Post-traumatic cauda equina nerve calcification: A case report

BACKGROUND Post-traumatic cauda equina nerve calcification is extremely rare in clinical practice, and its etiology, pathogenesis, treatment and prognosis are unclear. There are few studies and reports on Post-traumatic cauda equina nerve calcification, and this review reports a case of Post-traumatic cauda equina nerve calcification for reference.CASE SUMMARY A 52-year-old patient presented to our hospital with a history of lumbar spinal stenosis and a lumbar vertebral fracture caused by trauma...     

慢性炎症性脱髓鞘性多发性神经根神经病患者自主神经症状评估的临床研究

目的探讨慢性炎症性脱髓鞘性多发性神经根神经病（CIDP）患者自主神经症状评估的临床研究。方法应用交感神经皮肤反应（SSR）、R—R间期变化率（RRIV）及自主神经功能量表（ASP）对29例CIDP患者（实验组）和30例健康对照组分别进行评估,并分析CIDP患者SSR、RRIV及ASP之间的相关性。结果两组SSR、RRIV及ASP异常率比较,差异均有统计学意义（P均〈0．05）。实验组有自主神经症状的患者与无自主神经症状的患者SSR异常率比较,差异有统计学意义（P〈0．042）,而RRIV及ASP异常率比较,差异均无统计学意义（P均〉0．05）。此外,实验组患者SSR、RRIV及ASP间均存在显著相关性（P均〈0．05）。结论SSR、RRIV与ASP均可用于CIDP患者的自主神经功能评估,且SSR对CIDP患者自主神经症状的检测敏感性较高。     

Cauda equina syndrome caused by the application of DuraSealTM in a microlaminectomy surgery: A case report

BACKGROUNDThe management of dural tears is important. While a massive dura can be repaired with absorbable suture lines, cerebrospinal fluid leakage can be attenuated by dural sealant when an unintended tiny durotomy occurs intraoperatively. DuraSeal is often used because it can expand to seal tears. This case emphasizes the need for caution when DuraSeal is used as high expansion can cause complications following microlaminectomy.CASE SUMMARYA 77-year-old woman presented with L2/3 and L3/4 lateral recess stenosis. She underwent microlaminectomy, foraminal decompression, and disk height restoration using an IntraSPINE^® device. A tiny incident durotomy occurred intraoperatively and was sealed using DuraSeal^TM. However, decreased muscle power, urinary incontinence, and absence of anal reflexes were observed postoperatively. Emergent magnetic resonance imaging revealed fluid collection causing thecal sac indentation and central canal compression. Surgical exploration revealed that the gel-like DuraSeal had entrapped the hematoma and, consequently, compressed the thecal sac and nerve roots. While we removed all DuraSeal^TM and exposed the nerve root, the patient’s neurological function did not recover postoperatively.CONCLUSIONDuraSeal expansion must not be underestimated. Changes in neurological status require investigation for cauda equina syndrome due to expansion.     

Tandem spinal stenosis: a case of stenotic cauda equina syndrome following cervical decompression and fusion for spondylotic cervical myelopathy

Tandem spinal stenosis is a clinical phenomenon which may cause a functional loss related to neurologic compression in numerous areas of the spinal cord. In this phenomenon, the second area of symptomatic neurologic insult is not revealed until the primary symptomatic area has been treated. This case describes a 71-year-old male referred to physical therapy 4 weeks following a combined anterior/posterior C3/4 decompression and fusion for treatment of cervical spondylotic myelopathy. Approximately 8 weeks post-operatively (4 weeks after initiation of physical therapy), the patient began to complain of bilateral lower extremity weakness, primarily with climbing stairs. At 12 weeks post-operatively, the patient developed bowel incontinence and saddle paresthesia. Magnetic resonance imaging revealed multiple levels of critical stenosis of the lower thoracic and upper lumbar spine, which resulted in referral for surgical intervention. Following surgical decompression there was complete recovery of lower extremity strength, saddle area sensation and bowel function. This case highlights the need for the clinician to remain vigilant for concomitant pathology despite successful surgical intervention. A thorough knowledge of the presentation of various spinal disorders, as well as a thorough neurologic examination, is required to accurately recognize both candid and subtle red flags requiring immediate referral for surgical intervention.     

Peripheral nerve involvement in a neurofibromatosis type 2 patient with plexiform neurofibroma of the cauda equina: a sonographic vignette

Kara M, Akyüz M, Y?lmaz A, Hatipo?lu C, Özçakar L. Peripheral nerve involvement in a neurofibromatosis type 2 patient with plexiform neurofibroma of the cauda equina: a sonographic vignette.We report a 20-year-old man with cauda equina syndrome and neurofibromatosis type 2. We discuss the role of sonographic and electromyographic evaluations in the management of our patient and suggest the use of sonographic imaging for visualization of peripheral nerve pathologic states, especially when involvement is widespread.     

抗结区及结旁区抗体阳性的慢性炎症性脱髓鞘性多发性神经根神经病的抗体检测及临床特征

目的:探讨抗郎飞结区和结旁区相关抗体在慢性炎症性脱髓鞘性多发性神经根神经病（CIDP）的检测及其临床特征。方法:收集2018年1月至2021年7月在复旦大学附属华山医院住院和门诊就诊及外院送检的212例临床诊断CIDP患者血清样本,采用细胞底物法检测抗郎飞氏结区和结旁区相关自身抗体（抗NF155、抗NF186、抗CNT...     

Spinal intraosseous schwannoma without spinal canal and neuroforamina involvement: A case report

BACKGROUND Spinal intraosseous schwannomas(SIS)are rare,and as yet have not been fully described in the literature.The first case of SIS was reported in 1971,and 24 cases of SIS have been reported so far.However,including the present case,there are only seven cases without spinal canal and neuroforamina involvement.CASE SUMMARY A 56-year-old man presented with a history of neck pain for 2 years.An obvious osteolytic destruction of the seventh cervical(C7)vertebra was observed on imaging examination.Magnetic resonance imaging of the cervical spine showed space-occupying lesions in the C7 vertebra,and destruction of the anterior cortex of the vertebra.The lesions had an exophytic component that extended from the C7 vertebra into the soft tissue on the front side.The foramen transversarium on both sides were intact.The patient underwent surgical biopsy and focal excision of the C7 lesion.The diagnosis of“schwannoma”was verified by postoperative pathological examinations.In a review of the literature,this is the seventh case of SIS without spinal canal and neuroforamina involvement,and the third reported case of type VIII SIS.We discussed our case with respect to reported classification characteristics of SIS.CONCLUSION SIS is a very rare tumor.We report a rare case that may be important for further classification of osteo-schwannoma.The establishment of a complete disease classification is of high importance for the treatment and prognosis of this disease.Thus,more basic studies and retrospective analysis of related cases are necessary.     

慢性皮肤黏膜念珠菌病1例及文献分析

目的探讨慢性皮肤黏膜念珠菌病的临床表现和诊疗方法。方法对1例慢性皮肤黏膜念珠菌病患者的临床资料进行分析,并行文献检索。结果患者男性,24岁。因右侧颈部出现浸润性斑块,表面密集增厚疣样痂2年。真菌检查:镜下见菌丝。组织病理示表皮大致正常,真皮见大量淋巴样细胞、浆细胞浸润,并见多核巨细胞反应,呈炎性肉芽肿改变。给予伊曲康唑抗真菌治疗后,皮疹好转。结论慢性皮肤黏膜念珠菌病临床表现具有多样性,组织病理检查和真菌培养对慢性皮肤黏膜念珠菌病的诊断具有重要意义,伊曲康唑抗真菌治疗对本病有效,但易复发。     

Negative conversion of autoantibody profile in chronic hepatitis B: A case report

BACKGROUNDAutoimmune antibodies are detected in many diseases. Viral infections are accompanied by several immunopathological manifestations. Some autoimmune antibodies have been associated with the immune response induced by virus or drugs. Thus, a comprehensive diagnosis of chronic hepatitis B combined with autoimmune hepatitis is required, and immunosuppressant or antiviral therapy should be carefully considered.CASE SUMMARYWe present a case of a patient who had negative transformation of autoimmune antibodies during chronic active hepatitis B. A 50-year-old female who had a history of asymptomatic hepatitis B virus carriers for more than 10 years presented to the hospital with the complaint of weakness for 1 wk. Blood tests revealed elevated liver enzymes; the detection of autoantibodies was positive. Hepatitis B viral load was 72100000 IU/mL. The patient started tenofovir alafenamide fumigate 25 mg daily. Liver biopsy was performed, which was consistent with chronic active hepatitis B. The final diagnosis of the case was chronic active hepatitis B. The autoimmune antibodies turned negative after 4 wk of antiviral therapy. The patient recovered and was discharged with normal liver function. There was no appearance of autoantibodies, and liver function was normal at regular follow-ups.CONCLUSIONAutoimmune antibodies may appear in patients with chronic active hepatitis. It is necessary to differentiate the diagnosis with autoimmune hepatitis.     

Hepatitis B virus-related liver cirrhosis complicated with dermatomyositis: A case report

BACKGROUND Twenty percent of patients infected with hepatitis B virus(HBV)develop extrahepatic manifestations with HBV detected in the lymph nodes,spleen,bone marrow,kidneys,and skin.HBV infection has been associated with some autoimmune disorders.Dermatomyositis(DM)is an idiopathic inflammatory myopathy,which involves a viral infection,and DM has been identified in patients infected with HBV,but there is no direct histological evidence for an association between HBV and DM.CASE SUMMARY We describe a familial HBV-infected patient admitted with liver function abnormality,rashes,a movement disorder,and an elevated level of creatine kinase(CK).A computed tomography scan of the lung showed pulmonary fibrosis,and a liver biopsy identified nodular cirrhosis.An electromyogram revealed myogenic damage,and a muscle biopsy showed nuclear migration in local sarcolemma and infiltration of chronic inflammatory cells.Immunohistochemical staining showed negative results for HBsAg and HBcAg.Fluorescence in situ hybridization showed a negative result for HBV DNA.The patient was diagnosed with HBV-related liver cirrhosis complicated with DM and was treated with methylprednisolone,mycophenolate mofetil,and lamivudine.Eight months later,the patient was readmitted for anorexia and fatigue.The blood examination showed elevated levels of aminotransferases and HBV DNA,however,the CK level was within the normal range.The patient developed a virological breakthrough and lamivudine was replaced with tenofovir.CONCLUSION DM in chronic HBV-infected patients does not always associate with HBV.Antiviral and immunosuppressive drugs should be taken into consideration.     

Delayed inflammatory response evoked in nasal alloplastic implants after COVID-19 vaccination: A case report

BACKGROUNDDelayed inflammatory reactions (DIRs) in alloplast rhinoplasty are a rare complication that may occur several months to years after surgery. The exact causes and mechanisms are unclear, but several triggering factors, including infections, trauma, dental procedures, and vaccination, have been reported.CASE SUMMARYA 39-year-old male patient who had undergone augmentation rhinoplasty 8 years ago had DIRs after the administration of the first dose of the mRNA Pfizer coronavirus disease 2019 (COVID-19) vaccine. He suddenly had tender, erythematous swelling on his face 6 d after vaccination. As there was no improvement in the patient’s condition after the conservative treatment, surgical removal of an alloplastic nasal implant was performed. Immediately after the surgery, the DIRs and accompanying symptoms ameliorated rapidly. A histological study conducted during surgery was fibrosis and small fragments of the hyaline cartilage.CONCLUSIONThe correlation between DIRs and COVID-19 vaccination has not been reported yet and the exact mechanism is unclear. Because the uncontrolled inflammatory reactions on the nose leave serious sequelae, surgeons should be conscious of the correlation between COVID-19 vaccines and DIRs associated with nasal alloplastic implants. And further histological or microbiological studies should be performed to determine the cause of DIRs.