Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis

Abstract

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.     

儿童无放射学影像异常的脊髓损伤14例临床分析

目的：提高对儿童无放射学影像异常的脊髓损伤（spinal cord injury without radiographic abnormality，SCIWORA）的认识。方法：对1992年1月至2005年8月北京儿童医院住院患者中诊断为“急性脊髓炎”或“脊髓损伤”的187例进行回顾性分析，发现其中14例为SCIWORA。男6例，女8例。年龄1岁3个月～15岁（15岁1例，1岁3个月～7岁13例）。均有明确外伤史。损伤水平在C6～T9，颈髓2例，胸髓12例。脊髓功能ASIA分级：A级9例，C级4例，D级1例。脊柱X线片和CT未见骨折及脱位；MRI检查示脊髓水肿9例,脊髓出血2例，脊髓挫伤3例。采用综合治疗，包括卧床、局部制动，应用激素、脱水剂、神经营养药等。结果：4例患者失访，10例患者随访6个月～5年，平均2年3个月，4例（C级3例，D级1例）患者（均为MRI显示水肿局限者）在伤后6个月运动、感觉及括约肌功能完全恢复（E级）；6例（A级）患者运动、感觉及括约肌障碍未恢复。2例（A级）病初MRI表现为脊髓弥漫水肿者，伤后4～6个月复查MRI脊髓呈萎缩样改变。结论：对怀疑SCIWORA的儿童，应首选MRI检查。脊髓水肿局限者预后好，水肿弥漫或伴有出血、挫伤者预后差。     

功能性磁共振成像技术在脊髓功能研究中的应用

正磁共振成像(MRI)具有软组织分辨率高、多方位任意切层、多参数成像等优点,在临床工作中备受欢迎。但其单一地呈现组织形态学变化的现状已经不能满足目前疾病诊断的需求,功能性磁共振成像(f MRI)应运而生。f MRI是在普通MRI的基础上,着重反映某一特定神经组织功能状态的成像技术,最早被广泛应用于脑组织疾病研究~([1-2])。早期因脊髓周围的解剖结构和运动伪影等问题而使脊髓f MRI的发展受到一定的限制。目前随着技术的改进     

Inflammatory sacroiliitis in a man with spinal cord injury

BACKGROUND: Inflammatory sacroiliitis associated with spinal cord injury (SCI) as an unusual cause of elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level has not been reported previously to our knowledge. OBJECTIVE: To represent a case of SCI associated with bilateral sacroiliitis causing ESR and CRP level elevation. METHODS: Case report of a man with T9 paraplegia. FINDINGS: ESR and CRP levels were high. Pelvic radiography was nearly normal, except for mildly blurred sacroiliac joints with normal margins. A 3-phase bone scan revealed bilateral sacroiliitis and heterotopic ossification at medial side of the left knee. Past history was significant for a recent urinary tract infection. Indomethacin and etidronate were prescribed. Significant decreases in ESR and CRP level were seen 1 month later. CONCLUSIONS: Sacroiliitis might be an unusual cause of elevated ESR and CRP levels in patients with SCI. Sensory and motor deficits may obscure the typical clinical presentation; therefore, imaging studies are essential for the diagnosis.     

Shoulder magnetic resonance imaging findings in manual wheelchair users with spinal cord injury

Objective: To investigate the prevalence of rotator cuff and long head of the biceps pathologies in manual wheelchair (MWC) users with spinal cord injury (SCI).Design: Cross-sectional study.Setting: Outpatient clinic at a tertiary medical center.Participants: Forty-four adult MWC users with SCI (36 men and 8 women) with an average age (SD) of 42 (13) years. SCI levels ranged from C6 to L1; complete and incomplete SCI.Outcome Measures: Participants’ demographic and anthropometric information, presence of shoulder pain, Wheelchair User’s Pain Index (WUSPI) scores, and magnetic resonance imaging findings of shoulder pathologies including tendinopathy, tendon tears, and muscle atrophy.Results: Fifty-nine percent of the participants reported some shoulder pain. The prevalence of any tendinopathy across the rotator cuff and the long head of biceps tendon was 98%. The prevalence of tendinopathy in the supraspinatus was 86%, infraspinatus was 91%, subscapularis was 75%, and biceps was 57%. The majority of tendinopathies had mild or moderate severity. The prevalence of any tears was 68%. The prevalence of tendon tears in the supraspinatus was 48%, infraspinatus was 36%, subscapularis was 43%, and biceps was 12%. The majority of the tears were partial-thickness tears. Participants without tendon tears were significantly younger (P < 0.001) and had been wheelchair user for a significantly shorter time (P = 0.005) than those with tendon tears.Conclusion: Mild and moderate shoulder tendinopathy and partial-thickness tendon tears were highly prevalent in MWC users with SCI. Additionally, the findings of this study suggest that strategies for monitoring shoulder pathologies in this population should not be overly reliant on patient-reported pain, but perhaps more concerned with years of wheelchair use and age.     

Magnetic resonance imaging in spinal emergency

Summary We studied the diagnostic value of MRI in spinal emergency. One hundred patients were analyzed retrospectively and the MR-findings were compared with operative results or autopsy whenever available. The advantages of MRI compared to CT and conventional myelography are discussed. The limitations of MRI are addressed and the important features of appropriate diagnostic procedure are outlined with special attention to neurosurgical requirements.     

应用改进封闭脊髓窗技术活体观察脊髓损伤后脊髓微循环变化

目的:探讨应用改进的封闭脊髓窗技术活体观察大鼠脊髓损伤后脊髓微循环变化的可行性及效果.方法:改进传统的脊髓窗,设计带有打击探头的脊髓窗.45只SD大鼠随机分为对照组(n=20)和实验组(n=25).实验组大鼠脊髓窗安装完成后进行窗内打击脊髓,然后即时观察并记录打击后2h内打击点周围微动脉直径的变化.对照组大鼠在脊髓窗安装完成后不进行打击,只对脊髓微动脉直径进行连续2h观察并记录.术后两组大鼠进行BBB运动功能评分,处死动物取脊髓标本切片,HE染色,观察脊髓组织改变情况.结果:实验组大鼠打击点周围2～6mm的微动脉直径在打击后10min、30min、1h、2h各时间点均较打击前明显减小,术后2d及7d时BBB功能评分明显低于术前,病理切片可见脊髓打击区神经组织变性液化.对照组大鼠在观测开始及结束时脊髓微动脉直径无明显变化,术后BBB评分与术前BBB评分均为21分,病理切片未见脊髓损伤表现.结论:改进的封闭脊髓窗技术可以有效地实现窗内打击脊髓,并可以安全地对脊髓表面微血管进行活体观测.脊髓表面打击点周围2～6mm的微动脉在脊髓损伤后10min即发生痉挛.     

Salmonella prostatitis in a man with spinal cord injury

Abstract

Context

Prostatitis is a very unusual manifestation of Salmonella urinary tract infection and has not been reported in men with spinal cord injury (SCI).

Findings

A 57-year-old man with paraplegia and a history of recurrent symptomatic urinary tract infections presented with Salmonella typhimurium prostatitis. Clinical and sonographic examination of the urinary tract, as well as urinalysis including microbiologic examination, revealed no relevant abnormalities. The microbiologic analysis of the ejaculate revealed growth of monophasic Salmonella enterica ssp. enterica serotype 4,12:i:-. A 6-week course of antibiotic treatment was initiated. There were no recurrent symptomatic urinary tract infections during follow-up.

Conclusion

Salmonellosis is a reportable disease and carriers have to refrain from activities in the food sector. Therefore, Salmonella prostatitis should be considered and excluded in men with SCI and a history of recurrent urinary tract infection who use intermittent catheterization for bladder management.     

TRH对大鼠脊髓损伤后SCBF和SEP的影响

脊髓损伤（ＳＣＩ）后内源性阿片肽释放，并参与脊髓的继发损伤机制。ＴＲＨ可阻断阿片肽的自主神经效应，而不影响痛觉。本实验探讨大剂量ＴＲＨ（２ｍｇ／ｋｇ／ｈ）治疗对大鼠脊髓打击伤（Ａｌｌｅｎｓ法１０ｇｘ５ｃｍ）后脊髓血流量（ＳＣＢＦ）和脊髓诱发电位（ＳＥＰ）的影响。脊髓损伤后１ｈ，ＳＣＢＦ开始显著下降，持续至伤后２４ｈ，ＳＥＰ峰潜时呈进行性延长趋势；伤后即刻静脉注射ＴＲＨ（２ｍｇ／ｋｇ／ｈ，共５次），可使伤后即刻和２４ｈ的ＳＣＢＦ显著升高，并使伤后ＳＣＢＦ下降时间延迟３ｈ，同时ＳＥＰ峰潜时有不同程度改善。结果表明，ＴＲＨ对受伤脊髓早期有一定的防治作用，并具有一定的后发效应；同时也可促进脊髓的神经传导功能。本文亦对ＴＲＨ治疗ＳＣＩ的病理生物学机制进行了讨论。     

Magnetic resonance imaging of the spinal cord in spinal dysraphisms

Magnetic resonance imaging (MRI) was performed 49 times in 42 patients with spinal dysraphism. Scoliosis and a changing neurological picture were the primary indications. Spinal cord anomalies included hydromyelia, diastematomyelia, lipoma, thickened filum terminali, and spinal cord atrophy. All but one patient exhibited Arnold-Chiari malformation. Twenty-two of the 42 patients had computed tomography (CT) scans, myelograms, or operations that corroborated the 41 MRI findings. Three false-positive MRI findings of hydromyelia and no false-negative studies were observed. MRI is a noninvasive investigative technique that provides more information than myelography or CT in defining spinal cord anatomy in spinal dysraphism.     

Cystic spinal cord tumors: Magnetic resonance imaging correlated to histopathological findings

We report the characteristics of magnetic resonance imaging (MRI) of cystic intradural extramedullary spinal cord tumors (cystic neurilemmoma, epidermoid cyst, and enterogeneous cyst). T1-weighted MRI enhanced with gadolinium-DTPA clearly demonstrated the rim morphology of these tumors. The comparison between the rim enhancement pattern and histopathological findings offered possible qualitative diagnosis of these cystic spinal cord tumors by MRI.     

Simultaneously diagnosed pulmonary thromboembolism and hemopericardium in a man with thoracic spinal cord injury

Abstract

Background

Simultaneous pulmonary thromboembolism (PTE) and hemopericardium is a rare but life-threatening condition. As hemopericardium is a contraindication to anticoagulation treatment, it is challenging to handle both conditions together.

Objective

The objective of the study was to report a rare case of a man with thoracic spinal cord injury presenting with simultaneous PTE and hemopericardium.

Design

Case report.

Subject

A 43-year-old man with incomplete T9 paraplegia (American Spinal Injury Association Impairment Scale D) complained of fever one and a half months after spinal cord injury sustained in a fall.

Findings

During evaluation of fever origin, chest computed tomography and transthoracic echocardiogram revealed simultaneous PTE and hemopericardium. After serial echocardiograms over 2 days demonstrated stability, intravenous heparin, and oral warfarin were administered and his medical status was observed closely. Ultimately, both conditions improved without significant complications.

Conclusion

We report successful treatment of man with acute spinal cord injury who presented with simultaneously diagnosed PTE and hemopericardium, a rare complication involving two distinct and opposing pathological mechanisms and conflicting treatments.     

Salmonella prostatitis in a man with spinal cord injury

Context

Prostatitis is a very unusual manifestation of Salmonella urinary tract infection and has not been reported in men with spinal cord injury (SCI).

Findings

A 57-year-old man with paraplegia and a history of recurrent symptomatic urinary tract infections presented with Salmonella typhimurium prostatitis. Clinical and sonographic examination of the urinary tract, as well as urinalysis including microbiologic examination, revealed no relevant abnormalities. The microbiologic analysis of the ejaculate revealed growth of monophasic Salmonella enterica ssp. enterica serotype 4,12:i:-. A 6-week course of antibiotic treatment was initiated. There were no recurrent symptomatic urinary tract infections during follow-up.

Conclusion

Salmonellosis is a reportable disease and carriers have to refrain from activities in the food sector. Therefore, Salmonella prostatitis should be considered and excluded in men with SCI and a history of recurrent urinary tract infection who use intermittent catheterization for bladder management.     

皮导节段性脊髓诱发电位在脊髓型颈椎病中的应用

本文通过对１０只成兔、 ２０名神经功能正常看、 ３例椎管狭窄症不伴有脊髓功能障碍和 ３０例脊髓型颈椎病者经皮导出的皮导节段性脊髓诱发电位 （ｐｅｒｃｕｔａｎｅｏｕｓ ｓｅｇｍｅｎｔａｌ ｓｐｉｎａｌ ｃｏｒｄ ｅｖｏｋｅｄｐｏｔｅｎｔｉａｌ，ＰＳＳＣＥＰ）进行对比分析研究后，证实了从颈背侧中线皮下导出的Ｐ１、Ｎ１和Ｐ２波不仅能对脊髓型颈椎病做出脊髓功能定位诊断，而且对估计预后和制定正确手术方案都有一定参考和实用价值。     

Simultaneously diagnosed pulmonary thromboembolism and hemopericardium in a man with thoracic spinal cord injury

Background

Simultaneous pulmonary thromboembolism (PTE) and hemopericardium is a rare but life-threatening condition. As hemopericardium is a contraindication to anticoagulation treatment, it is challenging to handle both conditions together.

Objective

The objective of the study was to report a rare case of a man with thoracic spinal cord injury presenting with simultaneous PTE and hemopericardium.

Design

Case report.

Subject

A 43-year-old man with incomplete T9 paraplegia (American Spinal Injury Association Impairment Scale D) complained of fever one and a half months after spinal cord injury sustained in a fall.

Findings

During evaluation of fever origin, chest computed tomography and transthoracic echocardiogram revealed simultaneous PTE and hemopericardium. After serial echocardiograms over 2 days demonstrated stability, intravenous heparin, and oral warfarin were administered and his medical status was observed closely. Ultimately, both conditions improved without significant complications.

Conclusion

We report successful treatment of man with acute spinal cord injury who presented with simultaneously diagnosed PTE and hemopericardium, a rare complication involving two distinct and opposing pathological mechanisms and conflicting treatments.     

Inpatient rehabilitation outcomes in patients with malignant spinal cord compression compared to other non-traumatic spinal cord injury: A population based study

Abstract

Objective

To compare and describe demographic characteristics, clinical, and survival outcomes in patients admitted for inpatient rehabilitation following malignant spinal cord compression (MSCC) or other causes of non-traumatic spinal cord injury (NT-SCI).

Design

A retrospective cohort design was employed, using data retrieved from administrative databases.

Setting

Rehabilitation facilities or designated rehabilitation beds in Ontario, Canada, from April 2007 to March 2011.

Participants

Patients with incident diagnoses of MSCC (N = 143) or NT-SCI (N = 1,274) admitted for inpatient rehabilitation.

Outcome measures

Demographic, impairment, functional outcome (as defined by the Functional Independence Measure (FIM)), discharge, healthcare utilization, survival, and tumor characteristics.

Results

There was a significant improvement in the FIM from admission to discharge (mean change 20.1 ± 14.3, <0.001) in the MSCC cohort. NT-SCI patients demonstrated a higher FIM efficiency (1.2 ± 1.7 vs. 0.8 ± 0.8, <0.001) and higher total (24.0 ± 14.4 vs. 20.1 ± 14.3, <0.001) FIM gains relative to MSCC cases. However, there were no differences between the MSCC and NT-SCI cohorts in length of stay (34.6 ± 30.3 vs. 37.5 ± 35.2, P = 0.8) or discharge FIM (100.7 ± 19.6 vs. 103.3 ± 18.1, P = 0.1). Three-month, 1-year, and 3-year survival rates in the MSCC and NT-SCI cohorts were 76.2% vs. 97.6%, 46.2% vs. 93.7%, and 27.3% vs. 86.7%, respectively. The majority (65.0%) of patients with MSCC was discharged home and met their rehabilitation goals (75.5%) at comparable rates to patients with NT-SCI (69.7 and 81.3%).

Conclusion

Despite compromised survival, patients with MSCC make clinically significant functional gains and exhibit favorable discharge outcomes following inpatient rehabilitation. Current administrative data suggests the design and scope of inpatient rehabilitation services should reflect the unique survival-related prognostic factors in patients with MSCC.     

Diffusion tensor MR imaging in spinal cord injury

BackgroundThe ability of diffusion tensor imaging (DTI) to complement conventional MR imaging by diagnosing subtle injuries to the spinal cord is a subject of intense research. We attempted to study change in the DTI indices, namely fractional anisotropy (FA) and mean diffusivity (MD) after traumatic cervical spinal cord injury and compared these with corresponding data from a control group of individuals with no injury. The correlation of these quantitative indices to the neurological profile of the patients was assessed.Material and methods20 cases of acute cervical trauma and 30 age and sex matched healthy controls were enrolled. Scoring of extent of clinical severity was done based on the Frankel grading system. MRI was performed on a 3T system. Following the qualitative tractographic evaluation of white matter tracts, quantitative datametrics were calculated.ResultsIn patients, the Mean FA value at the level of injury (0.43+/−0.08) was less than in controls (0.62+/−0.06), which was statistically significant (p value <0.001). Further, the Mean MD value at the level of injury (1.30+/−0.24) in cases was higher than in controls (1.07+/−0.12, p value <0.001). Statistically significant positive correlation was found between clinical grading (Frankel grade) and FA values at the level of injury (r value = 0.86). Negative correlation was found between clinical grade and Mean MD at the level of injury (r value = −0.38) which was however statistically not significant.ConclusionQuantitative DTI indices are a useful parameter for detection of spinal cord injury. FA value was significantly decreased while MD value was significantly increased at the level of injury in cases as compared to controls. Further, FA showed significant correlation with clinical grade. DTI could thus serve as a reliable objective imaging tool for assessment of white matter integrity and prognostication of functional outcome.     

Inpatient rehabilitation outcomes in patients with malignant spinal cord compression compared to other non-traumatic spinal cord injury: A population based study

ObjectiveTo compare and describe demographic characteristics, clinical, and survival outcomes in patients admitted for inpatient rehabilitation following malignant spinal cord compression (MSCC) or other causes of non-traumatic spinal cord injury (NT-SCI).DesignA retrospective cohort design was employed, using data retrieved from administrative databases.SettingRehabilitation facilities or designated rehabilitation beds in Ontario, Canada, from April 2007 to March 2011.ParticipantsPatients with incident diagnoses of MSCC (N = 143) or NT-SCI (N = 1,274) admitted for inpatient rehabilitation.ResultsThere was a significant improvement in the FIM from admission to discharge (mean change 20.1 ± 14.3, <0.001) in the MSCC cohort. NT-SCI patients demonstrated a higher FIM efficiency (1.2 ± 1.7 vs. 0.8 ± 0.8, <0.001) and higher total (24.0 ± 14.4 vs. 20.1 ± 14.3, <0.001) FIM gains relative to MSCC cases. However, there were no differences between the MSCC and NT-SCI cohorts in length of stay (34.6 ± 30.3 vs. 37.5 ± 35.2, P = 0.8) or discharge FIM (100.7 ± 19.6 vs. 103.3 ± 18.1, P = 0.1). Three-month, 1-year, and 3-year survival rates in the MSCC and NT-SCI cohorts were 76.2% vs. 97.6%, 46.2% vs. 93.7%, and 27.3% vs. 86.7%, respectively. The majority (65.0%) of patients with MSCC was discharged home and met their rehabilitation goals (75.5%) at comparable rates to patients with NT-SCI (69.7 and 81.3%).ConclusionDespite compromised survival, patients with MSCC make clinically significant functional gains and exhibit favorable discharge outcomes following inpatient rehabilitation. Current administrative data suggests the design and scope of inpatient rehabilitation services should reflect the unique survival-related prognostic factors in patients with MSCC.     

Experimental determination of the effect of progressive sharp-angle spinal deformity on the spinal cord

Neurological deficit is a serious though not well-known complication associated with spinal deformity. Sharp-angle kyphosis may be congenital, traumatic, degenerative, infectious, or iatrogenic in origin. Many kyphotic deformities are underestimated, thus leading to severe neurological deficit. In order to determine exactly what procedures of angulation the patients should undergo to stabilize the spine, which are major operations, the authors analyzed in an experimental model the effects of progressive sharp angulation on the anatomy of spinal canal and cord. We found that sharp anterior angulation of 50° causes ante rior-posterior stenosis and the dura will touch the spinal cord. At 90° of angulation, the spinal cord will be squeezed and the pressure in the canal will be double what it was initially, probably leading to ischemia. The experimental confirmation (determination) of these angulations allows the physician in charge to define early in the treatment program when a surgical stabilization procedure should be included, before the angulation causes any neurological damage.