Cases reported "Paraparesis"

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1/20. Spinal clear cell meningioma presented with progressive paraparesis in infancy.

    Clear cell meningioma, about 20 cases of which have been reported in the literature, is a morphological variant of meningioma. The authors report a case of spinal clear cell meningioma that occurred in a child. A 14-month-old girl showed gradually progressive paraparesis 1 month after she started to walk. Magnetic resonance image showed an intradural extramedullary mass compressing the conus medullaris and cauda equina. Complete excision of the tumor was done, and the patient gradually recovered from motor weakness and neurogenic bladder. Histological examinations along with immunohistochemical and ultrastructural investigations allowed a diagnosis of clear cell meningioma. During the follow-up period, a recurrent mass lesion was detected on the 8-month follow-up MR image in the same region. Because clear cell meningioma might be biologically aggressive, postoperative adjuvant therapy and close follow-up investigation should be considered.
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2/20. paraparesis induced by inflammatory contents of a pneumonectomy cavity. Case report.

    The authors report on a patient who developed acute-onset paraparesis after underoing a thoracotomy 40 years earlier for a carcinoid adenoma. No infectious or neoplastic origin could be found to explain the patient's current clinical course and radiographic findings. The postoperative events in this case are discussed, as well as the literature regarding postthoracotomy complications.
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3/20. lower extremity paraparesis or paraplegia subsequent to endovascular management of abdominal aortic aneurysms.

    lower extremity paraplegia or paraparesis is an extremely rare event after operative repair of infrarenal abdominal aortic aneurysms (AAAS). We report two such cases that occurred after endovascular repair or attempted endovascular repair of routine AAAS. To our knowledge, these are the first two cases reported specifically in the literature. These cases may have significant implications with regard to the endovascular management of AAAS, because atheroembolization to the spinal cord appears to be the underlying cause.
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4/20. Intradural disc herniation at the T1-T2 level.

    Intradural disc herniations comprise 0.26-0.30% of all herniated discs. Five percent are found in the thoracic, 3% in the cervical, and 92% in the lumbar region. Although intradural disc herniation may be suspected on preoperatively made CT scans, myelograms, and MRI scans, establishing the diagnosis prior to the surgery is difficult. We present a case of the patient with severe neurological deficits, caused by intradural thoracic disc herniation at T1-T2 interspace, which required surgical treatment. The symptoms were relieved immediately after surgery. This is the first description of an intradural disc herniation at that level.
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5/20. Cervical intramedullar schistosomiasis as a rare cause of acute tetraparesis.

    INTRODUCTION: The trematode infection schistosomiasis affects at least 200 million people in endemic areas. Granulomas cause the typical manifestations of urogenital, intestinal and hepatolienal schistosomiasis. Involvement of other organs especially the central nervous system (CNS) is uncommon. CASE REPORT: We describe a 40-year old male with a history of repeated contact with schistosome contaminated water. After having suffered from flu-like symptoms with fever and arthralgias, he first presented with a polyradiculopathy of unknown origin. Then 4 weeks later an acute tetraparesis occurred. Spinal magnetic resonance imaging (MRI) revealed a spinal stenosis and query medullary hyperintensities at C6-C8 without contrast-enhancement. Serologic testing was positive for schistosomiasis. The intraoperative appearance at decompressive laminectomy revealed a myelitic form of schistosomiasis. Under therapy with praziquantel, initially high dose cortisone and intensive physiotherapy, symptoms slowly improved over months. On follow-up 1 year later, the patient presented with a spastic distally marked tetraparesis and sensory impairment from C6 downwards. CONCLUSION: Cervical intramedullar schistosomiasis is a rare cause of acute tetra- or para-paresis in patients, who have had contact with schistosomes. early diagnosis is essential because of the excellent prognosis with specific therapy.
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6/20. Anterior spinal artery stroke demonstrated by echo-planar DWI.

    diffusion-weighted MR (DWI) is becoming an established method for the investigation of cerebral ischemia. Its value in spinal ischemia has to be demonstrated. We report on a patient presenting with postoperative paraparesis who underwent emergency MRI of the spine with echo-planar diffusion-weighted imaging which showed an area of hyperintensity corresponding to a decrease of diffusion as measured by the apparent diffusion coefficient. On follow-up imaging spinal stroke was confirmed. In conclusion, spinal echo-planar MR imaging can demonstrate ischemic changes despite strong echo-planar artifacts. It could become an important adjunct to the management of patients with suspected spinal ischemia.
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7/20. paraparesis after excision of intrathoracic meningoceles in a patient with neurofibromatosis.

    Intrathoracic meningocele associated with neurofibromatosis is a rarity. We treated a 16-year-old boy with neurofibromatosis, marked kyphoscoliosis, and two right-sided intrathoracic meningoceles. Because his chief complaints of cough and chest pain were thought to be caused by the meningoceles, resection of these lesions was performed prior to correction of the spinal deformity. On the day after the resection, complete paraplegia developed, followed by recovery to paraparesis. Decompressive lumbar puncture was performed, but intraspinal pressure was normal. Postoperative spinal cord damage and consequent paresis may have resulted from a loss of pressure buffering by the meningocele, which rendered the cord vulnerable to injury. The possibility of a similar unusual complication should be borne in mind when treating patients with intrathoracic meningocele associated with neurofibromatosis.
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8/20. Thoracic epidural anesthesia and epidural hematoma.

    This report involves a 74-year-old-male who developed a thoracic epidural hematoma with paraparesis on the second postoperative day in conjunction with thoracic epidural anesthesia established before surgery for acute abdominal aortic dissection. The finding indicates that laminectomy can be performed successfully as late as three days after diagnosis of the hematoma, with a complete restitution of neurological function. High-dose steroid treatment may have been a contributing factor for the positive outcome.
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9/20. Acute thoracic myelopathy after a traumatic episode in a patient with neurofibromatosis associated with sharply angular scoliosis: a case report.

    We treated a 16-year-old boy with acute thoracic myelopathy due to sharply angular scoliosis. The patient underwent posterior decompression and posterior spinal fusion using Luque spinal segmental instrumentation. Postoperatively, spasticity increased, and voluntary movement of the lower extremities disappeared. The patient could walk without assistive devices 5 months postoperatively. As pseudarthrosis at the posterior fusion site was suspected, anterior spinal fusion was performed using a fibular bone strut. His neurologic deficits were completely alleviated, and bony union was obtained. In our case, paraparesis followed relatively mild trauma because the spinal cord was predisposed to injury by continuous mechanical compression, although the cause of the severe temporary deficits following the first operation was not identified.
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10/20. Intraspinal extradural teratoma mimicking neural sheath tumor in infant.

    INTRODUCTION: An intraspinal teratoma that is located entirely extradurally is unusual both in children and in adults. CASE history: The authors present a case of an 8-month-old male infant with an extradurally arising intraspinal mature teratoma located from T-2 to T-4, who had suffered from progressive paraparesis (grade 1). The patient did not have any stigmata or anomalies suggesting spinal dysraphism. Spinal MRI showed a cystic extradural mass markedly compressing the dural sac. On operation, the only way of getting sufficient space for exposure of the whole tumor was to perform hemilaminectomies with preservation of facetal areas to prevent postoperative instability. The tumor was well encapsulated and located entirely extradurally, and the cystic portion was occupied with yellowish fluid. The site of tumor occurrence was the spinal root sheath, mimicking a neural sheath tumor. paraparesis had improved markedly to grade 4 by the time of the neurological examination 3 months after operation.
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