1/55. Painful tonic/dystonic spasms in sjogren's syndrome.Three patients with sjogren's syndrome are presented in whom frequent tonic/dystonic spasms of the limbs developed during the course of the illness. These patients' clinical findings suggested spinal cord involvement, a localization that was confirmed by magnetic resonance imaging in two patients. In one patient the painful movements responded to treatment with phenytoin and in one other to baclofen. sjogren's syndrome should be considered in the differential diagnosis of conditions that produce tonic/dystonic limb spasms.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/55. Evoked spinal cord potential monitoring reveals peroneal nerve ischemia during thoracoabdominal repair: a case report.An 82-year-old man underwent thoracoabdominal aortic replacement under cardiopulmonary bypass with left femoral artery cannulation. Lumber descending evoked spinal cord potentials and segmental evoked spinal cord potentials were monitored simultaneously for detecting spinal cord damage. When the cardiopulmonary bypass was terminated, a peripheral nerve ischemia pattern was evident. Left peroneal nerve paralysis was present at emergence from anesthesia. This monitoring system revealed that peroneal nerve paralysis can occur due to leg ischemia caused by femoral artery cannulation. This is, to our knowledge, the first report that segmental evoked spinal cord potential monitoring reveals peroneal nerve ischemia during thoracoabdominal surgery.- - - - - - - - - - ranking = 8keywords = spinal (Clic here for more details about this article) |
3/55. Reversal of twice-delayed neurologic deficits with cerebrospinal fluid drainage after thoracoabdominal aneurysm repair: a case report and plea for a national database collection.Delayed neurologic deficits are an uncommon yet devastating complication of thoracoabdominal aortic aneurysm repair. The mechanisms involved in the development of delayed spinal cord ischemia remain ill defined. We report a case of complete reversal of delayed neurologic deficits with postoperative cerebrospinal fluid (CSF) drainage. After a thoracoabdominal aneurysm extent I repair, the patient experienced delayed paraplegia at 6 hours and again at 34 hours after the operation, with elevated CSF pressure (>10 mm Hg) on both occasions. Prompt CSF decompression completely reversed the neurologic deficits within hours after onset. The findings in this case further support the role of CSF drainage in spinal cord protection for patients who undergo thoracoabdominal aneurysm repair and make a plea for a national database collection.- - - - - - - - - - ranking = 7keywords = spinal (Clic here for more details about this article) |
4/55. cerebrospinal fluid drainage to reverse paraplegia after endovascular thoracic aortic aneurysm repair.PURPOSE: To report a case of endovascular descending thoracic aortic aneurysm (TAA) repair in which delayed-onset paraplegia was reversed using cerebrospinal fluid (CSF) drainage. methods AND RESULTS: A 74-year-old patient with a 6.0-cm TAA underwent endovascular stent-graft repair that involved overlapping placement of 3 Talent devices to cover the 31-cm-long defect. Twelve hours later, a neurological deficit occurred manifesting as left leg paralysis with paresis on the right. After urgent intrathecal catheter placement and drainage of cerebrospinal fluid for 48 hours, the neurological deficit resolved. The patient's clinical condition was normal and endoluminal exclusion of the TAA remained secure at 8-month follow-up. CONCLUSIONS: This case demonstrates the potential therapeutic role for CSF drainage to reduce the complications of spinal cord injury after endovascular thoracic aneurysm repair.- - - - - - - - - - ranking = 7keywords = spinal (Clic here for more details about this article) |
5/55. Spinal cord infarction and tetraplegia--rare complications of meningococcal meningitis.A previously healthy 25-yr-old female developed flaccid areflexic tetraplegia, with intact cranial nerve function, 36 h after the diagnosis of bacterial meningitis. polymerase chain reaction studies of cerebrospinal fluid and blood were positive for neisseria meningitidis, serogroup b. Magnetic resonance of the cervicothoracic spine revealed increased signal intensity and expansion in the lower medulla, upper cervical cord and cerebellar tonsils. Neurosurgical consultation recommended hyperventilation, dexamethasone and regular mannitol therapy rather than decompressive intervention. The clinical course over the following 12 days was complicated by the development of progressive central nervous and multisystem organ failure with disseminated intravascular coagulopathy. autopsy revealed cerebral oedema with cystic infarction extending from the medulla to the upper cervical cord and cerebellar tonsils. Flaccid areflexic tetraplegia with spinal cord infarction has not been reported following bacterial infection in an adult. The clinical implications would suggest complete central nervous system evaluation of patients recovering from meningococcal meningitis, since spinal cord lesions, although uncommon, do occur. In those very rare situations where a patient develops significant peripheral neurological deficits, urgent magnetic resonance imaging is warranted, to rule out an infective focus or an underlying anatomical anomaly.- - - - - - - - - - ranking = 3keywords = spinal (Clic here for more details about this article) |
6/55. Spinal cord infarction following vertebral angiography: clinical and pathological findings.Spinal cord damage from radiographic contrast material has been known to occur in both spinal and nonspinal angiographic procedures. Reported here is cervical spinal cord injury (SCI) during vertebral angiography. During the procedure, the patient displayed signs of acute cervical spinal cord irritation that should have been taken as a warning of impending injury. autopsy 9 years later showed evidence of central cervical spinal cord necrosis. The pathological findings are similar to those seen in animal models of contrast media-induced SCI; and the pathophysiological mechanisms of such injury are discussed.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
7/55. Lumbar artery compression by the diaphragmatic crus: a new etiology for spinal cord ischemia.We describe a new cause of spinal cord ischemia illustrated by two cases--compression by the diaphragmatic crus of a lumbar artery giving rise to a spinal artery. The diagnosis has been established by dynamic spinal angiography, showing complete occlusion of the lumbar artery. Surgical section of the diaphragmatic crus prevents irreversible infarction.- - - - - - - - - - ranking = 7keywords = spinal (Clic here for more details about this article) |
8/55. Neuropathic pain syndrome as an occult manifestation of injury of the spinal cord after surgical repair of aortic coarctation.Injury to the spinal cord injury with paraplegia, is a rare complication of surgical repair of aortic coarctation recognized immediately post-operatively. We present the case of a 41-year-old male undergoing surgery for restenosis at the site of a repair. Intra-operatively, he suffered inadvertent injury to an intercostal arterial branch during isolation of the aorta below the graft. Over the following months, he developed unusual symptoms involving the legs and genitourinary tract which, only after extensive investigations, were attributed to ischemic damage to the spinal cord related to the surgery. We suspect that similar syndromes reflecting injury to the spinal cord injury may be unrecognized following surgical repair of coarctation.- - - - - - - - - - ranking = 7keywords = spinal (Clic here for more details about this article) |
9/55. Ischaemic myelopathy presenting as guillain-barre syndrome.Spinal cord stroke is uncommon. We report a woman presenting with paraesthesia followed by tetraparesis and respiratory failure who was initially diagnosed as having guillain-barre syndrome. Subsequent clinical and imaging features supported the diagnosis of an anterior spinal cord infarction. We describe the main clinical and imaging features of this condition.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
10/55. Acute thoracoabdominal aortic dissection presenting as painless, transient paralysis of the lower extremities: a case report.Acute dissection of the aorta can be one of the most dramatic of cardiovascular emergencies. Its symptoms can occur abruptly and progress rapidly. Prompt recognition and appropriate intervention is crucial. However, not all aortic dissections present with classic symptoms of abrupt chest, back, or abdominal pain, and the diagnosis may be missed. A 63-year-old woman presented with transient loss of lower extremity motor and sensory function as the only symptom of an acute thoracoabdominal aortic dissection. Aortic dissection presenting as a transient neurologic syndrome is quite unusual. The sudden onset of weakness and parasthesia can result from the interruption of blood flow to the spinal cord. These symptoms of acute spinal cord ischemia, suggestive of a serious cardiovascular event, must be recognized and thoroughly investigated.- - - - - - - - - - ranking = 2keywords = spinal (Clic here for more details about this article) |
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