Cases reported "Spinal Diseases"

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1/32. Spinal subdural hematoma: a rare complication of lumbar puncture. Case report and review of the literature.

    Spinal subdural hematoma, though rare, is an established complication of lumbar puncture. A young man with persistent back and neck pain after a traumatic lumbar puncture for the diagnosis of lymphocytic meningitis is presented. A diagnosis of spinal subdural hematoma at T2 to T8 levels without significant spinal cord compression was confirmed by magnetic resonance imaging. Symptoms resolved after one month of analgesics and muscle relaxants.
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2/32. Intramedullary spinal cryptococcoma: a case report.

    Intramedullary spinal cryptococcosis is very rare. We describe a case of intramedullary spinal cryptococcoma at the T12 level in a 60-year-old man who presented with a 3-month history of progressive bilateral lower limb weakness and no obvious immunocompromise. Magnetic resonance (MR) imaging revealed a 1.2 cm diameter mass within the spinal cord at T12 with intermediate signal intensity on T1-weighted images, a slight degree of homogeneous low signal intensity on T2-weighted images, and intense enhancement after infusion of gadopentetate dimeglumine. These findings led to a preoperative diagnosis of intramedullary tumor. After 2 months of postoperative antifungal treatment, the patient's clinical condition had markedly improved. Cryptococcoma should be considered when an enhancing lesion of the spinal cord is found on MR imaging, even in apparently immunocompetent patients. A careful lumbar puncture for cerebrospinal fluid analysis to diagnose cryptococcosis of the central nervous system should be made promptly, as early treatment is associated with a good prognosis.
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3/32. Extradural extrusion of roots of the cauda equina.

    For lumbar spondylotic stenosis causing progressive disability, multiple laminectomy was about to be completed. Suddenly roots of the cauda equina herniated through the myelography puncture site in the dura mater, resembling redundant nerve roots. This case is being reported not only because such sudden extradural extrusion is rare, but also to raise the question of the relationship of redundancy of nerve roots to spondylotic stenosis.
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4/32. Acute spinal epidural abscess and spinal leptomeningitis: report of 2 cases with comparative neuroradiological and autopsy study.

    A 21-year-old male developed back pain, fever, and rapidly progressive quadriparesis. Lumbar tap yielded frank pus which was confirmed on magnetic resonance imaging (MRI) to be located mainly in the cervical epidural space. Conservative antibiotic remedy was partially effective for restoration of the neurological deficits. A 82-year-old female noticed low-back pain which was rapidly accompanied with clouding of consciousness, paraplegia, and sphincter disturbances. Lumbar puncture revealed thick pus which was best depicted on MRI in the thoracolumbar subarachnoid space. At autopsy, spinal subarachnoid abscess or leptomeningitis was confirmed, and a spinal infarction previously unrecognized on MRI was found. Usefulness and shortcomings of MRI in the diagnosis of paraspinal infections are discussed.
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5/32. Spontaneous spinal hematomas and low-molecular-weight heparin. Report of four cases and review of the literature.

    The purpose of this article is to raise awareness of spontaneous spinal hematomas that develop after administration of low-molecular-weight heparin therapy. The authors describe four patients in whom these hematomas developed without precipitating events while receiving a treatment dose of enoxaparin (Clexane) (approximately 1 mg/kg). Spontaneous spinal hematomas (not related to trauma, surgery, or lumbar puncture) are a rare clinical entity. Several causes have been identified, including acquired and congenital clotting abnormalities and underlying vascular lesions. aspirin, warfarin, tissue plasminogen activator, and heparin have all been implicated in causing spinal hematomas. Concerns regarding the use of low-molecular-weight heparin agents in neuraxis anesthesia have been well documented. Their possible contribution to nontraumatic spinal hematomas has been less well described. The authors believe that low-molecular-weight heparin agents present a small but significant risk of spinal hematoma. This should be considered when prescribing therapy because such a complication may be catastrophic.
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6/32. ligamentum flavum hematoma in the lumbar spine.

    A 62-year-old male presented with a rare case of ligamentum flavum hematoma manifesting as low back pain and gait difficulty beginning 1 month before consulting our institute. He had no history of lumbar spine surgery or lumbar puncture. However, he might have suffered forgotten back injury while practicing martial arts. magnetic resonance imaging showed a heterogeneous intensity mass lesion with a cystic component at the L3-4 levels. The lesion was totally removed through a hemilaminectomy. Intraoperative and histological findings confirmed the diagnosis of old hematoma with granulomatous change in the ligamentum flavum. Postoperatively, his low back pain and gait difficulty resolved within a few days.
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7/32. Acquired lumbar epidermoid cyst in an adult.

    A 61-year-old female complained of low back pain, and had been treated by spinal anesthetic injection more than 70 times over 14 years. Magnetic resonance (MR) imaging, performed at the age of 47 years, revealed no abnormal lesion. However, she developed irritable hypesthetic pain in the left leg at 61 years of age. MR imaging revealed a round mass appearing isointense on the T1-weighted and slightly hyperintense on the T2-weighted images. laminectomy revealed an epidermoid cyst, which was removed. This case clearly demonstrates that adults can acquire epidermoid tumor which very probably has an iatrogenic origin. The incidence of epidermoid tumor is low, but we should be aware of the potential adverse complications such as formation of epidermoid tumors after lumbar puncture.
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8/32. Two cases of spinal epidural abscess with granulation tissue associated with epidural catheterization.

    Two cases of spinal epidural abscess are reported whose abscesses became granulated after epidural catheterization. Although emergency surgical intervention was performed almost within 24 h after the diagnosis of epidural abscess in case 1, the patient revealed a poor outcome. After laminoplasty, case 2 received lumbar epidural catheterization, and he had a complete recovery. The abscesses were recognized to spread around the catheter insertion site of the operative procedure in both cases, and MRI in case 2 showed the connection between the epidural abscess and the interspinous space where the catheter had been inserted. methicillin-sensitive staphylococcus aureus (MSSA) was identified at the operative field in both cases. Also, MSSA was identified at the subcutaneous abscess around the catheter in case 1 and at the catheter tip in case 2. Those findings suggest the midpoint of the abscess is the puncture site and that MSSA is found in or around the catheter. infection at epidural catheterization seems to be caused by catheter insertion or skin contamination after catheterization. As those catheterizations were completed in the outpatient theater, we conclude that epidural catheterization should be performed in the operating room or with a restricted aseptic technique.
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9/32. Chemical meningism after lumbar facet joint block with local anaesthetic and steroids.

    A case is reported in which chemical meningism occurred after lumbar facet joint block with methylprednisolone acetate and bupivacaine. This complication was probably due to inadvertent dural puncture. The use of steroids in facet joint injections is questioned.
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10/32. Case report: cerebrospinal fluid fistula--a rare complication of myelography.

    A case of a cerebrospinal fluid fistula developing following a lumbar puncture done for myelography is described. Radiographic documentation was obtained by a sinogram using an oily contrast medium. The exact aetiology of the fistula was undetermined, however, the large calibre of the spinal needle used for lumbar puncture as well as the patient's decubitus ulcer in the early post-myelography state may have had a role to play. The presence of a low grade infection also remains a possibility as the needle used was of an autoclaved, reusable type.
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