Paciente con lesión medular cervical y vértigo posicional paroxístico benigno tratado con maniobras de reposición de partículas / Patient with cervical spinal cord injury and benign paroxysmal positional vertigo treated with particle repositioning maneuvers

El vértigo posicional paroxístico benigno (VPPB) se caracteriza por episodios cortos y bruscos de vértigo cuando la cabeza se mueve en posiciones específicas. El tratamiento son las terapias de reposición de partículas. En general el VPPB es subdiagnosticado, no reportado y por lo tanto no es tratado de forma adecuada. Presentamos el caso de un paciente con lesión medular y VPPB. Paciente de 72 años que sufre una fractura de C5 y como resultado una lesión medular C5 AIS C que necesitó la fijación quirúrgica. En la unidad de lesionados medulares se documentó VPPB del conducto semicircular lateral izquierdo y se trató mediante el uso de terapias de reposición específicas; el paciente mejoró progresivamente y pudo concluir el tratamiento rehabilitador. Las unidades de lesión medular con acceso a unidades de rehabilitación vestibular pueden realizar el diagnóstico y tratamiento específico del VPPB, minimizando los riesgos para el paciente.(AU)

Benign paroxysmal positional vertigo (BPPV) is characterized by short, sudden episodes of vertigo when the head moves in specific positions. The treatment is particle repositioning maneuvers. BPPV usually is underdiagnosed, unreported and therefore not adequately treated. We present the case of a patient with spinal cord injury and BPPV. A 72-year-old patient who suffered a C5 fracture with spinal cord injury C5 AIS C that required surgical fixation. In the spinal cord injury unit BPPV of the left lateral semicircular canal was documented and treated using specific repositioning maneuvers, the patient progressively improved and was able to complete the rehabilitation treatment. The spinal cord injury unit with access to vestibular rehabilitation units can carry out the diagnosis and specific treatment of BPPV, minimizing the risks for the patient.(AU)

[Patient with cervical spinal cord injury and benign paroxysmal positional vertigo treated with particle repositioning maneuvers]. / Paciente con lesión medular cervical y vértigo posicional paroxístico benigno tratado con maniobras de reposición de partículas.

Benign paroxysmal positional vertigo (BPPV) is characterized by short, sudden episodes of vertigo when the head moves in specific positions. The treatment is particle repositioning maneuvers. BPPV usually is underdiagnosed, unreported and therefore not adequately treated. We present the case of a patient with spinal cord injury and BPPV. A 72-year-old patient who suffered a C5 fracture with spinal cord injury C5 AIS C that required surgical fixation. In the spinal cord injury unit BPPV of the left lateral semicircular canal was documented and treated using specific repositioning maneuvers, the patient progressively improved and was able to complete the rehabilitation treatment. The spinal cord injury unit with access to vestibular rehabilitation units can carry out the diagnosis and specific treatment of BPPV, minimizing the risks for the patient.

Predictive factors of destination at discharge after spinal cord injury.

INTRODUCTION: One of the main goals of the rehabilitation of patients with spinal cord injury (SCI) is the reintegration of the individual to their family, social, and work setting. The objective of this study was to identify the factors that determine the discharge destination after a traumatic spinal cord injury. MATERIAL AND METHODS: We conducted a retrospective descriptive study of 305 patients with SCI who completed the rehabilitation treatment at the spinal injury unit of Hospital Insular de Gran Canaria between 2001 and 2018. RESULTS: During the study period, we observed an increase in the number of patients referred to long-term care centres, from 9.14% between 2001 and 2010 to 18.4% between 2011 and 2018 (P < .01). Of 20 variables that presented a significant association with destination at discharge in the univariate study, 7 presented a significant association in the multivariate study: age (OR: 1.05; 95% CI, 1.02-1.08), living with a partner (OR: 0.26; 95% CI, 0.09-0.76), residing on another island (OR: 3.57; 95% CI, 1.32-9.63), smoking (OR: 3.44; 95% CI, 1.26-9.44), diabetes (OR: 6.51; 95% CI, 1.46-29.02), history of psychiatric disorders (OR: 3.79; 95% CI, 1.31-10.93), and scores on the Spinal Cord Independence Measure-III (SCIM-III) (OR: 0.48; 95% CI, 0.33-0.69). CONCLUSIONS: Our findings identified advanced age, living on the island of Tenerife, not being married, smoking, type 2 diabetes mellitus, history of psychiatric disorders, and low SCIM-III scores as predictive factors of referral to a long-term care centre in patients with traumatic SCI in the Canary Islands.

Factores asociados a la mejoría funcional en pacientes con lesión medular traumática cervical / Factors associated with functional improvement in patients with cervical spinal cord injuries

Objetivo Determinar los factores que influyen en la mejoría funcional de un lesionado medular cervical traumático durante la hospitalización. Material y métodos Se ha realizado un estudio retrospectivo donde se han incluido los pacientes que han sufrido una lesión medular cervical traumática aguda y que han concluido un programa de rehabilitación en la Unidad de Lesionados Medulares de Canarias entre 2001 y 2018. Para medir la mejoría funcional se ha realizado una valoración del SCIM III al ingreso y al alta. Resultados El 88% de los 141 pacientes de nuestra muestra han sido hombres: pacientes de edad avanzada, con antecedentes de consumo de alcohol, las lesiones completas y de mayor gravedad en la Escala de ASIA han tenido menores resultados funcionales. El tiempo desde la lesión hasta el ingreso en la unidad, el tiempo de estancia hospitalaria y el tiempo desde la lesión al alta hospitalaria han tenido una relación significativa con la mejoría funcional. Conclusiones En pacientes con edad avanzada y con antecedentes de consumo de alcohol las lesiones completas y de mayor gravedad en la Escala de ASIA han tenido menores resultados funcionales. Por otro lado, el ingreso precoz ha sido fundamental para obtener mejores resultados funcionales y se ha relacionado con estancias hospitalarias más cortas (AU)

Objective To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission. Material and methods We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge. Results Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge. Conclusions Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays (AU)

[Factors associated with functional improvement in patients with cervical spinal cord injuries]. / Factores asociados a la mejoría funcional en pacientes con lesión medular traumática cervical.

OBJECTIVE: To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission. MATERIAL AND METHODS: We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge. RESULTS: Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge. CONCLUSIONS: Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays.

Oxycodone improves pain control and quality of life in anticonvulsant-pretreated spinal cord-injured patients with neuropathic pain.

STUDY DESIGN: A 3-month follow-up, observational, prospective, multicenter, study in traumatic spinal cord-injured (SCI) patients with neuropathic pain (NP). OBJECTIVES: To assess the effectiveness and safety of oxycodone treatment in SCI patients with anticonvulsants-refractory NP. SETTING: 'Spinal injury follow-up units' throughout Spain. METHODS: Data regarding NP characteristics were collated from male and female adults with traumatic SCI and difficult-to-control central NP of moderate-to-severe intensity (visual analog scale (VAS) ≥4) persisting ≥1 month, who had been para- or tetraplegic for ≥2 months, had been previously treated with anticonvulsants and were now treated with oxycodone. RESULTS: In all, 54 out of the 57 patients recruited were assessable. A total of 81% were men and the mean age was 46.4. Patients were treated with oxycodone, 83% combined with anticonvulsant. Pain intensity (VAS: 7.1 ± 1.3-4.3 ± 1.7) and Lattinen total score (13.2 ± 3-7.7 ± 3.4) decreased significantly (P < 0.001) along the study. No patient got worse regarding pain impact on physical activity and on sleep (Lattinen scale). EQ-5D VAS showed a trend to increase (P = 0.061) and the index of preference values increased significantly from baseline to month 3 (0.26-0.62; P < 0.001). A total of 53.7% patients showed at least one treatment-related adverse event, with constipation being the most frequent one (33.3%). CONCLUSION: Oxycodone treatment, mostly in combination with anticonvulsants, in SCI patients with NP decreases pain intensity, improves health-related quality of life and diminishes the impact of pain on physical activity and sleep.

Granuloma eosinófilo vertebral. Un caso clínico / Vertebral eosinophilic granuloma. A case report

La lesión medular es un proceso patológico que afecta a la médula espinal, produciendo pérdida de fuerza, déficit de sensibilidad por debajo del nivel de la lesión, alteración del control de los esfínteres, disfunción sexual y alteraciones en el sistema nervioso vegetativo. Su etiología es debida a causas traumáticas, congénitas o médicas. El granuloma eosinófilo es una de las formas clínicas de presentación de la histiocitosis X consiste en una lesión osteolítica solitaria, limitada al esqueleto, que afecta de forma preferente a niños y adultos jóvenes. En este artículo presentamos el caso de un niño de 12 años que ingresa en la Unidad de Lesionados Medulares del Hospital Universitario Insular de Gran Canaria por un cuadro de paraplejia secundaria a una fractura vertebral tras sufrir un traumatismo leve. Mediante pruebas de imagen y biopsia percutánea fue diagnosticado de granuloma eosinófilo en la vértebra D8

Bone marrow lesion is a pathological condition that affects the spinal cord, producing loss of force, sensitivity deficit below the lesion level, alteration of sphincter control, sexual dysfunction, and alterations in the vegetative nervous system. Its etiology is due to traumatic, congenital or medical causes. Eosinophilic granuloma is one of the clinical presentation forms of histiocytosis X and consists in a solitary osteolytic lesion, limited to the skeleton that basically affects children and young adults. In this article, we present the case of a 12 year old boy who was admitted to the Spinal Cord Injury Unit of the University Hospital Insular of Canary Islands, due to a paraplegic picture secondary to a vertebral fracture after suffering a mild traumatism. Eosinophilic granuloma of the D8 vertebra was diagnosed through imaging tests and percutaneous biopsy

Lesión medular por enfermedad descompresiva. A propósito de un caso / Bone marrow injury due to decompression disease. A case report

Introducción. La afectación neurológica por enfermedad descompresiva representa el 60 % de los accidentes por inmersión. La lesión medular constituye del 10 al 30 % de este tipo de accidentes. El objetivo del presente caso clínico es describir el proceso diagnóstico y terapéutico de un paciente que sufre una lesión medular tras un accidente por descompresión. Caso clínico. Mostramos el caso de un sujeto que practicando submarinismo realizó un ascenso rápido sin las paradas descompresivas adecuadas. Tras haber sido sometido a tratamiento en una cámara hiperbárica, presentó una lesión medular completa con nivel motor C8 y sensitivo D2, American Spinal Cord Injury Association (ASIA A). En la resonancia magnética nuclear se observó una lesión isquémica en cordones posteriores de los segmentos cervicodorsales de la médula espinal. Discusión. Ante un paciente con sintomatología de una enfermedad descompresiva, es primordial el traslado a una cámara hiperbárica en las primeras horas para reducir la sobresaturación de nitrógeno a la que se encuentra sometido el organismo

Introduction. Neurological involvement in due to decompression disease accounts for 60 % of immersion accidents. Bone marrow injury accounts for 10 % to 30 % of them. The purpose of the present clinical case is to describe the diagnostic and therapeutic procedure for a patient to suffers a bone marrow injury after a decompression accident. Clinical case. We provide the case of a subject who practiced scuba diving, and made a rapid ascent without adequate decompression stops. After being treated in a hyperbaric chamber, he had a complete bone marrow injury motor level C8 and sensitive level D2, ASIA A (American Spinal Cord Injury Association). The magnetic nuclear resonance imaging showed an ischemic lesion in the posterior cord of the cervical dorsal segments of the spinal cord. Discussion. When a patient has symptoms of decompression disease, it is essential to transfer the patient to a hyperbaric chamber in the early hours to reduce the nitrogen oversaturation that the body is subjected to

Eficacia de la gabapentina en el tratamiento del dolor neuropático secundario a la lesión medular / Efficacy of the gabapentine in the treatment of the neuropathic pain due to spinal cord injury

en el tratamiento del dolor neuropático en pacientes afectos de lesión medular. Pacientes y métodos: Estudio prospectivo y comparativo en el que se incluyeron pacientes con lesión medular y dolor neuropático de acuerdo con la clasificación de Siddall y definición de la IASP, de más de tres meses de evolución y que no hubieran recibido tratamiento previo con gabapentina. Se valoraron y cuantificaron las características e intensidad del dolor neuropático y su interferencia con el sueño, así como su tolerabilidad a través de visitas seriadas. Resultados: Fueron incluidos 43 pacientes, 80,5 % varones con una edad media de 42 + 10,2 años. Se apreció mejoría en la descripción, valoración e intensidad del dolor en las escalas de Lattinen y McGill (p< 0,0001); así como en la interferencia con el sueño (p<0,0001) entre las dos visitas de seguimiento. La tolerabilidad del medicamento fue calificada como excelente en el 73,8%. Conclusiones: El tratamiento del dolor neuropático secundario a la lesión medular con gabapentina ofrece resultados satisfactorios en cuanto a la reducción de la intensidad y frecuencia del mismo; consigue disminuir la interferencia que produce en el sueño y constituye una alternativa segura, con pocos efectos secundarios

Objective: To evaluate the efficacy and tolerability of gabapentin in the treatment of neuropathic pain in patients with spinal cord injury. Patients and methods: Prospective and comparative study was designed. Individuals with spinal cord injury and neuropathic pain in accord with Siddall's classification and IASP's definition were included. The evolution of pain was longer than three moths and any patient had received previously treatment with gabapentine. Intensity and characteristic of neurophatic pain and its interference with sleep were measured and the tolerability was also assessed. Results: Fourty three patients were included, 80,5% men, 42+10,2 years aged. The results of description and intensity of pain in Lattinen and McGill scales were better (p<0,001), as also the interference with sleep (p<0,001) between the visits of control. Conclusions: The treatmet of neurophatic pain due to spinal cord with gabapentine offers satisfactory results to decrease its intensity and frecuency, to get a lower interference with sleep and it is a safe alternative with very few secundary effects

Fentanilo transdérmico en el tratamiento para el dolor neuropático del lesionado medular / Transdermal fentanyl in the treatment of neuropathic pain of spinal cord injured patient

Diseño. Estudio prospectivo, longitudinal y abierto. Objetivos. Valorar la eficacia analgésica del fentanilo transdérmico en dolor neuropático secundario a lesión medular comparándola con otros grupos de pacientes con dolor neuropático. Material y métodos. Se incluyeron pacientes con dolor neuropático afectos de lesión medular, conformándose un grupo control de enfermos amputados y afectos de un accidente cerebrovascular. Fueron registradas las características del dolor: intensidad según escala analógica visual y escala de Latineen, interferencia con el sueño y los efectos secundarios presentados. Se realizaron controles mediante visitas seriadas, monitorizándose los cambios manifestados respecto al dolor tras la administración del fentanilo transdérmico. En el estudio estadístico se emplearon la prueba de x 2 de Pearson y la prueba t, siendo considerados significativos valores de p < 0,05. Resultados. Treinta y dos pacientes fueron incluidos en el estudio, 20 lesionados medulares, 8 amputados y 4 pacientes afectos de un accidente cerebrovascular. La intensidad del dolor neuropático se redujo en ambos grupos, determinándose el descenso global en la escala analógica visual, de 7,54 a 3,8 a los tres meses (p < 0,05) y en la escala de Lattinen de 12,78 a 7,14 (p < 0,05). El descenso en la escala analógica visual fue menos intenso en el grupo de lesionados medulares, de 7,7 a 4,91 (p < 0,05), que en amputados y en pacientes con accidentes cerebrovasculares. Conclusiones. El fentanilo transdérmico es una alternativa terapéutica eficaz para el tratamiento del dolor neuropático secundario a lesión medular, si bien el descenso de intensidad del dolor es menor que en pacientes con dolor neuropático de otro origen

Design. Prospective, longitudinal and open-labeled study. Objectives. Assess analgesic efficacy of transdermal fentanyl in neuropathic pain secondary to spinal cord injury comparing it with other groups of patients with neuropathic pain. Material and methods. Patients with neuropathic pain affected by spinal cord injury were included, the control group being formed by amputee patients and those affected by cerebrovascular accident. The pain characteristics were recorded: intensity according to visual analogue scale and Lattinen scale, interference with sleep and side effects presented. Controls were conducted by seriated visits, monitoring the changes seen regarding pain after administration of transdermal fentanyl. Pearson's x 2 test and the t-test were used in the statistical study, values of p < 0.05 being considered as significant. Results. A total of 32 patients were included in the study, 20 with spinal cord injury, 8 amputees and 4 patients with cerebrovascular accident. Neuropathic pain intensity decreased in both groups, the global decrease on the visual analogue scale being determined from 7.54 to 3.8 at three months (p < 0.05) and on the Lattinen scale from 12.78 to 7.14 (p < 0.05). Decrease on the visual analogue scale was less intense in the spinal cord injured group, from 7.7 to 4.91 (p < 0.05), than in the amputees and in patients with cerebrovascular accidents. Conclusions. Transdermal fentanyl is an effective therapeutic alternative for treatment of neuropathic pain secondary to spinal cord injury although the decrease in pain intensity is less than in patients with neuropathic pain of another origin

Determination of changes in blood pressure during administration of sildenafil (Viagra) in patients with spinal cord injury and erectile dysfunction.

STUDY DESIGN: Prospective, open-label, comparative study, to assess the effects of sildenafil on blood pressure in a population of patients with spinal cord injury (SCI). OBJECTIVES: To determine the effect of sildenafil on blood pressure in patients with erectile dysfunction secondary to SCI by comparing changes in blood pressure in SCI patients with a neurologic level below T5 versus higher levels. To establish a relationship between the potential hypotensive effect and protective muscle spasm against blood pressure reduction. To assess the effects of age, complexity and duration of SCI on changes in blood pressure. To record any adverse effects occurring during the study. SETTING: Spinal Cord Injury Unit, Insular University Hospital of Gran Canaria, Canary Islands, Spain. SUBJECTS: In total, 22 male SCI patients aged 18 years or older with a history of SCI greater than 3 months in duration. METHODS: Patients with erectile dysfunction secondary to SCI were included in the study, without excluding patients with a neurologic level above 75 or asymptomatic low blood pressure. Patients with specific contraindications for use of the drug were excluded. A personal history was obtained, and the level of injury (ASIA/IMSOP scales of international standards), impairment grade (ASIA impairment scale), spasticity grade (modified Ashworth scale) and baseline sitting and supine blood pressure values were determined. A single dose of 50 mg of sildenafil was administered, and patients remained sitting at 45 degrees . Blood pressure was monitored every 10 min for 4 h and whenever the patient reported symptoms. Any relevant signs and symptoms manifested during the study period were also recorded. Analysis of the changes in blood pressure values was performed using a paired t-test in each group of patients according to neurologic level and spasticity grade. RESULTS: A decrease in blood pressure was observed in all patients, although patients with a level of injury at T5 or above and those with a complete SCI showed a less intense decrease (P<0.05). The spasticity grade of the patients was protective against the fall in blood pressure, as it was less significant in patients with grade 3 (P>0.1) than in those with grade 0. Adverse effects were few and transient. None were related to hypotension. CONCLUSION: Sildenafil caused a decrease in blood pressure in SCI patients with a neurologic level of injury above T5 and complete injuries (grade A), but did not have clinical implications in the patients studied. A higher spasticity grade tends to protect the patient from the fall in blood pressure. Age and duration of injury do not appear to influence this decrease.

Epidemiología de la lesión medular en la provincia de Las Palmas / Epidemiology of the spinal cord injury in the province of Las Palmas

Introducción: La asistencia terapéutica al lesionado medular requiere una planificación que exige el manejo de parámetros epidemiológicos. El conocer la prevalentablacia de la lesión medular en una zona permite abordar el control y tratamiento de la misma desde un plano más real. La apertura de una nueva Unidad de Lesionados Medulares en Canarias ha puesto de relieve la necesidad de ajustar estos parámetros a la población dependiente de la misma. La ausencia de datos y registros de pacientes con lesión medular en esta Comunidad ha impulsado a este grupo de trabajo a realizar un estudio de prevalencia de la lesión medular en la provincia de Las Palmas y la observación de otras variables epidemiológicas relacionadas.Material y métodos: Entre noviembre de 2000 y diciembre de 2001 se procedió a realizar un registro de todos los afectos de lesión medular residentes en la provincia de Las Palmas. Tanto aquellos lesionados con anterioridad a la apertura de la Unidad como los que ingresaron en la misma.Los pacientes fueron entrevistados individualmente mediante una encuesta que incluía las siguientes variables: datos identificadores del paciente, edad en el momento de la lesión, sexo, etiología de la lesión, tipo de la lesión al alta, nivel de la lesión al alta, grado de la lesión al alta y centro especializado donde recibió tratamiento. Para obtener el valor de prevalencia se comparó la cifra de lesionados medulares con la población censada en la provincia.Resultados: La prevalencia estimada para la provincia fue de 30,87 casos por 100.000 habitantes, con valores más altos para varones, 44,92 frente a 16,98 casos por 100.000 habitantes en mujeres. El grupo de edad con mayor número de casos se encontró en los 15-29 años y la etiología traumática resultó la más habitual (AU)

Secondary tetraplegia due to giant-cell tumors of the cervical spine.

BACKGROUND AND PURPOSE: Giant-cell tumor of the bone is a neoplasm which rarely affects the spine, and occurs even more infrequently above the sacrum. The symptomatology depends on the tumor site, and may be attributable to a compression mechanism. Spinal cord injury is seldom a complication and tetraplegia is even more infrequent. In this paper, we present an unusual case involving a giant cell tumor. We also review its possible diagnoses and treatments. CLINICAL CASE: We present the case of giant-cell tumors in the cervical spine affecting C6 and C7, in a young woman who suffered tetraplegia due to spinal cord compression. After surgery and radiotherapy, the tumor reappeared, requiring a second operation. CONCLUSION: Early clinical diagnosis of giant-cell tumors of the spine is difficult because their development tends to go unnoticed. Imaging techniques, especially MRI, help identify them; but their diagnosis still requires histopathologic tests. Resection of the neoplasm is recommended, when possible. Curettage may allow recurrence and radiotherapy may lead to sarcomatous degeneration of the tumor.