Tapia Syndrome After Cervical Laminoplasty: A Case Report and Review of the Literature.

BACKGROUND: Tapia syndrome is a rare complication of surgical positioning with resulting unilateral cranial nerve X and XII deficits that may provide diagnostic challenges in the perioperative period. Timely diagnosis will facilitate obtaining the necessary supportive care while preventing unnecessary workup and procedures. CASE DESCRIPTION: The following case report illustrates a patient that developed Tapia syndrome immediately after a posterior cervical laminoplasty with eventual resolution of symptoms. A review of the literature was also undertaken for comparison. CONCLUSIONS: Tapia syndrome can occur with a variety of surgeries, but appear to be most common in surgeries of the posterior cervical spine in the neurosurgical literature. It is theorized that flexed head position common among posterior cervical procedures makes patients more prone to Tapia syndrome in these cases. The ideal management remains poorly defined in the literature. The time course and resolution of neurologic deficits support a transient neuropraxic mechanism in most cases, though some patients do suffer permanent deficits.

Traumatic lumbar spondylolisthesis resulting in complete thoracic spinal cord avulsion: an unusual presentation.

Traumatic spondylolisthesis is a known occurrence in trauma, but complete cord transection is relatively rare. Moreover, complete cord transection at a site distant from the traumatic spondylolisthesis without spondyloptosis is exceedingly rare. In this report, authors describe the first case of thoracic cord avulsion following a traumatic grade II lumbar spondylolisthesis. The unusual presentation of this case highlights the importance of further evaluating patients with neurological symptoms out of proportion with the injuries seen on initial imaging. Magnetic resonance imaging performed after initial imaging studies demonstrated T11 cord transection with the distal cord herniating into the lumbar paraspinal soft tissues, thus allowing for preoperative planning to prepare for a more significant intervention including complex dural repair and lumbar drain placement, in addition to instrumented fusion to stabilize the traumatic spondylolisthesis.

Preconditioning effect on cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage.

BACKGROUND: Recent experimental evidence indicates that endogenous mechanisms against cerebral vasospasm can be induced via preconditioning. OBJECTIVE: To determine whether these vascular protective mechanisms are also present in vivo in humans with aneurysmal subarachnoid hemorrhage. METHODS: A multicenter retrospective cohort of patients with aneurysmal subarachnoid hemorrhage was examined for ischemic preconditioning stimulus: preexisting steno-occlusive cerebrovascular disease (CVD) and/or previous cerebral infarct. Generalized estimating equation models were performed to determine the effect of the preconditioning stimulus on the primary end points of radiographic vasospasm, symptomatic vasospasm, and vasospasm-related delayed cerebral infarction and the secondary end point of discharge modified Rankin Scale score. RESULTS: Of 1043 patients, 321 (31%) had preexisting CVD and 437 (42%) had radiographic vasospasm. Patients with preexisting CVD were less likely to develop radiographic vasospasm (odds ratio = 0.67; 95% confidence interval = 0.489-0.930; P = .02) but had no differences in other end points. In terms of the secondary end point, patients with preexisting CVD did not differ significantly from patients without preexisting CVD in mortality or unfavorable outcome in multivariate analyses, although patients with preexisting CVD were marginally more likely to die (P = .06). CONCLUSION: This retrospective case-control study suggests that endogenous protective mechanisms against cerebral vasospasm-a preconditioning effect-may exist in humans, although these results could be the effect of atherosclerosis or some combination of preconditioning and atherosclerosis. Additional studies investigating the potential of preconditioning in aneurysmal subarachnoid hemorrhage are warranted.