, Levin HS, Steinmuller DR |title=Vertebral osteomyelitis and aortic lesions: case report and review |journal=Rev. Infect. Dis. |volume=13 |issue=6 |pages=1184–94 |date=1991 |pmid=1775852 |doi= |url=}}</ref> | |||
|Acute | |||
|Minutes to hours | |||
|Sudden, severe, sharp | |||
|Shoulders, arms, hips and legs | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
| +/- | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|CBC | |||
* [[Leukocytosis]] and left shift | |||
ESR | |||
* Elevated | |||
CRP | |||
* Elevated | |||
Procalcitonin | |||
* Elevated | |||
Culture and sensitivity | |||
* To identify causative agent | |||
|Radiography | |||
* Demonstrates endosteal or medullary lesion | |||
* Sequestration and cavity formation | |||
MRI | |||
* [[Bone marrow]] abnormalities and lytic changes | |||
CT | |||
* Articular and periarticular involvement | |||
Ultrasound | |||
* Soft tissue abnormalities | |||
Nuclear imaging | |||
* Loss of bone density | |||
| | |||
*Often caused by hematogenous spread of organism | |||
|- | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease | |||
! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation | |||
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments | |||
|- | |||
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms | |||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging | |||
|- | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Headache | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Nausea and vomiting | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Syncopy | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Motor weakness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Sensory deficit | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pulse Deficit | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Heart Murmur | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel or bladder dysfunction | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome | |||
|- | |||
! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Referred pain | |||
![[Myalgia]]<ref name="pmid7677303">{{cite journal |vauthors=Gumber SC, Chopra S |title=Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations |journal=Ann. Intern. Med. |volume=123 |issue=8 |pages=615–20 |date=October 1995 |pmid=7677303 |doi= |url=}}</ref><ref name="pmid3404526">{{cite journal |vauthors=Archard LC, Bowles NE, Behan PO, Bell EJ, Doyle D |title=Postviral fatigue syndrome: persistence of enterovirus RNA in muscle and elevated creatine kinase |journal=J R Soc Med |volume=81 |issue=6 |pages=326–9 |date=June 1988 |pmid=3404526 |pmc=1291623 |doi=10.1177/014107688808100608 |url=}}</ref><ref name="pmid18452688">{{cite journal |vauthors=Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD |title=Diagnosis and treatment of Lyme disease |journal=Mayo Clin. Proc. |volume=83 |issue=5 |pages=566–71 |date=May 2008 |pmid=18452688 |doi=10.4065/83.5.566 |url=}}</ref> | |||
|Chronic | |||
|Years | |||
|Dull aching | |||
|Variable | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|*Typically no specific lab findings | |||
*A full workup should be done to exclude other etiologies, such as; | |||
[[Rheumatoid factor]] and/or anti-cyclic citrullinated peptide antibodies | |||
*May indicate cause is [[rheumatoid arthritis]] | |||
CRP and ESR | |||
*May be elevated | |||
CBC | |||
*May indicate [[anemia]] | |||
Bone profile | |||
*May be caused by a [[vitamin D]] or calcium deficiency | |||
| | |||
*Typically no routine imaging done | |||
| | |||
*May be associated with [[Hepatitis C]] and [[Lyme disease]] | |||
|- | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease | |||
! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation | |||
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments | |||
|- | |||
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms | |||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging | |||
|- | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Headache | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Nausea and vomiting | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Syncopy | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Motor weakness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Sensory deficit | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pulse Deficit | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Heart Murmur | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel or bladder dysfunction | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome | |||
|- | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Tumors | |||
![[Ewing's sarcoma]]<ref name="pmid10963639">{{cite journal |vauthors=Cotterill SJ, Ahrens S, Paulussen M, Jürgens HF, Voûte PA, Gadner H, Craft AW |title=Prognostic factors in Ewing's tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing's Sarcoma Study Group |journal=J. Clin. Oncol. |volume=18 |issue=17 |pages=3108–14 |date=September 2000 |pmid=10963639 |doi=10.1200/JCO.2000.18.17.3108 |url=}}</ref><ref name="pmid2213103">{{cite journal |vauthors=Nesbit ME, Gehan EA, Burgert EO, Vietti TJ, Cangir A, Tefft M, Evans R, Thomas P, Askin FB, Kissane JM |title=Multimodal therapy for the management of primary, nonmetastatic Ewing's sarcoma of bone: a long-term follow-up of the First Intergroup study |journal=J. Clin. Oncol. |volume=8 |issue=10 |pages=1664–74 |date=October 1990 |pmid=2213103 |doi=10.1200/JCO.1990.8.10.1664 |url=}}</ref><ref name="pmid9053479">{{cite journal |vauthors=Raney RB, Asmar L, Newton WA, Bagwell C, Breneman JC, Crist W, Gehan EA, Webber B, Wharam M, Wiener ES, Anderson JR, Maurer HM |title=Ewing's sarcoma of soft tissues in childhood: a report from the Intergroup Rhabdomyosarcoma Study, 1972 to 1991 |journal=J. Clin. Oncol. |volume=15 |issue=2 |pages=574–82 |date=February 1997 |pmid=9053479 |doi=10.1200/JCO.1997.15.2.574 |url=}}</ref> | |||
|Chronic | |||
|Months to years | |||
|Dull aching | |||
|Variable | |||
| +/- | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
| | |||
Tests are used to rule out other pathologies; | |||
CBC | |||
*May indicate [[anemia]] | |||
Blood cultures | |||
*May be positive for various organisms | |||
ESR and CRP | |||
*May be elevated | |||
LDH | |||
*May be elevated | |||
Cytogenetic studies | |||
* May be positive for t(11;22) translocation | |||
Immunohistochemical markers | |||
*May be positive for MIC2 antigen (CD99) | |||
|Radiography | |||
*Periosteal reaction "onion skin" | |||
*Cortical thinning | |||
*Mottling | |||
MRI | |||
*Skip lesions | |||
*Edema | |||
*Metastasis | |||
PET - FDG | |||
*To identify metastatic disease | |||
|- | |||
![[Multiple myeloma]]<ref name="pmid12528874">{{cite journal |vauthors=Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR |title=Review of 1027 patients with newly diagnosed multiple myeloma |journal=Mayo Clin. Proc. |volume=78 |issue=1 |pages=21–33 |date=January 2003 |pmid=12528874 |doi=10.4065/78.1.21 |url=}}</ref><ref name="pmid20194150">{{cite journal |vauthors=Turesson I, Velez R, Kristinsson SY, Landgren O |title=Patterns of multiple myeloma during the past 5 decades: stable incidence rates for all age groups in the population but rapidly changing age distribution in the clinic |journal=Mayo Clin. Proc. |volume=85 |issue=3 |pages=225–30 |date=March 2010 |pmid=20194150 |pmc=2843108 |doi=10.4065/mcp.2009.0426 |url=}}</ref> | |||
|Chronic | |||
|Years | |||
|Dull aching | |||
|Hips, groin and legs | |||
| +/- | |||
| +/- | |||
| +/- | |||
| - | |||
| - | |||
| - | |||
| +/- | |||
| - | |||
| - | |||
| - | |||
| - | |||
| +/- | |||
| - | |||
|Serum protein [[electrophoresis]] | |||
*May demonstrate a M peak | |||
Serum free light chain assay and 24 - hour urine collection | |||
*May detect Bence-Jones proteins | |||
CRP | |||
*May be elevated | |||
Serum beta2-microglobulin | |||
*May be elevated | |||
Albumin | |||
*May demonstrate elevated [[albumin]] in urine | |||
LDH | |||
*May be elevated | |||
Peripheral blood smear | |||
*May demonstrate rouleaux formation > 50% | |||
*[[Leukopenia]] | |||
*[[Thrombocytopenia]] | |||
|Radiography, MRI and PET | |||
*Osteolytic lesions may be demonstrated | |||
| | |||
*Biopsy will demonstrate elevated plasma cells in the bone marrow | |||
|- | |||
|! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease | |||
! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation | |||
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments | |||
|- | |||
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms | |||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging | |||
|- | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Headache | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Nausea and vomiting | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Syncopy | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Motor weakness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Sensory deficit | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pulse Deficit | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Heart Murmur | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel or bladder dysfunction | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome | |||
|- | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Miscellaneous | |||
|- | |||
![[Sickle cell anemia]]<ref name="pmid1710777">{{cite journal |vauthors=Platt OS, Thorington BD, Brambilla DJ, Milner PF, Rosse WF, Vichinsky E, Kinney TR |title=Pain in sickle cell disease. Rates and risk factors |journal=N. Engl. J. Med. |volume=325 |issue=1 |pages=11–6 |date=July 1991 |pmid=1710777 |doi=10.1056/NEJM199107043250103 |url=}}</ref><ref name="pmid7097407">{{cite journal |vauthors=Keeley K, Buchanan GR |title=Acute infarction of long bones in children with sickle cell anemia |journal=J. Pediatr. |volume=101 |issue=2 |pages=170–5 |date=August 1982 |pmid=7097407 |doi= |url=}}</ref><ref name="pmid8888755">{{cite journal |vauthors=Resar LM, Oliva MM, Casella JF |title=Skull infarction and epidural hematomas in a patient with sickle cell anemia |journal=J. Pediatr. Hematol. Oncol. |volume=18 |issue=4 |pages=413–5 |date=November 1996 |pmid=8888755 |doi= |url=}}</ref> | |||
|Acute or chronic | |||
|Variable | |||
|Severe, sharp | |||
|Variable | |||
| +/- | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
| - | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|CBC | |||
*[[Hemoglobin]] level is between 5-9 g/dl | |||
*[[Hematocrit]] is decreased to 17-29% | |||
*[[Leukocytosis]] with predominance of [[neutrophils]] | |||
*[[Thrombocytopenia]] | |||
ESR | |||
*Decreased | |||
Reticulocyte count | |||
*Elevated | |||
Peripheral blood smear | |||
*May demonstrate [[target cell]]s, elongated cells, and sickle erythrocytes | |||
*Howell - Jolly bodies in an asplenic patient | |||
[[Hemoglobin]] solubility | |||
*Distinguishes between [[sickle cell disease]] and [[sickle cell trait]] | |||
Hemoglobin F | |||
*Percentage of [[Hemoglobin F]] is elevated | |||
LFT, [[renal function test]] and [[pulmonary function test]] | |||
*To assess organ distress or failure | |||
ABG | |||
*To detect [[oxygen saturation]] | |||
Urine analysis | |||
*May determine an [[urinary tract infection]] with hematuria and isosthenuria | |||
Sickling test | |||
*As screening for sickle hemoglobinopathies | |||
Secretory phospholipase A2 | |||
*May be increased in acute chest syndrome, a complication of [[sickle cell disease]] | |||
|Radiography | |||
*Osteonecrosis | |||
*Dactylitis indicated by medullary expansion, cortical thinning, trabecular resorption, and bone lucency | |||
*Osteomyelitis may be present and demonstrate sequestra, cortical destruction, periosteal growth and sinus formation | |||
MRI and CT | |||
*In addition to findings in radiography, may detect [[bone marrow hyperplasia]] | |||
*May also be useful in ruling out renal medullary carcinoma in those presenting with [[hematuria]] | |||
Nuclear imaging | |||
*Used to detect early osteonecrosis through Technetium-99m bone scanning | |||
*Used to detect early [[osteomyelitis]] through detection of elevation of[[white blood cell]]s in Indium-11 white blood cell scanning | |||
Transcranial doppler ultrasonography | |||
*Abnormally high blood flow is detected in those at increased risk of [[stroke]] | |||
Abdominal ultrasound | |||
*Used to exclude other pathologies such as, [[cholecystitis]], [[cholelithiasis]], [[ectopic pregnancy]], [[nephrolithiasis]], and [[papillary necrosis]] | |||
*May also be used to asses the size of the liver and spleen | |||
Echocardiography | |||
*Used to diagnose [[pulmonary hypertension]] based on tricuspid regurgitant jet velocity | |||
*Also used to assess abnormalities of systolic and diastolic function | |||
| | |||
*Sickle cell trait confers some protection against [[malaria]] | |||
|- | |||
![[Syringomyelia]]<ref name="pmid16676921">{{cite journal |vauthors=Milhorat TH |title=Classification of syringomyelia |journal=Neurosurg Focus |volume=8 |issue=3 |pages=E1 |date=March 2000 |pmid=16676921 |doi=10.3171/foc.2000.8.3.1 |url=}}</ref><ref name="pmid16549414">{{cite journal |vauthors=Brickell KL, Anderson NE, Charleston AJ, Hope JK, Bok AP, Barber PA |title=Ethnic differences in syringomyelia in New Zealand |journal=J. Neurol. Neurosurg. Psychiatry |volume=77 |issue=8 |pages=989–91 |date=August 2006 |pmid=16549414 |pmc=2077633 |doi=10.1136/jnnp.2005.081240 |url=}}</ref><ref name="pmid11807404">{{cite journal |vauthors=Larner AJ, Muqit MM, Glickman S |title=Concurrent syrinx and inflammatory central nervous system disease detected by magnetic resonance imaging: an illustrative case and review of the literature |journal=Medicine (Baltimore) |volume=81 |issue=1 |pages=41–50 |date=January 2002 |pmid=11807404 |doi= |url=}}</ref> | |||
|Chronic | |||
|Years | |||
|Dull aching | |||
|Variable | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|*Typically no specific lab findings | |||
|MRI | |||
*Of choice and demonstrates a syrinx (spinal cord cyst) | |||
*May also be useful in assessment of CSF flow dynamics | |||
Radiography and CT | |||
*May also visualize a syrinx | |||
Gadolinium scan | |||
*Useful in assessment of post-operative patients and can distinguish between a [[tumor]], [[scar]], and disk material | |||
Myelography | |||
*Used when MRI is unfruitful, and may detect widening of spinal cord and complete subarachnoid block | |||
| | |||
|- | |||
|} | |||
</small></small> | |||
Latest revision as of 18:03, 18 April 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Abbreviations: ABG = Arterial blood gases, ANA = Antinuclear antibodies, BUN = Blood urea nitrogen, CRP = C-reactive protein, CT = Computed tomography, DRA = Dual energy radiographic absorptiometry, DRE = Digital rectal exam, ERCP = Endoscopic retrograde cholangiopancreatography, ESR = Erythrocyte sedimentation rate, HSV = Herpes simplex virus, IVP = Intravenous pyelography, KUB = Kidney, bladder, ureter, LDH = Lactate dehydrogenase, LFT = Liver function test, MRA = Magnetic resonance angiography, MRC = Magnetic resonance cholangiopancreatography, MRI = Magnetic resonance imaging, MRU = Magnetic resonance urography, NSAIDs = Non-steroidal anti-inflammatory drugs, PCR = Polymerase chain reaction, PET - FDG = Positive emission tomography - fluorodeoxyglucose, PET = Positive emission tomography, PID = Pelvic inflammatory disease, PSA = Prostatic specific antigen, PTC = Percutaneous transhepatic cholangiography, RUQ = Right upper quadrant, SPECT = Single-photon emission computed tomography, TFT = Thyroid function test, VZV = Varicella zoster virus
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Neurological | Arachnoiditis[1] | Acute | Hours | Dull aching pain | Head, neck and back | +/- | + | +/- | +/- | +/- | +/- | +/- | +/- | +/- | - | - | +/- | +/- | CSF
Culture and sensitivity
Nucleic acid tests
|
Radiography
|
|
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Bone | |||||||||||||||||||||
Chronic recurrent focal osteomyelitis[2][3][4] | Chronic | Years | Dull aching pain | Local | +/- | + | + | - | - | - | +/- | - | - | - | - | - | - | CBC
Culture and sensitivity
|
Radiography
MRI
CT
Ultrasound
Nuclear imaging
|
| |
Sacroilitis[5][6] | Acute or chronic | Variable | Dull aching or throbbing | Hips and legs | +/- | + | +/- | - | - | - | +/- | +/- | +/- | - | - | +/- | - | CBC
ESR
CRP
Procalcitonin
Culture and sensitivity
|
MRI
CT
Radiography
Nuclear imaging
|
| |
Vertebral osteomyelitis[7][8][9] | Acute | Minutes to hours | Sudden, severe, sharp | Shoulders, arms, hips and legs | +/- | + | +/- | - | +/- | - | - | +/- | +/- | - | - | +/- | - | CBC
ESR
CRP
Procalcitonin
Culture and sensitivity
|
Radiography
MRI
CT
Ultrasound
Nuclear imaging
|
| |
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Referred pain | Myalgia[10][11][12] | Chronic | Years | Dull aching | Variable | +/- | +/- | +/- | +/- | - | - | - | - | - | - | - | - | - | *Typically no specific lab findings
Rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies
CRP and ESR
CBC
Bone profile
|
|
|
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Tumors | Ewing's sarcoma[13][14][15] | Chronic | Months to years | Dull aching | Variable | +/- | +/- | +/- | - | - | - | + | - | - | - | - | - | - |
Tests are used to rule out other pathologies; CBC
Blood cultures
ESR and CRP
LDH
Cytogenetic studies
Immunohistochemical markers
|
Radiography
MRI
PET - FDG
| |
Multiple myeloma[16][17] | Chronic | Years | Dull aching | Hips, groin and legs | +/- | +/- | +/- | - | - | - | +/- | - | - | - | - | +/- | - | Serum protein electrophoresis
Serum free light chain assay and 24 - hour urine collection
CRP
Serum beta2-microglobulin
Albumin
LDH
Peripheral blood smear
|
Radiography, MRI and PET
|
| |
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Miscellaneous | |||||||||||||||||||||
Sickle cell anemia[18][19][20] | Acute or chronic | Variable | Severe, sharp | Variable | +/- | + | +/- | - | - | - | - | - | - | - | - | - | - | CBC
ESR
Reticulocyte count
Peripheral blood smear
Hemoglobin solubility
Hemoglobin F
LFT, renal function test and pulmonary function test
ABG
Urine analysis
Sickling test
Secretory phospholipase A2
|
Radiography
MRI and CT
Nuclear imaging
Transcranial doppler ultrasonography
Abdominal ultrasound
Echocardiography
|
| |
Syringomyelia[21][22][23] | Chronic | Years | Dull aching | Variable | +/- | +/- | - | +/- | +/- | - | - | - | - | - | - | - | - | *Typically no specific lab findings | MRI
Radiography and CT
Gadolinium scan
Myelography
|
References
- ↑ Ozateş M, Kemaloglu S, Gürkan F, Ozkan U, Hoşoglu S, Simşek MM (January 2000). "CT of the brain in tuberculous meningitis. A review of 289 patients". Acta Radiol. 41 (1): 13–7. PMID 10665863.
- ↑ Lew DP, Waldvogel FA (2004). "Osteomyelitis". Lancet. 364 (9431): 369–79. doi:10.1016/S0140-6736(04)16727-5. PMID 15276398.
- ↑ Mader JT, Shirtliff M, Calhoun JH (December 1997). "Staging and staging application in osteomyelitis". Clin. Infect. Dis. 25 (6): 1303–9. PMID 9431368.
- ↑ Lew DP, Waldvogel FA (April 1997). "Osteomyelitis". N. Engl. J. Med. 336 (14): 999–1007. doi:10.1056/NEJM199704033361406. PMID 9077380.
- ↑ Foley BS, Buschbacher RM (December 2006). "Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment". Am J Phys Med Rehabil. 85 (12): 997–1006. doi:10.1097/01.phm.0000247633.68694.c1. PMID 17117004.
- ↑ Carette S, Graham D, Little H, Rubenstein J, Rosen P (February 1983). "The natural disease course of ankylosing spondylitis". Arthritis Rheum. 26 (2): 186–90. PMID 6600615.
- ↑ Beronius M, Bergman B, Andersson R (2001). "Vertebral osteomyelitis in Göteborg, Sweden: a retrospective study of patients during 1990-95". Scand. J. Infect. Dis. 33 (7): 527–32. PMID 11515764.
- ↑ Digby JM, Kersley JB (February 1979). "Pyogenic non-tuberculous spinal infection: an analysis of thirty cases". J Bone Joint Surg Br. 61 (1): 47–55. PMID 370121.
- ↑ McHenry MC, Rehm SJ, Krajewski LP, Duchesneau PM, Levin HS, Steinmuller DR (1991). "Vertebral osteomyelitis and aortic lesions: case report and review". Rev. Infect. Dis. 13 (6): 1184–94. PMID 1775852.
- ↑ Gumber SC, Chopra S (October 1995). "Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations". Ann. Intern. Med. 123 (8): 615–20. PMID 7677303.
- ↑ Archard LC, Bowles NE, Behan PO, Bell EJ, Doyle D (June 1988). "Postviral fatigue syndrome: persistence of enterovirus RNA in muscle and elevated creatine kinase". J R Soc Med. 81 (6): 326–9. doi:10.1177/014107688808100608. PMC 1291623. PMID 3404526.
- ↑ Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD (May 2008). "Diagnosis and treatment of Lyme disease". Mayo Clin. Proc. 83 (5): 566–71. doi:10.4065/83.5.566. PMID 18452688.
- ↑ Cotterill SJ, Ahrens S, Paulussen M, Jürgens HF, Voûte PA, Gadner H, Craft AW (September 2000). "Prognostic factors in Ewing's tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing's Sarcoma Study Group". J. Clin. Oncol. 18 (17): 3108–14. doi:10.1200/JCO.2000.18.17.3108. PMID 10963639.
- ↑ Nesbit ME, Gehan EA, Burgert EO, Vietti TJ, Cangir A, Tefft M, Evans R, Thomas P, Askin FB, Kissane JM (October 1990). "Multimodal therapy for the management of primary, nonmetastatic Ewing's sarcoma of bone: a long-term follow-up of the First Intergroup study". J. Clin. Oncol. 8 (10): 1664–74. doi:10.1200/JCO.1990.8.10.1664. PMID 2213103.
- ↑ Raney RB, Asmar L, Newton WA, Bagwell C, Breneman JC, Crist W, Gehan EA, Webber B, Wharam M, Wiener ES, Anderson JR, Maurer HM (February 1997). "Ewing's sarcoma of soft tissues in childhood: a report from the Intergroup Rhabdomyosarcoma Study, 1972 to 1991". J. Clin. Oncol. 15 (2): 574–82. doi:10.1200/JCO.1997.15.2.574. PMID 9053479.
- ↑ Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR (January 2003). "Review of 1027 patients with newly diagnosed multiple myeloma". Mayo Clin. Proc. 78 (1): 21–33. doi:10.4065/78.1.21. PMID 12528874.
- ↑ Turesson I, Velez R, Kristinsson SY, Landgren O (March 2010). "Patterns of multiple myeloma during the past 5 decades: stable incidence rates for all age groups in the population but rapidly changing age distribution in the clinic". Mayo Clin. Proc. 85 (3): 225–30. doi:10.4065/mcp.2009.0426. PMC 2843108. PMID 20194150.
- ↑ Platt OS, Thorington BD, Brambilla DJ, Milner PF, Rosse WF, Vichinsky E, Kinney TR (July 1991). "Pain in sickle cell disease. Rates and risk factors". N. Engl. J. Med. 325 (1): 11–6. doi:10.1056/NEJM199107043250103. PMID 1710777.
- ↑ Keeley K, Buchanan GR (August 1982). "Acute infarction of long bones in children with sickle cell anemia". J. Pediatr. 101 (2): 170–5. PMID 7097407.
- ↑ Resar LM, Oliva MM, Casella JF (November 1996). "Skull infarction and epidural hematomas in a patient with sickle cell anemia". J. Pediatr. Hematol. Oncol. 18 (4): 413–5. PMID 8888755.
- ↑ Milhorat TH (March 2000). "Classification of syringomyelia". Neurosurg Focus. 8 (3): E1. doi:10.3171/foc.2000.8.3.1. PMID 16676921.
- ↑ Brickell KL, Anderson NE, Charleston AJ, Hope JK, Bok AP, Barber PA (August 2006). "Ethnic differences in syringomyelia in New Zealand". J. Neurol. Neurosurg. Psychiatry. 77 (8): 989–91. doi:10.1136/jnnp.2005.081240. PMC 2077633. PMID 16549414.
- ↑ Larner AJ, Muqit MM, Glickman S (January 2002). "Concurrent syrinx and inflammatory central nervous system disease detected by magnetic resonance imaging: an illustrative case and review of the literature". Medicine (Baltimore). 81 (1): 41–50. PMID 11807404.