1/6. Use of a forced-choice test of tactile discrimination in the evaluation of functional sensory loss: a report of 3 cases.The loss of sensation is not an uncommon associated finding after injury to the peripheral nerves and the spinal cord. However, the sensory examination is prone to the influence of nonphysiologic factors, and one cannot use it to determine whether functional sensory loss reflects unconscious or intentional symptom production. This distinction has important implications for differential diagnosis and for decision making in the context of workers' compensation claims and personal injury litigation. We present 3 cases of patients with chronic pain and nondermatomal patterns of loss of fine-touch sensation, whose sensory loss was examined by a sensory forced-choice symptom validity test. Their below-chance scores showed intentionally produced sensory symptoms. The use of this methodology in differential diagnosis is discussed.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/6. Infiltrating spinal angiolipoma: a case report and review of the literature.Angiolipomas are rarely encountered in the spine. We report the case of a 47-year-old man with a thoracic angiolipoma involving the T9 vertebral body. A preoperative spinal angiogram confirmed a highly vascular neoplasm. The lesion was treated with endovascular embolization prior to a T9 corpectomy and resection of the epidural component of the tumor. At time of surgery, minimal blood loss occurred during resection of the vertebral body and the epidural mass. Pathologic examination demonstrated features consistent with spinal angiolipoma. This report emphasizes the clinical, radiographic, and pathologic features of infiltrating spinal angiolipoma and discusses therapeutic management options.- - - - - - - - - - ranking = 7keywords = spinal (Clic here for more details about this article) |
3/6. Intramedullary spinal cord germinoma expresses the protooncogene c-kit.A 33-year-old woman first noticed numbness in the both lower extremities and the numbness gradually extended up to the thorax. Magnetic resonance (MR) imaging demonstrated a mass with moderate and heterogeneous enhancement and peritumoural intramedullary cysts in the spinal cord at the T-1 to T-3 levels. The tumour was explored partially and intra-operative pathological examination demonstrated the so-called "two-cell pattern" typical of germinoma. The margin of the tumour was not clear. Histological examination showed germinoma with strong c-kit protein expression on the tumour cell surface. Chemotherapy and radiation therapy were given following surgery. Her neurological deficits were improved but not resolved.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
4/6. Spinal tanycytic ependymoma with hematomyelia--case report--.A 58-year-old man presented with an extremely rare case of "pure type" spinal tanycytic ependymoma associated with hematomyelia manifesting as sensory disturbance of the bilateral hands and weakness of the right arm. magnetic resonance imaging demonstrated a tumor in the spinal cord from C-2 to C-4 levels. The soft gelatinous tumor was subtotally resected and the adjacent chronic liquid hematoma was aspirated. The immunohistochemical and ultrastructural findings indicated a diagnosis of tanycytic ependymoma.- - - - - - - - - - ranking = 2keywords = spinal (Clic here for more details about this article) |
5/6. Effects of smoking on neuropathic pain in two people with spinal cord injury.BACKGROUND/OBJECTIVE: To describe an apparent relationship between smoking and the neuropathic pain experience in people with spinal cord injury (SCI). METHOD: case reports. PARTICIPANTS/methods: Two individuals treated at a rehabilitation center. The first was a 38-year-old white man with a T1 2 SCI, American Spinal Injury association (asia) impairment scale (AIS) A, secondary to motor vehicle crash. Duration of injury was 14 years. He reported burning pain in his legs, and has smoked 1/2 pack per day for the last 15 years. The second was a 55-year-old African American man with a T6 SCI, AIS A, secondary to gunshot wound. Duration of injury was 22 years. He was a 40-year 1/2 to 1 pack per day smoker, who, after injury, consistently experienced burning, radicular pain, rated 7/10, around the level of the injury. SUMMARY: The first subject rated his pain as 4/10 when not smoking and 7/10 when smoking. The pain subsided 30 minutes after smoking was discontinued. He noted an immediate increase in neuropathic pain when smoking. The second subject quit smoking for 1 month and immediately noted that the pain disappeared, rating it 0/10. After he resumed smoking, his radicular pain was 8.5/10 in the morning and 5/10 in afternoon. CONCLUSIONS: No similar reports have been published, based on a medline search. Nicotinic receptors have been implicated in pain perception. It is unclear to what extent these 2 cases generalize to the SCI population. We plan to explore this via survey and experimental research. smoking cessation may have a dual benefit of increased health and decreased neuropathic pain.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
6/6. Neurological bypass for sensory innervation of the penis in patients with spina bifida.PURPOSE: Most male patients with spina bifida have normal sexual desires. During puberty they begin to realize that they can achieve erection and sexual intercourse but without any sensation in the penis. We hypothesized that restored sensation in the penis would greatly contribute to their quality of life and sexual health. In this prospective study we investigated the outcome of a new operative neurological bypass procedure in patients with spina bifida. MATERIALS AND methods: In 3 patients who were 17, 18 and 21 years old with a spinal lesion at L5, L4 and L3-L4, respectively, the sensory ilioinguinal nerve (L1) was cut distal in the groin and joined by microneurorrhaphy to the divided ipsilateral dorsal nerve of the penis (S2-4) at the base of the penis. All patients underwent preoperative and postoperative neurological and psychological evaluations. RESULTS: By 15 months postoperatively all patients had achieved excellent sensation on the operated side of the glans penis. They were unequivocally positive about the results and the penis had become more integrated into the body image. In 2 patients masturbation became more meaningful and 1 became more sexually active with and without his partner. CONCLUSIONS: The newly designed neurological bypass procedure in patients with spina bifida resulted in excellent sensibility in the glans penis. The new sensation appeared to contribute to the quality of the patient sexuality and sexual functioning as well as to the feeling of being a more normal and complete individual who is more conscious of the penis. This new operation might become standard treatment in patients with spina bifida in the future.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |