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Gharios M, Stenimahitis V, El-Hajj VG, Mahdi OA, Fletcher-Sandersjöö A, Jabbour P, Andersson M, Hultling C, Elmi-Terander A, Edström E. Spontaneous spinal cord infarction: a systematic review. BMJ Neurol Open 2024; 6:e000754. [PMID: 38818241 PMCID: PMC11138300 DOI: 10.1136/bmjno-2024-000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024] Open
Abstract
Background and objectives Spontaneous spinal cord infarction (SCInf) is a rare condition resulting in acute neurological impairment. Consensus on diagnostic criteria is lacking, which may present a challenge for the physician. This review aims to analyse the current literature on spontaneous SCInf, focusing on epidemiology, the diagnostic process, treatment strategies and neurological outcomes. Methods The study was performed in accordance with a previously published protocol. PubMed, Web of Science and Embase were searched using the keywords 'spontaneous', 'spinal cord', 'infarction' and 'ischaemic'. The eligibility of studies was evaluated in two steps by multiple reviewers. Data from eligible studies were extracted and systematically analysed. Results 440 patients from 33 studies were included in this systematic review. Analysis of vascular risk factors showed that hypertension was present in 40%, followed by smoking in 30%, dyslipidaemia in 29% and diabetes in 16%. The severity of symptoms at admission according to the American Spinal Injury Association (ASIA) Impairment Scale was score A 19%, score B14%, score C36% and score D32%. The mean follow-up period was 34.8 (±12.2) months. ASIA score at follow-up showed score A 11%, score B 3%, score C 16%, score D 67% and score E 2%. The overall mortality during the follow-up period was 5%. When used, MRI with diffusion-weighted imaging (DWI) supported the diagnosis in 81% of cases. At follow-up, 71% of the patients were able to walk with or without walking aids. Conclusion The findings suggest a significant role for vascular risk factors in the pathophysiology of spontaneous SCInf. In the diagnostic workup, the use of DWI along with an MRI may help in confirming the diagnosis. The findings at follow-up suggest that neurological recovery is to be expected, with the majority of patients regaining ambulation. This systematic review highlights gaps in the literature and underscores the necessity for further research to establish diagnostic criteria and treatment guidelines.
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Affiliation(s)
- Maria Gharios
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Vasilios Stenimahitis
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Rehabilitation, Furuhöjden Rehab Hospital, Täby, Sweden
| | | | - Omar Ali Mahdi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Magnus Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
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Jadhav AP. Vascular Myelopathies. Continuum (Minneap Minn) 2024; 30:160-179. [PMID: 38330477 DOI: 10.1212/con.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Vascular injuries of the spinal cord are less common than those involving the brain; however, they can be equally devastating. This article discusses the diagnosis and management of ischemic and hemorrhagic vascular disorders of the spinal cord. LATEST DEVELOPMENTS Clinical suspicion remains the mainstay for recognizing vascular myelopathies, yet diagnoses are often delayed and challenging in part because of their rarity and atypical manifestations. Noninvasive imaging such as CT and MRI continues to improve in spatial resolution and diagnostic precision; however, catheter-based spinal angiography remains the gold standard for defining the spinal angioarchitecture. In addition to hemorrhagic and ischemic disease, the contribution of venous dysfunction is increasingly appreciated and informs treatment strategies in conditions such as intracranial hypotension. ESSENTIAL POINTS Vascular disorders of the spine manifest in variable and often atypical ways, which may lead to delayed diagnosis. Increased awareness of these conditions is critical for early recognition and treatment. The goal of treatment is to minimize long-term morbidity and mortality.
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Koori N, Senda J, Naito T. The usefulness of the apparent diffusion coefficient value in diagnosing acute spinal cord ischemia. NAGOYA JOURNAL OF MEDICAL SCIENCE 2023; 85:612-618. [PMID: 37829492 PMCID: PMC10565584 DOI: 10.18999/nagjms.85.3.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/28/2022] [Indexed: 10/14/2023]
Abstract
The purpose of our study was to assess the usefulness of the apparent diffusion coefficient (ADC) value in differentiating between a normal spinal cord and a spinal cord with acute ischemia. Control group of 113 and 8 acute spinal cord ischemia patients were enrolled in this study. The ADC values were measured when diffusion-weighted imaging was first performed after the onset of acute spinal cord ischemia. The mean ADC value each of the control group and acute spinal cord ischemia patients was 0.99 ± 0.19 × 10-3 mm2/s and 0.70 ± 0.15 × 10-3 mm2/s. The mean ADC value in patients with acute spinal cord ischemia was significantly lower than that in patients with a normal spinal cord (P < 0.01). We found the cutoff ADC value (0.86 × 10-3 mm2/s) to be a useful indicator of acute spinal cord ischemia (sensitivity = 100.0%, specificity = 71.7%, AUC = 0.92). In conclusions, it is suggested that the ADC value may be useful in the diagnosis of acute spinal cord ischemia.
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Affiliation(s)
- Norikazu Koori
- School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Inashiki, Japan
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Joe Senda
- Department of Neurology, Komaki City Hospital, Komaki, Japan
| | - Takehiro Naito
- Department of Neurosurgery, Komaki City Hospital, Komaki, Japan
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Hieu LT, Van Thanh L, Van Quang V, Khue DK, Anh NHN, Tien DD. Spinal cord ischemia after transcatheter artery chemoembolization for hepatocellular carcinoma: A case-report. Int J Surg Case Rep 2023; 106:108258. [PMID: 37099990 PMCID: PMC10164875 DOI: 10.1016/j.ijscr.2023.108258] [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: 03/24/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION Transarterial hepatic chemoembolization (TACE) has been used to treat unresectable hepatocellular carcinoma and has gained widespread acceptance as a treatment for both primary and secondary hepatic malignancies. CASE REPORT We report a case of 78-year-old male patient with chronic hepatitis B, diagnosed with HCC. He underwent the second TACE, and right after the procedure, the patient abruptly developed bilateral lower extremities motor weakness and sensory impairment below the T10 dermatome. Spinal magnetic resonance imaging showed T2-weighted scans showed increased intramedullary signal strength at the T1-T12 level. The patient received supportive care, ongoing rehabilitation, and steroid pulse therapy. The motor strength remained unchanged, but the sensory deficiencies practically disappeared. CLINICAL DISCUSSION The hepatic artery injury or decreased flow at the prior TACE site, which causes collateral recruitment, can explain why spinal cord injury following TACE typically happens after the second or third session. It can occasionally result from accidental embolized spinal branches originating from intercostal or lumbar collateral arteries. In our case, we hypothesize the embolism caused the infarction to the spinal cord travel through the connection between the lateral branches of the right inferior phrenic artery and the intercostal arteries, which supply the spinal cord through the anterior spinal artery. CONCLUSIONS TACE in rare case can have severe complications. A tailored therapeutic strategy, including consideration of a shunt and selection of the vessels utilized for the Lipiodol infusion prior to TACE, is crucial to achieving an optimal end outcome to avert these significant consequences.
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Affiliation(s)
- Le Trung Hieu
- Hepatobiliary and Pancreatic Surgery Department, 108 Military Central Hospital, Hanoi 100000, Viet Nam
| | - Le Van Thanh
- Hepatobiliary and Pancreatic Surgery Department, 108 Military Central Hospital, Hanoi 100000, Viet Nam.
| | - Vu Van Quang
- Hepatobiliary and Pancreatic Surgery Department, 108 Military Central Hospital, Hanoi 100000, Viet Nam
| | - Dang Kim Khue
- College of Health Sciences, VinUniversity, Hanoi 100000, Viet Nam.
| | - Nguyen Hoang Ngoc Anh
- Hepatobiliary and Pancreatic Surgery Department, 108 Military Central Hospital, Hanoi 100000, Viet Nam
| | - Dao Duc Tien
- Department of Gastroenterology, 175 Military Hospital, Ho Chi Minh City 700000, Viet Nam
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Features of non-traumatic spinal cord infarction on MRI: Changes over time. PLoS One 2022; 17:e0274821. [PMID: 36137128 PMCID: PMC9499193 DOI: 10.1371/journal.pone.0274821] [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: 01/20/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Spinal cord infarction (SCI) is difficult to diagnosis using MRI findings. We aimed to suggest the optimal timing of MRI studies for diagnosing SCI. Materials and methods This retrospective study was approved by our institutional review board. The requirement for informed consent was waived. MRI scans of SCI patients diagnosed between January 2015 and August 2019 were enrolled in the SCI group and subdivided according to the interval between symptom onset and time of MRI scan (A, within 6 h; B, 6–12 hours; C, 12–24 hours; D, 24–72 hours; E, 3–7 days). Three radiologists analyzed the T2WI scans and evaluated the confidence level of diagnosing SCI using a five-point Likert scale: 1, certainly not; 2, probably not; 3, equivocal; 4, probably yes; 5, certainly yes. Scores of 4 and 5 were defined as “T2WI-positive SCI” and scores of 1–3 were defined as “T2WI-negative SCI”. Results The SCI group included 58 MRI scans of 34 patients (mean age, 60.6 ± 14.0 years; 18 women). The T2WI positivity rate was 72.4% (42/58). In contrast to the other subgroups, subgroup A included fewer cases of T2WI-positive SCI (1/4, 25%) than T2WI-negative SCI. A confidence score of 5 was the most common in subgroup D (4/27, 14.8%). Among the 12 patients who underwent MRI studies more than twice, confidence scores increased with time. Conclusion In patients with suspected SCI showing equivocal initial MRI findings, follow-up MRI studies are helpful, especially when performed between 24 and 72 hours after symptom onset.
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Abstract
This article is devoted to the MR imaging evaluation of spine emergencies, defined as spinal pathologic conditions that pose an immediate risk of significant morbidity or mortality to the patient if not diagnosed and treated in a timely manner. MR imaging plays a central role in the timely diagnosis of spine emergencies. A summary of MR imaging indications and MR imaging protocols tailored for a variety of spinal emergencies will be presented followed by a review of key imaging findings for the most-encountered emergent spine pathologic conditions. Pathologic conditions will be broadly grouped into traumatic and atraumatic pathologic conditions. For traumatic injuries, a practical and algorithmic diagnostic approach based on the AO Spine injury classification system will be presented focused on subaxial spine trauma. Atraumatic spinal emergencies will be dichotomized into compressive and noncompressive subtypes. The location of external compressive disease with respect to the thecal sac is fundamental to establishing a differential diagnosis for compressive emergencies, whereas specific patterns of spinal cord involvement on MR imaging will guide the discussion of inflammatory and noninflammatory causes of noncompressive myelopathy.
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CHAN CH, DESAI SR, HWANG NC. Cerebrospinal Fluid Drains: Risks in Contemporary Practice. J Cardiothorac Vasc Anesth 2022; 36:2685-2699. [DOI: 10.1053/j.jvca.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 11/11/2022]
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Brum IV, Silva GD, Sodre DS, Nogueira FM, Pereira SLDA, Castro LHM. Myelopathy in sickle cell disease: a case-oriented review. Spinal Cord Ser Cases 2021; 7:85. [PMID: 34564705 DOI: 10.1038/s41394-021-00449-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Although neurological complications are well recognized in patients with sickle cell disease, myelopathy has been rarely described, with few reported cases of compressive and ischemic myelopathy. We present the first case report of longitudinally extensive myelitis (LETM) in SCD and review the differential diagnosis of myelopathy in these patients. CASE PRESENTATION We report the case of a 29-year-old African-Brazilian man with SCD, who experienced a subacute flaccid paraparesis, with T2 sensory level and urinary retention. Cerebrospinal fluid analysis showed a lymphocytic pleocytosis and increased protein levels. MRI disclosed a longitudinally extensive spinal cord lesion, with a high T2/STIR signal extending from C2 to T12. We searched Medline/PubMed, Embase, Scopus, and Google Scholar databases for myelopathy in SCD patients. DISCUSSION Spinal cord compression by vertebral fractures, extramedullary hematopoietic tissue, and Salmonella epidural abscess have been reported in SCD. We found only three case reports of spinal cord infarction, which is unexpectedly infrequent compared to the prevalence of cerebral infarction in SCD. We found only one case report of varicella-zoster myelitis and no previous report of LETM in SCD patients. Specific and time-sensitive causes of myelopathy should be considered in SCD patients. In addition to compression and ischemia, LETM is a possible mechanism of spinal cord involvement in SCD patients.
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Affiliation(s)
- Igor Vilela Brum
- Department of Neurology, University of São Paulo, São Paulo, Brazil.
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Aalbers MW, Groen RJM, Appelman APA, Heersema TDJ, Wokke BHA, Oterdoom DLM. Spinal Cord Ischemia Related to Disc Herniation: Case Report and a Review of the Literature. Int Med Case Rep J 2021; 14:429-433. [PMID: 34211300 PMCID: PMC8240129 DOI: 10.2147/imcrj.s316797] [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: 05/03/2021] [Accepted: 06/05/2021] [Indexed: 12/01/2022] Open
Abstract
Symptoms of spinal cord ischemia can mimic myelopathy due to spinal cord compression in the acute phase. Thoracic disc herniation with limited spinal cord compression but rapid progression of neurological symptoms causes a clinical dilemma as to whether emergency decompression should be performed. We report a case of acute progressive myelopathy due to spinal cord ischemia related to thoracic disc herniation initially managed by Th8 laminectomy with reduction of the herniated disc. Repeat imaging showed T2-weighted hyperintensity in the posterior cord. The clinical and radiological course supports posterior spinal artery ischemia. This case illustrates and a review of the literature shows that thoracic disc herniation may be complicated by ischemic myelopathy even in the absence of cord compression.
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Affiliation(s)
- Marlien W Aalbers
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Auke P A Appelman
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Thea D J Heersema
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Beatrijs H A Wokke
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D L Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
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10
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McEntire CR, Dowd RS, Orru' E, David C, Small JE, Cervantes-Arslanian A, Lerner DP. Acute Myelopathy: Vascular and Infectious Diseases. Neurol Clin 2021; 39:489-512. [PMID: 33896530 DOI: 10.1016/j.ncl.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular and infectious causes are rare but important causes of spinal cord injury. High suspicion for these processes is necessary, as symptoms may progress over hours to days, resulting in delayed presentation and diagnosis and worse outcomes. History and clinical examination findings can assist with localization of the affected vascular territory and spinal level, which will assist with focusing spinal imaging. Open and/or endovascular surgical management depends on the associated vascular abnormality. Infectious myelopathy treatment consists of targeted antimicrobial therapy when possible, infectious source control, and again, close monitoring for systemic complications.
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Affiliation(s)
- Caleb R McEntire
- Department of Neurology, Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard S Dowd
- Department of Neurosurgery, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Emanuele Orru'
- Department of Radiology, Neurointerventional Radiology Division, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Carlos David
- Department of Neurosurgery, Tufts University School of Medicine, Boston, MA 02111, USA; Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Juan E Small
- Department of Radiology, Neuroradiology Section, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | | | - David P Lerner
- Division of Neurology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; Department of Neurology, Tufts University School of Medicine, Boston, MA 02111, USA.
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Anand KA, Bhowmik KK, Sarkar A, Ghosh R, Mandal A, Swaika B, Ray BK. Tubercular longitudinally extensive transverse myelitis (LETM): An enigma for primary care physicians. J Family Med Prim Care 2021; 10:1057-1060. [PMID: 34041124 PMCID: PMC8138341 DOI: 10.4103/jfmpc.jfmpc_2101_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/02/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022] Open
Abstract
Albeit, all forms of tuberculosis (TB) are endemic in India, spinal intramedullary TB and tubercular longitudinally extensive transverse myelitis (LETM) is deemed extremely rare. With recent advances in the field of neurology, autoimmune astrocytopathy (neuromyelitis optica spectrum disorders, NMOSD), myelin-oligodendrocyte glycoprotein associated encephalomyelitis (MOG-EM), metabolic myelopathy, connective tissue diseases and viral infections have gained considerable focus in the list of differentials of LETM whereas tubercular association is often forgotten. This report presents a rare case of acute transverse myelopathy which unveiled previously undiagnosed pulmonary tuberculosis in an adult rural Indian male. The patient responded well to anti-tubercular therapy and corticosteroids. Exact pathogenesis of LETM in TB remains elusive. Association of TB with MOG-EM has been one of the recent hot-cakes. However, an ill-defined immune-inflammatory response to the infectious agent is the likely cause of tubercular LETM. Hence, the primary care physicians who are the first medical contacts of acute LETM cases and in most cases due to diagnostic dilemma there is an unavoidable delay in accurate diagnosis and initiation of therapy. Primary care doctors should nurture a high index of suspicion to diagnose this potentially lifetime-debilitating yet absolutely treatable clinical condition i.e. tubercular LETM.
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Affiliation(s)
- Kumar Abhishek Anand
- Resident, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Kalyan Kumar Bhowmik
- Resident, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Amit Sarkar
- Assistant Professor, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Ritwik Ghosh
- Resident, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Arpan Mandal
- Associate Professor, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Bikash Swaika
- Professor and Head of the Department, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Biman Kanti Ray
- Professor, Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India
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Costamagna G, Meneri M, Abati E, Brusa R, Velardo D, Gagliardi D, Mauri E, Cinnante C, Bresolin N, Comi G, Corti S, Faravelli I. Hyperacute extensive spinal cord infarction and negative spine magnetic resonance imaging: a case report and review of the literature. Medicine (Baltimore) 2020; 99:e22900. [PMID: 33120840 PMCID: PMC7581089 DOI: 10.1097/md.0000000000022900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Spinal cord infarction (SCI) accounts for only 1% to 2% of all ischemic strokes and 5% to 8% of acute myelopathies. Magnetic resonance imaging (MRI) holds a role in ruling out non-ischemic etiologies, but the diagnostic accuracy of this procedure may be low in confirming the diagnosis, even when extensive cord lesions are present. Indeed, T2 changes on MRI can develop over hours to days, thus accounting for the low sensitivity in the hyperacute setting (ie, within 6 hours from symptom onset). For these reasons, SCI remains a clinical diagnosis. Despite extensive diagnostic work-up, up to 20% to 40% of SCI cases are classified as cryptogenic. Here, we describe a case of cryptogenic longitudinally extensive transverse myelopathy due to SCI, with negative MRI and diffusion-weighted imaging at 9 hours after symptom onset. PATIENT CONCERNS A 51-year-old woman presented to our Emergency Department with acute severe abdominal pain, nausea, vomiting, sudden-onset of bilateral leg weakness with diffuse sensory loss, and paresthesias on the trunk and legs. DIAGNOSES On neurological examination, she showed severe paraparesis and a D6 sensory level. A 3T spinal cord MRI with gadolinium performed at 9 hours after symptom onset did not detect spinal cord alterations. Due to the persistence of a clinical picture suggestive of an acute myelopathy, a 3T MRI of the spine was repeated after 72 hours showing a hyperintense "pencil-like" signal mainly involving the grey matter from T1 to T6 on T2 sequence, mildly hypointense on T1 and with restricted diffusion. INTERVENTIONS The patient was given salicylic acid (100 mg/d), prophylactic low-molecular-weight heparin, and began neuromotor rehabilitation. OUTCOMES Two months later, a follow-up neurological examination revealed a severe spastic paraparesis, no evident sensory level, and poor sphincteric control with distended bladder. LESSONS Regardless of its relatively low frequency in the general population, SCI should be suspected in every patient presenting with acute and progressive myelopathic symptoms, even in the absence of vascular risk factors. Thus, a clinical presentation consistent with a potential vascular syndrome involving the spinal cord overrides an initially negative MRI and should not delay timely and appropriate management.
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Affiliation(s)
- Gianluca Costamagna
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Megi Meneri
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Elena Abati
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Roberta Brusa
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Daniele Velardo
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Delia Gagliardi
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Eleonora Mauri
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Claudia Cinnante
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | - Nereo Bresolin
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Giacomo Comi
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Stefania Corti
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Irene Faravelli
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
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Seregni F, Sabanathan S, Cross J, Chitre M, Krishnakumar D. Sudden onset of lower limb flaccid paralysis. Arch Dis Child Educ Pract Ed 2020; 105:101-103. [PMID: 30478160 DOI: 10.1136/archdischild-2018-315903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/27/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Francesca Seregni
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Saraswathy Sabanathan
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Justin Cross
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Manali Chitre
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Deepa Krishnakumar
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Shah LM, Bisson EF. In Reply to the Letter to the Editor Regarding "Susceptibility of Cervical Spinal Stenosis to Hypoxic-Ischemic Cord Injury". World Neurosurg 2020; 136:441. [PMID: 32204293 DOI: 10.1016/j.wneu.2020.01.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Lubdha M Shah
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA.
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
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Bone Infarct as an Indicator of Acute Spinal Ischaemia. Case Rep Pediatr 2020; 2020:9703625. [PMID: 32181041 PMCID: PMC7063203 DOI: 10.1155/2020/9703625] [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: 05/13/2019] [Accepted: 01/29/2020] [Indexed: 11/17/2022] Open
Abstract
Acute spinal cord infarct in childhood is extremely rare, generally secondary to spinal/cardiovascular surgery or severe vertebral injuries. However, spontaneous spinal cord infarct cases have been described. We present a clinical case of a teenager who developed an acute weakness and paraesthesia in lower limbs after playing piggyback. Laboratory tests and MRI (magnetic resonance imaging) were normal. During her hospital admission, her motor strength improved. After 10 days, MRI was repeated, and a bone infarct was observed. She was medicated with acetylsalicylic acid, and she completed a rehabilitation program.
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16
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Hor H, Nader H, Tarnutzer AA. Absent F-waves in conus medullaris stroke mimicking Guillain-Barré syndrome. BMJ Case Rep 2018; 11:11/1/e227726. [DOI: 10.1136/bcr-2018-227726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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17
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Matos JR, George RM, Wilson SH. It Is Not Always the Epidural: A Case Report of Anterior Spinal Artery Ischemia in a Trauma Patient. A A Pract 2018; 11:148-150. [PMID: 29634525 DOI: 10.1213/xaa.0000000000000764] [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]
Abstract
Motor vehicle collisions impact millions of people annually resulting in multiinjury trauma. Anesthesiologists are consulted for rib fracture analgesia to improve respiratory mechanics and prevent intubation. This report describes a trauma patient who developed hypotension and lower extremity weakness after epidural placement for multiple rib fractures. Initially, hypotension was attributed to neuraxial sympathectomy. However, physical examination also indicated anterior spinal artery ischemia. Regional anesthesia and acute pain teams must be able to both identify contraindications and complications of regional techniques and discern when complications are not a result of regional interventions to initiate prompt management and definitive care.
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Affiliation(s)
- Jennifer R Matos
- From the Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
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18
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Spinal Cord Infarction with Aortic Dissection. Case Rep Orthop 2018; 2018:7042829. [PMID: 30050713 PMCID: PMC6046175 DOI: 10.1155/2018/7042829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/19/2018] [Indexed: 11/17/2022] Open
Abstract
Spinal cord infarction is an uncommon but devastating disorder caused by various conditions. Aortic dissection is a possible etiological factor and is usually associated with severe chest or back pain. We encountered two cases of spinal cord infarction associated with aortic dissection that presented without typical severe pain, and each case resulted in a different clinical course. Aortic dissection should be considered a cause of spinal cord infarction even if there is little or no pain. The different outcomes in our two patients reflected a difference in their initial functional scores.
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Abstract
Spinal cord infarction (SCI) is a rare type of stroke. The initial magnetic resonance imaging (MRI) is usually normal and can mimic the presentation of the acute transverse myelitis (ATM), acute inflammatory demyelinating polyneuropathy, and compressive myelopathies from neoplasm, epidural or subdural hematoma, or abscess. The aim of this report is to describe and discuss the case of a patient with SCI presenting as a diagnostic confusion with acute transverse myelitis. A 64-year-old male with a medical history of hypertension presented with an acute onset of urinary retention with lower limb weakness. Based on the initial MRI and evaluation, a diagnosis of acute transverse myelitis was made. Despite thorough evaluation, the etiology of transverse myelitis was undetermined. Hence, the MRI of the thoracic spine was repeated which showed patchier enhancements of the vertebral body with features suggestive of the spinal cord and vertebral body infarction. Thus, a repeat MRI is required to make an accurate diagnosis. The vertebral body is always involved and can be of diagnostic significance as it reflects the pathology of underlying blood supply.
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Affiliation(s)
- Nilesh H Pawar
- Department of General Medicine, Sengkang General Hospital, Sengkang Health, Singhealth
| | - Ealing Loke
- Department of General Medicine, Sengkang General Hospital, Sengkang Health, Singhealth
| | - Derrick C Aw
- Department of General Medicine, Sengkang General Hospital, Sengkang Health, Singhealth
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20
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Yamamoto N, Miyagi R, Sakai T, Morimoto K, Henmi T, Sairyo K. Magnetic resonance imaging and diffusion-weighted imaging findings in posterior spinal cord infarction: Case report. J Orthop Sci 2017; 22:1151-1154. [PMID: 27183891 DOI: 10.1016/j.jos.2016.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/05/2016] [Accepted: 04/09/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Norio Yamamoto
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Ryo Miyagi
- Department of Orthopedics, Institute of Health Biosciences, Tokushima University Graduate School, Tokushima, Japan.
| | - Toshinori Sakai
- Department of Orthopedics, Institute of Health Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kuniaki Morimoto
- Department of Orthopedic Surgery, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Tatsuhiko Henmi
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Health Biosciences, Tokushima University Graduate School, Tokushima, Japan
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21
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Rutman AM, Peterson DJ, Cohen WA, Mossa-Basha M. Diffusion Tensor Imaging of the Spinal Cord: Clinical Value, Investigational Applications, and Technical Limitations. Curr Probl Diagn Radiol 2017; 47:257-269. [PMID: 28869104 DOI: 10.1067/j.cpradiol.2017.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022]
Abstract
Although diffusion-weighted imaging (DWI) has become a mainstay in modern brain imaging, it remains less utilized in the evaluation of the spinal cord. Many studies have shown promise in using DWI and diffusion-tensor imaging (DTI) for evaluation of the spinal cord; however, application has been stalled by technical obstacles and artifacts, and questions remain regarding its clinical utility on an individual examination level. This review discusses the background, concepts, and technical aspects of DWI and DTI, specifically for imaging of the spinal cord. The clinical and investigational applications of spinal cord DTI, as well as the practical difficulties and limitations of DWI and DTI for the evaluation of the spinal cord are examined.
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Affiliation(s)
- Aaron M Rutman
- Department of Radiology, University of Washington, Seattle, WA.
| | | | - Wendy A Cohen
- Department of Radiology, University of Washington, Seattle, WA
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22
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Magnetic Resonance Imaging and Clinical Features in Acute and Subacute Myelopathies. Clin Neuroradiol 2017; 27:417-433. [PMID: 28667382 DOI: 10.1007/s00062-017-0604-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
Differential diagnosis of acute and subacute transverse myelopathy includes inflammatory, infectious, vascular, metabolic and paraneoplastic etiologies. Information on the diagnostic approach to transverse myelopathy with regard to daily clinical practice is provided. The differentiation between five lesion patterns on magnetic resonance imaging (MRI) in myelitis may be helpful: (1) longitudinal extensive transverse myelitis, (2) short segment ovoid or peripherally located, (3) "polio-like", (4) granulomatous and (5) segmental with rash. A correlation with these imaging features is supported if the clinical course and neurological symptoms are known. Although the mean interval from onset to nadir of symptoms in spinal cord infarction is 1 h, an overlap with a fulminant course of myelitis is possible, and impaired diffusion may also occur in acute inflammatory processes. As a result, laboratory testing, including aquaporin-4 antibodies and cerebrospinal fluid analysis, is crucial for the correct interpretation of imaging findings. Moreover, the discrimination of acute complete and acute partial transverse myelitis is advantageous in order to identify diverse entities, the latter often being a precursor to multiple sclerosis. Additional brain imaging is mandatory in suspected demyelinating, infectious, neoplastic and systemic autoimmune disease. A symmetrical lesion pattern restricted to individual tracts or dorsal columns indicates subacute combined degeneration of the spinal cord and, in addition to deficiency syndromes, a paraneoplastic etiology should be considered.
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23
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Sekine Y, Nishina T, Ueda Y. Rare spinal cord infarction in a patient with acute type B aortic dissection. Interact Cardiovasc Thorac Surg 2017; 24:976-977. [PMID: 28329371 DOI: 10.1093/icvts/ivx034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/18/2017] [Indexed: 11/12/2022] Open
Abstract
A 69-year-old man was admitted to our hospital with acute epigastric discomfort and subsequent paraplegia. Computed tomography revealed acute type B aortic dissection with a thrombosed false lumen. Magnetic resonance imaging did not reveal spinal cord infarction. Paraplegia resolved completely within 1 h. However, on the following day, the patient developed motor impairment in the left leg, sensory disorder of the bilateral legs and urinary retention. The symptoms gradually improved with conservative medical therapy. Magnetic resonance imaging on hospitalization Day 20 revealed spinal cord infarction limited to the right posterior area at level T7/T8 and the conus medullaris. The patient was discharged 44 days after admission. The presented case is notable for its atypical presentation of spinal cord infarction resulting from acute aortic dissection. The aetiology of neurological symptoms, especially that of lower extremity monoplegia, remained undiagnosed.
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Affiliation(s)
- Yuji Sekine
- Department of Cardiovascular Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Takeshi Nishina
- Department of Cardiovascular Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Yuichi Ueda
- Department of Cardiovascular Surgery, Nara Prefecture General Medical Center, Nara, Japan
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24
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Acute complete paraplegia of 8-year-old girl caused by spinal cord infarction following minor trauma complicated with longitudinal signal change of spinal cord. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:1432-1435. [DOI: 10.1007/s00586-017-4995-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/18/2017] [Accepted: 02/06/2017] [Indexed: 12/15/2022]
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The Temporal Pattern, Flux, and Function of Autophagy in Spinal Cord Injury. Int J Mol Sci 2017; 18:ijms18020466. [PMID: 28230791 PMCID: PMC5343998 DOI: 10.3390/ijms18020466] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 12/15/2022] Open
Abstract
Previous studies have indicated that autophagy plays a critical role in spinal cord injury (SCI), including traumatic spinal cord injury (TSCI) and ischemia-reperfusion spinal cord injury (IRSCI). However, while the understanding of mechanisms underlying autophagy in SCI has progressed, there remain several controversial points: (1) temporal pattern results of autophagic activation after SCI are not consistent across studies; (2) effect of accumulation of autophagosomes due to the blockade or enhancement of autophagic flux is uncertain; (3) overall effect of enhanced autophagy remains undefined, with both beneficial and detrimental outcomes reported in SCI literature. In this review, the temporal pattern of autophagic activation, autophagic flux, autophagic cell death, relationship between autophagy and apoptosis, and pharmacological intervention of autophagy in TSCI (contusion injury, compression injury and hemisection injury) and IRSCI are discussed. Types of SCI and severity appear to contribute to differences in outcomes regarding temporal pattern, flux, and function of autophagy. With future development of specific strategies on autophagy intervention, autophagy may play an important role in improving functional recovery in patients with SCI.
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26
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Klein JP. Imaging of progressive weakness or numbness of central or peripheral origin. HANDBOOK OF CLINICAL NEUROLOGY 2017; 136:923-37. [PMID: 27430450 DOI: 10.1016/b978-0-444-53486-6.00047-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Weakness and numbness occur in a variety of patterns that reflect injury to different parts of the central and peripheral nervous system. Progressive symptoms most often signify an underlying structural or degenerative problem. Familiarity with the major descending motor and ascending sensory tracts of the central nervous system, as well as radicular (dermatome and myotome) and peripheral nerve anatomy, is essential. Damage to these tracts and nerve fibers produces characteristic clinical symptoms and signs. Imaging, when used in a hypothesis-driven way, can be a valuable adjunct to the clinical history and physical examination. One of the most useful aspects of imaging is that it allows for differentiation of edema and inflammation from gliosis and atrophy, both of which can be associated with progressive weakness or numbness. Compression of nervous system structures by nonnervous system tissue can also be easily detected. The spectrum of diseases and imaging abnormalities associated with progressive weakness and numbness is highlighted in this review via a series of illustrative cases. In each case, anatomic localization and the key imaging findings are emphasized.
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Affiliation(s)
- Joshua P Klein
- Departments of Neurology and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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27
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Alanazy MH. Conus medullaris stroke. Does F wave predict return of ambulation? NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2016; 21:260-3. [PMID: 27356660 PMCID: PMC5107295 DOI: 10.17712/nsj.2016.3.20150554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Absent F wave in the stage of spinal shock has been described in cases of traumatic spinal cord injury. The role of F wave in predicting prognosis after conus medullaris infarct has not been described. We describe herein a middle aged-man with a conus medullaris infarct. Both tibial and peroneal F waves were absent on day 4. The left tibial F wave reappeared in the following study on day 18. All F waves reappeared on day 56 at which time the patient was still wheelchair bound. He regained walking on day 105. We hypothesize that reappearance of initially absent F waves post conus medullaris infarct is a good prognostic sign for the return of ambulation. The applicability of this observation requires further research. We also discuss clinical and diagnostic caveats in this case.
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Affiliation(s)
- Mohammed H Alanazy
- Division of Neurology, Department of Medicine, King Saud University, Riyadh, Saudi Arabia. Tel.+966 (11) 4699414. E-mail:
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28
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Abou Al-Shaar H, AbouAl-Shaar I, Al-Kawi MZ. Acute cervical cord infarction in anterior spinal artery territory with acute swelling mimicking myelitis. ACTA ACUST UNITED AC 2016; 20:372-5. [PMID: 26492118 PMCID: PMC4727627 DOI: 10.17712/nsj.2015.4.20150109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acute infarction of the cervical segment of the spinal cord is extremely uncommon. Patients may present with signs and symptoms mimicking that of acute myelitis. On imaging, both conditions may present as a hyperintense area on T-2 weighted MRI. History of sudden onset is essential in establishing the diagnosis. We report a case of cervical spinal cord infarction in a 40-year-old man who was diagnosed with acute transverse myelitis, and was treated with high dose intravenous corticosteroids followed by 5 sessions of plasma exchange. An MRI of the spine revealed abnormal high T2 signal intensity extending from the C2 to C7 level involving the anterior two-thirds of the cord with more central involvement. The findings were consistent with anterior spinal artery territory cervical cord infarction.
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Affiliation(s)
- Hussam Abou Al-Shaar
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia. Fax. +966 (11) 2157611. E-mail:
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29
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Simon FHP, Erhart P, Vcelar B, Scheuerle A, Schelzig H, Oberhuber A. Erythropoietin preconditioning improves clinical and histologic outcome in an acute spinal cord ischemia and reperfusion rabbit model. J Vasc Surg 2015; 64:1797-1804. [PMID: 26610640 DOI: 10.1016/j.jvs.2015.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/03/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study examined effects and functional outcome of recombinant human erythropoietin (rhEPO) and carbamylated erythropoietin fusion protein (cEPO-FC) preconditioning in a rabbit model for spinal cord ischemia and resulting paraplegia. This model was chosen because only a small surgical effect is needed to cause paraplegia in rabbits, which facilitates postoperative observation of animals. METHODS Anesthetized but spontaneously breathing New Zealand White rabbits randomly received cEPO-FC (50 μg/kg; n = 8), rhEPO (5000 IU/kg; n = 10), or vehicle (control; n = 10) 30 minutes before and after infrarenal aortic clamping. Ideal clamping time of 22 minutes was identified from preceding clamping tests (15-25 minutes). Postoperative observation time was 96 hours. Spinal cord function was assessed by neurologic evaluation of hind limb motor function every 12 hours using a modified Tarlov score. Spinal cord tissue damage was evaluated after 96 hours using hematoxylin and eosin, elastica van Gieson, Nissl, Masson-Goldner, and hemosiderin staining. Plasma levels of cell senescence markers stathmin, chitinase 1/3, elongation factor 1-α were determined. RESULTS Rabbits that received rhEPO showed significant improvement of spontaneous lower limb movements until 36 hours of reperfusion and improved histologic scores upon examination of the lumbar spinal cord compared with the control group. In contrast, cEPO-FC treatment showed comparable outcome to the control group concerning movements of the lower limbs and histology. Senescence markers were elevated in the control group, but not in the treatment groups, except for chitinase 3 in the rhEPO group. Only stathmin showed no significant effect. Markers for senescence might increase after acute ischemic injury. Attenuation of senescence markers might not come alone from improvement of the spinal cord. CONCLUSIONS Preconditioning with rhEPO attenuates ischemia/reperfusion injury of the spinal cord, whereas the carbamylated derivative (cEPO-FC) showed no positive effect on spinal cord function.
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Affiliation(s)
| | - Philipp Erhart
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany
| | | | | | - Hubert Schelzig
- Department of Vascular and Endovascular Surgery, University of Düsseldorf, Düsseldorf, Germany
| | - Alexander Oberhuber
- Department of Vascular and Endovascular Surgery, University of Düsseldorf, Düsseldorf, Germany
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30
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Imaging features and differentials in surfer’s myelopathy: a case report. Emerg Radiol 2015; 23:89-92. [DOI: 10.1007/s10140-015-1346-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/09/2015] [Indexed: 11/27/2022]
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31
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Differential Diagnosis of Acute Myelopathies: An Update. Clin Neuroradiol 2015; 25 Suppl 2:183-7. [PMID: 26031429 DOI: 10.1007/s00062-015-0401-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
Abstract
Appropriate description may lead to adequate diagnostic and therapeutic measures, and therefore, a simple scheme to categorize and term the imaging findings of acute myelopathy is suggested based on current literature. Assigning imaging findings to five groups, that is (a) "segmental with rash," (b) "poliolike," (c) "granulomatous-nodular," (d) "longitudinally extensive transverse myelitis," (e) "short-segment ovoid or peripherally located," provides a rationale to lessen differential diagnoses. The key for understanding, proper description and differential diagnosis is the correlation of two time points: When did the first symptoms appear and when did imaging take place? Early infarction within the first 24 h will show neither swelling nor enhancement.
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32
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Wang F, Li K, Mishra A, Gochberg D, Min Chen L, Gore JC. Longitudinal assessment of spinal cord injuries in nonhuman primates with quantitative magnetization transfer. Magn Reson Med 2015; 75:1685-96. [PMID: 25960050 DOI: 10.1002/mrm.25725] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/16/2015] [Accepted: 03/20/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE This study aimed to evaluate the reproducibility and specificity of quantitative magnetization transfer (qMT) imaging for monitoring spinal cord injuries (SCIs). METHODS MRI scans were performed in anesthetized monkeys at 9.4T, before and serially after a unilateral lesion of the cervical spinal cord. A two-pool fitting model was used to derive qMT parameters. RESULTS qMT measures were reproducible across normal subjects, with an average pool size ratio (PSR) of 0.086 ± 0.003 (mean ± SD) for gray matter, and 0.120 ± 0.005 for white matter, respectively. Compared with normal gray matter, the PSR of abnormal tissues rostral and caudal to the injury site decreased by 19.5% (P < 0.05), while the PSR of the cyst-like volume decreased drastically weeks after SCI. Strong correlations in cyst-like regions were observed between PSR and other MRI measures including longitudinal relaxation rate (R1 ), apparent diffusion coefficient and fractional anisotropy (FA). Decreased PSR and FA values correlated well with demyelination in abnormal tissues. CONCLUSION The qMT parameters provide robust and specific information about the molecular and cellular changes produced by SCI. PSR detected demyelination and loss of macromolecules in abnormal tissue regions rostral and caudal to the cyst/lesion sites.
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Affiliation(s)
- Feng Wang
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Ke Li
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Arabinda Mishra
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Daniel Gochberg
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Li Min Chen
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA.,Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - John C Gore
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA.,Psychology, Vanderbilt University, Nashville, Tennessee, USA.,Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
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Spinal cord ischemia secondary to hypovolemic shock. Asian Spine J 2015; 8:831-4. [PMID: 25558328 PMCID: PMC4278991 DOI: 10.4184/asj.2014.8.6.831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 01/09/2014] [Accepted: 01/24/2014] [Indexed: 11/09/2022] Open
Abstract
A 44-year-old male presented with symptoms of spinal cord compression secondary to metastatic prostate cancer. An urgent decompression at the cervical-thoracic region was performed, and there were no complications intraoperatively. Three hours postoperatively, the patient developed acute bilateral lower-limb paralysis (motor grade 0). Clinically, he was in class 3 hypovolemic shock. An urgent magnetic resonance imaging (MRI) was performed, showing no epidural hematoma. He was managed aggressively with medical therapy to improve his spinal cord perfusion. The patient improved significantly, and after one week, he was able to regain most of his motor functions. Although not commonly reported, spinal cord ischemia post-surgery should be recognized early, especially in the presence of hypovolemic shock. MRI should be performed to exclude other potential causes of compression. Spinal cord ischemia needs to be managed aggressively with medical treatment to improve spinal cord perfusion. The prognosis depends on the severity of deficits, and is usually favorable.
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34
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Baruah D, Chandra T, Bajaj M, Sonowal P, Klein A, Maheshwari M, Guleria S. A simplified algorithm for diagnosis of spinal cord lesions. Curr Probl Diagn Radiol 2015; 44:256-66. [PMID: 25801464 DOI: 10.1067/j.cpradiol.2014.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/07/2014] [Accepted: 12/29/2014] [Indexed: 11/22/2022]
Abstract
Neuroimaging is indispensable for evaluation of Myelopathy not only for localization but also for etiologic determination. MRI is the preferred examination for further characterization of the majority of these conditions. These include traumatic, inflammatory, infections, compressive and neoplastic conditions. This article provides an overview of a variety of pathologies that afflict the spinal cord in an easy to understand format. Their respective imaging manifestations on MRI and differential diagnoses are focused in this review. Early diagnosis and treatment of Myelopathy is critical in preventing or arresting neurological morbidity.
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Affiliation(s)
- Dhiraj Baruah
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI.
| | - Tushar Chandra
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Manish Bajaj
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Purabi Sonowal
- Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Andrew Klein
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Mohit Maheshwari
- Department of Radiology, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Saurabh Guleria
- Department of Pediatric Radiology, University of Alabama, Birmingham, AL
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35
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Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology 2014; 57:241-57. [PMID: 25398656 DOI: 10.1007/s00234-014-1464-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The purpose of this study was to analyse MR imaging features and lesion patterns as defined by compromised vascular territories, correlating them to different clinical syndromes and aetiological aspects. METHODS In a 19.8-year period, clinical records and magnetic resonance imaging (MRI) features of 55 consecutive patients suffering from spinal cord ischemia were evaluated. RESULTS Aetiologies of infarcts were arteriosclerosis of the aorta and vertebral arteries (23.6%), aortic surgery or interventional aneurysm repair (11%) and aortic and vertebral artery dissection (11%), and in 23.6%, aetiology remained unclear. Infarcts occurred in 38.2% at the cervical and thoracic level, respectively, and 49% of patients suffered from centromedullar syndrome caused by anterior spinal artery ischemia. MRI disclosed hyperintense pencil-like lesion pattern on T2WI in 98.2%, cord swelling in 40%, enhancement on post-contrast T1WI in 42.9% and always hyperintense signal on diffusion-weighted imaging (DWI) when acquired. CONCLUSION The most common clinical feature in spinal cord ischemia is a centromedullar syndrome, and in contrast to anterior spinal artery ischemia, infarcts in the posterior spinal artery territory are rare. The exclusively cervical location of the spinal sulcal artery syndrome seems to be a likely consequence of anterior spinal artery duplication which is observed preferentially here.
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Affiliation(s)
- Stefan Weidauer
- Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital of the Goethe - University, Frankfurt / Main, Seckbacher Landstraße 65, D 60389, Frankfurt / Main, Germany,
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36
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Wang F, Qi HX, Zu Z, Mishra A, Tang C, Gore JC, Chen LM. Multiparametric MRI reveals dynamic changes in molecular signatures of injured spinal cord in monkeys. Magn Reson Med 2014; 74:1125-37. [PMID: 25334025 DOI: 10.1002/mrm.25488] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/08/2014] [Accepted: 09/17/2014] [Indexed: 11/06/2022]
Abstract
PURPOSE To monitor the spontaneous recovery of cervical spinal cord injury (SCI) using longitudinal multiparametric MRI methods. METHODS Quantitative MRI imaging including diffusion tensor imaging, magnetization transfer (MT), and chemical exchange saturation transfer (CEST) were conducted in anesthetized squirrel monkeys at 9.4T. The structural, cellular, and molecular features of the spinal cord were examined before and at different time points after a dorsal column lesion in each monkey. RESULTS Images with MT contrast enhanced visualization of the gray and white matter boundaries and the lesion and permitted differentiation of core and rim compartments within an abnormal volume (AV). In the early weeks after SCI, both core and rim exhibited low cellular density and low protein content, with high levels of exchanging hydroxyl, amine, and amide protons, as evidenced by increased apparent diffusion coefficient, decreased fractional anisotropy, decreased MT ratio, decreased nuclear Overhauser effect, and large CEST effects. Over time, cellular density and fiber density increased, whereas amide, amine, and hydroxyl levels dropped significantly, but at differing rates. Histology confirmed the nature of the AV to be a cyst. CONCLUSION Multiparametric MRI offers a novel method to quantify the spontaneous changes in structure and cellular and molecular compositions of SC during spontaneous recovery from injury.
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Affiliation(s)
- Feng Wang
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Hui-Xin Qi
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Zhongliang Zu
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Arabinda Mishra
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Chaohui Tang
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - John C Gore
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Li Min Chen
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA.,Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
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Bazine A, Fetohi M, Berri MA, Essaadi I, Elbakraoui K, Ichou M, Errihani H. Spinal cord ischemia secondary to transcatheter arterial chemoembolization for hepatocellular carcinoma. Case Rep Gastroenterol 2014; 8:264-9. [PMID: 25408628 PMCID: PMC4209262 DOI: 10.1159/000368075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Transcatheter arterial chemoembolization (TACE) is accepted worldwide as an effective treatment for patients with unresectable hepatocellular carcinoma. Although considered relatively safe, TACE has been associated with several complications. Spinal cord ischemia secondary to TACE is an extremely rare but disastrous complication. We report a very rare case of spinal cord injuries after TACE, together with a literature review. During the procedure, the patient suddenly experienced sensory impairment below the T10 dermatome and bilateral lower extremity motor weakness. She was given high-dose steroids and supportive therapy. The sensory deficits nearly improved completely, but motor strength remained unchanged. Thereafter, a chest computed tomography scan showed tumor metastasis to the lungs. The patient is now receiving sorafenib and follow-up.
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Affiliation(s)
- Aziz Bazine
- Department of Medical Oncology, Military Hospital My Ismail, Meknès
| | - Mohamed Fetohi
- Department of Medical Oncology, Military Hospital My Ismail, Meknès
| | - Maha Ait Berri
- Departments of Neurology, Military Hospital Med V, Rabat, Morocco
| | - Ismail Essaadi
- Departments of Medical Oncology, Military Hospital Med V, Rabat, Morocco
| | - Kamal Elbakraoui
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
| | - Mohamed Ichou
- Departments of Medical Oncology, Military Hospital Med V, Rabat, Morocco
| | - Hassan Errihani
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
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Seeger A, Klose U, Bischof F, Strobel J, Ernemann U, Hauser TK. Zoomed EPI DWI of Acute Spinal Ischemia Using a Parallel Transmission System. Clin Neuroradiol 2014; 26:177-82. [PMID: 25168248 DOI: 10.1007/s00062-014-0342-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/14/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE A new method for diffusion-weighted imaging (DWI) using independent parallel transmission technique resulting in zoomed DWI was applied in four patients suffering from acute spinal cord ischemia. METHODS Four patients with clinical symptoms of acute spinal cord ischemia were examined on a 3 T MR-system equipped with a two-channel transmit array. Scans included T2-weighted turbo spin echo, conventional DWI, and zoomed DWI. Image evaluation was performed with regard to overall image quality, anatomic delineation of the spinal cord, and the level of confidence to establish the diagnosis of spinal cord ischemia. RESULTS Through spatially selective excitation, zoomed DWI allows for acquisition of high-resolution images with reduced scan time due to a reduced field of view in phase-encoding direction, resulting in zoomed images. In all cases the ischemia was demonstrated in conventional DWI as well as zoomed DWI. CONCLUSIONS Compared to conventional DWI, zoomed DWI enables a faster image acquisition and allowed a more detailed analysis of the spinal lesion which may be critical to attribute the lesion to a particular vessel territory.
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Affiliation(s)
- A Seeger
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - U Klose
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - F Bischof
- Department of Neurology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - J Strobel
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - U Ernemann
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - T-K Hauser
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Kim MJ, Jang MH, Choi MS, Kang SY, Kim JY, Kwon KH, Kang IW, Cho SJ. Atypical Anterior Spinal Artery Infarction due to Left Vertebral Artery Occlusion Presenting with Bilateral Hand Weakness. J Clin Neurol 2014; 10:171-3. [PMID: 24829605 PMCID: PMC4017022 DOI: 10.3988/jcn.2014.10.2.171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 10/24/2013] [Accepted: 10/25/2013] [Indexed: 11/30/2022] Open
Abstract
Background Infarct of the anterior spinal artery is the most common subtype of spinal cord infarct, and is characterized by bilateral motor deficits with spinothalamic sensory deficits. We experienced a case with atypical anterior-spinal-artery infarct that presented with bilateral hand weakness but without sensory deficits. Case Report A 29-year-old man presented with sudden neck pain and bilateral weakness of the hands. Magnetic resonance imaging (MRI) of the brain did not reveal any lesion. His motor symptoms improved rapidly except for mild weakness in his left wrist and fingers. Magnetic resonance angiography showed proximal occlusion of the left vertebral artery; a spine MRI revealed left cervical cord infarction. Conclusions Bilateral or unilateral hand weakness can be the sole symptom of a cervical cord infarct.
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Affiliation(s)
- Min-Ji Kim
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Mi-Hee Jang
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Mi-Song Choi
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Suk Yun Kang
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Joo Yong Kim
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Ki-Han Kwon
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Ik-Won Kang
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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Shimura S, Cho Y, Aki A, Ueda T. Successful reversal of immediate paraplegia associated with repair of acute Type A aortic dissection using cerebrospinal fluid drainage. Interact Cardiovasc Thorac Surg 2013; 17:1051-3. [PMID: 24014618 DOI: 10.1093/icvts/ivt389] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We present a case of a 49-year old man who suffered from immediate paraplegia upon awakening from anaesthesia after surgery for acute aortic dissection Type A. A catheter was promptly inserted into the spinal canal for cerebrospinal fluid drainage, and the cerebrospinal fluid pressure was maintained <10 cmH2O. Although magnetic resonance imaging showed extensive spinal cord ischaemia, the patient gradually recovered from the paraplegia and was able to walk by himself after rehabilitation. In some cases, cerebrospinal fluid drainage can be effective for the treatment of immediate postoperative spinal cord damage.
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Affiliation(s)
- Shinichiro Shimura
- Department of Cardiovascular Surgery, School of Medicine, Tokai University, Isehara, Kanagawa, Japan
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Safadi W, Srour S, Waksman I. Infarction of the cervical spinal cord in a 20-year-old healthy man resulting in complete quadriplegia. BMJ Case Rep 2013; 2013:bcr-2013-009359. [PMID: 23605842 DOI: 10.1136/bcr-2013-009359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
How often are we faced with a tragic diagnosis in a young patient whose life is completely changed? Often in medicine the tragedy is short-lived: the patients never stabilise, they succumb early to their injuries or complications. We present the case of a young man in whom the exact cause of a spinal cord infarct has never been confirmed. As it transpires, regardless of the sequence of events and the time elapsed between injury and the onset of paralysis, his symptoms came with no warning, were life-threatening and terrifying. He could have had no time to understand what had happened and is now faced with what must seem an eternity to come to terms with a life of quadriplegia. He gives an account of his life for the last 7 years as he has remained at home, while life for his siblings has moved on and he watches from his bed. The triumph is his adjustment to his life now, the vigilance and care of his family and the dedication of the medical staff of a local clinic in a small village in the mountains in the north of Israel.
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Affiliation(s)
- Wajdi Safadi
- Department of Surgery, Ziv Hospital, Galilee, Israel.
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