Cases reported "Spinal Cord Diseases"

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1/31. 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.
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2/31. Myelopathy due to calcification of the cervical ligamenta flava: a report of two cases in West Indian patients.

    Two cases of cervical myelopathy due to calcification of the ligamenta flava (CLF) are described for the first time in black patients from the French west indies. A pre-operative CT scan differentiated the diagnosis from one of ossification of the ligamenta flava. Microanalysis on the operatively excised specimen in one patient revealed a mixture of calcium pyrophosphate dihydrate crystals and hydroxypatite crystals. Poor outcome in one patient contrasting with excellent recovery in the other one, who had undergone posterior decompressive laminectomy, emphasizes the importance of surgery in the management of CLF.
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3/31. Transient oedema of the cervical spinal cord.

    Transient but very intense oedema of the cervical spinal cord was observed in two patients with obstruction of the cerebrospinal fluid (CSF) pathways. Both presented with hydrocephalus, one due to an infratentorial obstructing mass and the other due to postmeningitic adhesive obstruction of the outlet foramina of the fourth ventricle. In animal experiments with obstruction of CSF pathways (due to outlet foramina obstruction or to downward tentorial herniation) flattening and stretching of the ependymal cells along the central canal is observed, followed by disruption and splitting of the ependymal lining and then by extracellular oedema of the subependymal tissue. Without treatment, frank cavity formation develops in a fourth stage. In our two patients, however, most probably because of appropriate decompressive therapy, the oedema disappeared completely without a residual spinal cord lesion.
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4/31. 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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5/31. Juxtafacet cyst of the lumbar spine. Clinical, radiological and therapeutic aspects in 28 cases.

    OBJECT: A consecutive series of 28 "operated" juxtafacet cysts is reported. We emphasize the clinical and radiological aspects leading to diagnosis. We also discuss the results of the surgical treatment. MATERIAL AND methods: Medical information and radiological studies involving 28 patients were analyzed. Each patient has been operated on by decompressive laminectomy and resection of the cyst. The diagnosis was always confirmed by a pathological examination. The cyst most frequently occurred at the L4-L5 level (n = 18), and seldom at the L5-S1 (n - 6) or L3-L4 (n - 4) levels. RESULTS: The differential diagnosis from other pathological causes responsible for a radicular compression could not be done by physical examination. spine x-rays or myelogram were nonspecific. Computed tomography or CT-myelography could help in the diagnosis but MR imaging was the most sensitive. In our series, the respective sensitivities of these techniques are 56, 42 and 77%. The preoperative diagnosis was correct in 18 patients (64%). The cyst was sometimes adherent to the underlying dura, then significantly increasing the risk of dural tear and spinal fluid leak, especially when located at L3-L4 level. Surgical ablation lead to a complete recovery or an important improvement in 26 patients. CONCLUSIONS: The diagnosis of the juxtafacet cyst of the lumbar spine is better achieved by MRI. Surgery is the gold standard treatment, safe and long-term effective. When a total cyst removal with an internal facetectomy are performed, recurrence is exceptional.
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6/31. Intramedullary arachnoid cyst. Case report.

    The authors present an unusual case of intramedullary arachnoid cyst diagnosed in a patient after the lesion was resected. A wide decompressive surgery was performed and the lesion removed. Histopathological findings were consistent with the diagnosis of arachnoid cyst. Postoperatively the patient exhibited marked improvement in neurological status. To the best of the authors' knowledge, there is no case report of intramedullary arachnoid cyst reported in the literature. With the advent of newer neuroimaging modalities such as magnetic resonance imaging the number of cases of intramedullary arachnoid cysts encountered in the future may increase.
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7/31. Permanent thoracic myelopathy resulting from herniation of a calcified intervertebral disc in a child.

    This retrospective study was made to illustrate the rare occurrence of neurologic deficits resulting from intervertebral disc calcification (IDC) in a child. Most authors agree that juvenile IDC is usually a benign, self-limiting disease with excellent prognosis. The symptoms subside spontaneously in 95% of patients. Conservative treatment is therefore usually sufficient. Reviewing the English-speaking literature, only two further cases of operated juvenile IDC with myelopathy have been published. In the current report, we describe a case of permanent thoracic myelopathy resulting from juvenile IDC treated by urgent decompressive thoracic laminectomy. At the 3-year follow-up examination, the patient had not recovered fully. Persisting deficits in motor and sensory function were observed.
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keywords = decompressive
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8/31. Acute paraplegia caused by a spontaneous extradural heamatoma of the conus medullaris area.

    Four patients with a typical clinical picture of spinal extradural heamatoma of the conus area are presented. Initial symptoms were acute low back pains. The development of symmetrical paraparesis took place in a matter of hours, and spread to total paraplegia. The sensory level was as high as the groins and bladder and rectum paralysis developed early. All patients were over 63, mean age 67 years. Two patients had coagulation defects, one was on anticoagulants, and the other had a severe thrombocytosis. Two patients had used salicylates for rheumatic pains; in one of those patients there was a hemangioma on PAD . In 2 patients, the neuroradiological diagnosis was confirmed with rhizography (Figs. 1 and 2); in the third patient the rhizography was misleading but in her and in a fourth patient the oxygen-myelography was diagnostic, showing an extradural compression in the conus area. Haematomas were removed in all patients through an extensive decompressive laminectomy within 24 hours from the onset of the symptoms. Recovery was good in 2 cases, and fair in one patient who had a poor recovery of the bladder function. In on patient, both paraplegia and bladder paralysis were permanent after 3 years. The differential diagnosis by myelography between the cauda equina syndrome caused by typical disc compression from the one side and from vascular medullary syndromes and myelitis from the other side should be clear. For good functional recovery, early myelography and operative decompression are imperative.
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keywords = decompressive
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9/31. Spinal epidural lipomatosis.

    Epidural lipomatosis is an uncommon disorder defined as a pathologic overgrowth of normal epidural fat. It is most often associated with administration of exogenous steroids of variable duration and dose. However, it can occur in the absence of exposure to steroids. We report two cases of spinal epidural lipomatosis following more than 20 years of steroid use due to asthma. Pathologic compression fracture due to osteoporosis and acute cord compression syndrome were found in these 2 cases. After emergent decompressive laminectomy and fusion surgery, neurological function recovered. From a review of literature, most patients received decompressive laminectomy surgery. But in our additional cases, we performed decompressive laminectomy and fusion surgery which might prevent further spinal deformity and improve the spinal stability, then patients' symptoms subsided completely. Therefore, decompression surgery and fusion surgery may be necessary in patients with symptomatic spinal epidural lipomatosis with compression fracture.
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keywords = decompressive
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10/31. calcium pyrophosphate dihydrate crystal deposition disease in cervical radiculomyelopathy.

    One patient had cervical spinal canal stenosis with radiculomyelopathy due to deposition of calcium pyrophosphate dihydrate within the ligamentum flavum. The MRI of cervical spine showed a calcified nodule over C5-6 level ligamentum flavum with obvious cord compression. After posterior decompressive laminectomy with removal of the calcified nodule, the symptom and sign relieved remarkedly and the pathology showed calcium pyrophosphate dihydrate deposition within the ligamentum flavum. We presented this case and reviewed the literature to acknowledge so-call "pseudogout syndrome."
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keywords = decompressive
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