scholarly journals Pneumorrhachis causing cauda equina syndrome: a case report and literature review

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Areez Shafqat ◽  
Hamzah M. F. Magableh ◽  
Shameel Shafqat ◽  
Syed Shafqat Ul Islam
Keyword(s):  
Cauda Equina ◽  
Neurological Symptoms ◽  
Neurological Deficits ◽  
Disc Disease ◽  
Surgical Interventions ◽  
Vacuum Phenomenon ◽  
Perineal Region ◽  
Magnetic Resonance Imaging Mri ◽  
Radicular Symptoms

Abstract Background Pneumorrhachis (PR) describes the rare presence of intraspinal air, mainly following traumatic or iatrogenic procedures. According to the localization of air in the spinal canal, PR has been classified into internal (subdural) and external (epidural). PR rarely manifests in neurological deficits and usually resolves spontaneously without recurrence, with air being passed directly into the bloodstream. Here, we report a case of external PR occurring spontaneously (without any underlying trauma or surgical interventions) manifesting as neurological deficits. This is an extremely rare finding with only a limited number of cases in the literature. Case presentation We report a case of spontaneous external PR manifesting as neurological symptoms in a 62-year-old male diabetic patient with chronic low backpain who developed numbness in his perineal region mainly on the left side. His medical history was normal, without trauma or surgical intervention. Magnetic resonance imaging (MRI) and computed tomography (CT) in the past 2 years demonstrated degenerative changes in the lumbar spine, including end plates and disc spaces, with intervertebral disc vacuum phenomenon (VP); the CT additionally showed intraspinal air in the epidural space at L5-S1 levels compressing the cauda equina. A diagnosis of spontaneous external PR was made. A follow-up MRI upon exacerbation of neurological deficits showed an increase in air locule size. Our patient was managed conservatively on a nonsteroidal anti-inflammatory agent (NSAID) and was advised for regular follow-ups. No aspiration or surgery has been performed to date. Conclusions Spontaneous external pneumorrhachis manifesting as neurological symptoms is extremely rare. Due to degenerative disc disease producing vacuum phenomenon, we propose that spontaneous PR secondary to intradiscal VP be considered as part of the differential for radicular symptoms, especially with increasing age. The most effective noninvasive investigation for the diagnosis of PR is CT. MRI is less beneficial in the case of PR as gas and calcifications are hard to distinguish, both being of low-intensity signals on all MR sequences.

scholarly journals Outcome of Surgical Treatment for Lumber Disc Herniation Causing Painful Incomplete Foot-Drop

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
MUSAWER KHAN ◽  
AKRAM ULLAH ◽  
ADNAN AHMED ◽  
MUMTAZ ALI ◽  
MANSOOR AHMAD
Keyword(s):  
Surgical Treatment ◽  
Pain Relief ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Foot Drop ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Number Of Patients

Objective:  To determine the outcome of surgical treatment for lumder disc herniation causing the painful incomplete foot drop. Material and Methods:  This retrospective observational study was conducted at the Department of Neurosurgery Lady Reading Hospital, Peshawar. Both Male and female patients with lumbar disc disease causing unilateral incomplete painful foot drop were included in our study. Patients with complete or painless foot drop, bilateral foot-drop, Multiple level disc prolapse, cauda equina syndrome or sciatic neuropathy due to injection injury were excluded. Patients were followed was post-operatively in terms of power in foot dorsiflexion, medical research council (MRC) grade and pain relief  on a Visual Analogue Scale (VAS) after 1 month and then after 6 months. Results: Total number of patients included were 43. Age was ranging from 18 years to 54 years and mean age was 33 years. Before surgery,  power of MRC grade 3 or less, but greater than 1 in dorsiflexion was noted in all patients. The pain was scaled using VAS. Post peratively, at 1 month follow up, the foot-drop improved to MRC grade 4 or 5 along with pain relief of ≥ 2 points on VAS in 81. 4% (n = 35) patients and at 6 month follow-up, the figure rose to 93% (n = 40). Conclusion:  Lumbar disc disease can cause a debilitating foot-drop and pain. Improving or restoring a neurology early surgical intervention has proven benefits.

Doughnut vertebroplasty for circumferential aggressive vertebral hemangiomas

2021 ◽  
pp. neurintsurg-2020-016785
Author(s):  
Cecile Roscop ◽  
Florent Gariel ◽  
David Christopher Kieser ◽  
Benjamin Bouyer ◽  
Olivier Gille ◽  
...  
Keyword(s):  
Conscious Sedation ◽  
Neurological Symptoms ◽  
Resonance Imaging ◽  
Imaging Evaluation ◽  
Safety And Efficacy ◽  
Patient Demographics ◽  
Clinical Presentations ◽  
Magnetic Resonance Imaging Mri ◽  
Vertebral Hemangiomas

BackgroundTo assess the feasibility, safety and efficacy of a percutaneous doughnut vertebroplasty of circumferential aggressive vertebral hemangiomas (VHs).MethodsWe retrospectively reviewed our prospectively collected database of patients with VHs treated with vertebroplasty between January 2009 and January 2018. Patient demographics, clinical presentations and procedural details were recorded. All patients underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI). All vertebroplasties were performed under conscious sedation in the prone position, predominantly using biplane fluoroscopic guidance. A clinical and imaging evaluation (early CT scan and MRI) as well as a final follow-up clinical assessment was performed.ResultsTwenty-two patients with aggressive VHs who underwent circumferential vertebroplasty with cementation of the entire vertebral body and at least one posterior hemi-arch were included (six males, mean age 53 years). At 3 months follow-up, nine patients (41%) had complete, 11 (50%) had partial and two (9%) had no resolution of pain. Nine of 14 patients had a decrease in venous swelling on MRI. No complications were observed. Five patients (23%) underwent adjunctive surgery within 1 year for persistence or worsening of neurological symptoms. Clinical and radiographic improvements were maintained to final follow-up.ConclusionsDoughnut vertebroplasty offers a mini-invasive, safe and effective treatment of aggressive circumferential VHs. This technique improves pain in over 90% of patients as well as a reduction in radicular and neurological symptoms associated with a tendency to regression of the compressive epidural venous component of these lesions.

scholarly journals CyberKnife frameless single-fraction stereotactic radiosurgery for tumors of the sacrum

2003 ◽  
Vol 15 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Peter C. Gerszten ◽  
Cihat Ozhasoglu ◽  
Steven A. Burton ◽  
William C. Welch ◽  
William J. Vogel ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Cauda Equina ◽  
Surgical Techniques ◽  
Outpatient Setting ◽  
Neurological Deficits ◽  
Therapeutic Modality ◽  
Radiation Toxicity ◽  
Single Fraction

Object The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. The experience with radiosurgery for the treatment of spinal and sacral lesions is more limited. Sacral lesions should be amenable to radiosurgical treatment similar to that used for their intracranial counterparts. The authors evaluated a single-fraction radiosurgical technique performed using the CyberKnife Real-Time Image-Guided Radiosurgery System for the treatment of the sacral lesion. Methods The CyberKnife is a frameless radiosurgery system based on the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, which guides the therapy beam to the intended target without the need for frame-based fixation. All sacral lesions were located and tracked for radiation delivery relative to fiducial bone markers placed percutaneously. Eighteen patients were treated with single-fraction radiosurgery. Tumor histology included one benign and 17 malignant tumors. Dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Planning treatment volume was defined as the radiographically documented tumor volume with no margin. Tumor dose was maintained at 12 to 20 Gy to the 80% isodose line (mean 15 Gy). Tumor volume ranged from 23.6 to 187.4 ml (mean 90 ml). The volume of the cauda equina receiving greater than 8 Gy ranged from 0 to 1 ml (mean 0.1 ml). All patients underwent the procedure in an outpatient setting. No acute radiation toxicity or new neurological deficits occurred during the mean follow-up period of 6 months. Pain improved in all 13 patients who were symptomatic prior to treatment. No tumor progression has been documented on follow-up imaging. Conclusions Stereotactic radiosurgery was found to be feasible, safe, and effective for the treatment of both benign and malignant sacral lesions. The major potential benefits of radiosurgical ablation of sacral lesions are relatively short treatment time in an outpatient setting and minimal or no side effects. This new technique offers a new and important therapeutic modality for the primary treatment of a variety of sacral tumors or for lesions not amenable to open surgical techniques.

scholarly journals Acute disseminated encephalomyelitis following endonasal resection of a craniopharyngioma: illustrative case

2021 ◽  
Vol 2 (16) ◽  
Author(s):  
Konrad Gag ◽  
Jonas Müller ◽  
Marie Süße ◽  
Robert Fleischmann ◽  
Henry W. S. Schroeder
Keyword(s):  
White Matter ◽  
White Matter Lesions ◽  
Acute Disseminated Encephalomyelitis ◽  
Intravenous Immunoglobulins ◽  
Neurological Deficits ◽  
Illustrative Case ◽  
Sensorimotor Deficits ◽  
Fluid Analysis ◽  
Magnetic Resonance Imaging Mri

BACKGROUND Acute disseminated encephalomyelitis (ADEM) is a rare, acquired demyelination syndrome that causes cognitive impairment and focal neurological deficits and may be fatal. The potentially reversible disease mainly affects children, often after vaccination or viral infection, but may be seen rarely in adults. OBSERVATIONS A 50-year-old woman presented with loss of visual acuity of the left eye. Magnetic resonance imaging (MRI) revealed an intra- and suprasellar mass, which was removed successfully. On postoperative day 1, MRI showed gross total resection of the lesion and no surgery-related complications. On postoperative day 2, the patient presented with a progressive left-sided hemiparesis, hemineglect, and decline of cognitive performance. MRI showed white matter edema in both hemispheres. Cerebrospinal fluid analysis revealed mixed pleocytosis (355/µL) without further evidence of infection. In synopsis of the findings, ADEM was diagnosed and treated with intravenous immunoglobulins. Shortly thereafter, the patient recovered, and no sensorimotor deficits were detected in the follow-up examination. LESSONS Pituitary gland pathologies are commonly treated by transsphenoidal surgery, with only minor risks for complications. A case of ADEM after craniopharyngioma resection has not been published before and should be considered in case of progressive neurological deterioration with multiple white matter lesions.

scholarly journals MRI-Guided Stereotactic Laser Ablation of Deep-Seated Cerebral Cavernous Malformations

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
James A M Douglas ◽  
Alex C M Greven ◽  
Christopher W Rich ◽  
James G Malcolm ◽  
Robert E Gross ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Brain Structures ◽  
Neurological Symptoms ◽  
Neurological Deficits ◽  
Recurrent Bleeding ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Mri Guided ◽  
Deep Brain

Abstract INTRODUCTION Magnetic resonance imaging (MRI)-guided stereotactic laser ablation (SLA) is a minimally invasive alternative to open surgery for symptomatic cerebral cavernous malformations (CCMs). While SLA of neocortical and medial temporal lesions is described, we examined the safety and effectiveness of SLA of deep-seated symptomatic CCMs in patients considered to be poor candidates for open resection. METHODS We analyzed 4 patients who presented with neurological symptoms associated with a CCM in deep brain structures. Each patient underwent CCM SLA with an effort to exclude adjacent brain parenchyma followed by standard clinical and imaging follow-up. RESULTS Three patients presented with chronic medically refractory headache and small lesions (0.1-2.6 cm3) consistent with CCM in thalamus (2) or putamen (1). A fourth patient presented with recurrent bleeding and hemiparesis associated with a large CCM (4.3 cm3) of the subthalamus/midbrain. Symptoms durations were 0.5 to 7 yr. SLA was performed using Visualase (Medtronic, Inc.); perilesional brain was monitored to avoid thermal injury. Out of 4 patients, all demonstrated a decrease in CCM volume and improvement of neurological symptoms at 5 to 23 mo follow-up. Two patients (one thalamus, one putamen), experienced evidence of hemorrhage during ablation (apparent with intraoperative MRI), limiting the extent of ablation in one case. Both patients were stabilized and made full recoveries. The ablation in subthalamus/midbrain was not associated with bleeding but did exacerbate hemiparesis, requiring rehabilitation. Hospital stays ranged from 2 to 5 d. CONCLUSION In a retrospective series, MR thermography guided SLA of symptomatic deep brain CCM was technically feasible. Unlike a prior series of more superficial epileptogenic CCM in which no hemorrhages were observed, SLA of deep CCM may carry higher risk of bleeding and neurological deficits. Larger, longer-term studies are required.

Hypertrophic Synovitis of the Facet Joint Causing Root Pain

2008 ◽  
Vol 1 ◽  
pp. CMAMD.S411
Author(s):  
Koichi Iwatsuki ◽  
Toshiki Yoshimine ◽  
Masanori Aoki ◽  
Kazuhiro Yoshimura
Keyword(s):  
Facet Joint ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Leg Pain ◽  
Facet Joints ◽  
Resonance Imaging ◽  
Disc Disease ◽  
Articular Surfaces ◽  
Synovial Cysts ◽  
Magnetic Resonance Imaging Mri

Osteoarthritic changes in the facet joints are common in the presence of degenerative disc disease. Changes in the joint capsule accompany changes in the articular surfaces. Intraspinal synovial cysts that cause radicular pain, cauda equina syndrome, and myelopathy have been reported; however, there have been few reports in orthopedic or neurosurgical literature regarding hypertrophic synovitis of the facet joint presenting as an incidental para-articular mass. Here, we report a case of hypertrophic synovitis causing root pain. We describe the case of a 65-year-old man suffering from right sciatica and right leg pain in the L5 nerve-root dermatome for 1 year; magnetic resonance imaging (MRI) revealed an enhanced mass around the L4–5 facet joint. We investigated this mass pathologically. After right medial facetectomy, the symptoms resolved. Pathological investigation revealed this mass was hypertrophic synovitis. Hypertrophic synovitis of the facet joint might cause root pain.

scholarly journals Asymptomatic Brain Edema after Hemodialysis Initiation in a Patient with Severe Uremia

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Kiichiro Fujisaki ◽  
Kaneyasu Nakagawa ◽  
Hiroshi Nagae ◽  
Toshiaki Nakano ◽  
Masatomo Taniguchi ◽  
...  
Keyword(s):  
Cerebral Edema ◽  
Occipital Lobe ◽  
Neurological Deficits ◽  
Mri Findings ◽  
Severe Renal Insufficiency ◽  
Cranial Mri ◽  
Dialysis Disequilibrium Syndrome ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Changes

A 66-year-old man with severe renal insufficiency presented with mild confusion associated with uremia. Cranial magnetic resonance imaging (MRI) showed no remarkable changes. The patient was placed on short-duration hemodialysis (2 hours) with smaller surface area and low blood flow (100 mL/min) to avoid dialysis disequilibrium syndrome (DDS). His consciousness gradually improved and he did not develop apparent DDS symptoms. However, T2-weighted FLAIR MRI showed increased signal intensities bilaterally in the cortical and subcortical areas of the occipital lobe on day 15. In other words, cranial MRI showed cerebral edema, indicating asymptomatic DDS. On day 29, cranial MRI showed a return to findings on admission. In this case, because the patient did not have apparent DDS symptoms despite MRI changes, we diagnosed asymptomatic cerebral edema. The patient was discharged on regular intermittent HD without any neurological deficits. No further neurological disturbances were noted during 1-year follow-up. MRI findings in ESKD patients without DDS symptoms help to clarify the diagnosis of cerebral edema. In this case, the patient did not have apparent DDS symptoms and was therefore diagnosed with asymptomatic cerebral edema.

scholarly journals Radiotherapy efficacies for vertebral hemangioma patients with severe spinal cord compression and cauda equina syndrome

2021 ◽  
Author(s):  
Yi-Lun Chen ◽  
Shih-Huang Yang ◽  
Sung-Hsin Kuo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Volumetric Modulated Arc Therapy ◽  
Cauda Equina ◽  
Arterial Embolization ◽  
Cord Compression ◽  
Neurological Symptoms ◽  
Neurological Deficits ◽  
Vertebral Hemangioma ◽  
Canal Encroachment

Abstract Background: Although vertebral hemangioma is the most common benign spine tumor, rare patients may experience spinal cord compression accompanied by pain and neurological deficits, in whom surgery remains the standard treatment option. For patients with comorbidities who cannot tolerate operation, radiotherapy may be an alternative treatment, however, previous studies suggested that if spinal cord cannel was aggressively compressed by vertebral hemangioma, the efficacies of radiotherapy were suboptimal. Methods and results: Herein, we presented two patients with vertebral hemangioma who developed spinal cord compression, first patient with underlying congenital heart disease had spinal canal encroachment of 63.4% at ninth thoracic vertebra, and second patient failed to transcatheter arterial embolization for treating total encroachment of sacrum plexus. The first patient underwent radiotherapy with 44 Gy at 20 fractions using Tomotherapy and became fully recovered from the severe neurological deficits at 5.5 months after completing radiotherapy. The second patient benefited from neurological symptoms relief at 6 months after completion of radiotherapy using 42 Gy at 21 fractions using volumetric modulated arc therapy (VMAT) technique.Conclusions: Our results indicate that radiotherapy with 42 to 44 Gy using conventional fractions could efficiently cause tumor regressions and improve neurological symptoms resulted from vertebral hemangioma-causing spinal cord compression.

scholarly journals Civilian Gun Shot Wounds Associated With Spinal Injuries

2021 ◽  
pp. 219256822199180
Author(s):  
Laurence Ge ◽  
Ayodeji Jubril ◽  
Addisu Mesfin
Keyword(s):  
Clinical Improvement ◽  
Asian American ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Cauda Equina ◽  
Bladder Function ◽  
Neurological Deficits ◽  
Ambulatory Status ◽  
Shot Wounds

Study Design: Retrospective Objective: To evaluate functional outcomes and characteristics associated with gunshot wound (GSW) to the spine. Methods: Patients with GSW to the spine managed at a Level 1 Trauma Center from January 2003 to December 2017 were enrolled. Patient demographics, diagnoses, level of injury, American Spinal Injury Association (ASIA) score, ambulatory status at follow-up, bowel and bladder function, clinical improvement, and mortality were evaluated. Clinical improvement was defined as a progression in ambulatory status category at latest follow up. Results: 51 patients with GSW of the spine were identified. 48 (94.1%) were male and 3 (5.9%) were female, with a mean age of 27 years-old (range 15-56). 38 (74.5%) were Caucasian, 7 (13.7%) were African American, 1 (2.0%) Asian-American, and 5 (9.8%) were Other/Unknown. 46 (90.2%) patients had GSW related spinal fractures and 44 (86.3%) had neurological deficits. Among patients with neurologic deficits, 5 (9.8%) had Cauda Equina Syndrome, 1 (2%) had Brown-Sequard Syndrome, and 38 (74.5%) spinal cord injuries: ASIA A 26 (68.4%); ASIA B 3 (7.9%); ASIA C 7 (18.4%); ASIA D 2 (5.3%). At mean follow-up time of 4.2 years (SD 3.9), 27 (52.9%) patients were wheelchair bound, 11 (21.6%) were ambulating with assistance, and 13 (25.5%) had normal ambulation. ASIA grade (A or B) was significantly, P < 0.00001, associated with being wheelchair bound and having neurogenic bowel or bladder at follow-up. Conclusions: Most spinal GSW patients (70.6%) did not have any clinical improvement in ambulatory status and most injuries were ASIA A.

scholarly journals Safety and Efficacy of Rituximab in Multiple Sclerosis: A Retrospective Observational Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Bassem I. Yamout ◽  
Nabil K. El-Ayoubi ◽  
Johny Nicolas ◽  
Yehya El Kouzi ◽  
Samia J. Khoury ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Relapse Rate ◽  
Perianal Abscess ◽  
Disability Progression ◽  
Surgical Interventions ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Clinical Practice Setting ◽  
Magnetic Resonance Imaging Mri

Objective. To evaluate the efficacy and safety of rituximab in multiple sclerosis in a clinical practice setting. Methods. Clinical data for all adult patients with multiple sclerosis (MS) treated with off-label rituximab at a single MS center in Lebanon between March 2008 and April 2017 were retrospectively collected from medical charts. The main efficacy outcomes assessed were annualized relapse rate (ARR) and proportion of patients free from relapses, disability progression, or magnetic resonance imaging (MRI) activity. Results. A total of 89 rituximab-treated patients were included: 59 relapsing-remitting MS (RRMS) and 30 progressive MS (PMS). Patients were treated with 1000 or 2000 mg rituximab IV every 6–12 months for a mean duration of 22.2 ± 24.8 months. The subjects were 65.2% females with a mean age of 40.5 ± 12.3 years and a mean disease duration of 7.9 ± 6.2 years. During treatment, the ARR decreased from 1.07 at baseline to 0.11 in RRMS (p<0.0001) and from 0.25 to 0.16 in PMS patients (p=0.593). The mean Expanded Disability Status Scale (EDSS) remained unchanged in both RRMS and PMS patients. Between baseline and the last follow-up, the percent of patients free from any new MRI lesions increased from 18.6% to 92.6% in the RRMS group and from 43.3% to 82% in the PMS group. No evidence of disease activity (NEDA) was achieved in 74% of patients at 1 year of treatment. A total of 64 adverse events (AEs) (71.9%) were recorded with the most common being infusion-related reactions in 25.8% of patients, all mild in nature. Two of our rituximab-treated patients experienced serious AEs requiring surgical interventions: pyoderma gangrenosum vaginalis with perianal abscess and fistula and an increase in the size of a meningioma. No case of progressive multifocal leukoencephalopathy (PML) was detected. Conclusion. In our real-world cohort, rituximab was well-tolerated and effective in reducing relapse rate and disability progression in relapsing-remitting and progressive MS patients.

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