Cases reported "Spinal Cord Injuries"

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1/9. Feasibility and safety of neural tissue transplantation in patients with syringomyelia.

    Transplantation of fetal spinal cord (FSC) tissue has demonstrated significant potential in animal models for achieving partial anatomical and functional restoration following spinal cord injury (SCI). To determine whether this strategy can eventually be translated to humans with SCI, a pilot safety and feasibility study was initiated in patients with progressive posttraumatic syringomyelia (PPTS). A total of eight patients with PPTS have been enrolled to date, and this report presents findings for the first two patients through 18 months postoperative. The study design included detailed assessments of each subject at multiple pre- and postoperative time points. Outcome data were then compared with each subject's own baseline. The surgical protocol included detethering, cyst drainage, and implantation of 6-9-week postconception human FSC tissue. immunosuppression with cyclosporine was initiated a few days prior to surgery and continued for 6 months postoperatively. Key outcome measures included: serial magnetic resonance imaging (MRI) exams, standardized measures of neurological impairment and functional disability, detailed pain assessment, and extensive neurophysiological testing. Through 18 months, the first two patients have been stable neurologically and the MRIs have shown evidence of solid tissue at the graft sites, without evidence of donor tissue overgrowth. Although it is still too soon to draw any firm conclusions, the findings from the initial two patients in this study suggest that intraspinal grafting of human FSC tissue is both feasible and safe.
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2/9. A catheter based method to activate urethral sensory nerve fibers.

    PURPOSE: The ability to control bladder activity would provide a valuable tool to assist individuals with neurological disorders or spinal cord injury (SCI). Recent studies in animal models have shown that bladder contractions can be evoked by electrical stimulation of urethral afferent nerves. We developed and validated in cats a minimally invasive method to stimulate electrically the sensory nerve fibers that innervate the urethra. MATERIALS AND methods: The urethra was stimulated electrically along its length via a catheter mounted circumferential electrode in 6 cats. The urethra was similarly stimulated in a male individual with complete SCI. RESULTS: Robust bladder contractions were generated via intraurethral electrical stimulation in all cat experiments. Peak responses were obtained in the proximal and prostatic urethra. In the individual with SCI bladder contractions were generated via intraurethral stimulation at a position 4 cm distal to the bladder. Responses in cats and the human depended on bladder volume. CONCLUSIONS: To our knowledge this study provides the first documentation of generating bladder contractions via intraurethral electrical stimulation in cats and humans. This method provides a research tool for future studies to investigate these pathways in humans. Preliminary human results suggest that urethral afferent mediated neural pathways demonstrated in animal models exist in humans and support the development of neural prostheses using electrical stimulation of these nerves to restore control of bladder function in individuals with neurological disorders or SCI.
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3/9. Progressive neurodegenerative disease in presumed spinal cord injury: case report of a patient with prion disease.

    BACKGROUND: prion diseases or transmissible spongiform encephalopathies (TSEs) are neurodegenerative syndromes caused by proteinaceous infectious particles (or "prions"), are fatally progressive, and affect humans and animals. Human prion disease may be familial, sporadic, or due to iatrogenic causes. The signs and symptoms include dementia, ataxia, myoclonus, dysautonomia, pyramidal and extrapyramidal tract signs, and akinesia. The incubation period of iatrogenic TSE ranges from 15 months to 30 years, and clinical presentations may be atypical. DESIGN: Case report. FINDINGS: This article presents the case study of a 39-year-old man who fell at work and subsequently complained of subjective lower extremity weakness, followed by onset of ataxia, bowel and bladder incontinence, and progressive decline in ambulation over 6 months. In the absence of a unifying diagnosis, the patient was presumed to have had a spinal cord injury (SCI). Because neuro-axis imaging studies failed to explain his symptoms, the patient's complaints were thought to have a large psychologic component. The patient then developed neurologic abnormalities proximal to the presumed SCI. Somatosensory evoked potentials were suggestive of a thoracic or lumbar cord myelopathy and cerebrospinal fluid analysis was suggestive of prion disease. family members eventually revealed that the patient had had injections of growth hormones derived from cadaveric human pituitary glands as a child. Postmortem brain examination later revealed definitive Creutzfeldt-Jakob disease.
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4/9. spinal cord separation: MRI evidence of healing after omentum-collagen reconstruction.

    INTRODUCTION: animal experimentation has demonstrated that omental-collagen bridge reconstruction of a transected spinal cord in cats can result in the growth of axons crossing the transection site which resulted in the return of motor and sensory activity. This paper raises the possibility that a comparable spinal cord reconstruction model could be possible for human application. methods: cats had their spinal cord transected at the T-9 level. This led to a gap at the transection site that was filled with semi-liquid collagen, followed by omental transposition onto the underlying collagen bridge, which had subsequently hardened. A comparable technique was used on a patient who had, as reported by magnetic resonance imaging (MRI), a complete spinal cord transection at the T-6 level. RESULTS: Reconstruction of a transected spinal cord in cats using an omental-collagen bridge resulted in axons that grew across the transection site at the rate of 1 mm/day. Several animals developed forelimb and hindlimb locomotion. The patient in this paper had omental-collagen reconstruction of her cord and has clinically progressed to the point where she can ambulate with the use of a walker. The patient had a spinal cord defect of 4 cm, which, with multiple MRI studies, has shown the longitudinal development of a spinal cord connection in the area of the omental-collagen bridge that connects the proximal and distal ends of the transected spinal cord. CONCLUSION: This report suggests that a transected spinal cord has the ability to heal when the spinal cord separation is reconstructed using an omental-collagen bridge. This technique has led to neurological improvement.
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5/9. Trauma and multiple sclerosis. An hypothesis.

    An obligatory event in the pathogenesis of the multiple sclerosis plaque appears to be an increase in the permeability of the blood-brain barrier. Neuropathological observations of the brain of persons suffering from concussion after relatively minor head injury, as well as of animals subjected to experimental brain injury, have shown that alterations of the blood-brain barrier constitute a common result of such trauma. It is postulated that the alterations of the blood-brain barrier secondary to trauma of the brain or spinal cord of patients with already established multiple sclerosis may result in an exacerbation or recurrence of a previously symptomatic plaque, in the appearance of symptoms from a silent lesion, or in the formation of a new plaque in such an area of selected vulnerability. In other persons injury to the nervous system may cause the development of multiple sclerosis plaques in the previously damaged areas when the disease has its onset after the trauma. There is no evidence to support the idea that trauma ever causes multiple sclerosis.
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6/9. Animal bites causing central nervous system injury in children. A report of three cases.

    Three cases of animal bites causing central nervous system injury in children are reported. Two infants suffered compound depressed skull fractures as a result of dog bites to the head. An older child suffered direct injury to the spinal cord from a tiger bite. In 2 cases, pasteurella meningitis occurred. Pitfalls in the management of this type of problem are discussed.
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7/9. Clinical and anatomical observation of a patient with a complete lesion at C1 with maintenance of a normal blood pressure during 40 minutes after the accident.

    The authors report on their clinical observations concerning a patient with a complete spinal cord injury at the level of C1, followed by a cardiac hypoxic arrest, due to immediate respiratory paralysis after the accident. Normal cardiac activity was obtained as a result of rapid resuscitation measures, using only intubation and external cardiac massage without any drug administration. The blood pressure was maintained without any drugs at a level of 130 Torr during 40 minutes before it fell to a permanent level of 50--40 Torr on ventilation alone. The diagnosis during the first hours was believed to be that of an irreversible coma with no evidence of vertebral injury. The patient started to recover consciousness after a few days but died on the 15th day. The case is discussed in the light of the literature and of the recent physiological experiments concerning the rapid changes of blood pressure after spinal cord section in animals.
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8/9. Profound reflex bradycardia produced by transient hypoxia or hypercapnia in man.

    A quadraplegic patient was able to breathe adequately for the first 3 days after his cervical spinal cord was transected by a bullet. However, for several days thereafter spontaneous ventilation became inadequate, most likely due to edema of the cord, and mechanical ventilation was required. When the ventilator was disconnected for required tracheal aspiration, before there was any tracheal stimulation, profound bradycardia, hypotension and syncope occurred within a few seconds. The bradycardia could be diminished by atropine and its onset delayed by prior ventilation with oxygen. Because of the rapid onset of the hemodynamic changes and their correlation with relatively small changes in PaO2 and PaCO2, it is suggested that this vagally mediated bradycardia represents the primary cardiac reflex response to peripheral chemoreceptor stimulation, which, although extensively studied in experimental animals, has not before been described in man. Just as in animals, it seems likely that the inability to hyperventilate permitted the primary cardiac reflex to occur rather than the usual response of tachycardia to chemoreceptor stimulation which is prepotent with spontaneous ventilation. An understanding of this reflex was important in the clinical mangement of this patient.
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9/9. Effect of long-term implanted nerve cuff electrodes on the electrophysiological properties of human sensory nerves.

    During a long-term implantation (307 days) of a tripolar split cuff electrode around the palmar digital nerve to the radial side of the left index finger, branching off the median nerve in a medullary lesioned C6 patient, the physiological state of the nerve was intensively monitored. The resulting sensory nerve action potential (SNAP) amplitude was recorded, using both near-nerve electrodes and the implanted cuff electrode. The SNAP amplitude declined within 10 days to approximately 50% of the first SNAP cuff amplitude measured on Day 2 after implantation and recovered to the initial amplitude within 3 months. The SNAP amplitude measurements made with near-nerve electrodes were consistent with the cuff results; the SNAP conduction velocity (CV) recorded by the near-nerve electrodes and the cuff electrode was constant during the whole implantation period. This is in agreement with the results from two other patients: one with a cuff implanted around the sural nerve, and the other with a cuff implanted around a branch of the tibial nerve. These results and animals studies show that the cuff electrode is an electrically stable neural-electrical transducer.
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