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1.
Pankaj Kumar Singh Vinay K Singh Juhi Tomar Amir Azam Sanjeev Gupta Sushil Kumar 《The journal of spinal cord medicine》2009,32(5):583-586
Background/Objective:
Glioblastoma multiforme (GBM) is the most common glial cell tumor of the adult brain. However, primary GBM of the spinal cord is a rare condition.Methods:
Case report.Results:
A young man presented with acute onset quadriparesis after a whiplash injury. A magnetic resonance scan showed the typical appearance of a high-grade intramedullary tumor with fusiform expansion of the entire cervical cord. Subtotal decompression and biopsy was done by posterior laminectomy, followed by external beam radiotherapy. Signs and symptoms improved after the completion of radiotherapy but did not resolve completely. Death caused by respiratory failure occurred 3 months later.Conclusions:
This presentation of GBM of the cervical cord is rare; an intramedullary tumor should be considered when minor cervical trauma results in disproportionate neurologic deficit. To the best of our knowledge, this is the first reported case of spinal GBM with extensive pan-cervical involvement. 相似文献2.
Sébastien Richard Chifaou Abdallah Anne Chanson Sylvain Foscolo Pierre-Alexandre Baillot Xavier Ducrocq 《The journal of spinal cord medicine》2014,37(2):233-236
Context
Ischemia of the cervical spinal cord is a rare complication of spontaneous vertebral artery dissection (VAD) and usually involves the ventral portion. We describe a less evocative clinical presentation and images of unilateral posterior spinal cord infarction due to spontaneous VAD in order to facilitate early diagnosis.Findings
A previously fit 30-year-old man presented with persistent headaches and proximal motor deficit of the right arm. He was diagnosed with spontaneous dissection of both vertebral arteries, with occlusion of the right one, and the right carotid artery. Neurological examination also revealed a right C2–C3 tactile sensory loss, with unilateral proprioceptive deficit below. Brain images revealed small bilateral cerebellar infarcts which could not be responsible for the clinical symptoms. Magnetic resonance imaging of the spinal cord showed a right posterior cervical spinal cord infarction. The patient achieved nearly complete recovery after several weeks of anticoagulation and rehabilitation.Conclusion and clinical relevance
Infarction of the caudal portion of the cervical spinal cord, especially unilateral, caused by spontaneous VAD, has rarely been described and is certainly under-diagnosed due to less suggestive symptoms, like unilateral and mainly sensory deficit. Nevertheless, early diagnosis of this condition is important to guide patient management and rehabilitation. 相似文献3.
Kyung-Jin Song Jong Hyun Ko Byung-Wan Choi 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(3):263-269
Objective
The purpose of this study was to determine the relationship between magnetic resonance imaging (MRI) findings and neurologic symptoms in cervical spine extension injury and to analyze the MRI parameters associated with neurologic outcome.Materials and methods
This study included 102 patients with cervical spine extension injury, whose medical records and MRI scans at the time of injury were available. Quantitative MRI parameters such as maximum spinal canal compression (MSCC), maximum cord compromise (MCC), and lesion length showing intramedullary signal changes were measured. Furthermore, intramedullary hemorrhage, spinal cord edema, and soft tissue damage were evaluated. Fisher’s exact test was used for a cross-analysis between the MRI findings and the three American Spinal Injury Association category groups depending on the severity level of neurologic injury: complete (category A), incomplete (categories B–D), and normal (category E).Results
MSCC accounted for 23.05, 19.5, and 9.94 % for the complete, incomplete, and normal AIS categories, respectively, without showing statistically significant differences (P = 0.085). MCC was noted in 22.05, 15.32, and 9.2 %, respectively, with the complete-injury group (AIS category A) showing significantly higher. In particular, cases of complete injury had >15 % compression, accounting for 87.5 % (P < 0.001). The mean intramedullary lesion length was significantly higher in complete-injury patients than in incomplete-injury patients (24.22 vs. 8.24 mm). Intramedullary hemorrhage and spinal cord edema were significantly more frequently observed in complete-injury cases (P < 0.001). The incidence of complete injury was proportional to the severity of soft tissue damage.Conclusion
MCC, intramedullary lesion length, intramedullary hemorrhage, and spinal cord edema were MRI parameters associated with poor neurologic outcomes in patients with cervical spine extension injury.4.
Background:
Acute paraplegia is a true emergency. It is often the result of trauma but is rarely reported in association with cervical disk herniation in patients without antecedent injury.Methods:
Case report.Findings:
This 75-year-old man presented with acute paraplegia due to severe compression of the spinal cord by herniation of the C4-C5 cervical disk. He underwent emergency diskectomy and anterior fusion. Postoperatively, his neurologic functions improved gradually.Conclusions:
Cervical disk herniation should be considered in the differential diagnosis of nontraumatic acute paraplegia. Pre-existing narrowed canal is an important predisposing factor and excessive neck movements are believed to be triggering factors. Immediate early decompressive surgery is recommended to avoid irreversible progression of neurologic deficit. 相似文献5.
Cai HX Liu C Zhang JF Wan SL Uchida K Fan SW 《The journal of spinal cord medicine》2011,34(4):432-436
Background
Spontaneous spinal epidural hematoma (SSEH) is an uncommon clinical entity. It produces a severe neurological deficit and prompt decompression is usually the first choice of treatment. Brown-Séquard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm, but rarely caused by SSEH.Methods
Case report and literature review.Findings
A previously healthy man presented with Brown-Séquard syndrome below T5–T6 cord segment secondary to spontaneous epidural hematoma. He opted for conservative treatment, which was followed by rapid resolution.Conclusions
Although Brown-Séquard syndrome as a presenting feature of SSEH is rare, it does exist in exceptional case, which should be taken into consideration for differential diagnosis. Prompt surgical decompression is an absolute surgical indication widely accepted for patient with progressive neurological deficit. However, SSEH presenting with incomplete neurological insult such as Brown-Séquard syndrome might have a benign course. Successful non-operative management of this problem does not make it a standard of care, and surgical decompression remains the standard treatment for SSEH. 相似文献6.
Background:
Diagnosing patients with cervical cord compressive myelopathy in a timely manner can be challenging due to varying clinical presentations, the absence of pathognomonic findings, and symptoms that are usually insidious in nature.Objective:
To describe the clinical course of a patient with primary complaint of left medial knee pain that was nonresponsive to surgical and conservative measures; the patient was subsequently diagnosed with cervical cord compressive myelopathy.Design:
Case report.Subject:
A 63-year-old man with a primary complaint of left medial knee pain.Findings:
Physical examination of the left knee was normal except for slight palpable tenderness over the medial joint line. During treatment, he noted loss of balance during activities of daily living. Reassessment revealed bilateral upper extremity hyperreflexia, bilateral Babinski reflex, and positive bilateral Hoffman reflex. Magnetic resonance imaging of the cervical spine demonstrated moderately severe spinal stenosis at the C3-C4, C5-C6, and C6-C7 levels. After C3-C7 laminoplasty for cervical cord compressive myelopathy, he reported substantial improvement of his left medial knee. Three years later, he had no complaint of knee pain.Conclusion:
Appropriate diagnosis and treatment of cervical cord compressive myelopathy may avoid unnecessary diagnostic imaging, medical evaluations, invasive procedures, and potential neurologic complications. 相似文献7.
Background
Cervical spondylotic myelopathy (CSM) is a devastating pathology that can severely impair quality of life. The symptoms in CSM progress slowly and often do not manifest until they become severe and potentially irreversible. There is a consensus that surgical intervention is warranted in symptomatic patients. The recovery of the neurologic deficit after surgical decompression of the spinal cord varies, and halting the progression of the disease remains the principle aim of surgery.Questions/Purposes
The aim of this review is to address the key question of whether or not to intervene in cases that have radiographic evidence of significant cervical stenosis yet are asymptomatic or exhibit minimal symptoms?Methods
The PubMed databases for publications that addressed asymptomatic cervical spondylotic myelopathy were reviewed. The relevant articles were selected after screening all the resulting abstracts. The references of the relevant articles were then reviewed, and cross references with titles discussing CSM were picked up for review.Results
The search identified 14 papers which were reviewed. Seven articles were found to be relevant to the subject in question. Going through the references of the relevant articles, three articles were found to be directly related to the topic in study.Conclusion
There is paucity of evidence to support for or against surgery in the setting of asymptomatic cervical spondylotic myelopathy despite radiographic evidence of severe stenosis. Patient factors such as age, level of activity, and risk of injury should be considered in formulating a management plan. Moreover, the patient should play an integral role in the process of decision making.Electronic supplementary material
The online version of this article (doi:10.1007/s11420-014-9426-4) contains supplementary material, which is available to authorized users. 相似文献8.
Pandey S 《The journal of spinal cord medicine》2011,34(6):609-611
Background
Tabes dorsalis is a late manifestation of untreated syphilis that is characterized by ataxia, lancinating pains, and urinary incontinence. A form of tertiary syphilis or neurosyphilis, it is the result of slow, progressive degeneration of the nerve cells in the spinal cord.Method
Case report.Findings
A 39-year-old man presented with tingling paresthesia in the lower limbs, difficulty in walking, and loss of vision. Magnetic resonance imaging (MRI) of the dorsal spine showed intramedullary hyperintensity and cord atrophy, similar to changes seen in subacute combined degeneration. MRI features of tabes dorsalis have not been described previously to the best of our knowledge.Conclusion
MRI findings in this patient with tabes dorsalis were similar to those seen in subacute combined degeneration, which is characterized predominantly by cord atrophy and intramedullary hyperintensities. 相似文献9.
Mehmet Se?er Murat Uluta? Erdal Yayla Kadir ??nar 《International journal of surgery case reports》2014,5(3):149-151
INTRODUCTION
This report describes a rare case of the gunshot injury of the spine and spinal cord.PRESENTATION OF CASE
A rare case of the bullet lodged intra-durally in the upper cervical region without damaging the vertebrae or the spinal cord. The bullet was removed as microneurosurgical and duraplasty was performed.DISCUSSION
Surgical management of the gunshot wounds of the spine and spinal cord is not widely advocated and controversial.CONCLUSION
Advances in microneurosurgical instrumentation and microscopic techniques may open up a new era of surgical treatment of spinal cord gunshot wounds. 相似文献10.
Context
Isolated involvement of the spinal cord is an uncommon presentation of neuro-Behçet''s disease (NBD) and it is associated with a poor prognosis for functional recovery.Method
A case report of an 18-year-old Turkish man who presented with a progressive paraparesis and bladder dysfunction secondary to a longitudinally extensive transverse myelitis as the sole presentation of NBD.Findings
Examination revealed a spastic paraparesis and a T7 sensory level. Magnetic resonance imaging revealed multiple enhancing lesions throughout the thoracic cord and cerebrospinal fluid showed intense neutrophilia. On further enquiry a family history of Behçet''s disease was elicited. The patient subsequently reported a history of recurrent oral ulceration and intermittent occular inflammation. A diagnosis of NBD was made and intravenous high-dose steroids commenced with poor response. In view of the poor prognosis for functional recovery associated with spinal NBD the patient was treated with infliximab, an anti-tumour necrosis factor-alpha monoclonal antibody, leading to excellent recovery of function.Conclusion/clinical relevance
Early treatment with infliximab may facilitate a favourable functional recovery and should be considered in cases of NBD with spinal cord involvement. 相似文献11.
Norihiro Nishida Tsukasa Kanchiku Yoshihiko Kato Yasuaki Imajo Yuichiro Yoshida Syunichi Kawano Toshihiko Taguchi 《The journal of spinal cord medicine》2015,38(5):593-598
Objective
Cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL) is induced by static factors, dynamic factors, or a combination of both. We used a three-dimensional finite element method (3D-FEM) to analyze the stress distributions in the cervical spinal cord under static compression, dynamic compression, or a combination of both in the context of OPLL.Methods
Experimental conditions were established for the 3D-FEM spinal cord, lamina, and hill-shaped OPLL. To simulate static compression of the spinal cord, anterior compression at 10, 20, and 30% of the anterior–posterior diameter of the spinal cord was applied by the OPLL. To simulate dynamic compression, the OPLL was rotated 5°, 10°, and 15° in the flexion direction. To simulate combined static and dynamic compression under 10 and 20% anterior static compression, the OPLL was rotated 5°, 10°, and 15° in the flexion direction.Results
The stress distribution in the spinal cord increased following static and dynamic compression by cervical OPLL. However, the stress distribution did not increase throughout the entire spinal cord. For combined static and dynamic compression, the stress distribution increased as the static compression increased, even for a mild range of motion (ROM).Conclusion
Symptoms may appear under static or dynamic compression only. However, under static compression, the stress distribution increases with the ROM of the responsible level and this makes it very likely that symptoms will worsen. We conclude that cervical OPLL myelopathy is induced by static factors, dynamic factors, and a combination of both. 相似文献12.
Toklu HZ Hakan T Celik H Biber N Erzik C Ogunc AV Akakin D Cikler E Cetinel S Ersahin M Sener G 《The journal of spinal cord medicine》2010,33(4):401-409
Background:
Oxidative stress is a mediator of secondary injury to the spinal cord following trauma.Objective:
To investigate the putative neuroprotective effect of α-lipoic acid (LA), a powerful antioxidant, in a rat model of spinal cord injury (SCI).Methods:
Wistar albino rats were divided as control, vehicle-treated SCI, and LA-treated SCI groups. To induce SCI, a standard weight-drop method that induced a moderately severe injury (100 g/cm force) at T10 was used. Injured animals were given either 50 mg/kg LA or saline at 30 minutes postinjury by intraperitoneal injection. At 7 days postinjury, neurologic examination was performed, and rats were decapitated. Spinal cord samples were taken for histologic examination or determination of malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO) activity, and DNA fragmentation. Formation of reactive oxygen species in spinal cord tissue samples was monitored by using a chemiluminescence (CL) technique.Results:
SCI caused a significant decrease in spinal cord GSH content, which was accompanied with significant increases in luminol CL and MDA levels, MPO activity, and DNA damage. Furthermore, LA treatment reversed all these biochemical parameters as well as SCI-induced histopathologic alterations. Conversely, impairment of the neurologic function caused by SCI remained unchanged.Conclusion:
The present study suggests that LA reduces SCI-induced oxidative stress and exerts neuroprotection by inhibiting lipid peroxidation, glutathione depletion, and DNA fragmentation. 相似文献13.
Context
Cervical myelopathy is a spinal cord dysfunction that results from extrinsic compression of the spinal cord, its blood supply, or both. It is the most common cause of spinal cord dysfunction in patients greater than 55 years of age.Findings: A
57-year-old male with right shoulder septic arthritis underwent surgical debridement of his right shoulder and sustained a spinal cord injury intraoperatively. The most likely etiology is damage to the cervical spinal cord during difficult intubation requiring multiple attempts in this patient with underlying asymptomatic severe cervical stenosis.Conclusion
Although it is not feasible to perform imaging studies on all patients undergoing intubation for surgery, this patient''s outcome would suggest consideration of inclusion of additional pre-surgical screening examination techniques, such as testing for a positive Hoffman''s reflex, is appropriate to detect asymptomatic patients who may have underlying cervical stenosis. 相似文献14.
15.
Kyung-Jin Song Byung-Wan Choi Sul-Jun Kim Gyu-Hyung Kim Young-Shin Kim Ji-Hun Song 《Clinics in Orthopedic Surgery》2009,1(1):11-18
Background
This study examined the relationship between four radiological parameters (Pavlov''s ratio, sagittal diameter, spinal cord area, and spinal canal area) in patients with a traumatic cervical spine injury, as well as the correlation between these parameters and the neurological outcome.Methods
A total of 212 cervical spinal levels in 53 patients with a distractive-extension injury were examined. The following four parameters were measured: Pavlov''s ratio on the plain lateral radiographs, the sagittal diameter, the spinal cord area, and the spinal canal area on the MRI scans. The Pearson correlation coefficients between the parameters at each level and between the levels of each parameter were evaluated. The correlation between the radiological parameters and the spinal cord injury status classified into four categories, A (complete), B (incomplete), C (radiculopathy), and D (normal) was assessed.Results
The mean Pavlov''s ratio, sagittal diameter, spinal cord area and spinal canal area was 0.84, 12.9 mm, 82.8 mm2 and 236.8 mm2, respectively. An examination of the correlation between the radiological spinal stenosis and clinical spinal cord injury revealed an increase in the values of the four radiological parameters from cohorts A to D. Pavlov''s ratio was the only parameter showing statistically significant correlation with the clinical status (p = 0.006).Conclusions
There was a correlation between the underlying spinal stenosis and the development of neurological impairment after a traumatic cervical spine injury. In addition, it is believed that Pavlov''s ratio can be used to help determine and predict the neurological outcome. 相似文献16.
Shao J Zhu W Chen X Jia L Song D Zhou X Yan W Zhang Y 《The journal of spinal cord medicine》2011,34(6):555-562
Background
A relatively high early mortality rate (<30 days post-injury) for cervical spinal cord injury (SCI) has been observed.Objective
To investigate this early mortality rate observed after cervical SCI and analyze the associated influential factors.Methods
Medical records for 1163 patients with cervical SCI were reviewed, and the number of patients with early mortality was documented. Through logistic regression analysis, the effects of age, gender, occupation, cause of injury, severity of injury, highest involved spinal cord segment, nutritional condition during hospitalization, surgical treatment, tracheotomy, etc., on early mortality were assessed. Implementation of early treatment (i.e. surgery, tracheotomy, and nutritional support) and its effect on patient prognosis were also analyzed.Results
Early mortality occurred in 109 of 1163 patients (9.4%). Four factors affected the early mortality rate, including level and severity of SCI, whether or not surgery was performed, the time interval between SCI and surgery, malnutrition, and tracheotomy. Patients with an American Spinal Injury Association grade of A, a high cervical SCI (C1–C3), and/or no surgical intervention were statistically more likely to have early mortality (P < 0.001).Conclusion
Severe cervical SCI, upper-level cervical cord injury, malnutrition, and inappropriate tracheotomy are risk factors for early mortality in patients with cervical SCI. Surgery can reduce early mortality. Early tracheotomy should be performed in patients with complete upper-level cervical SCI, but patients with incomplete cervical SCI or complete low-level cervical SCI should initially be treated surgically to maintain smooth airway flow. 相似文献17.
Background context
Intramedullary spinal arachnoid cysts are considered to be very rare, and only 11 cases have been reported previously. Development of such a cyst in association with marked cervical spondylosis has not been reported until recently.Purpose
Brief review of reported cases and debate on likely treatment strategy when such a cyst is associated with symptomatic spondylosis.Study design
To report the first example of a cervicothoracic intramedullary arachnoid cyst along with a symptomatic cervical spondylosis.Methods
Evaluation of quadriparesis in a 58-year-old female resulted in detection of a cervical spondylotic stenosis that was accompanied with an intramedullary cystic lesion. Parallel management of both pathologies was through a wide laminectomy extending from the lower edge of C3 to T2 with subsequent fenestration and partial resection of the cyst wall via an appropriate dorsal entry root zone myelotomy. Cervicothoracic instrumentation from C3 down to T2 was done to prevent postlaminectomy deformity.Result
Histopathological findings were consistent with the diagnosis of arachnoid cyst. Postoperatively, the patient exhibited marked improvement in neurologic status.Conclusion
Through the review of the current case, first example from the literature, we concluded that surgery should target toward the proper management of both pathologies in a single-stage operation. 相似文献18.
Feng Zhou Jun Zou Minfeng Gan Ruofu Zhu Huilin Yang 《Annals of the Royal College of Surgeons of England》2010,92(5):406-410
INTRODUCTION
Usually, cervical pedicle screw fixation has been considered too risky for neurovascular structures. The purpose of this study was to investigate the method and efficacy of the cervical pedicle screw system for fracture-dislocation of the cervical spine because of its rigid fixation.PATIENTS AND METHODS
A prospective study was conducted involving 48 patients with cervical spine fracture-dislocation who underwent cervical pedicle screw fixation surgery between January 2003 and January 2007. All patients had various degrees of cord injury, and they were classified according to the American Spinal Cord Injury Association (ASIA) Impairment Scale: 18 cases were grade A, 15 grade B, 10 grade C, and 5 grade D.RESULTS
Six months after the operation, all patients had achieved solid bony fusion and stable fixation of the related segments. Thirty patients with incomplete spinal cord injury improved their ASIA Impairment Scale classification by 1 to 2 grades after the operation. Eighteen patients with complete spinal cord injury had no improvement in neural function. However, nerve root symptoms such as pain and numbness were alleviated to some extent.CONCLUSIONS
The cervical pedicle screw system is an effective and reliable method for the restoration of cervical stability. Sufficient pre-operative imaging studies of the pedicles and strict screw insertion technique should be emphasised. 相似文献19.
Devipriya Rathnasabapathi Liene Elsone Anita Krishnan Carolyn Young Andrew Larner Anu Jacob 《The journal of spinal cord medicine》2015,38(4):551-555
Context
Progressive myelopathy can be a manifestation of a variety of disorders including progressive multiple sclerosis. However it is extremely uncommon for a single lesion to cause a progressive myelopathy in MS. Such a myelopathy, i.e. a progressive neurological deficit from a solitary demyelinating lesion, not fulfilling the International diagnostic criteria for MS or Neuromyelitis Optica was first reported in 2012 and termed ‘solitary sclerosis’.Method
We report 3 further cases of progressive myelopathy fulfilling the diagnostic criteria for solitary sclerosis.Findings
Two patients had a single demyelinating lesion in the cervical cord and the third patient had it in the brain stem. All patients had serial MRI scans showing no dissemination or progression of lesions. Extensive diagnostic tests including aquaporin 4 antibodies were negative in all. At last follow-up at a median of 3.8 years, all patients continued to clinically progress despite immunosuppressive treatment.Conclusion/Clinical Relevance
Solitary demyelinating lesions can cause a progressive myelopathy without clinical or radiological evidence of dissemination. Importantly, clinicians, both surgical and medical should be aware of such a diagnosis, to avoid invasive and often harmful tests particularly biopsies. 相似文献20.
Thomas Liebscher Andreas Niedeggen Barbara Estel Rainer O. Seidl 《The journal of spinal cord medicine》2015,38(5):607-614