Lesión medular asociada a hematoma epidural espinal espontáneo / Spinal cord injury associated with spontaneous spinal epidural hematoma

Introducción: El hematoma epidural espinal espontáneo (HEEE) es una entidad de baja incidencia, de elevada morbimortalidad y que causa una importante limitación funcional en la vida de los pacientes. Material y métodos: Con el objetivo de determinar la incidencia del HEEE y el tipo de lesión medular provocada y su repercusión funcional en este centro hospitalario, se realizó un estudio descriptivo retrospectivo analizando variables demográficas, de la lesión (ISCNSCI) y de la funcionalidad (SCIMIII). Resultados: Se revisaron los casos de HEEE atendidos en este centro. El 75% eran varones, con una mediana de edad de 55años. Todas las lesiones fueron incompletas. La localización más frecuente de las lesiones fue a nivel cervical bajo y dorsal alto. La mitad de los sangrados se produjeron en la región medular anterior. Se objetivó mejoría funcional tras el programa específico de rehabilitación. Conclusión: El HEEE podría considerarse de buen pronóstico funcional, relacionado con lesiones medulares habitualmente posteriores e incompletas sensitivo-motoras que se beneficiarían de un tratamiento rehabilitador específico precoz.(AU)

Introduction: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. Material and methods: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). Results: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. Conclusion: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.(AU)

[Spinal cord injury associated with spontaneous spinal epidural hematoma]. / Lesión medular asociada a hematoma epidural espinal espontáneo.

INTRODUCTION: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. MATERIAL AND METHODS: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). RESULTS: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. CONCLUSION: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.

Os subtibiale: esa rara molestia en el tobillo / Os subtibiale: That odd ankle pain

El os subtibiale es un hueso accesorio del tobillo, poco frecuente. Localizado en el colículo posterior del maléolo tibial interno, puede verse en edad pediátrica y adulta. Puede causar dolor, enrojecimiento y/o inflamación del tobillo, pudiendo llevar al diagnóstico erróneo de fractura avulsiva. Su conocimiento anatómico es crucial. Se presenta el caso de un paciente en edad escolar, valorado en consulta por dolor en la cara interna de ambos tobillos durante 2 meses tras traumatismo casual. En segundo lugar, un paciente adulto con dolor en la cara interna del tobillo derecho de 3 días de evolución, sin traumatismo, valorado en urgencias. Es imprescindible la correcta anamnesis y exploración física. El diagnóstico se realiza mediante radiología convencional de tobillos, proyección anteroposterior y lateral en carga. El tratamiento inicial es conservador (férulas u ortesis) para establecer y mantener las funciones del pie durante las actividades en carga. Si persiste tras 6 meses, se podría plantear tratamiento quirúrgico (AU)

Os subtibiale is a low prevalence accessory bone of the ankle. This bone is located in the posterior colliculus of the tibial medial malleolus, both in paediatric and adult ages. It can cause pain, redness and/or swelling, which can lead to a mistaken diagnosis of avulsion fracture. Adequate anatomical knowledge is crucial. First, we present the case of a school-aged boy, seen at the outpatient clinic for a 2-month history of pain in both inner ankles after an injury. Second, we present the case of an adult patient with a 3-day history of right medial ankle pain, with no previous injury, evaluated at the Emergency Department. Accurate history-taking and physical examination are essential. The diagnosis is given by conventional radiology of both ankles, in antero-posterior and lateral load views. The initial treatment is conservative (splint or orthesis) to establish and maintain the function of the foot during loading activities. If there is no recovery after 6 months, surgical treatment can be considered (AU)

[Os subtibiale: That odd ankle pain]. / Os subtibiale: esa rara molestia en el tobillo.

Os subtibiale is a low prevalence accessory bone of the ankle. This bone is located in the posterior colliculus of the tibial medial malleolus, both in paediatric and adult ages. It can cause pain, redness and/or swelling, which can lead to a mistaken diagnosis of avulsion fracture. Adequate anatomical knowledge is crucial. First, we present the case of a school-aged boy, seen at the outpatient clinic for a 2-month history of pain in both inner ankles after an injury. Second, we present the case of an adult patient with a 3-day history of right medial ankle pain, with no previous injury, evaluated at the Emergency Department. Accurate history-taking and physical examination are essential. The diagnosis is given by conventional radiology of both ankles, in antero-posterior and lateral load views. The initial treatment is conservative (splint or orthesis) to establish and maintain the function of the foot during loading activities. If there is no recovery after 6 months, surgical treatment can be considered.