Primary spinal syringomyelia. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2005

In the present review the author describes the different types of syringomyelia that originate from abnormalities at the level of the spinal cord rather than at the craniovertebral junction. These include posttraumatic and postinflammatory syringomyelia, as well as syringomyelia associated with arachnoid cysts and spinal cord tumors. The diagnosis and the principles of managing these lesions are discussed, notably resection of the entity restricting cerebrospinal fluid flow. Placement of a shunt into the syrinx cavity is reserved for patients in whom other procedures have failed or who are not candidates for other procedures.     

Successful treatment of spinal arachnoiditis due to coccidioidomycosis. Case report

An unusual case is reported of a patient with spastic paraparesis who was found to have severe spinal arachnoiditis due to Coccidioides immitis. Despite an obstructive hydrocephalus and a spinal subarachnoid block, the patient was treated effectively with surgery (shunting) and antifungal therapy (amphotericin and ketoconazole). He remains asymptomatic 3 years after diagnosis. Aggressive surgical and medical treatment of coccidioidal infection of the central nervous system can be beneficial, even in patients with the worst prognosis.     

Relationship between arterial blood pressure and plasma norepinephrine levels in a patient with neurogenic hypertension

This study examined the relationship between arterial blood pressure and plasma norepinephrine levels during 12 hours of monitored sleep in a 35-year-old man in whom neurogenic hypertension developed immediately after surgical removal of a large hemangioblastoma at the obex region of the cervical-medullary junction. Plasma norepinephrine levels throughout the 12-hour sampling period correlated (r = 0.81, p less than 0.01) with mean arterial blood pressures, suggesting that sleep-related changes in blood pressure were dependent on associated changes in sympathetic nervous system activity in this patient with neurogenic hypertension.     

Sphenoid sinus mucocele (anterior clinoid variant) mimicking diabetic ophthalmoplegia and retrobulbar neuritis

Two patients (two men, 56 and 59 years old) had sphenoid sinus mucocele originating in the anterior clinoid process. In one case the mucocele initially mimicked diabetic ophthalmoplegia with pupil-sparing palsy of the oculomotor (third) nerve. After resolution of the palsy, severe visual loss developed with minimal recovery of vision after surgery. The second patient had recurrent episodes of retrobulbar optic neuropathy with optic atrophy and decreased vision. Visual loss from sphenoid sinus mucoceles is usually associated with a poor prognosis if surgical treatment is delayed more than seven to ten days.     

Grisel's syndrome. Cervical spine clinical, pathologic, and neurologic manifestations

Grisel's syndrome involves the subluxation of the atlantoaxial joint from inflammatory ligamentous laxity following an infectious process. Even though it was first described in 1830, it is a rare disease usually affecting children, but infrequent adult cases do occur. Patients generally seek treatment for progressive unrelenting throat and neck pain followed by torticollis and subluxation. Neurologic complications occur in approximately 15% of cases and can range from radiculopathy to myelopathy and even death. Principles of management include bacteriologic cure and correction of bony deformity and neurologic protection. The authors present two adult patients with Grisel's syndrome. The first illustrates the permanent spinal deformity that can occur if the disease remains unrecognized for a prolonged period of time. The second case demonstrates a delayed neurologic complication in an adult who had Grisel's syndrome in childhood. It is hoped that these two examples, together with a detailed discussion of the literature, will inform physicians of an unusual but important condition to be considered in the differential diagnosis of any patient complaining of neck pain.     

Effect of Low-Intensity Vibration on Bone Strength,Microstructure, and Adiposity in Pre-Osteoporotic Postmenopausal Women: A Randomized Placebo-Controlled Trial

There has been evidence that cyclical mechanical stimulation may be osteogenic, thus providing opportunities for nonpharmacological treatment of degenerative bone disease. Here, we applied this technology to a cohort of postmenopausal women with varying bone mineral density (BMD) T-scores at the total hip (−0.524 ± 0.843) and spine (−0.795 ± 1.03) to examine the response to intervention after 1 year of daily treatment with 10 minutes of vibration therapy in a randomized double-blinded trial. The device operates either in an active mode (30 Hz and 0.3 g) or placebo. Primary endpoints were changes in bone stiffness at the distal tibia and marrow adiposity of the vertebrae, based on 3 Tesla high-resolution MRI and spectroscopic imaging, respectively. Secondary outcome variables included distal tibial trabecular microstructural parameters and vertebral deformity determined by MRI, volumetric and areal bone densities derived using peripheral quantitative computed tomography (pQCT) of the tibia, and dual-energy X-ray absorptiometry (DXA)-based BMD of the hip and spine. Device adherence was 83% in the active group (n = 42) and 86% in the placebo group (n = 38) and did not differ between groups (p = .7). The mean 12-month changes in tibial stiffness in the treatment group and placebo group were +1.31 ± 6.05% and −2.55 ± 3.90%, respectively (group difference 3.86%, p = .0096). In the active group, marrow fat fraction significantly decreased after 12 months of intervention (p = .0003), whereas no significant change was observed in the placebo group (p = .7; group difference −1.59%, p = .029). Mean differences of the changes in trabecular bone volume fraction (p = .048) and erosion index (p = .044) were also significant, as was pQCT-derived trabecular volumetric BMD (vBMD; p = .016) at the tibia. The data are commensurate with the hypothesis that vibration therapy is protective against loss in mechanical strength and, further, that the intervention minimizes the shift from the osteoblastic to the adipocytic lineage of mesenchymal stem cells. © 2020 American Society for Bone and Mineral Research (ASBMR).