Spinal cord infarction following endoscopic variceal ligation

STUDY DESIGN

A case report of spinal cord infarction following endoscopic variceal ligation.

OBJECTIVES

To describe an exceedingly rare case of spinal cord infarction following endoscopic variceal ligation.

SETTING

Department of Orthopaedic Surgery, Kagoshima, Japan.

METHODS

A 75-year-old woman with cirrhosis caused by hepatitis C virus, who was admitted to our hospital for the treatment of esophageal varices, experienced numbness of the hands and lower extremities bilaterally following an endoscopic variceal ligation procedure. Sensory and motor dysfunction below C6 level progressed rapidly, resulting in inability to move the lower extremities the following day. Magnetic resonance imaging of the spine revealed abnormal spinal cord signal on T2-weighted images from approximately C6 through T5 levels, which was diagnosed as spinal cord infarction.

RESULTS

The patient underwent hyperbaric oxygen treatment. Her symptoms and signs related to spinal cord infarction gradually remitted, and nearly complete disappearance of neurological deficits was noted within 3 months after the start of treatment.

CONCLUSION

We speculate that the pathogenesis of the present case may have involved congestion of the abdominal-epidural-spinal cord venous network owing to ligation of esophageal varices and increased thoracoabdominal cavity pressure.

Hypoplasia of the atlas causing cervical myelopathy with situs inversus totalis

STUDY DESIGN

A case report of myelopathic hypoplasia of the atlas with situs inversus totalis.

OBJECTIVES

To describe a case of cervical myelopathy caused by hypoplasia of the atlas with situs inversus totalis, and to briefly review the pertinent literature.

SETTING

Department of Orthopaedic Surgery, Kagoshima, Japan.

METHODS

The history, results of examination, and findings of radiographic imaging studies for a 56-year-old man with a 10-year history of progressive myelopathy who presented to our hospital are described.

RESULTS

Imaging studies revealed congenital hypoplasia of the atlas, ossification of the posterior longitudinal ligament at the levels of C3-C4, and situs inversus totalis. He underwent laminectomy of the atlas and laminoplasty of C3-C7 for decompression of the spinal cord. Operative intervention resulted in significant neurological improvement and relief of occipital neuralgia.

CONCLUSION

To our knowledge, no case of myelopathic hypoplasia of the atlas with situs inversus totalis has previously been described. When encountering inherited disorders such as situs inversus totalis, a thorough search must be made for anomalies of the craniovertebral junction.