A: Cauda Equina Syndrome (cont.) IN THis ARTICLE * Cauda Equina Syndrome Overview * Cauda Equina Syndrome Causes * Cauda Equina Syndrome Symptoms * When to Seek Medical Care * Questions to Ask the Doctor * Exams and Tests * Cauda Equina Syndrome Treatment * Self-Care at Home * Medical Treatment * Medications * Surgery * Next Steps * Follow-up * Prevention * Outlook * Support Groups and Counseling * For More Information * Web Links * Multimedia * Synonyms and Keywords * Authors and Editors Cauda Equina Syndrome Symptoms Symptoms of cauda equina syndrome include the following: * Low back pain * Pain in one leg (unilateral) or both legs (bilateral) that starts in the buttocks and travels down the back of the thighs and legs… Subsequently the patient developed ten vesicular lesions on her body mostly at teh injection site. The present eruption started after the herpetic lesions had healed. Unspecified medial attention was sought. Subsequently the patient recovered from Herpes Zoster. The patient complained of intense sharp, stabbing pain and mild itching. Zoster keratitis is involvement of the opthalmic branch of the trigeminal nerve and is an opthalmologic emergency (sight threatening).
Ten days after the rash, progressive weakness on right leg and numbness in below waist appeared. She had full range of motion of her right hip and knee, and no lymphadenopathy was detected. Her white blood cell count was normal; blood and wound cultures were taken. For verification of the diagnosis and further treatment options, especially if the complaints are persistent, an imaging procedure will usually be performed. The patient was previously healthy, circumcised, and fully immunized through the age of two to include varicella. email@example.com. Recently, we observed a child who had developed shingles of the foot.
Allergic contact dermatitis is a delayed hypersensitivity reaction, usually caused by skin contact with an allergen. Lesions can be vesicular, edematous, erythematous, and pruritic. Concurrent medications were SYNTHROID, sulindac, MAXIDE, VICODIN, LIDODERM, NEURONTIN, prednisone, and PLAQUENIL. Herpes zoster is a reactivation of the varicella zoster virus, characterized by stabbing, neuritic pain in a dermatomal distribution. Clear vesicles on an erythematous, edematous base distributed along a dermatome constitutes the classic appearance. J Am Acad Dermatol 1999; 40:868–869. Pemphigus foliaceous is an autoimmune intraepidermal blistering disease with lesions occurring on the face, scalp, chest, and upper back.5 Intact blisters are not commonly seen.
The vesicle roof is very thin and ruptures easily, forming broad areas of crust. The incidence of herpes zoster is 14 cases per 100,000 person years among vaccine recipients and 20 to 63 (cases per 100,000 person years) among those with a natural varicella infection. As many as 61% of community-acquired methicillin-resistant S aureus (MRSA) infections are initially treated only with beta-lactam antibiotics, to which they are resistant.7 Risk factors for community-acquired MRSA infection include day-care attendance, recent hospitalization, recent antibiotic use, chronic illness, and frequent health care visits.8 A growing number of cases are reported among patients without risk factors. Community-acquired MRSA isolates are usually genetically different from nosocomial isolates, and have been relatively susceptible to non–beta-lactam antibiotics. These strains vary substantially, however, and it is important to check the susceptibility of the isolate. Awareness of the local antimicrobial susceptibility patterns of community S aureus isolates is also helpful. Oral antibiotics that have been successful include clindamycin, minocycline, doxycycline, and trimethoprim-sulfamethoxazole.
Cephalexin has no therapeutic value in treating community-acquired MRSA. Preventive efforts should be directed at patients with recurrent episodes of MRSA skin abscesses. Metabolic and immunologic screening should be performed to rule out underlying disease processes causing increased risk for infection. At the time of the report, the patient was recovering from the events. This pain is often described as numb, burning, or stinging. Fingernails should be kept short and clean. She could have any type of infection, or lymphonitis.
No diagnostic laboratory tests, including a direct fluorescent antibody, were performed and no specimens were collected for PCN analysis. For localized impetigo, topical therapy with mupirocin 2% ointment 3 times a day for 10 days is usually adequate. A 10-day course of oral antibiotic therapy with dicloxacillin or cephalexin is indicated in more widespread impetigo presumed to be methicillin-sensitive S aureus. Azithromycin (Zithromax) or clarithromycin (Biaxin) may be given to patients allergic to penicillin. However, it is becoming increasingly important to consider community-acquired methicillin-resistant S aureus species in cases such as this that do not respond to traditional therapy. Hence, culture and sensitivity of all suspicious lesions is highly suggested. In this case, the patient was diagnosed with bullous impetigo and admitted to the hospital.
She was started on intravenous clindamycin at 380 mg (30 mg/kg) every 8 hours. Clindamycin was chosen because most cases of community-acquired MRSA in this geographic area are resistant to trimethoprim-sulfamethoxazole and susceptible to clindamycin. In 80% of herpes zoster the skin rash appears after 3-5 days of prodromal pain and paresthesia.2 Yet, the prodromal stage may be longer or the cutaneous affection can be absent at all. Within 24 hours of intravenous clindamycin, the lesion was markedly improved and the culture confirmed that the MRSA was sensitive to clindamycin. No differences in cutaneous nerve density were found in relation to antiviral therapy. Exanthem on medial side of left foot. 2.
Bruijnzeels MA, van Suijlekom-Smit LW, van der Velden J, van der Wouden JC. On 03MAR11, patient had pain at the site which was significant especially anteriorly and she was wondering if her lupus could be making her pain worse. Dutch national survey of morbidity and interventions in general practice. Rotterdam: Erasmus University Rotterdam, 1993.