1/1457. Wasting of the small hand muscles in upper and mid-cervical cord lesions. Four patients are described with destructive rheumatoid arthritis of the cervical spine and neurogenic wasting of forearm and hand muscles. The pathological connection is not immediately obvious, but a relationship between these two observations is described here with clinical, radiological, electrophysiological and necropsy findings. Compression of the anterior spinal artery at upper and mid-cervical levels is demonstrated to be the likely cause of changes lower in the spinal cord. These are shown to be due to the resulting ischaemia of the anterior part of the lower cervical spinal cord, with degeneration of the neurones innervating the forearm and hand muscles. These findings favour external compression of the anterior spinal artery leading to ischaemia in a watershed area as the likeliest explanation for this otherwise inappropriate and bizarre phenomenon. ( info) |
2/1457. papilledema associated with a sacral intraspinal cyst. A rare case of papilledema associated with a large sacral intraspinal cyst is described in a 34-year-old male. Symptoms were aggravated by heavy work and consisted of low back pain, headache, dizziness and episodic vomiting. papilledema was observed on ophthalmological examination. A valvular mechanism was found to exist between the normal spinal sac and the huge sacral cyst. Division of the valvular fistula combined with a dural plastic operation brought complete relief of all symptoms. ( info) |
3/1457. MRI in vitamin B12 deficiency myelopathy. BACKGROUND: Little is known about vitamin B12 deficiency myelopathy's magnetic resonance imaging (MRI) manifestations and their relationship to the onset, evolution, and resolution of neurologic signs and symptoms. methods: We present a case and review eleven additional reported cases of subacute combined degeneration of the spinal cord detected by MRI. RESULTS: Our patient had increased T2-weighted signal and gadolinium contrast enhancement of the posterior columns in the cervical and thoracic regions and enhancement of the lateral columns in the high cervical region. This is a case with imaging evidence for lateral column lesions. Two prior reports have shown posterior column enhancement. T1-weighted images may show decreased signal in the posterior columns and sometimes demonstrate reversible spinal cord swelling. MRI abnormalities typically improve after vitamin replacement therapy. However, clinical signs may persist despite resolution of imaging abnormalities, and these abnormalities do not always resolve completely. In addition, symptoms may precede the imaging abnormality. CONCLUSIONS: Vitamin B12 deficiency may produce an increased T2-weighted signal, decreased T1-weighted signal, and contrast enhancement of the posterior and lateral columns of the spinal cord, mainly of the cervical and upper thoracic segments. Because the symptoms may precede any imaging abnormality, it is clear that spinal cord MRI may not be a highly sensitive, early test for subacute combined degeneration. ( info) |
4/1457. Spinal epidural hematoma and high thromboembolic risk: between Scylla and Charybdis. OBJECTIVE: To determine the optimal time for reinstitution of anticoagulant therapy after evacuation of spinal epidural hematoma in patients who have a high risk for cardiogenic embolization. MATERIAL AND methods: The clinical histories of all patients with a spinal epidural hematoma encountered at Mayo Clinic Rochester between 1975 and 1996 were reviewed. We present three cases of spontaneous spinal epidural hematoma and the management of anticoagulation in each case. RESULTS: Of the 17 patients identified, 3 received anticoagulant therapy at the onset of the hematoma and were at high risk for cardiogenic embolization. In two patients with a metallic heart valve and one patient with long-standing atrial fibrillation, anticoagulant therapy was discontinued for 5, 13, and 18 days, respectively, after decompressive laminectomy. Systemic embolization occurred in one patient with a previous history of embolization to the femoral artery. No systemic embolization occurred in the two patients with a metallic valve. CONCLUSION: Early resumption of warfarin therapy is indicated after a spinal surgical procedure; however, discontinuation of anticoagulation for several days seems safe while postoperative hemostasis is monitored. ( info) |
5/1457. The use of Gore-Tex membrane for adhesion prevention in tethered spinal cord surgery: technical case reports. OBJECTIVE: The incidence of retethering caused by postoperative adhesions at the repair site after initial tethered spinal cord surgery is not uncommon. To assess the effectiveness of a Gore-Tex membrane in preventing these adhesions, only clinical radiological and experimental animal evaluation has been reported. In this report, we describe two cases in which Gore-Tex membrane was implanted at the initial untethering surgery and in which we were able to confirm the real effectiveness of the Gore-Tex membrane during a second operation. methods: In the first patient, Gore-Tex membrane was used for dural repair in the untethering surgery of the split spinal cord malformation. Because of the suspicion of a thickened filum terminale, repeated surgery was indicated 10 months after the initial procedure. In the second patient, Gore-Tex membrane was implanted during the initial untethering surgery for a lipomyeloschisis and a dermal sinus. Because of a persistent fistula of the dermal sinus, a second operation was necessary 1 year after the first operation. RESULTS: During the repeated surgery, a thorough inspection of the implanted Gore-Tex membrane revealed no adhesions between the Gore-Tex membrane and the intradural content in both cases. CONCLUSION: We support the use of Gore-Tex membrane in the prevention of postoperative dural adhesions in the repair of spinal dysraphism. ( info) |
6/1457. Left leg paralysis in a renal transplant. The postoperative course of renal transplant patients is often complicated by opportunistic infection. Up to 4% of posttransplant infections are caused by nocardia species. We present an unusual case of a nocardial spinal cord abscess that caused left leg paralysis. ( info) |
7/1457. Spinal arachnoid cyst with weakness in the limbs and abdominal pain. A 7-year-old male admitted with neck rigidity, severe pain in the abdomen, and progressive weakness in the lower limbs was diagnosed as having a spinal intramedullary arachnoid cyst. There was a dramatic and immediate recovery after fenestration of the cyst. ( info) |
8/1457. Pachymeningeal gadolinium enhancement of the lumbar region secondary to neuraxis hypotension. STUDY DESIGN: A case of diffuse pachymeningeal gadolinium enhancement of the lumbar region secondary to neuraxis hypotension is presented. OBJECTIVE: To report a case of diffuse pachymeningeal gadolinium enhancement of the lumbar region and to show the importance of considering neuraxis hypotension in the differential diagnosis of this type of enhancement so as to avoid excessive invasive and noninvasive diagnostic testing. SUMMARY OF BACKGROUND DATA: Diffuse pachymeningeal gadolinium enhancement of the lumbar region secondary to neuraxis hypotension has not been reported previously. methods: A case of diffuse pachymeningeal gadolinium enhancement of the lumbar region is presented in the context of clinical signs and symptoms replete with a history of cerebrospinal fluid diversion that strongly suggest neuraxis hypotension. RESULTS: The patient's clinical presentation and history of shunting implicated neuraxis hypotension as a cause of the diffuse dural enhancement. CONCLUSION: Proper attribution of the dural gadolinium enhancement to neuraxis hypotension helped avoid a dural biopsy with its potential attendant morbidity. It is important to consider neuraxis hypotension in the differential diagnosis of diffuse pachymeningeal enhancement occurring anywhere in the central neuraxis to avoid unnecessary diagnostic testing with its attendant morbidity and cost. ( info) |
9/1457. Chronic spinal subdural haematoma associated with intracranial subdural haematoma: CT and MRI. Chronic spinal subdural haematoma is a uncommon. We describe the CT and MRI appearances of chronic spinal and intracranial subdural haematomas following minor trauma. The aetiology, pathogenesis and differential diagnosis are discussed. ( info) |
| Spinal epidural abscess (SEA) is a rare disease with an unknown incidence rate. This paper will illustrate that early diagnosis and rehabilitation may result in improved outcomes for patients with neck or back pain presenting with neurological deficits. Three cases of SEA in individuals without the commonly acknowledged risk factors of intravenous drug abuse (IVDA), invasive procedures, or immunosuppression were seen at our institution during a 10-month period between October 1995 and July 1996. The patients presented with neck or thoracic back pain and progressive neurological deficits without a febrile illness. Predisposing factors were thought to be urinary tract infection with underlying untreated diabetes mellitus in the first case, a history of recurrent skin infection in the second, and alcoholism without a definite source of infection in the third. leukocytosis, elevated sedimentation rate, and confirmatory findings reported on magnetic resonance imaging (MRI) led to the diagnosis of SEA in all three cases. Immediate surgical drainage and decompression followed by proper antibiotic treatment and early aggressive rehabilitation led to good functional outcomes. All the individuals became independent in activities of daily living, wheelchair mobility, and bowel and bladder management. Two eventually became ambulatory. ( info) |