Abstract 1122‐000230: Unique Clinical Finding of Localized Bifacial Hyperhydrosis in a Patient with Basilar Artery Thrombosis

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Haris Kamal ◽  
M Khaleeq Ahmed ◽  
Ashkan Mowla
Keyword(s):  
Basilar Artery ◽  
Brain Mri ◽  
Facial Asymmetry ◽  
The Body ◽  
Neurological Deficits ◽  
Excessive Sweating ◽  
Thoracic Spinal Cord ◽  
Basilar Artery Thrombosis ◽  
Thoracic Spinal ◽  
The Face

Introduction : Sweating abnormalities accompanied with other neurological deficits have been reported after cerebral infarcts involving the operculum, medulla and pons; however, these have always caused hyperhydrosis of the entire unilateral side of the body including the face, arms and legs. Methods : A 59 year old male who was found unresponsive to verbal and noxious stimuli after being admitted to our hospital for a vascular surgery procedure. He did not withdraw to pain in any of the extremities including to sternal rub. Pupils were bilaterally equal and reactive to light and the patient did not have any facial asymmetry. He did have intact brainstem reflexes initially in the first day. He was admitted to the Medical ICU and a brain MRI was obtained after initial head CT head was found to be unremarkable. MRI demonstrated a large bilateral pontine acute infarct, more prominent on the left side. There was also acute infarction in the left thalamus as well as some involvement of left midbrain. An MRA of Brain showed complete occlusion of the mid‐distal basilar artery. Results : The patient subsequently was found to have excessive sweating of both sides of his face, forehead and head from day 1 of the stroke onwards. This occurred independent of the patient’s body temperature (37C) and room temperature (28C).The patient remained afebrile for the next few days; however, profuse sweating continued for the next two weeks when he passed away. The patient continued to remain intubated and unresponsive off sedation during this time. Conclusions : Pure Bifacial hyperhydrosis might indicate bilateral pontine lesions. This appears to be due to disruption of a putative inhibitory pathway that controls sweating of the contralateral face and body. This pathway originates in the operculum and ends in the sympathetic sudomotor neurons in the contralateral thoracic spinal cord via the hypothalamus and brainstem. It is likely that in our patient, only the bulbar fibers of this pathway were disrupted making the face the only part with excessive sweating.

Histopathology of experimental hematomyelia

1991 ◽  
Vol 75 (6) ◽  
pp. 911-915 ◽  
Author(s):  
Thomas H. Milhorat ◽  
David E. Adler ◽  
Ian M. Heger ◽  
John I. Miller ◽  
Joanna R. Hollenberg-Sher
Keyword(s):  
Spinal Cord ◽  
Tissue Injury ◽  
Central Canal ◽  
Microglial Cells ◽  
Neurological Deficits ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Thoracic Spinal ◽  
Cellular Debris ◽  
Dorsal Columns

✓ The pathology of hematomyelia was examined in 35 rats following the stereotactic injection of 2 µl blood into the dorsal columns of the thoracic spinal cord. This experimental model produced a small ball-hemorrhage without associated neurological deficits or significant tissue injury. Histological sections of the whole spinal cord were studied at intervals ranging from 2 hours to 4 months after injection. In acute experiments (2 to 6 hours postinjection), blood was sometimes seen within the lumen of the central canal extending rostrally to the level of the fourth ventricle. Between 24 hours and 3 days, the parenchymal hematoma became consolidated and there was an intense proliferation of microglial cells at the perimeter of the lesion. The cells invaded the hematoma, infiltrated its core, and removed erythrocytes by phagocytosis. Rostral to the lesion, the lumen of the central canal was found to contain varying amounts of fibrin, proteinaceous material, and cellular debris for up to 15 days. These findings were much less prominent in the segments of the canal caudal to the lesion. Healing of the parenchymal hematoma was usually complete within 4 to 6 weeks except for residual hemosiderin-laden microglial cells and focal gliosis at the lesion site. It is concluded that the clearance of atraumatic hematomyelia probably involves two primary mechanisms: 1) phagocytosis of the focal hemorrhage by microglial cells; and 2) drainage of blood products in a rostral direction through the central canal of the spinal cord.

scholarly journals Seronegative Neuromyelitis Optica: A Case Report of a Hispanic Male

2016 ◽  
Vol 8 (2) ◽  
pp. 102-107 ◽  
Author(s):  
Nabeel Badri ◽  
Mohamed Teleb ◽  
Saad Syed ◽  
Miraie Wardi ◽  
Mateo Porres-Aguilar ◽  
...  
Keyword(s):  
Optic Neuritis ◽  
Neuromyelitis Optica ◽  
Brain Mri ◽  
Sudden Onset ◽  
Interesting Case ◽  
Imaging Studies ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal ◽  
Hispanic Male

Neuromyelitis optica (NMO) is a rare disease, common in white females and rarely reported in Hispanic males. It is usually associated with recurrent demyelinating spectrum that is autoimmune in nature. The diagnosis is usually confirmed by antibody biomarkers; however, they can be negative and lead to more dilemma in diagnosis. Furthermore, the course of disease and prognosis are different in seronegative as compared to seropositive NMO. Treatment is similar in both subgroups with new approaches under investigation for seronegative NMO patients. We present an interesting case of a 37-year-old Hispanic male who presented with sudden onset of lower extremity weakness, numbness, blurry vision, and urinary retention. Magnetic resonance imaging (MRI) of the thoracic spine showed multiphasic demyelinating process involving the thoracic spinal cord. His brain MRI also revealed changes suggesting optic neuritis. The patient met the criteria for diagnosis of NMO by having optic neuritis and myelitis by imaging studies despite having negative aquaporin-4 antibodies (AQP4-Ab). His condition improved after plasma exchange. NMO can be difficult to distinguish from acute multiple sclerosis in the early stages of the disease. Having AQP4-Ab testing is important for diagnosis with imaging studies; however, negative antibody results cannot exclude the diagnosis, but rather group it in seronegative subtype. Ongoing studies and research suggest that seronegative NMO might have a different pathophysiology, manifestation, and prognosis.

Implantation of a Thoracic Spinal Cord Stimulator Paddle Electrode and Generator Under General Anesthesia With Intraoperative Neuromonitoring: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (6) ◽  
pp. E169-E169 ◽  
Author(s):  
Lauren E Stone ◽  
Steven M Falowski
Keyword(s):  
Spinal Cord ◽  
Video Recording ◽  
Intraoperative Neuromonitoring ◽  
The Body ◽  
Spinal Cord Stimulator ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Lead Placement ◽  
Patient Consent ◽  
Spinal Flexibility

Abstract Spinal cord stimulation is a well-established and effective therapy in the treatment of pain. Proper patient selection and accurate lead placement are paramount in its success. Placement is a multifaceted process requiring proper paddle placement, a well thought out generator placement and appropriate means to limit complications and enhance success. Several intraoperative techniques maximize outcomes, including removal of the superior portion of the inferior level's spinous process for paddle access into the epidural space, generator pocket placement in a location that limits patient discomfort, a strain relief loop at the thoracic incision to prevent lead fractures and allow for full spinal flexibility, generator placement parallel to the body and secured in the pocket to prevent unwanted movement, and intraoperative neuromonitoring for patient comfort and more accurate lead placement compared to X-ray alone or awake placement. This case demonstrates these key elements of intraoperative technique in a candidate with the most common indication for spinal cord stimulator placement–postlaminectomy syndrome–underscoring the ease and viability of this procedure in the appropriate patient population in a means that reduces future complications and adverse events while maximizing success.  Full patient consent for video-recording and subsequent use for research purposes was attained. All patient identifiers have been removed for the purpose of patient confidentiality.

scholarly journals Management challenge of basilar artery occlusion in SUS: Case report

2021 ◽  
Author(s):  
Isadora Santos Ferreira ◽  
Mauricio Elias Nunes da Silva ◽  
Liz Barros Rebouças ◽  
Rafael Bernhart Carra ◽  
Rene de Araújo Gleizer ◽  
...  
Keyword(s):  
Case Report ◽  
Basilar Artery ◽  
Intravenous Thrombolysis ◽  
Tertiary Hospital ◽  
Artery Occlusion ◽  
Neurological Deficits ◽  
Basilar Artery Occlusion ◽  
High Morbidity ◽  
Basilar Artery Thrombosis ◽  
The Right

Context: Stroke caused by basilar artery occlusion is rare, corresponding to 1% of strokes. There is no consensus in the literature on the ideal management of this disease at acute phase. However, mechanical thrombectomy may be a viable treatment option. Case report: 68-year-old female, with no comorbidities, admitted to a secondary hospital 14h after headache, dizziness, vomiting and difficulty walking. She was disoriented, with severe dysarthria and dysphonia, horizontal and vertical ophthalmoparesis and pronation of the right upper limb (NIHSS: 4). Cranial tomography was normal and cranial angiotomography showed a basilar artery thrombosis. Patient was out of the window for intravenous thrombolysis and our hospital did not have another possibility of treatment. Due to high morbidity and mortality, also the possibility of neurological deterioration, medical contact was made with a tertiary hospital with hemodynamic service. During patient transference, she evolved with decreased level of consciousness, aphasia and tetraparesis (NIHSS: 18). Upon arrival at the hospital, a thrombectomy was performed due to an important clinical-radiological mismatch, 19 hours within symptoms onset and 3 hours after neurological worsening. After discharge, patient walked with assistance and physical examination showed a significant improvement in neurological deficits (NIHSS: 6). Conclusions: This case demonstrates the importance of engaging Brazil’s public health system in the management of acute ischemic stroke, especially in challenging cases such as basilar artery occlusion. This patient was the first admitted to our hospital to perform a thrombectomy after effective transference for a tertiary hospital and staff engagement of both hospitals.

scholarly journals Spontaneous resolution of idiopathic thoracic spinal cord herniation: case report

2015 ◽  
Vol 23 (3) ◽  
pp. 306-308 ◽  
Author(s):  
Nardin Samuel ◽  
Christina L. Goldstein ◽  
Carlo Santaguida ◽  
Michael G. Fehlings
Keyword(s):  
Spinal Cord ◽  
Neurological Impairment ◽  
Primary Treatment ◽  
Spontaneous Resolution ◽  
Neurological Deficits ◽  
Thoracic Myelopathy ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation

Spinal cord herniation is a relatively rare but increasingly recognized clinical entity, with fewer than 200 cases reported in the literature to date. The etiology of this condition remains unknown, and surgery is used as the primary treatment to correct the herniation and consequent spinal cord compromise. Some patients without clinical progression have been treated with nonoperative measures, including careful follow-up and symptomatic physical therapy. To date, however, there has been no published report on the resolution of spinal cord herniation without surgical intervention. The patient in the featured case is a 58-year-old man who presented with mild thoracic myelopathy and imaging findings consistent with idiopathic spinal cord herniation. Surprisingly, updated MRI studies, obtained to better delineate the pathology, showed spontaneous resolution of the herniation. Subsequent MRI 6 months later revealed continued resolution of the previous spinal cord herniation. This is the first report of spontaneous resolution of a spinal cord herniation in the literature. At present, the treatment of this disorder is individualized, with microsurgical correction used in patients with progressive neurological impairment. The featured case highlights the potential variability in the natural history of this condition and supports considering an initial trial of nonoperative management for patients with mild, nonprogressive neurological deficits.

scholarly journals Segmental hypoplasia of the spinal cord and syringomyelia in a calf

2020 ◽  
Vol 50 (3) ◽  
Author(s):  
Luciana Aparecida de Souza ◽  
Samara de Paula Lopes ◽  
Yasmin Daoualibi ◽  
Ana Cristina Sbaraini Mósena ◽  
Vinícius Vasconcellos da Cruz Gonçalo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
White Matter ◽  
Congenital Malformations ◽  
Rio De Janeiro ◽  
The Body ◽  
Radiographic Examination ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Organ Systems ◽  
Spinous Processes

ABSTRACT: Congenital malformations are functional and structural changes in organ systems, tissues, or organs that may develop during the embryonic or fetal phase. Spinal cord malformations, such as segmental hypoplasia of the spinal cord (SHSC) and syringomyelia, are rare in bovines. A Girolando calf from Valença, Rio de Janeiro, was admitted to the Veterinary Hospital of Universidade Federal Rural do Rio de Janeiro because of motor incoordination. Clinical evaluation revealed a 5-cm depression area in the spine at the dorsal line of the thoracic region. Neurological examination revealed reduced proprioception, pelvic limb extension with increased nociceptive activity, and reduced anal reflex. In radiographic examination, the body of the T11 vertebra had a trapezoidal wedge shape with ventral hemivertebra, probable agenesis or hypoplasia of the T11-T12 spinous processes, and fusion of the T9-T10 spinous processes. Myelography revealed extradural spinal compression caused by vertebral malformations. Necropsy showed no spinous processes (T11-T12), cranial stenosis in the medullary canal (T11-T13), and 1-3-mm pores in the white matter of the thoracic spinal cord (T8-T11). Microscopy revealed cystic dilatations in the white matter (T9-T11), cystic areas of varying sizes (T8-T9), and moderate reduction in the gray matter around the central canal of the medulla (T11-T13). Here, we reported the clinical and pathological findings of SHSC and syringomyelia in a Girolando calf. The features should be differentiated from other spinal cord syndromes. Congenital malformations are of economic importance, and their etiology and diagnosis are fundamental to disease control and progenitor-selection programs.

scholarly journals Role of Multimodality Intraoperative Neurophysiological Monitoring during Embolisation of a Spinal Cord Arteriovenous Malformation

2000 ◽  
Vol 6 (3) ◽  
pp. 223-234 ◽  
Author(s):  
F. Sala ◽  
Y. Niimi ◽  
A. Berenstein ◽  
V. Deletis
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
General Anesthesia ◽  
Endovascular Procedures ◽  
Motor Evoked Potentials ◽  
Neurological Deficits ◽  
Neurophysiological Monitoring ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal

The decision whether or not to embolise during endovascular procedures for arteriovenous malformations (AVMs) of the spinal cord under general anesthesia, relies primarily on neurophysiological results of provocative tests with Lidocaine and short-acting barbiturates. Because of the complex haemodynamics of spinal AVMs, when either sensory (CSEPs) or muscle motor evoked potentials (mMEPs) are used independently, they can mislead the interpretation of provocative tests. This report illustrates the specific but complementary role played by provocative tests using CSEPs and mMEPs during embolisation of a low thoracic spinal cord AVM. We present the case of a 46 year old male with six year history of right lower extremity weakness. At that time, Magnetic Resonance (MR) imaging of the spine disclosed an intramedullary AVM at T11. He remained neurologically stable up to seven months before admission, when he developed sudden onset of low back pain, followed by progressive paraparesis, numbness in lower extremities, urinary retention and fecal incontinence. A new MR imaging study indicated venous thrombosis of the AVM. A two-stage embolisation was performed. During the first procedure, after provocative tests did not affect either CSEPs or mMEPs, an embolisation was performed through a sulco-commisure feeder from the anterior spinal artery (ASA) at T9. Conversely, provocative tests with Lidocaine performed from a right posterior spinal artery (PSA) feeder to the AVM nidus resulted in a significant (>50%) decrease of CSEPs, while mMEPs remained unchanged. The repeatedly positive tests warranted further investigation of the vascular anatomy which disclosed a normal right PSA distal to the nidus; the distal normal PSA was protected with coils. A repeated Lidocaine test was negative and the posterior feeder was embolised with no subsequent changes in CSEPs or mMEPs. After the procedure, the patient experienced only a mild transitory increase in right leg numbness, but no additional motor deficits. Five days later, the embolisation through the ASA feeder at T9 was completed on the basis of negative provocative tests. No additional neurological deficits were observed. Favoring either CSEPs or MEPs during endovascular procedures in the spinal cord is not justified by a solid scientific background. This case report illustrates that monitoring both CSEPs and mMEPs combined with provocative tests allows the safest and most effective embolisation of spinal cord AVMs under general anesthesia.

Congenital intradural melanoma surrounding the spinal cord of a nine-day-old Saanen goat

2020 ◽  
Vol 8 (2) ◽  
pp. e001117
Author(s):  
Devinn M Sinnott ◽  
Kevin D Woolard ◽  
Meera Heller ◽  
Verena K Affolter
Keyword(s):  
Spinal Cord ◽  
Primary Tumour ◽  
Postmortem Examination ◽  
The Body ◽  
Thoracic Spinal Cord ◽  
Homogeneous Population ◽  
Saanen Goat ◽  
Lumbosacral Spinal Cord ◽  
Thoracic Spinal ◽  
Congenital Tumours

A nine-day-old Saanen kid presented for progressive hind limb paresis since birth. Euthanasia was elected, and on postmortem examination a large, pigmented mass was present in the vertebral canal surrounding the lumbosacral and caudal thoracic spinal cord. Histopathology revealed a homogeneous population of round to spindle neoplastic cells containing finely granular pigment consistent with a melanoma. This diagnosis was further supported by a Fontana-Masson stain and immunohistochemistry for PNL2, MelanA and SOX10. The tumour presumably arose from melanocytes or melanocytic precursors within the meninges of the lumbosacral spinal cord. No evidence of neoplasia was seen elsewhere in the body; therefore, the meningeal melanoma likely represents the primary tumour. Goats develop neoplasms less frequently than other species, and reports of congenital tumours in goats are rare.

scholarly journals Facial asymmetry in a newborn

2021 ◽  
Vol 8 (2) ◽  
pp. 367
Author(s):  
Sheela Madipelli
Keyword(s):  
Facial Asymmetry ◽  
Bottle Feeding ◽  
Cosmetic Outcome ◽  
Neurological Deficits ◽  
Elective Cesarean Section ◽  
Cardiac Defects ◽  
Normal Limits ◽  
The Face ◽  
Elective Cesarean

Facial asymmetry especially Neonatal asymmetric crying facies (NACF) is not an uncommon diagnosis. Many cases are undiagnosed or underreported. Early determination of the etiology is important for better cosmetic outcome. Newborn infant presents at birth with asymmetry of the right side of the face every time he cried. Infant's face is symmetric when he is calm and not crying. Infant is born at full term by elective cesarean section. Pregnancy was uncomplicated and the infant had normal APGARS.  No forceps, vacuum or other instruments were used to facilitate the delivery. No family history of similar asymmetry of face, cardiac defects or neurological problems. Infant is both breastfeeding and bottle feeding with normal sucking and no drooling. On examination, vitals are within normal limits. Infant has asymmetry of the lower face when crying with no asymmetry of the upper face. He had no lagophthalmos and nasolabial folds were intact. Infant had no asymmetry of the face when he was not crying or quiet. A harsh systolic murmur is noted at the left lower sternal border. Infant has good peripheral pulses, good perfusion and no cyanosis. Infant is moving all extremities and has no neurological deficits. Rest of the physical examination is within normal limits. NACF is not uncommon and the actual incidence may be higher, as milder cases are either undiagnosed or underreported. A thorough birth history and careful physical exam are important as well as looking for associated anomalies like cardiac defects. Early determination of etiology is important as cosmetic outcome is better in the nerve compression group than the muscle hypoplasia group.

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