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1.
Adv Clin Exp Med ; 29(4): 441-448, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32369275

RESUMO

BACKGROUND: Several studies have identified changes in the spinal cord DTI measurements in patients with multiple sclerosis (MS). However, correlations between changes in DTI parameters in normal appearing cervical spine and neurological findings have not been clearly established. OBJECTIVES: To determine whether diffusion tensor imaging (DTI) measurements such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) are sufficiently sensitive in detecting microstructure alterations in normal-appearing spinal cords in patients with MS and whether they reflect these patients' clinical disability. MATERIAL AND METHODS: Fifteen patients diagnosed with relapsing-remitting MS (RRMS) with normal-appearing cervical spinal cords on plain MRI and 11 asymptomatic volunteers were enrolled in the study. Overall, 75 cervical spinal segments were analyzed. The regions of interest were drawn from the entire spinal cord cross-section and in the normal-appearing white matter tracts: the superior and inferior cerebellar peduncles and the posterior limbs of the internal capsules. Neurological deficit and the level of disability were evaluated using the Expanded Disability Status Scale (EDSS), the timed 25-foot walk test (T25FW) and the 9-hole peg test (9HPT) for manual dexterity. RESULTS: A significant difference (p < 0.05) in FA values between patients with MS and the control group was found at levels C2 (p = 0.047) and C3 (p = 0.023). No significant changes in ADC values were found. There was correlation between FA and ADC values in selected white matter tracts and at particular spinal cord levels. We also observed significant correlations between diffusion tensor imaging parameters and manual dexterity. CONCLUSIONS: Our preliminary results may suggest that the spinal cord's structural loss is the dominant factor in the inflammatory/demyelinating component in patients with MS. Diffusion tensor imaging changes in the spinal cord correlate with brain DTI changes. Manual functioning seems to be more affected than walking.


Assuntos
Encéfalo/diagnóstico por imagem , Medula Cervical/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Esclerose Múltipla/diagnóstico por imagem , Medula Espinal/anatomia & histologia , Medula Espinal/patologia , Anisotropia , Humanos , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Fibras Nervosas Mielinizadas/patologia
2.
World Neurosurg ; 134: e497-e504, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31669690

RESUMO

BACKGROUND: White matter volume loss may be an anatomic driver in the development of clinical symptoms in cervical spondylotic myelopathy (CSM). Considerably less attention has been devoted to gray matter (GM) injury. Newly developed atlas-based mapping techniques may allow evaluation of GM cord volume alterations in CSM. METHODS: There were 29 subjects evaluated: 15 patients with CSM (61.1 ± 8.7 years old) and 14 age-matched control subjects (56.1 ± 5.3 years old). All subjects underwent 3T magnetic resonance imaging of the cervical spine. Post-processing with the Spinal Cord Toolbox (v3.0) provided GM volumetric analysis. Clinical scores collected included modified Japanese Orthopaedic Association, neck and arm numeric rating scales, Nurick Scale, and Neck Disability Index. All volumes were normalized to account for anatomic variability. RESULTS: Normalized mean ventral GM volume in the compression region was significantly lower in patients compared with control subjects (1.103 ± 0.21 vs. 1.35 ± 0.32, P = 0.027). Normalized mean dorsal volume in the compression region was decreased in patients compared with control subjects (0.90 ± 0.17 vs. 1.04 ± 0.15, P = 0.049). GM volumes were associated with clinical scores, including Neck Disability Index, arm numeric rating scale, modified Japanese Orthopaedic Association, and Nurick Scale scores (P = 0.022, P = 0.004, P = 0.027, and P = 0.016). CONCLUSIONS: GM volume loss may be evaluated through atlas-based post-processing techniques and may correlate with clinical symptoms in CSM.


Assuntos
Atlas como Assunto , Medula Cervical/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Estenose Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Adulto , Idoso , Medula Cervical/anatomia & histologia , Feminino , Substância Cinzenta/anatomia & histologia , Humanos , Masculino , Pessoa de Meia-Idade
3.
PLoS One ; 14(12): e0226020, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31877151

RESUMO

OBJECTIVES: The mainstay treatment for Degenerative Cervical Myelopathy (DCM) is surgical decompression. Not all cases, however, are suitable for surgery. Recent international guidelines advise surgery for moderate to severe disease as well as progressive mild disease. The goal of this study was to examine the factors in current practice that drive the decision to operate in DCM. STUDY DESIGN: Retrospective cohort study. METHODS: 1 year of cervical spine MRI scans (N = 1123) were reviewed to identify patients with DCM with sufficient clinical documentation (N = 39). Variables at surgical assessment were recorded: age, sex, clinical signs and symptoms of DCM, disease severity, and quantitative MRI measures of cord compression. Bivariate correlations were used to compare each variable with the decision to offer the patient an operation. Subsequent multivariable analysis incorporated all significant bivariate correlations. RESULTS: Of the 39 patients identified, 25 (64%) were offered an operation. The decision to operate was significantly associated with narrower non-pathological canal and cord diameters as well as cord compression ratio, explaining 50% of the variance. In a multivariable model, only cord compression ratio was significant (p = 0.017). Examination findings, symptoms, functional disability, disease severity, disease progression, and demographic factors were all non-significant. CONCLUSIONS: Cord compression emerged as the main factor in surgical decision-making prior to the publication of recent guidelines. Newly identified predictors of post-operative outcome were not significantly associated with decision to operate.


Assuntos
Medula Cervical/fisiopatologia , Compressão da Medula Espinal/patologia , Idoso , Medula Cervical/diagnóstico por imagem , Tomada de Decisões , Descompressão Cirúrgica , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia
4.
BMJ Case Rep ; 12(10)2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31628092

RESUMO

We report a case of prolonged survival in a patient with known cervical intramedullary H3K27M-mutant diffuse midline glioma. A 39-year-old man presented for evaluation with several months of progressive upper extremity pain and weakness. MRI of the cervical spine revealed an intramedullary ring-enhancing lesion centred at C3-C4. Following subtotal surgical resection, a diagnosis of glioblastoma (GBM) was confirmed. Subsequent testing at a later date revealed an H3K27M mutation. He was initially treated with radiation and concomitant and adjuvant temozolomide. He had multiply recurrent disease and was treated with various regimens, including the histone deacetylase inhibitor valproic acid. The patient passed away 31 months (~2.5 years) after diagnosis. Our case is one of few reported adult spinal cord GBMs possessing the H3K27M mutation, and one with the longest reported overall survival in the literature to date.


Assuntos
Medula Cervical/patologia , Glioblastoma/genética , Glioblastoma/terapia , Neoplasias da Medula Espinal/genética , Neoplasias da Medula Espinal/terapia , Adulto , Medula Cervical/diagnóstico por imagem , Terapia Combinada , Evolução Fatal , Glioblastoma/diagnóstico por imagem , Histonas/genética , Humanos , Laminectomia , Imagem por Ressonância Magnética , Masculino , Radioterapia , Neoplasias da Medula Espinal/diagnóstico por imagem
5.
World Neurosurg ; 130: e709-e714, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279106

RESUMO

OBJECTIVE: We sought to investigate the relationship between cervical cord compression and factors related to whole-spine sagittal balance. METHODS: This retrospective single-center study included patients who visited our clinic for the evaluation of lumbar pathology including trauma and degeneration. Patients aged 60-89 years who underwent whole-spine sagittal T2 scout magnetic resonance imaging and whole-spine radiograph between 2014 and 2018 were included in our study. We consecutively enrolled 100 patients for our study without any prejudice. We collected data on patient characteristics, diagnosis, cervical cord compression index (CCI), sagittal vertical axis (C7-S1, C2-7), and other parameters related to sagittal balance such as pelvic incidence minus lumbar lordosis. Pearson correlation coefficients were calculated to compare CCI with each whole-spine sagittal balance parameter. RESULTS: Of the 100 patients, 44 were men. The mean age was 74.21 years. On the basis of Pearson correlation coefficients, CCI showed the strongest positive linear correlation with C7-S1 sagittal vertical axis (r = 0.688; P < 0.01), followed by the C2-7 sagittal vertical axis (r = 0.563; P < 0.01). CONCLUSIONS: Cervical cord compression is more likely to develop in patients with sagittal imbalance. It is important to use whole-spine radiograph and whole-spine T2 scout magnetic resonance imaging to analyze CCI in these patients.


Assuntos
Medula Cervical/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Compressão da Medula Espinal/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Medula Cervical/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Estudos Retrospectivos , Compressão da Medula Espinal/cirurgia , Doenças da Coluna Vertebral/cirurgia
6.
J Med Case Rep ; 13(1): 230, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31311599

RESUMO

INTRODUCTION: Extradural schwannoma arising from high cervical spinal root is a rare entity in children. We report a case of extradural cervical schwannoma in a 14-year-old boy. CASE PRESENTATION: Our patient is a 14-year-old Madhesi boy presenting with swelling in the posterior triangle of his neck. The radiological features suggested solitary extradural cervical schwannoma which was confirmed later by histopathological findings. There were no postoperative neurological complications in our patient. CONCLUSION: Extradural spinal schwannoma is a benign tumor. Gross total resection with good clinical outcome can be achieved with minimal risks.


Assuntos
Neurilemoma/patologia , Neoplasias da Medula Espinal/patologia , Adolescente , Medula Cervical/diagnóstico por imagem , Medula Cervical/patologia , Medula Cervical/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pescoço , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia
7.
J Neurol ; 266(9): 2294-2303, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31175433

RESUMO

BACKGROUND: In patients with MS, the effect of structural damage to the corticospinal tract (CST) has been separately evaluated in the brain and spinal cord (SC), even though a cumulative impact is suspected. OBJECTIVE: To evaluate CST damages on both the cortex and cervical SC, and examine their relative associations with motor function, measured both clinically and by electrophysiology. METHODS: We included 43 patients with early relapsing-remitting MS. Lesions were manually segmented on SC (axial T2*) and brain (3D FLAIR) scans. The CST was automatically segmented using an atlas (SC) or tractography (brain). Lesion volume fractions and diffusion parameters were calculated for SC, brain and CST. Central motor conduction time (CMCT) and triple stimulation technique amplitude ratio were measured for 42 upper limbs, from 22 patients. RESULTS: Mean lesion volume fractions were 5.2% in the SC portion of the CST and 0.9% in the brain portion. We did not find a significant correlation between brain and SC lesion volume fraction (r = 0.06, p = 0.68). The pyramidal EDSS score and CMCT were both significantly correlated with the lesion fraction in the SC CST (r = 0.39, p = 0.01 and r = 0.33, p = 0.03), but not in the brain CST. CONCLUSION: Our results highlight the major contribution of SC lesions to CST damage and motor function abnormalities.


Assuntos
Encéfalo/diagnóstico por imagem , Medula Cervical/diagnóstico por imagem , Potencial Evocado Motor/fisiologia , Destreza Motora/fisiologia , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Tratos Piramidais/diagnóstico por imagem , Adulto , Encéfalo/fisiologia , Medula Cervical/fisiologia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética/tendências , Masculino , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Tratos Piramidais/fisiologia , Substância Branca/diagnóstico por imagem , Substância Branca/fisiologia
8.
BMJ Case Rep ; 12(5)2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31092497

RESUMO

Cobalamin (vitamin B12) deficiency often manifests with neurologic symptoms and may rarely mimic multiple sclerosis (MS) among other neurological disorders. However, MRI changes associated with cobalamin deficiency are typically spinal predominant and distinct from MS-related changes. We report a case of a patient with cobalamin deficiency who was recommended by her primary neurologist to commence treatment with ocrelizumab, a potent anti-CD20 B-cell depleting monoclonal antibody, after being diagnosed with primary progressive MS. However, cervical spine MRI demonstrated changes classical of cobalamin deficiency including 'inverted V sign' signal hyperintensity and following parenteral cobalamin supplementation her neurological symptoms quickly and dramatically improved.


Assuntos
Esclerose Múltipla/diagnóstico , Deficiência de Vitamina B 12/diagnóstico , Deficiência de Vitamina B 12/tratamento farmacológico , Vitamina B 12/administração & dosagem , Complexo Vitamínico B/administração & dosagem , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Medula Cervical/diagnóstico por imagem , Erros de Diagnóstico , Feminino , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Deficiência de Vitamina B 12/sangue
9.
Neurology ; 92(24): e2793-e2802, 2019 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-31092621

RESUMO

OBJECTIVE: To assess whether preserved dorsal and ventral midsagittal tissue bridges after traumatic cervical spinal cord injury (SCI) encode tract-specific electrophysiologic properties and are predictive of appropriate recovery. METHODS: In this longitudinal study, we retrospectively assessed MRI scans at 1 month after SCI that provided data on width and location (dorsal vs ventral) of midsagittal tissue bridges in 28 tetraplegic patients. Regression analysis assessed associations between midsagittal tissue bridges and motor- and sensory-specific electrophysiologic recordings and appropriate outcome measures at 12 months after SCI. RESULTS: Greater width of dorsal midsagittal tissue bridges at 1 month after SCI identified patients who were classified as being sensory incomplete at 12 months after SCI (p = 0.025), had shorter sensory evoked potential (SEP) latencies (r = -0.57, p = 0.016), and had greater SEP amplitudes (r = 0.61, p = 0.001). Greater width of dorsal tissue bridges predicted better light-touch score at 12 months (r = 0.40, p = 0.045) independently of baseline clinical score and ventral tissue bridges. Greater width of ventral midsagittal tissue bridges at 1 month identified patients who were classified as being motor incomplete at 12 months (p = 0.002), revealed shorter motor evoked potential (MEP) latencies (r = -0.54, p = 0.044), and had greater ratios of MEP amplitude to compound muscle action potential amplitude (r = 0.56, p = 0.005). Greater width of ventral tissue bridges predicted better lower extremity motor scores at 12 months (r = 0.41, p = 0.035) independently of baseline clinical score and dorsal tissue bridges. CONCLUSION: Midsagittal tissue bridges, detectable early after SCI, underwrite tract-specific electrophysiologic communication and are predictors of appropriate sensorimotor recovery. Neuroimaging biomarkers of midsagittal tissue bridges may be integrated into the diagnostic workup, prediction of recovery, and patients' stratification in clinical trials.


Assuntos
Medula Cervical/diagnóstico por imagem , Potencial Evocado Motor/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Lesões do Pescoço/diagnóstico por imagem , Quadriplegia/fisiopatologia , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/diagnóstico por imagem , Adulto , Idoso , Medula Cervical/lesões , Vértebras Cervicais , Feminino , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/complicações , Lesões do Pescoço/fisiopatologia , Prognóstico , Quadriplegia/etiologia , Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Adulto Jovem
10.
Neuroimage ; 200: 590-600, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31108213

RESUMO

The spinal cord is the main interface between the brain and the periphery. It notably plays a central role in motor control, as spinal motoneurons activate skeletal muscles involved in voluntary movements. Yet, the spinal mechanisms underlying human movement generation have not been completely elucidated. In this regard, functional magnetic resonance imaging (fMRI) represents a potential tool to probe spinal cord function non-invasively and with high spatial resolution. Nonetheless, a thorough characterization of this approach is still lacking, currently limiting its impact. Here, we aimed at systematically quantifying to which extent fMRI can reveal spinal cord activity along the rostrocaudal direction. We investigated changes in the blood oxygenation level dependent signal of the human cervical spinal cord during bimanual upper limb movements (wrist extension, wrist adduction and finger abduction) in nineteen healthy volunteers. Prior to scanning, we recorded the muscle activity associated with these movements in order to reconstruct the theoretical motor-pool output pattern using an anatomy-based mapping of the electromyographic (EMG) waveforms. EMG-derived spinal maps were characterized by distinct rostrocaudal patterns of activation, thus confirming the task-specific features of the different movements. Analogous activation patterns were captured using spinal cord fMRI. Finally, an additional fMRI dataset was acquired from a subset of the participants (n = 6) to deploy a multivoxel pattern analysis, which allowed successful decoding of movements. These combined results suggest that spinal cord fMRI can be used to image rostrocaudal activation patterns reflecting the underlying activity of the motoneuron pools innervating the task-related muscles. Spinal cord fMRI offers the prospect of a novel tool to study motor processes and potentially their modification following neurological motor disorders.


Assuntos
Medula Cervical/fisiologia , Neuroimagem Funcional/métodos , Atividade Motora/fisiologia , Músculo Esquelético/fisiologia , Extremidade Superior/fisiologia , Adulto , Medula Cervical/diagnóstico por imagem , Eletromiografia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Adulto Jovem
11.
World Neurosurg ; 127: 302-306, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30954744

RESUMO

BACKGROUND: Subependymomas are rare in the spinal cord. They are typically expansile, intramedullary spinal cord masses, eccentrically located with minimal gadolinium enhancement. CASE DESCRIPTION: We present a case of subependymoma originating from the cervical cord with an unusual exophytic appearance. Hallmarks of subependymoma and treatment are reviewed. CONCLUSIONS: This is the first case, to our knowledge, where imaging revealed a mass appearing to be completely extramedullary with a primary exophytic component. Therefore, subependymomas should remain on the differential for masses in the spinal cord that appear extramedullary and exophytic.


Assuntos
Glioma Subependimal/diagnóstico por imagem , Neoplasias da Medula Espinal/diagnóstico por imagem , Adulto , Medula Cervical/diagnóstico por imagem , Medula Cervical/patologia , Medula Cervical/cirurgia , Feminino , Glioma Subependimal/patologia , Glioma Subependimal/cirurgia , Humanos , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia
12.
Mult Scler Relat Disord ; 31: 131-133, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30986646

RESUMO

OBJECTIVE: To describe two cases of cervical spondylotic myelopathy initially misdiagnosed as transverse myelitis. METHODS: Case series. RESULTS: A 44- and 56-year-old man presented with chronic progressive myelopathy. Initial work up revealed cervical spondylosis and an enhancing intramedullary cervical cord lesion. The younger individual was diagnosed with multiple sclerosis, and the other as an unspecified autoimmune demyelinating disorder. They were both treated with immune therapies, but had progression in their symptoms and functional decline, prompting re-evaluation. Due to persistent enhancement of the intramedullary cervical cord lesion on repeat imaging, lack of new lesion formation over time, and lack of intrathecal antibody production, all of which are atypical for a primary demyelinating disorder, both men ultimately underwent cervical decompressive surgery. Interestingly, though symptoms and disability level improved or stabilized, persistent enhancement of the intramedullary cord lesion years after surgery was noted for both individuals. CONCLUSION: Spondylotic myelopathy is an important consideration in the differential of inflammatory myelopathy, especially since misdiagnosis may result in serious consequences as was seen in the cases presented, including exposure to unnecessary costly treatments and irreversible neurological disability from delayed appropriate surgical intervention. Intramedullary spinal cord enhancement can occur with spondylotic myelopathies, albeit rare, and may persistently enhance for an extended period of time even after decompressive surgery.


Assuntos
Medula Cervical/diagnóstico por imagem , Mielite Transversa/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Adulto , Medula Cervical/patologia , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite Transversa/patologia , Espondilose/patologia
13.
Neuroimage ; 196: 200-206, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30981859

RESUMO

Human spinal white matter tract anatomy has been mapped using post mortem histological information with the help of molecular tracing studies in animal models. This study used 7 Tesla diffusion MR tractography on a human cadaver that was harvested 24 hours post mortem to evaluate cuneate fasciculus anatomy in cervical spinal cord. Based on this method, for the first time much more nuanced tractographic anatomy was used to investigate possible new routes for cuneate fasciculus in the posterior and lateral funiculus. Additionally, current molecular tracing studies were reviewed, and confirmatory data was presented along with our radiological results. Both studies confirm that upon entry to the spinal cord, upper cervical level tracts (C1-2-3) travel inside lateral funiculus and lower level tracts travel medially inside the posterior funiculus after entry at posterolateral sulcus which is different than traditional knowledge of having cuneate fasciculus tracts concentrated in the lateral part of posterior funiculus.


Assuntos
Medula Cervical/anatomia & histologia , Medula Cervical/diagnóstico por imagem , Imagem de Tensor de Difusão , Processamento de Imagem Assistida por Computador/métodos , Substância Branca/anatomia & histologia , Substância Branca/diagnóstico por imagem , Vias Aferentes/anatomia & histologia , Vias Aferentes/diagnóstico por imagem , Humanos , Masculino , Vias Neurais/anatomia & histologia , Vias Neurais/diagnóstico por imagem
14.
World Neurosurg ; 127: 418-422, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31028978

RESUMO

BACKGROUND: Intramedullary schwannomas of the spinal cord are extremely rare. Most previous studies are case reports, which have found that intramedullary schwannomas could be homogeneous or asymmetrically enhanced with gadolinium. However, intramedullary schwannomas with minimal enhancement have not been reported. CASE DESCRIPTION: This article describes a 34-year-old patient who presented with nonradiative neck pain, progressive weakness of the left limbs, and sensory deficit of both lower extremities. Preoperative examinations such as magnetic resonance imaging (MRI) were performed, and the patient underwent surgical treatment. MRI showed that the lesion presented unsharp enhancement with gadolinium on T1-weighted images. Histopathologic findings were consistent with the diagnosis of schwannoma. CONCLUSIONS: We report a case of intramedullary schwannoma that presented inconspicuous enhancement with gadolinium. MRI is useful but cannot be used to differentiate schwannomas from other intramedullary spinal tumours. Surgical resection is the most vital factor for the treatment of intramedullary schwannoma.


Assuntos
Medula Cervical/diagnóstico por imagem , Gadolínio , Neurilemoma/diagnóstico por imagem , Neoplasias da Medula Espinal/diagnóstico por imagem , Adulto , Medula Cervical/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Neurilemoma/cirurgia , Neoplasias da Medula Espinal/cirurgia
15.
BMJ Case Rep ; 12(3)2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30898958

RESUMO

First reported in 1988, Staphylococcus lugdunensis is a virulent coagulase-negative Staphylococcus species often associated with endocarditis. This is the first case report describing this infection in the cervical spine. A 58-year-old, left-handed Caucasian woman with no significant medical history presented with neck and left arm pain. Neurological examination revealed mild left deltoid 4/5 weakness and myelopathy. She was found to have an epidural cervical spinal cord mass that was causing severe cord compression and underwent partial anterior cervical decompression of the mass. On entering what was believed to be the mass, yellow-tinged fluid was encountered. An abscess was immediately suspected, so the dura was not entered. The specimen sent for culture was identified a day later as S. lugdunensis A two-dimensional echocardiogram was negative for vegetations. A peripherally inserted central catheter line was placed and the patient discharged on 6 weeks of physical therapy and 6-8 weeks of intravenous cefazolin.


Assuntos
Antibacterianos/administração & dosagem , Cefazolina/administração & dosagem , Abscesso Epidural/complicações , Rifampina/administração & dosagem , Compressão da Medula Espinal/etiologia , Infecções Estafilocócicas/complicações , Medula Cervical/diagnóstico por imagem , Abscesso Epidural/diagnóstico por imagem , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/microbiologia , Espaço Epidural/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Compressão da Medula Espinal/diagnóstico por imagem , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus lugdunensis/isolamento & purificação
16.
BMJ Case Rep ; 12(3)2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30898959

RESUMO

We report the case of a 59-year-old Arab woman who was presented with acute onset of neck pain followed by quadriparesis, paraesthesias of lower limbs and incontinence of urine. Examination revealed asymmetric sensorimotor quadriparesis with sensory level at T1, establishing a clinical diagnosis of transverse myelitis. Cervical and thoracic spinal MRI showed enhancing T2/fluid attenuated inversion recovery (FLAIR) hyperintense lesion extending from C4 to C7 level in addition to long-segment lesion extending the whole of the spinal cord. She was known to have rheumatoid arthritis for the past 20 years and has been on etanercept for the past 8 years and methotrexate since past 3 years. Etanercept was stopped and she was treated with methylprednisolone followed by oral steroids and physiotherapy with which she had near complete recovery.


Assuntos
Antirreumáticos/efeitos adversos , Etanercepte/efeitos adversos , Mielite Transversa/induzido quimicamente , Anti-Inflamatórios/administração & dosagem , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Medula Cervical/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Mielite Transversa/tratamento farmacológico , Cervicalgia/etiologia , Prednisolona/administração & dosagem , Prednisolona/análogos & derivados
17.
World Neurosurg ; 126: 508-512, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904802

RESUMO

BACKGROUND: Migratory tumors of the spinal cord are rare and can present as a missing tumor intraoperatively. This can lead to unnecessary abandonment of surgery or unnecessary laminectomies. CASE DESCRIPTION: We present a case of migratory intradural extramedullary tumor of the spine, which was missing intraoperatively. The surgery was abandoned, and on reimaging the tumor was found to have migrated. Here we summarize a review of the literature of such cases and the lessons we learned from our experience, emphasizing the measures to prevent tumor displacement and the importance of intraoperative imaging. CONCLUSIONS: Migratory schwannoma should be suspected in case of a missing lesion. Intraoperative ultrasonography and myelography use should be definitely considered where facility for intraoperative magnetic resonance imaging is not available. Preventive measures should be taken to avoid tumor migration in all routine cases of intradural extramedullary lesions.


Assuntos
Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Adulto , Medula Cervical/diagnóstico por imagem , Medula Cervical/patologia , Humanos , Masculino , Neurilemoma/complicações , Neoplasias da Medula Espinal/complicações
19.
Brain ; 142(3): 633-646, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30715195

RESUMO

Spinal cord lesions detected on MRI hold important diagnostic and prognostic value for multiple sclerosis. Previous attempts to correlate lesion burden with clinical status have had limited success, however, suggesting that lesion location may be a contributor. Our aim was to explore the spatial distribution of multiple sclerosis lesions in the cervical spinal cord, with respect to clinical status. We included 642 suspected or confirmed multiple sclerosis patients (31 clinically isolated syndrome, and 416 relapsing-remitting, 84 secondary progressive, and 73 primary progressive multiple sclerosis) from 13 clinical sites. Cervical spine lesions were manually delineated on T2- and T2*-weighted axial and sagittal MRI scans acquired at 3 or 7 T. With an automatic publicly-available analysis pipeline we produced voxelwise lesion frequency maps to identify predilection sites in various patient groups characterized by clinical subtype, Expanded Disability Status Scale score and disease duration. We also measured absolute and normalized lesion volumes in several regions of interest using an atlas-based approach, and evaluated differences within and between groups. The lateral funiculi were more frequently affected by lesions in progressive subtypes than in relapsing in voxelwise analysis (P < 0.001), which was further confirmed by absolute and normalized lesion volumes (P < 0.01). The central cord area was more often affected by lesions in primary progressive than relapse-remitting patients (P < 0.001). Between white and grey matter, the absolute lesion volume in the white matter was greater than in the grey matter in all phenotypes (P < 0.001); however when normalizing by each region, normalized lesion volumes were comparable between white and grey matter in primary progressive patients. Lesions appearing in the lateral funiculi and central cord area were significantly correlated with Expanded Disability Status Scale score (P < 0.001). High lesion frequencies were observed in patients with a more aggressive disease course, rather than long disease duration. Lesions located in the lateral funiculi and central cord area of the cervical spine may influence clinical status in multiple sclerosis. This work shows the added value of cervical spine lesions, and provides an avenue for evaluating the distribution of spinal cord lesions in various patient groups.


Assuntos
Medula Cervical/patologia , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/patologia , Adulto , Encéfalo/patologia , Medula Cervical/diagnóstico por imagem , Medula Cervical/metabolismo , Avaliação da Deficiência , Progressão da Doença , Feminino , Substância Cinzenta/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Crônica Progressiva/patologia , Esclerose Múltipla Recidivante-Remitente/patologia , Análise Espacial , Medula Espinal/patologia , Doenças da Medula Espinal , Substância Branca/patologia
20.
Korean J Radiol ; 20(3): 469-478, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30799578

RESUMO

OBJECTIVE: To investigate the image quality, radiation dose, and intermodality agreement of cervical spine CT using spectral shaping at 140 kVp by a tin filter (Sn140-kVp) in comparison with those of conventional CT at 120 kVp. MATERIALS AND METHODS: Patients who had undergone cervical spine CT with Sn140-kVp (n = 58) and conventional 120 kVp (n = 49) were included. Qualitative image quality was analyzed using a 5-point Likert scale. Quantitative image quality was assessed by measuring the noise and attenuation within the central spinal canals at C3/4, C6/7, and C7/T1 levels. Radiation doses received by patients were estimated. The intermodality agreement for disc morphology between CT and MRI was assessed at C3/4, C5/6, C6/7, and C7/T1 levels in 75 patients who had undergone cervical spine MRI as well as CT. RESULTS: Qualitative image quality was significantly superior in Sn140-kVp scans than in the conventional scans (p < 0.001). At C7/T1 level, the noise was significantly lower and the decrease in attenuation was significantly less in Sn140-kVp scans, than in the conventional scans (p < 0.001). Radiation doses were significantly reduced in Sn140-kVp scans by 50% (effective dose: 1.0 ± 0.1 mSv vs. 2.0 ± 0.4 mSv; p < 0.001). Intermodality agreement in the lower cervical spine region tended to be better in Sn140-kVp acquisitions than in the conventional acquisitions. CONCLUSION: Cervical spine CT using Sn140-kVp improves image quality of the lower cervical region without increasing the radiation dose. Thus, this protocol can be helpful to overcome the artifacts in the lower cervical spine CT images.


Assuntos
Medula Cervical/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Artefatos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Razão Sinal-Ruído
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