Thoracic Pyogenic Spondylitis Misdiagnosed As Osteoporotic Compression Fracture Status Post Vertebral Augmentation With Resultant Paraplegia: A Case Report.

This paper describes a case of serious complications following vertebral augmentation resulting from a misdiagnosis of pyogenic spondylitis as osteoporotic compression fracture (OCF). A 56-year-old female with systemic lupus erythematosus underwent vertebral augmentation following a diagnosis of T10 OCF based on plain film analysis. Note that preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were not performed. One day after vertebral augmentation, the patient experienced a recurrence of low back pain with fever and paraplegia. MRI findings revealed paravertebral and epidural soft tissue over T9 and T10 with cord compression. Subsequent laminectomy of T9 and T10 revealed devitalized lamina, epidural abscess, and granulation tissue. Pathological analysis indicated a combination of acute and chronic inflammation. A pus culture identified Staphylococcus aureus, indicative of pre-existing pyogenic spondylitis. Further revision surgery was performed at another hospital. The patient remained in a paraplegic state one year after surgery. Infectious spondylitis often manifests with nonspecific symptoms similar to those of compression fracture, and plain radiographs are insufficient to differentiate between the two, often leading to misdiagnosis and mistreatment. Nonetheless, many practitioners base preoperative planning solely on plain film imaging. We advocate the routine usage of CT and/or MRI for patients diagnosed with compression fractures, particularly for immunocompromised individuals.

Spinal arteriovenous malformation with a calcified nodule: illustrative case.

BACKGROUND: This article describes a rare case of cervical spinal arteriovenous malformation (AVM) mimicking a neurogenic spinal tumor. OBSERVATIONS: A 22-year-old female presenting with a C6-7 AVM with a calcification nodule experienced new-onset acute right upper radiculopathy associated with extradural compression of the spinal cord. Note that spinal AVMs with a calcified nodule are rare. Endovascular embolization is generally used to relieve the symptoms of AVM; however, this procedure cannot relieve cord compression, particularly in cases complicated by calcified nodules. This article discusses treatment options. LESSONS: Decompression surgery is preferable to endovascular embolization because it alleviates symptoms while preventing cord compression and minimizing the risk of recurrence.

Stereo-EEG for Epileptogenic Focus Localization in Schizencephaly: A Single-center Experience in Four Patients.

OBJECTIVE: Schizencephaly is a congenital cerebral malformation characterized by clefts in the hemispheres of the brain, where variations in semiology often make it difficult to localize epileptogenic focus. Here, we report on a series of patients who underwent stereo-encephalography (SEEG) for epileptogenic focus localization and subsequent SEEG-guided surgical intervention. METHODS: Four patients (ages 27, 33, 27, 25 years) with a mean seizure history of 16 years (range 8-22 years) were analyzed. Data pertaining to semiology, video encephalography (EEG), magnetic resonance imaging, positron emission tomography, and invasive EEG studies, surgical intervention and post-surgery outcome were collected and analyzed. RESULTS: All seizure onset zones were within the extent of schizencephaly; however, the limbic system (including the hippocampus, amygdala, cingulate gyrus, or insula) was involved in early spreading. Two patients underwent SEEG-guided radiofrequency thermo-ablation (RFTA) in the seizure onset zone, 1 patient underwent lesionectomy via craniotomy, and 1 underwent neither RFTA nor lesionectomy. At 2 years post-surgery, the outcomes were as follows: Engel grade Ia (n = 2), Ib (n = 1), and III (n = 1). CONCLUSIONS: This article reports on a precise approach to treating patients with schizencephaly dependent of seizure onset zone and functional cortex mapping. Subsequent SEEG-guided surgical interventions (radiofrequency thermo-ablation and lesionectomy) were shown to reduce seizure frequency, while preserving the neurologic functions in drug-resistant epilepsy patients with schizencephaly.

High Expression of Sp1 is Associated with Recurrence of Meningioma.

BACKGROUND: Meningioma has the second highest incidence among primary intracranial tumors. There is no effective treatment or targeted therapy for meningioma except excision and radiotherapy. Sp1 (specificity protein 1) is a transcription factor that regulates tumor growth, but the literature describing the relationship between Sp1 and meningioma is scarce. The purpose of this study was to investigate the relationship between Sp1 expression and the clinicopathological parameters in meningioma by immunohistochemical staining. METHODS: We collected samples from 74 patients from 2008-2012 in Kaohsiung Medical University Hospital, with staging and prognosis of the pathological section of the meningioma. RESULTS: Our results show that Sp1 expression was significantly associated with World Health Organization grade, malignancy, and recurrence in patients with meningioma. CONCLUSIONS: High expression of Sp1 in patients with meningioma was linked to poor prognosis of recurrence-free time. Therefore Sp1 may be a candidate biomarker of prognosis and therapy target in meningioma.