Cases reported "Spinal Cord Diseases"

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1/33. Epidural blood patch under fluoroscopic control: non-surgical treatment of lumbar cerebrospinal fluid fistula following implantation of an intrathecal pump system.

    The treatment of lumbar cerebrospinal fluid fistula in the presence of an intrathecal catheter is known to be difficult. Open revision surgery is recommended in the literature, although the rate of recurrence is high. The epidural blood patch technique is well established as a successful treatment for post-dural-puncture headaches. Recent work about the distribution of the injected blood and theoretical considerations about the mechanism of action make this method suitable for the occlusion of spinal leakage even in the presence of an intrathecal catheter. In this note technical details are given for a successful therapy of lumbar cerebrospinal fluid fistula including the right positioning of the opening of the needle (cerebrospinal fluid can be expected intrathecally and epidurally) by injection of contrast medium first for myelography then for epidurography. In this procedure the (epidural) distribution of autologous blood can be indirectly controlled by compression of the dural sac. The method is easy to perform, and the possible risks are small.
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2/33. Pneumoencephalomeningitis secondary to infected lumbar arthrodesis with a fistula: a case report.

    pneumocephalus associated with spinal problems is very rare. association with encephalomeningitis secondary to a fistula after an infected elective lumbar spine fusion has not been previously reported. The authors report a case in which the clinical onset of pneumoencephalomeningitis occurred after an airplane flight. CT-scan and lumbar puncture were used to make diagnosis; the treatment was based on parenteral antibiotics. The symptoms and signs of infection and neurological deficit resolved but the fistula remained. diagnosis in such cases must be based upon CT-scan and lumbar puncture. Treatment should consist of systemic antibiotic therapy. Surgical management of infection and fistula is desirable, should the status of the patient allow such a treatment. In any case, as airplane flights in such cases may predispose to pneumocephalus, patients with an infected CSF fistula should avoid airplane flights until the problem is solved.
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3/33. Percutaneous spinal cord puncture and myelocystography. Its role in the diagnosis and treatment of intramedullary neoplasms.

    Three patients with cystic tumors of the cervical spinal cord were evaluated with percutaneous cord puncture and myelocystography. This procedure gives relief of symptoms and permits delineation of the extent and character of the cystic mass.
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4/33. Iatrogenic spinal epidermoid tumor. A complication of spinal puncture in an adult.

    A case of an intraspinal epidermoid tumor following a lumbar puncture (LP) is described. This tumor developed 5 years after a LP in a man aged 31 years. The majority of epidermoid tumors reported are late complications of spinal puncture during the early neonatal period. To the best of our knowledge, this case is the third oldest patient, whose symptoms presented relatively early after the initial LP. He was successfully treated by surgery. Pathologic diagnosis revealed an epidermoid cyst. The relation between LP and epidermoid tumor and the possible risk factors involved are discussed.
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5/33. Spinal subdural empyema: report of two cases.

    Spinal subdural empyema (SSE) is a rare variety of intraspinal infection. SSE should be suspected in patients presenting with fever, back pain, and signs of cord or nerve root compression. Two patients with SSE are presented. The first patient complained of fever and back pain. She had no neurological deficit but was found to have SSE. The second patient, who presented with intracerebral hemorrhage in the fifth month of pregnancy and spontaneous abortion, was found to have SSE at lumbar puncture. The clinical manifestations and management are discussed.
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6/33. Spinal subarachnoid hematoma after lumbar puncture producing acute thoracic myelopathy: case report.

    A case of subarachnoid hematoma after a difficult lumbar puncture and anticoagulation is presented. Subarachnoid adhesions preventing the free flow of spinal fluid at the T-6 level served to limit the cranial progression of the hemorrhage and produced a transverse myelopathy at that level. The underlying pathology, clinical course, and myelographic findings are reviewed. Pertinent literature is presented.
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7/33. Neurosarcoidosis--a diagnostic pitfall with consequences.

    Neurosarcoidosis is often a diagnostic dilemma, especially in the absence of other organ involvement. We report a 64-year-old patient who had suffered from paraplegia due to an intramedullar process since 1995. The presumptive diagnosis based on computed tomography was spinal cord infarction. Six years later, he complained about increasing paresthesia. magnetic resonance imaging of the spinal cord showed nodular meningeal enhancement. Computed tomography of the thorax revealed mediastinal and hilar lymphadenopathy. bronchoscopy under generalized anesthesia was performed. The differential cell count in bronchoalveolar lavage fluid showed 39% lymphocytes and a CD4( )/CD8( ) ratio of 17.7. Histological examination of biopsy specimens from the hilar lymph nodes revealed non-necrotizing granulomas with epitheloid cells and Langerhans-type giant cells, consistent with the diagnosis of sarcoidosis. As a result of these findings, lumbar puncture was undertaken and a raised protein concentration and pleocytosis were found in the cerebrospinal fluid. The number of lymphocytes (9,250 lymphocytes/l) and a CD4( )/CD8( ) ratio of 10.78 led to the diagnosis of neurosarcoidosis. paralysis might have been prevented if the correct diagnosis of neurosarcoidosis had been established earlier in this patient.
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8/33. Iatrogenic intraspinal epidermoid tumor: case report.

    Iatrogenic spinal epidermoid tumors are extremely rare and may be caused by skin fragments which were implanted in the spine as a result of a trauma or lumbar puncture. Due to the time lag between the lumbar puncture and the development of a symptomatic tumor, this relationship is often overlooked and can cause a delay in the proper diagnosis. Here, we report a rare case of an intraspinal epidermoid tumor, which developed 7 years after a lumbar puncture in a 12-year-old boy, who presented with back pain and radiating pain to the posterior of both thighs. A total excision of the tumor via L3-L4 hemilaminectomy yielded a good functional recovery.
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9/33. Spinal epidural abscess as a complication of Fournier's gangrene.

    Fournier's gangrene is a rare, multi-organism infection of the perineum. The disease is most often confined to the groin area with distant spread being extremely unusual. A ase of spinal epidural abscess as a complication of Fournier's gangrene is presented. The infection appears to have spread by the hematogenous route. The patient had several symptoms, including fever, which could have provided an early diagnostic clue. Multiple fever workups were negative, however, and the diagnosis was not made until quadriplegia developed. A lumbar puncture as part of the fever workup might have allowed for an earlier diagnosis and more prompt surgery.
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10/33. Spinal epidural hematoma following epidural anesthesia versus spontaneous spinal subdural hematoma. Two case reports.

    Two cases of lumbar hemorrhage with subsequent persistent neurologic sequelae are presented and their possible causes are discussed in the context of a literature review: one patient with spontaneous spinal subdural hematoma with no trauma or lumbar puncture and one with spinal epidural hematoma associated with preceding epidural catheterization for postoperative pain relief. The subdural hematoma was associated with a thrombocytopenia of about 90,000/microliters due to intraoperative blood loss. This might have been contributory to the formation or expansion of the hematoma, but it is not convincing since a platelet count of this amount should not lead to spontaneous bleeding. Both patients received low-dose heparin, but since coagulation tests were normal, prolonged bleeding does not appear to be a likely cause, although it cannot be excluded. In conclusion, the reasons for both hematoma remain unclear. With regard to the epidural hematoma and low-dose heparinization, the possible coincidence of spontaneous lumbar hematoma and lumbar regional block should be taken into consideration.
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