Cervical neuromyelitis optica with thoracic ependymoma

Background: The occurrence of cervical neuromyelitis optica (NMO) in a patient with a thoracic ependymoma is uncommon. Here, we present a patient with a spinal ependymoma who developed the new onset of NMO 2 months later. Case Description: A 66-year-old male presented with right lower limb weakness. The magnetic resonance (MR) revealed an intramedullary spinal cord tumor at the T2-T4 level. It was surgically excised and proved pathologically to be an ependymoma. 2 months later, the patient presented with an acute partial quadriparesis and a high signal intensity cord lesion at the C2-C3 level attributed to seropositive NMO (i.e. additional diagnostic studies confirmed this diagnosis). Conclusion: Patients with intramedullary thoracic ependymomas may also develop NMO resulting in recurrent/ new neurological deficits. Critical studies utilized to diagnose NMO include brain and spine MRs showing unique intramedullary brain/cord lesions, aquaporin-4 positive serology, and classical abnormal visual studies. If the diagnosis of NMO is established, multiple additional medical therapies are warranted.

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Dorsal Column Mapping via Phase Reversal Method

Neurosurgery ◽

10.1227/neu.0000000000000287 ◽

2014 ◽

Vol 74 (4) ◽

pp. 437-446 ◽

Cited By ~ 18

Author(s):

Dinesh Nair ◽

Vishakhadatta M. Kumaraswamy ◽

Diana Braver ◽

Ronan D. Kilbride ◽

Lawrence F. Borges ◽

...

Keyword(s):

Spinal Cord ◽

Evoked Potentials ◽

Somatosensory Evoked Potentials ◽

Spinal Cord Tumor ◽

Tumor Resection ◽

Dorsal Column ◽

Neurological Deficits ◽

Reliable Technique ◽

Intramedullary Spinal Cord ◽

Phase Reversal

ABSTRACT BACKGROUND: Safe resection of intramedullary spinal cord tumors can be challenging, because they often alter the cord anatomy. Identification of neurophysiologically viable dorsal columns (DCs) and of neurophysiologically inert tissue, eg, median raphe (MR), as a safe incision site is crucial for avoiding postoperative neurological deficits. We present our experience with and improvements made to our previously described technique of DC mapping, successfully applied in a series of 12 cases. OBJECTIVE: To describe a new, safe, and reliable technique for intraoperative DC mapping. METHODS: The right and left DCs were stimulated by using a bipolar electric stimulator and the triggered somatosensory evoked potentials recorded from the scalp. Phase reversal and amplitude changes of somatosensory evoked potentials were used to neurophysiologically identify the laterality of DCs, the inert MR, as well as other safe incision sites. RESULTS: The MR location was neurophysiologically confirmed in all patients in whom this structure was first visually identified as well as in those in whom it was not, with 1 exception. DCs were identified in all patients, regardless of whether they could be visually identified. In 3 cases, negative mapping with the use of this method enabled the surgeon to reliably identify additional inert tissue for incision. None of the patients had postoperative worsening of the DC function. CONCLUSION: Our revised technique is safe and reliable, and it can be easily incorporated into routine intramedullary spinal cord tumor resection. It provides crucial information to the neurosurgeon to prevent postoperative neurological deficits.

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Idiopathic Transverse Myelitis Mimicking an Intramedullary Spinal Cord Tumor

Case Reports in Pathology ◽

10.1155/2016/8706062 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Andrew A. Fanous ◽

Nathan P. Olszewski ◽

Lindsay J. Lipinski ◽

Jingxin Qiu ◽

Andrew J. Fabiano

Keyword(s):

Spinal Cord ◽

Clinical Symptoms ◽

Spinal Cord Tumor ◽

Transverse Myelitis ◽

Neurological Deficits ◽

Spinal Tumors ◽

Surgical Biopsy ◽

Cross Sectional ◽

Intramedullary Spinal Cord ◽

Imaging Characteristics

The differential diagnoses for spinal cord lesions include spinal tumors and inflammatory processes. The distinction between these pathologies can be difficult if solely based on imaging. We report for the first time to our knowledge a case of idiopathic transverse myelitis (ITM) mimicking a discrete cervical spinal lesion in a 66-year-old man who presented with gait instability and neck pain. The patient’s symptoms failed to resolve after an initial course of steroid therapy. Surgical biopsy confirmed the diagnosis of ITM. Subsequent treatment with dexamethasone resulted in complete resolution of the symptoms as well as the intramedullary enhancement. ITM is most common in the cervical and thoracic spine, spanning 3-4 spinal segments. It usually occupies more than 50% of the cross-sectional area of the spinal cord and tends to be central, uniform, and symmetric. It exhibits patchy and peripheral contrast enhancement. These criteria are useful guidelines that help distinguish ITM from neoplastic spinal lesions. A decision to perform biopsy must take into consideration the patient’s clinical symptoms, the rate of progression of neurological deficits, and the imaging characteristics of the lesion. Surgical biopsy for questionable lesions should be reserved for patients with progressive neurological deficits refractory to empirical medical therapy.

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Microsurgical resection of intramedullary spinal cord ependymoma

Neurosurgical FOCUS ◽

10.3171/2014.v3.focus14276 ◽

2014 ◽

Vol 37 (v2supplement) ◽

pp. Video9

Author(s):

Paul C. McCormick

Keyword(s):

Spinal Cord ◽

Growth Rate ◽

Spinal Cord Tumor ◽

Intramedullary Spinal Cord ◽

Clear Margin ◽

Intramedullary Spinal Cord Tumor ◽

Link Type ◽

Microsurgical Resection ◽

Spinal Cord Ependymoma ◽

Posterior Midline

Ependymomas are the most commonly occurring intramedullary spinal cord tumor in adults. With few exceptions these tumors are histologically benign, although they exhibit some biologic variability with respect to growth rate. While unencapsulated, spinal ependymomas are non-infiltrative and present a clear margin of demarcation from the surrounding spinal cord that serves as an effective dissection plane. This video demonstrates the technique of microsurgical resection of an intramedullary ependymoma through a posterior midline myelotomy.The video can be found here: http://youtu.be/lcHhymSvSqU.

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101 Case report: to stent, or not to stent? The pale cast of evidence-based practice in acute stroke

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-anzan.89 ◽

2019 ◽

Vol 90 (e7) ◽

pp. A33.1-A33

Author(s):

Chris Blair ◽

Kartik Bhatia ◽

David Brunacci ◽

John Worthington ◽

Rebekah Ahmed

Keyword(s):

Blood Pressure ◽

Acute Stroke ◽

Evidence Based Practice ◽

Blood Pressure Monitoring ◽

Neurological Deficits ◽

Evidence Based ◽

Limb Weakness ◽

Vasopressor Support ◽

Course Of Action ◽

The Right

IntroductionWith approximately 200 procedures performed in the last year at our centre, worthwhile clinical lessons continue to emerge in the practice of endovascular clot retrieval (ECR) for acute stroke. This case demonstrates the value of considered clinical appraisal in a dynamic, information-rich setting. A 68 year-old man with established vertebrobasilar atherosclerotic disease developed capricious, blood pressure-sensitive neurological deficits after successful ECR for a basilar artery stroke, inviting the possibility of further intervention in the form of intracranial stenting. We avoided pursuing this course of action in favour of a more measured approach, entailing the provision of vasopressor support over the following week.MethodFollowing ECR, our patient was admitted to the intensive care unit for continuous blood pressure monitoring and close observation of his neurological deficits with serial NIHSS (National Institutes of Health Stroke Scale) scoring. Systolic blood pressures were maintained between 140–160 mmHg using vasopressor support, with the aim of allowing time for recovery of vascular autoregulation and collateralization.ResultsOver six days, the patient developed moderate left upper and lower limb weakness. An MRI performed on Day 5 revealed limited interval infarction of the right hemipons and cerebellum, with complete re-occlusion of the mid-basilar arterial segment. He left the ICU with a NIHSS score of 7, and was living independently at 90-day follow-up (Modified Rankin Score 1).ConclusionThe ultimately favourable net outcome for our patient clearly illustrates the imperative to remain within the boundaries of evidence-based practice in this bold and rapidly evolving discipline.

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Espondilodiscite Brucélica: Casuística dos Últimos 25 Anos

Acta Médica Portuguesa ◽

10.20344/amp.4117 ◽

2014 ◽

Vol 27 (2) ◽

pp. 204 ◽

Cited By ~ 3

Author(s):

Ana Lebre ◽

Jorge Velez ◽

Diana Seixas ◽

Eduardo Rabadão ◽

Joaquim Oliveira ◽

...

Keyword(s):

Average Duration ◽

Signs And Symptoms ◽

Neurological Deficits ◽

Imaging Method ◽

Low Back ◽

Positive Serology ◽

Abscess Drainage ◽

Duration Of Symptoms ◽

Spinal Magnetic Resonance Imaging ◽

Appropriate Therapy

Introduction: Brucellosis is an endemic zoonosis in Portugal. Brucellar spondylodiscitis is one of the most frequent focal manifestations which may cause severe sequelae despite appropriate therapy. Material and Methods: Retrospective study of patients with diagnosis of brucellar spondylodiscitis admitted to the Infectious Diseases Department of Centro Hospitalar e Universitário de Coimbra, over a 25-year period (1988-2012). Results: We identified 54 patients, 55.6% male, mean age of 54.8 years. In 81.5% an epidemiological context was identified, mostly contact with sheep and goats. The duration of symptoms prior to diagnosis was 5.5 months. The most common signs and symptoms were pain (98.1%), fever (46.3%) and neurological deficits (25.9%). Spinal magnetic resonance imaging was the most used imaging method (77.8%) showing abscesses in 29.6% of patients. Lumbar location predominated (77.7%). Diagnosis was attained in 47 patients (87.0%): positive blood cultures (3 patients), positive serology (32 patients) or by both methods (12 patients). Combined regimens of doxycycline and rifampicin (64.8%), or streptomycin (24.1%) were most used, for an average duration of 4.4 months. A patient was referred for surgery for abscess drainage. Evolution was mostly favorable (92.6%), no deaths occurring. Discussion: Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial. Conclusions: Brucellar spondylodiscitis should be considered in the differential diagnosis of patients with low back pain, even in the absence of fever, particularly in regions where the disease is endemic. Antibiotic regimen, its’ duration and the need for surgery should be individualized to achieve a better prognosis. Cases have declined over the years, a fact related to better control of animal endemic.

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Anti-CD20 therapies decrease humoral immune response to SARS-CoV-2 in patients with multiple sclerosis or neuromyelitis optica spectrum disorders

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2021-326904 ◽

2021 ◽

pp. jnnp-2021-326904

Author(s):

Céline Louapre ◽

Michella Ibrahim ◽

Elisabeth Maillart ◽

Basma Abdi ◽

Caroline Papeix ◽

...

Keyword(s):

Multiple Sclerosis ◽

Neuromyelitis Optica ◽

Seroconversion Rate ◽

Neuromyelitis Optica Spectrum Disorders ◽

Linear Regression Models ◽

Positive Serology ◽

Humoral Immune ◽

Antibody Positivity ◽

Spectrum Disorders ◽

Anti Cd20

BackgroundSARS-CoV-2 seroconversion rate after COVID-19 may be influenced by disease-modifying therapies (DMTs) in patients with multiple sclerosis (MS) or neuromyelitis optica spectrum disorders (NMO-SD).ObjectiveTo investigate the seroprevalence and the quantity of SARS-CoV-2 antibodies in a cohort of patients with MS or NMO-SD.MethodsBlood samples were collected in patients diagnosed with COVID-19 between 19 February 2020 and 26 February 2021. SARS-CoV-2 antibody positivity rates and Ig levels (anti-S IgG titre, anti-S IgA index, anti-N IgG index) were compared between DMTs groups. Multivariate logistic and linear regression models were used to estimate the influence of DMTs and other confounding variables on SARS-CoV-2 serological outcomes.Results119 patients (115 MS, 4 NMO, mean age: 43.0 years) were analysed. Overall, seroconversion rate was 80.6% within 5.0 (SD 3.4) months after infection. 20/21 (95.2%) patients without DMT and 66/77 (85.7%) patients on DMTs other than anti-CD20 had at least one SARS-CoV-2 Ig positivity, while this rate decreased to only 10/21 (47.6%) for patients on anti-CD20 (p<0.001). Being on anti-CD20 was associated with a decreased odd of positive serology (OR, 0.07 (95% CI 0.01 to 0.69), p=0.02) independently from time to COVID-19, total IgG level, age, sex and COVID-19 severity. Time between last anti-CD20 infusion and COVID-19 was longer (mean (SD), 3.7 (2.0) months) in seropositive patients compared with seronegative patients (mean (SD), 1.9 (1.5) months, p=0.04).ConclusionsSARS-CoV-2 antibody response was decreased in patients with MS or NMO-SD treated with anti-CD20 therapies. Monitoring long-term risk of reinfection and specific vaccination strategies in this population may be warranted.Trial registration numberNCT04568707.

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Surgical treatment of intramedullary spinal cord tumor.

Spinal Surgery ◽

10.2531/spinalsurg.2.147 ◽

1988 ◽

Vol 2 (0) ◽

pp. 147-151 ◽

Cited By ~ 1

Author(s):

Yoshinobu Iwasaki ◽

Toyohiko Isu ◽

Minoru Akino ◽

Kazutoshi Hida ◽

Izumi Koyanagi ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Spinal Cord Tumor ◽

Intramedullary Spinal Cord ◽

Intramedullary Spinal Cord Tumor

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Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview

Neurosurgical FOCUS ◽

10.3171/2012.1.focus11376 ◽

2012 ◽

Vol 32 (5) ◽

pp. E17 ◽

Cited By ~ 40

Author(s):

Jennifer E. Fugate ◽

Giuseppe Lanzino ◽

Alejandro A. Rabinstein

Keyword(s):

Spinal Cord ◽

Clinical Symptoms ◽

Neurological Deficits ◽

Intramedullary Spinal Cord ◽

Lower Extremity Weakness ◽

Arteriovenous Fistulas ◽

Signal Abnormality ◽

Dural Arteriovenous Fistulas ◽

Sensory Disturbances ◽

Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (AVFs), the most common type of spinal cord vascular malformation, can be a challenge to diagnose and treat promptly. The disorder is rare, and the presenting clinical symptoms and signs are nonspecific and insidious at onset. Spinal dural AVFs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances. Patients with severe neurological deficits at presentation tend to have worse posttreatment functional outcomes than those with mild or moderate pretreatment disability. However, improvement or stabilization of symptoms is seen in the vast majority of treated patients, and thus treatment is justified even in patients with substantial neurological deficits. The extent of intramedullary spinal cord T2 signal abnormality does not correlate with outcomes and should not be used as a prognostic factor.

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