scholarly journals Neurobrucellosis with ischemic stroke and spinal cord involvement: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hongfeng Wen ◽  
Di Jin ◽  
Lina Cai ◽  
Tao Wu ◽  
Haichao Liu
Keyword(s):  
Spinal Cord ◽  
Ischemic Stroke ◽  
Clinical Manifestations ◽  
Transverse Myelitis ◽  
Lower Limbs ◽  
Spinal Cord Atrophy ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Next Generation Sequencing Ngs

Abstract Background Brucellosis is a common zoonotic disease that may have a variety of clinical manifestations when it affects the nervous system. Ischemic stroke is a rare clinical symptom, but if it is not diagnosed and treated early, it may cause more severe consequences. Case presentation We report a 38-year-old man presenting with hearing impairment for four years and sudden weakness of the right limb for two years, recurrent aphasia, and gradual weakness of bilateral lower limbs for nine months. He had bilateral positive Babinski’s sign. Cerebrospinal fluid (CSF) showed raised protein and pleocytosis. Magnetic resonance imaging (MRI) showed ischemic infarcts in the pons and extensive enhancement of spinal meninges combined with spinal cord atrophy and ischemia. The tests revealed Brucella Rose Bengal positive in serum and CSF. Brucella culture in CSF was also positive. Next-generation sequencing (NGS) of CSF revealed positive for Brucella with 105 species were detected. He showed significant improvement with antibiotics at five months follow-up. Conclusions Neurobrucellosis may mimic stroke and transverse myelitis like syndromes. NB is a treatable infectious condition and should always be considered in the differentials, especially if there are risk factors, as in our case.

Contribution of spinal cord biopsy to diagnosis of aquaporin-4 antibody positive neuromyelitis optica spectrum disorder

2013 ◽  
Vol 20 (7) ◽  
pp. 882-888 ◽  
Author(s):  
M Ringelstein ◽  
I Metz ◽  
K Ruprecht ◽  
A Koch ◽  
J Rappold ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuromyelitis Optica ◽  
Transverse Myelitis ◽  
Aquaporin 4 ◽  
Diagnostic Process ◽  
Antibody Testing ◽  
Magnetic Resonance Imaging Mri ◽  
Extensive Transverse Myelitis ◽  
Aqp4 Antibody

Longitudinally extensive transverse myelitis is characteristic but not pathognomonic for neuromyelitis optica spectrum disorders (NMOSDs) and may mimic local tumors. In this retrospective study based on a cohort of 175 NMOSD patients we identified seven patients who initially presented with a longitudinally extensive spinal cord lesion and underwent spinal cord biopsy due to magnetic resonance imaging (MRI)-suspected malignancies. Remarkably, routine neuropathology was inconclusive and did not guide the diagnostic process to anti-aquaporin-4 (AQP4)-seropositive NMOSD. Serious postoperative complications occurred in 5/7 patients and persisted during follow-up in 2/7 patients (29%). Considering these sequelae, AQP4-antibody testing should be mandatory in patients with inconclusive longitudinally extensive spinal cord lesions prior to biopsy.

Misdiagnosis of Spinal Dural Arteriovenous Fistula: An Analysis of 12 Cases

2020 ◽  
Author(s):  
Baohui Yang ◽  
Shuai Cao ◽  
Xijing He ◽  
Haopeng Li
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Spinal Stenosis ◽  
Dural Arteriovenous Fistula ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Spinal Dural Arteriovenous Fistula ◽  
Flow Void ◽  
Spinal Cord Edema

Abstract Background: Spinal dural arteriovenous fistula (SDAVF) is a rare spinal vascular disease. The clinical misdiagnosis rate is very high. The highest misdiagnosis rate is reported in orthopedics. The specific reason for misdiagnosis remains unclear. Objective: To investigate the clinical and imaging manifestations of SDAVF, analyze the causes of misdiagnosis, propose countermeasures, and improve the orthopedists and other specialists’ understanding of this disease. Methods: The clinical data, diagnosis and treatment of 12 patients who had SDAVF that was misdiagnosed as a different disease were retrospectively analyzed, and the modified Aminoff-Logue Disability Scale (ALS) scores before and during follow-up were compared. Results: From 2014 to February 2019, 15 patients were diagnosed with SDAVF at our institution. Twelve (80%) were misdiagnosed; of these, 6 (50%) were misdiagnosed more than twice, and 6 patients (50%) were misdiagnosed at least once. The initial diagnoses included lumbar spinal stenosis and lumbar disc herniation (LDH) in 6 patients, cervical spinal stenosis in one patient, benign prostatic hyperplasia (BPH) in one patient, myelitis in 2 patients, and syringomyelia in one patient. After the initial diagnosis, one patient was misdiagnosed with LDH, one was misdiagnosed with subacute combined degeneration of the spinal cord, and 4 were misdiagnosed with myelitis. The clinical manifestations mainly included weakness and numbness of the lower limbs, urinary symptoms, and numbness of the perineal area. In the 12 misdiagnosed patients, magnetic resonance imaging(MRI) showed signs of spinal cord edema and typical or atypical flow-void patterns. One patient had undergone extended cervical decompression and lumbar decompression. All patients eventually underwent microsurgical treatment. The average follow-up duration was 0.9 years. The modified ALS scores showed significant improvement in gait, bladder function and bowel movement, and the differences before and during follow-up were statistically significant (P<0.05). Conclusion: When patients, especially those with bladder and bowel dysfunction, have symptoms such as weakness of the lower limbs and/or numbness, a diagnosis of SDAVF should be considered. Furthermore, if MRI shows signs of spinal cord edema and typical or atypical flow-void patterns, the diagnosis of SDAVF should be strongly considered, and further angiography is needed to confirm the diagnosis.

scholarly journals Acute spinal cord infarction syndrome unusually mimicking Transverse myelitis: A case report

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Aliyu Ibrahim ◽  
Aisha Shuaibu ◽  
Usman Adamu Nuhu ◽  
Hauwa A. Aliyu
Keyword(s):  
Spinal Cord ◽  
Transverse Myelitis ◽  
Sudden Onset ◽  
Dorsal Column ◽  
Lower Limbs ◽  
Spinal Cord Infarction ◽  
History Of ◽  
Extensor Plantar Response ◽  
Magnetic Resonance Imaging Mri ◽  
Repeat Examination

Anterior Spinal Cord Infarction (ASCI) syndrome typically results from ischemia that affects the anterior spinal artery territory characterized by history of sudden onset flaccid paraplegia or quadriplegia depending on the level of the lesion. We describe a 57-years-old woman with sudden onset flaccid weakness of the lower limbs and numbness of the feet of two days duration, preceded by a day history of fever and several episodes of vomiting. Examination initially revealed bilateral hypotonia, hyporeflexia and dense paraplegia, with preservation of dorsal column sensations (fine touch/2-point discrimination, position and vibration sensation). Twenty-four hours thereafter a repeat examination showed hyper-reflexia and extensor plantar response with spastic paraplegia. Thoracic spine Magnetic Resonance Imaging (MRI) revealed thinning of the spinal cord extending from T1 to T9 levels with associated widening of the thecal sac suggestive of anterior spinal cord infarction with no other signal changes seen within the substance.

CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

2019 ◽  
Vol 1 (4) ◽  
Author(s):  
Yustinus Robby Budiman Gondowardojo ◽  
Tjokorda Gde Bagus Mahadewa
Keyword(s):  
Spinal Cord ◽  
Left Lung ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
High Mobility ◽  
Early Mobilization ◽  
Cord Injury ◽  
Cardiothoracic Surgeon ◽  
The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

Hypogastric Artery Stenting for Chronic Intermittent Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 27 (5) ◽  
pp. 801-804
Author(s):  
Catharina Gronert ◽  
Nikolaos Tsilimparis ◽  
Giuseppe Panuccio ◽  
Ahmed Eleshra ◽  
Fiona Rohlffs ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Ischemia ◽  
Thoracic Endovascular Aortic Repair ◽  
Neurological Symptoms ◽  
Endovascular Aortic Repair ◽  
Hypogastric Artery ◽  
Lower Extremity Weakness ◽  
Aortic Repair ◽  
The Right

Purpose: To report a case of chronic intermittent spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) and its successful treatment using hypogastric artery stenting. Case Report: A 79-year-old patient presented in May 2013 with a thoracic aortic aneurysm (TAA) and a contained rupture. He urgently underwent TEVAR that covered 274 mm of descending thoracic aorta without immediate postoperative signs of acute SCI. At 3-month follow-up, he reported repeating incidents of sudden lower extremity weakness leading to a fall with a humerus fracture. A neurological consultation revealed the tentative diagnosis of intermittent SCI caused by TEVAR and initially recommended a conservative approach. During the following year there was no clinical improvement of the symptoms. Computed tomography angiography showed a high-grade stenosis of the right hypogastric artery, which was stented in November 2014 to improve the collateral network of spinal cord perfusion. Following treatment, the patient had no further neurological symptoms; at 32 months after the reintervention, the imaging follow-up documented a patent stent and continued exclusion of the TAA. Conclusion: Intermittent neurological symptoms after TEVAR should be suspected as chronic intermittent SCI. The improvement of collateral networks of the spinal cord by revascularization of the hypogastric artery is a viable treatment option.

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.

Acute Transverse Myelitis Associated with COVID-19 vaccine: A Case Report

2021 ◽  
Vol 12 (3) ◽  
pp. 2083-2087
Author(s):  
Ali Alshararni
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Acute Inflammation ◽  
Transverse Myelitis ◽  
Preventive Measure ◽  
Mri Findings ◽  
Dorsal Spinal Cord ◽  
Lumbosacral Spinal Cord ◽  
Acute Transverse Myelitis ◽  
Magnetic Resonance Imaging Mri

The case report demonstrates the issue of Khalid Ali, who is a citizen of Yamen, explicitly living in Saudi Arabia. He is 38 years, weighs 82kgs, and of 162 cm in height. He is a sales professional and married with two kids. Khalid Ali has been living healthy until two years ago when he started experiencing pains in his lower extremities accompanied by numbness. He was treated, and everything went back to normal until soon when the case came back after the administration of the Pfizer vaccine as a preventive measure for COVID-19 disease. The consequence of the administration of the Pfizer vaccine resulted in severe pain and weaknesses in his legs and severe headache on the second day, which resulted in him being put on an ICU after 48 hours since he was almost paralyzed. A series of tests were conducted on him, including magnetic resonance imaging (MRI), hematology, and biochemistry which involved Cerebrospinal Fluid (CSF) protein test. MRI findings were significant since they indicated acute inflammation on the spine observed on the dorsal spinal cord with contrast and lumbosacral spinal cord. All the hematology tests turned out to be expected. Biochemistry conducted tests were similarly standard except for CSF protein which was highly abnormal. The combination of the high abnormal CSF protein test and acute inflammation of the spine observed from the MRI findings were confirmed evidence of acute transverse myelitis as a result of the administration of the Pfizer vaccine.

Lateral Medullary Infarction with Contralateral Segmental Dysesthesia and Ipsilateral Headache: A Case Report

2021 ◽  
Vol 17 ◽  
Author(s):  
Renjie Wang ◽  
Yankun Shao ◽  
Lei Xu
Keyword(s):  
Medulla Oblongata ◽  
Clinical Manifestations ◽  
Lateral Medullary Infarction ◽  
Case Presentation ◽  
Specific Sign ◽  
Temperature Sense ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
The Brain ◽  
Medullary Infarction

Introduction: The medulla oblongata is the lowest segment of the brain stem, located adjacent to the spinal cord, with a complex anatomical structure. Thus, a small injury to the medulla oblongata can show complex clinical manifestations. Case Presentation: A patient experienced dysesthesia, which manifested as numbness in her right lower limb and decreased temperature sense, and dizziness 20 days before admission. The numbness worsened 1 week before admission, reaching the right thoracic (T) 12 dermatomes. Her thermoception below the T12 dermatomes decreased, and the degree of dizziness increased, accompanied by nausea and vomiting. Magnetic resonance imaging (MRI) of the neck, chest, and abdomen performed at a local hospital showed no abnormalities. MRI of the brain was performed after admission. One week after admission, she experienced a severe headache in the upper left periorbital area. The numbness extended to T4, and thermoception decreased below T4. Diagnosis: Lateral medullary infarction. Interventions: Anti-platelet aggregation and mitochondrial nutritional therapies were performed along with treatments for improving circulation and establishing collateral circulation. Outcomes: The intensity of limb numbness decreased, and the symptoms of headache and dizziness resolved. Conclusion: Lesions leading to segmental sensory disorders can occur in the medulla oblongata. Ipsilateral headaches with contralateral segmental paresthesia can be a specific sign of lateral medullary infarction.

scholarly journals MANAGEMENT OF THROMBOANGIITIS OBLITERANS - A CASE REPORT

2021 ◽  
Vol 9 (7) ◽  
pp. 1560-1563
Author(s):  
Vishal Chougule ◽  
Shailesh Shetty
Keyword(s):  
Case Report ◽  
Strong Association ◽  
Complete Healing ◽  
Lower Limbs ◽  
Thromboangiitis Obliterans ◽  
Foul Smell ◽  
Treatment Principle ◽  
The Right ◽  
Time Of Admission

Thromboangitis obliterans (TAOs) is a rare disease affecting arteries and veins of the upper and lower limbs. The condition has a strong association with the use of tobacco. Thromboangitis obliterans also known as Buerger's disease is found in the age group between 40 to 45 years, and men are most prone to get affected. The present case is a male aged 65 years complaining of a wound on the heel on the right foot, associated with pain, discharge, slough, foul smell, edema and discolouration of the skin for which he visited our hospital, the patient was previ- ously diagnosed as TAO, considering his clinical features at the time of admission, an intervention was planned based on the treatment principle of Dusta Vrana like Virechana, Basti and Raktamokshana. There was complete healing of the wound at the end of the treatment with no signs of recurrence during the follow-up suggesting the need for Shodhana in the effective management of TAO. Keywords: Dushta Vrana, Thromboangiitis Obliterans, Ayurveda, Panchakarma, Shodhana, Case report

scholarly journals High-frequency spinal cord stimulation for treating pain in the lower limbs accompanied by bilateral para-anesthesia: A case report

2020 ◽  
Vol 8 (3) ◽  
pp. 132-137
Author(s):  
Zhuqiang Cheng
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Severe Pain ◽  
Traffic Accident ◽  
Lower Limbs ◽  
Sensory Impairment ◽  
Remarkable Effect ◽  
Muscle Twitching

A 46-year-old female patient experienced severe pain in both lower limbs following a traffic accident in 2008. The pain mainly presented in her feet; she also experienced sensory impairment, convulsions, and exercise function disorders. She was diagnosed with neuropathic pain, and no medicine had any remarkable effect. Therefore, spinal cord stimulation (SCS) was performed in October 2019. Her pain did not reduce after the initial adoption of conventional SCS until the application of high frequency SCS (HF-SCS). At the 6-month follow-up, the pain in her lower limbs was considerably reduced, lower limb motor function was slightly improved, and muscle twitching in both feet disappeared.

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