Acute spinal-cord lesions in a pediatric population: epidemiological and clinical features

SUMMARY:A study has been made of the neurophysiological changes that follow spinal cord lesions in man. The Achilles tendon reflex (ATR) is used to estimate transmission in the la monosynaptic pathway, and the tonic vibration reflex (TVR) to estimate transmission in the la polysynaptic pathway to motoneurons. The inhibition of the H reflex by vibration is used as an estimate of presynaptic inhibition of the la monosynaptic pathway. Immediately following a complete lesion of the spinal cord presynaptic inhibition of the la monosynaptic pathway appears to be greatly increased. This enhanced inhibition may last several months but it eventually declines and in some instances becomes less than normal. Transmission in the la polysynaptic pathway is permanently abolished by a complete spinal lesion. A hypothesis is developed from these findings to explain the evolution of some of the clinical features that follow complete spinal lesions in man. Distinct differences are observed when the spinal lesion is incomplete. Transmission in the la polysynaptic pathway may be preserved and there may be no increase in presynaptic inhibition. These differences may depend upon the integrity of certain spinal long tracts which cannot be tested clinically.

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Relationship between Barkhof criteria and the clinical features of multiple sclerosis in northern Japan

Multiple Sclerosis Journal ◽

10.1177/1352458509350305 ◽

2009 ◽

Vol 15 (12) ◽

pp. 1450-1458 ◽

Cited By ~ 5

Author(s):

M. Nakamura ◽

H. Houzen ◽

M. Niino ◽

K. Tanaka ◽

H. Sasaki

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Clinical Features ◽

Brain Lesions ◽

Spinal Cord Lesions ◽

Common Features ◽

The Brain ◽

Northern Japan

We previously reported that the prevalence of multiple sclerosis (MS) in the Tokachi Province of Hokkaido increased from 8.6 to 13.1 per 100,000 individuals between 2001 and 2006. Here, we study the frequency of MS patients who fulfill the Barkhof criteria and identified their common features. All 47 subjects in our previous study, who fulfilled Poser’s criteria, were included in this study. Of these, 33 satisfied the Barkhof criteria. In 2006, 9.2 per 100,000 MS patients fulfilled the Barkhof criteria; the percentage of patients who fulfilled these criteria was significantly higher among patients born after 1960 than among those born before 1960 (84.3% and 40.0%, respectively). The proportion of patients with conventional MS (C-MS) who fulfilled the Barkhof criteria was higher than that of patients with opticospinal MS (OS-MS) who fulfilled these criteria (93.9% and 71.4%, respectively). Longitudinally extensive spinal cord lesions (LESCLs) were not associated with the brain lesions defined in the Barkhof criteria (Barkhof brain lesions). In Tokachi Province, the increased percentage of MS patients who fulfill the Barkhof criteria was associated with increased C-MS incidence and an increase in the proportion of C-MS patients with Barkhof brain lesions among people born after 1960.

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Correlations among disability, anti-AQP4 antibody status and prognosis in the spinal cord involved patients with NMOSD

BMC Neurology ◽

10.1186/s12883-021-02171-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jung Lung Hsu ◽

Ming-Feng Liao ◽

Kuo-Hsuan Chang ◽

Mei-Yun Cheng ◽

Long-Sun Ro

Keyword(s):

Spinal Cord ◽

Clinical Features ◽

Muscle Power ◽

Brain Regions ◽

Spinal Cord Lesions ◽

Good Outcome ◽

The Poor ◽

Outcome Group ◽

The Mean ◽

Aqp4 Antibody

Abstract Background Neuromyelitis optica spectrum disorder (NMOSD) is a rare neuroinflammatory disorder of the central nervous system that typically involves the optic nerve, the spinal cord and other specific brain regions. In relapse of the disease, factors associated with clinical features and lesion severity are important for clinicians to predict disease-related disability. Methods We retrospectively analyzed 22 female patients with NMOSD who had spinal cord lesions. Detailed clinical features, onset symptoms, motor disability, relapse episodes, serum aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) autoantibodies and MRI characteristics were documented to correlate their associations with the nadir and three-month Expanded Disability Status Scale (EDSS) scores. Patients with three-month EDSS scores below four (< 4) were categorized as the good outcome group, while those with scores of four or more (> 4) were categorized as the poor outcome group. Results In patients with NMOSD, the mean age was 44.5 ± 12.8 years, and the mean three-month EDSS score was 4.3 ± 1.9. A significantly higher all-limb muscle power score was found in the good EDSS group than in the poor EDSS group (p = 0.01). A tendency toward longer follow-up periods and lower anti-AQP4 antibody levels was found in the good outcome group. Serum anti-AQP4 antibodies were present in 86% of patients with NMOSD, and MOG autoantibodies were found in one anti-AQP4 antibody-negative patient (33.3%). In patients with NMOSD, more than 40% of spinal cord lesions were distributed at the middle cervical and upper thoracic levels. Conclusions Our findings suggest that EDSS scores and MRC scores at the nadir had significant associations with three-month EDSS scores. The topographic distributions of the spinal cord lesions might relate to different serum anti-AQP4 antibody status. However, further studies will be needed to corroborate this finding.

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MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

Diagnostics ◽

10.3390/diagnostics11081424 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1424

Author(s):

Esben Nyborg Poulsen ◽

Anna Olsson ◽

Stefan Gustavsen ◽

Annika Reynberg Langkilde ◽

Annette Bang Oturai ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Cervical Spinal Cord ◽

Brain Mri ◽

Anatomical Location ◽

Spinal Cord Lesions ◽

Chi Square ◽

Exact Test ◽

Mcdonald Criteria ◽

Chi Square Test

Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

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Clinical features and prognosis of COVID-19/SARS-CoV-2 infections in persons with spinal cord injury: a review of current literature

Spinal Cord Series and Cases ◽

10.1038/s41394-021-00420-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Apurba Barman ◽

Sankha Subhra Roy ◽

Sreeja Kamala Sasidharan ◽

Jagannatha Sahoo

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Features ◽

Current Literature ◽

Cord Injury

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Diagnosis, treatment, and misdiagnosis analysis of 28 cases of central nervous system echinococcosis

Chinese Neurosurgical Journal ◽

10.1186/s41016-021-00248-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Guojia Du ◽

Yandong Li ◽

Pan Wu ◽

Xin Wang ◽

Riqing Su ◽

...

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Clinical Features ◽

Multiple Organ ◽

Pathological Examination ◽

Surgical Removal ◽

Surgical Treatments

Abstract Background To explore central nervous system (CNS) involvement in this disease, from the perspectives of diagnosis, treatment, and misdiagnosis Methods Twenty-eight patients with CNS echinococcosis were included in this retrospective study, including 18 males (64.3%) and 10 (35.7%) females. The average age of all the patients were 23.5 years (ranged 4–60 years). Twenty-three (23) patients (82.1%) received the first surgical resection in our hospital. Five (5) patients (17.9%) gave up surgical treatment for multiple-organ hydatidosis and previous surgery history at other hospitals, and albendazole was applied for a long-term (3–6 months) adjunct therapy for the 5 patients. The average follow-up time was 8 years. Results For the 28 patients, 23 cases received surgical treatments, and the diagnosis was confirmed by pathological examinations. The diagnosis of 4 cases of brain echinococcosis and 2 cases of spinal cord echinococcosis could not be confirmed, resulting in a misdiagnosis rate of 21.4% (6/28). For the pathological examination, a total of 17 cases were infected with Echinococcus granulosus (including 2 cases of spinal cord echinococcosis), and 6 cases were infected with Echinococcus alveolaris. Conclusion The diagnosis should be specifically considered in endemic regions. The clinical features of CNS hydatidosis were intracranial space-occupying lesions. For the treatment, the surgical removal of cysts should be necessary. In addition, the adjuvant therapy with drug and intraoperative prophylaxis is also suggested. The misdiagnosis may have resulted from atypical clinical features and radiographic manifestations, as well as the accuracy of hydatid immunologic test.

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