Cases reported "Quadriplegia"

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11/43. Unusual stab injury of the spinal cord.

    OBJECTIVE: To report an unusual penetrating stab injury of the spinal cord. DESIGN: Case report of a 13-year-old boy who sustained cervical trauma following an accident while playing. SETTING: spinal cord injuries Unit, Musgrave Park Hospital, Belfast, UK. CASE REPORT: Mechanism of injury was by a spear-like electric fence post entering the neck. Initial neurological examination revealed tetraplegia with C4 sensory level. magnetic resonance imaging (MRI) of spinal cord demonstrates the penetrating injury. CONCLUSION: No ligamentous instability was demonstrated. In the absence of this, the penetrating injury by a short blade thrown at speed was felt to be responsible for the subsequent injury and resulting outcome at discharge of C4 American Spinal Injury association (asia) grade D tetraplegia.
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keywords = neck
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12/43. AAEM case report #24: electrodiagnosis in posttraumatic syringomyelia.

    An adult male with C-7 quadriplegia developed neck pain. Axillary F central latencies were prolonged, and MRI showed a syrinx extending to C-1. After shunting, F latencies normalized. At subsequent follow-up, a rostral syrinx persisted by magnetic resonance imaging (MRI); motor evoked potential (MEP) latencies were prolonged but F latencies were normal. Later, the syrinx was less distended by MRI, MEPs normalized, and strength improved. We discuss the electrophysiologic methods available for diagnosing and monitoring posttraumatic syringomyelia.
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13/43. Complete recovery of severe quadriparesis caused by stab wound at the craniocervical junction.

    Non-missile penetrating spinal cord injuries are uncommon, and involvement of the craniocervical junction is even less frequent. The author reports a case of 42-year-old male who presented with quadriparesis immediately following stab injury inflicted with a kitchen knife to the back of his neck. The knife was retained in the patient's neck. Neurological examination revealed spastic paraplegia and severe weakness of the left upper limb and the right-hand grip, and sensory disturbance from C2 and downwards. In addition to these symptoms, cerebrospinal fluid (CSF) was leaking from the wound. Computerised tomography (CT) scan showed the blade passed through the spinal canal and its tip reached the odontoid peg. After retrieval of the knife, his quadriparesis recovered. The management and outcome of the patient are described.
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keywords = neck
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14/43. Spinal epidural epitheloid hemangioma--case report and review of the literature.

    Epitheloid hemangiomas are benign vascular lesions composed of epitheloid endothelial-cell-lined channels. We report an unusual case of a purely extradural non-osseous spinal epitheloid hemangioma presenting with quadriparesis. A 5-year-old boy presented with neck pain and quadriparesis following a trivial fall. MRI revealed a mixed intensity extradural lesion compressing the cervico-thoracic spinal cord posteriorly. At surgery the lesion consisted of vascular granulation tissue admixed with blood clots without abnormal vessels. Bone was normal. Histopathology revealed it to be an epitheloid hemangioma. The case and relevant literature is reviewed.
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15/43. Transient tetraplegia after cervical facet joint injection for chronic neck pain administered without imaging guidance.

    We report about a patient in whom transient tetraplegia with intact proprioception occurred immediately after infiltration of a facet joint at the C6 level guided by anatomical landmarks. After positioning the patient supine and applying atropine and oxygen, respiration and circulation were stable and all symptoms resolved within the next 30 min. The type of neurological pattern and the course of disease suggest an inadvertent injection into a cervical radicular artery that reinforces the anterior spinal artery. This complication is potentially serious and may be permanently disabling or life threatening. It should be considered by any clinician performing "blind" zygapophysial joint injections in the cervical spine. Using imaging guidance should help prevent this type of complication.
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keywords = neck
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16/43. Quadriparesis following cervical epidural steroid injections: case report and review of the literature.

    BACKGROUND CONTEXT: Cervical epidural steroid injections are frequently used in the conservative management of neck pain, cervical radiculitis, and cervical radiculopathy. Between 64-76% of patients who receive injections report subjective pain improvement. injections are usually well-tolerated with only mild, transient side effects, although a few case reports of patients with adverse effects do appear in the literature. Some clinicians have expressed concerns about epidural injections above the C7-T1 level, and in the use of methylprednisolone epidurally; as yet, neither is a consensus viewpoint. PURPOSE: This case report describes severe adverse effects (quadriplegia and respiratory arrest) associated with an epidural injection into the C6-C7 space. Although the patient's symptoms improved somewhat with supportive care, quadriparesis appears irreversible. No reports of quadriparesis after cervical epidural injection were found in the literature, although other adverse effects have been reported. STUDY DESIGN/SETTING: The patient was injected by a fellowship-trained pain management specialist in an outpatient surgicenter using C-arm fluoroscopic guidance. Immediately he experienced respiratory arrest with quadriplegia. He was intubated and transferred to the hospital, then transferred again to Christiana health Care Services. methods: The patient was hospitalized, treated with steroid protocol within 8 hours, and followed clinically for 6 months. RESULTS: magnetic resonance imaging within 6 hours of the injury and 6 months later showed no significant findings aside from lordosis (40 degrees angle) of the cervical spine at the C6-C7 level. CONCLUSION: Although evidence is not conclusive, this patient may have suffered a vascular event from a cervical epidural injection.
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keywords = neck
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17/43. Acute quadriparesis caused by calcification of the entire cervical ligamentum flavum in a white female--report of an unusual case and a brief review of the literature: case report.

    STUDY DESIGN: Case report. OBJECTIVES: To describe an extremely unusual case of acute quadriparesis in a white female caused by calcification of the ligamentum flavum (LF) from C1 to T2, and to review briefly the pertinent literature. SUMMARY OF BACKGROUND DATA: Diseases characterized by abnormal calcium deposition on the spinal ligaments have an unclear etiology. The overwhelming majority of these cases has been reported in people of Asian descent and has a predilection for the thoracic spine. Multilevel involvement of the cervical LF in white patients is exceptionally rare. To our knowledge, complete calcification of the entire cervical LF has not been previously reported in the literature. methods: The history, physical examination, and radiographic studies of a 64-year-old white female with a history of scleroderma are described. The patient presented with neck pain and acute quadriparesis caused by spinal cord impingement by calcified cervical LF from C1 to T2. The patient underwent emergent C3-C7 laminectomy and C2-C7 posterior spinal fusion. RESULTS: Operative intervention resulted in marked neurologic improvement and relief from neck pain. Histopathologic examination of the calcified LF showed that the deposits consisted of hydroxyapatite crystals exclusively with no heterotopic bone. However, kyphosis did develop in the patient after laminectomy. CONCLUSION: To our knowledge, this unusual case of complete calcification of the entire cervical LF has not previously been described. Multilevel laminectomy and fusion can improve neurologic function but may result in kyphosis.
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keywords = neck
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18/43. Delayed postoperative spinal epidural hematoma causing tetraplegia. Case report.

    The authors describe a case of postoperative spinal epidural hematoma (PSEH) that developed in a patient 9 days after he underwent laminoplasty. A PSEH is a rare but critical complication of spinal surgery that usually occurs within a few days of the procedure. The authors draw attention to the possibility of delayed PSEH and its triggering mechanism. In this case, a 59-year-old man with no history of bleeding disorder underwent cervical laminoplasty for mild myelopathy. On the 7th postoperative day computed tomography demonstrated no abnormal findings in the operative field. On the 9th postoperative day, while straining to defecate, the patient suddenly felt neck and shoulder pain, and tetraplegia rapidly developed. magnetic resonance imaging demonstrated a huge epidural hematoma. The clot was evacuated during emergency revision surgery, during which the arterial bleeding from a split muscle wall was confirmed. The postoperative course after the revision surgery was uneventful and the patient had none of the previous symptoms 1 year later. A PSEH causing paralysis can occur even more than a week after surgery. The possibility of a delayed-onset PSEH should be kept in mind, and prompt diagnosis should be made when a patient presents with paresis or paralysis after an operation. The authors recommend advising patients that for a while after surgery they avoid strenuous activity.
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keywords = neck
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19/43. phrenic nerve stimulation for central ventilatory failure with bipolar and four-pole electrode systems.

    A multi-channel phrenic nerve stimulator developed in Tampere has been implanted into seven patients with C2-tetraplegia and into three patients with central sleep apneas. Six bipolar cuff electrodes were implanted bilaterally into the neck. Two four-pole cuff and 14 four-pole noncuff electrodes were used in seven patients and to replace one bipolar electrode. Four-pole electrodes were implanted within the thorax. Seven patients achieved total independence from conventional ventilators within 4 months of implantation, and one for 18 hours each day. Two patients died 12 days and 3 months after implantation and two patients after having achieved independence from mechanical ventilators from causes unrelated to the stimulators. Reoperations were necessary because of dislocation of receivers, electrodes, electrode lesions, nerve injuries, and technical failures in seven patients. Most of the problems appeared in two patients with obesity and in three patients with very thin phrenic nerves. Single unit prototypes failed technically more frequently than units of prototype serial fabrication. New electrode design, progress in the manufacture of receivers, and improved implantation technique should help to diminish failures in future.
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keywords = neck
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20/43. quadriplegia after chiropractic manipulation in an infant with congenital torticollis caused by a spinal cord astrocytoma.

    An infant with congenital torticollis underwent chiropractic manipulation, and within a few hours had respiratory insufficiency, seizures, and quadriplegia. A holocord astrocytoma, with extensive acute necrosis believed to be a result of the neck manipulation, was found and resected. We believe that every child with torticollis, regardless of age, should undergo neurologic and radiologic evaluation before any form of physical treatment is instituted.
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