Physical Manipulation-Induced Femoral Neck Fracture: A Case Report

Manipulative treatments for pain are very widely used nowadays by a variety of physicians. These treatment modalities are generally safe, but various studies have reported serious complications. This report presents the case of a 78-year-old male patient with a history of Parkinson’s disease, who was diagnosed with a right hip fracture that occurred as a result of physical manipulative treatment. He underwent a cemented hemi-arthroplasty as appropriate surgical treatment of his condition. Manipulative treatments can result in minor and major complications ranging from simple sprains and rib fractures to cerebrovascular accidents and death. The frequency of these events seems to be rare; however, no robust studies are present and further investigations are urgently needed. Hip fractures as a result of this treatment have not been previously mentioned. This is the first reported case in the literature of a hip fracture resulting from manipulative treatment. Primary care physicians and orthopedists should be aware of the possibility of this outcome and rule it out whenever necessary.

Parkinsonism with a Hint of Huntington’s from 29 CAG Repeats in HTT

Huntington’s disease is caused by at least 36 cytosine-adenine-guanine (CAG) repeats in an HTT gene allele, but repeat tracts in the intermediate range (27–35 repeats) also display a subtle phenotype. This patient had a slightly elongated CAG repeat tract (29 repeats), a prominent family history of Parkinson’s disease (PD), and a clinical phenotype mostly consistent with PD, but early dystonia and poor levodopa response. Neurophysiological test results were more consistent with Huntington’s disease (HD) than PD. It is suggested that the intermediate allele modulated the clinical phenotype of PD in this patient.

Symptomatic, left-sided deep brain stimulation lead edema 6 h after bilateral subthalamic nucleus lead placement

Background: Deep brain stimulation (DBS) lead edema can be a serious, although rare, complication in the postoperative period. Of the few cases that have been reported, the range of presentation has been 33 h–120 days after surgery. Case Description: We report a case of a 75-year-old male with a history of Parkinson’s disease who underwent bilateral placement of subthalamic nucleus DBS leads that resulted in symptomatic, left-sided lead edema 6 h after surgery, which is the earliest reported case. Conclusions: DBS lead edema is noted to be a self-limiting phenomenon. It is critical to recognize the possibility of lead edema as a cause of postoperative encephalopathy even in the acute phase after surgery. Although it is important to rule out other causes of postoperative changes in the patient examination, the recognition of lead edema can help to avoid extraneous diagnostic tests or DBS lead revision or removal.

Andrew Lees, a visionary mentored by a madman

ABSTRACT Andrew Lees, Professor of Neurology at the National Hospital Queen Square (London, UK), has been recognized as the world’s most highly-cited researcher over the 200-year history of Parkinson’s Disease. Although he remains actively involved in the investigation of movement disorders, Prof. Lees embarked on a literary career that started in 2011 with the publication of a social history of his native Liverpool. His last work is Mentored by a Madman: The William Burroughs Experiment, which is reviewed here.

History of Parkinsonism

This chapter explores the history of Parkinson’s disease and similar conditions. Dr James Parkinson’s initial description of this syndrome is covered along with all of the major developments in the understanding of the disease since then up to the modern era. Therapies are detailed, from early herbal remedies up to current treatment, including dopamine and levodopa, non-levodopa therapy, and surgery, and glimpses are given of potential future therapies. The conditions that are similar, the so-called “parkinsonian conditions,” are discussed as well. Synonyms: idiopathic Parkinson disease; Parkinson syndrome, Parkinson’s disease, Parkinson plus.