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Children and patients with a history of cancer are the primary subsets of patients in whom serious etiologies for back pain are most likely. Get full access to all EB Medicine articles published 3 years (or more) ago, including evidence-based, peer-reviewed diagnosis and treatment recommendations. A 45 year-old male presents with progressive jaundice over 1 month, he denies abdominal pain.
Patient age was not significantly different among the groups at the time of MR examination.
The susceptibility effect associated with iron deposition might decrease ADC values in such regions [1].
Histological changes in the substantia nigra in the midbrain and the locus ceruleus in the pons might be too small to be detected as elevated rADC values in these regions in PD [30]. The evaluation of rADC values in separated anatomical regions seems to be useful method to reflect gradient severity of histopathological changes in MSA and PSP.
ROIs are placed manually in the head of the caudate nucleus, thalamus, anterior, intermediate and posterior regions of the putamen (A), medial and lateral parts of the globus pallidus (B), midbrain (C), pons and superior cerebellar peduncle (D), middle cerebellar peduncle, cerebellar dentate nucleus (E), and cerebellar white matter (F).
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Rarest of Rare: A pictorial review of most atypical and unusual presentations of central nervous system tuberculosis. The utility of semi-quantitative dynamic contrast-enhanced MR imaging for differentiating type II endometrial carcinoma from type I endometrial carcinoma.
August 20, 2015 By Allison Zwingenberger Leave a Comment Today’s case is a 6 year old female neutered domestic medium hair cat with bilateral pelvic limb lameness. There is bilateral tarsal effusion affecting all joints, particularly within the tibiotarsal joint.
Allison Zwingenberger: This is a fairly big dog so the bronchi are a bit more visible than usual.


The emergency physician should use extreme caution when evaluating these patients.Back Pain In ChildrenTry to think of the last time that you evaluated a child who suffered from atraumatic back pain.
The process is often preceded by a viral or bacterial infection, surgery, immunization, lymphoma, or exposure to toxins.
It may be difficult to recall the case…not because you have a weak mind, but because children rarely present to the ED with this complaint. Common clinical manifestations include progressive weakness, loss of sensation, and loss of deep tendon reflexes. However, when it occurs, back pain in children is more likely to result from a serious etiology.7,60When taking the history, consider several factors.
Specifically, has the patient started a new exercise program, or is he or she participating in gymnastics, football, or dance?
These activities raise concern for spondylolysis and spondylolisthesis.60 Have there been any preceding bacterial or febrile illnesses? Patterns of intrahepatic bile duct dilatation at CT: correlation with obstructive disease processes. Ask whether there been a change in the child’s gait, or any voluntary limitation of their activity because of the pain.
Differential diagnosis of intrahepatic bile duct dilatation without demonstrable mass on ultrasonography or CT: benign versus malignancy. Finally, nocturnal pain raises concern for either tumor or infection.The physical examination is similar to that of the adult patient, with emphasis on several areas.
Specifically, examine the skin looking for “birthmarks” such as cafe au lait spots, which may indicate neurofibromatosis.
Also, be alert for midline skin abnormalities on the back, such as a hairy nevus, hemangioma, lipoma, or dermoid sinus. When examining the spine, note the amount of thoracic kyphosis and lumbar lordosis, and test for scoliosis.
The initial diagnostic evaluation of the child with back pain should be more comprehensive than that of the adult patient.


Almost every child who presents with back pain should have anteroposterior and lateral radiographs of the involved spine. In addition to the radiographs, consider obtaining an ESR, UA (and possibly the unreliable CBC) depending upon a worrisome complaint, such as night pain, fever, or limitations of activity secondary to pain. If there is suspicion for infection, tumor, or bony abnormalities, MRI or CT scan may be indicated.The differential diagnosis of pediatric back pain can be classified according to age. Adolescent pathologies continue until the age of 18, after which “adult” etiologies predominate.Back Pain In The Patient With A History Of Cancer Patients who have back pain and a history of cancer represent a unique group. They are at risk of spinal metastases that can produce disastrous neurological deterioration. Signs and symptoms include new urinary urgency or incontinence, weakness, numbness, paresthesias, gait disturbances, absent reflexes, or the involvement of multiple or bilateral spinal levels. This group is at the highest risk of developing a complete epidural compression syndrome over hours to days and requires emergent intervention.
Findings are limited and may include an isolated Babinski’s sign, or radicular pain, weakness, sensory or reflex changes in the distribution of a single nerve root. The involvement of multiple nerve roots, multiple spinal levels, or bilateral symptoms places patients into Group I.Group II patients require plain spinal radiography of the involved spine. If radiographs are consistent with metastatic disease, epidural extension is present in up to 88%.46 These patients require 10 mg of intravenous dexamethasone and should undergo a spinal MRI within 24 hours, if not emergently.
If normal, treat these patients conservatively with appropriate precautions and primary care follow-up within 3-7 days.
If abnormal, these patients necessitate consultation, as they will require a localized spinal MRI. However, the MRI does not need to be obtained on an emergent basis, nor do these patients require dexamethasone.



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