1/117. Parenchymatous cerebral neurocysticercosis in a quadriplegic patient.OBJECTIVE: To present and discuss a case of cerebral neurocysticercosis in a quadriplegic patient. DESIGN: Case report of a case of neurocysticercosis in a high level spinal cord injury (SCI) patient who developed episodes of autonomic dysreflexia and orthostatic hypotension associated with transient neurologic deficits and seizures. SETTING: spinal cord Unit of the University Hospital of Geneva, switzerland. SUBJECT: Single patient case report. MAIN OUTCOME MEASURE: Clinical and radiological magnetic resonance imaging follow-up of the patient between July 1995 and October 1997. RESULTS: Treatment of cysticercosis with praziquantel relieved the patient from autonomic dysreflexia, symptomatic orthostatic hypotension, transitory neurological deficits and seizures. CONCLUSION: diagnosis of neurocysticercosis in a quadriplegic patient might be difficult because of frequent overlaps with some usual symptoms occurring in high level SCI, mostly autonomic dysreflexia and orthostatic hypotension. neurocysticercosis should be kept in mind when a SCI patient living in, or coming from endemic zones presents with new neurological abnormalities and seizures. magnetic resonance imaging appears to be more sensitive than computerised tomography to confirm the diagnosis of active cysticercosis. Treatment with praziquantel associated with cimetidine to increase the drug bioavailability and prednisone to reduce the inflammatory reaction gives good results.- - - - - - - - - - ranking = 1keywords = reflex (Clic here for more details about this article) |
2/117. Antidepressant exacerbation of spasticity.patients with spinal cord injury (SCI) may develop depression. This may be related to adjustment to living with an SCI in addition to dealing with complications of the injury, such as spasticity. Pharmacologic treatment of depression can be difficult because of neurochemical and receptor changes that are associated with SCI. Newer antidepressant agents are purported to have selective activity by alteration of serotonergic neurotransmission. A case report is presented that illustrates exacerbation of spasticity by this family of antidepressant medications. Mechanisms possibly explaining this exacerbation of spasticity are the effects of serotonin on motor neuron and reflex activity, denervation supersensitivity, and the serotonin syndrome. Understanding the relationship between serotonergic systems and spasticity can be important in treating depression in patients with spasticity.- - - - - - - - - - ranking = 0.33333333333333keywords = reflex (Clic here for more details about this article) |
3/117. Spontaneous expulsion of large vesicle calculi in a woman with paraparesis.INTRODUCTION: urolithiasis is a common but preventable complication of spinal cord Disorders (SCD). CASE REPORT: We report a 25-year-old woman with paraparesis who spontaneously passed two large calculi perurethra without pain and developed urethral scarring. Detrusor hyperreflexia, absence of sensations and lack of sphincter tone could have contributed to painless expulsion of the large calculi in this patient. CONCLUSION: dysuria, a prominent symptom of urolithiasis may not be present in subjects with SCD. awareness about urolithiasis among health professionals involved in the care of SCD patients is necessary for prevention and early intervention.- - - - - - - - - - ranking = 119.46130740893keywords = hyperreflexia, reflex (Clic here for more details about this article) |
4/117. Phantom sensations in a patient with cervical nerve root avulsion.This case study reports detailed phantom sensations in a 35-yr.-old man who had his C5 and C6 cervical nerve roots avulsed from the cord during a motorcycle accident at the age of 22 years. The subject, who was left with a paralyzed right deltoid muscle, anesthetic sensation along the upper lateral portion of the right arm, and absent right biceps reflex, became aware of phantom right arm and hand sensations a few months after the original injury. This finding--which has important implications for understanding the process involved in bodily perception as well as the development of these perceptions--provides evidence of a distributed neural representation of the body that has both genetic and experiential determinants. The implications of these findings are discussed with reference to recent concepts of phantom limb experiences and related phenomena.- - - - - - - - - - ranking = 0.33333333333333keywords = reflex (Clic here for more details about this article) |
5/117. Catecholamine-induced hypertension in lumbosacral paraplegia: five case reports.hypertension in the patient with SCI is relatively rare and generally restricted to patients with high-level injuries where autonomic dysreflexia can occur. Resting blood pressure in individuals with SCI has been described as lower than that in the normal population. This report describes five previously normotensive teenagers with subsequent paraplegia as a result of gunshot wounds who presented with hypertension secondary to idiopathic elevation of plasma or urinary catecholamine levels. A clonidine suppression test was used as a neuroprobe to inhibit centrally mediated sympathetic outflow, excluding the probability of an extra-axial autonomous catecholamine-secreting tumor as the possible source of hypertension. Positive suppression was achieved in four patients (41%, 37.2%, 4.8%, and 37.2% decreases). One patient had values corresponding to orthostatic changes (an increase of 63%) because of poor compliance with the test. This patient was lost to follow-up; in the remaining four, hypertension resolved at 12, 8, 9, and 6 weeks postinjury. The increased circulating catecholamine level appears to be promoted by a centrally mediated response to the SCI. Elevated blood pressure probably results from an upgraded receptor regulation or an increased receptor sensitivity on the affected cells in the absence of restraining spinal reflexes. The pathophysiology of such hypertension seems to be secondary to autonomic dysfunction and, although it may be transient, it should be treated promptly and reevaluated periodically until stabilization is achieved.- - - - - - - - - - ranking = 0.66666666666667keywords = reflex (Clic here for more details about this article) |
6/117. An unusual complication during electroejaculation in an individual with tetraplegia.infertility in males is a common problem after spinal cord injury, often requiring interventional methods. In the authors' fertility program they have experienced 4 pregnancies and 3 live births using both electroejaculation (EEJ) and vibratory stimulation techniques. EEJ is a relatively safe procedure with few complications reported in the literature. Here is a case of a 23-year-old with C-6 asia A tetraplegia who, while receiving EEJ, developed autonomic dysreflexia that was followed by new onset atrial fibrillation. The patient's cardiac condition required management in the Emergency Department with pharmacologic conversion to a normal sinus rhythm. Although autonomic dysreflexia is a common adverse effect during EEJ, atrial fibrillation has not been previously reported as a complication. It is proposed that the patient's atrial fibrillation developed as a result of cardiac changes induced through autonomic dysreflexia.- - - - - - - - - - ranking = 1keywords = reflex (Clic here for more details about this article) |
7/117. Laparoscopic bladder auto-augmentation in an incomplete traumatic spinal cord injury.OBJECTIVES: To assess the urodynamic and clinical outcome of a laparoscopic auto-augmentated bladder. methods: Laparoscopic bladder autoaugmentation in a 27-year-old woman with an incomplete spinal cord injury at T12 level with urge incontinence caused by a hyperreflexic bladder. RESULTS: Six months later the patient voids by Valsalva's manoeuvre every 3 h and remains dry day and night. The radio-urodynamic study, performed 2 months later, revealed an intact bladder with a diverticulum of anterior wall and a capacity of 510 ml with filling rate of 100 ml/min without evidence of leakage of infusion water. CONCLUSION: Laparoscopic retropubic auto-augmentation allows a brief hospital stay and minor postoperative discomfort. Moreover the laparoscopic approach should not complicate or preclude subsequent enterocystoplasty if necessary.- - - - - - - - - - ranking = 0.33333333333333keywords = reflex (Clic here for more details about this article) |
8/117. Early autonomic dysreflexia.INTRODUCTION: During the stage of spinal shock the conventional view is that autonomic activity is abolished. Here, evidence is presented that autonomic activity is still present. patients: Four patients with acute cord transactions are presented: one new case and three from the literature. DEFINITIONS: The definitions of spinal shock and autonomic dysreflexia are given. methods: All four cases showed acute autonomic dysreflexia between 7 and 31 days after acute cord transection at a stage when the tendon reflexes were abolished. RESULTS: Two cases showed a severe rise in blood pressure; the two earlier cases, before blood pressure was routinely recorded, profuse sweating. In two cases autonomic dysreflexia was obtained when the bladder was overdistended with 1000 ml and 1600 ml. In the other two cases it occurred in response to traumatic catheterisation. This was found when supramaximal stimuli were applied. It has not been recorded routinely as, with modern management, the bladder does not get overdistended or traumatised. DISCUSSION: Other evidence, the blood pressure, and urethral tone is presented to show that sympathetic reflex activity of the cord is not abolished during spinal shock. CLINICAL SIGNIFICANCE: The clinical importance of this is that autonomic dysreflexia can be seen at an early stage and it should be considered in the differential diagnosis of a sick patient immediately after spinal injury.- - - - - - - - - - ranking = 3.3333333333333keywords = reflex (Clic here for more details about this article) |
9/117. Bilateral S3 nerve stimulation, a minimally invasive alternative treatment for postoperative stress incontinence after implantation of an anterior root stimulator with posterior rhizotomy: a preliminary observation.STUDY DESIGN: A preliminary report. OBJECTIVES: Urinary stress incontinence following implantation of an anterior root stimulator and a posterior rhizotomy is a rare complication which is difficult to treat. It is seen in patients with an open bladder neck (T9-L2 lesion). An artificial urinary sphincter is a possible treatment for this condition but has a higher failure rate in patients with neurogenic bladder disease and could complicate micturition. SETTING: Ghent, belgium. methods: A male paraplegic patient (T9, complete lesion) aged 36 was suffering from severe urinary incontinence due to detrusor hyperreflexia. Preoperatively the bladder neck was closed on cystography. Following implantation (6/95) of an intradural anterior root stimulator with posterior rhizotomy, severe urinary stress incontinence presented. Bilateral S3 foramen leads were implanted and connected to a pulse generator. RESULTS: The patient has been continent with continuous stimulation of both S3 roots for 4 years, and no fatigue of the levator muscles has been seen. Preoperative urodynamics are compared to results 3 years postoperatively. CONCLUSION: Bilateral S3 stimulation is a feasible and minimally invasive treatment of urinary stress incontinence following implantation of an anterior root stimulator.- - - - - - - - - - ranking = 119.46130740893keywords = hyperreflexia, reflex (Clic here for more details about this article) |
10/117. Management of autonomic hyperreflexia with magnesium sulfate during labor in a woman with spinal cord injury.Autonomic hyperreflexia, one of the gravest complications of delivery among women with spinal cord injury, has been treated with spinal or epidural anesthesia but not always successfully. We discovered dramatically beneficial effects of magnesium sulfate on autonomic hyperreflexia during labor in a patient with spinal cord injury at a high level.- - - - - - - - - - ranking = 716.76784445359keywords = hyperreflexia, reflex (Clic here for more details about this article) |
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