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Kumral E, Bayam FE, Özerol R, Orman M. Predictors of Outcome in Patients with Medullary Hemorrhage. J Stroke Cerebrovasc Dis 2020; 29:105337. [PMID: 33007679 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Isolated medullary hemorrhage (MH) is an uncommon presentation of spontaneous intraparenchymal hemorrhage. The relationship between MH and neurological outcome is not well known. This study aims to assess predictive parameters for the outcome of medullary hemorrhage. METHODS We conducted an extensive search of the literature for cases with spontaneous, isolated MH. The study was conducted according to the statement of Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA). Forty-three cases diagnosed by CT or MRI have been reported in the literature, to which we add three confirmed by MRI. The ventrodorsal size of hemorrhage was taken into account as a parameter of outcome. Early neurologic deterioration (END) was defined as an incremental increase in the National Institutes of Health Stroke Scale score by ≥1 point in motor power, or ≥2 points in the total score within the first week after admission. Modified Rankin Score (mRS) 0-2 was presumed as favorable outcome (FO) and mRS 3-6 score as unfavorable outcome (UO) at discharge and at 3 months after stroke. RESULTS We enrolled 46 patients, and 17 (37%) patients were diagnosed with END. The cause of medullary hemorrhage was mostly vascular malformations, including cavernous malformation (33%) and arteriovenous malformation (11%). In univariate analyses, neither arteriovenous malformations (OR, 1.04; 95%CI, 0.10-10.53; P = 0.68) nor cavernomas (OR, 1.04; 95%CI, 0.22-4.89; P = 0.62) were associated with UO. Acute respiratory distress syndrome was higher in patients with UO group (44%) compared to those with FO group (16%), but this difference did not reach to a significant level (OR, 4.13; 95%CI, 0.85-20.04; P = 0.09). The diameter of hemorrhage was significantly larger (≥1 cm) in patients with UO compared to those with FO (OR, 16.67; 95%CI, 1.87-148.89; P = 0.003). Three months after stroke, 37 patients (80%) had FO and 9 (19.5%) had UO, and 5 (11%) died. Multiple logistic regression analysis using predetermined variables found to be significant in univariate analyses (END, consciousness disturbance at admission, hemorrhage size, and hypertension) showed that END at stroke onset was significantly associated with UO (OR, 4.97; CI95%, 1.13-21.94; P = 0.03). CONCLUSIONS These results suggest that the END is a predictor for UO in patients with medullary hemorrhage. The extent of the medullary hemorrhage along the conduction tract may contribute to deterioration.
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Affiliation(s)
- Emre Kumral
- Neurology Department, Ege University, Medical School Hospital, İzmir, Turkey.
| | | | - Rana Özerol
- Neurology Department, Ege University, Medical School Hospital, İzmir, Turkey
| | - Mehmet Orman
- Biostatistic Department, Ege University, Medical School Hospital, İzmir, Turkey
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Morozumi M, Imagama S, Ando K, Kobayashi K, Hida T, Ito K, Tsushima M, Matsumoto A, Tanaka S, Machino M, Ota K, Nishida Y, Ishiguro N. Surgical intervention for a pediatric isolated intramedullary spinal aneurysm. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:342-346. [PMID: 28785998 DOI: 10.1007/s00586-017-5256-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/01/2017] [Accepted: 08/03/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE To report the case of a pediatric patient with intramedullary spinal aneurysm. METHODS A 9-year-old boy presented with low back pain and subsequent gait disturbance. He had no history of trauma. After admission, MRI revealed an intramedullary spinal cord mass lesion surrounded by hemorrhage at the cervical-thoracic junction. Initial treatment was started with intravenous methylprednisolone and bed rest. Neurological deficit disappeared under careful observation for a few months. Surgical intervention was applied for diagnosis and resection of the mass lesion to prevent recurrent hemorrhage. RESULTS Intraoperative ultrasound sonography helped to diagnose the lesion as a spinal cord aneurysm, prior to midline myelotomy. Monitoring of transcranial muscle evoked potentials helped to avoid spinal cord damage during surgery. There has been no evidence of spinal aneurysm on MRI for 3 years after surgery and no neurological deterioration. CONCLUSION To our knowledge, this is a first report of an intramedullary spinal cord aneurysm at the cervical-thoracic junction in a pediatric patient. Careful observation after initial symptoms followed by surgical intervention was favorable in this case.
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Affiliation(s)
- Masayoshi Morozumi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan.
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
| | - Tetsuro Hida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
| | - Kenyu Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
| | - Mikito Tsushima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
| | - Akiyuki Matsumoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
| | - Satoshi Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
| | - Kyotaro Ota
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
| | - Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan
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Zhang HL, Wu J, Liu P, Lei J, Liu J. Wallenberg syndrome caused by hemorrhage in medulla oblongata: a case report. Health (London) 2010. [DOI: 10.4236/health.2010.210180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Santos-Franco JA, de Oliveira E, Mercado R, Ortiz-Velazquez RI, Revuelta-Gutierrez R, Gomez-Llata S. Microsurgical considerations of the anterior spinal and the anterior-ventral spinal arteries. Acta Neurochir (Wien) 2006; 148:329-38; discussion 338. [PMID: 16328774 DOI: 10.1007/s00701-005-0663-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 09/22/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are few data describing the microanatomy of the anterior-ventral spinal (AVSA) and anterior spinal arteries (ASA) and discussing their clinical and surgical implications. We describe the anatomical features of this arterial complex, and highlight their use when planning and performing surgical approaches to lesions involving the ventral aspect of the medulla and the foramen magnum. METHOD The microsurgical anatomy and branching pattern of the AVSA and the ASA from fifty human cadaver brain stems is described using a surgical microscope. RESULTS We found one anterior-ventral spinal artery at each side in 30 of the brain stems (60%). The ASA was a direct branch emerging from the left vertebral artery (VA) in 15 (30%), from the right VA in 4 (8%), and from the basilar artery (BA) in one brain stem (2%). The previously described as "typical pattern" of the junction of the AVS arteries from both sides, was observed only in 9 brain stems (18%). The anterior communicating spinal artery (ACoSA) was observed in 15 brain stems (30%). Also multiple ACoS arteries were described in one brain stem. Both, the AVSA and the ASA were observed to send long circumferential branches that supplied irrigation to the olive in 42 (84%) brain stems. CONCLUSIONS This anatomical study gives important information for a better understanding of the clinical picture of ischemic lesions of the brain stem, such as the medial medullary syndrome, and highlights the remarkable role of the AVSA and ASA as anatomical landmarks during the surgical approaches to lesions involving the ventral aspect of the medulla and the foramen magnum.
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Affiliation(s)
- J A Santos-Franco
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico.
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