Management dilemma of tuberculous paraplegia in pregnancy – A case report and review of literature

Background: Tuberculosis (TB)/tuberculous spondylodiscitis of the spine causing paraplegia in the 2nd trimester of pregnancy is rare and poses significant management dilemmas. Pregnancy, a relatively immunocompromised state with high hormonal levels, may prompt rapid TB destruction of a vertebral body resulting in an acute/ profound neurological deficit. Here, a pregnant paraplegic mother was diagnosed with spondylodiscitis that warranted immediate decompression/fusion to achieve neurological recovery. Case Description: A 26-year-old female was 23 weeks pregnant when she presented with an acute spastic paraplegia (complete motor, sensory deficit, and sphincter loss). Operative decompression utilized a Versatile Approach along with a “Hartshill rectangle” for fusion and sublaminar wiring. This procedure accomplished simultaneous anterior and posterior fixation with a single approach without the need for intraoperative radiologic imaging. Although the pregnancy was continued with an uneventful perioperative period, intra-uterine fetal demise was documented 1 month postoperatively. Within 18 postoperative months the patient was neurologically intact, and fusion was confirmed on a computed tomography scan. Conclusion: A 23-week pregnant female acutely became paraplegic due to T5 tuberculous spondylitis confirmed on an X-ray (only source of radiation), and magnetic resonance imaging. Following a decompression/ instrumented fusion performed without fluoroscopic guidance, the patient regained full neurological function. However, 1 month postoperatively, the fetus spontaneously aborted.

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Voluminous Intrapericardial Lipoma Mimicking Pericardial Effusion

Case Reports in Medicine ◽

10.1155/2020/6295634 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Fabíola Prado de Morais ◽

Noah Romero Nakajima ◽

Olívia Félix Marconi Andalécio ◽

Pedro de Santana Prudente ◽

Guilherme Emílio Ferreira ◽

...

Keyword(s):

Computed Tomography ◽

Pericardial Effusion ◽

Signs And Symptoms ◽

Tumor Location ◽

Pathological Examination ◽

Computed Tomography Scan ◽

Radiologic Imaging ◽

Heart Tumors ◽

Tomography Scan

Lipomas are rare primary heart tumors and may involve the endocardium, myocardium, or pericardium. Signs and symptoms depend on the tumor location and size. The intrapericardial lipoma we report has massive dimensions and mimics a pericardial effusion. A 38-year-old male complained of dyspnea and precordial pain. On physical examination, heart sounds were diminished. The patient had received extensive medication for a clinically suspected pericardial effusion due to heart failure. A voluminous mass resembling fat within the pericardial sac was revealed by transesophageal echocardiography and a computed tomography scan. The tumor was removed successfully by a subxiphoid surgical approach. The diagnosis of a 635 gram intrapericardial lipoma was confirmed by pathological examination. After surgery, the patient recovered well and was completely asymptomatic at a follow-up at 90 days. No medications were being taken since. The diagnosis of a pericardial effusion should be secured by imaging exams to avoid unnecessary medications. Cardiac lipomas can be readily recognized by their typical features on radiologic imaging. The surgical pathology examination confirms the diagnosis and rules out malignancy criteria.

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Hemiparesis resulting from an unusual C1 fracture: A case report and literature review

Surgical Neurology International ◽

10.25259/sni_479_2020 ◽

2020 ◽

Vol 11 ◽

pp. 449

Author(s):

Sung-Joo Yuh ◽

Zhi Wang ◽

Ghassan Boubez ◽

Daniel Shedid

Keyword(s):

Cord Compression ◽

Surgical Decompression ◽

Neurological Deficits ◽

Lateral Mass ◽

Computed Tomography Scan ◽

Instrumented Fusion ◽

Jefferson Fracture ◽

Type 3 ◽

Neurologically Intact ◽

Tomography Scan

Background: Jefferson fractures are burst fractures involving both the anterior and posterior arches of C1. They typically result from axial compression or hyperextension injuries. Most are stable, and neurological deficits are rare. They are often successfully treated with external immobilization, but require surgery (e.g., fusion/ stabilization). Case Description: An 89-year-old male presented with a left-sided hemiplegia following a trivial fall. The cervical computed tomography scan revealed a left-sided displaced comminuted C1 fracture involving the arch and lateral mass. The MR revealed posterior cord compression and focal myelomalacia. Six months following an emergent C1–C3 decompression with occiput to C4 instrumented fusion, the patient was neurologically intact and pain-free. Conclusion: An 89-year-old male presented with a left-sided hemiplegia due to a Type 3/4 C1 Jefferson fracture. Following posterior C1–C3 surgical decompression with C0–C4 instrumented fusion, the patient sustained a complete bilateral motor recovery.

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PulseRider Treated Aneurysm with Significant Artifact on Postoperative Magnetic Resonance Angiography: A Case Report and Literature Review

Neurointervention ◽

10.5469/neuroint.2021.00241 ◽

2021 ◽

Author(s):

Anthony V. Nguyen ◽

Laura K. Reed ◽

Walter S. Lesley

Keyword(s):

Case Report ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Intracranial Aneurysms ◽

Parent Artery ◽

Contrast Enhanced ◽

Radiologic Imaging ◽

Basilar Tip Aneurysm ◽

Neurologically Intact ◽

Metal Burden

The PulseRider is a neuroendovascular adjunct for wide-necked intracranial aneurysms. The decreased metal burden of the PulseRider theoretically reduces artifact on radiologic imaging. However, we report here on a case of a patient who underwent PulseRider-assisted stent-coiling of a basilar tip aneurysm. He returned 19 months later for intermittent diplopia and darkening of vision but was neurologically intact on exam. Both contrast-enhanced and time-of-flight magnetic resonance angiography (MRA) demonstrated absence of signal in the basilar artery in the proximal anchors of the PulseRider. Given his lack of reproducible symptoms and high functional status, it is presumed that the imaging reflected artifact and not thrombosis/stenosis. Although the PulseRider is a useful treatment option for wide-necked intracranial aneurysms, the clinician should be aware that even contrast-enhanced MRA can produce artifact that resembles thrombosis/stenosis. Non-angiogram radiologic imaging modalities may be appropriate for evaluation for residual aneurysm but not patency of the parent artery.

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Work status after posterior fixation of unstable but neurologically intact burst fractures of thoracolumbar spine

Spinal Cord ◽

10.1038/sc.1991.88 ◽

1991 ◽

Vol 29 (9) ◽

pp. 600-606 ◽

Cited By ~ 3

Author(s):

R J Huler ◽

S I Esses ◽

D J Botsford

Keyword(s):

Thoracolumbar Spine ◽

Work Status ◽

Posterior Fixation ◽

Burst Fractures ◽

Neurologically Intact

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The impact of the lateral decubitus position in the perioperative period on posterior fixation for thoracolumbar fracture with ankylosing spinal disorder

Journal of Neurosurgery Spine ◽

10.3171/2021.8.spine21996 ◽

2021 ◽

pp. 1-8

Author(s):

Hisanori Ikuma ◽

Tomohiko Hirose ◽

Shinichiro Takao ◽

Masataka Ueda ◽

Kazutaka Yamashita ◽

...

Keyword(s):

Perioperative Period ◽

Anterior Wall ◽

Thoracolumbar Fracture ◽

Lateral Decubitus Position ◽

Posterior Fixation ◽

Thoracolumbar Fractures ◽

Surgical Time ◽

Number Of Patients ◽

Lateral Decubitus ◽

The Impact

OBJECTIVE Patients with ankylosing spinal disorders (ASDs), such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis, often have rigid kyphosis of the spine. The fracture site is sometimes unintentionally displaced when surgery is conducted with the patient prone. To prevent this incident, the authors adopted the lateral decubitus position for patients intraoperatively for this pathology. The aim of this study was to retrospectively assess the impact of the lateral decubitus position in the perioperative period on posterior fixation for thoracolumbar fractures with ASD. METHODS Thirty-seven consecutive patients who underwent posterior instrumentation for thoracolumbar fracture with ASD at the authors’ institute were divided into 15 lateral decubitus positions (group L) and 22 prone positions (group P). Surgical time, estimated blood loss (EBL), number of levels fused, perioperative complications, length of stay (LOS), ratio of fracture voids, and ratio of anterior wall height were investigated. The ratio of fracture void and the ratio of anterior wall height were the radiological assessments showing a degree of reduction in vertebral fracture on CT. RESULTS Age, sex, BMI, fracture level, and LOS were similar between the groups. Levels fused and EBL were significantly shorter and less in group L (p < 0.001 and p = 0.04), but there was no significant difference in surgical time. The complication rate was similar, but 1 death within 90 days after surgery was found in group P. The ratio of fracture voids was 85.4% ± 12.8% for group L and 117.5% ± 37.3% for group P. A significantly larger number of patients with a fracture void ratio of 100% or less was found in group L (86.7% vs 36.4%, p = 0.002). The ratio of anterior wall height was 107.5% ± 12.3% for group L and 116.9% ± 18.8% for group P. A significantly larger number of patients with the anterior wall height ratio of 100% or less was also found in group L (60.0% vs 27.3%, p = 0.046). CONCLUSIONS The results of this study suggest that the lateral decubitus position can be expected to have an effect on closing or maintaining the fracture void or a preventive effect of intraoperative unintentional extension displacement of the fractured site, which is often seen in the prone position during surgery for thoracolumbar fractures involving ASD.

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Contemporary Radiologic Imaging in the Evaluation of Middle Ear-Attic-Antral Complex Cholesteatomas

Otolaryngologic Clinics of North America ◽

10.1016/s0030-6665(20)31366-9 ◽

1989 ◽

Vol 22 (5) ◽

pp. 897-909 ◽

Cited By ~ 4

Author(s):

David P.C. Liu ◽

R. Thomas Bergeron

Keyword(s):

Middle Ear ◽

Radiologic Imaging

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Extrinsic Pathway Inhibitor in Elective Surgery: A Comparison with other Coagulation Inhibitors

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651017 ◽

1989 ◽

Vol 62 (03) ◽

pp. 856-860 ◽

Cited By ~ 28

Author(s):

P M Sandset ◽

H E Høgevold ◽

T Lyberg ◽

T R Andersson ◽

U Abildgaard

Keyword(s):

Vascular Surgery ◽

Protein C ◽

Elective Surgery ◽

Perioperative Period ◽

Acute Phase Reactant ◽

Hip Surgery ◽

Albumin Concentration ◽

Extrinsic Pathway ◽

Heparin Cofactor Ii ◽

Coagulation Inhibitors

SummaryExtrinsic coagulation pathway inhibitor may be an important regulator of haemostasis to prevent thrombosis after tissue damage. The functional activity of this inhibitor was determined using a chromogenic substrate assay, and compared to the activities of anti thrombin, heparin cofactor II and protein C during the perioperative period of elective hip replacement (n = 28), cholecystectomy (n = 11), and vascular surgery (n = 5). Peroperatively, all the inhibitors decreased rather similarly and to the same degree as the decrease in albumin concentration. The decreases during hip surgery were about 2-fold the decreases observed during cholecystectomy. A significant peroperative increase in extrinsic pathway inhibitor activity was observed in vascular surgery, probably due to a bolus injection of heparin. Antithrombin, heparin cofactor II and protein C levels normalized on days 3-5 postoperatively in all three patient groups. Sustained low levels of extrinsic pathway inhibitor were observed on postoperative days 1 to 7 in hip surgery patients. Apparently, extrinsic pathway inhibitor is not an acute phase reactant. In uncomplicated surgery, the decreases of the coagulation inhibitor levels are mainly due to hemodilution.

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