Cervical myelopathy induced by calcium pyrophosphate tophus in primary chondrocalcinosis

A 78 year old female patient with cervical myelopathy induced by a calcium pyrophosphate dihydrate tophus around the dens axis with clinical signs of a cervical tumor is presented. After operation of the tumor, the diagnosis of a generalized CPPD disease was established retrospectively, where by patient had complained of joint pain already for many years. This known complication of a primary chondrocalcinosis should be a reason for a careful investigation of the cervical spine in CPPD disease, because neurological disturbances might increase the joint destruction in the manner of "Charcot joints".     

Cervical myelopathy due to atraumatic odontoid fracture in patients with rheumatoid arthritis: A case series

To highlight the risk of cervical myelopathy due to occult, atraumatic odontoid fracture in patients with rheumatoid arthritis, we retrospectively reviewed radiographic findings and clinical observations for 7 patients with this disorder. This fracture tends to occur in patients with long-lasting rheumatoid arthritis and to be misdiagnosed as simple atlantoaxial dislocation. Since this fracture causes multidirectional instability between C1 and C2 and is expected to have poor healing potential due to bone erosion and inadequate blood supply, posterior spinal arthrodesis surgery is indicated upon identification of the fracture to prevent myelopathy.     

Cervical myelopathy due to a "tight dural canal in flexion" with a posterior epidural cavity

A 41-year-old man noticed weakness and atrophy in his right hand and forearm resembling the non-progressive juvenile muscular atrophy of unilateral upper extremity (Hirayama's disease). MRI showed an abnormal cavity in the posterior epidural space which appeared on neck flexion communicating with the subarachnoid space in addition to the flattening of the lower cervical spinal cord on neck flexion. When evaluating atypical cases of Hirayama's disease, the pathomechanism demonstrated in the present case should be taken into consideration.     

Cervical myelopathy caused by periodontoid synovial pannus in a patient with psoriatic arthritis: a case report

The atlantoaxial subluxation and the formation of a synovial periodontoid pannus are associated with rheumatoid arthritis causing mechanical compression of the spinal cord and cervical myelopathy. Atlantoaxial subluxation is very rare in psoriatic arthritis (PsA). Even more rare is the formation of a periodontoid synovial pannus associated with PsA and signs of myelopathy. In this report, cervical myelopathy caused by periodontoid synovial pannus in PsA is described.     

肝性脊髓病

肝性脊髓病(hepatic myelopathy)又称肝硬化脊髓病,门腔脊髓病,分流性脑脊髓病等,是慢性肝病晚期的一种特殊的并发症,临床较少见。1949年Leigh与Card首先报道。国内自1976年以来已有较多报道。本文就其研究进展综述如下。 1 病因与机制肝性脊髓病的病因目前为止仍不很清楚,有多     

肝性脊髓病的研究进展

肝性脊髓病(HM)是由多种肝病引起的一种少见的神经系统并发症,有着多重复杂的发病机制,主要病理改变为脊髓对称性侧索脱髓鞘病变,以慢性、进展性双下肢运动受累的痉挛性截瘫为特征性临床表现。运动诱发电位(MEP)可以在出现临床症状前帮助早期诊断HM,并且早期肝移植可望治愈HM。     

AIDS-associated vacuolar myelopathy

AIDS-associated vacuolar myelopathy (VM) is a common neurologic complication of AIDS. Pathologically, VM is characterized by vacuolization in the lateral and posterior columns of the thoracic spinal cord and has a striking similarity with the myelopathy of vitamin B12 deficiency. In autopsy series, 20% to 55% of patients with AIDS have evidence of spinal cord disease consistent with VM. The myelopathy usually manifests late in the course of HIV infection, with slowly progressive weakness of the lower extremities, gait disorder, sensory abnormalities in the legs, impotence in men, and urinary frequency and urgency. Its course is invariably progressive and leads to severe paralysis of the lower limbs, with loss of the ability to walk and of sphincter control. The differential diagnosis is extensive and includes metabolic, infective, and neoplastic spinal cord diseases. The diagnosis is based on the clinical observation and the exclusion of other causes of myelopathy via serologic, radiographic, and cerebrospinal fluid studies. The pathogenesis of VM is unknown. Attempts to detect HIV in the spinal cord have not yielded significant results, and there is no evidence of a relationship between the presence of HIV and the development of myelopathy. A metabolic disorder of the vitamin B12-dependent transmethylation pathway, induced by HIV or cytokine activation, is considered the possible cause of VM associated with AIDS. There is no known treatment for AIDS myelopathy and there is no evidence that antiretroviral drugs can improve the symptoms or slow the progression of VM. The symptomatic treatment includes antispasticity agents, management of sphincter dysfunction, and physical therapy. Experimental treatments are being tested in clinical trials.     

Ischemic myelopathy.

Ischemic myelopathy and Angiology of the Spinal Cord have recently drawn the attention of both paraplegists and angiologists, and their details are now fairly well known. Ischemic myelopathies increased with the rise of vascular surgery, but the means of prevention have been carefully studied and the incidence is now decreasing. Twenty-five hundred cases of cord injury have been reviewed, and among 92 nontraumatic cases, 16 ischemic myelopathies have been tabulated. The anatomy and physiology of the spinal cord circulation have been described.     

Postshunt myelopathy.

Postshunt myelopathy is a rare, severely debilitating syndrome complicating portosystemic shunts that is characterized by spastic paraparesis. In this report we describe a 39-year-old woman with alcoholic liver disease and postshunt myelopathy resulting in an inability to walk. The syndrome did not become manifest until eight years after construction of a side-to-side portacaval shunt. This case is compared with reported literature on the subject.     

Amphotericin B-induced myelopathy

Two patients with coccidioidal meningitis experienced transient neurologic deficits shortly after receiving intrathecal injections of amphotericin B. Continuation of treatment eventually led to a severe flaccid paraparesis with a thoracic sensory level in one patient, and a partial Brown-Séquard's syndrome in the other. Myelography was normal in both, with no evidence of arachnoiditis. Autopsy findings in the first patient showed a focal area of necrosis in the left half of the spinal cord consistent with the patient's clinical findings during life. The distribution of the lesion corresponded to the area supplied by a central sulcal artery. Amphotericin B may exert a direct toxic effect on the spinal cord or its vascular supply when given intrathecally.     

Cervical myelopathy, ossification of the posterior longitudinal ligament, and diffuse idiopathic skeletal hyperostosis: problems in investigation.

This report describes a patient presenting with a spastic quadriplegia who was found to have both diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. There was a dramatic worsening of his symptoms during a myelogram examination of the neck. It is suggested that computed tomographic imaging of the neck is the preferred investigative procedure if OPLL is suspected as a cause of cervical myelopathy.