1/1608. Postoperative gas bubble foot drop. A case report.STUDY DESIGN: An unusual case of foot drop occurring 10 days after disc surgery is reported. Imaging studies identified a gas bubble compressing the nerve root. OBJECTIVE: To describe the origin and management of a radiculopathy caused by an intraspinal gas bubble. SUMMARY OF BACKGROUND DATA: A recurrent lumbar disc herniation was diagnosed by clinical and imaging studies. A vacuum disc also was noted at the same level. These are common and not considered to be of pathologic significance. methods: The patient underwent a microdiscectomy for a lumbar disc extrusion. The postoperative course was excellent, with relief of symptoms and no neurologic deficit. Ten days later, the awoke with a foot drop and pain in the leg. Imaging studies showed a 4-mm gas bubble compressing the nerve root. Oral steroids were given for 10 days. RESULTS: Progressive improvement occurred, and the patient was asymptomatic 6 weeks later. Although in some instances it may be necessary to evacuate intraspinal gas, an initial period of observation is warranted, because the gas and its resulting symptoms may disappear spontaneously. CONCLUSION: Intradiscal gas accumulation, better known as vacuum disc, is considered to be a benign indication of degenerative disc disease. On occasion it can be a cause of symptoms. A case is reported in which gas leaked after surgery into the spinal canal, causing a foot drop. The symptoms and gas disappeared spontaneously without further treatment.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/1608. paraplegia after thoracotomy--not caused by the epidural catheter.BACKGROUND: paraplegia and peripheral nerve injuries may arise after general anaesthesia from many causes but are easily ascribed to central block if the latter has been used. CASE REPORT: A 56-yr-old woman, with Bechterev disease but otherwise healthy, was operated with left-sided thoracotomy to remove a tumour in the left lower lobe. She had an epidural catheter inserted in the mid-thoracic area before general anaesthesia was started. bupivacaine 0.5% 5 ml was injected once and the infusion of bupivacaine 0.1% with 2 micrograms/ml fentanyl and 2 micrograms/ml adrenaline (5 ml/h) started at the end of surgery. The patient woke up with total paralysis in the lower limb and sensory analgesia at the level of T8, which remained unchanged at several observations. laminectomy, performed 17 h after the primary operation, showed a large piece of a haemostatic sponge (Surgicel) compressing the spinal cord, which was then decompressed but the motor and sensory deficit remained virtually unchanged both then and a year later. CONCLUSIONS: This case shows--once again--that although central blocks may cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly.- - - - - - - - - - ranking = 0.66666666666667keywords = spinal (Clic here for more details about this article) |
3/1608. paraplegia, a severe complication to epidural analgesia.We report four cases where continuous epidural analgesia resulted in epidural abscesses (EA) causing spinal cord damage and paraplegia. The first symptom of EA was intense back pain, which developed 0-20 days after removal of the epidural catheter. The diagnosis of EA was not made prior to the development of severe neurologic disturbances in any of the patients. In all cases there was a time lag of 2-4 days between the first symptoms and institution of the appropriate treatment.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
4/1608. akinetic mutism after fourth ventricle choroid plexus papilloma: treatment with a dopamine agonist.BACKGROUND: akinetic mutism is a behavioral state wherein a patient seems to be awake but does not move or speak. Several patients are reported to have developed mutism after posterior fossa surgery. We present a patient who developed akinetic mutism after total excision of a choroid plexus papilloma of the fourth ventricle, and who was treated with bromocriptine. CASE DESCRIPTION: An 18-year-old woman was admitted with akinetic mutism, which had developed 6 days after posterior fossa surgery. She had had no neurologic deficit in the first 5 days after surgery and could communicate with her family. Despite antioedematous therapy and daily lumbar punctures to drain cerebrospinal fluid, there was no clinical improvement after she entered the akinetic mute state. brain magnetic resonance revealed ventriculomegaly; brain single photon emission computed tomography revealed bilateral reduction of perfusion in the frontal region. Because daily lumbar drainage did not result in clinical improvement, shunt placement was not considered. bromocriptine therapy was begun at a dose of 2x2.5 mg; 24 hours later, the patient started to speak and move her upper extremities. Further improvement occurred over the following week when the dose was increased to 3x2.5 mg. bromocriptine was replaced with a placebo to determine whether the neurologic improvement was caused by the medicine. The patient's neurologic status deteriorated progressively; therefore, bromocriptine was restarted and she was discharged from the hospital. During the 6 months of follow-up, the patient has remained in good health. CONCLUSIONS: The etiology of akinetic mutism is not clear. Monoaminergic pathways, particularly dopaminergic cell groups, are most probably involved in this syndrome, because bromocriptine has a dramatic effect on these patients, as demonstrated in our case.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
5/1608. Unaccountable severe hypercalcemia in a patient treated for hypoparathyroidism with dihydrotachysterol.This report describes a forty-seven-year-old female patient with a complex medical history. She was suffering from an unspecified interstitial lung disease, papillary thyroid carcinoma which had been treated, hypoparathyroidism after thyroidectomy for which she was receiving dihydrotachysterol and calcium, and atrial fibrillation and congestive heart failure as a result of mitral stenosis. Shortly after mitral valve replacement she developed a severe hypercalcemia (serum calcium 5.95 mmol/l) during a febrile illness. At that time anti-tuberculous agents were also being administered for presumed tuberculosis. The possible mechanisms for this severe elevation of the calcium level are discussed. immobilization, while Paget's bone disease was present, and perhaps enhanced activation of dihydrotachysterol by rifampicin, could have led to increased calcium-release into the circulation. Continuous supplecation of calcium and vitamin d, provoked dehydration and the mechanism of the milk-alkali syndrome also contributed to this extremely high calcium level. It is concluded that hypoparathyroid patients being treated with vitamin d and calcium should be carefully monitored in the case of an intercurrent illness or a change in medication.- - - - - - - - - - ranking = 0.53462801929201keywords = stenosis (Clic here for more details about this article) |
6/1608. Emergency resection of distal tracheal stenosis. A case report.A case of tracheal stenosis secondary to tracheostomy and respirator treatment is presented. The stenosis caused acute respiratory failure, which made immediate surgical intervention mandatory. It is stressed that usually the tracheal lumen is severely reduced when the stenosis causes alarming symptoms. Rational treatment, which must be instituted immediately, consists of resection of the stenotic area and end-to-end anastomosis.- - - - - - - - - - ranking = 3.7423961350441keywords = stenosis (Clic here for more details about this article) |
7/1608. Contralateral deafness following unilateral suboccipital brain tumor surgery in a patient with large vestibular aqueduct--case report.A 68-year-old female developed contralateral deafness following extirpation of a left cerebellopontine angle epidermoid cyst. Computed tomography showed that large vestibular aqueduct was present. This unusual complication may have been caused by an abrupt pressure change after cerebrospinal fluid release, which was transmitted through the large vestibular aqueduct and resulted in cochlear damage.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
8/1608. Anatomical and embryological considerations in the repair of a large vertex cephalocele. Case report.The case of a neonate with a large vertex cephalocele is presented. The anatomical features of this anomaly were evaluated by means of magnetic resonance imaging and magnetic resonance angiography. Fusion of the thalami, dysgenesis of the corpus callosum, and failure of adequate formation of the interhemispheric fissure were characteristics of the major cerebral anomalies associated with the cephalocele. The absence of a falx in the midline, a split configuration of the superior sagittal sinus, and a dysgenetic tentorium with a concomitant abnormal venous drainage pattern were found in association with a large dorsal cyst. Repair of the anomaly was undertaken on the 3rd postnatal day. A cerebrospinal fluid shunt was required to treat hydrocephalus on Day 30. The child is well at age 3 years, but with significant developmental delay. The pathogenesis of this vertex cephalocele relates to semilobar holoprosencephaly and dorsal cyst formation. In addition, a disturbance in the separation of the diencephalic portion of the neural tube from the surface ectoderm or skin during the final phases of neurulation had occurred to help create the large cephalocele. Detailed preoperative imaging studies and awareness of the embryology and anatomy of this lesion facilitated the repair of the cephalocele. The prognosis of the child is determined not only by the presence of hydrocephalus, but also by the number of associated major cerebral anomalies. Options for treatment are discussed.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
9/1608. saphenous vein interposition graft for recurrent carotid stenosis after prior endarterectomy and stent placement. Case report.Although the use of carotid artery stents is increasing, the management of recurrent stenosis after their placement is undefined. The authors report on a patient who underwent two left carotid endarterectomies followed by left carotid angioplasty and stent placement for recurrent stenosis. A third symptomatic recurrence was subsequently managed by placement of a saphenous vein interposition graft from the common carotid artery to the distal cervical internal carotid artery. The patient remained without hemispheric or retinal ischemia at his 5-month follow-up visit. Interposition grafting should be considered as a treatment option for carotid restenosis after initial endarterectomy and stent placement.- - - - - - - - - - ranking = 3.7423961350441keywords = stenosis (Clic here for more details about this article) |
10/1608. Subacute ischaemic proctitis: a rare condition requiring extensive rectal surgery.Subacute ischaemic proctitis is a rare condition. We describe the case of a 60-year-old male patient who developed, after aortic aneurysm repair, a transient ischaemic colitis that totally healed without sequelae. He eventually developed symptoms of severe proctitis. Investigations identified a stenosis of the mid rectum, while the upper rectum was inflammatory. On angiogram, there was a poor blood flow through the Riolan's arcade and a stenosis of the proximal aorto-graft anastomosis. diagnosis of subacute ischaemic proctitis due to poor blood supply through the internal iliac arteries was made. Anti-inflammatory drugs and dilations were inefficient. A subtotal proctectomy with low colorectal anastomosis was required. On pathological specimen, the lesions were strongly suggestive of an ischaemic process. The patient had an excellent recovery and was asymptomatic 8 months after the operation.- - - - - - - - - - ranking = 1.069256038584keywords = stenosis (Clic here for more details about this article) |
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