RESUMO
BACKGROUND: Many patients with transverse myelitis suffer from sensory loss below the spinal level of the lesion. This is commonly associated with chronic neuropathic pain. However, the presence of somatic pain below a complete thoracic sensory level after transverse myelitis is exceptionally rare, and it is unclear if surgical decompression is an effective form of treatment for these patients. CASE PRESENTATION: In this report, we describe a 22-year-old Caucasian female who suffered from chronic lumbar back pain despite a complete thoracic sensory level secondary to prior transverse myelitis. Imaging demonstrated multilevel central stenosis below the sensory level, and her pain improved after surgical decompression. To our knowledge, this is the first reported case of symptomatic lumbar stenosis below a sensory level after transverse myelitis successfully treated with surgical decompression. CONCLUSION: This is the first reported case of a patient with symptomatic lumbar stenosis after transverse myelitis whose lower back pain and quality of life improved following surgical decompression and fusion. This case provides evidence that typical lumbago is possible in patients with sensory loss from transverse myelitis, and standard lumbar decompression may provide benefit for these patients.
Assuntos
Dor Lombar , Mielite Transversa , Fusão Vertebral , Estenose Espinal , Humanos , Feminino , Adulto Jovem , Adulto , Estenose Espinal/complicações , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Constrição Patológica/complicações , Mielite Transversa/complicações , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/cirurgia , Qualidade de Vida , Dor nas Costas/etiologia , Dor nas Costas/cirurgia , Dor Lombar/etiologia , Descompressão Cirúrgica/métodos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Resultado do TratamentoRESUMO
OBJECTIVES: To explore the aetiological, clinical and radiological profiles of patients with LETM presenting to this tertiary care hospital in North India. PATIENTS AND METHODS: All eligible LETM patients presenting to our hospital between April 2015 and Jan 2016 were prospectively studied. A total of 37 patients were included and after thorough history, examination, relevant laboratory and radiological investigation, were profiled according to the various aetiologies of LETM. RESULTS: Our study included 37 patients (62% males and 38% females). Most patients were young (21-30 years). Main aetiologies of LETMp were NMO (8), inflammatory (9), idiopathic (6), NMOSD (4), Vitamin B12 deficiency (4) and others (6). Most patients (62%) had acute onset of symptoms except NMOSD and B12 deficient patients who presented subacutely too. NMO group was most disabled (poor Rankin and MRC assessments) at presentation; prognostically no (87%) or minimal improvement (13%) at discharge was seen in this group compared to other aetiologies. Forty point five percent patients had thoracic sensory complaints. CSF (pleocytosis 62%) and raised protein (81%) and brain abnormalities on MRI were seen in 11% patients. Bladder and optic nerve involvement (75.7% and 35% patients respectively). Seventy five percent NMO and 67% probable inflammatory aetiology patients also had B12 deficiency. CONCLUSION: This study concludes that LETMp has varied aetiologies with NMO having more disability and poorer outcomes. Thoracic cord segment is most commonly involved. Vitamin B12 deficiency may predispose patients to inflammatory LETM including NMO syndromes.
Assuntos
Mielite Transversa/patologia , Neuromielite Óptica/patologia , Nervo Óptico/patologia , Medula Espinal/cirurgia , Aquaporina 4/imunologia , Autoanticorpos/imunologia , Feminino , Humanos , Índia , Imageamento por Ressonância Magnética/efeitos adversos , Masculino , Pessoa de Meia-Idade , Mielite Transversa/diagnóstico , Mielite Transversa/cirurgia , Neuromielite Óptica/diagnósticoRESUMO
Progressive fibrobullous changes in the residual lobes are sometimes observed after lobectomy. Aspergillus osteomyelitis is an uncommon infection that rarely occurs sternally. A 70-year-old man who had undergone lobectomy 12 years earlier was admitted to our hospital for chest pain. He was diagnosed with Aspergillus sternomyelitis based on sternal bone culture after an ultrasound-guided percutaneous needle biopsy. The fibrosis and right residual lung apex volume loss had gradually progressed over 12 years, and therefore, chronic pulmonary aspergillosis (CPA) with direct invasion sternal from the CPA was considered. Aspergillus sternomyelitis can develop from CPA as a late complication of lobectomy.
Assuntos
Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/terapia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Mielite Transversa/tratamento farmacológico , Mielite Transversa/cirurgia , Aspergilose Pulmonar/tratamento farmacológico , Aspergilose Pulmonar/cirurgia , Idoso , Antibacterianos/uso terapêutico , Humanos , Neoplasias Pulmonares/patologia , Masculino , Mielite Transversa/etiologia , Pneumonectomia/efeitos adversos , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/etiologia , Resultado do Tratamento , Voriconazol/uso terapêuticoRESUMO
The article contains the description of Foix-Alajouanine syndrome (FAS) from literature. Three our own cases of FAS, which developed in two men and one woman, are presented. An analysis of FAS clinical picture revealed a step-like progression of the disease with a possibility of short-term fluctuation of some focal neurological signs. Five stages of clinical course of FAS were detected. Some peculiar sings of spinal neurovisualization, together with serum and cerebro-spinal fluid (CSF) laboratory examinations, were indicated in FAS. Surgery is first-choice of FAS treatment. Pharmacological treatment with high doses of anticoagulants, together with antiviral therapy (and antibiotics, if necessary), neuroprotectors, antiedematic and symptomatic therapy must be started early. Prevention of thrombotic, trophic and purulent complications is required.
Assuntos
Mielite Transversa/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Mielite Transversa/patologia , Mielite Transversa/cirurgia , Síndrome , Vértebras Torácicas/patologiaRESUMO
Intramedullary spinal cord metastases (ISCMs) are rare lesions but their presence should not be underestimated in a cancer patient with rapidly progressive neurological compromise. Due to similar timing of clinical progression and imaging characteristics, these lesions may be misdiagnosed as transverse myelitis, an inflammatory disorder of the spinal cord that may be idiopathic or secondary to other diseases including infections, connective tissue disorders, nutritional deficiencies, and demyelinating disorders. We present a case of a 44 year-old male with a history of parotid gland metastatic salivary ductal carcinoma (SDC) and incidental demyelinating white matter lesions on brain magnetic resonance imaging (MRI) diagnosed as radiologically isolated syndrome with a CSF that was positive for oligoclonal bands. The patient initially presented with mid-thoracic dermatomal numbness, bilateral lower extremity weakness, and neurogenic bladder. MRI spine demonstrated an enhancing T5-7 intramedullary lesion initially diagnosed as transverse myelitis. After progressing to complete motor and sensory loss below T6 despite high-dose intravenous steroids and plasmapheresis, surgical biopsy was undertaken. Intraoperative findings revealed an intramedullary tumor for which a subtotal resection was performed. Pathology was consistent with a metastatic deposit from the patient's primary parotid SDC. The patient underwent postoperative chemotherapy but expired due to systemic disease progression seven months following surgery without neurological improvement. This is the first reported case of ISCM from a primary SDC. The median survival is 6 months for patients with ISCMs treated surgically. The goals of surgery are spinal cord decompression, functional preservation, and tissue diagnosis.
Assuntos
Carcinoma Ductal/diagnóstico por imagem , Mielite Transversa/diagnóstico por imagem , Neoplasias Parotídeas/diagnóstico por imagem , Ductos Salivares/patologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Adulto , Carcinoma Ductal/cirurgia , Diagnóstico Diferencial , Evolução Fatal , Humanos , Masculino , Mielite Transversa/cirurgia , Neoplasias Parotídeas/cirurgia , Radiografia , Ductos Salivares/cirurgia , Neoplasias da Medula Espinal/secundário , Neoplasias da Medula Espinal/cirurgia , Síndrome , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgiaAssuntos
Neurilemoma/diagnóstico , Neoplasias Torácicas/diagnóstico , Vértebras Torácicas/cirurgia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Mielite Transversa/diagnóstico , Mielite Transversa/cirurgia , Neurilemoma/cirurgia , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/cirurgia , Neoplasias Torácicas/cirurgiaRESUMO
Spinal anesthesia is widely used during surgical procedures. It is generally safe and the frequency of severe, permanent neurological complications associated with it has been reported to be extremely low. We report a patient, who developed paraplegia following spinal anesthesia. A 29-year-old male was referred with acute, flaccid, sensory motor paraplegia, with bladder and bowel involvement. He developed this immediately after an operation for inguinal hernia under spinal anesthesia. Spinal magnetic resonance imaging revealed hemorrhagic myelitis in the conus at D12. He was referred after he did not respond to intravenous methylprednisolone for 10 days. This case brings up the difficulty encountered in determination of the interspace used for spinal anesthesia and the potential for traumatic injury to the spinal cord. It also demonstrates the tragic outcome after a clinician violates some important, standard and established guidelines.
Assuntos
Raquianestesia/efeitos adversos , Mielite Transversa/etiologia , Adulto , Hérnia Inguinal/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Mielite Transversa/patologia , Mielite Transversa/cirurgia , Procedimentos Neurocirúrgicos , Medula Espinal/patologiaRESUMO
AIM: The aim of this study was to analyse the number of thoracic injuries associated with acute traumatic paraplegia of the upper and middle thoracic spine and review the early management in respect to treatment standards. METHODS: Using a prospective study protocol, data were sampled and analyzed from 12 December 2000 to 31 March 2002 at a level 1 trauma center. RESULTS: Twenty-two consecutive patients were included in the study. Sixteen suffered severe chest traumata. Lung contusion was diagnosed in 81%, followed by haemopneumothorax (75%) and fracture of the bony chest (75%). Intubation was performed 12 times in all. Chest drainage was performed in 14 patients. The mean duration of artificial ventilation was 20 days (range 2-93) and of intensive care treatment 25 days (range 2-93). Five patients died. CONCLUSIONS: Acute traumatic paraplegia of the upper and middle thoracic spine caused by high energy trauma is highly associated with severe chest trauma. Therefore, respiratory impairment must be kept in mind during the early treatment. If respiratory failure becomes more evident, emergency procedures such as intubation and chest drainage have to be performed. Secondary transfer should be avoided.
Assuntos
Emergências , Traumatismo Múltiplo/cirurgia , Paraplegia/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Traumatismos Torácicos/cirurgia , Vértebras Torácicas/lesões , Acidentes por Quedas , Acidentes de Trânsito , Doença Aguda , Adolescente , Adulto , Idoso , Cuidados Críticos , Serviços Médicos de Emergência , Feminino , Hemopneumotórax/diagnóstico , Hemopneumotórax/etiologia , Hemopneumotórax/cirurgia , Humanos , Escala de Gravidade do Ferimento , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/etiologia , Mielite Transversa/diagnóstico , Mielite Transversa/etiologia , Mielite Transversa/cirurgia , Paraplegia/diagnóstico , Paraplegia/etiologia , Estudos Prospectivos , Respiração Artificial , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/cirurgia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Sucção , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/etiologia , Vértebras Torácicas/cirurgia , Transporte de Pacientes , Centros de TraumatologiaRESUMO
This report describes the case of a 26-yr-old man experiencing transverse myelitis, a rare but serious complication of systemic lupus erythematosus occurring in less than 1% of patients with systemic lupus erythematosus, 4 yr after the onset of systemic lupus erythematosus. Significant neurologic deficits, including spastic paraplegia, dysthetic pain, and impaired bladder control, which made him completely bedridden and dependent in activities of daily living, continued, despite his immediate diagnosis and treatment. The patient received bilateral L1 to S1 selective posterior rhizotomy 1 yr after the onset of transverse myelitis, and 10 mo after selective posterior rhizotomy, he was completely independent in ambulation and self-care, demonstrating that selective posterior rhizotomy can be safely performed and its goals achieved under different medical conditions, as long as thorough preoperative evaluation and every possible precaution have been taken.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Mielite Transversa/cirurgia , Rizotomia/métodos , Atividades Cotidianas , Adulto , Humanos , Masculino , Mielite Transversa/complicações , Mielite Transversa/fisiopatologia , Resultado do TratamentoAssuntos
Abscesso/transmissão , Analgesia Epidural/efeitos adversos , Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Dor Lombar/tratamento farmacológico , Meningites Bacterianas/transmissão , Mielite Transversa/diagnóstico , Abscesso do Psoas/transmissão , Infecções Estafilocócicas/transmissão , Abscesso/diagnóstico , Abscesso/cirurgia , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Meninges/patologia , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/cirurgia , Mielite Transversa/cirurgia , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/cirurgia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The authors report a case of transverse myelitis caused by Schistosoma mansoni. Although this is a treatable disease if diagnosed in the early stage, it is very rarely seen in developed countries and can result in complications if diagnosis is delayed.
Assuntos
Mielite Transversa/patologia , Esquistossomose mansoni , Adulto , Humanos , Imageamento por Ressonância Magnética , Masculino , Mielite Transversa/diagnóstico , Mielite Transversa/cirurgia , Praziquantel/uso terapêutico , Esquistossomose mansoni/tratamento farmacológico , Medula Espinal/patologiaRESUMO
Two patients with severe neuropathic bladders were successfully treated with selective dorsal rhizotomy in conjunction with a ventral root neuroprosthesis. Both patients achieved stabilization of their renal function, continence, resolution of vesicoureteral reflux, and relief from indwelling urethral catheters. This alternative form of management avoids the complications of other operative approaches.
Assuntos
Gânglios Espinais/cirurgia , Próteses e Implantes , Traumatismos da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/cirurgia , Bexiga Urinaria Neurogênica/reabilitação , Bexiga Urinaria Neurogênica/cirurgia , Adulto , Feminino , Humanos , Masculino , Mielite Transversa/complicações , Mielite Transversa/reabilitação , Mielite Transversa/cirurgia , Traumatismos da Medula Espinal/complicações , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/etiologia , Cateterismo UrinárioRESUMO
A 45-year-old man with transverse myelitis developed an unstable neuropathic spinal arthropathy manifesting as a "silent" L1-L2 dislocation after laminectomy and rhizotomies performed for increased spasticity. Treatment consisted of reduction, posterolateral spinal fusion with Cotrel-Dubousset instrumentation utilizing hooks and pedicular screws, and a posterior lumbar interbody fusion. The authors conclude that laminectomy on a chronic paralytic through the insensate area should be coupled with fusion and instrumentation even if the facet joints and capsules are preserved during the laminectomy.
Assuntos
Artropatia Neurogênica/etiologia , Luxações Articulares/etiologia , Laminectomia/efeitos adversos , Vértebras Lombares/lesões , Mielite Transversa/complicações , Adulto , Artropatia Neurogênica/cirurgia , Humanos , Fixadores Internos , Luxações Articulares/cirurgia , Vértebras Lombares/cirurgia , Masculino , Espasticidade Muscular/cirurgia , Mielite Transversa/cirurgia , Paraplegia/etiologia , Fusão Vertebral , Raízes Nervosas Espinhais/cirurgiaRESUMO
A child was given intramuscular benzathine penicillin and experienced manifestations of sudden, irreversible transection of the spinal cord in the lower thoracic region. The biopsy supported an intravascular injection with occlusion of the spinal vasculature as the etiological mechanism. A review of similar cases reveals a recurring pattern--intramuscular injection with standard techniques and sites into a small muscle mass without evident blood return followed by rapid progression of paralysis. The problem seems to turn upon an inability to recognize the inadvertent intraarterial injection.
Assuntos
Injeções Intra-Arteriais/efeitos adversos , Mielite Transversa/etiologia , Mielite/etiologia , Penicilina G Benzatina/administração & dosagem , Penicilina G/administração & dosagem , Humanos , Lactente , Laminectomia , Masculino , Microscopia Eletrônica , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/patologia , Mielite Transversa/cirurgia , Mielografia , Medula Espinal/ultraestrutura , Tomografia Computadorizada por Raios XAssuntos
Neoplasias da Coluna Vertebral/cirurgia , Placas Ósseas , Diagnóstico Diferencial , Feminino , Fraturas Espontâneas/cirurgia , Hemangioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mielite Transversa/cirurgia , Osteoma Osteoide/cirurgia , Plasmocitoma/cirurgia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral , Neoplasias da Coluna Vertebral/secundárioRESUMO
Schistosomiasis of the spinal cord is a rare presentation of a disease involving over 200 million people. A patient from an endemic area presenting as a transverse myelitis or a spinal cord tumor, and with eosinophilia, should alert the physician to the possibility of schistosomiasis of the spinal cord. Diagnosis is based on finding the characteristic eggs in the stool or urine, or if necessary, by rectal, bladder or liver biopsies. Myelography is performed to determine if decompressive laminectomy is necessary.