1/12. Liquid ammonia injury.The toxic effects of a gas depend on the time of exposure, concentration and its chemical nature. Pressurized liquids and gases exert an additional cold thermal injury and this may complicate the clinical picture. A patient who had an accidental exposure to liquid ammonia over a prolonged period, manifesting in cutaneous, respiratory and ocular damage in addition to a severe cold thermal injury (frostbite) with a fatal outcome is presented. The patient had flaccid quadriparesis and episodes of bradycardia, which has not been reported previously. These manifestations raise the possibility of the systemic toxicity in patients with prolonged exposure to ammonia.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/12. Cervical spine injuries in the athlete.Special considerations must be brought into play when the physician is consulted about when to allow an athlete to return to play following injury. This is especially true for brain and spinal cord injury. Although it is generally best to be on the conservative side, being too reticent about allowing any athlete to return may be very detrimental to the athlete and/or the entire team. Therefore, it behooves the sports physician to be circumspect with regard to not only the type of injury the athlete has suffered but also the nature, duration, and the repetitive aspects of the trauma along with the inherent strengths of any player. This article will provide the sports physician with criteria for making sound decisions regarding return to competition after cervical spine injury and "functional" cervical spinal stenosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/12. Episodic coma in a new leukodystrophy.Among the leukodystrophies of a hypomyelinating nature, childhood ataxia with diffuse central nervous system hypomyelination exhibits the unique feature of rapid decrease in mental status after relatively minor head injuries or otherwise noncomplicated febrile illnesses. This article reports the case of a child with progressive spastic quadriparesis in whom unconsciousness developed repeatedly as a result of minor head trauma and required prolonged critical-care nursing. Although cognition is believed to be relatively preserved in this disorder, this child developed progressive cognitive decline. A detailed review of the literature is presented along with discussion of the potential mechanisms of neurologic deterioration.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/12. proctitis cystica profunda in paraplegics. Report of three cases.proctitis cystica profunda is a benign disease of the rectal mucosa that can be mistaken for rectal carcinoma both grossly and microscopically. Symptoms may consist of blood or mucus in the stool, diarrhea, tenesmus, or rectal pain. The disease has never been reported in a paraplegic population before, but the proposed etiology makes this group seem to be at high risk. We report three cases in our paraplegic population and discuss the nature of the disease as well as its treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/12. Pseudo-tumours of the urinary tract in patients with spinal cord injury/spina bifida.OBJECTIVE: To raise awareness of pseudo-tumours of urinary tract, as pseudo-tumours represent benign mass lesions simulating malignant neoplasms. Accurate diagnosis helps to avoid unnecessary surgery in spinal cord injury patients. SETTING: Regional spinal injuries Centre, Southport, UK case reports: Pseudo-tumour of kidney: A 58-year-old man with tetraplegia developed a right perirenal haematoma while taking warfarin; ultrasound and CT scanning showed no evidence of tumour in the right kidney. The haematoma was drained percutaneously. After 8 months, during investigation of a urine infection, ultrasound and CT scan revealed a space-occupying lesion in the mid-pole of the right kidney. CT-guided biopsy showed features suggestive of an organising haematoma; the lesion decreased in size over the next 13 months, thus supporting the diagnosis. Pseudo-tumour of urinary bladder: A frail, 34-year-old woman, who had spina bifida, marked spinal curvature and pelvic tilt, had been managing her neuropathic bladder with pads. She had recurrent vesical calculi and renal calculi. CT scan was performed, as CT would be the better means of evaluating the urinary tract in this patient with severe spinal deformity. CT scan showed a filling defect in the base of the bladder, and ultrasound revealed a sessile space-occupying lesion arising from the left bladder wall posteriorly. Flexible and, later, rigid cystoscopy and biopsy demonstrated necrotic slough and debris but no tumour. Ultrasound scan after 2 weeks showed a similar lesion, but ultrasound-guided biopsy was normal with nothing to explain the ultrasound appearances. A follow-up ultrasound scan about 7 weeks later again showed an echogenic mass, but the echogenic mass was seen to move from the left to the right side of the bladder on turning the patient, always maintaining a dependent position. The echogenic bladder mass thus represented a collection of debris, which had accumulated as a result of chronic retention of urine and physical immobility. CONCLUSION: Recognising the true, non-neoplastic nature of these lesions enabled us to avoid unnecessary surgical procedures in these patients, who were at high risk of surgical complications because of severely compromised cardiac and respiratory function.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/12. Multifocal neurotoxicity during interleukin-2 therapy for malignant melanoma.A 43-year-old female with metastatic melanoma was treated with a combination chemoimmunotherapeutic regimen of DTIC with interleukin-2. Three days after cessation of her interleukin-2 she developed a rapid onset quadriparesis. Computed tomographic scanning failed to show any intracranial pathology but magnetic resonance imaging demonstrated the presence of multiple foci of cellular infiltration. The patient gradually recovered both clinically and radiologically over the following three months. The nature of these infiltrative foci remains uncertain; however, they are unlikely to have been of neoplastic origin and may be due to interleukin-2-induced lymphocytic infiltration. Whenever possible, we suggest that assessment of cerebral involvement with metastatic disease in these patients be by magnetic resonance if initial computed tomography is negative.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/12. Epidural varix at the cervicothoracic junction: unusual cause of quadriplegia: a case report.STUDY DESIGN: A case report describing an unusual incident of quadriplegia in a young adult male caused by an epidural varix at the cervicothoracic junction. OBJECTIVE: To report an unusual case of quadriplegia caused by an epidural varix at the cervicothoracic junction. SUMMARY OF BACKGROUND DATA: Epidural varices are dilated tortuous elongated veins inside the central canal. In degenerative spinal stenosis, these varices are a result of venous stagnation and contribute to the pathogenesis of radicular pain. In the absence of stenosis, primary varicosities develop as a result of dynamic obstruction to venous outflow during spinal movements. A primary epidural varix can produce neurologic deficit similar to a space occupying lesion within the spinal canal. The myeloradiculopathy is of a slow progressive nature. MATERIAL AND methods: A young man presented with an acute onset flaccid quadriplegia in the absence of significant trauma. magnetic resonance imaging revealed an extradural space occupying lesion at the cervicothoracic junction that was diagnosed as an isolated epidural varix during surgery. RESULTS: No neurologic recovery occurred. Postoperative magnetic resonance imaging revealed a syrinx in the cervicothoracic cord. CONCLUSION: In the absence of other precipitating factors, the cord injury was attributed to the epidural varix. A temporary impedance to the venous outflow with the increase in the venous pressure has been hypothesized as the mechanism of cord injury.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/12. Locked-in syndrome: a team approach.A person who suffers brainstem infarction resulting in quadriplegia, lower cranial nerve paralysis and mutism with intact cortical function may survive in a condition aptly termed "locked-in syndrome" (LIS). Literally a mind locked inside the body, the person remains fully aware without the ability to move or communicate. Because of the awesome nature of the condition and its likely permanent basis, family and staff may feel hopeless and incapacitated when planning care. Anatomical findings, etiologies, manifestations and outcomes are discussed in the literature but offer few suggestions for case management. Our clinical team has worked intensively with several LIS patients and has found that an interdisciplinary team approach is essential for providing creative patient care.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/12. spinal cord dysfunction with quadriplegia complicating pneumococcal meningitis.A case of pneumococcal meningitis complicated by brain-stem herniation and flaccid quadriplegia is described, from which the patient, an 11 year old boy, made a partial recovery. The patient had suffered a head injury with skull fracture some years previously; this was his third episode of meningitis. The aetiology of the quadriplegia has not been fully established, but is presumed to be of vascular nature at spinal cord level, associated with an acute hypotensive episode. Preventative aspects of recurrent bacterial meningitis and brain-stem herniation following lumbar puncture are stressed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/12. Acute central cervical spinal cord syndrome caused by missile injury: case report and brief review of the syndrome.The authors present the second reported case of acute central cervical spinal cord syndrome caused by a missile injury. A low caliber, low velocity bullet penetrated the spinal cord posteroanteriorly at C-2, C-3 in the midline, producing quadriplegia and respiratory failure. Within 3 months the patient was ambulatory. Because such a good outcome is possible, patients with similar injuries should be supported vigorously. Injury to the central cervical spinal cord seems to produce a constant syndrome irrespective of the specific nature of the primary injury. The literature on this syndrome is briefly reviewed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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