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Heckman CA, Miller DJ, Kremer KM, Martinez ML, Jea AH. An ischemic myelopathy case series: Flaccid paraplegia following a spike ball save and numbness while walking normally. Brain Circ 2023; 9:107-111. [PMID: 37576578 PMCID: PMC10419739 DOI: 10.4103/bc.bc_80_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 08/15/2023] Open
Abstract
Spinal cord infarctions in children are rare and early magnetic resonance imaging studies are often negative. A high clinical suspicion must be maintained to identify stroke and initiate workup for underlying etiology to suggest appropriate treatment. We present two cases of spinal cord infarction without major preceding trauma. The first was caused by disc herniation and external impingement of a radiculomedullary artery and the second was due to fibrocartilaginous embolism with classic imaging findings of ventral and dorsal cord infarctions, respectively. These cases were treated conservatively with diagnostic workup and aspirin, though additional treatments which can be considered with prompt diagnosis are also explored in our discussion. Both cases recovered the ability to ambulate independently within months. Case 1 is attending college and ambulates campus with a single-point cane. Case 2 ambulates independently, though has some difficulty with proprioception of the feet so uses wheelchairs for long-distance ambulation.
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Affiliation(s)
- Caroline A. Heckman
- Undergraduate, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Derryl J. Miller
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kelly M. Kremer
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States
| | - Mesha L. Martinez
- Department of Clinical Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew H. Jea
- Pediatric Neurosurgery, Oklahoma University, Oklahoma Children’s Hospital, Oklahoma, United States
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2
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Slavkov D. Artery of Adamkiewicz. Korean J Neurotrauma 2022; 18:399-403. [PMID: 36381458 PMCID: PMC9634319 DOI: 10.13004/kjnt.2022.18.e60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/24/2022] Open
Abstract
This article reviews the case of a 65-year-old patient with unstable L1 fracture after trauma. The fracture was treated via balloon kyphoplasty, shortly after which the patient developed shortness of breath and severe headache. Subsequent computed tomography (CT) of the head revealed subarachnoid hemorrhage. CT angiography did not reveal any intracranial aneurysms or arteriovenous malformations. A massive spinal subdural hematoma, which caused the patient to develop right leg paresis and hip joint weakness with grade 2-3, was found during magnetic resonance imaging (MRI). The hematoma was removed using multi-stage laminectomy Th5-L3. A follow-up MRI showed no pathological findings. Due to the unusual findings, spinal angiography was performed, revealing the artery of Adamkiewicz (A. radicularis magna, AKA) on the L1 level on the right side. Control CT showed a suboptimal insertion of the needle into the right pedicle, which caused the injury of the artery. AKA is present in the majority of the population, and surgical attention should be paid to avoid injury. Surgeons operating on the thoracolumbar spinal cord should have a thorough understanding of the anatomical features and surgical implications of this artery.
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Affiliation(s)
- Dimitar Slavkov
- Clinic for Neurosurgery, Spine Surgery and Neuromodulation, Helios Vogtland-Klinikum Plauen GmbH, Plauen, Germany
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3
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Fu W, Church J, Garton H, Geiger J, Newman E. Pre-operative lumbar drain placement: A technique for minimizing ischemic spinal cord injury during neuroblastoma resection. J Pediatr Surg 2022; 57:1443-1445. [PMID: 34903356 DOI: 10.1016/j.jpedsurg.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Whitney Fu
- Department of Surgery, Michigan Medicine, 1500 East Medicine Center Drive, 2920 Taubman Center, SPC 5331, Ann Arbor, MI 48109, United States.
| | - Joseph Church
- Department of Surgery, Division of Pediatric Surgery, Michigan Medicine, Ann Arbor, MI, United States; Division of Pediatric General and Thoracic Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Hugh Garton
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, United States
| | - James Geiger
- Department of Surgery, Division of Pediatric Surgery, Michigan Medicine, Ann Arbor, MI, United States
| | - Erika Newman
- Department of Surgery, Division of Pediatric Surgery, Michigan Medicine, Ann Arbor, MI, United States
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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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Abstract
Context: Surfer's myelopathy (SM) is an acute syndrome identified by nontraumatic paraparesis or paraplegia. Though traditionally tied to first-time surfers, the condition encompasses any activity involving hyperextension of the back such as gymnastics, yoga, and Pilates.Methods: MEDLINE® and Google Scholar literature searches were gathered to identify relevant case reports for determining the etiology, pathogenesis, evaluation, and management of SM.Results: While the rare nature of SM limits its full understanding, studies have pinpointed that hyperextension in the back leads to vasculature insufficiency secondary to dynamic compression of the artery of Adamkiewicz. In surfing, this hyperextension combined with the execution of the Valsalva maneuver while trying to stand up on the surfboard likely increases intraspinal pressure. Due to its nontraumatic origin, the presence of SM is not immediately clear. Moreover, its similarity in clinical and radiological presentations with other entities can further complicate diagnosis. Seemingly, idiopathic urological symptoms can be explained by the physician if they conduct a thorough history.Conclusion: In an effort to raise awareness for the practicing physician, we presently review the etiology, diagnosis, treatment, and prolonged effects of SM. With the surging popularity of surfing as well as the advent of children participating in precarious sports and activities at an earlier age, we can expect a rising incidence of traumatic and nontraumatic spinal cord injuries. Neurologists, urologists, emergency medicine and sports medicine physicians alike can utilize this review to build a high index of suspicion for SM. The risk factors for SM should be conveyed to those participating in novices in surfing, yoga, gymnastics, ballet, and any activity enabling sustained or repeated spinal extension. Increased general awareness will facilitate increased symptom recognition in order to arrest aggravation of injury.
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Affiliation(s)
- Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, New York, USA,Medical Student Research Institute, St. George’s University School of Medicine, St. George, Grenada
| | - Min Yea Lee
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, New York, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, New York, USA,Department of Urology, Stony Brook University School of Medicine, Stony Brook, New York, USA,Correspondence to: Sardar Ali Khan, Department of Urology, Health Sciences Center T9-040, Stony Brook University School of Medicine, 101 Nicolls Road, Stony Brook, NY, 11794-8093, USA; Ph: +1-631-987-0132, Fax: +1-631-444-7620.
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Svetanoff WJ, Zendejas B, Frain L, Visner G, Smithers CJ, Baird CW, Prabhu SP, Jennings RW, Hamilton TE. When to consider a posterolateral descending aortopexy in addition to a posterior tracheopexy for the surgical treatment of symptomatic tracheobronchomalacia. J Pediatr Surg 2020; 55:2682-9. [PMID: 32444171 DOI: 10.1016/j.jpedsurg.2020.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/09/2020] [Accepted: 04/23/2020] [Indexed: 11/23/2022]
Abstract
PURPOSES The descending thoracic aorta typically crosses posterior to the left mainstem bronchus (LMSB). We sought to evaluate patient factors that may lead one to consider a posterolateral descending thoracic aortopexy (PLDA) in addition to a posterior tracheopexy (PT) in the surgical treatment of symptomatic tracheobronchomalacia (TBM) that involves the LMSB. METHODS Retrospective review of patients who underwent PT with or without PLDA between 2012 and 2017. Severity and extent of TBM were assessed using dynamic tracheobronchoscopy. Aortic positioning compared to the anterior border of the spine (ABS) at the level of the left mainstem bronchus was identified on computed tomography (CT). Factors associated with performing a PLDA were evaluated with logistic regression. RESULTS Of 188 patients who underwent a PT, 70 (37%) also had a PLDA performed. On multivariate analysis, >50% LMSB compression on bronchoscopy (OR 8.06, p < 0.001), >50% of the aortic diameter anterior to the ABS (OR 2.06, p = 0.05), and more recent year of surgery (OR 1.61, p = 0.003) were associated with performing a PLDA. CONCLUSION When performing a PT, a PLDA should be considered for patients who have >50% LMSB compression on dynamic bronchoscopy, and in those with a descending thoracic aorta located >50% anterior to the ABS. LEVEL OF EVIDENCE III TYPE OF STUDY: Retrospective comparative study.
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Cawley CM, Howard BM, Barrow DL. Microsurgical Management of a Spinal Dural Arteriovenous Fistula With Shared Blood Supply to the Artery of Adamkiewicz: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2019; 16:E174-E175. [PMID: 30252106 DOI: 10.1093/ons/opy293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/27/2018] [Indexed: 11/12/2022] Open
Abstract
The presented case is of a 65-yr-old gentleman referred for thoracic myelopathy. He developed bilateral, nondermatomal foot dysesthesia 14 mo prior to presentation, which progressed to numbness below the L3 level. He reported progressive gait instability, bilateral lower extremity weakness, and required a cane for ambulation. He subsequently developed urinary incontinence, while bowel function was spared. The neurological examination upon presentation revealed lower extremity strength was reduced to 4/5 in all major muscle groups bilaterally, while sensation and proprioception were reduced below the L3 level. Patellar and Achilles reflexes were not elicited and clonus was absent. Gait was unsteady and slow. The patient was not able to perform heel, toe and tandem gait. MRI revealed abnormal T2 hyper-intense signal and spinal cord expansion from T6 through the conus medullaris. Angiography revealed a dural arteriovenous fistula (dAVF) originating from the left T9 radicomedullary pedicle, which also supplied the Artery of Adamkiewicz (AoA). The patient underwent T8-10 laminectomies. Prior to disconnection of the fistula, an aneurysm clip was applied to the fistulous point and an indocyanine green video angiogram was completed to show that the fistula no longer opacified, but that the AoA remained patent, which was later confirmed with angiography. As of discharge, the patient's motor exam had improved substantially, though his sensory deficits persisted. This case demonstrates that surgical disconnection is requisite in the treatment of spinal dAVF that have a shared blood supply with the AoA, as embolization risks spinal cord infarction. The patient consented to presentation of this case in a de-identified fashion.
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Affiliation(s)
- C Michael Cawley
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.,Department of Radiology and Imaging Sciences, Division of Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia
| | - Brian M Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.,Department of Radiology and Imaging Sciences, Division of Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel L Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
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Scatchard R, Alves Rosa J, Bowen P, Mortimer A, Sharples PM, Lux AL. A case report: Paediatric surfer's myelopathy. Eur J Paediatr Neurol 2018; 22:199-202. [PMID: 29102345 DOI: 10.1016/j.ejpn.2017.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/19/2017] [Accepted: 09/30/2017] [Indexed: 11/19/2022]
Abstract
Surfer's myelopathy was first described by Thompson et al., in 2004.1 It is a rare cause of sudden spinal cord injury that occurs in the absence of direct trauma to the spinal area in novice healthy surfers. We present the case of the youngest patient we are aware of to be diagnosed with surfer's myelopathy following actual surfing. A clear aetiology for surfer's myelopathy has not previous been described. However, the hypothesis that there is ischaemia to the lower spinal cord is supported by our case, where we present the first clear angiographic evidence of the occlusion of the great anterior radicular artery of Adamkiewicz in a patient diagnosed with surfer's myelopathy.
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Affiliation(s)
- Rebecca Scatchard
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom.
| | - Joao Alves Rosa
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom; Department of Radiology (Neuroradiology Section), North Bristol NHS Trust, Southmead Hospital, Southmead Way, Bristol BS10 5NB, United Kingdom
| | - Philippa Bowen
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom
| | - Alex Mortimer
- Department of Radiology (Neuroradiology Section), North Bristol NHS Trust, Southmead Hospital, Southmead Way, Bristol BS10 5NB, United Kingdom
| | - Peta M Sharples
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom
| | - Andrew L Lux
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom
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Yoshioka K, Tanaka R, Takagi H, Ueyama Y, Kikuchi K, Chiba T, Arakita K, Schuijf JD, Saito Y. Ultra-high-resolution CT angiography of the artery of Adamkiewicz: a feasibility study. Neuroradiology 2018; 60:109-15. [PMID: 29080918 DOI: 10.1007/s00234-017-1927-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Preoperative identification of the artery of Adamkiewicz can help prevent postoperative spinal cord injury following thoracic and thoracoabdominal aortic repair. Several studies have demonstrated the feasibility of evaluating the artery of Adamkiewicz using multi-detector row computed tomography (CT), but precise visualization remains a challenge. The present study was conducted to evaluate the usefulness of ultra-high-resolution CT for visualizing the artery of Adamkiewicz with a slice thickness of 0.25 versus 0.5 mm in patients with aortic aneurysms. METHODS Our institutional review board approved this study. Twenty-four patients with thoracic and thoracoabdominal aneurysms were scanned with beam collimation of 0.25 mm × 128. Images were reconstructed with slice thicknesses of 0.25 and 0.5 mm. The signal-to-noise ratio (SNR) of the aorta and contrast-to-noise ratio (CNR) between the anterior spinal artery and spinal cord were measured. Two independent observers evaluated visualization of the artery of Adamkiewicz and its continuity between the anterior spinal artery and the aorta using a four-point scale. RESULTS No significant differences in the SNR of the aorta or CNR of the anterior spinal artery were observed between 0.25- and 0.5-mm slices. The average visualization score was significantly higher for 0.25-mm slices (3.58 ± 0.78) than for 0.5-mm slices (3.13 ± 0.99) (p = 0.01). The percentage of patients with nondiagnostic image quality was significantly lower for 0.25-mm slices (8.3%) than for 0.5-mm slices (33.3%) (p = 0.03). CONCLUSION In patients with aortic aneurysms, ultra-high-resolution CT with 0.25-mm slices significantly improves visualization of the artery of Adamkiewicz compared to 0.5-mm slices.
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10
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AbdeleRahman KT, Rakocevic G. Paraplegia following lumbosacral steroid epidural injections. J Clin Anesth 2014; 26:497-9. [PMID: 25200706 DOI: 10.1016/j.jclinane.2014.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 03/16/2014] [Accepted: 03/21/2014] [Indexed: 10/24/2022]
Abstract
Spinal cord ischemia is a rare but possible neurological complication following routine conservative treatment of lumbosacral radiculopathy. A case of a 46 year old woman with chronic L5 radiculopathy, who developed spinal cord ischemia following epidural steroid injection, is reported. Two months after the epidural injection, she required crutches for walking and had neurogenic bladder and bowel.
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Affiliation(s)
- Kader Tawfiq AbdeleRahman
- Department of Neurology, Thomas Jefferson University Hospital, 900 Walnut St., Suite 200, Philadelphia, PA 19107, USA.
| | - Goran Rakocevic
- Department of Neurology, Thomas Jefferson University Hospital, 900 Walnut St., Suite 200, Philadelphia, PA 19107, USA
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11
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Reynolds JM, Belvadi YS, Kane AG, Poulopoulos M. Thoracic disc herniation leads to anterior spinal artery syndrome demonstrated by diffusion-weighted magnetic resonance imaging (DWI): a case report and literature review. Spine J 2014; 14:e17-22. [PMID: 24252234 DOI: 10.1016/j.spinee.2013.10.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/26/2013] [Accepted: 10/31/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Thoracic disc herniation rarely causes acute ischemic events involving the spinal cord. Few reports have suggested this as a mechanism leading to anterior spinal artery syndrome, and none with illustration through diffusion-weighted magnetic resonance imaging (DWI). PURPOSE The purpose of this study was to report a case of anterior spinal artery syndrome secondary to thoracic disc herniation and demonstrate the first use of DWI to aid in diagnosis of this rare myelopathy. STUDY DESIGN Case report. METHODS A 36-year-old woman developed sudden onset of back pain followed by evolving paraparesis and sensory loss consistent with anterior spinal artery distribution ischemia. T2-weighted magnetic resonance imaging (MRI) demonstrated an acute herniated nucleus pulposus at the T7-T8 disc, which produced a focal indentation of the adjacent anterior spinal cord without cord displacement or canal stenosis. T2-weighted hyperintensities were seen at T4-T7 levels with corresponding brightness on DWI and reduction of the apparent diffusion coefficient, consistent with cord ischemia. RESULTS Remarkably, within just a few days and following conservative treatment, including heparin and steroids, this patient's neurologic status began to show improvement. Within 3 weeks, she was ambulating with assisted devices, and at the 10-month follow-up, the patient had nearly complete neurological improvement. A follow-up MRI at 10 months showed normal T2-weighted imaging except for a 1×2-mm area of anterior-left lateral cord myelomalacia at T4-T5. CONCLUSIONS Acute thoracic disc herniation with cord contact but without canal stenosis is able to disrupt blood flow to the cord leading to anterior spinal artery distribution ischemia. This case represents the first demonstrated use of DWI in diagnosing this rare cause of anterior spinal artery ischemia.
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Affiliation(s)
- Jacques M Reynolds
- Department of Internal Medicine, UMass Memorial Medical Center 55 N Lake Ave Worcester, MA 01605.
| | - Yeshaswi S Belvadi
- Department of Internal Medicine, Eastern Maine Medical Center, 489 State St, Bangor, ME 04401, USA
| | - Arthur G Kane
- Department of Radiology, Neuroradiology, Eastern Maine Medical Center, 489 State St, Bangor, ME 04401, USA
| | - Markos Poulopoulos
- Department of Neurology, Eastern Maine Medical Center, Clinical Assistant Professor in Neurology, University of Vermont, 489 State St, Bangor, ME 04401, USA
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Abstract
We present a paediatric case of Papillary Ca thyroid under evaluation for elevated Thyroglobulin (Tg) level with negative 131I wholebody scintigraphy. Differentiated thyroid cancer (DTC) arises from follicular epithelium and retains basic biological features like expression of sodium iodide symporter (NIS), which is the cellular basis of radio iodine (131I) concentration during thyroid ablation. Once dedifferentiation of thyroid cells occurs, cells fail to concentrate 131I, posing both diagnostic and therapeutic problems in DTC and one may have to resort to other imaging techniques for disease localization. As DTC progression is slow, patients have a relatively good prognosis. However children with thyroid malignancies need aggressive management, as initial presentation itself maybe with nodal metastases. It is well known that FDG PET CT apart from its oncological applications, is also used in the evaluation of vascular inflammation especially Takayasu’s arteritis. It is also reported in literature, that 18F-FDG uptake can be seen relatively frequently in the arterial tree of cancer patients. Dunphy et al reported the association of vascular FDG uptake in inflammation as well as in normal arteries. This study typically describes FDG uptake in a patchwork of normal vessel, focal inflammation and or calcification of vessels. The other plausible reasons for significant vascular 18F-FDG uptake are drugs such as potent non steroidal anti-inflammatory agents, dexamethasone, prednisone and tacrolimus. Our patient showed false positive 18F Fluorodeoxyglucose (FDG) uptake in spinal cord at D11/12 and D12/L1 vertebral levels in FDG PET CT imaging performed as part of raised Thyroglobulin workup. This intra spinal FDG uptake is attributed to physiological uptake and inadequate FDG clearance from artery of Adamkiewicz, which can be added as a new physiological cause of FDG uptake unreported in literature as yet.
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Affiliation(s)
- S Padma
- Department of Nuclear Medicine and PET CT, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
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