scholarly journals Metastases to the craniovertebral junction: illustrative case report and review of literature

2018 ◽  
Vol 6 (5) ◽  
pp. 1825
Author(s):  
Chandramouleeswaran Venkatraman ◽  
Sindhuja Lakshminarasimhan ◽  
Pratheep Kumar S. ◽  
Krishnaprasad Thuvarapalayam Periasamy
Keyword(s):  
Neck Pain ◽  
Craniovertebral Junction ◽  
Metastatic Lesion ◽  
Cord Compression ◽  
Acute Onset ◽  
Cervical Cord ◽  
Illustrative Case ◽  
Lower Cranial Nerve ◽  
Metastatic Lesions ◽  
Cranial Nerve Palsies

Metastases at the craniovertebral junction represent 0.5-1% of spinal metastatic lesions. Common primary sites include breast, lung and prostate carcinoma. Initial presenting features include neck pain and occipital neuralgia. High index of suspicion is required to recognize this entity in patients presenting with neck pain. If left unrecognized, these metastatic lesions have the propensity to cause catastrophic collapse leading to significant morbidity and mortality due to fracture subluxation and spinal cord compression. Here we discuss such a patient who presented with acute onset quadriparesis and lower cranial nerve palsies due to metastatic lesion involving the C1 and C2 vertebra causing medullary and cervical cord compression. Early detection and timely intervention are key to improving outcomes in such patients.

Institutional experience of tuberculosis of craniovertebral junction

2017 ◽  
Vol 5 (4) ◽  
pp. 1294 ◽  
Author(s):  
Ravi Dasari ◽  
Kadali Satyavara Prasad ◽  
Phaneeswar Thota ◽  
Raman B. V. S.
Keyword(s):  
Neck Pain ◽  
Radical Surgery ◽  
Treatment Options ◽  
Craniovertebral Junction ◽  
Cord Compression ◽  
Basilar Invagination ◽  
Neurological Deficits ◽  
Occipitocervical Fusion ◽  
Bony Destruction ◽  
King George Hospital

Background: Craniovertebral junction tuberculosis (CVJ-TB) is a rare entity occurring in only 0.3 to 1% of tuberculous spondylitis. It causes severe instability and neurological deficits. Present study includes 16 cases of CVJ tuberculosis with neck pain and progressive quadriparesis. Radiological evaluation showed wide spread disease around clivus, C1, C2, C3 with extensive bony destruction, cord compression, basilar invagination and atlantoaxial dislocation.Methods: The study included all the cases admitted with cv junction tuberculosis in neurosurgery ward in King George hospital, Visakhapatnam during a period of three years from 2014 to 2016. Four cases were managed conservatively and four cases were treated by only posterior occipitocervical fusion. We performed two stage operation in single sitting i.e. transoral decompression and posterior occipitocervical fusion in 12 cases. The pathological findings confirmed tuberculosis.Results: Postoperatively all the patients had decreased neck pain and two third of the patients (10 of 16 patients) had improvement in motor power.Conclusions: In the available literature, the treatment options offered for cvj-tb have ranged from a purely conservative approach to radical surgery without well-defined guidelines. In this study, we followed a radical approach as the patients included in our study presented with extensive TB cv junction. So, we recommend radical surgery for extensive TB of cv junction.

Unusual presentation of cervical spine metastases to the ENT surgeon

2012 ◽  
Vol 127 (1) ◽  
pp. 92-95 ◽  
Author(s):  
P Baruah ◽  
C J Randall ◽  
A Burgess
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Spinal Metastases ◽  
Craniovertebral Junction ◽  
Radiological Investigation ◽  
Spine Metastases ◽  
Metastatic Lesions ◽  
Spine Pathology ◽  
Histological Confirmation ◽  
High Degree

AbstractObjective:Cervical spine metastases account for 10 per cent of all spinal metastases. We report three cases of cervical spine metastases whose unusual primary presentation was with ENT-related symptoms.Methods:The three patients reported herein did not have a confirmed diagnosis of malignancy at presentation. The first patient presented with stridor, the second presented with dysphagia and the third presented with dysphonia. All patients complained of significant neck pain that preceded and was concomitant to the other symptoms. Clinical suspicion of cervical spine involvement led to radiological investigation with computed tomography, which showed metastatic lesions in the craniovertebral junction and cervical spine region. Histological confirmation of malignancy was obtained for two of the three patients. The condition proved uniformly fatal in the weeks following diagnosis. A review of the literature on this condition was conducted using PubMed and Medline databases.Conclusion:Cervical spine pathology may present initially to the ENT surgeon. A high degree of suspicion of cervical spine involvement should be maintained in elderly patients with persistent or progressive neck pain, with or without other ENT symptoms. Adequate radiological imaging will usually confirm the diagnosis.

Contrast-Enhanced MRI with Magnetization Transfer Effect in the Imaging of Brain Metastatic Lesions

2017 ◽  
pp. 8-17
Author(s):  
A. A. Ermakova ◽  
O. Yu. Borodin ◽  
M. Yu. Sannikov ◽  
S. D. Koval ◽  
V. Yu. Usov
Keyword(s):  
Comparative Analysis ◽  
Roc Analysis ◽  
Magnetization Transfer ◽  
Metastatic Lesion ◽  
Transfer Effect ◽  
Wilcoxon Test ◽  
Post Contrast ◽  
Metastatic Lesions ◽  
The Brain ◽  
Non Parametric

Purpose: to investigate the diagnostic opportunities of contrast  magnetic resonance imaging with the effect of magnetization transfer effect in the diagnosis of focal metastatic lesions in the brain.Materials and methods.Images of contrast MRI of the brain of 16  patients (mean age 49 ± 18.5 years) were analysed. Diagnosis of  the direction is focal brain lesion. All MRI studies were carried out  using the Toshiba Titan Octave with magnetic field of 1.5 T. The  contrast agent is “Magnevist” at concentration of 0.2 ml/kg was  used. After contrasting process two T1-weighted studies were  performed: without T1-SE magnetization transfer with parameters of pulse: TR = 540 ms, TE = 12 ms, DFOV = 24 sm, MX = 320 × 224  and with magnetization transfer – T1-SE-MTC with parameters of pulse: ΔF = −210 Hz, FA(МТС) = 600°, TR = 700 ms, TE = 10 ms,  DFOV = 23.9 sm, MX = 320 x 224. For each detected metastatic  lesion, a contrast-to-brain ratio (CBR) was calculated. Comparative  analysis of CBR values was carried out using a non-parametric  Wilcoxon test at a significance level p < 0.05. To evaluate the  sensitivity and specificity of the techniques in the detection of  metastatic foci (T1-SE and T1-SE-MTC), ROC analysis was used. The sample is divided into groups: 1 group is foci ≤5 mm in size, 2  group is foci from 6 to 10 mm, and 3 group is foci >10 mm. Results.Comparative analysis of CBR using non-parametric Wilcoxon test showed that the values of the CBR on T1-weighted  images with magnetization transfer are significantly higher (p  <0.001) that on T1-weighted images without magnetization transfer. According to the results of the ROC analysis, sensitivity in detecting  metastases (n = 90) in the brain on T1-SE-MTC and T1-SE was  91.7% and 81.6%, specificity was 100% and 97.6%, respectively.  The accuracy of the T1-SE-MTC is 10% higher in comparison with  the technique without magnetization transfer. Significant differences (p < 0.01) between the size of the foci detected in post-contrast T1- weighted images with magnetization transfer and in post-contrast  T1-weighted images without magnetization transfer, in particular for  foci ≤5 mm in size, were found. Conclusions1. Comparative analysis of CBR showed significant (p < 0.001)  increase of contrast between metastatic lesion and white matter on  T1-SE-MTC in comparison with T1-SE.2. The sensitivity, specificity and accuracy of the magnetization transfer program (T1-SE-MTC) in detecting foci of  metastatic lesions in the brain is significantly higher (p < 0.01), relative to T1-SE.3. The T1-SE-MTC program allows detecting more foci in comparison with T1-SE, in particular foci of ≤5 mm (96% and 86%, respectively, with p < 0.05).

METASTATIC LESION OF THE SPINE: DIAGNOSIS AND TACTICS OF SURGICAL TREATMENT

2019 ◽  
Vol 65 (6) ◽  
pp. 868-876
Author(s):  
Anton Yarikov ◽  
Anton Yermolaev ◽  
Igor Smirnov ◽  
Anton Denisov ◽  
Olga Perlmutter ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Epidemiological Studies ◽  
Metastatic Lesion ◽  
Spinal Cord Damage ◽  
Metastatic Lesions ◽  
Spinal Lesions ◽  
Cancer Pathology ◽  
Surgical Methods ◽  
The Stability ◽  
Methods Of Treatment

Epidemiological studies show an increase in the number of people with cancer. Bone metastases are a frequent manifestation of generalized cancer, because it is in malignant tumors of the spine more often than other bones of the skeleton becomes a target for metastasis. The article describes in detail the methods of diagnosis of spinal lesions in cancer pathology. Particular attention is paid to the scales reflecting the severity of the patient’s condition, the degree of spinal cord damage, the severity of pain in metastasis to the spine, the prognosis of survival in oncovertebrology and evaluation of the stability of the spine in metastatic lesions. Further, the paper presents non-radical (decompression, vertebroplasty) and radical (spondylectomy, corporectomy) surgical methods of treatment

Posttraumatic Delayed Jugular Foramen Syndrome in a Toddler

2021 ◽  
Author(s):  
Cristina Toledo-Gotor ◽  
Nerea Gorría ◽  
Miren Oscoz ◽  
Katia Llano ◽  
Pablo la Fuente Rodríguez-de ◽  
...  
Keyword(s):  
Physical Examination ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Exceptional Case ◽  
Cerebellar Tonsil ◽  
Occipital Condyle ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Blunt Head Trauma ◽  
Condyle Fracture

Abstract Background Multiple lower cranial nerve palsies have been attributed to occipital condyle fractures in older children and adults, but no clinical details of other possible mechanisms have been described in infants. Case Report A 33-month-old boy suffered blunt head trauma. A bilateral skull base fracture was diagnosed, with favorable outcome during the first days after trauma. On the sixth day, the patient began to refuse drinking and developed hoarseness. Physical examination and additional investigations revealed paralysis of left VII, IX, X, and XI cranial nerves. A follow-up computed tomography (CT) scan disclosed a left petrous bone fracture involving the lateral margin of the jugular foramen, and a cranial magnetic resonance imaging (MRI) study showed a left cerebellar tonsil contusion. He improved after methylprednisolone was started. Three months later, he was asymptomatic, although mild weakness and atrophy of the left sternocleidomastoid and trapezius muscles remained 1 year later. Discussion A posttraumatic “jugular foramen syndrome” is rare in children, but it has been reported shortly after occipital condyle fracture, affecting mainly IX, X, and XI cranial nerves. In this toddler, delayed symptoms appeared with unilateral involvement. While an occipital fracture was ruled out, neuroimaging findings suggest the hypothesis of a focal contusion as a consequence of a coup-contrecoup injury. Conclusion This exceptional case highlights the importance of gathering physical examination, anatomical correlation, and neuroimaging to yield a diagnosis.

scholarly journals Walk and Run Test in Patients with Degenerative Compression of the Cervical Spinal Cord

2021 ◽  
Vol 10 (5) ◽  
pp. 927
Author(s):  
Zdenek Kadanka ◽  
Zdenek Kadanka ◽  
Tomas Skutil ◽  
Eva Vlckova ◽  
Josef Bednarik
Keyword(s):  
Cervical Spinal Cord ◽  
Japanese Orthopaedic Association ◽  
Cord Compression ◽  
Cervical Cord ◽  
Cross Sectional ◽  
Severity Of Disability ◽  
Degree Of Disability ◽  
Degenerative Cervical Myelopathy ◽  
Cardinal Symptoms ◽  
Run Test

Impaired gait is one of the cardinal symptoms of degenerative cervical myelopathy (DCM) and frequently its initial presentation. Quantitative gait analysis is therefore a promising objective tool in the disclosure of early cervical cord impairment in patients with degenerative cervical compression. The aim of this cross-sectional observational cohort study was to verify whether an objective and easily-used walk and run test is capable of detecting early gait impairment in a practical proportion of non-myelopathic degenerative cervical cord compression (NMDCC) patients and of revealing any correlation with severity of disability in DCM. The study group consisted of 45 DCM patients (median age 58 years), 126 NMDCC subjects (59 years), and 100 healthy controls (HC) (55.5 years), all of whom performed a standardized 10-m walk and run test. Walking/running time/velocity, number of steps and cadence of walking/running were recorded; analysis disclosed abnormalities in 66.7% of NMDCC subjects. The DCM group exhibited significantly more pronounced abnormalities in all walk/run parameters when compared with the NMDCC group. These were apparent in 84.4% of the DCM group and correlated closely with disability as quantified by the modified Japanese Orthopaedic Association scale. A standardized 10-m walk/run test has the capacity to disclose locomotion abnormalities in NMDCC subjects who lack other clear myelopathic signs and may provide a means of classifying DCM patients according to their degree of disability.

Poster 364 Cervical Cord Compression Presenting with Lower Extremity Numbness and Weakness: A Case Report

PM&R ◽  
2014 ◽  
Vol 6 (9) ◽  
pp. S312-S313
Author(s):  
Maria Margarita Lopez ◽  
Manish Mammen ◽  
Joseph David ◽  
Sanjeev Agarwal ◽  
Hana Ilan
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Cord Compression ◽  
Cervical Cord ◽  
Cervical Cord Compression

scholarly journals Delayed presentation of neck arteries dissection, caused by water slide activity

2018 ◽  
Vol 11 (1) ◽  
pp. e226333
Author(s):  
Ayman Mahmoud Alboudi ◽  
Pournamy Sarathchandran ◽  
Samar Sameer Geblawi
Keyword(s):  
Neck Pain ◽  
Posterior Inferior Cerebellar Artery ◽  
Acute Onset ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Delayed Presentation ◽  
Intravenous Tissue Plasminogen Activator ◽  
Cervical Artery ◽  
Ct Brain ◽  
Headache And Neck Pain

A 16-year-old Korean boy presented with acute onset vertigo, dysphagia and gait ataxia of 16 hours duration. He had history of headache and neck pain along with transient vertigo during a water slide ride 12 days before presentation. CT brain showed left cerebellar and left lateral medullary infarcts. CT angiography showed left vertebral dissection with occlusion of left posterior inferior cerebellar artery. A 52-year-old Indian man, presented with acute onset global aphasia and right hemiparesis within 3 hours of onset of symptoms. He received intravenous tissue plasminogen activator (tPA) with partial improvement in his symptoms. He had headache and neck pain since 2 weeks, ever since he had a water slide ride. CT brain was normal, while the CT angiogram showed left carotid dissection. Cervical artery dissection has been reported with roller coaster rides and rarely with delayed presentations. Delayed presentation of cervical artery dissection after water rides have not been reported.

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