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Extra Credit Project

Spring, 2016

Copyright 2016 Douglas Gillard, DC


Case Study
47-year-old male from London is three months status
post microdiscectomy at L5/S1 with complaints of
recurrent left radicular pain down the lateral portion of
the thigh, leg and foot (8/10) which came on slowly for
no reason approximately 6 weeks after the surgery
Treating doctor (general practice physician) orders an
MRI (without contrast) and tells the patient he will need
another surgery
I am consulted for a second opinion
Heres the first MRI

Copyright 2016 Douglas Gillard, DC


Can you
make a
diagnosis
now? Or is
there
something
else you
need to
order?
Copyright 2016 Douglas Gillard, DC
Contrast MRI is needed!
If the discectomy fails, then you must always order
the postsurgical MRI with gadolinium (contrast)!
The first part of the MRI is done without contrast
About halfway through the procedure, they pull the
patient out, and inject gadolinium into the median cubital
vein
It typically gives the patient a weird but mild burning sensation
throughout their body
Thats what I did ordered a new MRI with
gadolinium.
Lets take a look new MRI

Copyright 2016 Douglas Gillard, DC


Contrast MRI

Copyright 2016 Douglas Gillard, DC


Close-
up of
contrast
MRI

Copyright 2016 Douglas Gillard, DC


With and without gadolinium

Copyright 2016 Douglas Gillard, DC


So now, whats the final diagnosis?

Copyright 2016 Douglas Gillard, DC


Extra Credit Assignment
Total class is worth 100 points, and this project is worth a
maximum of 10 points
in order to get these points heres what you must do:
1. I want you to figure out what the main diagnosis is and
the best differential diagnosis.
Ive talked about this before, so it should be pretty easy
if youve confused, ask Dr. Beadle or Dr. Scuderi for help if need
be
2. I want you to go to www.pubmed.com through the
library, and pull one research paper on this topic
3. Then read the paper and write me a short summary
regarding what this study was about, the conclusions,
and your opinion of the paper.
Copyright 2016 Douglas Gillard, DC
Extra Credit Assignment
4. I will only allow five students to write about one paper, so
you must talk amongst yourselves so you know who is
writing about what paper there are many papers on the
subject so you shouldnt have a problem finding a different
paper on the subject.
5. You will not get credit for the paper if you dont write
something that is not included in the abstract I want you
to actually pull the paper and read it; dont just regurgitate
the abstract.
6. You can hand these papers in during class next week or
email them to me. If you email them, make sure you keep
proof that you emailed them! In fact, you should ask for
confirmation from me.
7. Good luck! The deadline is the start of class next Thursday!

Copyright 2016 Douglas Gillard, DC