Cases reported "Quadriplegia"

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1/405. 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.
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2/405. 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.
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3/405. Using seat contour measurements during seating evaluations of individuals with SCI.

    Measuring the shape of the buttock-cushion interface has been used successfully in research to study tissue loading and as a means to fabricate custom contoured cushions. Seat contours are also able to provide useful clinical information on the weight-bearing surface of the cushion, which can be used to address posture. This article offers specific case studies that demonstrate how the analysis of seat contours can be used to identify pelvic tilt, pelvic obliquity, and areas of high loading. Seat contour measurements complement other clinical measures, such as seat interface pressures and general postural assessments, to form a more complete picture of the buttock-cushion interface. They have become useful in the clinical management of various pressure and posture problems experienced by individuals with spinal cord injury and other wheelchair users.
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4/405. Restoration of strong grasp and lateral pinch in tetraplegia due to cervical spinal cord injury.

    patients with tetraplegia who have "strong" sixth cervical neurologic (C-6) function often can be given active grasp and strong lateral pinch by tendon transfers and tenodeses. wrist control can be retained by the extensor carpi radialis brevis and flexor carpi radialis and can permit transfer of the extensor carpi radialis longus to provide finger flexion. Either the brachioradialis or pronator teres then is available for transfer to restore adduction-opposition of the thumb with an in situ tendon graft of a paralyzed flexor superficialis rerouted to the thumb through a palmar fascial pulley. The other motor can provide thumb flexion for strong lateral pinch. Extrinsic extension can be provided by tendoeses. With seventh cervical neurologic (C-7) function retained, active digital extension is present and functional expectations are better. Ten hands in seven patients with traumatic tetraplegia from injuries at C-6 or C-7 level have been reconstructed. The average grasp and pinch force after operation was 5.5 and 3.0 Kg., respectively. All patients but one were pleased with the increased function a
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5/405. pathology of the spinal cord damaged by ossification of the posterior longitudinal ligament associated with spinal cord injury.

    A 63-year-old male became quadriplegic after spinal injury associated with ossification of the posterior longitudinal ligament of the cervical spine and died 4 years later. A postmortem examination of the cervical spinal cord showed various unfavorable pathological changes accounting for severe myelopathy.
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6/405. Surgical challenge of massive bilateral staghorn renal calculi in a spinal cord injury patient.

    We report a rare case of massive bilateral staghorn calculi in a spinal cord injury patient with significant renal compromise. The patient was successfully treated with percutaneous nephrolithotomy to achieve a stone-free status. The various options of treatment are discussed with special attention to the technical aspects necessary to achieve complete eradication of the stone burden during percutaneous nephrolithotomy. Furthermore, the importance of treating bladder dysfunction and urinary metabolic abnormalities is emphasized.
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7/405. Control of FES thumb force using slip information obtained from the cutaneous electroneurogram in quadriplegic man.

    A tetraplegic volunteer was implanted with percutaneous intramuscular electrodes in hand and forearm muscles. Furthermore, a sensory nerve cuff electrode was implanted on the volar digital nerve to the radial side of the index finger branching off the median nerve. In laboratory experiments a stimulation system was used to produce a lateral grasp (key grip) while the neural activity was recorded with the cuff electrode. The nerve signal contained information that could be used to detect the occurrence of slips and further to increase stimulation intensity to the thumb flexor/adductor muscles to stop the slip. Thereby the system provided a grasp that could catch an object if it started to slip due to, e.g., decreasing muscle force or changes in load forces tangential to the surface of the object. This method enabled an automatic adjustment of the stimulation intensity to the lowest possible level without loosing the grip and without any prior knowledge about the strength of the muscles and the weight and surface texture of the object.
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8/405. Anomaly of the axis causing cervical myelopathy. Case report.

    Although the craniovertebral junction is one of the most common sites at which anomalies develop, spina bifida occulta of the axis (C-2) associated with cervical myelopathy is extremely rare. The authors present the case of a 46-year-old man who developed progressive tetraparesis caused by a cervical canal stenosis at the level of the axis. The spinal cord was compressed by an invaginated bifid lamina of the axis. The patient made a remarkable recovery after undergoing decompressive laminectomy of C-3 and removal of the bifid posterior arch of the axis.
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9/405. Intravenous immunoglobulin therapy in acute disseminated encephalomyelitis.

    We describe 4 patients with acute disseminated encephalomyelitis (ADEM) who were treated with intravenous immunoglobulins (IVIg) after getting no immediate response from a 3-5 day course of high dose intravenous methylprednisolone. All had clinical features to suggest poor prognosis and MRI findings to indicate extensive white matter changes in the brain. Two patients who had spinal cord involvement as well, required ventilatory support during acute phase of the illness. All the 4 patients recovered dramatically. Recovery pattern suggested that IVIg might be useful in fulminant ADEM. Further trials are needed to look for the efficacy of IVIg alone and in combination with methylprednisolone in the treatment of ADEM.
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10/405. Delayed diffuse upper motor neuron syndrome after compressive thoracic myelopathy.

    A 54-year-old man developed progressive spastic paraparesis beginning 2 weeks after a back injury caused by a subacute compressive thoracic myelopathy attributable to a post-traumatic arachnoid cyst. Three to 18 months after surgical decompression of the thoracic arachnoid cyst, the patient developed a diffuse predominantly upper motor neuron syndrome characterized by spastic quadriparesis, pseudobulbar paresis, and pseudobulbar affect. Retrograde corticospinal tract degeneration and upper motor neuron death after spinal cord injury is recognized. This case suggests that focal upper motor neuron injury can occasionally precipitate diffuse upper motor neuron dysfunction.
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