11/292. Cervical cord and dorsal medullary infarction presenting with retro-orbital pain.A 36-year-old woman experienced an excruciating right retro-orbital paroxysmal headache after a stroke of the anterior two-thirds of the right hemicord at the C1 level (anterior spinal artery territory) and the dorsal medulla (posterior spinal artery territory). A right vertebral artery dissection was demonstrated. This unusual infarct mimicked a cluster headache attack or paroxysmal hemicrania.- - - - - - - - - - ranking = 1keywords = pain, headache (Clic here for more details about this article) |
12/292. Symptomatic sacral extradural arachnoid cyst associated with lumbar intradural arachnoid cyst.A case of sacral extradural arachnoid cyst associated with lumbar intradural arachnoid cyst in a 35-year-old male is reported. The patient presented with a history of severe sacrococcygeal pain, constipation, and dysuria for several months. Computed tomographic (CT) myelograms and magnetic resonance imaging (MRI) scans showed a huge sacral cyst without neural components. A favorable outcome could be achieved by decompression of the cyst, obliteration of the fistulous channel between the cyst and the thecal sac, and fenestration of the arachnoid cyst into the subarachnoid space. The relevant literatures are also reviewed.- - - - - - - - - - ranking = 0.22887832779131keywords = pain (Clic here for more details about this article) |
13/292. Epidural blood patch under fluoroscopic control: non-surgical treatment of lumbar cerebrospinal fluid fistula following implantation of an intrathecal pump system.The treatment of lumbar cerebrospinal fluid fistula in the presence of an intrathecal catheter is known to be difficult. Open revision surgery is recommended in the literature, although the rate of recurrence is high. The epidural blood patch technique is well established as a successful treatment for post-dural-puncture headaches. Recent work about the distribution of the injected blood and theoretical considerations about the mechanism of action make this method suitable for the occlusion of spinal leakage even in the presence of an intrathecal catheter. In this note technical details are given for a successful therapy of lumbar cerebrospinal fluid fistula including the right positioning of the opening of the needle (cerebrospinal fluid can be expected intrathecally and epidurally) by injection of contrast medium first for myelography then for epidurography. In this procedure the (epidural) distribution of autologous blood can be indirectly controlled by compression of the dural sac. The method is easy to perform, and the possible risks are small.- - - - - - - - - - ranking = 0.042243344417384keywords = headache (Clic here for more details about this article) |
14/292. A case of traumatic high thoracic myelopathy presenting dissociated impairment of rostral sympathetic innervations and isolated segmental sweating on otherwise anhidrotic trunk.A 3 year-old boy developed flaccid paraplegia, anesthesia below T3 and impaired vesical control immediately after a car accident. Three months later, the pupils and their pharmacological reactions were normal. Thermal sweating was markedly reduced on the right side of the face, neck, and shoulder and on the bilateral upper limbs, and was absent below T3 except for band like faint sweating on T7 sensory dermatome. The left side of the face, neck and shoulder showed compensatory hyperhidrosis. Facial skin temperature was higher on the sweating left side. Cervico-thoracic MRI suggested almost complete transection of the cord at the levels of T2 and T3 segments. We discussed the pathophysiology of the dissociated impairment of rostral sympathetic innervations and isolated segmental sweating on otherwise anhidrotic trunk.- - - - - - - - - - ranking = 0.031189185497499keywords = upper (Clic here for more details about this article) |
15/292. A 15-year-old with back pain, fever, and leg numbness.Spinal epidural abscess (SEA) is an uncommon entity. We report an adolescent presenting with fever and back pain beginning 3 months after a leg abscess. This case highlights several important aspects of the diagnosis and care of patients with SEA. As illustrated by this case, plain radiographs and computed tomography of the spine can miss the diagnosis, thus when spinal epidural abscess is suspected, magnetic resonance imaging is the imaging modality of choice. Epidural abscesses most commonly arise from hematological dissemination, with staphylococcus aureus being the most often cultured organism. Surgical intervention early combined with the administration of proper antibiotics leads to the best outcome.- - - - - - - - - - ranking = 14.456985761576keywords = back pain, pain, back (Clic here for more details about this article) |
16/292. spinal cord herniation into an extensive extradural meningeal cyst: postoperative analysis of intracystic flow by phase-contrast cine MRI.We report a patient with idiopathic spinal cord herniation who underwent postoperative myelography and phase-contrast cine magnetic resonance imaging (MRI) to clarify the condition of the ventral cystic lesion into which the spinal cord had been herniated. This 58-year-old man showed symptoms and signs compatible with brown-sequard syndrome. A myelogram and MRI showed that the spinal cord was incarcerated in a small space, and this finding led to the diagnosis of spinal cord herniation. In the operation, the herniated spinal cord was returned to the initial intradural space, and the dural defect was enlarged to prevent recurrence of the herniation. After the operation, leg muscle strength improved and bladder and bowel dysfunction resolved, but analgesia was unchanged. Postoperative myelography revealed a very large extradural cystic lesion, which extended from C2 to L1 vertebral level. A cerebrospinal fluid (CSF) flow study of the intradural space disclosed a near-normal pattern, but the intracystic CSF dynamics were abnormal. In the intracystic space at just the upper level of the lesion, cranial flow (reverse directional flow in comparison with the intradural flow) was seen in the systolic cycle after momentary fast caudal flow, and these CSF dynamics may have been related to the spinal cord herniation.- - - - - - - - - - ranking = 0.031189185497499keywords = upper (Clic here for more details about this article) |
17/292. Progressive necrotic myelopathy: clinical course in 9 patients.OBJECTIVE: To review the clinical, laboratory, and radiological findings of 9 patients who had progressive idiopathic myelopathy with evidence of spinal cord necrosis. DESIGN AND methods: We reviewed personally examined cases of myelopathy that fulfilled the following criteria: (1) regional loss of reflexes, flaccidity, and muscle atrophy; (2) magnetic resonance imaging showing a shrunken or cavitated cord without evidence of arteriovenous malformation; (3) electromyogram showing denervation over several contiguous spinal cord sgements with preservation of sensory potentials in some cases; and (4) the absence of evidence of systemic disease or neoplasm. RESULTS: The illness began in these patients after the age of 40 years, with prominent burning or tingling limb pain, occasionally with radicular features or with less well-defined back, neck, or abdominal pain. Leg or infrequently arm weakness appeared concurrently or soon after the onset of pain. The most distinctive feature was a saltatory progression of symptoms, punctuated by both acute and subacute worsenings approximately every 3 to 9 months, culminating in paraplegia or tetraplegia. The distinguishing clinical findings, together indicative of destruction of gray matter elements of the cord, were limb atrophy, persistent areflexia, and flaccidity. The concentration of cerebrospinal fluid protein was typically elevated between 500 g/L and 1000 g/L, without oligoclonal bands, accompanied infrequently by pleocytosis. magnetic resonance imaging showed features suggesting cord necrosis, specifically swelling, T2-weighted hyperintensity, and gadolinium enhancement over several spinal cord segments, succeeded months later by atrophy in the same regions. necrosis of the cord was found in biopsy material from one patient and postmortem pathology in another case, but inflammation and blood vessel abnormalities were absent. Only 2 patients had prolonged visual evoked responses. The disease progressed despite immune-modulating treatments although several patients had brief epochs of limited improvement. CONCLUSIONS: The saltatory course, prolonged visual evoked responses in 2 patients, and a cranial abnormality on magnetic resonance imaging in another, raised the possibility of a link to multiple sclerosis. However, the normal cranial magnetic resonance imaging scans in 6 other patients, uniformly absent oligoclonal bands, and poor response to treatment were atypical for multiple sclerosis. On the basis of shared clinical and laboratory features, idiopathic progressive necrotic myelopathy is indistinguishable from a limited form of Devic disease.- - - - - - - - - - ranking = 0.846822668169keywords = pain, back (Clic here for more details about this article) |
18/292. Irreversible spinal cord injury as a complication of subarachnoid ethanol neurolysis.ARTICLE ABSTRACT: Subarachnoid neurolysis using ethanol to destroy selectively the posterior roots of the spinal cord is a method for providing pain relief in patients with advanced cancer. Weakness of the extremities is a complication of the procedure that has been attributed to spread of the neurolytic agent to the anterior roots. The authors provide evidence of spinal cord injury as a cause of lower extremity weakness in a patient after subarachnoid ethanol neurolysis.- - - - - - - - - - ranking = 0.22887832779131keywords = pain (Clic here for more details about this article) |
19/292. Rosai-Dorman disease causing cervical myelopathy.STUDY DESIGN: A case report of a rare disease entity and review of the literature. OBJECTIVES: To illustrate the occurrence of an unusual disease affecting the spine and spinal canal. SUMMARY OF BACKGROUND DATA: Rosai-Dorman disease is considered an idiopathic benign lymphoproliferative disease that typically occurs in the earlier decades of life. The usual manifestation is painless massive cervical lymphadenopathy, although involvement of many extra nodal sites is common. This case illustrates Rosai-Dorman disease occurring in an elderly man with myelopathy and mass lesions of the cervical, thoracic, and lumbar spinal canal without typical lymphadenopathy.- methods: Case report illustrating clinical presentation as well as radiographic and pathologic findings, including comparisons to cases previously reported. RESULTS: Surgical decompression with incomplete resection of the lesion was performed, providing diagnosis and treatment guidance. The patient experienced significant neurologic improvement of myelopathy. CONCLUSIONS: Recognizing clinical and laboratory features of this disease may permit earlier diagnosis and limit or avoid surgical intervention in some cases.- - - - - - - - - - ranking = 0.22887832779131keywords = pain (Clic here for more details about this article) |
20/292. Acute traumatic myelopathy secondary to a thoracic cyst in a professional football player.STUDY DESIGN: Case report of acute traumatic myelopathy secondary to thoracic synovial cyst in a professional football player. OBJECTIVE: To emphasize examination for myelopathy and describe the radiographic and magnetic resonance findings of a rare source of traumatic myelopathy. BACKGROUND: magnetic resonance imaging is the best initial evaluation for myelopathy in a traumatic setting. Heightened awareness during evaluation of a player involved in a traumatic incident allowed the diagnosis of potential cord damage and paralysis. methods: A subject with symptoms resulting from a direct blow to the back was evaluated for myelopathy, with diagnosis assisted by magnetic resonance imaging used to pinpoint the source of the disorder. RESULTS: The diagnosis allowed a surgical excision of the traumatic synovial cyst and full recovery of the injured football player. CONCLUSIONS: awareness during examination for myelopathy in an acutely injured athlete is imperative to prompt the clinician to order the proper diagnostic studies and thereby embark on a surgical correction of the problem.- - - - - - - - - - ranking = 0.16018768479508keywords = back (Clic here for more details about this article) |
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