No. 223 Case Report of Woman With Severe Refractory Thoracolumbar Pain: Evaluation and Treatment

Abstract

Description: The patient was admitted to our department with severe neck pain and headache which had been lasting for 4 weeks. Brain CT was normal and cervical x-ray showed cervical spondylosis. Cervical MRI revealed spinal stenosis at C5-C6 intervertebral disc level. Neurologic exam was normal. 15 sessions of electrotherapy and exercises were applied but her complaints did not resolve. As we questioned the patient carefully, persistent pain and stiffness affecting both shoulder and pelvic girdles were detected. Morning stiffness was lasting more than an hour. Erythrocyte sedimentation rate (ESR) was 60 mm/hr. Based on these findings, PMR diagnosis was given. Low-dose prednisolone (10 mg/day) was begun. Prednisolone led to significant clinical improvement after the 4th day of the treatment. ESR was 25 mm/hr at the 10th day of the treatment. The patient had continued prednisolone treatment for 6 months. Discussion: In this case report we aimed to present an elderly patient who had diagnostic challenge for PMR. We wanted to emphasize that the pathological finding on MRI can not always be the cause of the patient's pain. Clinical examination can sometimes be more valuable than diagnostic images. Conclusion: Clinicians should keep in mind PMR diagnosis in old patients with cervical pain and headache who do not respond to conservative treatments. Patients should be asked whether they have shoulder/pelvic girdle pain and morning stiffness. Reprinted with permission.