Progressive motor impairment from a critically located lesion in highly restricted CNS-demyelinating disease

2018 ◽  
Vol 24 (11) ◽  
pp. 1445-1452 ◽  
Author(s):  
B Mark Keegan ◽  
Timothy J Kaufmann ◽  
Brian G Weinshenker ◽  
Orhun H Kantarci ◽  
William F Schmalstieg ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Demyelinating Disease ◽  
Cervical Spinal Cord ◽  
Motor Impairment ◽  
Subcortical White Matter ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Demyelinating Lesions ◽  
Magnetic Resonance Imaging Mri

Objective: To report progressive motor impairment from a critically located central nervous system (CNS) demyelinating lesion in patients with restricted magnetic resonance imaging (MRI)-lesion burden. Methods: We identified 38 patients with progressive upper motor-neuron impairment for >1 year, 2–5 MRI CNS-demyelinating lesions, with one seemingly anatomically responsible for progressive motor impairment. Patients with any alternative etiology for progressive motor impairment were excluded. A neuroradiologist blinded to clinical evaluation reviewed multiple brain and spinal-cord MRI, selecting a candidate critically located demyelinating lesion. Lesion characteristics were determined and subsequently compared with clinical course. Results: Median onset age was 47.5 years (24–64); 23 (61%) women. Median follow-up was 94 months (18–442); median Expanded Disability Status Scale Score (EDSS) at last follow-up was 4.5 (2–10). Clinical presentations were progressive: hemiparesis/monoparesis 31; quadriparesis 5; and paraparesis 2; 27 patients had progression from onset; 11 progression post-relapse. Total MRI lesions were 2 ( n = 8), 3 ( n = 12), 4 ( n = 12), and 5 ( n = 6). Critical lesions were located on corticospinal tracts, chronically atrophic in 26/38 (68%) and involved cervical spinal cord in 27, cervicomedullary/brainstem region in 6, thoracic spinal cord in 4, and subcortical white matter in 1. Conclusion: Progressive motor impairment may ascribe to a critically located CNS-demyelinating lesion in patients with highly restricted MRI burden. Motor progression from a specific demyelinating lesion has implications for understanding multiple sclerosis (MS) progression.

scholarly journals Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management

1999 ◽  
Vol 6 (1) ◽  
pp. E6 ◽  
Author(s):  
Fernando L. Vale ◽  
Jennifer Burns ◽  
Amie B. Jackson ◽  
Mark N. Hadley
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Cervical Spinal Cord ◽  
Bladder Function ◽  
Thoracic Spinal Cord ◽  
Arterial Blood ◽  
Thoracic Spinal ◽  
Cord Injury

The optimal management of acute spinal cord injuries remains to be defined. The authors prospectively applied resuscitation principles of volume expansion and blood pressure maintenance to 77 patients who presented with acute neurological deficits as a result of spinal cord injuries occurring from C-1 through T-12 in an effort to maintain spinal cord blood flow and prevent secondary injury. According to the Intensive Care Unit protocol, all patients were managed by Swan-Ganz and arterial blood pressure catheters and were treated with immobilization and fracture reduction as indicated. Intravenous fluids, colloid, and vasopressors were administered as necessary to maintain mean arterial blood pressure above 85 mm Hg. Surgery was performed for decompression and stabilization, and fusion in selected cases. Sixty-four patients have been followed at least 12 months postinjury by means of detailed neurological assessments and functional ability evaluations. Sixty percent of patients with complete cervical spinal cord injuries improved at least one Frankel or American Spinal Injury Association (ASIA) grade at the last follow-up review. Thirty percent regained the ability to walk and 20% had return of bladder function 1 year postinjury. Thirty-three percent of the patients with complete thoracic spinal cord injuries improved at least one Frankel or ASIA grade. Approximately 10% of the patients regained the ability to walk and had return of bladder function. As of the 12-month follow-up review, 92% of patients demonstrated clinical improvement after sustaining incomplete cervical spinal cord injuries compared to their initial neurological status. Ninety-two percent regained the ability to walk and 88% regained bladder function. Eighty-eight percent of patients with incomplete thoracic spinal cord injuries demonstrated significant improvements in neurological function 1 year postinjury. Eighty-eight percent were able to walk and 63% had return of bladder function. The authors conclude that the enhanced neurological outcome that was observed in patients after spinal cord injury in this study was in addition to, and/or distinct from, any potential benefit provided by surgery. Early and aggressive medical management (volume resuscitation and blood pressure augmentation) of patients with acute spinal cord injuries optimizes the potential for neurological recovery after sustaining trauma.

scholarly journals Tissue bridges predict recovery after traumatic and ischemic thoracic spinal cord injury

Neurology ◽  
2019 ◽  
Vol 93 (16) ◽  
pp. e1550-e1560 ◽  
Author(s):  
Dario Pfyffer ◽  
Eveline Huber ◽  
Reto Sutter ◽  
Armin Curt ◽  
Patrick Freund
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Status ◽  
Lesion Length ◽  
Lesion Area ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Cord Injury ◽  
Cystic Cavity

ObjectiveTo investigate the spatiotemporal evolution and predictive properties of intramedullary damage and midsagittal tissue bridges at the epicenter of a thoracic spinal cord injury (SCI) using MRI.MethodsWe retrospectively assessed midsagittal T2-weighted scans from 25 patients with thoracic SCI (14 traumatic, 11 ischemic) at 1 month post-SCI. In 12 patients with SCI, linear mixed-effects models on serial MRI explored temporal trajectories of quantifiable lesion markers (area, length, and width) and tissue bridges. Using partial correlation analysis, we assessed associations between structural lesion characteristics at 1 month post-SCI and recovery at 1 year postinjury, adjusting for baseline clinical status, age, and sex.ResultsLesion area decreased by 5.68 mm2 (p = 0.005), lesion length by 2.14 mm (p = 0.004), and lesion width by 0.13 mm (p = 0.004) per month. Width of tissue bridges increased by 0.06 mm (p = 0.019) per month, being similar in traumatic and ischemic SCI (p = 0.576). Smaller lesion area, length, width, and wider tissue bridges at 1 month post-SCI predicted better recovery at 1-year follow-up.ConclusionsOver time, the immediate area of cord damage shrunk while the cystic cavity became demarcated. Adjacent to the cyst, midsagittal tissue bridges became visible. The width of tissue bridges at 1 month post-SCI predicted recovery at 1 year follow-up. Measures of lesion area and tissue bridges early after traumatic and ischemic thoracic SCI therefore allow characterizing the evolution of focal cord damage and are predictive of recovery in thoracic SCI. Thus, lesion extent and tissue bridges hold potential to improve diagnosis and patient stratification in interventional trials.

scholarly journals Intermittent Atrioventricular Block following Fingolimod Initiation

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
E. Gialafos ◽  
S. Gerakoulis ◽  
A. Grigoriou ◽  
V. Haina ◽  
C. Kilidireas ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Atrioventricular Block ◽  
Frequency Domain Analysis ◽  
Thoracic Spinal Cord ◽  
Sympathetic Function ◽  
Thoracic Spinal ◽  
Demyelinating Lesions ◽  
Cardiac Sympathetic Function ◽  
Upper Thoracic

A 47-year-old female patient with multiple sclerosis (MS) developed symptomatic intermittent 2nd degree atrioventricular block (AVB) of five-hour duration, five hours after the first two doses of fingolimod, that resolved completely. Frequency domain analysis of heart rate variability (HRV) revealed increased parasympathetic activity and decreased sympathetic tone, while modified Ewing tests were suggestive of impaired cardiac sympathetic function. We hypothesize that expression of this particular arrhythmia might be related to autonomic nervous system (ANS) dysfunction due to demyelinating lesions in the upper thoracic spinal cord, possibly augmented by the parasympathetic effect of the drug.

scholarly journals Cervicomedullary Ganglioglioma in a Child – A Case Report

2018 ◽  
Vol 119 (2-3) ◽  
pp. 122-127
Author(s):  
Eshagh Bahrami ◽  
Morteza Taheri ◽  
Feyzollah Ebrahimniya
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Frozen Section ◽  
Young Patients ◽  
Neurological Status ◽  
Upper Cervical ◽  
Magnetic Resonance Imaging Mri ◽  
Slow Growing ◽  
Section Report

Ganglioglioma is a benign slow-growing neoplasm that most frequently occurs at the supratentorial region. Nevertheless, there are occasional reports of ganglioglioma occurring in the brainstem and spinal cord. Here we report a rare case of the craniocervical ganglioglioma. A 3.5-year-old male, presented with severe progressive quadriparesis, gait disturbance, and sphincter deficit. Physical examination demonstrated the quadriparesis, associated with positive Hoffman, Babinski, and clonus signs, and increased respond of deep tendon reflexes. Magnetic resonance imaging (MRI) demonstrated an ill-defined mass within medulla and upper cervical spinal cord, which was hypo to iso signal on T1, heterogeneous iso to hypersignal on T2 and demonstrated marked bright enhancement on T1 with gadolinium (Gad) injection. On surgery, the mass had a soft texture, ill-defined border, and grey to brown appearance. According to the frozen section report, and due to the absence of the tumour-neural parenchymal interference, only decompression of the tumour and expansile duraplasty were performed. The histopathology revealed ganglioglioma. On last follow-up 14 months after surgery, the patient was asymptomatic and neurological status was improved. The craniocervical MRI demonstrated the tumour that did not grow. Although it is rare, the ganglioglioma should be in the differentiated diagnoses of tumours with compatible clinical and radiologic features even in the unusual locations, especially in the pediatric and young patients. Safety surgical resection should be considered in these patients, whenever possible. In the case of partial resection, that is common in the tumours located within functionally critical structures, long close follow-up rather than radiation therapy is required.

scholarly journals Acute Polyradiculomyelitis With Spinal Cord Gray Matter Lesions: A Report of Two Cases

2021 ◽  
Vol 12 ◽  
Author(s):  
Charidimos Tsagkas ◽  
Maria Janina Wendebourg ◽  
Matthias Mehling ◽  
Johannes Lorscheider ◽  
Philippe Lyrer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Gray Matter ◽  
Case Reports ◽  
Motor Impairment ◽  
Bowel Dysfunction ◽  
Motor Deficits ◽  
Spinal Cord Lesions ◽  
Rare Presentation ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal

Objective: Inflammatory polyradiculomyelitis belongs to a rare group of immune-mediated diseases affecting both the central and peripheral nervous system. We aimed to describe an unusual presentation of acute polyradiculomyelitis with marked spinal cord lesions restricted to the gray matter.Methods: Thorough examination of two case reports including clinical, MRI, serologic, electrophysiologic and CSF examinations as well as short-term follow-up.Results: We present two adult patients with acute polyradiculomyelitis and unusual spinal cord lesions restricted to the gray matter on MRI. The clinical presentation, serologic, electrophysiologic and CSF features of the two patients varied, whereas both patients demonstrated severe, asymmetrical, predominantly distal, motor deficits of the lower extremities as well as bladder and bowel dysfunction. Both patients only partially responded to anti-inflammatory treatment. Severe motor impairment and bladder dysfunction persisted even months after symptom onset.Conclusions: To our best of knowledge, these are the first reports of acute polyradiculomyelitis with distinct involvement of the lower thoracic spinal cord gray matter. Currently, it remains unclear whether gray matter lesions reflect a separate pathophysiologic mechanism or an exceedingly rare presentation of spinal cord involvement in acute polyradiculomyelitis.

scholarly journals Syringomyelia in demyelinating disease of the central nervous system: Report of two cases

2011 ◽  
Vol 139 (9-10) ◽  
pp. 657-660 ◽  
Author(s):  
Dejan Savic ◽  
Slobodan Vojinovic ◽  
Mirjana Spasic ◽  
Zoran Peric ◽  
Stevo Lukic
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Magnetic Resonance ◽  
Demyelinating Disease ◽  
Clinical Signs ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
The Central Nervous System

Introduction. Syringomyelia is a cavitary extension inside the spinal cord which can be either symptomatic or congenitally-idiopathic. Syringomyelia during the course of the disease in patients presenting with clinically definite multiple sclerosis was described earlier. Syringomyelia in patients presenting with a clinically isolated syndrome suggestive of multiple sclerosis is unusual. Case Outline. We present two patients presenting with demy-elinating disease of the central nervous system with syringomyelia in the cervical and thoracic spinal cord. We did not find classical clinical signs of syringomyelia in our patients, but we disclosed syringomyelia incidentally during magnetic resonance exploration. Magnetic resonance exploration using the gadolinium contrast revealed the signs of active demyelinating lesions in the spinal cord in one patient but not in the other. Conclusion. Syringomyelia in demyelinating disease of the central nervous system opens the question whether it is a coincidental finding or a part of clinical features of the disease. Differentiation of the significance of syringomyelia finding in these patients plays a role in the choice of treatment concept in such patients.

Transthoracic Approach to an Intramedullary Vascular Malformation of the Thoracic Spinal Cord

Neurosurgery ◽  
1982 ◽  
Vol 10 (5) ◽  
pp. 631-634 ◽  
Author(s):  
Richard B. Raynor ◽  
Richard Weiner
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Vascular Malformation ◽  
Anterior Spinal Artery ◽  
Intercostal Artery ◽  
Transthoracic Approach ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal

Abstract A transthoracic approach with resection of a vertebral body was used to obtain access to an intramedullary vascular malformation of the thoracic spinal cord. The malformation consisted of three discrete intramedullary tufts of vessels fed by an abnormal branch of the anterior spinal artery arising from the T-9 intercostal artery. Although the abnormal branch of the anterior spinal artery did not appear to supply normal cord, the patient developed transient weakness postoperatively after occlusion of this artery. Follow-up angiography showed that one part of the malformation was still present and was fed by the T-6 intercostal artery.

scholarly journals Sulcal artery syndrome presenting as an incomplete Brown–Sequard syndrome – Report of an unusual case and review of the literature

2020 ◽  
Vol 29 (1) ◽  
pp. 59-63
Author(s):  
May Myat Win ◽  
Monica Saini ◽  
Shrikant Digambarrao Pande ◽  
Kappaganthu Venkatesh Prasanna
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Vertebral Artery Dissection ◽  
Artery Occlusion ◽  
Sudden Onset ◽  
Artery Dissection ◽  
Spinal Cord Infarction ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Brown Sequard Syndrome

Sulcal arteries perfuse the anterior two-thirds of the spinal cord, and spinal cord infarction as a result of sulcal artery occlusion is rare. Most reported cases are associated with vertebral artery dissection, and commonly involve the cervical spinal cord. A 74-year-old man presented with sudden onset weakness and numbness after a brief bout of abdominal pain. Further investigations concluded that this was sulcal artery syndrome. We report a case of sulcal artery syndrome affecting the thoracic spinal cord presenting as Brown–Sequard syndrome. Sulcal artery syndrome usually has good prognoses, unlike anterior spinal artery infarction.

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