1/6. A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome.STUDY DESIGN: We have applied conventional histochemical and morphometric techniques to study the changes within the human spinal 'hand' motor neuron pool after spinal cord injury in patients who presented with acute traumatic central cord syndrome (ATCCS). OBJECTIVE: To determine whether a reduction of large alpha motor neurons at the C7, C8 and T1 spinal cord levels underlies the mechanism which causes hand dysfunction seen in patients with (ATCCS). BACKGROUND: The etiology of upper extremity weakness in ATCCS is debated and injury and/or degeneration of motor neurons within the central gray matter of the cervical enlargement has been advanced as one potential etiology of hand weakness. methods: The spinal cords of five individuals with documented clinical evidence of ATCCS and three age-matched controls were obtained. The ATCCS spinal cords were divided into acute/sub-acute (two cases) and chronic (three cases) groups depending on the time to death after their injury; the chronic group was further subdivided according to the epicenter of injury. We counted the motor neurons using light microscopy in 10 randomly selected axial sections at the C7, C8 and T1 spinal cord levels for each group. We also analyzed the lateral and ventral corticospinal tracts (CST) in all groups for evidence of wallerian degeneration and compared them to controls. RESULTS: A primary injury to the lateral CST was present in each case of ATCCS with evidence of wallerian degeneration distal to the epicenter of injury. There was minimal wallerian degeneration within the ventral corticospinal tracts. In the chronic low cervical injury group, there was a decrease in motor neurons supplying hand musculature relative to the other injury groups where the motor neurons sampled at the time of death were not reduced in number when compared to the control group. CONCLUSIONS: We hypothesize that hand dysfunction in ATCCS can be observed after spinal cord injury without any apparent loss in the number of motor neurons supplying the hand musculature as seen in our acute/sub-acute (n=2) and our chronic high injury (n=1) groups. The motor neuron loss seen in the chronic low level injury was felt to be secondary to the loss of C7, C8, and T1 neurons adjacent to the injury epicenter.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/6. Injury to the spinal cord without radiological abnormality (SCIWORA) in adults.Injury to the spinal cord without radiological abnormality often occurs in the skeletally immature cervical and thoracic spine. We describe four adult patients with this diagnosis involving the cervical spine with resultant quadriparesis. The relevant literature is reviewed. The implications for initial management of the injury, the role of MRI and the need for a high index of suspicion are highlighted.- - - - - - - - - - ranking = 0.38461538461538keywords = spinal (Clic here for more details about this article) |
3/6. central cord syndrome following assault and subsequent resuscitation.Following physical assault, a 71-year-old male suffered apparent cardio-respiratory arrest. Bystander basic life support was provided. Advanced life support including endotracheal intubation was subsequently provided. The patient sustained an injury to the cervical spinal cord, manifesting as central cord syndrome. central cord syndrome is a rare complication of endotracheal intubation and there is no published description following physical assault. This case illustrates that determining precise causality with respect to cervical cord injury may be difficult following standard resuscitation procedures. The pathophysiology of central cord syndrome is reviewed and the possible mechanism in this case, which was the subject of considerable legal debate, is also examined.- - - - - - - - - - ranking = 0.076923076923077keywords = spinal (Clic here for more details about this article) |
4/6. Treatment of chronic neuropathic pain after traumatic central cervical cord lesion with gabapentin.central cord syndrome may be associated with severe pain, resistant to conventional pain therapy regimens. chronic pain may be a persistent problem in rehabilitation of spinal cord injuries. These pain syndromes are long lasting and challenging to treat. Gabapentin has been shown to be useful in treatment of different conditions which may be caused by increased neuronal excitability. This report describes a case where central cord syndrome and its chronic neuropathic pain associated with allodynia was successfully treated with gabapentin.- - - - - - - - - - ranking = 0.076923076923077keywords = spinal (Clic here for more details about this article) |
5/6. Recurrent central cord syndrome at the level of a solid cervical vertebral fusion.STUDY DESIGN: A case of a solid cervical vertebral fusion that failed to protect against recurrent central cord syndrome at the same spinal level is described. OBJECTIVES: To alert clinicians to the potential for incomplete spinal cord lesions at the same level as cervical vertebral fusions. SUMMARY OF BACKGROUND DATA: The clinical symptomatology of central cord syndrome is discussed and the advantages of T2-weighted magnetic resonance imaging in such cases is considered. No prior reports of central cord syndrome occurring directly posterior to a solidly fused disc segment were found in the literature. methods: The clinical and T2-weighted magnetic resonance imaging features associated with central cord syndrome are presented. The traumatized region developed immediately posterior to the site of an anterior cervical diskectomy and uncovertebral osteophytectomy between the fourth and fifth cervical vertebrae with bone grafting that had been performed more than 3 years earlier. RESULTS: Symptoms of the central cord syndrome resolved over the course of 4 months with no other intervention other than the use of a philadelphia cervical collar. Five years later, the patient remained symptom free. CONCLUSION: This case illustrates that clinicians must be aware of the potential occurrence of central cord syndrome in patients with solidly fused cervical segments, and that cervical fusion does not necessarily protect against future incomplete spinal cord injury, such as central cord syndrome, at the level of the fusion.- - - - - - - - - - ranking = 0.23076923076923keywords = spinal (Clic here for more details about this article) |
6/6. sleep-related painful erections.BACKGROUND: A 45-year-old man presented with repeated awakenings at night caused by nocturnal painful erections, in sharp contrast with normal erections at other times, 2 years after surgical removal of a thoracic (Th6-7) ependymoma. INVESTIGATIONS: physical examination, pharmaco-sensitized penile Doppler ultrasound, spinal and brain MRI, neurophysiological work-up (tibial and perineal somatosensory-evoked potential; hand, foot and perineal sympathetic skin response assessment), polysomnography with recording of nocturnal penile tumescence. diagnosis: sleep-related painful erections, characterized by penile pain during nocturnal erection, typically during rapid eye movement sleep, in the presence of a residual thoracic spinal cord syndrome. MANAGEMENT: amitriptyline, an antidepressant that suppresses rapid eye movement sleep, was ineffective. Treatments with other antidepressants, clozapine and beta-blockers were suggested, but the patient declined because of potential severe side effects.- - - - - - - - - - ranking = 0.15384615384615keywords = spinal (Clic here for more details about this article) |