Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.487
Filtrar
2.
Medicine (Baltimore) ; 99(30): e21346, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791734

RESUMO

RATIONALE: Papillary thyroid carcinoma (PTC) is the most common type of primary thyroid cancer with a low incidence of distant metastases. PTC represents more than 70% to -90% of thyroid malignancies. Distant metastases have only been observed in only 1% to 15% of patients with PTC. In this article, we reported the case of a patient with PTC and hyperthyroidism as well as simultaneous multiple metastases. PATIENT CONCERNS: A 47-year-old man was admitted to our hospital on February 22, 2019, with several neck masses that had been present for 12 months, low back pain for 9 months, and lower limb paraplegia for 3 months. DIAGNOSES: According to the patient physical examination, adjuvant examination (e.g., ultrasound, computed tomography, magnetic resonance imaging, blood test, and biopsy) and medical history, the clinical diagnosis was as follows: thyroid papillary carcinoma; cervical lymph node metastasis; multisite bone metastasis (6th and 7th cervical vertebrae, left clavicle proximal, right scapula bone, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, bilateral ilium, and left pubic bone); muscular metastasis (the right medial femoral muscle, the vastus lateralis muscle, left thigh muscle, and the flexor superficialis of the left forearm); possible mediastinal lymph node metastasis; and paraplegia due to the soft-tissue metastasis around the 9th thoracic vertebral spine; and hyperthyroidism (free thyroxine: 36.59 pmol/L, free triiodothyronine: 9.58 pmol/L, thyroid-stimulating hormone: 0.005 µIU/mL, thyroid autoantibody: 2.53 IU/L). INTERVENTIONS AND OUTCOMES: The patient refused to undergo further intervention or follow-up. LESSONS: In summary, this is the 1st case of in which a patient with PTC and hyperthyroidism, as well as simultaneous multiple skeletal muscles and bone metastases, lymph node metastasis, and paraplegia was observed. In practice, in cases where patients have PTC and hyperthyroidism, practitioners should perform further examinations to rule out the presence of distant metastases. We believe that the use of ultrasound has a unique advantage in the diagnosis of PTC and skeletal muscle metastasis.


Assuntos
Carcinoma Papilar/patologia , Hipertireoidismo/diagnóstico , Paraplegia/etiologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Paraplegia/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Recusa do Paciente ao Tratamento , Ultrassonografia/métodos
4.
Medicine (Baltimore) ; 99(19): e20032, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384463

RESUMO

RATIONALE: Spontaneous spinal subdural hematoma (SSDH) is a rare disease that can cause severe permanent neurological dysfunction. Here we present a case of spontaneous SSDH, in which a series of magnetic resonance images (MRIs) taken through the course of the disease facilitated understanding of the resolution process of the hematoma and the diagnosis of SSDH. PATIENT CONCERNS: A 59-year-old male presented with sudden severe back pain and rapid onset of paraplegia. This symptom had continued developing while he was transferred to the emergency department. Initial physical examination showed flaccid paralysis of both lower limbs with areflexia and loss of all sensation below T6 bilaterally. MRI images showed an anterior subdural hematoma from C7 to T7 with spinal cord compression. DIAGNOSIS: Based on MRI findings, the diagnosis was SSDH. INTERVENTIONS: We chose conservative treatment of 1-week bed rest and intensive rehabilitation for the patient due to the presence of sacral sparing and the slight motor recovery at 24 hours after the onset. OUTCOMES: Frequent MRI images demonstrated that the spinal cord compression was surprisingly mitigated only 2 days and mostly absorbed 4 days after the onset. The patient's motor function was recovered completely and he was discharged after 8 weeks of hospitalization. LESSONS: Our chronological MRI findings provide crucial information for diagnosing SSDH and also suggest that spinal surgeons should consider the potential option of a conservative approach for treating SSDH. Although prompt selection of a therapeutic strategy for SSDH could be challenging, the surgeons could observe the course of the patient's neurological status for a few days to detect signs of spontaneous recovery.


Assuntos
Tratamento Conservador/métodos , Hematoma Subdural Espinal , Imagem por Ressonância Magnética/métodos , Paraplegia , Canal Vertebral/diagnóstico por imagem , Hematoma Subdural Espinal/complicações , Hematoma Subdural Espinal/diagnóstico , Hematoma Subdural Espinal/fisiopatologia , Hematoma Subdural Espinal/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Exame Neurológico/métodos , Paraplegia/etiologia , Paraplegia/fisiopatologia , Paraplegia/reabilitação , Recuperação de Função Fisiológica , Remissão Espontânea , Resultado do Tratamento
5.
World Neurosurg ; 140: 162-165, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32389872

RESUMO

BACKGROUND: Paraplegia after lumbar spinal surgery has been previously described. It was generally provoked by a missed thoracic compression because of degenerative processes, arachnoid cyst, and spinal cord tumor such as meningioma. We describe here a case of a patient with neurofibromatosis type 2 (NF-2) with multiple spinal meningiomas that developed postoperative paraplegia because of decompensation of spinal cord compression below and far from the operated level. CASE DESCRIPTION: A 54-year-old woman with NF-2 was followed-up for multiple spinal meningiomas (C7-T1, T6-7, T9-10 levels). Surgery for the symptomatic and larger lesion (C7-T1) was scheduled. Postoperatively, the patient was found to have paraplegia with sensor anesthesia below the level of the T6 vertebra. An urgent spinal magnetic resonance imaging (MRI) scan was performed revealing the absence of complication at the operated level (C7-T1) but the appearance of a marked intramedullary hyperintensity at the T6-7 level. An urgent T6-7 laminectomy and removal of the meningioma was performed. The postoperative phase was marked by a poor recuperation. Spinal MRI scan at 3 months clearly showed a severely injured spinal cord at the T6-7 level consistent with the neurologic status of the patient. CONCLUSIONS: We report here the first case of acute neurologic deterioration after decompensation of a spinal cord compression below the operated level in spinal intradural surgery. Neurosurgeons must be aware of this possible complication when treating patients with multiple spinal meningiomas.


Assuntos
Meningioma/cirurgia , Neurofibromatose 2/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Paraplegia/etiologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/cirurgia , Feminino , Humanos , Laminectomia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paraplegia/diagnóstico por imagem , Paraplegia/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
6.
J Neuroeng Rehabil ; 17(1): 51, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32299483

RESUMO

BACKGROUND: Participation in physical and therapeutic activities is usually severely restricted after a spinal cord injury (SCI). Reasons for this are the associated loss of voluntary motor function, inefficient temperature regulation of the affected extremities, and early muscle fatigue. Hydrotherapy or swim training offer an inherent weight relief, reduce spasticity and improve coordination, muscle strength and fitness. METHODS: We present a new hybrid exercise modality that combines functional electrical stimulation (FES) of the knee extensors and transcutaneous spinal cord stimulation (tSCS) with paraplegic front crawl swimming. tSCS is used to stimulate the afferent fibers of the L2-S2 posterior roots for spasticity reduction. By activating the tSCS, the trunk musculature is recruited at a motor level. This shall improve trunk stability and straighten the upper body. Within this feasibility study, two complete SCI subjects (both ASIA scale A, lesion level Th5/6), who have been proficient front crawl swimmers, conducted a 10-week swim training with stimulation support. In an additional assessment swim session nine months after the training, the knee extension, hip extension, and trunk roll angles where measured using waterproof inertial measurement units (IMUs) and compared for different swimming conditions (no stimulation, tSCS, FES, FES plus tSCS). RESULTS: For both subjects, a training effect over the 10-week swim training was observed in terms of measured lap times (16 m pool) for all swimming conditions. Swimming supported by FES reduced lap times by 15.4% and 8.7% on average for Subject A and Subject B, respectively. Adding tSCS support yielded even greater mean decreases of 19.3% and 20.9% for Subjects A and B, respectively. Additionally, both subjects individually reported that swimming with tSCS for 30-45 minutes eliminated spasticity in the lower extremities for up to 4 hours beyond the duration of the session. Comparing the median as well as the interquartile range of all different settings, the IMU-based motion analysis revealed that FES as well as FES+tSCS improve knee extension in both subjects, while hip extension was only increased in one subject. Trunk roll angles were similar for all swimming conditions. tSCS had no influence on the knee and hip joint angles. Both subjects reported that stimulation-assisted swimming is comfortable, enjoyable, and they would like to use such a device for recreational training and rehabilitation in the future. CONCLUSIONS: Stimulation-assisted swimming seems to be a promising new form of hybrid exercise for SCI people. It is safe to use with reusable silicone electrodes and can be performed independently by experienced paraplegic swimmers except for transfer to water. The study results indicate that swimming speed can be increased by the proposed methods and spasticity can be reduced by prolonged swim sessions with tSCS and FES. The combination of stimulation with hydrotherapy might be a promising therapy for neurologic rehabilitation in incomplete SCI, stroke or multiples sclerosis patients. Therefore, further studies shall incorporate other neurologic disorders and investigate the potential benefits of FES and tSCS therapy in the water for gait and balance.


Assuntos
Terapia por Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Paraplegia/reabilitação , Traumatismos da Medula Espinal/reabilitação , Natação/fisiologia , Adulto , Terapia por Estimulação Elétrica/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/reabilitação , Paraplegia/etiologia , Projetos Piloto , Traumatismos da Medula Espinal/complicações
7.
Ann Vasc Surg ; 68: 570.e1-570.e4, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32339676

RESUMO

Spinal cord ischemia (SCI) is a rare presenting symptom of acute complicated type B aortic dissection, occurring in approximately 3% of patients . We present a case report of a patient with this presentation who had observed resolution of his paraplegia symptoms immediately after placement of a thoracic stent graft under local anesthesia. The temporal association between true lumen flow restoration and paraplegia resolution intraoperatively is a novel finding. We feel that this case report may provide support for recognized cord perfusion theory , as well as contribute to the understanding of the time frame associated with SCI and reversibility of paraplegia.


Assuntos
Anestesia Local , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Extremidade Inferior/inervação , Paraplegia/etiologia , Isquemia do Cordão Espinal/etiologia , Doença Aguda , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Paraplegia/diagnóstico , Paraplegia/fisiopatologia , Recuperação de Função Fisiológica , Isquemia do Cordão Espinal/diagnóstico , Isquemia do Cordão Espinal/fisiopatologia , Resultado do Tratamento
8.
World Neurosurg ; 139: 151-157, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305599

RESUMO

OBJECTIVE: Paralysis (paraplegia or quadriplegia) after posterior fossa surgery is a rare but devastating complication. We investigated previous reports of this complication to examine similarities among patients, risk factors, and methods by which it may be prevented. METHODS: A systematic review was completed according to PRISMA guidelines. Electronic databases were searched until November 2019 using keywords "paraplegia," "quadriplegia," or "spinal cord injury" added to "posterior fossa surgery." RESULTS: Thirteen case reports published between 1996 and 2019 were included. Five (38.5%) involved quadriplegia/quadriparesis and 8 (61.5%) involved paraplegia after surgery. Ten cases (76.9%) were tumor resections and 3 (23.1%) were posterior fossa decompressions (2 for Chiari malformations and 1 for Morquio syndrome). Seven surgeries (53.8%) were performed in the sitting position and 6 (46.2%) were prone. Proposed mechanisms of paralysis involved cervical hyperflexion yielding spinal cord ischemia in 8 patients (61.5%), arterial hypotension in 2 patients (15.4%), spinal cord compression from hematoma in 1 patient (7.7%), and decreased cardiac output in 1 patient (7.7%) (1 study did not propose a cause). Cervical hyperflexion was equally likely in the sitting and prone positions (4 patients each). Only 3 patients (23.1%) involved intraoperative complications (all cardiopulmonary in nature). CONCLUSIONS: Paralysis after posterior fossa surgery often involves spinal cord infarction apparently caused by cervical hyperflexion. Extreme care during patient positioning is needed in both the sitting or prone positions. Electrophysiologic monitoring might enable early identification of spinal cord dysfunction to minimize or avoid this complication.


Assuntos
Fossa Craniana Posterior/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Paraplegia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Quadriplegia/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Isquemia do Cordão Espinal/epidemiologia , Malformação de Arnold-Chiari/cirurgia , Neoplasias Encefálicas/cirurgia , Humanos , Neoplasias Infratentoriais/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Paraplegia/etiologia , Posicionamento do Paciente , Complicações Pós-Operatórias/etiologia , Decúbito Ventral , Quadriplegia/etiologia , Postura Sentada , Traumatismos da Medula Espinal/etiologia , Isquemia do Cordão Espinal/etiologia
9.
World Neurosurg ; 139: 175-178, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32311568

RESUMO

BACKGROUND: Guillain-Barré syndrome (GBS) is a rare but well-documented cause of paralysis, often occurring after infection. Few cases have been reported in association with spinal cord injury (SCI), which masks the characteristic ascending paralysis. To our knowledge, this is the first reported case of confirmed GBS during the clinical course of thoracic paraplegia due to a gunshot wound (GSW). CASE DESCRIPTION: A 23-year-old male presented with a GSW to the right axilla that lodged in the spinal canal at the level of T4, causing right hemothorax and American Spinal Injury Association A paraplegia. He had full strength in bilateral upper extremities until 2 weeks after the injury, at which time he developed progressive weakness in the arms with associated paresthesias and dyspnea. Within 5 days, he was intubated and nearly quadriplegic. Cerebrospinal fluid analysis and electromyography led to a diagnosis of GBS. He was treated with plasmapheresis and experienced rapid and marked recovery in respiratory and upper extremity motor function. CONCLUSIONS: The differential diagnosis for new-onset weakness in patients with GSW-induced SCI is complicated by the inability to obtain magnetic resonance imaging. This unique case of GBS in a patient with T4 paraplegia highlights the importance of obtaining a thorough history and using diagnostic tools to explore possibilities beyond surgery.


Assuntos
Síndrome de Guillain-Barré/complicações , Paraplegia/etiologia , Traumatismos da Medula Espinal/complicações , Vértebras Torácicas/lesões , Ferimentos por Arma de Fogo/complicações , Eletromiografia , Síndrome de Guillain-Barré/líquido cefalorraquidiano , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/terapia , Humanos , Masculino , Plasmaferese , Canal Vertebral , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Ann Vasc Surg ; 66: 669.e5-669.e9, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32032702

RESUMO

Frozen elephant trunk repair is a technique described to simplify total arch repair for Stanford type A aortic dissection. Spinal cord ischemia is a devastating complication after frozen elephant trunk repair. In this report, we describe a case of spinal cord ischemia resulting in paralysis after frozen elephant trunk repair. Our spinal cord ischemia protocol was implemented and rescued patients from paraplegia. We report a dedicated spinal cord ischemia protocol that can rescue patients from paraplegia after hybrid arch repair with frozen elephant trunk.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/efeitos adversos , Isquemia do Cordão Espinal/terapia , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Paraplegia/etiologia , Paraplegia/fisiopatologia , Paraplegia/terapia , Recuperação de Função Fisiológica , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
12.
World Neurosurg ; 137: 416-420, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32084615

RESUMO

BACKGROUND: Osteoporosis has become an important issue owing to the increasing elderly population. It is the most common cause of vertebral compression fracture. Conservative treatment is often ineffective, whereas surgical treatment has a vital role in compression fracture. Vesselplasty is a new surgical alternative to traditional vertebroplasty and kyphoplasty. It uses a polyethylene terephthalate balloon that functions as both a vertebral body expander and a bone cement container. We present a rare but catastrophic case of cement leakage during vesselplasty resulting in devastating neurologic compromise. This case highlights the need for awareness of vesselplasty safety and the importance of using a low-temperature bone cement. CASE DESCRIPTION: A 77-year-old woman presented with debilitating back pain owing to acute T6 compression fracture as detected by magnetic resonance imaging. Under biplanar fluoroscopy, vesselplasty using a polyethylene terephthalate balloon container was performed at the T6 vertebrae. During cement injection, balloon rupture and cement leakage occurred compromising the spinal canal. Emergent laminectomy and cement removal were performed. Paraplegia developed postoperatively. CONCLUSIONS: Though vesselplasty is claimed to be safe, cement leakage related to balloon rupture occurred in our case. Furthermore, thermal effects were difficult to observe during polymethyl methacrylate polymerization. Heat not only might cause irreversible complications but also might make the balloon rupture more easily.


Assuntos
Cimentos para Ossos , Fraturas por Compressão/cirurgia , Complicações Intraoperatórias/etiologia , Cifoplastia/efeitos adversos , Fraturas por Osteoporose/cirurgia , Traumatismos da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Idoso , Feminino , Fluoroscopia , Glucocorticoides/uso terapêutico , Humanos , Pseudo-Obstrução Intestinal/etiologia , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/terapia , Laminectomia , Paraplegia/etiologia , Polimetil Metacrilato , Traumatismos da Medula Espinal/terapia
14.
Ann Vasc Surg ; 66: 670.e1-670.e4, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31978482

RESUMO

BACKGROUND: Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis is one of the most important methods for deep venous thrombosis treatment. Spontaneous spinal subdural hematoma is a remarkably rare complication in the thrombolysis process with catastrophic consequences, as shown in this case report. METHODS: Percutaneous mechanical thrombectomy, percutaneous angioplasty, and catheter-directed thrombolysis were performed for the patient. Postoperatively, the patient was diagnosed with spontaneous spinal subdural hematoma and received a series of medical treatments and surgical interventions. RESULTS: The patient was still paraplegic and incontinent at the postoperative 7-month follow-up. CONCLUSIONS: Neurologic symptoms must be monitored carefully both during and after the thrombolysis procedure. The onset of spinal neurologic deficits in any patient must raise the suspicion that a spinal subdural hematoma has occurred. Surgical decompression beyond 24 hr may cause permanent neurological damage.


Assuntos
Hematoma Subdural Espinal/etiologia , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Trombose Venosa/terapia , Terapia Combinada , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Feminino , Hematoma Subdural Espinal/diagnóstico por imagem , Hematoma Subdural Espinal/fisiopatologia , Hematoma Subdural Espinal/terapia , Humanos , Pessoa de Meia-Idade , Paraplegia/etiologia , Paraplegia/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Trombose Venosa/diagnóstico por imagem
15.
J Thorac Cardiovasc Surg ; 159(4): 1189-1196.e1, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31126657

RESUMO

OBJECTIVE: We seek to assess the safety of total arch replacement with frozen elephant trunk for acute type A aortic dissection in respect to the risks of operative mortality, stroke, and paraplegia using an international multicenter registry (ARCH). METHODS: The ARCH Registry database from 37 participating centers was analyzed between 2000 and 2015. Patients who underwent emergency surgery for acute type A aortic dissection treated by total arch replacement with or without frozen elephant trunk were included. Operative mortality, permanent neurologic deficits, and spinal cord injury were primary end points. These end points were analyzed using univariate and hierarchical multivariate regression analyses, as well as conditional logistic regression analysis and post hoc propensity-score stratification. RESULTS: A total of 11,928 patients were enrolled in the ARCH database, of which 6180 were managed with total arch replacement. A comprehensive analysis was performed for 978 patients who underwent total aortic arch replacement for acute type A aortic dissection with or without frozen elephant trunk placement. In propensity-score matching, there were no significant differences between total arch replacement and frozen elephant trunk in terms of permanent neurologic deficits (11.9% vs 10.1%, P = .59) and spinal cord injury (4.0% vs 6.3%, P = .52) For patients included in the post hoc propensity-score stratification, frozen elephant trunk was associated with a statistically significantly lower mortality risk (odds ratio, 0.47; P = .03). CONCLUSIONS: The use of frozen elephant trunk for acute type A aortic dissection does not appear to increase the risk of paraplegia in appropriately selected patients at experienced centers. The exact risk factors for paraplegia remain to be determined.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Paraplegia/etiologia , Complicações Pós-Operatórias/etiologia , Doença Aguda , Adulto , Idoso , Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/mortalidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Paraplegia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Pontuação de Propensão , Desenho de Prótese , Sistema de Registros , Fatores de Risco
16.
World Neurosurg ; 133: 188-191, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605857

RESUMO

BACKGROUND: Cerebrospinal fluid (CSF) drainage reduces the risk of paraplegia in thoracoabdominal aortic aneurysm (TAAA) repair. Intracranial hemorrhage after TAAA repair has been reported as a rare complication of CSF drainage; however, spinal subarachnoid hematoma has never been reported. Here, we present a case of lumbosacral subarachnoid hematoma after CSF drainage in TAAA repair. CASE DESCRIPTION: The patient was a 76-year-old man who was hospitalized for TAAA repair. Just before the operation, a CSF drainage catheter was inserted into the L4/5 vertebral interspace. Continuous CSF drainage was performed during the operation. The CSF drain was clamped just after the operation, and the drainage catheters were removed at 24 hours after the operation. On postoperative day 1, the patient experienced pain and paralysis in both lower limbs that worsened over time. Magnetic resonance imaging of the brain and spinal cord was indicative of a spinal subarachnoid hematoma. Removal of hematoma with thoracolumbar and lumbosacral laminectomy was performed, and immediately after the surgery, the pain and paralysis in both lower limbs improved. Six months after the removal of the hematoma, the paralysis in both lower limbs completely resolved and the patient achieved the preinjury activity level. CONCLUSIONS: We present a rare case of lumbosacral subarachnoid hematoma after CSF drainage in TAAA repair. We should consider spinal subarachnoid hematoma when paralysis in the lower limbs occurs after CSF drainage.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Paraplegia/etiologia , Hemorragia Subaracnóidea/etiologia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Drenagem/efeitos adversos , Humanos , Imagem por Ressonância Magnética , Masculino , Paraplegia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Medula Espinal/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares/efeitos adversos
17.
World Neurosurg ; 133: 178-184, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606502

RESUMO

BACKGROUND: Radiofrequency ablation (RFA) focally destroys abnormal or dysfunctional tissue using thermal energy generated from alternating current. The utilization of RFA has gained popularity as a minimally invasive procedure for the treatment of skeletal metastases with a particular focus on palliative pain treatments to the spine, pelvis, long bones, sternum, and glenoid. More recently, single-session procedures that combine RFA with vertebral augmentation techniques have allowed treatment to areas of pain associated with pathologic fractures secondary to metastatic disease. Although many studies have been done to investigate the safety and efficacy of RFA, there have been no reported cases to date in which the use of RFA for the treatment of spinal metastases has led to any major permanent neurological injury. CASE DESCRIPTION: This report describes a case of a 61-year-old woman who underwent RFA and kyphoplasty for spinal metastases and noted the immediate onset of lower extremity paralysis after the procedure. To the best of our knowledge, this is the first documented case of permanent lower extremity paralysis in the medical literature after radiofrequency thermal ablation of spine metastases. CONCLUSIONS: Postoperative magnetic resonance imaging and physical examination suggest RFA-induced thermal injury as the most likely mechanism of paralysis. In this report, a review of previous in vivo models used in studying the efficacy and safety of spine RFA is conducted. Additionally, the literature has been reviewed for any neurological events reported with the use of RFA in the treatment of patients with vertebral pathology.


Assuntos
Cifoplastia/efeitos adversos , Paraplegia/etiologia , Ablação por Radiofrequência/efeitos adversos , Neoplasias da Coluna Vertebral/cirurgia , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paraplegia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário
19.
J Cardiovasc Surg (Torino) ; 61(2): 226-233, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30465415

RESUMO

BACKGROUND: Spinal cord ischemia (SCI) and paraplegia are complications of surgery for type A acute aortic dissection (TAAAD). Since the segmental arteries play a key role in SCI, this study evaluated the association between SCI and false lumen segmental arteries (FLSAs: segmental arteries originating from the false lumen). METHODS: The study included 101 consecutive TAAAD patients (mean age, 66±13; range, 34-89 years) who underwent surgery from January 2011 to April 2017. The diagnosis of TAAAD and the number of FSLAs were determined by preoperative computed tomography (CT). Patients were divided into two groups according to the number of FLSAs at the Th9-L2 level: Group A (N.=13), ≥8 FLSAs; and group B (N.=88), ≤7 FLSAs. Preoperative, perioperative, and postoperative findings were compared between the groups, and risk factors for SCI were evaluated. RESULTS: The frequency of preoperative paralysis was significantly higher in Group A than Group B (P=.0070). The overall incidence of postoperative SCI was 8% (8/101) and significantly higher in Group A than Group B (5/13 [45%] vs. 3/88 (4%), P<0.0001). Hospital mortality was 8% (8/101) and significantly higher in Group A than Group B (3/13 [23%] vs. 5/88 [6%], P=.0302). Multivariate analysis showed that the independent risk factors for SCI were ≥8 FLSAs at Th9-L2 (odds ratio [OR], 20.4; 95% confidence interval [95% CI], 3.34-124.9, P=0.0011) and diabetes mellitus (OR, 22.3; 95% CI, 1.69-294.5; P=0.0184). CONCLUSIONS: In patients who underwent surgery for TAAAD, ≥8 FLSAs at the Th9-L2 levels on preoperative CT was a risk factor for SCI.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Causas de Morte , Isquemia do Cordão Espinal/epidemiologia , Malformações Vasculares/complicações , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/métodos , Angiografia por Tomografia Computadorizada/métodos , Intervalos de Confiança , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Paraplegia/diagnóstico por imagem , Paraplegia/epidemiologia , Paraplegia/etiologia , Cuidados Pré-Operatórios/métodos , Prognóstico , Estudos Retrospectivos , Medição de Risco , Amostragem , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/etiologia , Análise de Sobrevida , Vértebras Torácicas/irrigação sanguínea , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem
20.
World Neurosurg ; 134: 408-414, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31678311

RESUMO

BACKGROUND: To date, only a few documented cases exist of complete or near-complete paraplegia of the lower extremities following collapse of a vertebral body secondary to an aneurysmal bone cyst. We describe the preceding symptoms associated with this catastrophic event along with surgical management and recovery. CASE DESCRIPTION: A previously healthy, 13-year-old girl had experienced months of ongoing back pain with associated posture change. After collapsing at home in the bathroom, she was brought in by emergency medical services and presented to the neurosurgery service with an American Spinal Injury Association A spinal cord injury. Imaging revealed a collapsed T4 vertebral body including expanded and fluid-filled posterior elements and severe kyphotic spine angulation resulting in cord compression corresponding to her sensory and motor deficits. She underwent emergent surgery for spinal cord decompression with a T2-T4 laminectomy, transpedicular tumor resection, and T1-7 instrumented fusion. The patient tolerated the procedure well postoperatively. At 9 months after the event, she is ambulating independently without the use of crutches or a cane and has regained full strength for all muscle groups of her lower extremities. CONCLUSIONS: The unique combination of back pain and posture change symptoms in an otherwise healthy pediatric patient should heighten clinical suspicion for a possible aneurysmal bone cyst of the spine when formulating a differential diagnosis. Additionally, despite the clinical severity at presentation, patients may still experience significant recovery following expeditious surgical intervention.


Assuntos
Cistos Ósseos Aneurismáticos/complicações , Cistos Ósseos Aneurismáticos/cirurgia , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/patologia , Doenças da Coluna Vertebral/cirurgia , Adolescente , Cistos Ósseos Aneurismáticos/patologia , Descompressão Cirúrgica , Feminino , Humanos , Paraplegia/etiologia , Compressão da Medula Espinal/etiologia , Vértebras Torácicas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA