1/20. dialysis-related spinal canal stenosis: a clinicopathological study on amyloid deposition and its AGE modification.Three cases operated for spinal canal stenosis induced by dialysis-related amyloidosis (DRA) were investigated clinicopathologically. Cases were all-male, and had undergone hemodialysis around 20 years. In two cases, cervical plain x-rays showed only minor spondylotic changes. However, magnetic resonance imaging (MRI), myelography, and computed tomography (CT) showed extradural thickness with compression on the cervical spinal cord and cauda equina. In one case cervical x-rays showed typical destructive spondyloarthropathy (DSA), and MRI showed compression myelopathy. Surgical treatment on both cervical and lumbar spine in two cases and on cervical spine only in one case successfully reduced the symptoms. Extradural thickened tissue and ligament flavum obtained during surgery were studied histopathologically and immunostained by using anti-CD68, anti-beta2-microglobulin (beta2m), and anti-advanced glycation end product (AGE) antibody. congo red stain showed diffuse or nodular amyloid deposition, and immunostaining with anti-beta2m and anti-AGE antibodies also demonstrated the same distribution pattern. Thus, beta2m-positive amyloid tissue in the extradural thickness (extradural amyloid deposition) was immunohistochemically demonstrated to be modified with AGE. Inflammatory reaction with histiocytic and giant cell infiltration was also shown around the amyloid tissues. There were CD68-positive cells, and some cells were positive for AGE and beta2m. These findings suggest that beta2m accumulation and inflammatory reaction finally promote destruction of connective tissues. MRI, CT and/or myelography are necessary for diagnosing spinal canal stenosis accompanied by DRA. In conclusion, we propose a more comprehensive concept of dialysis-related spinal canal stenosis, which includes both DSA and myeloradiculopathy induced by extradural thickness.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/20. May 2001: 32 year old female with dural mass encircling cervical spinal cord.The May COM. A 32-year-old woman with a history of previous mastoid surgery presented with bilateral extremity weakness and ambulatory instability. MRI revealed a dural-based mass completely encircling the upper cervical spinal cord. Workup was significant for an abnormally elevated c-ANCA, positive at a dilution of 1:128. A portion of the lesion was removed by a posterior surgical approach to decompress the cervical cord. Histologic examination of the dura showed a dense granulomatous infiltrate with vasculitis and giant cells; coupled with the positive c-ANCA, the process was felt to be most consistent with Wegener's granulomatosis. Wegener's granulomatosis infrequently involves the dura or meninges and has not previously been reported to affect dura of the cervical cord. Symptomatic improvement followed surgical decompression and high-dose corticosteroid therapy, with resultant resolution of an elevated c-ANCA titer.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/20. Castleman's disease: unusual case of inflammatory spinal dorsal epidural mass: case report.OBJECTIVE AND IMPORTANCE: Castleman's disease (giant lymph node hyperplasia) is a rare, heterogeneous, lymphoproliferative disorder of unknown cause and pathogenesis. Most cases occur as mediastinal masses, although extrathoracic involvement, including nodal and extranodal locations, has been reported. The localized variants (solitary lesions) respond well to surgical excision. CLINICAL PRESENTATION: We report the case of a 34-year-old man with headache, intermittent febrile sense, progressive weakness of the legs, and urinary incontinence. magnetic resonance imaging disclosed an enhancing dorsal extradural mass with impingement on the spinal cord at the T2-T3 level. Other abnormal laboratory findings were increased erythrocyte sedimentation rate and mild leukocytosis. TECHNIQUE: The mass lesion was removed; the histopathological findings included diffuse lymphoid cell infiltration and vascular proliferation, which are compatible with Castleman's disease. CONCLUSION: Although the dorsal epidural site of this case is very unusual, Castleman's disease was considered the most appropriate diagnosis on the basis of the associated systemic findings. This patient with dorsal epidural Castleman's disease may be the first reported case in the literature.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/20. Cervical myelopathy due to gouty tophi in the intervertebral disc space.gout, like diabetes mellitus, is a common metabolic disorder. Typically affecting the distal joint of the appendicular skeleton, its occurrence in the spine is rare. We report the case of a 68-year-old male with a long history of diabetes mellitus and hyperuricemic gout. neck pain developed over two weeks with subsequent quadriparesis, with concomitant subcutaneous deposition of gouty tophi in the right elbow. Magnetic resonance image of the cervical spine revealed multiple segmental narrowing of the thecal sac at the C3-6 levels due to hypertrophic spurs and bulging discs. Anterior discectomies of C3-4 and C4-5 were performed, with a chalky-white, granular material noted in the C4-5 disc space. Histological examination of the surgical specimen revealed deposits of needle-like crystals surrounded by histiocytes and multinucleated giant cells, with the appearance compatible with gout. The patient was ambulatory with the assistance of a walking frame six months after the operation. We emphasize that gouty tophi can be deposited in the spine over a relatively short time, subsequently precipitating a variety of symptoms, from pain to cord compression. The regular administration of antihyperuricemia drug treatment for hyperuricemic gout is necessary to prevent this deposition. If neurological defects are found, surgical decompression can provide satisfactory results.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
5/20. Spinal compression caused by multiple arachnoidal cyst.A 14-year-old boy presented with subacute onset of paraparesis. The spinal compression was due to multiple giant sized spinal arachnoid cysts. Postoperatively the patient recovered completely.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
6/20. Giant anterior cervicothoracic arachnoid cyst.STUDY DESIGN: A case report with a review of the literature is presented demonstrating the imaging findings of a patient with recent onset, progressive spinal cord compression at T6 caused by a giant arachnoid cyst that was successfully treated. OBJECTIVE: To present the imaging findings of a giant anterior cervicothoracic intradural arachnoid cyst using several methods before and after treatment. SUMMARY OF BACKGROUND DATA: This case demonstrates the imaging findings of the largest described anterior cervical arachnoid cyst straddling the cervicothoracic junction. It presented with spinal cord compression in a 26-year-old diagnosed by MRI and successfully treated surgically. methods: The patient experienced progressive left-sided sensory and motor deficits below T6. Pain and temperature sensation were decreased. Reflexes were increased in both lower extremities with clonus. Preoperative MRI was followed by laminectomy and cyst fenestration with subsequent postoperative myelogram and CT. RESULTS: Imaging confirmed the presence of a giant arachnoid cyst straddling the cervicothoracic junction. Postoperative imaging documented relief of spinal cord compression. Symptoms improved progressively after surgery. By the time of discharge all residual neurologic deficits had resolved. CONCLUSION: Anterior arachnoid cysts straddling the cervicothoracic junction have yet to be reported, and arachnoid cysts involving the cervical region are extremely rare. Imaging demonstrated the cyst and its response to treatment. This patient responded well to surgery and was discharged without neurologic sequelae.- - - - - - - - - - ranking = 3keywords = giant (Clic here for more details about this article) |
7/20. Secondary tetraplegia due to giant-cell tumors of the cervical spine.BACKGROUND AND PURPOSE: Giant-cell tumor of the bone is a neoplasm which rarely affects the spine, and occurs even more infrequently above the sacrum. The symptomatology depends on the tumor site, and may be attributable to a compression mechanism. Spinal cord injury is seldom a complication and tetraplegia is even more infrequent. In this paper, we present an unusual case involving a giant cell tumor. We also review its possible diagnoses and treatments. CLINICAL CASE: We present the case of giant-cell tumors in the cervical spine affecting C6 and C7, in a young woman who suffered tetraplegia due to spinal cord compression. After surgery and radiotherapy, the tumor reappeared, requiring a second operation. CONCLUSION: Early clinical diagnosis of giant-cell tumors of the spine is difficult because their development tends to go unnoticed. Imaging techniques, especially MRI, help identify them; but their diagnosis still requires histopathologic tests. Resection of the neoplasm is recommended, when possible. curettage may allow recurrence and radiotherapy may lead to sarcomatous degeneration of the tumor.- - - - - - - - - - ranking = 7keywords = giant (Clic here for more details about this article) |
8/20. schistosoma mansoni of the conus medularis: case report.A six year old girl was admitted to the Kenyatta National Hospital paediatric unit with history of headaches, fever, neck stiffness and paraesthesias of the lower limbs. She was empirically commenced on antimeningitic treatment. Her neurological state deteriorated over a period of two months to paraparesis and paraplegia of the lower limbs with urinary and stool incontinence. A neurology review revealed a sensory level at T10 with power grade 2 in the lower limbs. A myelogram revealed a block of contrast at T12. An impression of cord compression by an intraspinal tumour was made. laminectomy and posterior midline myelotomy was performed. At operation a greyish-white intramedullary mass lesion was found. histology revealed a schistosoma mansoni ovum surrounded by granulomatous tissue with giant cells and polymorphoneuclear leucocytes. The child was commenced on paziquantel 1000 mg and dexamethasone 24 mg per day in divided doses. There was marked neurological improvement and the patient went home one month later. She was able to walk without support and was continent of urine and stool at the time of discharge.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
9/20. Pigmented villonodular synovitis (giant cell tumor of the synovium) occurring in the vertebral column. Report of a case.A case of pigmented villonodular synovitis (giant cell tumor of the synovium) involving the vertebral column is presented. The tumor grew outside the dura and extended to the paravertebral connective tissue, causing sensory and motor disturbance indicative of spinal cord compression. This anatomic location is very rare for lesions of this type, and to our knowledge, this case is only the fifth reported in the English-language literature.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
10/20. Response of fractured osteoporotic bone to polymethylacrylate after vertebroplasty: case report.BACKGROUND CONTEXT: Polymethylmethacrylate (PMMA) is the most commonly used bone cement for vertebroplasties to treat osteoporotic vertebral compression fractures (VCFs). Several studies have described the reaction of normal bone to PMMA, but it is still unclear how fractured osteoporotic bone responds to PMMA. PURPOSE: To describe the response of fractured osteoporotic bone to PMMA after vertebroplasty. STUDY DESIGN/SETTING: Case report. methods: A 69-year-old woman with a previous vertebroplasty at T8 to treat an osteoporotic VCF was admitted to the hospital after she developed lower extremity motor weakness, diffuse hypoesthesia and decreased rectal tone. magnetic resonance imaging studies of the thoracic spine showed that she had severe spinal cord compression at the level of T8 and T9, as well as akyphotic deformity. A corpectomy of T8 and T9 was performed as part of a spinal cord decompression procedure. Tissue from vertebral body T8, intervertebral discs T7-T8 and T8-T9 and the PMMA implant were then submitted for histologic evaluation.RESULTS: Vertebral body T8 demonstrated viable bone trabeculae, osteoid. fibrosis, granulation tissue and multinucleated giant cells containing PMMA. Scattered necrotic bone fragments were identified throughout the vertebral body, most evident near the PMMA. PMMA leakage into the T7-T8 disc was identified without significant disc inflammation or necrosis. CONCLUSION: Fractured osteoporotic bone is capable of undergoing a reparative healing response after vertebroplasty using PMMA.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
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