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Scalia G, Costanzo R, Brunasso L, Garufi G, Bonosi L, Ricciardo G, Graziano F, Nicoletti GF, Cardali SM, Iacopino DG, Maugeri R, Umana GE. Correlation between "Snake-Eyes" Sign and Role of Surgery with a Focus on Postoperative Outcome: A Systematic Review. Brain Sci 2023; 13:brainsci13020301. [PMID: 36831844 PMCID: PMC9954568 DOI: 10.3390/brainsci13020301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
(1) Background: The "snake-eyes" sign represents a unique finding characterized by bilateral hyperintense symmetric, circular, or ovoid foci on T2-weighted MRI sequences in the anterior horn cells of the spinal cord. There are conflicting opinions as some authors affirm that it does not affect the prognosis of cervical myelopathy while other papers emphasize the opposite, stating how the "snake-eyes" sign constitutes an irreversible lesion and a predictor of poor prognosis. This systematic review evaluates the correlation between the "snake-eyes" sign and the prognosis of cervical myelopathy after surgery including anterior and/or posterior approaches; (2) Methods: A systematic literature review was conducted following the PRISMA statement and a total of seven papers were included; (3) Results: A total of 419 patients were evaluated, with a mean age of 55.72 ± 14.38 years. After surgery, 26.01% of patients experienced a significant clinical improvement, while in 61.81%, there was no significant improvement. In particular, 144 of 196 patients (73.5%) treated through an anterior approach and 114 of 223 (51.1%) that underwent a posterior approach, did not present a significant improvement. Furthermore, in 12.17% of patients, the postoperative outcome was not reported, leading to a high risk of bias in the assessment of the prognostic significance of the "snake-eyes" appearance; (4) Conclusions: The "snake-eyes" sign is usually considered as an unfavorable predictive marker for myelopathic surgical patients, but the pathophysiology is still unclear, and the results have not yet reached unified levels of evidence.
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Affiliation(s)
- Gianluca Scalia
- Neurosurgery Unit, Head and Neck Surgery Department, Garibaldi Hospital, 95123 Catania, Italy
- Correspondence: ; Tel.: +39-3470589736
| | - Roberta Costanzo
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Giada Garufi
- Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, 98158 Messina, Italy
| | - Lapo Bonosi
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Ricciardo
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, 98158 Messina, Italy
| | - Francesca Graziano
- Neurosurgery Unit, Head and Neck Surgery Department, Garibaldi Hospital, 95123 Catania, Italy
| | | | - Salvatore Massimiliano Cardali
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, 98158 Messina, Italy
- Division of Neurosurgery, BIOMORF Department, University of Messina, 98125 Messina, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
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Zheng C, Zhu Y, Yu Q, Zhu D, Li J, Lyu F, Weber R, Qiao K, Jiang J. Quantitative assessment of motor impairment and surgical outcome in Hirayama disease with proximal involvement using motor unit number index. Neurophysiol Clin 2021; 51:375-386. [PMID: 33676826 DOI: 10.1016/j.neucli.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the feasibility of motor unit number index (MUNIX) in quantitatively evaluating Hirayama disease (HD) with proximal involvement and to identify the effectiveness of anterior cervical fusion (ACF) in treating atypical HD with proximal involvement. METHODS This study included 28 atypical HD patients with proximal involvement (proximal-distal vs. distal-proximal groups: 5 vs. 23) and 41 healthy controls. All patients underwent pre- and postoperative 1-year MUNIX tests on abductor pollicis brevis (APB), abductor digiti minimi (ADM), biceps brachii (BB) and deltoid (Del). The disabilities of arm, shoulder and hand (DASH) and Medical Research Council (MRC) scales were also performed in these patients before and one year after operation. RESULTS Preoperatively, the patients in the distal-proximal group showed reduced compound muscle action potential (CMAP), decreased MUNIX and increased motor unit size index (MUSIX) in bilateral distal muscles and symptomatic-side proximal muscles (P < 0.05), and similar abnormalities were also observed in ADM, BB and Del on the symptomatic side in the proximal-distal groups (P < 0.05). Postoperative follow-up analysis identified increased MUNIX in the symptomatic-side proximal muscles with improved motor function in the proximal-distal groups (P < 0.05), and distal-proximal group patients showed an increase in both CMAP and MUSIX in the symptomatic-side proximal muscles (P < 0.05). CONCLUSIONS MUNIX may serve as an available supplementary test to quantitatively evaluate the motor dysfunction and treatment outcome in HD with proximal involvement. ACF procedures can effectively treat these atypical HD patients, especially for those whose symptoms started in proximal muscles.
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Affiliation(s)
- Chaojun Zheng
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu Zhu
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 10212, USA
| | - Qifeng Yu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Dongqing Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jun Li
- Department of Orthopedics, Shanghai Songjiang District Central Hospital, Shanghai 201600, China
| | - Feizhou Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China; Department of Orthopedics, The Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Robert Weber
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 10212, USA
| | - Kai Qiao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China.
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Fontanella MM, Zanin L, Bergomi R, Fazio M, Zattra CM, Agosti E, Saraceno G, Schembari S, De Maria L, Quartini L, Leggio U, Filosto M, Gasparotti R, Locatelli D. Snake-Eye Myelopathy and Surgical Prognosis: Case Series and Systematic Literature Review. J Clin Med 2020; 9:E2197. [PMID: 32664657 PMCID: PMC7408892 DOI: 10.3390/jcm9072197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 12/11/2022] Open
Abstract
The prognostic value of "snake-eyes" sign in spinal cord magnetic resonance imaging (MRI) is unclear and the correlation with different pathological conditions has not been completely elucidated. In addition, its influence on surgical outcome has not been investigated in depth. A literature review according to PRISMA (Preferred reporting items for systematic review and meta-analysis protocols) guidelines on the prognostic significance of "snake-eyes" sign in operated patients was performed. Clinical, neuroradiological, and surgical data of three institutional patients, were also retrospectively collected. The three patients, with radiological evidence of "snake-eyes" myelopathy, underwent appropriate surgical treatment for their condition, with no new post-operative neurological deficits and good outcome at follow-up. The literature review, however, reported conflicting results: the presence of "snake-eyes" sign seems a poor prognostic factor in degenerative cervical myelopathy, even if some cases can improve after surgery. "Snake-eyes" myelopathy represents a rare form of myelopathy; pathophysiology is still unclear. The frequency of this myelopathy may be greater than previously thought and according to our literature review it is mostly a negative prognostic factor. However, from our experience, prognosis might not be so dire, especially when tailored surgical intervention is performed; therefore, surgery should always be considered and based on the complete clinical, neurophysiological, and radiological data.
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Affiliation(s)
- Marco Maria Fontanella
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (L.Z.); (R.B.); (C.M.Z.); (G.S.); (L.D.M.)
| | - Luca Zanin
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (L.Z.); (R.B.); (C.M.Z.); (G.S.); (L.D.M.)
| | - Riccardo Bergomi
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (L.Z.); (R.B.); (C.M.Z.); (G.S.); (L.D.M.)
| | - Marco Fazio
- Neurosurgery Unit, Poliambulanza Foundation, 24124 Brescia, Italy;
| | - Costanza Maria Zattra
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (L.Z.); (R.B.); (C.M.Z.); (G.S.); (L.D.M.)
| | - Edoardo Agosti
- Neurosurgery Unit, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (E.A.); (S.S.); (D.L.)
| | - Giorgio Saraceno
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (L.Z.); (R.B.); (C.M.Z.); (G.S.); (L.D.M.)
| | - Silvia Schembari
- Neurosurgery Unit, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (E.A.); (S.S.); (D.L.)
| | - Lucio De Maria
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (L.Z.); (R.B.); (C.M.Z.); (G.S.); (L.D.M.)
| | - Luisa Quartini
- Intensive Care Unit, Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili di Brecia, 25123 Brescia, Italy;
| | - Ugo Leggio
- Neurophysiopathology Unit, Department of Neurological Sciences and Vision, ASST Spedali Civili di Brecia, 25123 Brescia, Italy;
| | - Massimiliano Filosto
- Center for Neuromuscular Diseases, Unit of Neurology, ASST “Spedali Civili”, 25123 Brescia, Italy;
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25123 Brescia, Italy;
| | - Davide Locatelli
- Neurosurgery Unit, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (E.A.); (S.S.); (D.L.)
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Lyu F, Zheng C, Wang H, Nie C, Ma X, Xia X, Zhu W, Jin X, Hu Y, Sun Y, Zhu Y, Kuwabara S, Cortese R, Maqbool Hassan K, Takai K, Paredes I, Webere R, Turk M, Kimura J, Jiang J. Establishment of a clinician-led guideline on the diagnosis and treatment of Hirayama disease using a modified Delphi technique. Clin Neurophysiol 2020; 131:1311-1319. [DOI: 10.1016/j.clinph.2020.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 11/27/2022]
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Transcranial Magnetic Stimulation-Induced Motor Evoked Potentials in Hirayama Disease: Systematic Review of the Literature. J Clin Neurophysiol 2020; 37:181-190. [PMID: 32142026 DOI: 10.1097/wnp.0000000000000611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Hirayama disease (HD) is a rare motor disorder mainly affecting young men, characterized by atrophy and unilateral weakness of forearm and hand muscles corresponding to a C7-T1 myotome distribution. The progression is self-limited. The etiology of HD is unclear. The usefulness of motor evoked potentials (MEPs) in pyramidal tracts damage evaluation still appears to be somehow equivocal. METHODS We searched PubMed for original articles, evaluating the use of transcranial magnetic stimulation elicited MEPs in HD using keywords "motor evoked potentials Hirayama" and "transcranial magnetic stimulation Hirayama." RESULTS We found seven articles using the above keywords that met inclusion criteria. The number of participants was small, and diagnostic procedures varied. There were also differences in methodology. Abnormal central motor conduction time was found in 17.1% of patients in one study, whereas it was normal in two other studies. Peripheral motor latency was evaluated in one study, which found abnormally increased peripheral motor latencies in at least one tested muscle in 16 of 41 HD patients (39.0%). Abnormal MEP parameters were found in three studies in 14.3% to 100% patients. In one study they were not evaluated, in three other studies they were normal, and in one they were normal also in standard and flexed neck position In one study, inconsistent results were found in MEP size after neck flexion in patients after treatment with neck collar. CONCLUSIONS Although MEP parameters may be abnormal in some HD patients, these have not been thoroughly assessed. Further studies are indispensable to evaluate their usefulness in assessing pyramidal tract damage in HD.
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Snake-Eyes Appearance on MRI Occurs during the Late Stage of Hirayama Disease and Indicates Poor Prognosis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9830243. [PMID: 30756087 PMCID: PMC6348931 DOI: 10.1155/2019/9830243] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/30/2018] [Accepted: 12/30/2018] [Indexed: 12/14/2022]
Abstract
Purpose Because Hirayama disease is stereotyped as a self-limited disease in the absence of a definite pathology, we investigated the potential relationship between snake-eyes appearance (SEA) and Hirayama disease to bring a new perspective in the pathological process of Hirayama disease based on relevant radiological and clinical evidence. Methods A total of 30 cases observed SEA were selected from 293 patients with Hirayama disease to constitute the SEA group, and an equal number of cases were randomly selected from the remaining patients to form the non-SEA group. Cervical magnetic resonance imaging (MRI) was performed and subsequently used to measure the anteroposterior diameter and anterior shifting of the spinal cord. Additionally, clinical data, such as age, sex, duration of symptoms, symptoms, and signs, were collected and analyzed. Results Of 293 patients, 10.6% appeared with the SEA, which was mainly multisegmental (86.7%), particularly at the C5-6 segment (73.3%), and intense with a well-defined border (70.0%). The SEA group was an older population (p < 0.0001) with a longer duration (p < 0.0001) and a higher incidence of Hoffmann signs and knee hyperreflexia (p < 0.0001, p = 0.0038, respectively). The degree of spinal cord atrophy demonstrated a close association with the SEA, as it was significantly worse in the SEA group and SEA segment (p = 0.0008, p < 0.0001, respectively). The degree of spinal cord atrophy was positively related to both age and duration (p = 0.0095, p = 0.0176, respectively). Conclusions Confirmed as an irreversible lesion and an indication of poor prognosis, SEA appears during the late stage of Hirayama disease and is closely related to pyramidal signs and spinal cord atrophy.
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Zheng C, Zhu Y, Lu F, Zhu D, Yang S, Ma X, Xia X, Weber R, Jiang J. Changes in the soleus H-reflex test and correlations between its results and dynamic magnetic resonance imaging abnormalities in patients with Hirayama disease. Clin Neurophysiol 2017; 128:2375-2381. [PMID: 29096208 DOI: 10.1016/j.clinph.2017.09.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/28/2017] [Accepted: 09/10/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate changes in soleus H-reflex tests in patients with Hirayama disease (HD) and to analyse correlations between these changes and forward-shifting of the cervical cord during neck flexion. METHODS The amplitude of the soleus H-reflex with and without vibration on the Achilles tendon was recorded bilaterally in 81 HD patients and 34 controls to measure both the vibratory inhibition index (VII) and the Hmax/Mmax ratio. The maximum forward-shifting degree of cervical cord during neck flexion was measured using dynamic magnetic resonance imaging in all HD patients. RESULTS Significantly higher VII was recorded in 6/81 (7.4%) HD patients, along with abnormal Hmax/Mmax ratios in 5 of 6 cases. Compared to illness duration (r = 0.29-0.36, p < 0.05), the maximum forward-shifting degree of the cervical cord was more strongly correlated with both VII and the Hmax/Mmax ratio (r = 0.51-0.81, p < 0.05). CONCLUSIONS HD patients may develop cervical spinal cord injury with disease progression, and these lesions may be more likely to occur in cases with relatively severe cervical-flexion structural abnormalities even during early stages. SIGNIFICANCE More caution should be taken when managing HD patients with severe cervical-flexion abnormalities because of the possible early occurrence of upper motor neuron lesions.
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Affiliation(s)
- Chaojun Zheng
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu Zhu
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 10212, USA
| | - Feizhou Lu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China; Department of Orthopedics, The Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Dongqing Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shuo Yang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Robert Weber
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 10212, USA
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China.
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Zheng C, Zhu D, Lu F, Zhu Y, Ma X, Xia X, Jiang J. A double determination of central motor conduction time in the assessment of Hirayama disease. Clin Neurophysiol 2017; 128:2369-2374. [DOI: 10.1016/j.clinph.2017.07.394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 12/14/2022]
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Motor unit number estimation in the quantitative assessment of severity and progression of motor unit loss in Hirayama disease. Clin Neurophysiol 2017; 128:1008-1014. [DOI: 10.1016/j.clinph.2017.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/21/2017] [Accepted: 03/05/2017] [Indexed: 12/12/2022]
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Compound Muscle Action Potential Decrement to Repetitive Nerve Stimulation Between Hirayama Disease and Amyotrophic Lateral Sclerosis. J Clin Neurophysiol 2016; 34:119-125. [PMID: 27560305 DOI: 10.1097/wnp.0000000000000336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare repetitive nerve stimulation (RNS) between Hirayama disease (HD) and amyotrophic lateral sclerosis (ALS). METHODS The 3-Hz RNS test was performed on bilateral abductor pollicis brevis, abductor digiti minimi, middle deltoid, and upper trapezius muscles in 33 HD patients and 37 ALS patients. RESULTS In HD patients, none of tested muscles showed any abnormal decrements (≥10%). Significant decrements were observed in 73% of the ALS patients, and decrements were more frequently observed in proximal muscles (deltoid: 70.3%; trapezius: 48.6%). Illness duration did not correlate with decrement percentage in either patient group, and there was no relationship between decrement incidence and ALS diagnostic category (P > 0.05). CONCLUSIONS The significantly different RNS results between ALS and HD patients support the application of RNS, especially performing RNS in proximal muscles, as a supplementary test in distinguishing these two diseases, even in the early stages. These results may also imply a difference in underlying pathophysiology between ALS and HD.
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The Quantitative Assessment of Imaging Features for the Study of Hirayama Disease Progression. BIOMED RESEARCH INTERNATIONAL 2015; 2015:803148. [PMID: 26558283 PMCID: PMC4629000 DOI: 10.1155/2015/803148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/19/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Abstract
Objective. To evaluate the forward shifting of cervical spinal cords in different segments of patients with Hirayama disease to determine whether the disease is self-limiting. Methods. This study was performed on 11 healthy subjects and 64 patients. According to the duration, the patients were divided into 5 groups (≤1 year, 1-2 years, 2-3 years, 3-4 years, and ≥4 years). Cervical magnetic resonance imaging (MRI) of flexion and conventional position was performed. The distances between the posterior edge of the spinal cord and the cervical spinal canal (X), the anterior and posterior wall of the cervical spinal canal (Y), and the anterior-posterior (A) and the transverse diameter (B) of spinal cord cross sections were measured at different cervical spinal segments (C4 to T1). Results. In cervical flexion position, a significant increase in X/Y of C4-5 segments was found in groups 2–5, the C5-6 and C6-7 segments in groups 1–5, and the C7-T1 segments in group 5 (P < 0.05). The degree of the increased X/Y and cervical flexion X/Y of C5-6 segments were different among the 5 groups (P < 0.05), which was likely due to rapid increases in X/Y during the course of Hirayama's disease. Conclusion. The X/Y change progression indicates that Hirayama disease may not be self-limiting.
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Sasaki S. Sporadic lower motor neuron disease with a snake eyes appearance on the cervical anterior horns by MRI. Clin Neurol Neurosurg 2015; 136:122-31. [PMID: 26099699 DOI: 10.1016/j.clineuro.2015.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Lower motor neuron disease (LMND) is the term generally used to describe diseases in which only lower motor neuron signs are detected. A snake eyes appearance on magnetic resonance imaging (MRI) is associated with a wide spectrum of neurological conditions including LMND. The author reports on three unique LMND patients with upper limb muscle weakness and atrophy who show a snake eyes appearance by MRI. PATIENTS AND METHODS The patients were aged 18, 40 and 52 years, respectively, at the onset of the disease and had a longstanding clinical course (more than 10 years for two patients and 8 years for one patient). They were followed up for more than 6 years. RESULTS Clinical manifestations were characterized by (1) longstanding slow progression or delayed spontaneous arrest of asymmetric lower motor neuron signs localized exclusively in the upper extremities with unilateral predominance and distal or proximal preponderance; (2) the absence of upper motor neuron signs, bulbar signs, sensory disturbances and respiratory involvement; (3) a snake eyes appearance on the anterior horns of the cervical cord over more than 3 vertebrae by axial T2-weighted MRI and a longitudinal linear-shaped T2-signal hyperintensity by sagittal MRI; (4) neurogenic change with fasciculation and denervation potentials (fibrillation and a positive sharp wave) confined to the affected muscles by needle electromyogram; and (5) normal cerebrospinal fluid and a normal creatine kinase level. These cases did not fall into any existing category of LMND, such as progressive muscular atrophy, flail arm syndrome or Hirayama disease. CONCLUSIONS These patients should be classified as sporadic LMND with snake eyes on MRI with a relatively benign prognosis.
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Affiliation(s)
- Shoichi Sasaki
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan.
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Safain MG, Engelberg RB, Riesenburger R, Kryzanski J, Jea A, Hwang SW. Pediatric iatrogenic thoracic kyphosis and tension myelopathy treated with a thoracic pedicle subtraction osteotomy: a case report and review of the literature. Childs Nerv Syst 2014; 30:1293-9. [PMID: 24504334 DOI: 10.1007/s00381-014-2373-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/24/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Pediatric kyphotic deformity is an uncommon clinical entity that can occur following posterior spinal operations and has significant complexity in its treatment. Tension myelopathy in a pediatric patient with a thoracic kyphotic deformity has not been reported in the literature. CASE REPORT We present a 17-year-old boy with a progressive thoracic kyphosis and tension myelopathy 4 years after he underwent a thoracic laminoplasty at an outside institution for the treatment of a dorsal spinal arachnoid cyst. At our institution, he was treated with a pedicle subtraction osteotomy as well as thoracic Ponte osteotomies for sagittal plane correction to relieve the tension myelopathy. CONCLUSIONS Both clinical and radiographic improvements were observed after surgery. We review the literature on pediatric thoracic kyphosis and tension myelopathy and the treatment of these pathologies.
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Affiliation(s)
- Mina G Safain
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, 800 Washington St, Box #178, Boston, MA, 02111, USA
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Nalini A, Gourie-Devi M, Thennarasu K, Ramalingaiah AH. Monomelic amyotrophy: clinical profile and natural history of 279 cases seen over 35 years (1976-2010). Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:457-65. [PMID: 24853410 DOI: 10.3109/21678421.2014.903976] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to study the clinical characteristics and natural history of monomelic amyotrophy (MMA). We used a retrospective study of 279 patients diagnosed to have either upper (Hirayama disease) or lower limb MMA. Results showed that brachial MMA (BMMA) occurred in 224 patients (male:female, 9:1). Mean age of onset was 19.5 ± 4.18 years. Progression occurred over less than five years in the majority (95.9%) of patients. Duration at the last follow-up was: up to five years in 61.4%, 5-10 in 21.3%, 10-15 in 7.2%, > 15 years in 10.1%. MRI showed asymmetrical lower cervical cord atrophy in 44.6% of patients. Crural MMA (CMMA) occurred in 55 patients (male:female, 13:1). Mean age of onset was 21.38 ± 5.3 years. Similar to BMMA, most cases (65.5%) had onset between 15 and 25 years of age. Total duration of illness at the last follow-up was up to five years in 52.7%, 10 and beyond in 47.3%. In conclusion, a large cohort of patients with monomelic amyotrophy seen over 35 years (1976-2010) is described. Study data support the clinical findings and its natural history with long term follow-up, and the findings emphasize that monomelic amyotrophy is a 'benign' condition with a self-limiting course.
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Affiliation(s)
- Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences , Bangalore , India
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Ritter C, Wunderlich G, Macht S, Schroeter M, Fink GR, Lehmann HC. [Differential diagnostics of diseases of the brachial plexus]. DER NERVENARZT 2014; 85:176-188. [PMID: 24343110 DOI: 10.1007/s00115-013-3949-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Progressive, atrophic, asymmetrically distributed flaccid paresis of arm and hand muscles represents a frequent symptom of neuromuscular diseases that can be attributed to injury of the arm nerves, the plexus or the cervical roots. A timely and exact diagnosis is mandatory; however, the broad spectrum of differential diagnoses often represents a diagnostic challenge. A large variety of neuromuscular disorders need to be considered, encompassing autoimmune mediated inflammatory neuropathic conditions, such as multifocal motor neuropathy, as well as chronic degenerative and nerve compression disorders. This review provides an overview of the most frequent disorders of the upper plexus and cervical roots and summarizes the characteristic clinical features as well as electrodiagnostic and laboratory test results. In addition the diagnostic value of magnetic resonance imaging and sonography is discussed.
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Affiliation(s)
- C Ritter
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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