A 25-Year-Old Man With Recurrent Back Pain and Rapid-Onset Paraplegia

2021 ◽  
pp. 242-245
Author(s):  
Nicholas L. Zalewski
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Digital Subtraction Angiography ◽  
Drugs Of Abuse ◽  
Cavernous Malformation ◽  
Short Interval ◽  
Transverse Myelitis ◽  
Digital Subtraction ◽  
Cross Sectional ◽  
Thoracic Spinal

A 25-year-old man was transferred for evaluation and management of severe transverse myelitis. He had no pertinent past medical history. His symptoms started approximately 6 months earlier with new, substantial low back pain for 2 days, followed by a 3-day history of lower extremity weakness. He could only ambulate with the help of a rolling chair and had to discontinue work because of the severity of the weakness, but his symptoms resolved spontaneously within a few days. Findings of repeated spinal cord magnetic resonance imaging were consistent with evolution of a recent hemorrhage in the lower thoracic spinal cord. Digital subtraction angiography of the spinal canal showed normal findings, without evidence of arteriovenous malformation. Additional thorough evaluations for bleeding diatheses, drugs of abuse, thorough skin evaluation to exclude melanoma, and systemic imaging with computed tomography of the chest, abdomen, and pelvis and testicular ultrasonography were all normal. Given the clinical timeline, the lobulated hemorrhagic appearance of the lesion with a surrounding T2-hypointense rim and heterogeneous T1 and T2 signal indicating recent hemorrhage, no pattern on imaging to suggest a neoplasm, with negative systemic evaluation and normal digital subtraction angiography, a diagnosis of hematomyelia due to intramedullary spinal cavernous malformation was made. No neurosurgical management was recommended given the complete cross-sectional spinal cord injury at the level of hemorrhage, with potential risk of surgery with resection of the intramedullary spinal cavernous malformation. Short-interval follow-up imaging 3 weeks later showed expected evolution of the recent hemorrhage secondary to intramedullary spinal cavernous malformation. Hematomyelia may be caused by several potential mechanisms. The most common nontraumatic causes are attributable to cavernous malformations and arteriovenous malformations. Hematomyelia most commonly presents with acute back pain referable to the site of hemorrhage and myelopathy deficits with a range of severity (often severe).

scholarly journals Disseminated Cryptococcosis revealed by transverse myelitis in Immunocompetent patient: a case report and review of the literature

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Fangfang Qu ◽  
Zhenzhen Qu ◽  
Yingqian Lv ◽  
Bo Song ◽  
Bailin Wu
Keyword(s):  
Spinal Cord ◽  
Amphotericin B ◽  
Transverse Myelitis ◽  
Immunocompetent Patient ◽  
Lower Limbs ◽  
Coxsackie Virus ◽  
Gadolinium Contrast ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Cord Injury

Abstract Background Transverse myelitis (TM) is due to inflammatory spinal cord injury with bilateral neurologic involvement, which is sensory, motor, or autonomic in nature. It may be associated with autoimmune disease, vaccination, intoxication and infections. The most common infection cause of TM is Coxsackie virus and Mycoplasma pneumoniae. The cryptococcosis is rare. We present the case of disseminated cryptococcosis revealed by transverse myelitis in an immunocompetent 55-year-old male patient. The literature review is also stated. Case presentation The 55-year-old man suffered from gradual numbness, weakness in both lower limbs and finally paralyzed in the bed. The thoracic spine Computed tomography (CT) was normal, but multiple nodules in the lung were accidentally discovered. Thoracic Magnetic Resonance Imaging (MRI) showed diffused thoracic spinal cord thickening and extensively intramedullary T2 hyper intensity areas. Gadolinium contrast enhanced T1WI showed an intramedullary circle-enhanced nodule at 9th thoracic level. Diagnosis was made by histological examination of the bilateral lung biopsy. The patient was treated successfully with systemic amphotericin B liposome and fluconazole and intrathecal dexamethasone and amphotericin B liposome. Conclusions This is a patient with disseminated cryptococcosis involving the lung, spinal cord and adrenal glands, which is rare in the absence of immunodeficiency.

scholarly journals Paraplegia after contrast media application: a transient or devastating rare complication? Case report

2016 ◽  
Vol 24 (5) ◽  
pp. 806-809 ◽  
Author(s):  
Dorothee Mielke ◽  
Kai Kallenberg ◽  
Marius Hartmann ◽  
Veit Rohde
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Contrast Media ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Dural Arteriovenous Fistula ◽  
Rare Complication ◽  
Digital Subtraction ◽  
Spinal Dural Arteriovenous Fistula ◽  
The Individual

The authors report the case of a 76-year-old man with a spinal dural arteriovenous fistula. The patient suffered from sudden repeated reversible paraplegia after spinal digital subtraction angiography as well as CT angiography. Neurotoxicity of contrast media (CM) is the most probable cause for this repeated short-lasting paraplegia. Intolerance to toxicity of CM to the vulnerable spinal cord is rare, and probably depends on the individual patient. This phenomenon is transient and can occur after both intraarterial and intravenous CM application.

scholarly journals Prevalence of musculoskeletal problems in caregivers handling non-ambulatory spinal cord injury patients

2021 ◽  
Vol 7 (9) ◽  
pp. 454
Author(s):  
Pranjali Kulkarni ◽  
Manish Ray ◽  
Ashok Shyam ◽  
Parag Sancheti
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Low Back Pain ◽  
Back Pain ◽  
Cross Sectional Study ◽  
Low Back ◽  
Cross Sectional ◽  
Validated Questionnaire ◽  
Cord Injury ◽  
Musculoskeletal Problems

<p class="abstract"><strong>Background:</strong> Spinal cord injury (SCI) is a distressing disorder that can cause of loss of physical, psychological and social functioning, that can cause high level of disability in patients. Due to disability, they are dependent on caregivers for their daily activities. Caregivers of SCI can be family or professional caregivers. Due to lack of training and awkward posture, caring for SCI patients may be burdensome which results in musculoskeletal problems in caregivers so it is important to find out the prevalence of musculoskeletal problems. The objectives were to find out the prevalence of musculoskeletal problems in caregivers handling non-ambulatory SCI patients and most common site of injury.</p><p class="abstract"><strong>Methods:</strong> A cross sectional study was carried out on 80 caregivers including both professional and family caregivers. Self-structured validated questionnaire used to interview the caregivers based on convenient sampling. The data was analysed by descriptive statistics.</p><p class="abstract"><strong>Results:</strong> The prevalence of musculoskeletal problems is 95% in caregivers including both family and professional caregivers. Low back pain was the commonest site of symptoms (53%) followed by 15% neck, 12% upper back pain, right shoulder (10%), right wrist (5%) and no pain (5%).</p><p class="abstract"><strong>Conclusions:</strong> The prevalence of musculoskeletal problems in caregivers handling non ambulatory SCI is high. Most affected area is low back pain and neck pain. The findings of the study indicated that proper training and exercise are required, on means of preventing musculoskeletal problems.</p><p> </p>

Angiography

ESC CardioMed ◽  
2018 ◽  
pp. 528-531
Author(s):  
Jan Bogaert
Keyword(s):  
Digital Subtraction Angiography ◽  
Vessel Wall ◽  
Duplex Ultrasound ◽  
Vascular Imaging ◽  
Digital Subtraction ◽  
Cross Sectional ◽  
Non Invasive ◽  
Vessel Imaging ◽  
Vessel Stenosis ◽  
Cross Sectional Imaging

Digital subtraction angiography is the accepted reference for vascular imaging and grading of vessel stenosis. This test, however, is invasive, and uses nephrotoxic agents and ionizing radiation, making it a poor choice for first-line diagnosis of vascular disease. Duplex ultrasound is a widely used, non-invasive modality to perform vascular imaging, but this technique is operator dependent and has a high percentage of failed exams usually as a result of an inadequate acoustic window or patient habitus. Computed tomography angiography features non-invasive, cross-sectional imaging of the entire arterial and venous vasculature from head to toe, but this modality suffers similar limitations as digital subtraction angiography, and vessel wall calcifications may influence image analysis and rendering. Cardiovascular magnetic resonance (CMR) angiography has emerged as an excellent non-invasive angiographic substitute to digital subtraction angiography. Over the past three decades a series of CMR angiography approaches have been developed to pass the different hurdles inherently linked to vessel imaging. As such, dedicated CMR angiography sequences are nowadays available to study accurately the arterial and venous vessels in all parts of the human body. CMR angiography is either a standalone or can be part of a more comprehensive CMR approach including vessel wall imaging, quantitative flow imaging, and perfusion imaging of the end-organ. The aim of this chapter is to provide the reader with a comprehensive review of how CMR angiography is performed in clinical practice and how well this technique competes with other vascular imaging modalities.

scholarly journals Anomalous Development of the Spinal Cord in a Calf

1979 ◽  
Vol 16 (1) ◽  
pp. 49-59 ◽  
Author(s):  
R. Bradley ◽  
F. D. Kirby
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Skeletal Muscles ◽  
Central Canal ◽  
Cross Sectional ◽  
Thoracic Spinal Cord ◽  
Inflammatory Lesions ◽  
Bull Calf ◽  
Thoracic Spinal ◽  
Extended Range

A full term Friesian bull calf was born unable to stand. The dam had no signs of illness during pregnancy. In the thoracic spinal cord there was anomalous development of the central canal and a dorsally placed fusiform and longitudinal dilatation. Mild inflammatory lesions were seen in some body organs and central nervous system where they were suggestive of viral infection. Several skeletal muscles had an extended range of muscle cell cross sectional areas and some cells had numerous internal nuclei.

scholarly journals Digital Subtraction Angiographic Study of Circle of Willis in Indian Population in a Tertiary Super-Specialty Hospital

2018 ◽  
Vol 3 (2) ◽  
pp. 99-105
Author(s):  
Muhammad Abdul Momen Khan ◽  
Shakir Husain ◽  
Md Shohidul Islam ◽  
Md Amir Hossain
Keyword(s):  
Digital Subtraction Angiography ◽  
Cerebrovascular Disorders ◽  
Clinical Importance ◽  
Uttar Pradesh ◽  
Anatomical Variations ◽  
Circle Of Willis ◽  
Anterior Communicating Artery ◽  
Digital Subtraction ◽  
Anterior Circulation ◽  
Cross Sectional

Background: Circle of Willis is an anastomotic polygon at the base of the brain which forms an important collateral network to maintain adequate cerebral perfusion. Changes in the normal morphology of the circle may causes the appearance and severity of symptoms of cerebrovascular disorders, such as aneurysms, infarctions and other vascular anomalies.Objectives: The aim of the present study was to analyses the anatomical variations of the circle of Willis by observing the variations in the cerebral arterial circle and was to clarify the clinical importance of these variations in certain forms of cerebrovascular diseases.Methodology: This cross-sectional study was conducted in the department of Neurointervention of Max Super-speciality Hospital, New Delhi, India and Neo multispeciality Hospital, Noida, Uttar Pradesh (UP), India during July 2016 to December 2016 for a period of six (6) months. Patients who were admitted in the Neurointervention department for digital subtraction angiography (DSA) were included in this study. The circle of Willis was then analyzed with the special reference to the complete or incomplete circle, any asymmetry in the configuration and variations in the size, and number of the component vessels, circle with multiple anomalies and absence, fenestration, duplication or triplication of any of the vessels.Results: Morphology and variations of the circle of Willis were studied in 74 patients undergone digital subtraction angiography (DSA). The normal pattern of circle of Willis was observed in 40(54.06%) cases and the remaining 34(45.94%) cases had one or more variations; however, 24(70.58%) cases had variations in the anterior circulation and 10(29.42%) cases had variations in the posterior circulation. 17(50%) cases had variations on the right side compared to 13(38.24%) variations on the left side. 4(11.76%) cases had variations in the anterior communicating artery. Incomplete circle of Willis were found 12(35.28%) cases. Multiple variations were observed in 11 cases (32.35%) in this study. In 4 cases anterior communicating artery aneurysms were observed.Conclusion: Variation of circle of Willis is common in this study of Indian population.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 99-105

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