11/73. Intramedullary tuberculosis manifested as brown-sequard syndrome in a patient with systemic lupus erythematosus. A 25-year-old girl presented with progressive deterioration of right side weakness with decreased sensation on the left trunk. She had been treated with high dose steroid due to autoimmune thrombocytopenia for 2 months. Clinical, laboratory and immunologic studies revealed that she had systemic lupus erythematosus (SLE), MRI of spinal cord showed marginal contrast enhancing and fluid containing mass in the cord of the C5-6 level, suggesting intramedullary abscess. She underwent surgery of mass removal with biopsy. The pathologic findings from cord tissues revealed numerous acid fast bacilli (AFB) in necrotic tissues. After surgery and anti-tuberculous treatment, her neurologic symptoms were markedly improved with restoration of right side motor weakness. To our knowledge, this is the first case report of intramedullary tuberculosis in a patient with SLE. Since intramedullary tuberculosis may sometimes mimic neurologic complication of SLE itself, it may pose diagnostic and therapeutic confusion for clinicians. We report a case of spinal cord tuberculosis affecting C5, 6 level which was manifested as brown-sequard syndrome in a patient with SLE. ( info) |
| We describe a rare herniation of the disc at the C2/C3 level in a 73-year-old woman. It caused hemicompression of the spinal cord and led to the Brown-Sequard syndrome. The condition was diagnosed clinically and by MRI six months after onset. Discectomy and fusion gave complete neurological resolution. ( info) |
13/73. Spinal intramedullary cavernoma: clinical presentation and surgical outcome. OBJECT: Improved neuroimaging techniques have led to an increase in the reported cases of intramedullary cavernomas. The purpose of this study was to define the spectrum of presenting signs and symptoms in patients with spinal intramedullary cavernomas and to analyze the role of surgery as a treatment for these lesions. methods: The authors reviewed the charts of 16 patients who underwent surgery for spinal intramedullary cavernomas. All patients underwent preoperative magnetic resonance imaging studies. Cavernomas represented 14 (5.0%) of 280 intramedullary lesions found in adults and two (1.1%) of 181 intramedullary lesions found in pediatric cases. A posterior laminectomy and surgical resection of the malformation were performed in all 16 patients. CONCLUSIONS: magnetic resonance imaging is virtually diagnostic for spinal cavernoma lesions. patients with spinal intramedullary cavernomas presented with either an acute onset of neurological compromise or a slowly progressive neurological decline. Acute neurological decline occurs secondary to hemorrhage within the spinal cord. Chronic progressive myelopathy occurs due to microhemorrhages and the resulting gliotic reaction to hemorrhagic products. There is no evidence that cavernomas increase in size. The rate of rebleeding is unknown, but spinal cavernomas appear to be clinically more aggressive than cranial cavernomas, probably because the spinal cord is less tolerant of mass lesions. Complete surgical removal of the cavernoma was possible in 15 of 16 of the authors' cases. ( info) |
14/73. Idiopathic spinal cord herniation: report of three cases and review of the literature. STUDY DESIGN: Three case reports and a literature review are presented. OBJECTIVE: To describe characteristic clinical and radiographic findings of idiopathic spinal cord herniation. SUMMARY OF BACKGROUND DATA: Idiopathic spinal cord herniation is a rare disease, with only 26 cases reported before the current study. methods: Three cases of idiopathic spinal cord herniation are reported, and previous reports on this subject are reviewed. RESULTS: The responsible regions were in the thoracic spine from T2 to T7. Symptoms were mainly unilateral muscle atrophy in the lower extremity and sensory disturbance below the thoracic level. These symptoms had been progressing gradually. magnetic resonance imaging demonstrated a unique feature: The spinal cord shifted anteriorly in a few segments. Computed tomographic myelogram showed another distinctive picture: There was no subarachnoid space anterior to the spinal cord. CONCLUSIONS: Because idiopathic spinal cord herniation is out of the concept of "compression myelopathy," this condition may be a pitfall in the diagnosis. Idiopathic spinal cord herniation should be recognized as one of the treatable causes for thoracic myelopathy. ( info) |
| 1. The purpose of this study was to determine the contributions of central command and the exercise pressor reflex in regulating the cardiovascular response to static exercise in patients with brown-sequard syndrome. In this rare condition, a hemisection of the spinal cord typically leaves one side of the body with diminished sensation and normal motor function and the other side with diminished motor function and normal sensation. 2. Four, otherwise healthy, patients with brown-sequard syndrome and varying degrees of motor and sensory dysfunction were studied during four isometric knee extension protocols involving both voluntary contraction and electrically stimulated contractions of each leg. heart rate, blood pressure, force production and ratings of perceived exertion were measured during all conditions. Measurements were also made during post-contraction thigh cuff occlusion and during a cold pressor test. 3. With the exception of electrical stimulation of the leg with a sensory deficit, protocols yielded increases in heart rate and blood pressure. Cuff occlusion sustained blood pressure above resting levels only when the leg had intact sensation. 4. While voluntary contraction (or attempted contraction) of the leg with a motor deficit produced the lowest force, it produced the highest ratings of perceived exertion coupled with the greatest elevations in heart rate and blood pressure. 5. These data show that the magnitude of the heart rate and blood pressure responses in these patients was greatly affected by an increased central command; however, there were marked cardiovascular responses due to activation of the exercise pressor reflex in the absence of central command. ( info) |
16/73. brown-sequard syndrome associated with Horner's syndrome after a penetrating trauma at the cervicomedullary junction. STUDY DESIGN: Case report of a 21-year-old man that had concurrence of brown-sequard syndrome and Horner's syndrome after a penetrating trauma in the neck. OBJECTIVES: This report analyzes the location of lesions that cause a combination of Horner's and brown-sequard syndrome. It is important to know the anatomic structure of spinal cord and the sympathetic nerve chain. SETTING: spinal cord Unit, Department of Physical medicine and rehabilitation, Hospital La Fe, Valencia, Instituto Oftalmologico de Alicante, Alicante, spain. methods: Description of a single patient case report. RESULTS: The clinical findings and MRI showed a good correlation. The Horner's syndrome was confirmed with a 4% cocaine test. The patient received a conservative treatment with high-dose steroid therapy (NASCIS-3). CONCLUSION: The patient presented with Brown-Sequard syndrome and Horner's syndrome. Clinical examination and MRI made a quick and correct diagnosis. The patient recovered completely after the conservative treatment. ( info) |
17/73. Traumatic invagination of the fourth and fifth cervical laminae with acute hemiparesis. We describe a patient with traumatic right-sided invagination of two consecutive laminae into the spinal canal. The injury resembled a greenstick fracture and resulted in an acute brown-sequard syndrome. There was also an undisplaced hangman's fracture of the axis vertebra. These injuries were caused by an acute hyperextension and axial compression of the cervical spine. Open reduction and internal fixation of the laminar fractures without fusion was followed by full neurological recovery within six weeks. ( info) |
18/73. Myelopathy following influenza vaccination in inflammatory CNS disorder treated with chronic immunosuppression. We report a patient who developed a transverse myelitis with brown-sequard syndrome following a prophylactic influenza vaccination, despite being chronically immunosuppressed for a steroid-responsive optic neuropathy. Although influenza vaccination is recommended in patients receiving chronic immunosuppression, its use may on occasion be associated with neurological complications previously reported in immunocompetent individuals. ( info) |
19/73. Idiopathic spinal cord herniation. spinal cord herniation is a rare condition that has become increasingly recognised in the last few years. The authors report a case of idiopathic spinal cord herniation in a 33 year old woman who presented with progressive brown-sequard syndrome. The diagnosis was made on MR imaging. After repairing the herniation the patient made a gradual improvement. Potential causes are discussed, including the possible role of dural tethering. In conclusion, idiopathic spinal cord herniation is a potentially treat able condition that should be more readily diagnosed with increased awareness and newer imaging techniques such as high resolution MRI. ( info) |
| STUDY DESIGN: A case of idiopathic spinal cord herniation is reported, and the literature is reviewed. OBJECTIVE: To report a case of thoracic spinal cord herniation with a ventral dural defect, probably caused by thoracic disc extrusion. SUMMARY OF BACKGROUND DATA: Recently, reports of spinal cord herniation have been increasing. This increase can be attributed to the development of magnetic resonance imaging and increased awareness of this entity. However, the cause of the ventral dural defect remains unknown. methods: A 54-year-old woman had experienced brown-sequard syndrome for 2 years. magnetic resonance imaging demonstrated an S-shaped anterior kinking of the spinal cord, with dilation of the dorsal subarachnoid space. RESULTS: After incision of the dural sac and gentle retraction of the spinal cord, a dural defect was recognized into which the spinal cord had herniated. An extruded disc was visualized through the defect at T3-T4. The ventral dural defect and the dorsal incision of the dural sac were repaired with a fascial graft from the thigh. CONCLUSIONS: Intraoperative findings suggest that the thoracic disc herniation in the current case was the probable cause of the ventral dural defect. Surgical reconstruction using double fascial graft under careful spinal cord monitoring resulted in a satisfactory neurologic recovery. ( info) |