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Waack A, Fliegner M, Menkes DL, Staudt MD. Incomplete Anterior Spinal Artery Syndrome Responsive to Intrathecal Baclofen. Cureus 2023; 15:e40391. [PMID: 37456462 PMCID: PMC10345232 DOI: 10.7759/cureus.40391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Anterior cord syndrome (ACS) occurs as a result of ischemia in the territory of the anterior spinal artery (ASA). Although spinal cord strokes are rare, the ASA is the most commonly affected vessel in the spinal cord. The typical presentation of an ASA stroke is paraparesis or paraplegia, bilateral loss of pain and temperature sensation, and fecal or urinary incontinence; the underlying neural structures responsible for these symptoms include the corticospinal tracts and anterior horns, anterolateral spinothalamic tracts, and lateral horns, respectively. ACS is a feared complication of aortic procedures and has been well-documented to occur during or after endovascular abdominal aortic aneurysm revascularization (EVAR). We report a case of incomplete or partial ACS presenting with delayed-onset spasticity and instability several months following EVAR, who was subsequently treated with intrathecal baclofen. We hypothesize that this patient's ischemia selectively damaged descending white matter tracts responsible for modulating the stretch receptor reflex, including damage to the corticospinal tract, which likely also impaired positional stability.
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Affiliation(s)
- Andrew Waack
- Neurosurgery, The University of Toledo, Toledo, USA
| | - Maximilian Fliegner
- Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Daniel L Menkes
- Neurology, Beaumont Health, Royal Oak, USA
- Neurology, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Michael D Staudt
- Neurosurgery, Beaumont Health, Royal Oak, USA
- Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester, USA
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2
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Puente-Hernandez M, Rivero-de-Aguilar A, Varela-Lema L. Cancer-associated spinal cord infarction: A systematic review and analysis of survival predictors. J Neurol Sci 2023; 446:120580. [PMID: 36764185 DOI: 10.1016/j.jns.2023.120580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/09/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The association between spinal cord infarction (SCI) and cancer is an infrequent condition but requires an accurate diagnosis to establish the appropriate treatment. Clinical features and prognosis of cancer-associated SCI have never been assessed. The aim of this systematic review is to describe the characteristics and outcomes of patients with cancer-associated SCI. Illustratively, a case of ovarian cancer-related SCI is presented. MATERIAL AND METHODS Two authors independently analysed three different bibliographic databases looking for cancer-associated SCI case reports and case series. Data regarding age, sex, cardiovascular risk factors (CVRF), history of known cancer, infarction localization, spinal cord syndrome, Zalewski criteria classification, mechanism of ischemia, diagnostic tests, treatment and functional outcome were registered. A statistical analysis was carried out to identify factors related to mortality and survival time. RESULTS A total of 48 articles met the inclusion criteria and 52 patients were identified. The median age was 62 years. The most frequent neoplasm was intravascular large B-cell lymphoma. The median survival time was 17.4 weeks and the cumulative probability of survival at 12 months was 16.3%. In the group of deceased patients there was a higher proportion of malignant neoplasms than in those who survived (94.7% vs. 5.3%, p < 0.01). There were no statistically significant differences in terms of mortality or survival time depending on age, previously known cancer or CVRF. CONCLUSION Cancer-associated SCI entails a poor outcome. Mortality is increased in patients with malignant neoplasm. No other prognosis factors could be identified.
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Affiliation(s)
| | - Alejandro Rivero-de-Aguilar
- Department of Neurology, University Hospital of the Canary Islands, carretera Ofra S/N, La Laguna, Tenerife, Spain
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Praza do Obradoiro, Santiago de Compostela, A Coruña, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBER de Enfermedades Respiratorias/CibeRes), Av. de Monforte de Lemos 3-5, Madrid, Spain
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3
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Ramon JF, Rairan LG, Usuga V, Mejia JA. Spinal Venous Vascular Ectasia With Unusual presentation of Abdominal Pain: Case Report. NEUROSURGERY OPEN 2023. [DOI: 10.1227/neuprac.0000000000000033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
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4
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Belenky VV, Plakhotina NA, Skoromets AA, Dugaev PP, Komantsev VN, Leontiev OV. [Diagnostic capabilities of spinal MR angiography and spinal MR tractography in a patient with motor neuron disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:111-115. [PMID: 37796077 DOI: 10.17116/jnevro2023123091111] [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] [Indexed: 10/06/2023]
Abstract
Motor neuron diseases (MND) include two main forms - amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA). A certain part of these diseases is hereditary, while etiology of sporadic cases remains unknown. Both entities are known to develop because of motoneurons damage. Difference between them lies in the state of the descending pyramidal pathways. The pyramidal pathways in SMA are intact, as brain pyramidal neurons are not affected, thus pathology of SMA is restricted to anterior horns of spinal cord. Meanwhile, most forms of ALS arise due to loss of both cerebral and spinal motoneurons, which, in addition to anterior horn lesion, leads to pyramidal descending pathways damage either in brain or in spinal cord. While pathological distinction between these two entities is clear and definite, the clinical difference remains obscure. We present the case of 41-year old patient with MND, in whom spinal MR tractography has revealed lateral columns to be intact that proves the utility of spinal MR tractography in differential diagnosis between ALS and SMA. Given that ischemic diseases of the spinal cord often occur with a clinical picture of MND, we also examined this patient using spinal MRI angiography, revealing a pronounced narrowing and tortuosity of the spinal arteries, complicated by occlusion of the right twelve intercostal artery.
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Affiliation(s)
| | - N A Plakhotina
- Berezin Sergey Medical Institute, St. Petersburg, Russia
| | - A A Skoromets
- Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russia
| | - P P Dugaev
- Berezin Sergey Medical Institute, St. Petersburg, Russia
| | - V N Komantsev
- Saint-Petersburg Institute of Advanced Training for Specialist Physicians, St. Petersburg, Russia
| | - O V Leontiev
- Nikiforov Center of Urgent and Radiologic Medicine, St. Petersburg, Russia
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Acute Onset Quadriplegia and Stroke: Look at the Brainstem, Look at the Midline. J Clin Med 2022; 11:jcm11237205. [PMID: 36498778 PMCID: PMC9740674 DOI: 10.3390/jcm11237205] [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: 10/14/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Acute onset quadriplegia with or without facial sparing is an extremely rare vascular syndrome, and the main focus of attention is on the cervical and upper thoracic spinal cord as the putative site of the damage. Quadriplegia has been occasionally reported in brainstem strokes within well-defined lesion patterns, but these reports have gained little attention so far because of the rarity of this clinical syndrome. The clinical, neuroanatomical and neuroimaging features of ischemic stroke locations associated with quadriplegia have been collected and reviewed in a pragmatical view, which includes a detailed description of the neurological signs associated with the damage of the pyramidal pathways. Two clinical examples have been added to raise practical suggestions in neurovascular practice. Ischemic stroke sites determining quadriplegia have some main well-defined midline locations in the brainstem, involving the pyramidal pathways of both sides in a single synchronous ischemic lesion in the medulla oblongata and in the pons. Several accompanying neurological signs have been described when the ischemic lesion involves tracts and nuclei other than the pyramidal pathways, and they can be useful as localizing clues. In some cases, the typical neuroimaging appearance of the ischemic lesion on Magnetic Resonance Imaging (MRI) has been reported as being a "heart appearance sign". This last sign has been described in midbrain strokes too, but this location is not associated with quadriplegia. The main etiology is atherothrombosis involving the intradural segment of the vertebral artery (VA) and their perforating branches. Two clinical examples of these rare vascular syndromes have been chosen to support a pragmatical discussion about the management of these cases. A midline ischemic stroke in the brainstem is a very rare vascular syndrome, and the acute onset quadriplegia is a distinctive feature of it. The awareness of this cerebrovascular manifestation might help to recognize and treat these patients.
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Asimakidou E, Meszaros LT, Anestis DM, Tsitsopoulos PP. A systematic review on the outcome of intramedullary spinal cord cavernous malformations. 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 2022; 31:3119-3129. [PMID: 35931791 DOI: 10.1007/s00586-022-07332-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to investigate the neurological outcome, trends and sequelae following surgical or conservative treatment of intramedullary spinal cord cavernous malformations (ISCCMs). METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome measure was the change in the neurological status after surgery or conservative management. A logistic regression analysis investigating prognostic factors related to outcome was also performed. RESULTS Twenty-one studies with 1091 patients in total were included, of which 1005 (92.1%) underwent surgical resection and 86 (7.9%) were treated conservatively. Gross total resection was achieved in 95.7% of the patients and partial resection in 4.3%. Most lesions (60.2%) were located in the thoracic spine and presented with motor (60.4%) and sensory deficits (59.7%). In the long term, surgical treatment resulted in an improved neurological status in 36.9% of the patients, in 55.8% it remained stable, and in 7.3% it deteriorated compared to the preoperative state. In the conservative cohort, 21.7% improved, 69.6% remained stable, and 8.7% deteriorated. Solitary lesions, duration of preoperative symptoms less than 3 months as well as an improved post-operative neurological status were predictors of a favourable long-term outcome. CONCLUSIONS Whenever feasible, symptomatic patients with ISCCM are recommended to undergo surgery within 3 months from symptom onset. Absence of multiple lesions and, most importantly, post-operative symptom improvement foresee a favourable long-term outcome. Further research is warranted to discern the role of conservative treatment in symptomatic patients.
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Affiliation(s)
- Evridiki Asimakidou
- Department of Neurosurgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloniki, Greece.
| | | | - Dimitrios M Anestis
- Department of Neurosurgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Parmenion P Tsitsopoulos
- Department of Neurosurgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloniki, Greece
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Xing W, Zhang W, Ma G, Ma G, He J. Long-segment spinal cord infarction complicated with multiple cerebral infarctions: a case report. BMC Neurol 2022; 22:362. [PMID: 36138353 PMCID: PMC9494757 DOI: 10.1186/s12883-022-02888-8] [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] [Received: 04/28/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Spinal cord infarction is a rare disorder, constituting only 1% to 2% of all neurological vascular emergencies (making it less frequent than ischaemic brain injury); however, it is severe. A case of long-segment spinal cord infarction complicated with multiple cerebral infarctions has not been reported to date. Case presentation Here, we describe one such case: a patient with spinal cord infarction from the cervical 7 (C7) to thoracic 6 (T6) vertebrae, along with anterior spinal artery syndrome and complicated by multiple cerebral infarctions. A 65-year-old farmer experienced sudden onset of severe pain in his chest, back and upper limbs while unloading heavy objects. Subsequently, both his lower limbs became weak and hypoaesthetic, and he was unable to walk. Spinal magnetic resonance imaging (MRI) revealed equal T1 and long T2 signals centred on the anterior horn of the spinal cord. The axial slice of these signals was shaped like an owl’s eye. After receiving drug treatment and active rehabilitation treatment, the patient’s ability to walk was restored. Conclusions Long-segment spinal cord infarction is rare and can be complicated with cerebral infarction. The specific aetiology is worth exploring.
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Affiliation(s)
- Weifang Xing
- Department of Neurology, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Heyuan, 517000, Guangdong Province, China.
| | - Wensheng Zhang
- Department of Neurology, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Heyuan, 517000, Guangdong Province, China
| | - Guozhong Ma
- Department of Neurology, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Heyuan, 517000, Guangdong Province, China
| | - Guofen Ma
- Department of Neurology, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Heyuan, 517000, Guangdong Province, China
| | - Jinzhao He
- Department of Neurology, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Heyuan, 517000, Guangdong Province, China
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Kalaszi M, Donlon E, Ahmad MW, Mohamed AS, Boers P. Case report: Dueling etiologies: Longitudinally extensive spinal cord lesion mimicking spinal cord infarct with simultaneous positive Lyme serology and amphiphysin antibody. Front Neurol 2022; 13:905283. [PMID: 36176565 PMCID: PMC9513320 DOI: 10.3389/fneur.2022.905283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Longitudinally extensive spinal cord lesions are challenging diagnostic entities as they are uncommon, but various etiologies can cause them. Case report We report a case of a 55-year-old man with a past medical history of hypertension. He is an ex-smoker. He presented with chest pain, followed by right lower limb weakness, preceded by 2 weeks of constipation and voiding dysfunction. The examination revealed right lower limb mild flaccid paresis, absent reflexes, reduced anal tone, and urinary retention. His symptoms deteriorated over 24 h, and he developed severe flaccid paraparesis with impaired pinprick sensation below the T4 level. MRI spine showed an abnormal, non-enhancing signal in the anterior aspect of the spinal cord extending from the T4 level to the conus without associated edema. He was commenced on intravenous steroids and had significant improvement after one dose. The imaging was felt to be consistent with spinal cord infarction, and aspirin was started. The cerebrospinal fluid analysis showed elevated protein (0.8 mg/ml). Investigations for stroke and autoimmune pathologies were negative. The Lyme immunoblot confirmed intrathecal production of IgG to Borrelia antigens. The patient was started on ceftriaxone. The paraneoplastic screen identified amphiphysin antibodies. CT-TAP and PET-CT did not identify occult malignancy. The patient had a significant improvement over 2 months, strength was almost fully recovered, and autonomic functions returned to normal. Conclusion We describe an unusual steroid-responsive, longitudinally extensive spinal cord lesion with radiological features of spinal cord infarct and a simultaneous finding of intrathecal Lyme antibodies and serum amphiphysin antibodies.
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Alfaro-Olivera M, Otiniano-Sifuentes RD, Simbrón-Ribbeck L, Zelada-Ríos L, Barrientos-Imán D, Abanto C, Ramírez-Quiñones J, Valencia A. Spinal Dural Arteriovenous Fistula: A Mimic of Demyelinating Disease and Radiculopathy. Cureus 2022; 14:e24134. [PMID: 35573541 PMCID: PMC9106543 DOI: 10.7759/cureus.24134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/09/2022] Open
Abstract
Spinal dural arteriovenous fistula (SDAVF) is characterized by an abnormal connection between a radicular artery and the venous plexus producing spinal cord venous congestion. It manifests with nonspecific sensory and motor symptoms. We present three cases of SDAVF with different forms of presentation; in two cases, an autoimmune etiology was considered, and in the third case, the initial diagnosis was chronic radiculopathy. In all three cases, a serpentine enhancement was observed after the gadolinium in the dorsal region of the spinal cord corresponded to flow voids in T2-weighted images, which guided the diagnosis. SDAVF should be considered in atypical clinical presentations of radiculopathies or spinal cord syndromes, especially spinal conus or epicone syndrome. Likewise, it should be part of the differential diagnosis of spinal cord presentations of demyelinating diseases such as multiple sclerosis or neuromyelitis optica spectrum disorders.
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10
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Lawson EC, Hu R, Silver M, Greene JG. Administration of Recombinant Tissue Plasminogen Activator for Sulcal Artery Syndrome. Neurol Clin Pract 2022; 11:e901-e903. [PMID: 34992975 DOI: 10.1212/cpj.0000000000000995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/16/2020] [Indexed: 11/15/2022]
Abstract
A 58-year-old man with history of left parietal lobe ischemic stroke, multifocal lacunar infarctions with residual mild right sided weakness, ongoing tobacco abuse, and hypertension presented to the emergency department with an initial complaint of right sided throbbing headache, right neck, arm, and leg pain that started acutely 3 hours prior. Patient denied new weakness or numbness from his baseline and was ambulatory. While undergoing triage, he acutely developed right arm and leg flaccid paralysis. Upon evaluation by the stroke team he was noted to have an NIHSS of 11. CT head demonstrated chronic infarctions, and CT angiogram head and neck did not show large vessel occlusion, dissection, or focal intracranial atherosclerosis. Initial screening labs included complete blood count with differential, glucose, and complete metabolic panel all within normal range. Patient was administered rTPA and admitted to the neurologic intensive care unit. MRI brain without gadolinium did not reveal an acute infarction, but showed known prior left superior middle cerebral artery division stroke and prior lacunar infarctions. On hospital day 1 there was subjective improvement in right hemibody weakness, but also new left sided sensory deficits. Examination was notable for 4-/5 right upper extremity strength, 5-/5 right lower extremity strength, nearly at baseline from prior ischemic stroke, except for increased right hand weakness. Sensory examination demonstrated new left sided diffuse loss to pain and temperature in the upper and lower extremity with bilaterally intact vibration and proprioception.
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Affiliation(s)
- Eric C Lawson
- Department of Neurology (ECL, MS, JGG); and Department of Radiology and Imaging Sciences, Division of Neuroradiology (RH), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Ranliang Hu
- Department of Neurology (ECL, MS, JGG); and Department of Radiology and Imaging Sciences, Division of Neuroradiology (RH), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Michael Silver
- Department of Neurology (ECL, MS, JGG); and Department of Radiology and Imaging Sciences, Division of Neuroradiology (RH), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - James G Greene
- Department of Neurology (ECL, MS, JGG); and Department of Radiology and Imaging Sciences, Division of Neuroradiology (RH), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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Sarto J, Semerano A, Moreno JL, Mayà-Casalprim G, Blasco J, Urra X. Spinal cord hemodynamic infarction after vertebral artery endovascular trapping despite preserved flow in the anterior spinal artery. J Spinal Cord Med 2021; 44:1001-1004. [PMID: 31944930 PMCID: PMC8725780 DOI: 10.1080/10790268.2019.1706290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Context: Spinal cord infarction is a rare condition that develops as a result of insufficient vascular perfusion, sometimes related to procedures involving the aorta and vertebral arteries.Findings: We present the case of a 66-year-old woman who developed weakness on all four extremities and thermalgesic sensory deficit following an elective endovascular embolization of an incidentally diagnosed aneurysm in the posterior circulation. The procedure involved the cathetherization of both vertebral arteries, but was unremarkable and the flow into the anterior spinal artery was preserved. Radiological findings highly suggested a spinal cord infarction. She was started on corticosteroids and showed a significant neurological improvement.Clinical relevance: The present case illustrates that spinal cord infarction is a typical - but uncommon - complication that has to be suspected after vertebral artery endovascular procedures. It can result from hypoperfusion of smaller branches that irrigate the cervical spinal cord, and patients can make remarkable recoveries despite severe initial deficits.
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Affiliation(s)
- Jordi Sarto
- Neurology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aurora Semerano
- Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Jordi Blasco
- Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xabier Urra
- Neurology Department, Hospital Clínic de Barcelona, Barcelona, Spain,Correspondence to: Xabier Urra, Hospital Clinic, Comprehensive Stroke Center, 170 Villarroel, 08036Barcelona, Spain; +34932275414.
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12
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Jani JR, Parenrengi MA, Suryaningtyas W. Intramedullary Spinal Cystic Lesions Mimicking Cavernoma with Spontaneous Myelum Hemorrhage in Children: A Case Report. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Intramedullary spinal masses is a rare yet devastating and challenging. One of the biggest difficulty is to reveal the mass type and feature, thus determine the definitive treatment. Despite its difficulties, many controversies persist regarding diagnosis and management.
Case Presentation: We report a case of 6 years old female came with gradual right limb weakness for 1 week before admission. It preceded by neck stiffness and for 2 weeks ago. Radiological examination revealed intradural intramedullary mass suggesting a cavernoma at VC1-C2 and VTh12-L1 level. The histopathological results shows unspecified hematoma.
Conclusions: Intramedullary tumors in pediatric population is rare and can mimic any other mass lesion. MRI is the mainstay diagnostic tool of this patient. Complete surgical resection is the main goal of treatment, but the histopathologic features is the most important predictor of the functional outcome.
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Spinal vascular lesions: anatomy, imaging techniques and treatment. Eur J Radiol Open 2021; 8:100369. [PMID: 34307789 PMCID: PMC8283341 DOI: 10.1016/j.ejro.2021.100369] [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: 04/30/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 11/23/2022] Open
Abstract
Vascular myelopathies include different aetiology and mechanism of damage. The level of the lesion and the localization within the SC correlates with the clinical symptoms. CT, MRI and angiography are essential for diagnosis and treatment playing a complementary role. MRI is the gold standard for the evaluation of spinal cord lesions. Spinal angiography is the gold standard for evaluation of spinal cord vasculature and vascular malformations.
Background Vascular lesions of the spinal cord are rare but potentially devastating conditions whose accurate recognition critically determines the clinical outcome. Several conditions lead to myelopathy due to either arterial ischemia, venous congestion or bleeding within the cord. The clinical presentation varies, according with the different aetiology and mechanism of damage. Purpose The aim is to provide a comprehensive review on the radiological features of the most common vascular myelopathies, passing through the knowledge of the vascular spinal anatomy and the clinical aspects of the different aetiologies, which is crucial to promptly address the diagnosis and the radiological assessment.
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14
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Abstract
CONTEXT Recent literature points towards myelitis, like encephalitis, as a common central nervous system complication of COVID-19. This review elaborates on disorders of the spinal cord caused by the SARS-CoV-2 virus. OBJECTIVES To review the published data about SARS-CoV-2-associated spinal cord disorders and assess their clinical, neuroimaging, treatment, and prognostic aspects. METHODS The PubMed and Google Scholar databases were searched for published cases using the search items "COVID-19 OR SARS-CoV-2 AND myelitis", "COVID-19 OR SARS-CoV-2 AND myelopathy", and "COVID-19 OR SARS-CoV-2 AND spinal cord". RESULTS Thirty-three isolated cases were included in the present review, of which 14 were aged 60 years and above (range: 3-70 years). Eighteen patients had lung abnormalities on chest imaging. Eight patients had developed either an areflexic paraparesis or quadriparesis. In 17 patients, neuroimaging demonstrated longitudinally extensive transverse myelitis, while 3 cases showed neuroimaging changes in the spinal cord as a part of acute disseminated encephalomyelitis syndrome. Cerebrospinal fluid (CSF) examinations revealed inflammatory changes in 18 patients. However, the SARS-CoV-2 virus in the CSF was discovered in 2 patients. In 2 patients, anti-SARS-CoV-2 antibodies were demonstrated in the CSF. Following treatment, 13 patients were able to walk. CONCLUSIONS A variety of COVID-19-related spinal cord manifestations, such as acute transverse myelitis, acute necrotizing myelitis, SARS-CoV-2 myelitis, acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorder, hypoxic myelopathy, MOG antibody-associated myelitis, spinal cord infarction, and spinal epidural abscess, have been reported. The possible mechanisms of this involvement being direct invasion, cytokine storm, coagulopathy, and an autoimmune response. However, response to treatment has been generally unsatisfactory, with many patients having residual weakness necessitating long-term rehabilitation.
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Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ankit Gupta
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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15
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Menezes FTL, Alencar JMD, Oliveira da Cruz A, Candeias da Silva C, Oliveira EML, Bichuetti DB. Myelopathies in patients older than 50: not to miss inflammatory etiologies. Mult Scler Relat Disord 2021; 50:102826. [PMID: 33618122 DOI: 10.1016/j.msard.2021.102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/31/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Inflammatory myelopathies are primarily associated with younger age, and there are few studies in the elderly. Longitudinally extensive spinal cord lesions (LECL) are common in inflammatory myelopathies, but when the first event occurs in older age may have a broader differential diagnosis. OBJECTIVES To identify all non-traumatic myelopathies' etiologies in patients older than 50 years in a tertiary care hospital and to evaluate characteristics that differentiate inflammatory from non-inflammatory etiologies, focusing on the late-onset (≥50 years old) longitudinally extensive spinal cord lesions (LO-LECL) group. METHODS Retrospective study of patients admitted between 2008 to 2019. Demographic, clinical, laboratory, and magnetic resonance imaging (MRI) data of all patients were analyzed to identify predictors that could more easily identify inflammatory from non-inflammatory etiologies and further identify the etiologies of LO-LECL. RESULTS One hundred and three patients 50 years or older diagnosed with non-traumatic myelopathy were included, despite the lesion extension. Five were vascular (5%), 10 spondylotic (10%), 16 other etiologies (16%), 22 inflammatory (21%) and 50 neoplastic myelopathies (49%). Among 23 LO-LECL, 3 were vascular (13%), 4 neoplastic (17%), 7 other etiologies (30%) and 9 inflammatory (39%). The inflammatory LO-LECL had the median time to nadir significantly different from the neoplastic and the other etiologies groups and had the median EDSS at last visit (3.5) significantly lower than the non-inflammatory LO-LECL (7.0-7.5). CONCLUSIONS Inflammatory etiologies are not to be disregarded in older adults with non-traumatic myelopathies. The symptoms' temporal profile is critical to differentiate inflammatory LO-LECL from other etiologies and it has better functional recovery after adequate treatment.
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Affiliation(s)
- Felipe Toscano Lins Menezes
- Neuroimmunogy Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Jéssica Monique Dias Alencar
- Neuroimmunogy Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Anisse Oliveira da Cruz
- Neuroimmunogy Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Carolina Candeias da Silva
- Movement Disorders Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Enedina Maria Lobato Oliveira
- Neuroimmunogy Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Denis Bernardi Bichuetti
- Neuroimmunogy Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
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16
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Sabayan B, Lineback C, Viswanathan A, Leslie‐Mazwi TM, Shaibani A. Central nervous system vascular malformations: A clinical review. Ann Clin Transl Neurol 2021; 8:504-522. [PMID: 33434339 PMCID: PMC7886037 DOI: 10.1002/acn3.51277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/11/2020] [Accepted: 11/27/2020] [Indexed: 11/27/2022] Open
Abstract
CNS vascular malformation is an umbrella term that encompasses a wide variety of pathologies, with a wide range of therapeutic and diagnostic importance. This range spans lesions with a risk of devastating neurological compromise to lesions with a slow, static or benign course. Advances in neurovascular imaging along with increased utilization of these advances, have resulted in more frequent identification of these lesions. In this article, we provide an overview on definitions and classifications of CNS vascular malformations and outline the etiologic, diagnostic, prognostic, and therapeutic features for each entity. This review covers intracranial and spinal cord vascular malformations and discusses syndromes associated with CNS vascular malformations.
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Affiliation(s)
- Behnam Sabayan
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Christina Lineback
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Anand Viswanathan
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Thabele M. Leslie‐Mazwi
- Departments of Neurosurgery and NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ali Shaibani
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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17
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Eissa M, Abdelhady M, Alqatami H, Salem K, Own A, El Beltagi AH. Spinal cord infarction in a 41-year-old male patient with COVID-19. Neuroradiol J 2021; 34:245-248. [PMID: 33480310 DOI: 10.1177/1971400921988925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) pandemic, became rapidly recognised by variable phonotypic expressions that involve most major body organs. Neurological complications of severe acute respiratory syndrome coronavirus disease are increasingly encountered in patients with COVID-19 infection, more frequently in patients with severe infection, and develop as a consequence of the neurotropic potential of this virus, secondary cytokine storm and acquired syndrome of COVID-19 coagulopathy. Spinal cord involvement after COVID-19 more commonly includes infectious transverse myelitis, para and post infection myelopathy and, rarely, spinal cord ischaemia related to increased coagulopathy with thromboembolic consequences. We herein report a COVID-19-positive patient with increased coagulopathy and vertebral artery thrombosis leading to posterior circulation and subsequent spinal cord infarction.
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Affiliation(s)
- Mamdouh Eissa
- Neuroradiology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Hosam Alqatami
- Neuroradiology Department, Hamad Medical Corporation, Doha, Qatar
| | - Khaled Salem
- Neuroradiology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroradiology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed H El Beltagi
- Neuroradiology Department, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine, Qatar
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18
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Ashton C, Banham N, Needham M. Acute spontaneous spinal cord infarction: Utilisation of hyperbaric oxygen treatment, cerebrospinal fluid drainage and pentoxifylline. Diving Hyperb Med 2020; 50:325-331. [PMID: 33325011 DOI: 10.28920/dhm50.4.325-331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/09/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Spinal cord infarction (SCI) is a potentially devastating disorder presenting with an acute anterior spinal artery syndrome, accounting for an estimated 1% of stroke presentations. Aetiologies include aortic surgical complications, systemic hypotension, fibrocartilaginous embolism and vascular malformations. Diagnosis is clinical combined with restriction on diffusion-weighted magnetic resonance imaging (MRI). There are no treatment guidelines for non-perioperative cases although there is limited literature regarding potential therapies, including hyperbaric oxygen treatment (HBOT) and cerebrospinal fluid (CSF) drainage. We describe 13 cases of acute SCI, five receiving HBOT, and three also receiving pentoxifylline and drainage of lumbar CSF. METHODS Data for all patients with MRI-proven SCI at Fiona Stanley Hospital from 2014-2019 were reviewed. RESULTS Thirteen patients, median age 57 years (31-74), 54% female, were identified. Aetiologies: two fibrocartilaginous emboli; seven likely atherosclerotic; two thromboembolic; two cryptogenic. All presented with flaccid paraplegia except one with Brown-Sequard syndrome. Levels ranged from C4 to T11. Five patients received HBOT within a median time of 40 hours from symptom onset, with an average 15 treatments (10-20). Three of these received triple therapy (HBOT, pentoxifylline, CSF drainage) and had median Medical Research Council manual muscle testing power of 5, median modified Rankin Score (mRS) of 1 and American Spinal Injury Association (ASIA) score of D on discharge, compared with 2 power, mRS 3.5 and ASIA B in those who did not. CONCLUSIONS SCI can be severely disabling. Triple therapy with pentoxifylline, CSF drainage and HBOT may reduce disability and further prospective trials are required.
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Affiliation(s)
- Catherine Ashton
- Neurology Department, Fiona Stanley Hospital, Murdoch, Australia.,Corresponding author: Dr Catherine Ashton, Neurology Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia,
| | - Neil Banham
- Department of Hyperbaric Medicine, Fiona Stanley Hospital, Murdoch, Australia
| | - Merrilee Needham
- Neurology Department, Fiona Stanley Hospital, Murdoch, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia.,Perron Institute for Neurological and Translational Science, Nedlands, Australia.,University of Notre Dame, Fremantle, Australia
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19
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Singh R, Deshmukh N, Lalla R, Khadilkar S. Syringomyelia Associated with Spinal Dural Arteriovenous Fistula: Clinical and Radiological Improvement after Embolization. Neurointervention 2020; 15:140-143. [PMID: 32932570 PMCID: PMC7608500 DOI: 10.5469/neuroint.2020.00192] [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] [Received: 05/19/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022] Open
Abstract
Spinal dural arteriovenous fistulae (AVF) are rare and can result in spinal cord dysfunction. We present one such case wherein the patient presented with a venous congestive myelopathy. Magnetic resonance imaging showed a syrinx formation, spinal cord edema, and flow voids. Digital subtraction angiography confirmed the dural AVF, which was treated with embolization. The syrinx disappeared, other spinal cord changes improved, and the patient had remarkable clinical improvement. The case is presented to draw attention to the rare formation of a syrinx in a spinal dural arteriovenous fistula and its disappearance after successful embolization.
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Affiliation(s)
- Rakesh Singh
- Department of Neurology, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Narayan Deshmukh
- Department of Neurology, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Rakesh Lalla
- Department of Neurology, Fortis Hospital, Kalyan, Kalyan, India
| | - Satish Khadilkar
- Department of Neurology, Bombay Hospital and Medical Research Centre, Mumbai, India
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20
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Fiani B, Reardon T, Jenkins R, Covarrubias C, Sekhon M, Soula M, Kortz M. Intramedullary spinal cord cavernous malformations in the pediatric population. Surg Neurol Int 2020; 11:275. [PMID: 33033637 PMCID: PMC7538982 DOI: 10.25259/sni_494_2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/22/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Intramedullary spinal cavernous malformations (ISCM) account for just 1% of all intramedullary pediatric spinal cord lesions. Pathologically, they are well-circumscribed vascular malformations that typically appear dark blue or reddish-brown, often coming to the spinal cord surface. With regard to the histopathology findings, ISCMs are comprised sinusoidal vascular spaces lined by a single layer of endothelial cells within a loose connective tissue stroma. As these lesions are often misdiagnosed in the pediatric population, appropriate treatment may be unduly delayed. Methods: The authors performed an extensive review of the published literature (PubMed) focusing on ISCM in the pediatric age group. Results: The search yielded 17 articles exclusively pertaining to ISCM affecting the pediatric population. Conclusion: Here, we reviewed the clinical, radiographic, surgical, and outcome data for the treatment of ISCM in the pediatric age groups. Notably, over 50% of pediatric patients with ISCM experienced an improvement in their neurological status after a mean postoperative follow-up duration of 4 years. Future meta-analyses are needed to highlight the potential presence of ISCM and, thereby, decrease the rate of misdiagnosis of these lesions in the pediatric population presenting with recurrent intramedullary spinal cord hemorrhages.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY
| | - Ryne Jenkins
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA, United States
| | - Claudia Covarrubias
- School of Medicine, Universidad Anáhuac Querétaro, Cto. Universidades, Santiago, de Querétaro, Mexico
| | - Manraj Sekhon
- William Beaumont School of Medicine, Oakland University, Rochester, Michigan
| | - Marisol Soula
- Grossman School of Medicine, New York University, New York
| | - Michael Kortz
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, United States
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21
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Li XY, Zhang HQ, Ling F, Sun LY, Yu JX, Ren J, He JH. Changes in Evoked Potentials in a Hybrid Surgery of Spinal Arteriovenous Malformations Associated with Nerve Root AVF. Neurol India 2019; 67:1156-1158. [PMID: 31512668 DOI: 10.4103/0028-3886.266251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Xiao-Yu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Hong-Qi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Li-Yong Sun
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jia-Xing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jian-Hua He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
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22
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Hsu JL, Cheng MY, Liao MF, Hsu HC, Weng YC, Chang KH, Chang HS, Kuo HC, Huang CC, Lyu RK, Lin KJ, Ro LS. The etiologies and prognosis associated with spinal cord infarction. Ann Clin Transl Neurol 2019; 6:1456-1464. [PMID: 31402616 PMCID: PMC6689689 DOI: 10.1002/acn3.50840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study aims to investigate the etiology and prognosis of spinal cord infarction (SCI). METHODS Over a period of 16 years, we retrospectively analyzed 31 patients with SCI. Demographic features and symptom presentations were carefully documented. Etiology-specific MRI features, such as the length and distribution of the lesions and owl's eyes sign, were recorded and analyzed to determine their associations with the clinical signs/symptoms. RESULTS In total, seven patients had aortic or vertebral artery dissections. We divided the patients with SCI into two groups: those with or without vessel dissection. Among SCI patients, the onset age was younger, and the proportion of patients with long-segment lesions and posterior pattern involvement on axial view was higher in the group with dissection than in the group without dissection (all P < 0.05). The lesions were frequently located in the upper cervical or lower thoracic-lumbar regions, and the lengths of the lesions were associated with 1-month outcomes, suggesting that artery dissection may contribute to the longitudinal and posterior extension of SCI. In contrast, among patients without dissection, the range of longitudinal extensions of in spans of vertebral bodies was broader (range, 1-8). A higher proportion of patients had focal pain adjacent to the lesion (P = 0.05) and a poorer 1-month outcome (P = 0.04) in the long-segment lesion group than in the short-segment lesion group. CONCLUSIONS A detailed history and the use of modern imaging tools may help clinicians search for vessel dissection and other etiologies, evaluate the spatial extension of lesions in SCI, and predict prognosis.
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Affiliation(s)
- Jung Lung Hsu
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Mind, Brain, and Consciousness, Taipei Medical University, Taipei, Taiwan.,Brain and Consciousness Research Center, TMU Shuang Ho Hospital, New Taipei City, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Ming-Feng Liao
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Ching Hsu
- Department of Traditional Chinese Medicine, Division of Chinese Acupuncture and Traumatology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Weng
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Chang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hong-Shiu Chang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chou Kuo
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Chang Huang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Rong-Kuo Lyu
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Ju Lin
- Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Long-Sun Ro
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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23
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Hsu JL, Cheng MY, Liao MF, Hsu HC, Weng YC, Chang KH, Chang HS, Kuo HC, Huang CC, Lyu RK, Lin KJ, Ro LS. A comparison between spinal cord infarction and neuromyelitis optica spectrum disorders: Clinical and MRI studies. Sci Rep 2019; 9:7435. [PMID: 31092838 PMCID: PMC6520381 DOI: 10.1038/s41598-019-43606-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 04/23/2019] [Indexed: 01/06/2023] Open
Abstract
This study aims to investigate the clinical features and magnetic resonance imaging (MRI) findings in patients with spinal cord infarction (SCI) and neuromyelitis optica spectrum disorders (NMOSDs). Over a period of 16 years, we retrospectively analyzed 39 patients with SCI and 21 patients with NMOSD. The demographic features and clinical presentations of both diseases were carefully documented. Etiology-specific MRI features, such as the length and distribution of the lesions, the owl's eyes sign and bright spotty lesions, were recorded and analyzed regarding their association with the clinical signs/symptoms. Patients with SCI were older than patients with NMOSD and had sudden onset of clinical symptoms with focal pain adjacent to the lesions. Concomitant spinal cord and vertebral body infarctions were frequently associated with aortic pathology (p = 0.04). In addition, artery dissection was highly associated with combined ASA and unilateral PSA infarctions and long segments of SCI (all p < 0.05). In contrast, patients with NMOSD had a relatively younger age of onset, female predominance and subacute progression of limbs weakness. As observed by MRI, the length and location of the lesions demonstrated significant differences between the two diseases (P < 0.01). The owl's eyes sign showed more frequently in patients with SCI than NMOSD (p < 0.01). The predicted prognoses in SCI and NMOSD were significantly associated with initial motor function (muscle power), after adjustments for age and gender (p < 0.01 and p = 0.02, respectively). Along with patient demographic characteristics, lesion features on MRI can help clinicians differentiate acute noncompressive myelopathy due to SCI from that due to NMOSD, which may lead to immediate initiation of adequate therapeutic measures.
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Affiliation(s)
- Jung Lung Hsu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan.,Graduate Institute of Mind, Brain, and Consciousness, Taipei Medical University, Taipei and Brain and Consciousness Research Center, TMU Shuang Ho Hospital, New Taipei City, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan.,Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Ming-Feng Liao
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan
| | - Hui-Ching Hsu
- Department of Traditional Chinese Medicine, Division of Chinese Acupuncture and Traumatology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Weng
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan
| | - Hong-Shiu Chang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan
| | - Hung-Chou Kuo
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan
| | - Chin-Chang Huang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan
| | - Rong-Kuo Lyu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan
| | - Kun-Ju Lin
- Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Long-Sun Ro
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan.
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24
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Paláu-Hernández S, Rodriguez-Leyva I, Shiguetomi-Medina JM. Late onset adrenoleukodystrophy: A review related clinical case report. eNeurologicalSci 2019; 14:62-67. [PMID: 30671550 PMCID: PMC6330384 DOI: 10.1016/j.ensci.2019.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/07/2019] [Indexed: 12/28/2022] Open
Abstract
Our objective is to review the initial presentation, evolution, progression, final stage, and images in the follow up of an adult patient who presented an uncommon peroxisomal disease (1/20,000 males) that occurred by ABCD1 gene mutation in the Xq28 chromosome; to bring forward the imaging features (which nowadays is the most useful and accessible diagnostic tool) and clinical presentation of adrenoleukodystrophy in adulthood; to propose a differential diagnosis in aid of a prompt recognition of the disease hereafter from a neurologist approach. In relation of a clinical case we reviewed the literature to correlate the principal findings and evolution of the disease. This thrilling but at the same time unfortunate disease is not only a diagnostic problem is also a therapeutic quest besides all the related familial, labor, and social related problems. The very-long chain fatty acids (VLCFA) accumulation leads to a not completely understood mechanisms that precipitate the specific malfunction of the nervous system and adrenal gland. The initial corticospinal bilateral involvement provokes a spastic paraparesis but with the affection of others pathways multiple manifestations appears, with dementia and finally loss of the most of cortical functions secondary to the white matter affection. Since the hematopoietic stem cell transplantation can be treated with variable results, other treatments, as the Lorenzo's oil, have not been consistent with a substantial improvement of the affected individual. The genetic advice and support to the patient and the family are essentials as well as the screening in individuals at risk before the onset of the disease.
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Affiliation(s)
- Santiago Paláu-Hernández
- Faculty of Medicine, Universidad Autónoma de San Luis Potosí, Mexico
- Service of Neurology of Hospital Central "Dr. Ignacio Morones Prieto" San Luis Potosi, S.L.P., Mexico
| | - Ildefonso Rodriguez-Leyva
- Faculty of Medicine, Universidad Autónoma de San Luis Potosí, Mexico
- Service of Neurology of Hospital Central "Dr. Ignacio Morones Prieto" San Luis Potosi, S.L.P., Mexico
| | - Juan Manuel Shiguetomi-Medina
- Faculty of Medicine, Universidad Autónoma de San Luis Potosí, Mexico
- Department of Postgraduate, Faculty of Medicine, Universidad Autónoma de San Luis Potosí, Mexico
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