JMIR Publications

ABSTRACT

Diffuse idiopathic skeletal hyperostosis (DISH) syndrome and lumbar epidural lipomatosis are relatively asymptomatic neurological conditions, with findings often seen incidentally on radiological studies. Concomitant, symptomatic variants, however, are rare and present challenges to treatment and management as seen with a 60-year-old African American female who presented with worsening disequilibrium and new onset bilateral fingertip numbness. Past medical history was significant for alcohol abuse disorder, hypertension, hyperlipidemia, and multiple episodes of self-resolving vertigo and lower extremity neuropathy. The patient was admitted to neurology for stroke workup, which was negative. Osteopathic structural exam revealed thoracolumbar and sacral dysfunctions. MRI revealed findings consistent with thoracic DISH syndrome and lumbar epidural lipomatosis in the areas of somatic dysfunctions. Due to minimal information on osteopathic manipulative treatment (OMT) in rare neurological diseases, only gentle techniques of myofascial release, balanced ligamentous tension, and muscle energy were performed with resultant minimal improvement, thus highlighting the necessity for greater guidelines and further research.