Tophaceous pseudogout of the thoracic spine.

Calcium pyrophosphate dihydrate deposition disease (CPDD, tophaceous pseudogout) is a rare crystal arthropathy characterized by pyrophosphate crystal deposition in joints, synovitis and chondrocalcinosis on imaging. We present the case of a 72-year-old man with 6 months of left chest pain; magnetic resonance imaging revealed a T9/T10 herniated disc. Intraoperatively, the material was sent for pathological analysis revealing pseudogout. Axial calcium pyrophosphate crystal deposition is rare but reported in the literature and found at the craniocervical junction and skull. Spinal calcium pyrophosphate crystal deposition is rare in the thoracic spine. It is often asymptompatic and can involve the disc or ligaments. This case demonstrates a unique presentation of CPDD.

Termination of the normal conus medullaris in children: a whole-spine magnetic resonance imaging study.

OBJECT: The mean level of the conus medullaris (CM) has been estimated to lie opposite the L1/2 disc space in several previous studies using ultrasound, CT myelography, and magnetic resonance (MR) imaging, but these studies have been limited in examining only the lumbar spine and including patients being evaluated for back pain and sciatica (creating a selection bias). Moreover, significant variability was found in the termination of the CM, with a small subset of subjects having a CM as low as the mid-body of L4. The authors sought to determine the normal level of the CM and its variability. METHODS: Children with brain or spinal cord tumors who underwent whole-spine surveillance MR imaging were identified retrospectively. The level of the CM was identified in each subject by counting down from C1. Vertebral anomalies, such as lumbarized S1, sacralized L5, or fewer rib-bearing segments, and the presence of fatty filum were noted. RESULTS: Findings regarding the level of termination of the CM were tightly grouped; the average was at the lower third of L1 and the mode of the distribution was at the L1/2 disc space, with very little variation. No CM ended below the mid-body of L2. The level of the CM was not significantly different among individuals with lumbarized or sacralized vertebrae or 11 rib-bearing segments. CONCLUSIONS: The CM terminates most commonly at the L1-2 disc space and in the absence of tethering, the CM virtually never ends below the mid-body of L2. A CM that appears more caudal on neuroimages should be considered tethered.

Assessment of Nogo-66 receptor 1 function in vivo after spinal cord injury.

BACKGROUND: Neuronal Nogo-66 receptor 1 (NgR1) has attracted attention as a converging point for mediating the effects of myelin-associate inhibitory ligands in the central nervous system, establishing the growth-restrictive environment, and limiting axon regeneration after traumatic injury. OBJECTIVE: To investigate the factors that may be contributing to the discrepancy in the importance of NgR1, which has been undermined by several studies that have shown the lack of substantial axon regeneration after spinal cord injury (SCI) in NgR1-knockout or -knockdown animal models. METHODS: We used mice carrying either a homozygous or heterozygous null mutation in the NgR1 gene and subjected them to either a moderate or severe SCI. RESULTS: Locomotor function assessments revealed that the level of functional recovery is affected by the degree of injury suffered. NgR1 ablation enhanced local collateral sprouting in the mutant mice. Reactive astrocytes and chondroitin sulfate proteoglycans (CSPGs) are upregulated surrounding the injury site. Matrix metalloproteinase-9, which has been shown to degrade CSPGs, was significantly upregulated in the homozygous mutant mice compared with the heterozygous or wild-type mice. However, CSPG levels remained higher in the homozygous compared with the heterozygous mice, suggesting that CSPG-degrading activity of matrix metalloproteinase-9 may require the presence of NgR1. CONCLUSION: Genetic ablation of NgR1 may lead to significant recovery in locomotor function after SCI. The difference in locomotor recovery we observed between the groups that suffered various degrees of injury suggests that injury severity may be a confounding factor in functional recovery after SCI.

Demographics of abusive head trauma in the Commonwealth of Pennsylvania.

OBJECT: The aim of this study was to characterize the prevalence and demographic features of abusive head trauma (AHT) among infants and children < 36 months of age in Pennsylvania. METHODS: The authors included all cases of substantiated AHT involving children < 36 months of age in Pennsylvania between 1996 and 2002 that had been reported to a statewide registry. Demographic information was derived from child abuse reports and birth certificates; the study cohort was contrasted with all infants born in Pennsylvania during the same period. RESULTS: The study identified 327 cases. The incidence was 14.7 cases (95% confidence interval 13.1-16.5) per 100,000 person-years for the first 2 years of life with a higher incidence during the 1st year (26.0 cases per 100,000 person-years) than the 2nd year (3.4 cases per 100,000 person-years). The incidence was similar among metropolitan, non-metropolitan, and rural counties. Significantly more cases occurred during the holiday months (October-December). The median age of victims was 4.1 months. Both victims and perpetrators were more commonly male (58.4% of victims, and 70% of identified perpetrators). Compared with the entire population of Pennsylvania parents, the parents of the study cohort were more likely to be younger, less educated, and unmarried. Both mothers and fathers were more often African-American and fathers more often Hispanic. Finally, mothers more often smoked during pregnancy, sought prenatal care later in the pregnancy, and delivered low birth weight infants. CONCLUSIONS: This population-based study of abusive head injuries throughout an entire state adds significantly to the growing knowledge about this condition. The results suggests that families of infants with abusive head injuries have significantly different demographic features compared with the general population, although which of these variables is independently significant cannot be ascertained from this study and require further investigation.