January/February - West Virginia State Medical Association

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Scientific Article | References 1. Chen CJ, Hsu HL, Niu CC et al: Cervical Degenerative Disease at Flexion-Extension MR Imaging: Prediction Criteria. Radiology 227:136-142, 2003. 2. Dvorak J: Epidemiology, Physical Examination, and Neurodiagnostics. Spine 23(24):2663-2673, 1998. 3. Edwards CC, Heller JG, Murakami H: Corpectomy versus Laminoplasty for Multilevel Cervical Myelopathy: an Independent Matched-Cohort Analysis. Spine 27(11):1168-1175, 2002. 4. Emery SE: Cervical Spondylotic Myelopathy: Diagnosis and Treatment. J Am Acad Orthop Surg 9(6):376-388, 2001. 5. Fehlings MG, Skaf G: A Review of the Pathophysiology of Cervical Spondylotic Myelopathy with Insights for Potential Novel Mechanisms Drawn From Traumatic Spinal Cord Injury. Spine 23(24):2730-2736, 1998. 6. Fouyas IP, Statham PF, Sandercock PA: Cochrane Review on the Role of Surgery in Cervical Spondylotic Radiculomyelopathy. Spine 27(7):736-747, 2002. 7. Inufusa A, An HS, Lim TH, Hasegawa T, Haughton VM, Nowicki BH: Anatomic Changes of the Spinal Canal and Intervertebral Foramen Associated With Flexion-Extension Movement. Spine 21(21):2412-2420, 1996. 8. Muhle C, Metzner J, Weinert D et al: Classification System Based on Kinematic MR Imaging in Cervical Spondylitic Myelopathy. American Journal of Neuroradiology 19:1763-1771, 1998. 9. Muhle C, Wiskirchen J, Weinert D et al: Biomechanical Aspects of the Subarachnoid Space and Cervical Cord in Healthy Individuals Examined with Kinematic Magnetic Resonance Imaging. Spine 23:556-567, 1998. 10. Nugent GR: Clinicopathologic Correlations in Cervical Spondylosis. Neurology 9:273- 279, 1959. 11. Okada Y, Ikata T, Katoh S, Yamada H: Morphologic Analysis of the Cervical Spinal Cord, Dural Tube, and Spinal Canal by Magnetic Resonance Imaging in Normal Adults and Patients with Cervical Spondylotic Myelopathy. Spine 19:2331- 2335, 1994. 12. Sampath P, Bendebba M, Davis JD, Ducker TB: Outcome of Patients Treated for Cervical Myelopathy: A Prospective, Multicenter Study with Independent Clinical Review. Spine 25(6):670-676, 2000. 13. Young WF: Cervical Spondylotic Myelopathy: A Common Cause of Spinal Cord Dysfunction in Older Persons. Amer Fam Phys 62(5):1064-1070, 2000. Drug or Alcohol Problem? Mental Illness? If you have a drug or alcohol problem, or are suffering from a mental illness you can get help by contacting the West Virginia Medical Professionals Health Program. Information about a practitioner’s participation in the program is confidential. Practitioners entering the program as self-referrals without a complaint filed against them are not reported to their licensing board. ALL CALLS ARE CONFIDENTIAL (304) 414-0400 West Virginia Medical Professionals Health Program PO Box 40027 Charleston, WV 25364 14 West Virginia Medical Journal
| Scientific Article Melkersson-Rosenthal Syndrome with Migraine-Like Headaches Treated With Minocycline: A Case Report and Review of the Literature Matthew A. Hazey, BS Medical Student Anthony J. Van Norman, MD Resident, Section of Dermatology Drury L. Armistead, MD Assistant Professor, Section of Dermatology West Virginia University School of Medicine, Morgantown Abstract Cheilitis granulomatosa (CG), which presents clinically as persistent lip swelling, is characterized histologically by noncaseating granulomatous inflammation of unknown origin. CG may also be part of the classic triad of the Melkersson-Rosenthal Syndrome (MRS) and alone is considered by some to be an oligosymptomatic form of MRS. We report a case of CG associated with migrainelike headaches in a 44-year-old woman. The clinical presentation, histologic findings, and subsequent treatment are described. A brief review of the literature also is provided. left side (Figure 1). The patient’s symptoms were initially intermittent but became persistent. She gave a history of severe headaches that were temporally related to increased swelling of her upper lip. She was otherwise well and denied symptoms in any other organ system. Further, the patient denied a history of any drug ingestion, nor could she recall any provocative factors such as foods, contactants, or activities. Physical examination revealed soft, nonpitting edema of the upper lip, left greater than right, with overlying erythema. The tongue was normal in appearance, and there were no findings consistent with facial nerve paralysis. Serologic evaluation including complete blood count, C1 esterase inhibitor, C3, C4, serum angiotensin-converting enzyme level, and antinuclear antibody were within normal limits. Chest x-ray and magnetic resonance imaging of the brain and sinuses were performed and found to be within normal limits. A 4-mm punch biopsy specimen from the cutaneous upper lip showed scattered noncaseating granulomas, mild edema, lymphectasia, as well as superficial and deep perivascular lymphocytic inflammation (Figures 2 and 3). Special stains were negative for evidence of fungi or acid-fast bacilli. No foreign bodies were seen on examination of the specimen under polarized light. Treatment was initiated with minocycline hydrochloride,100mg, Figure 2. Noncaseating granulomas, mild edema, lymphectasia, as well as superficial and deep perivascular lymphocytic inflammation (H&E, original magnification x 20). Case Report A 44-year-old white female presented with persistent, painless, non-pruritic swelling of the upper lip for 8 months. The swelling, which was associated with an overlying erythema, was more severe on the Figure 1. Before treatment. Upper lip with firm edema accompanied by erythema. January/February, 2009, Vol. 105 15
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January/February - West Virginia State Medical Association

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