1/32. Nontraumatic acute spinal subdural hematoma: report of five cases and review of the literature.Acute subdural spinal hematoma occurs rarely; however, when it does occur, it may have disastrous consequences. The authors assessed the outcome of surgery for this lesion in relation to causative factors and diagnostic imaging (computerized tomography [CT], CT myelography), as well as eventual preservation of the subarachnoid space. The authors reviewed 106 cases of nontraumatic acute subdural spinal hematoma (101 published cases and five of their own) in terms of cause, diagnosis, treatment, and long-term outcome. Fifty-one patients (49%) were men and 55 (51%) were women. In 70% of patients the spinal segment involved was in the lumbar or thoracolumbar spine. In 57 cases (54%) there was a defect in the hemostatic mechanism. spinal puncture was performed in 50 patients (47%). Late surgical treatment was performed in 59 cases (56%): outcome was good in 25 cases (42%) (in 20 of these patients preoperative neurological evaluation had shown mild deficits or paraparesis, and three patients had presented with subarachnoid hemorrhage [SAH]). The outcome was poor in 34 cases (58%; 23 patients with paraplegia and 11 with SAH). The formation of nontraumatic acute spinal subdural hematomas may result from coagulation abnormalities and iatrogenic causes such as spinal puncture. Their effect on the spinal cord and/or nerve roots may be limited to a mere compressive mechanism when the subarachnoid space is preserved and the hematoma is confined between the dura and the arachnoid. It seems likely that the theory regarding the opening of the dural compartment, verified at the cerebral level, is applicable to the spinal level too. Early surgical treatment is always indicated when the patient's neurological status progressively deteriorates. The best results can be obtained in patients who do not experience SAH. In a few selected patients in whom neurological impairment is minimal, conservative treatment is possible.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/32. Clinical observations on 278 cases of cervical spondylopathy treated with electroacupuncture and massotherapy.From Dec. 1990 to Dec. 1993, 278 cases of cervical spondylopathy were treated with electroacupuncture and massotherapy. The cure rate was 82.7%; but in the control group, it was only 61%, indicating that electroacupuncture may enhance the cure rate (P < 0.05). Of the 278 cases treated by three to five sessions, the pain and numbness disappeared in about 96% of the patients.- - - - - - - - - - ranking = 3keywords = puncture (Clic here for more details about this article) |
3/32. Successful epidural blood patch in a patient with headache for 6 months after lumbar root decompression.Prolonged headache following dural puncture is an uncommon problem that may occur after a spinal tap, often as a complication of epidural anaesthesia. This problem has also been described after long-term epidural or spinal anaesthesia, myelography or spinal surgery. A case of prolonged postdural puncture headache following lumbar nerve root decompression is described in a healthy young man. No other cause could be found either clinically or with the aid of scanning by computerized tomography or magnetic resonance imaging techniques at the spinal level involved. The symptoms were successfully treated with an epidural blood patch performed seven months following the original surgical operation.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/32. Symptomatic intraspinal air entrapment.A 59-year-old man who had undergone the removal of a lipoma of the thoracic spine presented with progressive weakness of the lower limbs when lumbar puncture followed drainage of a subcutaneous collection of cerebrospinal fluid. Computed tomography showed entrapped intraspinal air which compressed the spinal cord. This rare, but serious complication can occur in a patient with altered intrathecal pressure following spinal surgery.- - - - - - - - - - ranking = 0.5keywords = puncture (Clic here for more details about this article) |
5/32. Flaccid quadriplegia from tonsillar herniation in pneumococcal meningitis.A young woman with fulminant pyogenic meningitis became quadriplegic, areflexic and flaccid due to herniation of the cerebellar tonsils and compression of the upper cervical cord. This state of spinal shock was associated with absent F-waves. intracranial pressure was greatly elevated and there was an uncertain relationship of tonsillar descent to a preceding lumbar puncture. Partial recovery occurred over 2 years. Tonsillar herniation can cause flaccid quadriplegia that may be mistaken for critical illness polyneuropathy. This case demonstrates cervicomedullary infarction from compression, a mechanism that is more likely than the sometimes proposed infectious vasculitis of the upper cord.- - - - - - - - - - ranking = 0.5keywords = puncture (Clic here for more details about this article) |
6/32. Spontaneous spinal epidural abscess in a neonate. With a review of the literature.Spinal epidural abscess is uncommon in neonates and infants, and is usually related to previous lumbar puncture or epidural anaesthesia. diagnosis is often delayed because of the non-specific presentation. We present a 7-week-old girl who developed paraplegia 3 weeks after transient fever and a self-limiting skin rash. MR imaging revealed an epidural contrast-enhancing lesion compressing the spinal cord. At operation, an organised granulated abscess was identified with staphylococcus aureus the causative organism. laminectomy and removal of the organised abscess and systemic intravenous antibiotics resulted in complete neurological recovery. The patient did not develop late spinal deformity following the decompressive laminectomy. The rapid onset of paraplegia can often be missed in such a young child but should be promptly investigated, as surgical treatment of cord compression carries an excellent prognosis for neurological recovery. We review the literature on the initial presentation, usual investigations, causative organisms and surgical management of paediatric spinal epidural abscesses.- - - - - - - - - - ranking = 0.5keywords = puncture (Clic here for more details about this article) |
7/32. Symptomatic spinal extramedullary mass lesion secondary to chronic overdrainage of ventricular fluid--case report.A 69-year-old man presented with progressive nuchal pain and spastic gait 2 years after undergoing ventriculoperitoneal (VP) shunting for a pineal astrocytoma with obstructive hydrocephalus. The neurological manifestations were compatible with radiculomyelopathy caused by an upper cervical lesion. magnetic resonance imaging showed an enhanced extramedullary mass lesion tightly constricting the upper cervical spinal cord. The pressure of the shunt system was 150 mmH2O, and lumbar puncture revealed normal cerebrospinal fluid (CSF) pressure of 170 mmH2O. After removal of the shunt system, the clinical symptoms and neuroradiological findings markedly improved. This symptomatic spinal mass lesion was thought to be formed secondary to chronic depletion of ventricular CSF through the VP shunt.- - - - - - - - - - ranking = 0.5keywords = puncture (Clic here for more details about this article) |
8/32. 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 = 1keywords = puncture (Clic here for more details about this article) |
9/32. Percutaneous technique for sclerotherapy of vertebral hemangioma compressing spinal cord.PURPOSE: In this study we report a percutaneous technique to achieve sclerosis of vertebral hemangioma and decompression of the spinal cord and nerve roots. methods: Under CT guidance the affected vertebral body is punctured by a biopsy needle and sclerosant is injected directly into the tumor. In the case of large paravertebral extension, additional injection is given in the paravertebral soft tissue component to induce shrinkage of the whole tumor mass and release of the compressed spinal cord. RESULTS: Using this technique we treated five patients in whom vertebral hemangioma gave rise to neurologic symptoms. In three patients, sclerotherapy was the only treatment given. In the other two patients, sclerotherapy was preceded by transcatheter embolization. Neither decompressive surgery, radiation therapy nor stabilization was required with this technique. CONCLUSION: Our experience with CT-guided intraosseous sclerotherapy has proved highly satisfactory.- - - - - - - - - - ranking = 0.5keywords = puncture (Clic here for more details about this article) |
10/32. Extradural extrusion of roots of the cauda equina.For lumbar spondylotic stenosis causing progressive disability, multiple laminectomy was about to be completed. Suddenly roots of the cauda equina herniated through the myelography puncture site in the dura mater, resembling redundant nerve roots. This case is being reported not only because such sudden extradural extrusion is rare, but also to raise the question of the relationship of redundancy of nerve roots to spondylotic stenosis.- - - - - - - - - - ranking = 0.5keywords = puncture (Clic here for more details about this article) |
| | Next -> |