Parkinson’s disease occurs in elderly it is noted to be one percent in population over the age of sixty it’s associated with tremor muscle rigidity bradykinesia and akinesia difficulty with muscle motion akinesia is the loss of normal automatic motion such as eye blinking swallowing so patients can drool and have a decreased arms swing when walking many patients will have a pil rolling maneuver at rest motor strength will be normal even though the motion is slow and seventy five percent of patients may have unilateral symptoms there is rest tremor present that is a pill rolling.
But the voice tremor typically does not occur and there is a typical gait called a festianation gait the patient tends to take short steps with the upper body traveling faster than the lower body and a walk will typically turn into a run in advanced diseases charcot marie tooth disease is an inherited disease of peripheral nerves there’s actually a number of different types it’s also called peroneal muscle atrophy the myelin sheath and the nerve itself are both affected and it’s both motor and sensory the hallmark of this disease.
Is a cavovarus foot a fancy way of saying a very high arch turned in foot with arched toes the picture on the side is significant for this some individuals have a quote stork leg appearance unquote where they have lower leg muscle atrophy but the upper muscles in the thighs are still intact ten percent of patients with charcot marie tooth will have a spinal deformity and intrinsic muscles of the hand can also be involved lyme disease lyme disease is in infectious neurologic diesease caused by the bite of the deer tick.
Inflammatory, Autoimmune, Infectious Diseases Part 2 Lower Back Pain Spine Expert in Colorado
This deer tick will carry the bacteria borrelia burgdorferi which is a spirochete the onset from the tick bite is about three to thirty two days and eighty percent of patients will experience a rash called in erythema migrans what they’ll see is a small central erythematuous macula or papule that spreads into a larger red ring with central clearing called the target lesion seen on the lady on the right the symptoms will initially be headaches fever chills myalgias and fatigue fifteen percent of these patients will develop frank nerve.
Abnormalities such as meningitis encephalitis cranial neuritis such as bell’s palsy plexitis or momoneuritis multiplex individual nerves which all become involved in months to years later the patient can develop chronic nerve manifestations which include mood memory sleep patterns spinal and even radicular pain and eight percent will develop cardiac manifestations the treatment is doxycyclin and erythromycin if caught early guillain barre syndrome is called ascending paralysis it’s an autoimmune disorder associated with myelin destruction onset can be days or weeks after a viral prodrome it starts always in the foot it works up the leg and then ascends up the.
Spine the ascent can take two to three weeks but some aggressive cases have noted to see three to four hours of ascent the mildest form of guillain barre is simple fatigue and typically won’t be recognized when the ascent goes to the diaphragm lifesupport it’s necessary and the affestc typically disappear within months but fifteen percent of patients can have lasting impairment herpes zoster as most people know herpes zoster or shingles is the varicella virus or the chicken pox virus if a patient hasn’t had chicken pox they won’t develop herpes zoster.
The virus typically lies dormant in the spinal dorsal root ganglion and for some reason a unknown stressor will activate the virus the symptoms are unilateral pain down the dermatome of the nerve and two to three days later a rash will develop these are small reddish fluid filled blisters called vesicles the rash increases from onset for three days and then dries up and small scars can permanently form there is a very painful condition that can occur to an injured nerve called postherpetic neuralgia which is painful scarring of a nerve.
And a permanent painful condition if steroids are given during the beginning of the attack this will typically prevent nerves scarring parsonage turner syndrome is a brachial plexopathy an involvement of the lower motor neurons of the brachial plexus it will be an onset somewhat similar to a herniated disc in the neck it’s one sided unilateral shoulder pain which is severe and crescendos in a day or two it’s associated with significant weakness of the shoulder and the upper extremities the paralysis can last months to a year and typically there’s full recovery in about seventy five percent.
But this is prolonged males are noted to be much more common than females at 21 to 41 the diagnosis is made by exclusion and an EMG as this is a plexopathy an EMG should not show any involvement of the pair of vertebral muscles autoimmune vertebral involvement or spondyloarthropathies most of these disorders start with the sacroiliac joint involvement except for rheumatoid arthritis and lupus most are unilateral SI involvement except ankylosing spondylitis which is typically bilateral involvement stiffness in the morning that gets better with motion is a typical indicator of.
The autoimmune vertebral involvement fatigue is also very common the types of spondyloarthropathies are rheumatoid arthritis psoriatic arthritis ulcerative colitis crohns reiter’s syndrome ankylosing spondylitis and lupus DISH is diffuse idiopathic skeletal hyperostosis or forestier’s disease this is a typically non painful disease and associated with diabetes ten percent of patients with diabetes will have this disease it’s characterized by these non marginal very large osteophytes sites where the spine starts becoming stiff and the spine can eventually fuse together unilateral SI involvement as noted before are typically the seronegative spondyloarthropathies.
Seronegative because the serum is negative there is no HLA B27 here and again noted ulcerative colitis and crohn’s psoratic arthritis reiter’s syndrome but not ankylosing spondylitis as there is bilateral involvement in this CT scan we can see the right SI joined is not involved and the left SI joint is fused indicating a unilateral SI involvement or seronegative spondyloarthropathies seronegative spondyloarthropathies develop non marginal syndesmophytes these are spurs that join the vertebra together that are not right on the margin they actually swing out here marginal syndesmophytes that go right edge to edge are typical of ankylosing spondylitis.
And again these diseases have sacroiliac involvement fatigue and lethargy and typically not common HLA B27 but they can have that this is compared to ankylosing spondylitis the prototype for these diseases it first starts with bilateral joint sacroiliac involvement the incidence is considered to be one in a thousand in patients there’s periods of remission and aggravation it’s typical to have back pain that wakes the patient up at night morning stiffness it is relieved with exercise anterior uveitis and unlike the others marginal syndesmophytes it’s typically called a bamboo spine in ninety five percent of patients.
Are positive for HLA B27 it’s also a typical to have a kyphosis and as we can see this patient’s bent forward with a few spine and we look at the brow chin angle ankylosing spondylitis starts on xrays with an initial squaring of the vertebra as you can see here the vertebra should typically be cut but they start to square and marginal syndesmopkytes are the most common findings physical exam findings and ankylosing spondylitis will first be noted with chest excursion if you measure inspiration and exploration of the chest.