1/13. Atlantal stenosis: a rare cause of quadriparesis in a child. Case report.The authors report the case of a 3-year-old boy who suffered from quadriparesis and respiratory distress after failing to execute a somersault properly. neuroimaging revealed spinal cord contusion with marked spinal canal stenosis at the level of the atlas. No subtle instability, occult fracture, or other congenital abnormalities were confirmed. spinal cord contusion with marked canal stenosis is rare, and only several adult cases have been reported. Severe stenosis at the level of the atlas may predispose individuals to severe spinal cord contusion, as occurred in our patient after sustaining trivial trauma.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/13. vertebral artery laceration mimicking elder abuse.elder abuse was first described almost 30 years ago. Today, approximately 1 in 25 elders is abused each year in the united states. A newly described form of domestic violence, the incidence of elder abuse will surely increase as the elderly population grows. Physical abuse/inflicted trauma is generally considered the most extreme form of elder mistreatment and includes blunt trauma, sexual assault, traumatic alopecia, and burns. Elder homicide is usually due to gunshot wounds, blunt trauma, stab wounds, or asphyxia. However, the difficult aspect of assessing the possible elder abuse homicide victim is delineating such inflicted trauma from accidental trauma. We report the case of a 94-year-old "demented" male, who reportedly fell out of his wheelchair. He was transported to a local emergency room, where he became unresponsive during examination. He experienced respiratory distress and was pronounced dead shortly thereafter. At autopsy, he had periorbital contusions and a midline abrasion between the eyes, with underlying supraorbital contusion. The skull, brain, and spinal cord were unremarkable for signs of trauma. The major traumatic finding was in the neck region. neck dissection revealed hemorrhage extending from the base of the skull to the level of T-1 and anteriorly about the soft tissues, strap muscles, and vasculature. The strap muscles were individually examined and were free of hemorrhage. The carotid arteries and jugular veins were unremarkable. The larynx, hyoid, and thyroid were intact, with only surrounding hemorrhage. Further examination revealed a horizontal fracture of the C5 vertebral body and a medial laceration of the left vertebral artery at the C5 level; subarachnoid hemorrhage was absent. What initially appeared to be trauma to the neck, worrisome for strangulation or blunt force trauma, was a large retropharyngeal hematoma from the left vertebral artery laceration. Traumatic rupture of the vertebral artery usually occurs at the C1 and C2 levels, with resultant subarachnoid hemorrhage. This is an especially vulnerable location since it is where the artery turns and then enters the skull. Associated injuries include spinal cord transection or contusion, brachial plexus injury, pharyngoesophageal injury, and vertebral fractures. Retropharyngeal hemorrhage may result from deep neck infection, tumor, and trauma. Hemorrhage associated with trauma often involves flexion of the cervical spine, followed by hyperextension. The accumulation of blood slowly impinges on the pharynx/larynx and vasculature structures. The exact injuries and etiology of the hemorrhage must be determined to distinguish strangulation from blunt force trauma. The presentation of signs and symptoms can be helpful in assessing the decedent; however, in the practice of forensic pathology such a history is more often lacking.- - - - - - - - - - ranking = 0.66666666666667keywords = spinal (Clic here for more details about this article) |
3/13. Post-traumatic venous and systemic air embolism associated with spinal epidural emphysema: multi-slice computed tomography diagnosis.A 30-year-old man was admitted with chest trauma after a road traffic accident. The patient was paraplegic and suffered from transient monoparesia of the left arm. The chest X-ray revealed a severe right tension pneumothorax and thoracic spine fractures. Emergency right thoracic drainage was carried out followed by angiography. Unfortunately the patient died and an autopsy was not permitted. Consequently post-mortem multi-slice computed tomography (MSCT) was performed, revealing presence of air inside the right cerebral arteries, bilateral pneumothorax accompanied by a severe right tension pneumothorax, bilateral haematic pleural effusion, pneumomediastinum and bilateral lung contusions. air was also observed within the right coronary artery, ascending aorta and right ventricle. Thoracic and cervical spinal epidural emphysema were diagnosed. Venous air embolism followed by arterial air embolism producing paradoxical embolism was diagnosed. To the best of our knowledge, this is the first case illustrating by post-mortem MSCT such simultaneous complications after chest trauma as spinal epidural emphysema and cerebral and coronary air embolism.- - - - - - - - - - ranking = 2keywords = spinal (Clic here for more details about this article) |
4/13. Traumatic spinal cord injury: unusual recovery in 3 children.We report on 3 children with traumatic spinal cord injury. All of them had normal x-rays of the vertebral column. There were no abnormalities of the spinal cord in myelography or magnetic resonance imaging. Although these situations are often associated with a poor neurological prognosis, we observed very unusual recoveries in these 3 cases.- - - - - - - - - - ranking = 2keywords = spinal (Clic here for more details about this article) |
5/13. An unusual presentation of gluteal hematoma during anticoagulation therapy for deep venous thrombosis in spinal cord injury.Soft tissue bleeding can be manifested clinically by swelling, skin discoloration, pain and tenderness. Early recognition can be difficult in the spinal cord-injured population in whom sensation is impaired. We are presenting a case of occult bleeding into the gluteal region during anticoagulation therapy in a paraplegic patient that presented as migrating pain and tenderness in the hip and pelvic area.- - - - - - - - - - ranking = 1.6666666666667keywords = spinal (Clic here for more details about this article) |
6/13. Acute central and intermediate cervical cord injury.Six cases with cervical cord contusion are described. All were over 50 years old, had an hyperextension injury of their cervical spine, suffered from tetraparesis predominant in the upper limbs and showed no X-ray evidence of injury to the cervical spine. Marked cervical spondylosis was present in five cases, one also had a narrow spinal canal. Cases No. 3 and 4 had an atypical recovery pattern. shoulder and elbow movements improved last or not at all, while in the classic cases the hand muscles recovered last. Upper motor neuron damage was thought to be the cause, a result of intermediate instead of central cord traumatic necrosis or ischaemia. Pathological findings in case No. 5 emphasizes the possible diagnostic importance of taking lateral x-rays of the cervical spine in hyperextension. It also shows why laminectomy and/or myelotomy cannot help. Case No. 6 shows the noxious effect of shock and the effectiveness of steroid therapy.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
7/13. Post-traumatic spinal epidural hematoma.Five patients with vertebral fracture and spinal epidural hematoma (SEH) are described. Another 58-year-old man developed a post-traumatic SEH without bony damage. From the literature, 38 patients (31 male, 4 female, and 3 unknown) were collected. Ankylosing spondylitis or rheumatoid arthritis was noted in 9 of 12 subjects between 50 and 75 years of age. Two groups of patients were identified: Group 1--16 patients with spinal fracture (aged 23 to 63 years), and Group 2--22 patients without spinal fracture (the age was less than 18 years in 12 subjects). In Group 2, a coagulation defect or spinal epidural vascular malformation resulted in a SEH in 6 patients. The preoperative myelopathy was complete in 3 patients each from Group 1 (23.1%) and Group 2 (16.7%). Of the 31 patients operated upon, 9 of the 13 from Group 1 (69.3%) and 6 of the 18 from Group 2 (33.3%) underwent laminectomy within 1 week after the onset of symptoms. Postoperative neurological return was observed in 38.5% (5 of 13) and 88.9% (16 of 18) of these two groups of patients, respectively. Post-traumatic SEHs, predominant in the male population, are often associated with vertebral disease in elderly patients. In the very young patient, there is usually no fracture/dislocation of the spine. A predisposing lesion may be present when spinal fracture is not evident. The prognosis after surgical intervention is better in patients without spinal fracture than in those with vertebral damage, probably because of less contusion to the spinal cord and the presence of very young subjects in the former group of patients.- - - - - - - - - - ranking = 3.6666666666667keywords = spinal (Clic here for more details about this article) |
8/13. Cervical spinal subdural hematoma.We report a case of intraspinal subdural hematoma following trauma - a rare entity - with a review of the literature. The location of the hematoma in the cervical spine as described in this report is even more uncommon and was reported only once before. The pathophysiology of this entity is discussed, and the myelographic features are emphasized to facilitate the preoperative diagnosis.- - - - - - - - - - ranking = 1.6666666666667keywords = spinal (Clic here for more details about this article) |
9/13. spinal cord concussion in previously undiagnosed osteogenesis imperfecta.An 11-year-old boy was a victim of a motor vehicle accident. He initially presented with paraplegia and inability to detect pain below the fourth thoracic dermatome. Two hours later, he had full return of motor and sensory function. Thoracolumbar spine radiography and magnetic resonance imaging (MRI) showed multiple compression fractures and marked osteopenia of the vertebrae. The patient's family history is significant for osteogenesis imperfecta (OI), although the patient had not been previously diagnosed with this disorder. Although the patient had no prior fractures or any of the classic stigmata of OI except for short stature, plain radiographic and MRI findings in conjunction with his family history support the diagnosis of OI. A brief discussion of both OI and spinal cord concussion is presented.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
10/13. reflex mechanisms of death in missile injuries of the neck.Three cases of missile injury to the neck are reported, two homicides and one suicide. In two fatalities, the autopsy revealed contusion of the spinal cord due to direct missile injury of the cervical spine but without laceration of the spinal dura. It was concluded that the temporary cavity following penetration of the bullet caused contusion of the spinal cord with subsequent reflex cardiac arrest. In the suicide case, the entrance wound was in the mouth, the bullet track traversed the pharynx and the cervical spine with complete transection of the cord, and the bullet lodged in the right scalenus muscle. The lack of vital signs such as blood aspiration, which was expected because of the injury of the pharynx, also indicates immediate occurrence of death owing to a reflex mechanism in this case. The underlying reflex mechanisms are discussed in the light of clinical experience in the treatment of paraplegics as well as the findings in experimental contusion and transection of the cervical cord.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
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