1/65. Bone amyloidoma in a diabetic patient with morbid obesity.Bone localisations of amyloidosis are rare, usually diffuse and associated with myeloma. We report the case of a patient with massive obesity complicated by diabetes, hypertension, sleep apnea and liver steatosis, who complained of rapidly worsening bilateral polyradiculalgia of the lower limbs. After sufficient weight loss made nuclear magnetic resonance imaging feasible, a spinal tumour was visualised on the 5th lumbar vertebra, extending to soft tissues. Total excision was performed, and pathological studies revealed an amyloid bone tumour with no evidence of myeloma.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/65. Progression of first degree atrioventricular block to second degree Mobitz type I block during spinal anesthesia associated with induced hypertension.A case is presented in which an elderly patient with preexisting first degree atrioventricular (AV) block progressed to second degree Mobitz Type I AV block during spinal anesthesia and associated with hypertension induced by a pure alpha 1 agonist. Second degree AV block caused by increased vagal tone was transient, which resolved as the blood pressure normalized. hypotension due to spinal anesthesia treated with pure alpha 1 agonist can increase AV block in patient with pre-existing first degree heart block.- - - - - - - - - - ranking = 6keywords = spinal (Clic here for more details about this article) |
3/65. airway obstruction due to late-onset angioneurotic edema from angiotensin-converting enzyme inhibition.PURPOSE: Angioneurotic edema is a well-documented complication of angiotensin-converting enzyme inhibitors (ACEI). We report a case of acute airway obstruction from a late-onset, probable ACEI-related angioneurotic edema and its subsequent management. CLINICAL FEATURES: A 48-yr-old obese man presented for transurethral resection of a bladder tumour (TURBT). His past medical history included hypertension controlled with hydrochlorothiazide and quinapril which had been started 13 mo earlier. Previous surgery was uncomplicated. midazolam was used for premedication and for intraoperative sedation together with fentanyl and propofol. After uneventful spinal anesthesia with bupivacaine, operation and recovery, he was transferred to the floor. Five hours later he developed severe edema of his face, tongue and neck, with drooling, that progressed into airway obstruction and respiratory arrest. ventilation was restored via immediate cricothyroidotomy, and a subsequent tracheotomy was completed uneventfully in the operating room. His serum C1 esterase inhibitor levels at 1, 5 and 23 days later were normal. The angioneurotic edema was attributed to the ACEI treatment. The edema resolved after 48 hr, and further follow-up was unremarkable. CONCLUSION: This observation is consistent with other reports that angioneurotic edema from ACEI can occur many months after the initiation of treatment. This can involve the airway and may produce life-threatening respiratory compromise. physicians should be aware of this association and the possible need for immediate surgical intervention for the establishment of an airway in case of worsening edema or respiratory arrest.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
4/65. Cervical subarachnoid hematoma of unknown origin: case report.OBJECTIVE AND IMPORTANCE: Spontaneous spinal subarachnoid hematoma is rare, having been reported in the English literature in only seven other cases. We describe the first case of spontaneous subarachnoid hematoma located in the cervical spinal cord of a 43-year-old man. The pathologic examination showed no apparent source of bleeding, but there was evidence of cervical spondylotic myelopathy. CLINICAL PRESENTATION: The patient presented with a 10-day history of severe neck pain, followed by the onset of quadriparesis that was more evident on the left side, urinary retention, and sensory loss below C5. His medical history included hypertension. magnetic resonance imaging showed a massive hemorrhage in the cervical spinal canal. INTERVENTION: A C4-C5 subarachnoid hematoma was removed. The patient died due to respiratory distress and uncontrollable hypotension on day 6 after surgery. Surgical exploration, neuroradiologic examinations, and autopsy showed no evidence of vascular malformations, tumors, or other possible sources of bleeding. CONCLUSION: After excluding more common causes of spontaneous subarachnoid hematoma in this patient, we suggest that chronic spinal cord compression (spondylotic myelopathy) and arterial hypertension in this patient may have caused the pathogenesis of this rare clinical entity. Experimental data supporting this hypothesis are discussed.- - - - - - - - - - ranking = 4keywords = spinal (Clic here for more details about this article) |
5/65. Prevention of hypertensive crises in patients with high spinal lesions during cystoscopy and lithotripsy.Three patients with high spinal lesions, admitted to the hospital for cystoscopy and lithotripsy, showed signs of severe hypertension due to mass reflex during this operation. This symptom was controlled with an intravenous drip of Arfonade inverted question mark, and the patients felt quite comfortable without any other anaesthesia. Other possibilities for handling such patients are discussed.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
6/65. Catecholamine-induced hypertension in lumbosacral paraplegia: five case reports.hypertension in the patient with SCI is relatively rare and generally restricted to patients with high-level injuries where autonomic dysreflexia can occur. Resting blood pressure in individuals with SCI has been described as lower than that in the normal population. This report describes five previously normotensive teenagers with subsequent paraplegia as a result of gunshot wounds who presented with hypertension secondary to idiopathic elevation of plasma or urinary catecholamine levels. A clonidine suppression test was used as a neuroprobe to inhibit centrally mediated sympathetic outflow, excluding the probability of an extra-axial autonomous catecholamine-secreting tumor as the possible source of hypertension. Positive suppression was achieved in four patients (41%, 37.2%, 4.8%, and 37.2% decreases). One patient had values corresponding to orthostatic changes (an increase of 63%) because of poor compliance with the test. This patient was lost to follow-up; in the remaining four, hypertension resolved at 12, 8, 9, and 6 weeks postinjury. The increased circulating catecholamine level appears to be promoted by a centrally mediated response to the SCI. Elevated blood pressure probably results from an upgraded receptor regulation or an increased receptor sensitivity on the affected cells in the absence of restraining spinal reflexes. The pathophysiology of such hypertension seems to be secondary to autonomic dysfunction and, although it may be transient, it should be treated promptly and reevaluated periodically until stabilization is achieved.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
7/65. An unusual complication during electroejaculation in an individual with tetraplegia.infertility in males is a common problem after spinal cord injury, often requiring interventional methods. In the authors' fertility program they have experienced 4 pregnancies and 3 live births using both electroejaculation (EEJ) and vibratory stimulation techniques. EEJ is a relatively safe procedure with few complications reported in the literature. Here is a case of a 23-year-old with C-6 asia A tetraplegia who, while receiving EEJ, developed autonomic dysreflexia that was followed by new onset atrial fibrillation. The patient's cardiac condition required management in the Emergency Department with pharmacologic conversion to a normal sinus rhythm. Although autonomic dysreflexia is a common adverse effect during EEJ, atrial fibrillation has not been previously reported as a complication. It is proposed that the patient's atrial fibrillation developed as a result of cardiac changes induced through autonomic dysreflexia.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
8/65. Posterior-fossa haemorrhage after supratentorial surgery--report of three cases and review of the literature.We present clinical details of three patients with posterior fossa haemorrhage after supratentorial surgery and discuss possible pathomechanisms of this rare complication. All patients were males of advanced age. Two patients presented with a history of hypertension. In all patients the occurrence of haemorrhage was associated with loss/removal of large amounts of cerebrospinal fluid (CSF) either intra-operatively (one patient undergoing aneurysm surgery) or postoperatively (all three patients: drainage of subdural hygromas or chronic subdural haematomas in two, external ventricular drainage in one patient). Treatment consisted in haematoma evacuation and/or external ventricular drainage. Two patients died, one patient recovered completely. Although haematomas distant from a craniotomy site are a well known entity, a review of the literature identified only 25 published cases of posterior fossa haemorrhage after supratentorial procedures in the CT era. Most often disturbances of coagulation, positioning of the patient and episodes of hypertension have been associated with this complication. Only one author described the occurrence of a haemorrhage after drainage of a supratentorial hygroma. We suggest that the loss of large amounts of CSF intra-operatively and post-operatively may lead to parenchymal shifts or a critical increase of transmural venous pressure with subsequent vascular disruption and haemorrhage.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
9/65. catecholamines response of high performance wheelchair athletes at rest and during exercise with autonomic dysreflexia.autonomic dysreflexia presents a special situation in high-lesion spinal cord injury, however, intentionally or self-induced autonomic dysreflexia directly before or during competition to increase performance, so called 'boosting', is also being reported. In order to examine the influence of autonomic dysreflexia on plasma catecholamines, cardiocirculatory and metabolic parameters, 6 spinal cord injured wheelchair athletes with high-level lesions underwent wheelchair ergometry without (ST1) and with (ST2) autonomic dysreflexia. At the point of exhaustion significantly higher values for norepinephrine and epinephrine were observed in ST2 than in ST1. During autonomic dysreflexia a significantly higher peak performance (77.5 vs. 72.5 watt), higher peak heart rate (161 vs. 149 x min(-1)), and peak oxygen consumption (1.96 vs. 1.85 l x min(-1)), with comparable peak lactate (7.11 vs. 7.00 mmol x l(-1)) were reached on average. The blood pressure values in ST2 were partially hypertensive and higher than in ST1. In conclusion, autonomic dysreflexia, as a sympathetic spinal reflex, leads to a higher release of catecholamines during exercise. This results in higher peak performance, peak heart rate, peak oxygen consumption, and higher blood pressure values. The peak lactate, as an indicator of the anaerobic lactate metabolism, was unchanged. However, autonomic dysreflexia presents an unpredictable risk, caused predominantly by hypertensive blood pressure values, for high-lesion spinal cord injured persons at rest and more so during exercise; it is seen as a prohibited manipulation by the doping guidelines of the International Paralympic Committee.- - - - - - - - - - ranking = 4keywords = spinal (Clic here for more details about this article) |
10/65. Microhemorrhages in the central nervous system: report of a patient with microhemorrhages in brain and spinal cord.A 53-year-old, woman with microhemorrhages in the brain and spinal cord is described. This patient was initially seen with a reversible oculomotor paresis and hypertension, a year later she developed spinal cord symptoms. T2-weighted magnetic resonance imaging showed characteristic hypointense lesions in the brain and spinal cord consistent with microhemorrhages. Although the occurrence of microhemorrhages in the brain has been described before, the combination of brain and spinal cord microhemorrhages has not been reported yet. The observations in our patient suggest that microvascular changes related to hypertension are a common cause for these microhemorrhages.- - - - - - - - - - ranking = 8keywords = spinal (Clic here for more details about this article) |
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