Cases reported "Spinal Cord Injuries"

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21/879. Ascending myelopathy in the early stage of spinal cord injury.

    A 30-year-old healthy woman was involved in a road traffic accident. She sustained a fracture dislocation of T11/12 with a complete Frankel A paraplegia below T11. She had no associated injuries. High Dose methylprednisolone was administered according to the NASCIS III protocol (48 h) together with low molecular weight heparin and gastroprotected medication. Complete transection of the spinal cord and an anterior haematoma from T11 to T12 were confirmed on X rays, CT's and MRI scans. Posterior surgical stabilisation was performed using Isola instrumentation, starting 8 h post injury. Her post surgical period was uneventful except for some episodes of low blood pressure (85/60 mmHg) from which she had no symptoms. On the 12th post operative day, while in the physiotherapy department, she complained of right scapular pain. This occurred every time she was sat up and was associated with paraesthesia of both upper limbs. Two days later she deteriorated neurologically and her level ascended initially to T8 and then to T3. MRI of the spine with and without gadolinium showed spinal cord oedema between C3 and T1. There was no evidence of haemorrhage or syringomyelia. The authors discussed this case making different hypotheses. They are mainly the following: (1) Gradually ascending ischaemia due to a vascular disorder; (2) Double spinal trauma; (3) Ischaemia related to repeated hypotensive episodes; (4) Low grade intramedullary tumour; and (5) Thrombus of the Radicularis Magna artery. The case has been recognised as being very rare and interesting. In the conclusions, the presenting author stresses the importance of adopting MRI-compatible instrumentation for the surgical stabilisation of the spine, and careful monitoring of blood pressure during the acute phase of spinal cord injury. Dr Aito agrees with Mr El Masry about the opportunity of forming a group of clinicians in order to discuss protocols to cope with this devastating complication.
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keywords = injury
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22/879. Perinatal spinal cord injury requiring long-term home mechanical ventilation: a report of four cases.

    Although perinatal spinal cord injury has been discussed in detail in the literature with respect to aetiology and diagnosis, few studies address long-term outcome, and none address the outcome of long-term home mechanical ventilation in this population. The four patients reported here with perinatal spinal cord injury have used home mechanical ventilation for time periods ranging from 6 to 17 years, with varying results. Their courses with respect to respiratory, neuromuscular, neuropsychological, and nutritional issues are described with reference to the current literature. It is believed that, with the advent of organized home mechanical ventilation programmes and increased acceptance of this technology by the lay public and medical community, the prognosis of the child with perinatal spinal cord injury requiring assisted ventilation is much improved, and may be more positive than the literature currently suggests.
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keywords = injury
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23/879. Spinal cord injury following an attempted thoracic epidural.

    Unsuccessful attempts were made to insert a thoracic epidural in an anaesthetised patient. Signs of spinal cord damage were observed the following day. magnetic resonance imaging demonstrated a haematoma anterior to the spinal cord. Surgical exploration revealed an intradural haematoma and a needle puncture of the cord. The patient suffered a permanent paraparesis.
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keywords = injury
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24/879. Post-traumatic syringomyelia.

    Post-traumatic syringomyelia is estimated to develop in more than 20% of individuals with traumatic spinal cord injury (SCI). The development can give rise to clinical symptoms 6 months to 26 years after the injury, and presentation 40 years post-injury has been seen by one of the authors.1234 We present an unusual case for comments and discussion.
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keywords = injury
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25/879. A functional strategy for classifying patients after traumatic spinal cord injury.

    OBJECTIVES: To present a function-based strategy for classifying patients by expected functional outcomes measured as patients' performances at discharge on each of the 18 component items of the FIMtrade mark instrument (previously known as the Functional Independence Measure). methods: Data included records from 3604 inpatients with traumatic spinal cord injury discharged from 358 rehabilitation units or hospitals in 1995. The function-based strategy assigned patients to four Discharge Motor-FIM-Function Related Groups defined by patients' admission performance on the motor-FIM items. RESULTS: The majority of patients whose motor-FIM scores at admission were above 30 were able to groom, dress the upper body, manage bladder function, use a wheelchair, and transfer from bed to chair, either independently or with supervision, by the time of discharge from inpatient rehabilitation. Most patients whose scores were above 52 attained independence in all but the most difficult FIM tasks, such as bathing, tub transfers, and stair climbing. CONCLUSIONS: This classification scheme can be used to determine the degree to which patients' actual FIM outcomes compare to other individuals who had similar levels of disabilities at the time of admission to rehabilitation. The clinician can apply these 'FIM item attainment benchmarks' retrospectively in quality improvement, in guideline development, and in anticipating the types of post-discharge care required by clinically similar groups.
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keywords = injury
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26/879. An unusual cause of spinal cord injury: case report and discussion.

    Traumatic spinal cord injury is a devastating condition that alters every aspect of the victim's life. Motor vehicle accidents cause about half of the cases, whereas others are the result of falls, recreational and sporting accidents, or acts of violence. We report a case of a C3 spinal fracture with a resultant Brown Sequard syndrome, which occurred in a unique manner and could have easily been prevented. There is a need for the medical community to play a more active role in educating the public to prevent accidents that lead to these catastrophic injuries.
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ranking = 0.83333333333333
keywords = injury
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27/879. Pediatric spinal cord injuries: a case presentation.

    spinal cord injuries (SCIs) in the pediatric population present a unique challenge to the caregiver in that both the physical injury and the growth and development issues need to be addressed simultaneously. Different types of injuries are anticipated than those seen in adults because of the developmental phases of the pediatric spinal cord. This article will review the differences between the pediatric and adult spinal cords, growth and development, and the types of injuries incurred by this population, followed by a case presentation.
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keywords = injury
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28/879. The older patient with a spinal cord injury.

    The most common cause of spinal cord injury (SCI) in older persons is falls, followed by motor vehicle crashes and pedestrian/motor vehicle crashes. Upper cervical injuries, particularly central cord syndrome, are prominent in the geriatric patient population. In addition, the mortality is higher, the complications are life threatening, the hospital stay is longer, and the cost of care is significantly increased for the older trauma victim.
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keywords = injury
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29/879. The development of a nurse-directed computerized functional electrical stimulation program.

    Today's spinal-cord-injured (SCI) person is discharged from the inpatient clinical setting very early in his or her recovery process. Faced with the tremendous challenges of relearning the skills of daily living and psychologically adjusting to a catastrophic injury, the newly injured person is thrust into an overwhelming environment. As early as 1994, when inpatient stays were longer, concern was expressed about the impact of early discharge on the health and well-being of persons with SCI (Ditunno & Formal, 1994). For over 10 years, the Medical Illness counseling Center (MICC) has offered a community-based, nurse-directed program of Computerized Functional Electrical Stimulation (CFES) for persons with SCI. The program is founded on the belief that when multi-system deterioration associated with paralysis is avoided and a behavioral approach is used, the person with SCI will have a renewed sense of well-being that enables him or her to overcome the challenges of daily living. Over time, the need for expansion of the program became apparent; it evolved into a comprehensive package of medical, nursing, and psychological care. This article describes the essential elements that comprised a successful program design, the benefits of participation in CFES, and the significance of this technology in a nurse-managed setting.
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ranking = 0.16666666666667
keywords = injury
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30/879. Phantom sensations in a patient with cervical nerve root avulsion.

    This case study reports detailed phantom sensations in a 35-yr.-old man who had his C5 and C6 cervical nerve roots avulsed from the cord during a motorcycle accident at the age of 22 years. The subject, who was left with a paralyzed right deltoid muscle, anesthetic sensation along the upper lateral portion of the right arm, and absent right biceps reflex, became aware of phantom right arm and hand sensations a few months after the original injury. This finding--which has important implications for understanding the process involved in bodily perception as well as the development of these perceptions--provides evidence of a distributed neural representation of the body that has both genetic and experiential determinants. The implications of these findings are discussed with reference to recent concepts of phantom limb experiences and related phenomena.
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ranking = 0.16729954257438
keywords = injury, nerve
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