Radicular dysfunction preponderance at early phase clinical evaluation in myelitis by Schistosoma mansoni

In neuroschistosomiasis, the spinal cord is the most common place of the disease. In high prevalent areas for schistosomiasis mansoni, the clinical alertness is important for an early diagnostic, in order to decrease the final neurological damage. This study provides some useful neurologic information about a series of patients with schistosomal myelitis. METHOD: The sample consisted of 13 schistosomiasis mansoni carriers examined at the moment of the diagnosis of myelitis. RESULTS: The classical triad (lumbago, weakness at the lower limbs and urinary dysfunctions) was documented in 11 (86.61%) patients. The distribution of the clinical forms was: myeloradicular in six patients (46.15%), radicular in four (30.76%) and myelitic in three (23.07%). CONCLUSION: The radicular dysfunction and their clinical associated forms were the most prominent pattern during the early phase of this disease.

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Elsberg Syndrome

10.5327/1516-3180.389 ◽

2021 ◽

Author(s):

Lília Tereza Diniz Nunes ◽

Flávia S. Silva, Karyme G. Aota ◽

Maria Beatriz Miranda S. B. de Assis ◽

João Fellipe B. Bento ◽

Oscar Nunes Alves ◽

...

Keyword(s):

Spinal Cord ◽

Lower Limbs ◽

Peripheral Polyneuropathy ◽

Elsberg Syndrome ◽

Slight Elevation ◽

The Moment ◽

Simplex Virus ◽

Clinical Conditions ◽

Immunocompetent Patients

Context: Elsberg Syndrome (ES) is a rare syndrome associated with acute or subacute infections, often accompanied by myelitis confined to the lower spinal cord, in addition to paresthesia, weakness in the lower limbs, urinary retention, constipation, among others. It is a self-limiting disease, manifested through primary HSV type 2 infection, especially in immunocompetent patients. Case report: Male patient J.F.C., 58 years old, reports a sudden paresthesia in the lower limbs without other associated clinical conditions for approximately 2 months that progressed to paresis, cramps and loss of sphincter control. Admitted to the General Hospital of Palmas, Tocantins on 02/18/2020 with suspicion of Peripheral Polyneuropathy that was discarded after electroneuromyography. Imaging exams without relevant findings. After a week of hospitalization, multiple lesions appeared in the region of the lower third of the dorsum and buttocks, compatible with lesions by HSV (herpes simplex virus) and the diagnosis of ES was concluded. At the moment, he was undergoing treatment with acyclovir and awaiting the evolution of the condition. Conclusion: ES is an often unrecognized cause of lumbosacral radiculitis, which is why it is important to establish as a diagnosis differential. The analysis of CSF, PCR and MRI confirm the diagnosis in cases of HSV-2 lumbosacral radiculomyelitis. CSF usually reveals a lymphocytic pleocytosis and a slight elevation of proteins.

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Is there a right time for surgery in paraplegic patients secondary to non traumatic spinal cord compression?

Einstein (São Paulo) ◽

10.1590/s1679-45082012000400020 ◽

2012 ◽

Vol 10 (4) ◽

pp. 508-511 ◽

Cited By ~ 2

Author(s):

Leonardo Giacomini ◽

Roger Neves Mathias ◽

Andrei Fernandes Joaquim ◽

Mateus Dal Fabbro ◽

Enrico Ghizoni ◽

...

Keyword(s):

Spinal Cord ◽

Prognostic Factor ◽

Spinal Cord Compression ◽

Cord Compression ◽

Lower Limbs ◽

Motor Deficit ◽

Indication For Surgery ◽

Sensory Deficits ◽

Sensory Involvement ◽

Spinal Cord Decompression

Paraplegia is a well-defined state of complete motor deficit in lower limbs, regardless of sensory involvement. The cause of paraplegia usually guides treatment, however, some controversies remain about the time and benefits for spinal cord decompression in nontraumatic paraplegic patients, especially after 48 hours of the onset of paraplegia. The objective of this study was to evaluate the benefits of spinal cord decompression in such patients. We describe three patients with paraplegia secondary to non-traumatic spinal cord compression without sensory deficits, and who were surgically treated after more than 48 hours of the onset of symptoms. All patients, even those with paraplegia during more than 48 hours, had benefits from spinal cord decompression like recovery of gait ability. The duration of paraplegia, which influences prognosis, is not a contra-indication for surgery. The preservation of sensitivity in this group of patients should be considered as a positive prognostic factor when surgery is taken into account.

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Acute-onset paraplegia as an unexpected complication under general anesthesia in supine position during abdominal endovascular aneurysm repair: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00447-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Atsushi Morio ◽

Hirotsugu Miyoshi ◽

Noboru Saeki ◽

Yukari Toyota ◽

Yasuo M. Tsutsumi

Keyword(s):

Spinal Cord ◽

General Anesthesia ◽

Supine Position ◽

Spinal Cord Ischemia ◽

Endovascular Aneurysm Repair ◽

Acute Onset ◽

Lower Limbs ◽

Canal Stenosis ◽

Cord Injury ◽

Aneurysm Repair

Abstract Background Acute onset paraplegia after endovascular aneurysm repair (EVAR) is a rare but well-known complication. We here show a 79-year-old woman with paraplegia caused by static and dynamic spinal cord insult not by ischemia after EVAR. Case presentation The patient underwent EVAR for abdominal aortic aneurism under general anesthesia in the supine position. She had a medical history of lumbar canal stenosis. After the surgery, we recognized severe paraplegia and sensory disorder of lower limbs. Although the possibility of spinal cord ischemia was considered at that time, postoperative magnetic resonance imaging (MRI) revealed burst fracture of vertebra and compressed spinal cord. Conclusions Patients with spinal canal stenosis can cause extrinsic spinal cord injury even with weak external forces. Thus, even after EVAR, it is important to consider extrinsic factors as the cause of paraplegia.

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

BMC Neurology ◽

10.1186/s12883-020-1598-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 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.

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Massive Edema of the Lower Limbs in Patients after Spinal Cord Injury—One Picture, Different Diagnoses

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084219 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4219

Author(s):

Magdalena Mackiewicz-Milewska ◽

Małgorzata Cisowska-Adamiak ◽

Katarzyna Sakwińska ◽

Iwona Szymkuć-Bukowska ◽

Iwona Głowacka-Mrotek

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Heterotopic Ossification ◽

Lower Limb ◽

Bone Fractures ◽

Lower Limbs ◽

University Hospital ◽

Pain Sensation ◽

Vein Thrombosis ◽

Cord Injury

Diagnosis of the cause of massive edema of the lower limbs in patients after spinal cord injury (SCI) can be difficult because of loss of pain sensation, commonly occurring in this group of patients. This paper reviews several different pathologies that can lead to lower-limb edema and the associated diagnostic difficulties. We present four cases of patients with massive edemas of lower limbs at different times after SCI undergoing treatment in the Department of Rehabilitation, University Hospital in Bydgoszcz, Poland. All patients had a lack of pain sensation in the lower limbs and significantly elevated levels of D-dimer. In two cases, deep vein thrombosis (DVT) and intramuscular hematomas (IHs) were diagnosed. IHs were probably a consequence of antithrombotic treatments implemented due to the occurrence of DVT. Heterotopic ossification (HO) was diagnosed in a third case, and, in another patient, who was hospitalized for the longest period after injury, we found humeral bone fractures. Heterotopic ossification, intramuscular haematomas, and bone fractures of the lower limb can mimic DVT. Careful observation of the edema evolution is recommended, as the onset of new symptoms may indicate a different cause of edema from that initially established.

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Feasibility of a Temporary Urethral Stent through the Striated Sphincter in Patients in the Early Phase (6 Months) of Spinal Cord Injury

European Urology ◽

10.1159/000052462 ◽

2001 ◽

Vol 39 (3) ◽

pp. 326-331 ◽

Cited By ~ 9

Author(s):

Emmanuel J. Chartier-Kastler ◽

Laurent Thomas ◽

Bernard Bussel ◽

Michael B. Chancellor ◽

François Richard ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Early Phase ◽

Cord Injury ◽

Urethral Stent

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Comparison of oxygen uptake during and after the execution of resistance exercises and exercises performed on ergometers, matched for intensity

Journal of Human Kinetics ◽

10.1515/hukin-2016-0021 ◽

2016 ◽

Vol 53 (1) ◽

pp. 179-187 ◽

Cited By ~ 4

Author(s):

José Vilaça-Alves ◽

Nuno Miguel Freitas ◽

Francisco José Saavedra ◽

Christopher B. Scott ◽

Victor Machado dos Reis ◽

...

Keyword(s):

Oxygen Uptake ◽

Ventilatory Threshold ◽

Lactate Concentration ◽

Blood Lactate Concentration ◽

Lower Limbs ◽

Lower Body ◽

Load Intensity ◽

Moment Effect ◽

The Moment ◽

The Individual

AbstractThe aim of this study was to compare the values of oxygen uptake (VO2) during and after strength training exercises (STe) and ergometer exercises (Ee), matched for intensity and exercise time. Eight men (24 ± 2.33 years) performed upper and lower body cycling Ee at the individual’s ventilatory threshold (VE/VCO2). The STe session included half squats and the bench press which were performed with a load at the individual blood lactate concentration of 4 mmol/l. Both sessions lasted 30 minutes, alternating 50 seconds of effort with a 10 second transition time between upper and lower body work. The averaged overall VO2 between sessions was significantly higher for Ee (24.96 ± 3.6 ml·kg·min-1) compared to STe (21.66 ± 1.77 ml·kg·min-1) (p = 0.035), but this difference was only seen for the first 20 minutes of exercise. Absolute VO2 values between sessions did not reveal differences. There were more statistically greater values in Ee compared to STe, regarding VO2 of lower limbs (25.44 ± 3.84 ml·kg·min-1 versus 21.83 ± 2·24 ml·kg·min-1; p = 0.038) and upper limbs (24.49 ± 3.84 ml·kg·min-1 versus 21.54 ± 1.77 ml·kg·min-1; p = 0.047). There were further significant differences regarding the moment effect (p<0.0001) of both STe and Ee sessions. With respect to the moment × session effect, only VO2 5 minutes into recovery showed significant differences (p = 0.017). In conclusion, although significant increases in VO2 were seen following Ee compared to STe, it appears that the load/intensity, and not the material/equipment used for the execution of an exercise, are variables that best influence oxygen uptake.

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Bone changes in the lower limbs from participation in an FES rowing exercise program implemented within two years after traumatic spinal cord injury

Journal of Spinal Cord Medicine ◽

10.1080/10790268.2018.1544879 ◽

2018 ◽

Vol 43 (3) ◽

pp. 306-314 ◽

Cited By ~ 7

Author(s):

Rebecca L. Lambach ◽

Nicole E. Stafford ◽

Julie A. Kolesar ◽

B. Jenny Kiratli ◽

Graham H. Creasey ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Exercise Program ◽

Lower Limbs ◽

Traumatic Spinal Cord Injury ◽

Cord Injury ◽

Bone Changes

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

Journal of Neurorestoratology ◽

10.26599/jnr.2020.9040012 ◽

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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An overlooked cause of longitudinally extensive spinal cord lesions: Primary central nervous system lymphoma

10.21203/rs.2.23382/v1 ◽

2020 ◽

Author(s):

Meng Wang ◽

Baochang Qi ◽

Jinming Han ◽

Chunjie Guo ◽

Limei Qu ◽

...

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Central Nervous System Lymphoma ◽

High Dose Chemotherapy ◽

Lower Limbs ◽

Whole Body ◽

Sensory Loss ◽

High Dose ◽

Spinal Cord Lesions

Abstract Background: Primary central nervous system lymphoma (PCNSL ) is a rare and aggressive malignant tumor. It is easy to be misdiagnosed due to its low incidence and unspecific presentations in clinical practice. PCNSL mainly occurs intracranially in the brain while spinal cord is rarely involved. Case presentation: Here we report a 76-year-old woman who had a suspicious tumor history and presented retardant paralysis, bladder dysfunction and sensory loss of the lower limbs. Magnetic resonance imaging (MRI) of the thoracic spine disclosed longitudinally extensive lesions extending from thoracic 4 (T4) to lumbar 1 (L1) vertebral level with an enhanced nodular lesion noting at levels of T10 and T11 . In order to further identify the cause, the whole body 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET)/computed tomography (CT) was performed and showed a hypermetabolic nodule corresponded to MRI enhancing lesions, which further suggesting the possibility of a tumor. The patient then underwent a surgical resection and spinal cord biopsy confirmed the diagnosis of non-Hodgkin's lymphoma (diffuse large B-cell type). The patient then received a high-dose chemotherapy based on methotrexate combined with Rituximab. Unfortunately, the symptoms of this patient have not been improved significantly after three rounds of chemotherapy. Conclusion: Our case indicates that PCNSL may also serve as a possible cause for longitudinally extensive spinal cord lesions, especially the patients who had a suspicious tumor history, MRI enhancing lesion s in the spinal cord corresponded to hypermetabolic nodules on 18 F-FDG- PET/CT at the same level.

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