Skip to main content
Ischemic Heart Disease

A very physically active 49-year-old male with a history of labile hypertension and hypercholesterolemia with an LDL cholesterol of 126 mg%. He underwent an exercise stress test which revealed reversible inferoseptal ischemia at a peak heart rate of 171 bpm and peak blood pressure of 195/85. In the expert's opinion, the results suggest that the patient has silent myocardial ischemia and may be at risk for sudden cardiac death, especially in light of the marked exertional level of activity.

Atrial Fibrillation at medium /high ventricular response_2

72-year-old male had a TIA in 1995 and has been in chronic atrial fibrillation since 1992. In 2005 2 ablative procedures were ineffective. The main treatment strategy for his atrial fibrillation has consisted of rate control and oral anticoagulation. Despite several attempts of different medications (digoxin, beta-blockers) he has remained in atrial fibrillation with a relatively moderate to fast ventricular response.

Sinus Tachycardia in Mitral Insufficiency

43-year-old female with history of continued cigarette smoking and complaints of palpitations. A sinus tachycardia of 160 is documented with little physical activity. Pulmonary function studies revealed obstructive ventilatory defects, consistent with the smoking or beta blockers. She has been documented to have moderate mitral regurgitation, consistent with prior rheumatic disease. At the present time, she is on Inderal.

Spinal pathology

75-year-old male with multiple complaints related to both his lumbar and cervical spine. He complains of low back pain, cramping and numbness in his thigh muscles, radiating left leg pain to his toes, as well as unsteady gait. He experiences numbness in his shoulders, arms and hands that gets worse over the day. He had a C4-5 fusion and a lumbar procedure at L4-5. The cervical MTI showed degenerative disease worse at C6-7 where there is moderate central and foraminal stenosis.

Axonal and Demyelinative Sensorimotor Neuropathy

66-year-old male with a 6-year history of sensory symptoms in the feet and hands. He describes a sensation of cold and stinging in the feet; and numbness in the hands, especially at night. Nerve conduction and EMG demonstrated axonal and demyelinative sensorimotor neuropathy with neurogenic changes in muscles. Follow-up nerve conduction testing that was performed 2 years later showed similar findings.

Persistent Vertigo

47-year-old female who had the onset of persistent vertigo. The first evaluations revealed right beating nystagmus on gaze straight and to the right, unsteady gait with limb ataxia, and positive head thrust to the left. Improvement seemed to be occurring in that gait deviation with eyes closed was no longer present. Vestibular physical therapy exercises were started. On the next evaluations there was paroxysmal positional vertigo from the left ear and minimal neurosensory hearing loss. An audiogram showed minor neurosensory deafness.

Left lumbosciatic pain from double disc protrusion

35-year-old female experienced an episode of lower back pain. Her doctor prescribed injections with Orudis, followed by further treatment with Voltaren. The treatment resulted in a simple remission of pain, that then re-appear at the same intensity as initially. The doctor established a new treatment that consisted of Indoxen and Bentelan. The patient experienced a remission of symptoms until even more intense lumbar pain returned spreading to the left leg. She recieved Voltaren, Muscoril, and Indoxen. Lumbar-sacral NMR showed disc central protrusion.

Post-trauma tendinopathy of left shoulder

44-year-old male that sustained a contusion to his left shoulder while falling at his home. Following the fall he suffered severe pain. An ultrasound to the shoulder was interpreted as showing some changes in the ACJ and peritendinitis of the biceps brachi. The orthopedic surgeon that examined the patient about 2 weeks post injury had the impression of tendinopathy and requested an MRI that had indicated changes in signals in the ACJ and superior impingement of the supraspinatus and peritendinitis of the biceps. On the basis of these findings an arthroscopy was suggested.

Pulmonary heteroplasia_2

66-year-old female was diagnosed, following persistent cough, with non-operable tumor of her lung with satellite nodules, and chemotherapy was initiated (first Cisplatin and Gemcitabine, and then switched to Tarceva). Response evaluation following the fourth cycle of chemotherapy showed either stability or an initiation of tumor response, but bone scintigraphy that was performed 6 months later revealed an area of increased uptake in the left hemithorax which could be suggestive of a secondary bone lesion.

Pulmonary Heteroplasia – additional opinion

66-year-old female was diagnosed, following persistent cough, with lung tumour with concomitant pulmonary nodules and a measurable enlargement of lymph nodes. FBS was positive for well differentiated neuroendocrine carcinoma and a needle biopsy revealed adenocarcinoma with associated neuroendocrine differentiation.

Pulmonary heteroplasia_3

66-year-old female was diagnosed, following persistent cough, with non-operable tumor of her lung with satellite nodules, and chemotherapy was initiated (first Cisplatin and Gemcitabine, and then switched to Tarceva). Response evaluation following the fourth cycle of chemotherapy showed either stability or an initiation of tumor response, but bone scintigraphy that was performed 6 months later revealed an area of increased uptake in the left hemithorax which could be suggestive of a secondary bone lesion.

 

Post Traumatic Double Pelvic Fracture

73-year-old female with history of backache and diagnosis of Adult Scoliosis, fell down getting a back trauma at the level of the left hip and inferior limb. After severe symptomatic worsening X-ray examination was performed. The findings were: asymmetric pelvis, bilateral coxarthrosis, coarse arthrosic and osteophytosic manifestations, discopathies and disc arthrosis. The prescribed therapy included Piroxicam, Tioside, Depalgos, and low-molecular-weight-heparin therapy that was later replaced by NSAIDs by injection

Cervical Disk Hernia_1

62-year-old male complained about sensation of pins and needles in the fingers accompanied by pain and feeling of pressure in the toes. The patient underwent CT and MRT of the cervical spine and conduction studies that showed signs of severe chronic neuropathy, Lordosis, disc hernias with pressure on the dural sac and narrowing of the canal together with segment myelopathy and spinal stenosis. In light of the weakness of the muscles in the patient's right hand, the expert recommendes a surgical solution.

Pulmonary heteroplasia

66-year-old female was diagnosed with lung tumour within the right hemithorax with concomitant pulmonary nodules and a measurable enlargement of lymph nodes. FBS was positive for well differentiated neuroendocrine carcinoma and a needle biopsy revealed adenocarcinoma with associated neuroendocrine differentiation. The patient was then treated with altogether four courses of induction chemotherapy.

Cervical Dystonia

47-year-old female with a 4-year history of cervical dystonia. She has been treated with botulinum toxin injections which were ineffective for her. In the expert's opinion, the success of Botulinum toxin in cervical dystonia depends on a thorough clinical assessment, exact targeting of the chosen muscles, and adequate doses of toxin injected. The expert also suggests additional or alternative treatment strategies: medical treatment by different oral drugs, or deep brain stimulation of the globus pallidus interna.

 

Right Post-Traumatic Gonalgia

55-year-old male diagnosed with Right side gonalgia due to degenerative meniscopathy. The expert suggests anti-inflammatory medications, physiotherapy and modified daily activity. Arthroscopy should be considered only in case of no symptomatic improvement.

Right foot pain

38-year-old female started to suffer pain in her right foot on without a notable trauma. She was examined by several orthopeadic doctors and she got different opinions. The first diagnosed medium sprain of right foot and slight tumefaction on forefoot, and suggested her paracetamol administration that was with no benefit. The second specialist diagnosed sesamoiditis and right plantar fasciitis with 3rd degree cavus-valgus feet and recommended Depomedrol + Lidocaine, Pennsaid drops and NSAIDs. As part of the examinations she underwent an MR with and without Gadolinium.

Spinal pathology – additional opinion

75-year-old male with multiple complaints related to both his lumbar and cervical spine. He complains of low back pain, cramping and numbness in his thigh muscles, radiating left leg pain to his toes, as well as unsteady gait. He experiences numbness in his shoulders, arms and hands that gets worse over the day. He had a C4-5 fusion and a lumbar procedure at L4-5. The cervical MTI showed degenerative disease worse at C6-7 where there is moderate central and foraminal stenosis.

Suspected Foreign Body

Female patient which history of fibrocystic breast surgery, gallbladder remove and appendix remove, underwent multiple in order to rule out migrated foreign body from previous surgery and ruptured residual bowel laceration. There was no evidence of foreign body, but the examinations found diverticulosis in the colon, hypodense lesion in the uterus with uterine myoma, and mural calcifications in the aorta and iliac arteries.

Incomplete Vitreous Detachment of the Left Eye

63-year-old female with clinical ocular history of mild myopia and presbyopia, started seeing floaters in her right eye, which worsened on the next day and were accompanied by photophobia. Examination revealed the existence of posterior vitreous detachment, with no evidence for retinal tear. Three days later she was examined again due to worsening of the symptoms and laser photocoagulation was performed at an area of suspected retinal traction. She still experiences the existence of floaters as well as light flashes.

 

Left lumbosciatic pain from L4-L5 and L5-S1 annular protrusion

The patient experienced an episode of lower back pain while carrying home shopping bags. Her family doctor diagnosed a “left lumbosciatic pain” and prescribed injections with vials of Orudis and Voltaren. The treatment resulted in temporary remission, therefore the patient started a new treatment regiment of Indoxen and Bentelan + acupuncture treatment which was partially beneficial.

Child suffering from NF-1 and optic nerve glioma

5-year-old boy with diagnosis of neurofibromatosis type 1 underwent ophthalmological evaluation that showed picture of slight reduction in visual acuity of the right eye and severe hypovision of the left eye with slight reduction of the bilateral visual field. MRI showed presence of a big expansive lesion and of right temporopolar arachnoid cyst. The treating doctors recommended an urgent surgery in order to reduce the cerebral hypertension.

Asthenic-dispeptic syndrome post laparoscopic cholecystectomy

48-year-old male underwent laparoscopic cholecystectomy for symptomatic cholelithiasis. During post-surgery he developed intense abdominal colics and a situation of hepatitis, probably from medicines as the tests carried out. Performed tests revealed changes of haematic values related to the hepato-renal function. MR-cholangiography showed cystic formation in the right lobe of the liver, and tumor markers that gave evidence of an increase of alpha-fetoprotein which should be monitored.

Severe right coronary artery stenosis

49-year-old-male complained of a feeling of oppression behind the sternum, always when there was emotional stress. His coronary CT showed Severe high level stenosis with wall irregularities of the right coronary artery. The treatment options are coronary revascularization procedure versus optimized pharmacologic management.

Multiple Sclerosis_2

21-year-old female with an acute onset of a unilateral sixth cranial nerve deficit. Brain MRI showed at least a dozen white matter lesions, one of them contrast-enhancing. Sensory evoked potentials showed a bilateral increase in latency. Multiple sclerosis was diagnosed, and the patient was treated by corticosteroids, followed by improvement of symptoms. The first follow-up revealed no focal neurological signs with a history of a transitory unilateral lower limb hyposthenia. On the second visit, a horizonto-rotatory nystagmus and irregular paraesthesia in the right toes are documented.

Multiple Sclerosis_1

21-year-old female with an acute onset of a unilateral sixth cranial nerve deficit. Brain MRI showed at least a dozen white matter lesions, one of them contrast-enhancing. Sensory evoked potentials showed a bilateral increase in latency. Multiple sclerosis was diagnosed, and the patient was treated by corticosteroids, followed by improvement of symptoms. The first follow-up revealed no focal neurological signs with a history of a transitory unilateral lower limb hyposthenia. On the second visit, a horizonto-rotatory nystagmus and irregular paraesthesia in the right toes are documented.

Cerebral Atrophy

A 52 year old began having difficulties with balance. His problems evolved and he had been seen by neurologists providing clinical evidence for a cerebellar motor syndrome. The most recent examination showed ataxia, dysarthria, nystagmus, dysphagia and hyperreflexia. Although the disease has progressed the patient is not severely disabled at this time. 

 

Guillain-Barré Syndrome / Acute Myeloradiculoneuritis

45-year-old male who presented with acute onset of flaccid paraparesis more pronounced on the left, sensation of current shocks in both legs and sensory level from the umbilicus downwards. The symptoms have reached their pick within less than a day. On examination the left lower limb was plegic and the right lower limb was partially weak. EMG was interpreted as demyelinating sensorimotor neuropathy. MRI showed hyperintense signals at the dorsal terminal segment of the marrow consistent with myelitis.

Multiple myeloma with renal involvement, bone lesions and Neuropathy

71-year-old-male had been diagnosed as having multiple myeloma (MM), apparently of the IgA-Lambda type, with renal involvement. The disease course is characterized by "ups and downs responding to anti-MM therapy. During the disease course, several problems and complications developed: Renal failure, Bone lesions and Neuropathy.