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1.
Brain Nerve ; 71(11): 1303-1307, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31722316

RESUMO

We report the case of a 71-year-old man with impaired left finger extension. The presence of nodular fibrosing lesions in his palm suggested Dupuytren contracture as the diagnosis. However, detailed neurological examination revealed muscle weakness associated with C7-Th1 lesions, and needle electromyography revealed denervation within the same distribution. Therefore, the patient was diagnosed with distal-type cervical spondylolisthesis muscular atrophy complicated with Dupuytren contracture. Due to shared symptoms with impaired finger extension, the other two conditions can be overlooked in patients affected by both diseases. Detailed clinical investigation of nodular fibrosing lesions, muscle weakness at the C7-Th1 level, and needle electromyography findings facilitate differential diagnosis of Dupuytren contracture and distal-type cervical spondylolisthesis. (Received June 24, 2019; Accepted September 17, 2019; Published November 1, 2019).


Assuntos
Contratura de Dupuytren/complicações , Doenças da Medula Espinal/complicações , Espondilolistese/complicações , Idoso , Vértebras Cervicais , Humanos , Masculino , Atrofia Muscular
2.
Artigo em Russo | MEDLINE | ID: mdl-31407676

RESUMO

AIM: To define the mechanism of formation of orthostatic hypotension in patients with traumatic tetraplegia. MATERIAL AND METHODS: The study included 64 patients with chronic (more 6 month) and subacute (less 6 month) tetraplegia; the period of observation was about 30 days after admission to the rehabilitation center. Changes in the state of the autonomic nervous systems (heart rate variability at rest and head-up tilt test, sinus arrhythmia) were studied. RESULTS: In the first 6 months, all patients, and after 6-12 months, one third of the patients experienced orthostatic hypotension, which was accompanied by lower values of the normalized sympatovagal index (LFn/HFn) 0.35 (0.260; 0.650) and expiratory-inspiratory coefficient (RRmax/RRmin) 1.09 (1.040; 1200). An increase in expiratory-inspiratory coefficient as a result of physical rehabilitation up to 1.16 (1.120; 1.24) was noted only in patients less than 6 months after injury. CONCLUSION: Both sympathetic and parasympathetic parts of the autonomic nervous system are involved in the formation of orthostatic hypotension syndrome in patients with spinal tetraplegia.


Assuntos
Hipotensão Ortostática , Doenças da Medula Espinal , Sistema Nervoso Autônomo , Frequência Cardíaca , Humanos , Hipotensão Ortostática/etiologia , Doenças da Medula Espinal/complicações , Teste da Mesa Inclinada
3.
Spine (Phila Pa 1976) ; 44(18): 1318-1331, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31261274

RESUMO

STUDY DESIGN: Systematic review. OBJECTIVE: This review aims to (1) outline how neurological complications and disease progression are defined in the literature and (2) evaluate the quality of definitions using a novel four-point rating system. SUMMARY OF BACKGROUND DATA: Degenerative cervical myelopathy (DCM) is a progressive, degenerative spine disease that is often treated surgically. Although uncommon, surgical decompression can be associated with neurological complications, such as C5 nerve root palsy, perioperative worsening of myelopathy, and longer-term deterioration. Unfortunately, important questions surrounding these complications cannot be fully addressed due to the heterogeneity in definitions used across studies. Given this variability, there is a pressing need to develop guidelines for the reporting of surgical complications in order to accurately evaluate the safety of surgical procedures. METHODS: An electronic database search was conducted in MEDLINE, MEDLINE in Process, EMBASE and Cochrane Central Register of Controlled Trials for studies that reported on complications related to DCM surgery and included at least 10 surgically treated patients. Data extracted included study design, surgical details, as well as definitions and rates of surgical complications. A four-point rating scale was developed to assess definition quality for each complication. RESULTS: Our search yielded 2673 unique citations, 42 of which met eligibility criteria and were summarized in this review. Defined complications included neurological deterioration, late onset deterioration, perioperative worsening of myelopathy, C5 palsy, nerve root or upper limb palsy or radiculopathy, surgery failure, inadequate decompression and progression of ossified lesions. Reported rates of these complications varied substantially, especially those for neurological deterioration (0.2%-33.3%) and progression of ossified lesions (0.0%-86.7%). CONCLUSION: Reported incidences of various complications vary widely in DCM surgery, especially for neurological deterioration and progression of ossified lesions. This summary serves as a first step for standardizing definitions and developing guidelines for accurately reporting surgical complications. LEVEL OF EVIDENCE: 2.


Assuntos
Vértebras Cervicais/cirurgia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/cirurgia , Descompressão Cirúrgica/métodos , Progressão da Doença , Humanos , Masculino , Paralisia/etiologia , Radiculopatia/etiologia
4.
World Neurosurg ; 130: 530-536.e2, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31254693

RESUMO

OBJECTIVE: Spondylotic cervical myelopathy is a severe condition commonly affecting aging people. Although many investigations have been conducted, a consensus on the best surgical management is still missing. The aim of our study was to systematically review the pertinent literature and carry out a meta-analysis to compare the clinical and radiological outcome of the anterior cervical decompression and fusion (ACDF) and the posterior laminoplasty. METHODS: This study was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines statement. Different medical database (PubMed, Embase, Scopus) were screened for eligible scientific reports. The key words "cervical," "spondylosis," "myelopathy," "laminoplasty," "ACDF" (MeSH) have been used in any possible combination. As outcome variables, the Japanese Orthopedic Association score, operation time, blood loss, cervical lordosis, range of motion and, complications were evaluated. RESULTS: A total of 626 articles were screened and 5 finally included in the meta-analysis. Comparing the anterior cervical decompression and fusion (ACDF) and laminoplasty groups, no differences were found in Japanese Orthopedic Association score, operation time, and complication rate. The ACDF was associated with lower intraoperative blood loss and better cervical lordosis preservation, whereas the laminoplasty was associated with a wider cervical range of motion. CONCLUSIONS: The results of this meta-analysis seem to suggest that ACDF should be preferred to the laminoplasty for the treatment of multilevel cervical myelopathy, although proper designed randomized controlled clinical trials are needed to further investigate this relevant ongoing issue.


Assuntos
Descompressão Cirúrgica/métodos , Laminoplastia/métodos , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Espondilose/diagnóstico , Espondilose/cirurgia , Humanos , Compressão da Medula Espinal/cirurgia , Doenças da Medula Espinal/complicações , Espondilose/complicações , Resultado do Tratamento
5.
BMC Musculoskelet Disord ; 20(1): 181, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31039764

RESUMO

OBJECTIVE: The effects of dural release on extended laminoplasty for the treatment of multi-level cervical myelopathy were explored and discussed. METHOD: Patients, who underwent extended laminoplasty combined with dural release for the treatment of multi-level cervical myelopathy (35 cases, group A), were compared with patients who underwent simple extended laminoplasty (38 cases, group B). The JOA score, improvement rate, VAS score, distance of retroposition of the spinal cord, cervical lordosis were compared between the two groups. RESULTS: Dural laceration occurred to five patients during surgery, three in group A and two in group B; cerebrospinal fluid leakage occurred to five patients, three in group A and two in group B. All patients were followed up for 10 to 48 months (mean 20.3 months). JOA scores and VAS scores in the last follow up period were significantly improved in the two groups than preoperative scores (p < 0.05). The improvement rate and JOA scores in group A were significantly higher than group B, while VAS scores in group A were significantly lower than group B (p < 0.05). There were no significant differences in cervical lordosis in the two groups in the last follow up (p > 0.05), and the distance of retroposition of the spinal cord in group A was higher than B (p < 0.05). No shut-up of the 'door' of vertebral lamina occurred in the period of follow-up. CONCLUSION: Dural release on extended laminoplasty can achieve retroposition of the spinal cord for multi-level cervical myelopathy, which is more effective than simple extended laminoplasty.


Assuntos
Vértebras Cervicais/cirurgia , Dura-Máter/cirurgia , Laminoplastia/métodos , Lordose/cirurgia , Doenças da Medula Espinal/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Lordose/diagnóstico , Lordose/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico , Resultado do Tratamento
6.
Pract Neurol ; 19(4): 368-371, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31048365

RESUMO

Portosystemic encephalopathy commonly occurs in patients with portal hypertension caused by end-stage liver disease or portal vein thrombosis. Congenital extrahepatic portosystemic shunt (CEPS) is an underdiagnosed and treatable condition that can cause encephalopathy and various neuropsychiatric symptoms. We report an unusual case of type 2 CEPS in a 29-year-old woman who presented with progressive myelopathy and fluctuating encephalopathy on a background of congenital cardiac disease. Investigations showed hyperammonaemia, and despite no evidence of portal hypertension on ultrasound imaging, CT scan of abdomen showed a shunt between the mesenteric and left internal iliac veins. Patients with unexplained fluctuating or progressive neuropsychiatric symptoms should have their serum ammonia checked. A raised serum ammonia concentration without known portal hypertension should prompt further investigations for extrahepatic shunts.


Assuntos
Encefalopatias/diagnóstico por imagem , Progressão da Doença , Encefalopatia Hepática/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Adulto , Encefalopatias/complicações , Feminino , Encefalopatia Hepática/complicações , Humanos , Doenças da Medula Espinal/complicações
7.
Am J Emerg Med ; 37(6): 1216.e3-1216.e5, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30940410

RESUMO

The frequency of stroke mimics among stroke patients has been reported to be up to 30%, and that in patients who receive thrombolytic therapy ranges between 1% and 16%. Atlantoaxial dislocation with myelopathy mimicking stroke is extremely rare. An 83-year-old man with a history of old cerebellar infarction presented to the emergency department with acute left hemiplegia after a chiropractic manipulation of the neck and back several hours before symptom onset. Mild hypoesthesia was observed on his left limbs. No speech disturbance, facial palsy, or neck or shoulder pain was observed. Intravenous thrombolytic treatment was given 238 min after symptom onset. Brown-Sequard syndrome subsequently developed 6 h after thrombolysis with a hypoesthetic sensory level below the right C5 dermatome. An emergent brain magnetic resonance angiography did not reveal an acute cerebral infarct but rather an atlantoaxial dislocation causing upper cervical spinal cord compression. Clinical symptoms did not deteriorate after thrombolysis. He received successful decompressive surgery 1 week later, and his muscle power gradually improved, with partial dependency when performing daily living activities 2 months later. A literature review revealed that only 15 patients (including the patient mentioned here) with spinal disorder mimicking acute stroke who received thrombolytic therapy have been reported. Atlantoaxial dislocation may present as acute hemiplegia mimicking acute stroke, followed by Brown-Sequard syndrome. Inadvertent thrombolytic therapy is likely not harmful for patients with atlantoaxial dislocation-induced cervical myelopathy. The neurological deficits of patients should be carefully and continuously evaluated to differentiate between stroke and myelopathy.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Fibrinolíticos/uso terapêutico , Luxações Articulares/diagnóstico por imagem , Lesões do Pescoço/complicações , Doenças da Medula Espinal/complicações , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Isquemia Encefálica , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Erros de Diagnóstico , Humanos , Luxações Articulares/cirurgia , Angiografia por Ressonância Magnética , Masculino , Acidente Vascular Cerebral
8.
Acta Medica (Hradec Kralove) ; 62(1): 39-42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931896

RESUMO

Spinal epidermoid cysts are benign tumors. Syringomyelia secondary to intramedullary tumors are frequently observed. However, the association between syringomyelia and spinal intradural extramedullary epidermoid cyst in the conus medullaris region is extremely rare. We present the case of a 3-year-old male who was admitted with paraparesis and urinary retention. Magnetic resonance imaging (MRI) of the spine demonstrated intradural extramedullary lesion, compatible with epidermoid cyst, that at the conus medullaris level and a large syringomyelia extending from T4 to L1 vertebrae. Total microsurgical excision of the cyst was performed. No additional drainage was carried out for the syringomyelic cavity. Histopathological examination verified the diagnosis of the epidermoid cyst. Total excision of the cyst and disappearance of the syringomyelia were observed on MRI at 15 days postoperatively. We have clarified the etiology, clinical, histopathological and radiological features, differential diagnosis, and treatment modalities of spinal epidermoid cysts. In addition, we have discussed the possible mechanisms of syringomyelia formation in spinal intradural lesions.


Assuntos
Cisto Epidérmico/cirurgia , Paraparesia/patologia , Doenças da Medula Espinal/cirurgia , Medula Espinal/patologia , Siringomielia/patologia , Retenção Urinária/patologia , Pré-Escolar , Cisto Epidérmico/complicações , Cisto Epidérmico/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Paraparesia/diagnóstico por imagem , Paraparesia/etiologia , Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/patologia , Siringomielia/diagnóstico por imagem , Resultado do Tratamento , Retenção Urinária/diagnóstico por imagem , Retenção Urinária/etiologia
9.
BMJ Case Rep ; 12(2)2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30819681

RESUMO

Spinal arachnoid cysts (SAC) are rare in isolation and the exact aetiology is still debated. Primary (congenital) cysts are caused by structural abnormalities in the arachnoid layer and largely affect the thoracic region. Secondary cysts are induced by a multitude of factors, infection, trauma or iatrogenic response, and can affect any level of the spinal cord. While subarachnoid haemorrhage (SAH) is a relatively common condition with significant repercussions, it is extremely uncommonly associated with SAC. When present, it may develop in the months and years after the original bleed, giving rise to new neurological symptoms. Prompt treatment is needed to halt or reverse the worsening of symptoms and questions are still being asked about how best to approach this condition. A 42-year-old man presented with chronic back pain, severe worsening ataxia and numbness below the umbilicus, 7 months after treatment for a World Federation of Neurosurgical Societies grade five (WFNS V) SAH. Imaging revealed a SAC extending from T12 to L4 and causing thecal compression. This was treated with a L3 laminectomy andmarsupialisation. An improvement in neurological function was observed at 6 months. Aetiology of the SAC and its association with SAH are discussed and a review of the relevant literature is provided.


Assuntos
Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Paraparesia/etiologia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Adulto , Cistos Aracnóideos/cirurgia , Dor nas Costas/etiologia , Humanos , Laminectomia , Imagem por Ressonância Magnética/métodos , Masculino , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
10.
World Neurosurg ; 126: 413, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30902767

RESUMO

Dural arteriovenous fistulas (DAVFs) represent 10%-15% of all intracranial arteriovenous malformations.1 DAVFs located in the posterior cranial fossa are rare and often present with intracranial hemorrhage and myelopathy.2 Arterial supply could be provided by the meningeal branches of the vertebral artery and external and internal carotid arteries.3 A 68-year-old man presented with progressive lower-extremity weakness (Video 1). Magnetic resonance imaging revealed a patchy longitudinal cord signal abnormality extending from the cervicomedullary junction to C7. A tentorial DAVF supplied by the right posterior meningeal artery with drainage via dorsal and ventral perimedullary veins was identified on angiography. According to the Cognard classification, the patient's DAVF was determined to be high risk as a type V lesion with spinal venous drainage and progressive myelopathy.4 The fistula was embolized with 50% ethanol resulting in near-complete occlusion. However, follow-up angiography revealed a persistent arteriovenous shunt and slightly worsening symptoms for the patient. He underwent a sitting supracerebellar approach with a torcular craniotomy for successful clip ligation of the dural arteriovenous fistula. The patient was discharged with improvements in lower-extremity strength and no residual arteriovenous shunting in postoperative imaging.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Fossa Craniana Posterior/cirurgia , Procedimentos Neurocirúrgicos/métodos , Idoso , Malformações Vasculares do Sistema Nervoso Central/complicações , Fossa Craniana Posterior/patologia , Humanos , Masculino , Procedimentos Neurocirúrgicos/educação , Doenças da Medula Espinal/complicações , Instrumentos Cirúrgicos , Resultado do Tratamento
11.
J Neuroimmunol ; 330: 136-142, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30878696

RESUMO

Paraneoplastic myelopathy is rare paraneoplastic neurological syndromes. We reviewed patients through medical records system and screened patients who presented with myelopathy, and/or coexisting cancer, and/or onconeural antibodies. Nine patients were identified as paraneoplastic myelopathy presenting with progressive subacute (2/9) or insidious (7/9) myelopathy. CSF abnormalities included elevated protein, 5; pleocytosis, 4; excess oligoclonal bands, 6. Seven patients had onconeural antibody. Cancer was confirmed histopathologically in 6 and diagnosed by PET-CT in 1. Four patients had symmetric, longitudinally extensive grey matter or tract-specific changes on spinal cord MRI. It was associated with significant morbidity and had poor response to treatment.


Assuntos
Imunoterapia , Síndromes Paraneoplásicas do Sistema Nervoso/complicações , Síndromes Paraneoplásicas do Sistema Nervoso/diagnóstico por imagem , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Idoso , Feminino , Seguimentos , Humanos , Imunoterapia/métodos , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas do Sistema Nervoso/tratamento farmacológico , Estudos Retrospectivos , Doenças da Medula Espinal/tratamento farmacológico
12.
J Orthop Sci ; 24(5): 798-804, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30777363

RESUMO

BACKGROUND: We termed chronic neuropathic pain (NeP) in patients with diseases associated with spinal cord damage as "spinal cord-related pain syndrome". We conducted a survey of patients with the syndrome to assess the type and severity of NeP and its effect on QOL, and treatment modalities. METHODS: This cross-sectional study was conducted in 185 patients recruited from 15 medical institutions. We analyzed the questionnaires sent to clinicians (basic information, magnetic resonance imaging (MRI) findings, type and effectiveness of medications) and patients [modified Neuropathic Pain Symptom Inventory (NPSI) and short form (SF)-36 healthy survey]. RESULTS: The incidence of spinal cord-related pain syndrome was highest in patients with cervical spondylotic myelopathy, ossification of posterior longitudinal ligament (OPLL) and spinal cord injury. The number of patients with at-level pain was higher than those with below-level pain; dysesthesia/paresthesia, spontaneous and evoked pain types were mainly seen in patients with at-level pain and dysesthesia/paresthesia was common among those with below-level pain. NPSI score was higher than 10 in the majority of patients, and the subscore for dysesthesia/paresthesia was significantly the highest. The NPSI score was the highest in patients with severe hyperintense signal increase on MRI. The scores of all SF-36 sub-items were significantly lower than the national average. The majority of patients used non-steroid anti-inflammatory drugs and gabapentin/pregabalin; the latter was significantly effective for allodynia, compared with other medications, regardless of the pain level. CONCLUSIONS: The majority of patients with spinal cord-related pain syndrome suffered from severe NeP, which affected physical activity. The pain phenotype varied according to the level of the lesion and dysesthesia/paresthesia was the most intense. Compared with other medications, gabapentin/pregabalin was significantly effective especially for dysesthesia/paresthesia and evoked pain regardless of the pain level.


Assuntos
Neuralgia/tratamento farmacológico , Neuralgia/etiologia , Doenças da Medula Espinal/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Inquéritos e Questionários , Adulto Jovem
13.
Neurourol Urodyn ; 38(3): 968-974, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30801793

RESUMO

AIMS: Neurogenic lower urinary tract dysfunction is common in individuals with spinal cord injury and disorders (SCI/D). The purpose of this study was to identify specific demographic, neurologic, and urologic factors associated with different bladder management methods (BMMs) in individuals with SCI/D. METHODS: A retrospective review of BMMs at a large Veterans Affairs SCI/D center was performed to identify associated risk factors including demographics, neurologic factors, and urologic factors. Bivariate analysis was performed to identify factors associated with specific BMMs. Then, a propensity-matched racial group analysis was performed to identify independent factors associated with differences in BMM. RESULTS: Data from 833 patients with SCI/D were reviewed and included 52.1% Caucasians and 39.6% African Americans. On bivariate analysis, current age, years since the injury, the severity of functional impairment, nonmedical mechanism of injury, and Caucasian race were associated with increased rates of indwelling catheter use. In an analysis of propensity-matched racial groups, African-American race was found to be an independent risk factor for not using indwelling catheters on multivariate analysis (odds ratio = 0.55). This finding was not related to access to care, as the rate of urodynamic testing was similar between races ( P = 0.174). CONCLUSIONS: Caucasians were more likely to use indwelling catheters and less likely to use conservative BMMs despite proper urodynamic evaluation. The racial discrepancy suggests a need for future research aimed at identifying unknown psychosocial factors associated with the use of indwelling catheters in individuals with SCI/D.


Assuntos
Doenças da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/reabilitação , Bexiga Urinaria Neurogênica/reabilitação , Bexiga Urinária , Veteranos/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano , Cateteres de Demora , Tratamento Conservador , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Sintomas do Trato Urinário Inferior/complicações , Sintomas do Trato Urinário Inferior/reabilitação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Doenças da Medula Espinal/complicações , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/etiologia , Cateterismo Urinário
14.
World Neurosurg ; 126: 99-100, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30797922

RESUMO

BACKGROUND: Calcified intraspinal epidermoids are a rare entity. We discuss the various pathogenesis and the clinical implication of such a finding during surgery. CASE DESCRIPTION: A 32-year-old female presented with progressive spastic paraparesis with incontinence. Imaging showed an unusual intralesional calcification, which was removed. Postoperatively she had no fresh deficits. CONCLUSIONS: To our knowledge this is the first reported case of spinal intramedullary epidermoid with intralesional calcification.


Assuntos
Calcinose/patologia , Cisto Epidérmico/patologia , Paraparesia Espástica/patologia , Doenças da Medula Espinal/patologia , Adulto , Calcinose/complicações , Calcinose/diagnóstico por imagem , Cisto Epidérmico/complicações , Cisto Epidérmico/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Paraparesia Espástica/diagnóstico por imagem , Paraparesia Espástica/etiologia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
World Neurosurg ; 126: e33-e40, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30708081

RESUMO

BACKGROUND: Symptomatic spinal epidural lipomatosis (SSEL) is characterized by hypertrophy of adipose tissue within the spinal canal and consequent neural compromise. The exact pathogenesis remains enigmatic. The authors describe a retrospective case series, define the full clinical spectrum, and discuss possible pathogenetic mechanisms. METHODS: The medical notes and imaging of 9 patients with SSEL undergoing surgery from 2008-2018 were analyzed. Seven patients presented secondary to lumbosacral spinal epidural lipomatosis (SEL); 3 patients with chronic incomplete cauda equina syndrome (CES), 3 patients with acute CES (including a 25-week gravid patient and a 40-year-old patient with intravenous leiomyomatosis, both of whom had mild SEL) and 1 patient with chronic lumbar radiculopathy. In addition, 2 patients presented with progressive myelopathy secondary to thoracic SEL. RESULTS: Patients presenting with acute CES had a mean age of 37 years (range 23-49 years) and mean extradural fat (EF)-to-spinal canal (SC) ratio of 47% (range 41%-58%), in comparison with patients with chronic CES; mean age 61 years (range 58-65 years) and EF:SC ratio 72% (range 65%-80%). Patients underwent laminectomy and resection of EF at compressive levels. All patients with CES experienced complete resolution of symptoms at follow-up (range 1-48 months). CONCLUSIONS: The clinician should be astute to the radiologic features of SEL, particularly in patients presenting with CES in the absence of acute disk herniation. The outcome of patients with CES and SEL after surgery is excellent regardless of symptom duration. Venous impedance related to increased body mass index and EF deposition may play the predominant role in addition to mechanical compression in the pathogenesis of SSEL.


Assuntos
Espaço Epidural/diagnóstico por imagem , Espaço Epidural/patologia , Lipomatose/diagnóstico por imagem , Lipomatose/patologia , Procedimentos Neurocirúrgicos/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/patologia , Adulto , Idoso , Síndrome da Cauda Equina/complicações , Descompressão Cirúrgica/métodos , Espaço Epidural/cirurgia , Feminino , Seguimentos , Humanos , Laminectomia , Lipomatose/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gravidez , Radiculopatia/complicações , Estudos Retrospectivos , Doenças da Medula Espinal/complicações , Doenças da Coluna Vertebral/cirurgia , Resultado do Tratamento , Adulto Jovem
16.
World Neurosurg ; 125: 126-128, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30610988

RESUMO

BACKGROUND: A rare case of familial genetic disorder Klippel-Feil syndrome and Arnold-Chiari malformation caused by cervical spondylotic myelopathy was reported here. CASE DESCRIPTION: The reconstruction of stability and spinal cord decompression was achieved by anterior cervical discectomy, fusion, and internal fixation. CONCLUSIONS: Although the disease genetic characteristics have been studied, operation is necessary when it leads to abnormal neurologic symptoms and the surgery of surgery can have a beneficial outcome.


Assuntos
Malformação de Arnold-Chiari/etiologia , Síndrome de Klippel-Feil/etiologia , Doenças da Medula Espinal/complicações , Espondilose/complicações , Adulto , Malformação de Arnold-Chiari/cirurgia , Vértebras Cervicais , Descompressão Cirúrgica , Discotomia , Feminino , Humanos , Síndrome de Klippel-Feil/cirurgia , Doenças da Medula Espinal/congênito , Doenças da Medula Espinal/cirurgia , Fusão Vertebral , Espondilose/congênito , Espondilose/cirurgia
17.
Medicine (Baltimore) ; 98(2): e13649, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30633153

RESUMO

RATIONALE: Posterior reversible encephalopathy syndrome (PRES) was termed by Hinchey in 1996. Patients have a reversible vasogenic brain edema in imaging and acute neurological symptoms such as headache, seizures, encephalopathy, and visual disturbances when suffering from hypertension, pre-eclampsia/eclampsia, renal failure, immunosuppressive medications, autoimmune disorders, sepsis, thrombocytopaenia, hypocalcaemia, alcohol withdrawal, and many other potential causes. de Havenon A et al have proposed a new syndrome named PRES with spinal cord involvement (PRES-SCI). The patients with PRES-SCI have similar symptoms these of PRES. Patients have neurologic signs with the spinal cord involved and lesions in magnetic resonance imaging (MRI) extending to the cervicomedullary junction, usually with extreme elevation in blood pressure and a history of hypertensive retinopathy. We administrated a young patient whose condition was consistent with PRES-SCI except for the hemisphere lesions. PATIENT CONCERNS: A 20-year-old Asian male patient was admitted for a 1 week history of blurred vision and weakness of the limbs. He has had poorly controlled hypertension for 1 year before admission. In emergency room, his blood pressure could raise to 260/140mmHg. Neurological examinations and cerebral spinal fluid tests were negative. The MRI of the brain and spinal cord showed reversible lesions in the medulla and upper cervical spinal cord that extended to the lower thoracic spine. DIAGNOSIS: Taking into account the characteristic lesions in the MRI as well as the reversible course upon treatment, he was diagnosed PRES-SCI. INTERVENTIONS: He was treated with medicines for the hypertension. OUTCOMES: His symptoms rapidly improved and finally the lesions on the MRI of the brain and spianl cord disappeared. LESSONS: Clinicians should suspect PRES-SCI when patients have mild or no neurologic signs accompanied with extreme elevation in blood pressure and lesions in spinal cord. Spinal lesions alone may be a subtype of PRES-SCI.


Assuntos
Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Anti-Hipertensivos/uso terapêutico , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/tratamento farmacológico , Adulto Jovem
18.
Spine (Phila Pa 1976) ; 44(1): E53-E59, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29933333

RESUMO

STUDY DESIGN: Case report and literature review. OBJECTIVE: To characterize the rare presentation of myelopathy occurring secondary to alkaptonuria and to evaluate the available evidence regarding its treatment. SUMMARY OF BACKGROUND DATA: Alkaptonuria is an autosomal recessive genetic condition with an estimated incidence of 1 in 250,000 to 1 in 1,000,000 people. Mutation of the enzyme homogentisate 1,2-dioxygenase leads to the production of high levels of homogentisic acid, with subsequent deposition in ligaments, cartilage, and menisci. Involvement of the spine is termed "ochronotic spondyloarthropathy," of which myelopathy is an uncommon presentation. METHODS: We present the case of a 57-year-old man with alkaptonuria-associated myelopathy, who underwent surgical decompression. Ten additional cases were identified in the literature by a systematic search of PubMed and Google Scholar. RESULTS: In a patient presenting with myelopathy, alkaptonuria may be suspected because of medical history, family history, symptoms (including darkened urine, pigmented ear cartilage, and sclera), or radiographic changes, such as multilevel disc collapse, progressive wafer-like disc calcification, extensive osteophyte formation, and spinal deformity. The diagnosis can be confirmed by urine homogentisic acid testing. Of the 11 patients presented here or identified in the literature, 2 were treated nonoperatively, 8 were treated with decompressive spinal surgery, and treatment of the myelopathy was not discussed for 1 patient. In all cases in which outcomes were reported, substantial improvement in the patient's condition was seen. CONCLUSION: Alkaptonuria is a rare cause of myelopathy, but one that clinicians should understand. Although no disease-modifying treatment currently exists for alkaptonuria, the use of symptomatic treatments and, particularly, surgical decompression is recommended to address myelopathy if it develops. LEVEL OF EVIDENCE: 4.


Assuntos
Alcaptonúria/diagnóstico por imagem , Alcaptonúria/cirurgia , Ocronose/diagnóstico por imagem , Ocronose/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Alcaptonúria/complicações , Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/diagnóstico por imagem , Doenças da Medula Óssea/cirurgia , Calcinose/complicações , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Descompressão Cirúrgica/métodos , Humanos , Tinta , Masculino , Pessoa de Meia-Idade , Ocronose/complicações , Doenças da Medula Espinal/complicações , Espondiloartropatias/complicações , Espondiloartropatias/diagnóstico por imagem , Espondiloartropatias/cirurgia
19.
Spine (Phila Pa 1976) ; 44(2): 96-102, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-29939973

RESUMO

STUDY DESIGN: Retrospective review. OBJECTIVE: To identify and compare the incidences of fragility fractures amongst three elderly populations: the general population, patients with surgically treated cervical spondylotic myelopathy (CSM), and patients with CSM not surgically treated. SUMMARY OF BACKGROUND DATA: CSM is a common disease in the elderly. Progression of myelopathic symptoms, including gait imbalance, can be a source of morbidity as it can lead to increased falls. METHODS: Records of elderly patients with Medicare insurance from 2005 to 2014 were retrospectively reviewed. Three mutually exclusive populations of patients were identified for analysis, including a cohort of patients with a diagnosis of CSM who were not treated with surgery; a cohort of patients with CSM who were treated with surgery; and a group of control patients who had never been treated with cervical spine surgery nor were diagnosed with CSM. Incidence of fractures of the distal radius, proximal humerus, proximal femur, and lumbar spine were assessed and compared between cohorts, adjusted by age, sex, osteoporosis, dementia, cerebrovascular disease, and Charlson Comorbidity Index. RESULTS: A total of 891,864 patients were identified, of which 60,332 had a diagnosis of CSM and 24,439 underwent cervical spine surgery. Compared to general population controls, the 12-month adjusted odds of experiencing at least one fragility fracture were 1.59 times higher in patients with CSM who were not treated with surgery (P < 0.001). The analogous odds ratio was 1.34 (P < 0.001) at 3 years. Compared to nonsurgically treated patients with CSM, the odds of experiencing at least one fragility fracture were reduced to 0.89 in surgically treated patients (P = 0.008). CONCLUSION: Fragility fractures are a significant source of morbidity and mortality in elderly patients. CSM is associated with increased rates of fragility fractures, although surgical management of CSM may be protective against risk of fragility fracture. LEVEL OF EVIDENCE: 3.


Assuntos
Fraturas Ósseas/epidemiologia , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais , Feminino , Humanos , Incidência , Masculino , Medicare/estatística & dados numéricos , Estudos Retrospectivos , Doenças da Medula Espinal/complicações , Espondilose/complicações , Estados Unidos
20.
Spine (Phila Pa 1976) ; 44(2): 103-109, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-29958201

RESUMO

STUDY DESIGN: A prospective cohort study. OBJECTIVE: The aim of this study was to quantify the amount of sway associated with maintaining a balanced posture in a group of untreated cervical spondylotic myelopathy (CSM) patients. SUMMARY OF BACKGROUND DATA: Balance is defined as the ability of the human body to maintain its center of mass (COM) within the base of support with minimal postural sway. Sway is the movement of the COM in the horizontal plane when a person is standing in a static position. CSM patients have impaired body balance and proprioceptive loss. METHODS: Thirty-two CSM patients performed a series of functional balance tests a week before surgery. Sixteen healthy controls (HCs) performed a similar balance test. Patients are instructed to stand erect with feet together and eyes opened in their self-perceived balanced and natural position for a full minute. All test subjects were fitted to a full-body reflective markers set and surface electromyography (EMG). RESULTS: CSM patients had more COM sway in the anterior-posterior (CSM: 2.87 cm vs. C: 0.74 cm; P = 0.023), right-left (CSM: 5.16 cm vs. C: 2.51 cm; P = 0.003) directions as well as head sway (anterior-posterior - CSM: 2.17 cm vs. C: 0.82 cm; P = 0.010 and right-left - CSM: 3.66 cm vs. C: 1.69 cm; P = 0.044), more COM (CSM: 44.72 cm vs. HC: 19.26 cm, p = 0.001), and head (Pre: 37.87 cm vs. C: 19.93 cm, P = 0.001) total sway in comparison to controls. CSM patients utilized significantly more muscle activity to maintain static standing, evidenced by the increased trunk and lower extremity muscle activity (multifidus, erector spinae, rectus femoris, and tibialis anterior, P < 0.050) during 1-minute standing. CONCLUSION: In symptomatic CSM patients, COM and head total sway were significantly greater than controls. Individuals with CSM exhibit more trunk and lower extremity muscle activity, and thus expend more neuromuscular energy to maintain a balanced, static standing posture. This study is the first effort to evaluate global balance as a dynamic process in this patient population. LEVEL OF EVIDENCE: 3.


Assuntos
Músculo Esquelético/fisiopatologia , Equilíbrio Postural , Doenças da Medula Espinal/fisiopatologia , Espondilose/fisiopatologia , Idoso , Vértebras Cervicais , Eletromiografia , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doenças da Medula Espinal/complicações , Espondilose/complicações , Posição Ortostática , Tronco/fisiopatologia
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