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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 and left lateral tibiotarsal instability

A 50 years old male with generalized ligamentous laxity and long history of distortions (Sprains) of the ankles. On the right ankle the incidence and severity of the sprains had increased significantly in recent months. On MRI imaging of both ankles: in the right ankle the lateral stabilizing ligaments are damaged and incongruent. On the left ankle the picture is similar with an old fracture of the tip of the medial malleolus which is not united, but not significantly displaced. Right ankle instability was diagnosed and  “Brodstrum“ type operation on right ankle has been suggested.

Vitamin D Abnormality / Parathyroid Hormone Abnormality

51-year-old female with vitamin D deficiency among other medical problems: high blood pressure, episodes of transient syncope, and sleep apnea. In the expert's opinion frequent changes and discontinuations of drugs as well as big intervals between one dose to another, can be responsible for hypertensive crisis. Therefore the expert recommends to stop too frequent investigations , and instead focus on appropriate treatment, that should be combination of Angiotensin Receptor Blocker and diuretics.

Bilateral Pronatory Syndrome Greater in the right foot – additional opinion

10-year-old female with pain and swelling of the right foot was diagnosed bilateral pronatory syndrome. The specialist recommended foot surgery for the lengthening of the Achilles tendon and application of retrograde endorthesis screw. The expert disagrees with the necessity of this procedure, and suggests differential diagnosis and conservative treatment that includes pain killers, soft shoes with soft insoles inside and mild elevation of the medial longitudinal arch of the feet.

Hypertensive Patient with mostly uncontrolled Blood Pressure

A known hypertensive female patient whose blood pressure is mostly uncontrolled. The expert recommends to focus on appropriate treatment which should include fixed combination of Angiotensin Receptor Blocker and diuretics together with 24 hour blood pressure monitoring. The expert emphasize that frequent changes, discontinuations of drugs or big intervals between one dose to another can be responsible for hypertensive crisis.