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Xu Y, Zhang Y, Luo Y, Qiu G, Liu Y, Zhao W, Wang Y. Thoracic ossification of the ligamentum flavum causing Brown-Séquard syndrome: a case report and literature review. J Int Med Res 2022; 50:3000605221110069. [PMID: 35903859 PMCID: PMC9340934 DOI: 10.1177/03000605221110069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Brown-Séquard syndrome (BSS) has many etiologies, including penetrating trauma, extramedullary tumors, and disc herniation. However, thoracic ossification of the ligamentum flavum (OLF) is an extremely rare cause of this syndrome. A 46-year-old woman with motor weakness in her right lower extremity and urinary retention was admitted to our department. Based on the results of physical examination, computed tomography, and magnetic resonance imaging, a diagnosis of BSS with OLF was considered. The patient underwent urgent conservative treatment. BSS is a rare condition characterized by hemisection or hemicompression of the spinal marrow. The herein-described case of incomplete BSS due to OLF responded to conservative treatment. However, the successful nonoperative management of this case is insufficient evidence to consider it as the standard of care. Therefore, emergency laminectomy decompression remains the standard of care for BSS.
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Affiliation(s)
- Yeqiu Xu
- Department of Orthopedic Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, Hangzhou, P.R. China.,Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yuanzhuang Zhang
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yinzhou Luo
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Guanzhen Qiu
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yize Liu
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Wei Zhao
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yong Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, Hangzhou, P.R. China.,Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
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Li B, Khoshhal Z, Common A, Qadura M. Recovery of neurological function following type B aortic dissection complicated by paraplegia. BMJ Case Rep 2022; 15:e248149. [PMID: 35459651 PMCID: PMC9036172 DOI: 10.1136/bcr-2021-248149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/04/2022] Open
Abstract
A woman in her 50s presented with uncontrolled hypertension, chest/back pain, paraplegia, right lower limb ischaemia and acute kidney injury. A CT angiogram demonstrated a type B aortic dissection originating distal to the left subclavian artery to bilateral common iliac arteries complicated by occlusion of the right renal artery and right common iliac artery. She was started on intravenous antihypertensive therapy and transferred to our institution for emergent thoracic endovascular aortic repair. Due to bleeding risk from coagulopathy, a spinal drain was not placed immediately post-operatively but instead was inserted after 24 hours while maintaining a mean arterial pressure of 80-100 mm Hg. Postoperatively, her right lower extremity perfusion was re-established, and her renal function recovered following temporary dialysis. At discharge on postoperative day 13, she regained full neurological function.
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Affiliation(s)
- Ben Li
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Zeyad Khoshhal
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Common
- Division of Interventional Radiology, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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Elshony H, Idris A, Ahmed A, Almaghrabi M, Ahmed W, Fallatah S. Spinal Cord Ischemia Secondary to Aortic Dissection: Case Report with Literature Review for Different Clinical Presentations, Risk Factors, Radiological Findings, Therapeutic Modalities, and Outcome. Case Rep Neurol 2021; 13:634-655. [PMID: 34720966 PMCID: PMC8543361 DOI: 10.1159/000518197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
Aortic dissection (AD) is a serious condition that causes transient or permanent neurological problems that include spinal cord ischemia (SCI), which occurs when AD extends into the descending aorta resulting in insufficient perfusion of segmental arteries that supplies the spinal cord. We report a 64-year-old male, presented with severe back pain, asymmetrical paresthesia, and weakness of both limbs, more in the left lower limb with loss of pinprick, temperature, and fine touch sensation on the lower left lower limb below the level of T5 with preserved proprioception and vibration and urine hesitancy. Computed tomography showed AD, Stanford type A, and spinal magnetic resonance imaging (MRI) showed hyperintense owl's eye sign at T5. The patient was diagnosed as anterior spinal artery syndrome secondary to an AD and referred for aortic surgical repair with good functional outcome. In our review to cases of SCI due to AD, it was more common in males above 55 years, pain only found in 47.8% of patients, with anterior cord syndrome on top of the clinical presentations, and hypertension is the most common risk factor. MRI spine showed thoracic location predominance. Surgical or endovascular repair especially for type A and complicated type B should be considered to avoid complications, and cerebrospinal fluid drainage is a very useful tool in reversing SCI specially if done early with favorable outcome. Only the old age is associated with increased risk of mortality. Early diagnosis and appropriate management are crucial for better outcome.
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Affiliation(s)
- Hosna Elshony
- Department of Neuropsychiatry, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Abdelrahman Idris
- Department of Neurology/Internal medicine, Security Forces Hospital, Makkah, Saudi Arabia
| | - Alaa Ahmed
- Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Walaa Ahmed
- Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Shouq Fallatah
- Faculty of Medicine, Taif University, Taif, Saudi Arabia
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Abstract
Context: Non-traumatic spinal cord infarction in the young adult is usually associated with a single or multiple genetic mutations. There are certain gene mutations that are more commonly associated with spinal cord infarctions. Homozygous or heterozygous mutations, and single mutations or polymorphism, do not seem to determine the probability of spinal cord infarction.Findings: We add another case of spinal cord infarction in a young adult to the few reported in the literature, and discuss the value of genetic studies and genetic counseling.Conclusion: Non-traumatic spinal cord infarction is usually caused by a genetic mutation. Early recognition of this entity and definition of the mutation will limit unnecessary and invasive procedures and allows early rehabilitation, preventive measures for complications and genetic counseling.
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Affiliation(s)
- Maria Khoueiry
- Department of Neurology, American University Medical Center, Beirut, Lebanon
| | - Hussein Moussa
- Department of Neurology, American University Medical Center, Beirut, Lebanon
| | - Raja Sawaya
- Department of Neurology, American University Medical Center, Beirut, Lebanon,Correspondence to: Raja Sawaya, Clinical Neurophysiology Laboratory, AmericanUniversity Medical Center, POB: 113 - 6044 / C-27, Beirut, Lebanon; Ph: 00-961-3347377.
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Tsushima T, Al-Kindi S, Patel T, Kalra A. Atypical complications of aortic intramural hematoma: Paraplegia resulting from spinal cord infarction. IJC HEART & VASCULATURE 2019; 22:154-155. [PMID: 30788412 PMCID: PMC6369244 DOI: 10.1016/j.ijcha.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 02/01/2023]
Key Words
- (AAS), acute aortic syndromes
- (ACS), acute coronary syndrome
- (CSFD), cerebrospinal fluid drainage
- (CTA), computed tomography angiogram
- (ECG), electrocardiogram
- (ER), emergency room
- (IMH), intramural hematoma
- (MRI), magnetic resonance imaging
- (SCI), spinal cord infarction
- (TEVAR), thoracic endovascular aortic repair
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Affiliation(s)
- Takahiro Tsushima
- Department of Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Sadeer Al-Kindi
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Toral Patel
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Ankur Kalra
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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