Midline septa in the lumbo-sacral thecal sac: Acquired abnormality or developmental anomaly? The equivalent of diastematomyelia occurring below the spinal cord?

Cervical Diastematomyelia: A Case Presentation and Systematic Review

Diastematomyelia is a rare congenital disorder characterized by the separation of the spinal cord by an osseocartilaginous or fibrous septum. While diastematomyelia has been reported to be more common in the thoracic and lumbar regions, the true incidence of cervical diastematomyelia is currently unknown. In this study, we conducted the most comprehensive systematic review to date of all other case reports of diastematomyelia to better characterize the incidence of cervical diastematomyelia and provide comprehensive statistics on the clinical characteristics of diastematomyelia generally. Ninety-one articles were included in our study, which comprised 252 males (27.9%) and 651 females (72.0%) (and one patient with unspecified gender). In 507 cases, the vertebral level of the diastematomyelia was described, and we recorded those levels as either cervical ( n  = 8, 1.6%), thoracic ( n  = 220, 43.4%), lumbar ( n  = 277, 54.6%), or sacral ( n  = 2, 0.4%). In 719 cases, the type of diastematomyelia was specified as either Type I ( n  = 482, 67.0%) or Type II ( n  = 237, 33.0%). Our study found that diastematomyelia has been reported in the cervical region in only 1.6% of cases, and we provide comprehensive data that this disorder occurs in female-to-male ratio of approximately 2.6:1 and Type I versus Type II diastematomyelia in an estimated ratio of 2:1.

Horseshoe adrenal gland associated with spinal and vascular anomalies

Horseshoe (or butterfly) adrenal gland (HAG) is an exceedingly rare congenital abnormality compared to horseshoe kidney. Here we present computed tomography findings of HAG in a 70-year-old man, associated with some spinal and vascular abnormalities; in addition, a brief review of HAG in adult people is presented. In our case, spinal anomalies included a severe scoliosis, a "butterfly" deformation of Th9 vertebra and the presence of a "split lumbosacral thecal sac" at L5 level. As regards, vascular anomalies, they were noted: the origin of the left common carotid artery from the innominate artery and the absence of celiac trunk with separate origin of three branches directly off the aorta (a splenic artery, a left gastrohepatic trunk and a right hepatic-pancreaticoduodenal artery).

Hemodynamic instability and Horner's syndrome following a labour lumbar neuraxial block: A warning sign of a potentially lethal event?

The development of Horner's syndrome during routine neuraxial anaesthesia suggests anatomic, technical or physiologic variance. Even more importantly, it warrants immediate cessation of the anaesthetic intervention.