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1.
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
2.
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
3.
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
4.
Arch Phys Med Rehabil ; 101(6): 985-993, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32059946

RESUMO

OBJECTIVE: Determine trunk and shoulder muscle strength cutoff points for functional independence and wheelchair skills, and verify the predictive capacity of relative and absolute peak torque in men with spinal cord injury (SCI). DESIGN: Cross-sectional study. SETTING: Rehabilitation hospital setting. PARTICIPANTS: Men (N=54) with SCI were recruited and stratified into high and low paraplegia groups. INTERVENTIONS: All participants performed maximum strength tests for shoulder abduction or adduction (isokinetic) and trunk flexion or extension (isometric) to determine relative and absolute peak torque cutoff points for the Spinal Cord Independence Measure version III (SCIM-III) and Adapted Manual Wheelchair Circuit (AMWC). MAIN OUTCOME MEASURES: The primary outcome measures were SCIM-III, AMWC-Brazil test, and strength variables (peak torques). Demographic characteristics obtained from participants' electronic medical records were the secondary outcomes used as predictor variables of functional independence. RESULTS: The best predictive model for SCIM-III (R=0.78, P≤.05) used the sum of trunk flexion and extension relative peak torque values to determine the cutoff points (1.42 N·m/kg for a score of 70). Relative shoulder abduction peak torque was used in the predictive models for AMWC outcomes: performance score (R=0.77, P≤.05, cutoff points of 0.97 N·m/kg for 300.0m) and 3-minute overground wheeling (R=0.72, P≤.05, cutoff points of 0.96 N·m/kg for 18.5s). CONCLUSIONS: Relative peak torque showed better predictive capacity compared to absolute peak torque. Cutoff points were established for relative muscle strength and could help health professionals set appropriate goals for individuals with SCI to achieve high functional independence and wheelchair ability.


Assuntos
Avaliação da Deficiência , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Paraplegia/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Cadeiras de Rodas , Adulto , Estudos Transversais , Humanos , Masculino , Ombro/fisiopatologia , Tórax/fisiopatologia , Torque
6.
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
7.
Arch Phys Med Rehabil ; 101(4): 607-612, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31891715

RESUMO

OBJECTIVE: To explore the potential effects of incorporating exoskeletal-assisted walking (EAW) into spinal cord injury (SCI) acute inpatient rehabilitation (AIR) on facilitating functional and motor recovery when compared with standard of care AIR. DESIGN: A quasi-experimental design with a prospective intervention group (AIR with EAW) and a retrospective control group (AIR only). SETTING: SCI AIR facility. PARTICIPANTS: Ten acute inpatient participants with SCI who were eligible for locomotor training were recruited in the intervention group. Twenty inpatients with SCI were identified as matched controls by reviewing an AIR database, Uniform Data System for Medical Rehabilitation, by an individual blinded to the study. Both groups (N=30) were matched based on etiology, paraplegia/tetraplegia, completeness of injury, age, and sex. INTERVENTION: EAW incorporated into SCI AIR. MAIN OUTCOME MEASURES: FIM score, International Standards for Neurological Classification of Spinal Cord Injury Upper Extremity Motor Score and Lower Extremity Motor Scores (LEMS), and EAW session results, including adverse events, walking time, and steps. RESULTS: Changes from admission to discharge LEMS and FIM scores were significantly greater in the intervention group (LEMS change: 14.3±10.1; FIM change: 37.8±10.8) compared with the control group (LEMS change: 4.6±6.1; FIM change: 26.5±14.3; Mann-Whitney U tests: LEMS, P<.01 and FIM, P<.05). One adverse event (minor skin abrasion) occurred during 42 walking sessions. Participants on average achieved 31.5 minutes of up time and 18.2 minutes of walk time with 456 steps in one EAW session. CONCLUSIONS: Incorporation of EAW into standard of care AIR is possible. AIR with incorporated EAW has the potential to facilitate functional and motor recovery compared with AIR without EAW.


Assuntos
Exoesqueleto Energizado , Traumatismos da Medula Espinal/reabilitação , Caminhada/fisiologia , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/fisiopatologia , Paraplegia/reabilitação , Projetos Piloto , Quadriplegia/fisiopatologia , Quadriplegia/reabilitação , Traumatismos da Medula Espinal/fisiopatologia
8.
J Thorac Cardiovasc Surg ; 159(3): 813-824.e1, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31030961

RESUMO

OBJECTIVES: Delayed paraplegia developed postoperatively after thoracoabdominal aneurysm surgery is primarily associated with spinal cord ischemia/reperfusion injury. Our previous study suggested that spinal cord stimulation postconditioning protected the spinal cord from ischemia/reperfusion injury through microglia inhibition. In this study, we further investigated whether α7 nicotinic acetylcholine receptors were involved in the neuroprotective mechanism of spinal cord stimulation. METHODS: Rabbits were randomly assigned to sham, control, 2 Hz, α-bungarotoxin, and 2 Hz-α-bungarotoxin groups (n = 24/group). Transient spinal cord ischemia was performed on all rabbits except rabbits in the sham group. Rabbits in the control group received no further intervention, rabbits in the 2 Hz group were given 2 Hz spinal cord stimulation, rabbits in the α-bungarotoxin group received prescribed intrathecal α-bungarotoxin (α-bungarotoxin, a specific α7 nicotinic acetylcholine receptor antagonist) injections, and rabbits in the 2 Hz-α-bungarotoxin group received both α-bungarotoxin injections and 2 Hz spinal cord stimulation. Hind-limb neurologic function was assessed, and spinal cord histologic examination, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling staining, and microglia staining were performed at 8 hours, 1 day, 3 days, and 7 days of reperfusion. RESULTS: Rabbits in the 2 Hz group had significantly better neurologic functions, more α-motor neurons, and lower terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling-positive neuron rates and microglia area/anterior horn area ratios (microglia area ratios) than the control group. The neurologic functions of the α-bungarotoxin group were significantly worse than those of the control group, whereas other results were not significantly different from the control group. The results of the 2 Hz-α-bungarotoxin group were insignificant to the control group except for the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling-positive neuron rates, which were significantly lower than in the control group. CONCLUSIONS: The neuroprotective effects of spinal cord stimulation postconditioning against spinal cord ischemia/reperfusion injury were partially mediated by activating α7 nicotinic acetylcholine receptors.


Assuntos
Microglia/metabolismo , Músculo Esquelético/inervação , Paraplegia/prevenção & controle , Traumatismo por Reperfusão/prevenção & controle , Isquemia do Cordão Espinal/prevenção & controle , Estimulação da Medula Espinal , Medula Espinal/irrigação sanguínea , Receptor Nicotínico de Acetilcolina alfa7/metabolismo , Animais , Apoptose , Modelos Animais de Doenças , Membro Posterior , Masculino , Microglia/patologia , Paraplegia/metabolismo , Paraplegia/patologia , Paraplegia/fisiopatologia , Coelhos , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/fisiopatologia , Isquemia do Cordão Espinal/metabolismo , Isquemia do Cordão Espinal/patologia , Isquemia do Cordão Espinal/fisiopatologia , Fatores de Tempo
9.
J Neurol ; 267(2): 369-379, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31646384

RESUMO

Hereditary spastic paraplegias (HSP) share as cardinal feature progressive spastic gait disorder. SPG4 accounts for about 25% of cases and is caused by mutations in the SPAST gene. Although HSP is an upper motor neuron disease, the relevance of non-motor symptoms is increasingly recognized because of the potential response to treatment. Our study sets out to evaluate non-motor symptoms and their relevance with regard to health-related quality of life. In 118 genetically confirmed SPG4 cases and age- and gender-matched controls, validated questionnaires were used to evaluate fatigue, depression, pain, and restless legs syndrome. In addition, self-reported medical information was collected concerning comorbidities and bladder, bowel, and sexual dysfunction. In a sub-study, cognition was evaluated using the CANTAB® test-battery and the Montreal Cognitive Assessment in 26 SPG4 patients. We found depression and pain to be significantly increased. The frequency of restless legs syndrome varied largely depending on defining criteria. There were no significant deficits in cognition as examined by CANTAB® despite a significant increase in self-reported memory impairment in SPG4 patients. Bladder, sexual, and defecation problems were frequent and seemed to be underrecognized in current treatment strategies. All identified non-motor symptoms correlated with health-related quality of life, which was reduced in SPG4 compared to controls. We recommend that clinicians regularly screen for depression, pain, and fatigue and ask for bladder, sexual, and defecation problems to recognize and treat non-motor symptoms accordingly to improve quality of life in patients with SPG4.


Assuntos
Paraplegia/fisiopatologia , Paraplegia/terapia , Paraplegia Espástica Hereditária/fisiopatologia , Paraplegia Espástica Hereditária/terapia , Adulto , Idoso , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Depressão/etiologia , Depressão/psicologia , Fadiga/etiologia , Fadiga/psicologia , Incontinência Fecal/etiologia , Feminino , Humanos , Masculino , Transtornos da Memória/etiologia , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Dor/etiologia , Paraplegia/psicologia , Qualidade de Vida , Síndrome das Pernas Inquietas/etiologia , Síndrome das Pernas Inquietas/psicologia , Autorrelato , Disfunções Sexuais Fisiológicas/etiologia , Paraplegia Espástica Hereditária/psicologia , Doenças da Bexiga Urinária/etiologia , Adulto Jovem
10.
World Neurosurg ; 134: e847-e854, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31715410

RESUMO

BACKGROUND: There is accumulating evidence of a potential beneficial effect of early surgical intervention after acute cervical spinal cord injury (SCI). However, around one third of all SCIs affect the thoracic spine. This cohort has not been extensively investigated, mainly because of less sensitive clinical readout measures. Apart from regaining full sensorimotor function, improvements in bladder and bowel management remain of the highest priority for patients with chronic paraplegia. Therefore, this study investigates the effect of early decompression (here defined as <8 hours) versus delayed management on neurologic and functional outcome. METHODS: We retrospectively analyzed data from the institutional database, in which follow-up data were collected prospectively according to the European Multicenter Study about Spinal Cord Injury standards. Within a 13-year period, we identified 43 patients who met inclusion and exclusion criteria. Of these, 32 (74%) were managed surgically within the first 8 hours. There was a trend toward a higher rate of patients with clinically complete SCI in the early group at baseline. RESULTS: After 1 year, we did not observe a benefit on the neurologic outcome as assessed via the American Spinal Injury Association Impairment Scale grade. Functional outcome was evaluated using the Spinal Cord Independence Measure (SCIM). The early decompressed group demonstrated significantly improved SCIM 6 (i.e., bladder management) (P < 0.045) and SCIM 9-11 subitems (i.e., mobility, transfer) (P < 0.019). CONCLUSIONS: Early decompression was an independent predictor for improved functional bladder outcome and mobility after 1 year. This effect needs to be studied in future prospective, multicenter studies.


Assuntos
Descompressão Cirúrgica/métodos , Procedimentos Neurocirúrgicos/métodos , Paraplegia/fisiopatologia , Traumatismos da Medula Espinal/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Bexiga Urinaria Neurogênica/fisiopatologia , Adulto , Idoso , Intervenção Médica Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Paraplegia/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Vértebras Torácicas , Resultado do Tratamento , Bexiga Urinaria Neurogênica/etiologia
11.
Am J Physiol Heart Circ Physiol ; 318(2): H223-H237, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31774690

RESUMO

Complications associated with spinal cord injury (SCI) result from unregulated reflexes below the lesion level. Understanding neurotransmission distal to the SCI could improve quality of life by mitigating complications. The long-term impact of SCI on neurovascular transmission is poorly understood, but reduced sympathetic activity below the site of SCI enhances arterial neurotransmission (1). We studied sympathetic neurovascular transmission using a rat model of long-term paraplegia (T2-3) and tetraplegia (C6-7). Sixteen weeks after SCI, T2-3 and C6-7 rats had lower blood pressure (BP) than sham rats (103 ± 2 and 97 ± 4 vs. 117 ± 6 mmHg, P < 0.05). T2-3 rats had tachycardia (410 ± 6 beats/min), and C6-7 rats had bradycardia (299 ± 10 beats/min) compared with intact rats (321 ± 4 beats/min, P < 0.05). Purinergic excitatory junction potentials (EJPs) were measured in mesenteric arteries (MA) using microlectrodes, and norepinephrine (NE) release was measured using amperometry. NE release was similar in all groups, while EJP frequency-response curves from T2-3 and C6-7 rats were left-shifted vs. sham rats. EJPs in T2-3 and C6-7 rats showed facilitation followed by run-down during stimulation trains (10 Hz, 50 stimuli). MA reactivity to exogenous NE and ATP was similar in all rats. In T2-3 and C6-7 rats, NE content was increased in left cardiac ventricles compared with intact rats, but was not changed in MA, kidney, or spleen. Our data indicate that peripheral purinergic, but not adrenergic, neurotransmission increases following SCI via enhanced ATP release from periarterial nerves. Sympathetic BP support is reduced after SCI, but improving neurotransmitter release might maintain cardiovascular stability in individuals living with SCI.NEW & NOTEWORTHY This study revealed increased purinergic, but not noradrenergic, neurotransmission to mesenteric arteries in rats with spinal cord injury (SCI). An increased releasable pool of ATP in periarterial sympathetic nerves may contribute to autonomic dysreflexia following SCI, suggesting that purinergic neurotransmission may be a therapeutic target for maintaining stable blood pressure in individuals living with SCI. The selective increase in ATP release suggests that ATP and norepinephrine may be stored in separate synaptic vesicles in periarterial sympathetic varicosities.


Assuntos
Artérias Mesentéricas/inervação , Artérias Mesentéricas/fisiopatologia , Receptores Purinérgicos/metabolismo , Traumatismos da Medula Espinal/fisiopatologia , Transmissão Sináptica , Trifosfato de Adenosina/metabolismo , Animais , Pressão Sanguínea , Bradicardia/etiologia , Bradicardia/fisiopatologia , Potenciais Pós-Sinápticos Excitadores , Masculino , Norepinefrina/metabolismo , Paraplegia/fisiopatologia , Quadriplegia/fisiopatologia , Ratos , Ratos Sprague-Dawley , Sistema Nervoso Simpático/fisiopatologia , Taquicardia/etiologia , Taquicardia/fisiopatologia
12.
Neurol Sci ; 41(3): 699-703, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31814071

RESUMO

BACKGROUND: Spastic paraplegia type 8 (SPG8) is an autosomal-dominant form of hereditary spastic paraplegia (AD-HSP) caused by a mutation in the KIAA0196 gene. SPG8 accounts for 1% of less of all AD-HSP and the genotype-phenotype correlation remains poorly understood. METHODS: We report the first clinical and genetic description of SPG8 disease in Italian patients. We identified four new mutations in KIAA0196 gene. These variants were identified using a multigene targeted resequencing HSP panel. We took this opportunity to review the pertinent literature. RESULTS: Age at disease onset was in the third or fourth decade of life. Stiffness of the lower limb with spastic gait, walking impairment, and decreased vibration sense were common early symptoms. Subjects of two families had bladder control abnormalities. Unlike previous reported cases, Italian SPG8 subjects have pure form of spastic paraparesis without cranial nerve involvement, and onset is in adult life. DISCUSSION: By a clinical point of view, it is hard to differentiate SPG8 from the SPG4, in which bladder and vibration sense dysfunctions are frequent signs. The differential diagnosis with other forms of AD-HSPs seems relatively easier if one considers the early-onset manifestations in SPG3A and the peripheral nervous system and cerebellar involvement seen in SPG31.


Assuntos
Paraplegia/genética , Paraplegia/fisiopatologia , Proteínas/genética , Paraplegia Espástica Hereditária/genética , Paraplegia Espástica Hereditária/fisiopatologia , Adulto , Estudos de Associação Genética , Humanos , Itália , Pessoa de Meia-Idade , Paraplegia/diagnóstico , Linhagem , Paraplegia Espástica Hereditária/diagnóstico
13.
BMC Vet Res ; 15(1): 433, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31796017

RESUMO

BACKGROUND: Progressive myelomalacia (PMM) is a usually fatal complication of acute intervertebral disc extrusion (IVDE) in dogs but its risk factors are poorly understood. The objective of this retrospective case-control study was to identify risk factors for PMM by comparing dogs with complete sensorimotor loss following IVDE that did and did not develop the disease after surgery. We also investigated whether any risk factors for PMM influenced return of ambulation. Medical records of client-owned dogs with paraplegia and loss of pain perception that underwent surgery for IVDE from 1998 to 2016, were reviewed. Dogs were categorized as PMM yes or no based on clinical progression or histopathology. Walking outcome at 6 months was established. Signalment, onset and duration of signs (categorized), steroids, non-steroidal anti-inflammatory drugs (yes or no), site of IVDE (lumbar intumescence or thoracolumbar) and longitudinal extent of IVDE were retrieved and their associations with PMM and walking outcome were examined using logistic regression. RESULTS: One hundred and ninety seven dogs were included, 45 with and 152 without PMM. A 6-month-outcome was available in 178 dogs (all 45 PMM dogs and 133 control dogs); 86 recovered walking (all in the control group). Disc extrusions at the lumbar intumescence were associated with PMM (p = 0.01, OR: 3.02, CI: 1.3-7.2). Surgery performed more than 12 h after loss of ambulation was associated with PMM (OR = 3.4; CI = 1.1-10.5, p = 0.03 for 12-24 h and OR = 4.6; CI = 1.3-16.6, p = 0.02 for the > 24 h categories when compared with the ≤12 h category). Treatment with corticosteroids was negatively associated with PMM (OR: 3.1; CI: 1.3-7.6, p = 0.01). The only variable to affect walking outcome was longitudinal extent of IVDE (OR = 2.6; CI = 1.3-5.3, p = 0.006). CONCLUSION: Dogs with lumbar intumescence IVDE are at increased risk of PMM. Timing of surgery and corticosteroid use warrant further investigations. PMM and recovery of walking are influenced by different factors.


Assuntos
Doenças do Cão/fisiopatologia , Deslocamento do Disco Intervertebral/veterinária , Paraplegia/veterinária , Doenças da Medula Espinal/veterinária , Animais , Estudos de Casos e Controles , Doenças do Cão/etiologia , Doenças do Cão/patologia , Cães , Feminino , Deslocamento do Disco Intervertebral/complicações , Modelos Logísticos , Masculino , Análise Multivariada , Paraplegia/etiologia , Paraplegia/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/patologia , Doenças da Medula Espinal/fisiopatologia
14.
PLoS One ; 14(12): e0222542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31794548

RESUMO

OBJECTIVE: The aims were to describe VO2peak, explore the potential influence of anthropometrics, demographics and level of physical activity within each cohort; b) to define common, standardized activities as percentages of VO2peak and categorize these as light, moderate and vigorous intensity levels according to present classification systems, and c) to explore how clinically accessible methods such as heart-rate monitoring and Borg rating of perceived exertion (RPE) correlate or can describe light, moderate and vigorous intensity levels. DESIGN: Cross sectional. SETTING: Rehabilitation facility and laboratory environment. SUBJECTS: Sixty-three individuals, thirty-seven (10 women) with motor-complete paraplegia (MCP), T7-T12, and twenty-six (7 women) with motor-complete tetraplegia (MCT), C5-C8. INTERVENTIONS: VO2peak was obtained during a graded peak test until exhaustion, and oxygen uptake during eleven different activities was assessed and categorized using indirect calorimetry. MAIN OUTCOME MEASURES: VO2peak, Absolute and relative oxygen consumption, Borg RPE. RESULTS: Absolute VO2peak was significantly higher in men than in women for both groups, with fairly small differences in relative VO2peak. For MCP sex, weight and time spent in vigorous-intensity activity explained 63% of VO2peak variance. For MCT sex and time in vigorous-intensity activity explained 55% of the variance. Moderate intensity corresponds to 61-72% HRpeak and RPE 10-13 for MCP vs. 71-79% HRpeak, RPE 13-14 for MCT. CONCLUSION: Using current classification systems, eleven commonly performed activities were categorized in relative intensity terms, (light, moderate and vigorous) based on percent of VO2peak, HRpeak and Borg RPE. This categorization enables clinicians to better guide persons with SCI to meet required physical activity levels.


Assuntos
Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Consumo de Oxigênio/fisiologia , Adulto , Estudos Transversais , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/metabolismo , Oxigênio/fisiologia , Paraplegia/fisiopatologia , Esforço Físico/fisiologia , Quadriplegia/fisiopatologia
15.
Rev. int. med. cienc. act. fis. deporte ; 19(76): 699-718, dic. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-187241

RESUMO

Objetivos: se analizaron la condición cardiorrespiratoria y la intensidad de esfuerzo durante la práctica recreativa del esquí náutico de slalom. Metodología: participaron tres esquiadores náuticos con paraplejia moderadamente activos. Realizaron un test incremental en un ergómetro de brazos para determinar su VO2pico y los umbrales ventilatorios y completaron 3 sesiones de práctica de esquí náutico, separadas por 48h, registrándose la FC cada 5 s. Resultados: obtuvieron un VO2pico de 22,3 ± 0,6 mL·kg-1·min-1 y los umbrales ventilatorios se analizaron al ~80 y ~50% del VO2pico. La FC media en las sesiones de esquí náutico fue de 111 ppm, lo que representó una intensidad de ~45% de la FC de reserva (FCR), permaneciendo por encima del 40% de la FCR ~12 min. Conclusión: la intensidad moderada de la práctica recreativa de esquí náutico de slalom podría servir para mantener o mejorar la condición cardiorrespiratoria en estas tres personas con paraplejia


Objectives: the cardiorespiratory fitness and the intensity of effort were analyzed during the recreational practice of slalom water skiing. Methodology: three moderately active water skiers with paraplegia participated. They performed an incremental test on an arm ergometer to determine their VO2peak and ventilatory thresholds and completed 3 sessions of water skiing, separated by 48h, where the HR was recorded every 5 s. Results: they obtained a VO2peak of 22.3 ± 0.6 mL·kg-1·min-1 and the ventilatory thresholds were analyzed at ~80 and ~50% of the VO2peak. The average heart rate in the water ski sessions was 111 bpm, which represented an intensity of ~45% of the heart rate reserve (HRR), remaining above 40% of the HRR ~12 min. Conclusion: the moderate intensity of recreational slalom skiing could serve to maintain or improve the cardiorespiratory fitness in these three people with paraplegia


Assuntos
Humanos , Masculino , Adulto , Esportes Aquáticos/fisiologia , Paraplegia/fisiopatologia , Esforço Físico/fisiologia , Frequência Cardíaca , Atividade Motora , Esportes Aquáticos/normas , Paraplegia/reabilitação , Índice de Massa Corporal , Ergometria/instrumentação
16.
Sensors (Basel) ; 19(21)2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31731458

RESUMO

Manual wheelchair propulsion results in physical demand of the upper limb extremities that, because of its repetitive nature, can lead to chronic pathologies on spinal cord injury patients. The aim of this study was to design and test a methodology to compare kinematic and kinetic variables of the upper limb joints when propelling different wheelchairs. Moreover, this methodology was used to analyze the differences that may exist between paraplegic and tetraplegic patients when propelling two different wheelchairs. Five adults with paraplegia and five adults with tetraplegia performed several propulsion tests. Participants propelled two different wheelchairs for three minutes at 0.833 m/s (3 km/h) with one minute break between the tests. Kinematic and kinetic variables of the upper limb as well as variables with respect to the propulsion style were recorded. Important differences in the kinetic and kinematic variables of the joints of the upper limb were found when comparing paraplegic and tetraplegic patients. Nevertheless, this difference depends on the wheelchair used. As expected, in all tests, the shoulder shows to be the most impacted joint.


Assuntos
Paraplegia/fisiopatologia , Quadriplegia/fisiopatologia , Extremidade Superior/fisiologia , Cadeiras de Rodas , Adulto , Fenômenos Biomecânicos , Engenharia Biomédica/métodos , Cotovelo/fisiologia , Feminino , Humanos , Ombro/fisiologia , Análise Espaço-Temporal , Traumatismos da Medula Espinal/fisiopatologia , Punho/fisiologia
17.
Ann Clin Transl Neurol ; 6(10): 2127-2132, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31602813

RESUMO

Anecdotal oculomotor disturbances have been described in spastic paraplegia type 7 (SPG7). We investigated oculomotor and vestibular dysfunction in five patients with genetically verified SPG7. All five patients exhibited significantly slower velocities of vertical saccades compared to controls, but significantly faster than in progressive supranuclear palsy, with upward saccades being particularly affected. Horizontal saccades, cerebellar oculomotor markers, and vestibuloocular reflex seem to be variably affected. Thus, albeit subclinical in some cases, slowing of the vertical saccades may belong to the phenotype of SPG7 and may serve as a valuable biomarker for differentiation from spastic ataxias and atypical parkinsonism.


Assuntos
Transtornos da Motilidade Ocular/fisiopatologia , Paraplegia/fisiopatologia , Reflexo Vestíbulo-Ocular/fisiologia , Movimentos Sacádicos/fisiologia , Paraplegia Espástica Hereditária/fisiopatologia , Biomarcadores , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/etiologia , Paraplegia/complicações , Fenótipo , Paraplegia Espástica Hereditária/complicações
18.
Turk Kardiyol Dern Ars ; 47(7): 612-615, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31582671

RESUMO

Paraplegia after percutaneous iliac angioplasty is very rare, and is typically associated with spinal cord ischemia (SCI). Presently described is a case of SCI and paraplegia developing after bilateral iliac stenting. This complication may be caused by a change in spinal blood flow in patients with diffuse atherosclerosis, and should be kept in mind.


Assuntos
Arteriopatias Oclusivas/terapia , Artéria Ilíaca , Paraplegia/diagnóstico , Isquemia do Cordão Espinal/diagnóstico , Stents/efeitos adversos , Idoso , Angioplastia/efeitos adversos , Diagnóstico Diferencial , Eletromiografia , Humanos , Imagem por Ressonância Magnética , Masculino , Paraplegia/diagnóstico por imagem , Paraplegia/etiologia , Paraplegia/fisiopatologia , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/fisiopatologia
20.
J Pak Med Assoc ; 69(9): 1337-1343, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511721

RESUMO

Background: Spinal cord injury (SCI) is a high-cost disabling condition, which brings a huge number of changes in individual's life. The emphasis of rehabilitation has moved from medical administration to issues that affect quality of life and community integration. This systematic review was conducted to identify the factors associated with community reintegration of patients with spinal cord injury. . METHODS: Google Scholar, PEDro, Pakmedinet, AMED, BIOMED central, Cochrane Library, MEDLINE, PsychoINFO, PUBMED, ScienceDIRECT, Scirus and Wiley Online Library databses were searched by using key words 'Spinal cord injury' 'Paraplegia' or 'Spinal Cord Lesion' or Tetraplegia. They were cross-linked with 'Community reintegration', 'Community participation' and 'Community access'. The methodological quality of the studies included was analysed by using McMaster University Tool and Thomas Tool. The data extracted included sample size, intervention, duration, results, outcome measures, and follow-up period. RESULTS: A total of 11 relevant studies were located. The evidence extracted was classified into four groups; health-related barriers or facilitators, environment-related barriers or facilitators, psychological barriers and social barriers that are associated with community reintegration of such individuals. CONCLUSIONS: The review revealed that there were more barriers in the form of health-related issues, personal and environmental, psychological and social issues that hinder the community reintegration of individuals with spinal cord injury compared to facilitators. Most studies identified special challenges related to environment in the sense of accessibility of home and public buildings and transportation. Removing barriers related to health, environment, and psychological and social factors can enhance community reintegration of such patients.


Assuntos
Atividades Cotidianas , Integração Comunitária , Participação Social , Traumatismos da Medula Espinal/reabilitação , Acessibilidade Arquitetônica , Atitude , Participação da Comunidade , Status Econômico , Humanos , Limitação da Mobilidade , Paraplegia/fisiopatologia , Paraplegia/psicologia , Paraplegia/reabilitação , Política Pública , Quadriplegia/fisiopatologia , Quadriplegia/psicologia , Quadriplegia/reabilitação , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/psicologia
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