1/9. Spinal subdural hematoma: a rare complication of lumbar puncture. Case report and review of the literature.Spinal subdural hematoma, though rare, is an established complication of lumbar puncture. A young man with persistent back and neck pain after a traumatic lumbar puncture for the diagnosis of lymphocytic meningitis is presented. A diagnosis of spinal subdural hematoma at T2 to T8 levels without significant spinal cord compression was confirmed by magnetic resonance imaging. Symptoms resolved after one month of analgesics and muscle relaxants.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/9. Acute intracranial hemorrhage caused by acupuncture.A 44-year-old Chinese man developed severe occipital headache, nausea, and vomiting during acupuncture treatment of the posterior neck for chronic neck pain. Computed tomography of the head showed hemorrhage in the fourth, third, and lateral ventricles. A lumbar puncture confirmed the presence of blood. magnetic resonance angiography with gadolinium did not reveal any saccular aneurysms or arteriovenous malformations. The patient's headache resolved over a period of 28 days without any neurological deficits. acupuncture of the posterior neck can cause acute intracranial hemorrhage.- - - - - - - - - - ranking = 1.1666666666667keywords = puncture (Clic here for more details about this article) |
3/9. Epidural hematoma after epidural block: implications for its use in pain management.BACKGROUND: Spinal epidural hematoma after spinal puncture such as for injection of steroids for pain management may result in a rare complication of a spinal epidural hematoma causing acute myelopathy. Although this complication is well known with epidural anesthesia, where it is usually seen with impaired hemostasis, there are surprisingly few case reports of epidural hematoma after an epidural steroid block. CASE DESCRIPTION: A healthy 34-year-old man with no evidence of coagulopathy and not taking antiplatelet medication suddenly had onset of acute cervical myelopathy from a large cervical epidural hematoma 8 days after a cervical epidural steroid block. Following prompt surgical evacuation of the clot, the patient made a near complete recovery. CONCLUSION: Spinal epidural hematoma after spinal puncture is usually associated with impaired hemostasis. This case illustrates that it may occur in the absence of known risk factors. The delayed onset and the absence of risk factors have implications for the use of this procedure in chronic pain management.- - - - - - - - - - ranking = 0.33333333333333keywords = puncture (Clic here for more details about this article) |
4/9. gadolinium enhancement of spinal subdural collection on magnetic resonance imaging after lumbar puncture.We report a 35-year-old male with an unusual contrast-enhancing sterile spinal subdural collection on magnetic resonance imaging (MRI), apparently occurring as a complication of lumbar puncture. Follow-up MRI after 4 weeks demonstrated spontaneous resolution of the collection without intervening treatment.- - - - - - - - - - ranking = 0.83333333333333keywords = puncture (Clic here for more details about this article) |
5/9. Crowned dens syndrome misdiagnosed as polymyalgia rheumatica, giant cell arteritis, meningitis or spondylitis: an analysis of eight cases.BACKGROUND: The crowned dens syndrome, related to microcrystalline deposition in the peri-odontoid articular and abarticular structures, is mainly responsible for acute or chronic cervical pain. patients: We report eight cases of crowned dens syndrome with atypical presentations mimicking giant cell arteritis, polymyalgia rheumatica, meningitis or discitis. The clinical and radiological aspects of these cases are presented and discussed. RESULTS: For all patients, fever, cervical stiffness, headaches and biological inflammatory syndrome were reported. For three patients, impairment of general condition, occipito-temporal or mandible pain and weakness with inflammatory pain of the shoulder girdle was suggestive of giant cell arteritis and/or polymyalgia rheumatica, leading to temporal artery biopsy and/or long-term steroid treatment. recurrence of clinical symptoms when tapering steroids was noted. In two cases, previous breast carcinoma led to the initial diagnosis of metastatic spondylitis. For three patients with vomiting, nausea and Kernig's and/or Brudzinski's sign, the first diagnosis was meningitis, leading to unhelpful lumbar puncture. In all cases, diagnosis of crowned dens syndrome once evoked, was confirmed by cervical CT scanning and dramatic improvement with non-steroidal anti-inflammatory drugs or colchicine. CONCLUSION: This under-recognized entity must be considered as a differential diagnosis of meningitis and discitis, but also of giant cell arteritis and polymyalgia rheumatica, as well as a possible aetiology for fevers of unknown origin. CT scanning is necessary for diagnosis. Clinicians should be aware of such misleading clinical presentations.- - - - - - - - - - ranking = 0.16666666666667keywords = puncture (Clic here for more details about this article) |
6/9. Transforaminal cervical blood patch for the treatment of post-dural puncture headache.A 40-yr-old woman received a series of three interlaminar epidural steroid injections for the treatment of axial neck pain secondary to degenerative disc disease. Immediately after her third injection, she experienced symptoms of a dural puncture-induced headache. This headache persisted on a daily basis for 3 mos, despite two epidural blood patches using an interlaminar approach, which was finally completely abated with a transforaminal blood patch. The headache was immediately relieved and remained alleviated through the follow-up interval of 1 yr. In this patient, a fluoroscopically guided transforaminal epidural blood patch proved to be more effective than the classic blind interlaminar approach in the treatment of post-dural puncture headache.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
7/9. Cervical spondylodiscitis: a rare complication after phonatory prosthesis insertion.BACKGROUND: Tracheoesophageal puncture has excellent voice rehabilitation after total laryngectomy. However, despite its easy insertion and use, severe complications have been reported. methods: We report a case of cervical spondylodiscitis, occurring in a 67-year-old woman submitted to phonatory prosthesis insertion. After 1 month, she complained of severe cervicalgia associated with fever. Spondylodiscitis involving C6, C7, and the intervening vertebral disk with medullary compression was detected by means of imaging studies. RESULTS: A right cervicotomy with drainage of necrotic tissue was performed, and a de-epithelialized fasciocutaneous deltopectoral flap was interposed between the neopharynx-esophagus and the prevertebral fascia to protect the neurovascular axis. MR performed 1 month later showed a complete resolution of the infectious process. CONCLUSIONS: Severe neck pain after tracheoesophageal puncture should alert the physician about the possibility of a cervical spondylodiscitis. MR is the most useful imaging technique for preoperative and postoperative evaluation. When neurologic symptoms are detected, surgical exploration of the neck is mandatory.- - - - - - - - - - ranking = 0.33333333333333keywords = puncture (Clic here for more details about this article) |
8/9. Preoperative embolization of hypervascular spinal metastases using percutaneous direct injection with n-butyl cyanoacrylate: technical case report.OBJECTIVE: Intraoperative blood loss constitutes a major cause of perioperative morbidity in surgical decompression and reconstruction of highly vascular spinal metastatic tumors. We propose a technique for embolization of highly vascular vertebral metastases using percutaneous direct injection using n-butyl cyanoacrylate (NBCA) instead of polymethylmethacrylate to complement preoperative transarterial embolization and to minimize operative blood loss. methods: Five patients with renal cell carcinoma metastases to the spine (one cervical, one thoracic, and three lumbar) underwent embolization by percutaneous direct injection of the affected vertebrae with a mixture of NBCA and iodized oil to supplement transarterial embolization with polyvinyl alcohol particles and fibered platinum coils. This was achieved via a transpedicular approach in four cases and by direct vertebral body puncture in one case. RESULTS: The percutaneous NBCA direct injection procedure was technically successful in all cases and was not associated with neurological or medical complications. All patients underwent subsequent vertebrectomy and spinal instrumentation. Surgical resection was performed with lower than expected blood loss and with a subjective improvement in tumor tissue handling and dissection. CONCLUSION: The extent of tumor devascularization can be improved by supplementing transarterial embolization with NBCA direct injection to decrease operative blood loss and increase the safety of surgical resection and stabilization of highly vascular spinal metastases.- - - - - - - - - - ranking = 0.16666666666667keywords = puncture (Clic here for more details about this article) |
9/9. Ballroom dancing and cervical radiculopathy: a case report.Dance injuries associated with cervical radiculopathy have not been described in the literature. This report describes the case of an international-style ballroom dancer who developed a cervical radiculopathy as a result of frequent lateral rotation and hyperextension of the cervical spine during dancing. The patient's symptoms and signs suggestive of a left C7 radiculopathy were confirmed and documented by both magnetic resonance imaging and electrodiagnostic testing. The patient was treated conservatively with activity modification, nonsteroidal anti-inflammatory drugs, and alternative medicine approaches, including herbs and acupuncture. Her neck pain and cervical radicular symptoms declined in severity, but continued even 4 1/2 months after the onset of her symptoms. She did not wish to try steroids either through an oral or epidural route and refused surgical intervention. This case report illustrates an unconventional manner in which a left cervical radiculopathy was clinically produced. The neck motions and positions of frequent hyperextension and lateral rotation demonstrated by this ballroom dancer simulated a pattern and sequence of movements that promoted the development of signs and symptoms of a left cervical radiculopathy.- - - - - - - - - - ranking = 0.16666666666667keywords = puncture (Clic here for more details about this article) |