Neurogenic Heterotopic Ossification in the Non-paretic Limb: A Case Report

Case Report

Austin J Radiol. 2024; 11(1): 1227.

Neurogenic Heterotopic Ossification in the Non-paretic Limb: A Case Report

Zahra SM Husain*; Abdullah Saad Al Driweesh

Department of Medical Imaging, Dammam Medical Complex, Dammam, Saudi Arabia

*Corresponding author: Zahra SM Husain Department of Medical Imaging, Dammam Medical Complex, Dammam, Saudi Arabia. Email: Zahra.4@live.com

Received: January 31, 2024 Accepted: February 19, 2024 Published: February 26, 2024

Abstract

Heterotopic Ossification (HO) is a pathological condition characterized by the formation of bone outside the skeletal tissues, which is usually caused by either traumatic or neurogenic factors. Neurogenic HO is a rare complication that can occur after a cerebral or spinal injury. The condition can manifest with a range of symptoms and is often challenging to diagnose clinically. Although various imaging techniques have been employed to diagnose HO, clinicians and radiologists may occasionally encounter radiological features of HO that can resemble other disease conditions. In this report, we present a unique case of neurogenic HO that developed in the non-paretic limb of a patient with Traumatic Brain Injury (TBI).

Keywords: Heterotopic Ossification; Hemiplegia; CT; MRI

Introduction

Heterotopic Ossification (HO) is a pathological condition characterized by the formation of lamellar bone in the soft tissue adjacent to a joint. It is commonly associated with Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI), burn injury, and orthopedic trauma [1]. HO can also occur in patients with post-stroke hemiplegia, although the incidence is low (0.5–1.2%) as reported by Varghese [2].

The pathogenesis of HO is not fully understood. It is postulated that the major pathogenic factors are immobilization and aggressive joint mobilization to preserve joint range of motion. Other factors that may predispose to HO are spasticity, fracture, infection, deep vein thrombosis and pressure ulceration. HO can be categorized into traumatic and neurogenic types. Traumatic HO may develop after direct injury or surgery to the muscles (mainly following total joint arthroplasty). Neurogenic HO may develop after neurological insults, such as brain injury or SCI [3].

HO in the non-paretic limb is rare; there are only a few case reports in the literature. We present here the case of an elderly man who had right-sided post-stroke hemiplegia with HO in the non-paretic limb.

Case Report

A 75-year-old male known case of hypertension, type II diabetes and ischemic heart disease. He presented to the emergency department with five hours history of right sided weakness. Neurological examination revealed motor power of 1/5 in the right upper and lower limb with no sensory deficit. Glasgow Coma Scale (GCS) was 13/15. Non-enhanced CT scan of the brain was performed and showed left basal ganglia acute intra-parenchymal hemorrhage (Figure 1). The diagnosis of acute hemorrhagic stroke was established. The patient was admitted under the neurology team and was managed conservatively. Following discharge, he underwent two sessions of physiotherapy after which he lost the follow-up.