scholarly journals Anterior thoracic intradural arachnoid cysts

1999 ◽  
Vol 6 (5) ◽  
pp. E10 ◽  
Author(s):  
Gerardo Caruso ◽  
Antonino Germanò ◽  
Mariella Caffo ◽  
Massimo Belvedere ◽  
Giovanni La Rosa ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Treatment Options ◽  
Relevant Literature ◽  
Spastic Paraparesis ◽  
Treatment Strategies ◽  
Arachnoid Cysts ◽  
Complete Excision ◽  
Medline Search ◽  
Excellent Outcome ◽  
Intradural Arachnoid Cysts

Anterior thoracic intradural arachnoid cysts (ATIACs) are a rare cause of spinal cord and nerve root compression, for which different treatment strategies have been proposed. Although ATIAC represents a well-known clinical entity, the choice of surgical method has not been uniform, and no study has been specifically designed to compare the results of the different treatment options adopted. The authors report the case of a 40-year old man with a 1-year history of dorsal pain, weakness in the lower extremities, gait disturbance, and mild sexual and urinary dysfunction. On neurological examination spastic paraparesis, lower-extremity hypertonia, and hypesthesia below T-2 were demonstrated. Magnetic resonance imaging revealed the presence of an ATIAC at the T-2 level. The patient underwent complete microsurgical removal of the cyst. The authors conducted a Medline search of the relevant literature from 1966 to 1998 and also obtained data on other cases in which patients underwent surgical treatment of ATIAC. The literature search yielded five such cases. Treatment strategies were complete excision and fenestration followed by placement of a shunt. In addition, one case was characterized by intraoperative cyst rupture during retraction of the spinal cord. Correct preoperative workup coupled with microneurosurgical technique allow for successful removal of the lesion and excellent outcome. Based on the literature review and the results in our case, the complete excision of ATIAC is associated with an excellent outcome, which is different from results achieved using other surgical strategies.

State of the Art Reviews: Nonpharmacologic Approaches for the Treatment of Insomnia

2007 ◽  
Vol 1 (4) ◽  
pp. 274-282 ◽  
Author(s):  
Ann M. Lynch ◽  
Courtney I. Jarvis ◽  
Ronald J. DeBellis ◽  
Anna K. Morin
Keyword(s):  
Behavioral Therapy ◽  
Treatment Options ◽  
Sleep Onset ◽  
Treatment Strategies ◽  
Economic Consequences ◽  
Patient Specific ◽  
Sleep Onset Latency ◽  
Medline Search ◽  
Wake Time ◽  
Nonpharmacologic Treatment

Insomnia is a common condition resulting in significant clinical and economic consequences. This review discusses the efficacy of nonpharmacologic treatment options commonly recommended for sleep onset and sleep maintenance insomnia. In addition, the efficacy of these approaches as part of a multifaceted intervention and in comparison to that of pharmacologic options is reviewed. The primary literature and review articles on the nonpharmacologic treatment of insomnia were identified through a MEDLINE search between 1966 and August 2006. Articles on the nonpharmacologic treatment of primary insomnia, including clinical trials on the efficacy of individual and combination treatment options, were reviewed. The nonpharmacologic treatment options for insomnia include stimulus control, sleep hygiene educations, sleep restriction, paradoxical intention, relaxation therapy, biofeedback, and cognitive-behavioral therapy. These treatment strategies produce significant changes in several sleep parameters of chronic insomniacs, including sleep-onset latency, wake time after sleep onset, sleep duration, and sleep quality. Many therapeutic options are available to treat insomnia, including nonpharmacologic strategies. Treatment recommendations, both pharmacologic and nonpharmacologic, should be made based on patient-specific insomnia symptoms, treatment history, and medical history.

Syringomyelia associated with intradural arachnoid cysts

2006 ◽  
Vol 5 (2) ◽  
pp. 111-116 ◽  
Author(s):  
Langston T. Holly ◽  
Ulrich Batzdorf
Keyword(s):  
Arachnoid Cyst ◽  
Treatment Strategies ◽  
Tethered Cord ◽  
Arachnoid Cysts ◽  
Cavity Size ◽  
Neurological Improvement ◽  
Arm Pain ◽  
History Of ◽  
Intradural Arachnoid Cysts

Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity. Methods The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus. All patients underwent thoracic laminectomy and resection of the arachnoid cyst wall, and postoperative neurological improvement was documented in each case. The mean follow-up duration was 19 months (range 4–37 months). Follow-up magnetic resonance imaging demonstrated the disappearance of the arachnoid cyst and a significant decrease in syrinx cavity size in each patient. Conclusions Spinal arachnoid cysts can be associated with syringomyelia, likely due to alterations in normal CSF dynamics. In symptomatic patients these cysts should be resected and the normal CSF flow restored. The results of the present series indicate that neurological improvement and reduction in syrinx cavity size can be achieved in patients with syringomyelia associated with intradural arachnoid cysts.

Augmentation and combination of antidepressants with each other and with antipsychotics

2011 ◽  
Vol 26 (S2) ◽  
pp. 698-698
Author(s):  
L. Timmerman
Keyword(s):  
Drug Treatment ◽  
Remission Rate ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Augmentation Therapy ◽  
First Line ◽  
Severe Problem ◽  
Medline Search ◽  
New Treatment ◽  
Line Drug

IntroductionNonrespons in first -line drug treatment of patients suffering from depression in psychiatric outpatient populations is a severe problem.The non respons rate is up tot 30% and the non remission rate more than 50% in the first line of treatment with antidepressants in this population.ObjectiveTo devellop more rapid and efficious drug treatment strategies in depression.AimsDuring the last few years several strategies to improve outcome in depression have been under investigation. A few have proven to be valuable.MethodsMedline search 2005–2010 into treatment resistent depression, combination therapy, augmentation therapy, drug therapy.ResultThere is growing evidence for the value of the combination of antidepressants and of combining antidepressants with antipsychotics.Treatment options as pindolol addition to antidepressants, substance P or folic acid addition do not seem of clinical significance yet.The same is true for treatment methods who directly influence the glucocorticoid system such as glucocorticoid receptor antagonists.NMDA antagonists look promising but more research into this option is needed.ConclusionsThere are two outstanding and much promising relatively new treatment options with: Combinations of antidepressants and with combinations of an antidepressant with an antipsychotic.

scholarly journals Alcohol-Induced Neuropathy in Chronic Alcoholism: Causes, Pathophysiology, Diagnosis, and Treatment Options

2020 ◽  
Vol 8 (4) ◽  
pp. 87-97
Author(s):  
Iga Dudek ◽  
Danuta Hajduga ◽  
Cezary Sieńko ◽  
Amr Maani ◽  
Elżbieta Sitarz ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Peripheral Neuropathy ◽  
Alcohol Abuse ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Chronic Alcoholism ◽  
Treatment Modalities ◽  
Excessive Alcohol Consumption ◽  
Chronic Alcohol Abuse ◽  
Wide Range

Abstract Purpose of the Review Alcohol abuse causes a wide range of disorders that affect the nervous system. These include confusion, cerebellar ataxia, peripheral neuropathy, and cognitive impairment. Chronic and excessive alcohol consumption is the primary cause of peripheral neuropathy. It is worth noting that peripheral neuropathy has no reliable treatment due to the poor understanding of its pathology. Recent Findings Coasting is a major feature of alcoholic neuropathy, largely due to chronic alcohol abuse. Its major features are hyperalgesia, allodynia, and burning pain. Even though much research was done in this area, still we do not have a full understanding of the mechanism of alcoholic neuropathy. However, some theories have been proposed. These include direct or indirect effects of alcohol metabolites, impaired axonal transport, suppressed excitatory nerve pathway activity, or imbalance in neurotransmitters. Activation of spinal cord microglia, mGlu5 spinal cord receptors, and hypothalamic-pituitary-adrenal axis also seem to be implicated in the pathophysiology of this alcoholic neuropathy. The goal of treatment is to impede further damage to the peripheral nerves while also restoring their normal physiology. Alcohol abstinence, intake of balanced diets, and treatment with medications are suggested including benfotiamine, alpha-lipoic acid, acetyl-l-carnitine, vitamin E, methylcobalamin, myo-inositol, N-acetylcysteine, capsaicin, tricyclic antidepressants, or antiepileptic drugs. Summary This review focuses on the many pathways that play a role in the onset and development of alcohol-induced neuropathy, as well as present the possible treatment strategies of this disorder, providing insights into a further search of new treatment modalities.

Intradural arachnoid cysts of the spinal canal associated with intramedullary cysts

1988 ◽  
Vol 68 (4) ◽  
pp. 544-549 ◽  
Author(s):  
Brian T. Andrews ◽  
Philip R. Weinstein ◽  
Mark L. Rosenblum ◽  
Nicholas M. Barbaro
Keyword(s):  
Spinal Cord ◽  
Arachnoid Cyst ◽  
Spinal Surgery ◽  
Spinal Canal ◽  
Late Complication ◽  
Arachnoid Cysts ◽  
Spinal Cord Trauma ◽  
Intramedullary Spinal Cord ◽  
Thoracic Spinal ◽  
Intradural Arachnoid Cysts

✓ Five patients had intradural arachnoid cysts of the thoracic spinal canal associated with syringomyelia or posttraumatic intramedullary spinal cord cysts. Three cases were diagnosed 6 to 18 years after spinal surgery and two 14 to 17 years after spinal cord trauma. In each case, delayed progression of symptoms led to the identification of the lesions. The diagnosis was assisted by the use of myelography and delayed computerized tomography scanning in two cases and by magnetic resonance imaging in all five. In each case, the arachnoid cyst appeared to compress the spinal cord or nerve roots; in three cases, the syrinx cavities appeared to exert a significant mass effect. In the two trauma-related cases, the intramedullary cysts were small and may have represented areas of cystic myelomalacia. In four cases, intraoperative real-time ultrasonography helped to localize the arachnoid and intramedullary cavities. All five patients were treated by fenestration of the arachnoid cyst; additional peritoneal shunting of the cyst was performed in one case and of the intramedullary cavity in three. In one patient, the two lesions appeared to have a balancing effect; after drainage of the arachnoid cyst, the syrinx cavity expanded and had to be treated separately. The neurological deficits were reduced in four patients and stabilized in one. Intradural arachnoid cysts and intramedullary cysts may occur together as a late complication of spinal surgery or spinal cord trauma, and either or both lesions may cause delayed neurological deterioration.

scholarly journals Surgical management of aneurysmal bone cysts of the spine

2003 ◽  
Vol 15 (5) ◽  
pp. 1-7 ◽  
Author(s):  
James K. Liu ◽  
Douglas L. Brockmeyer ◽  
Andrew T. Dailey ◽  
Meic H. Schmidt
Keyword(s):  
Treatment Options ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Bone Destruction ◽  
Unknown Origin ◽  
Neurological Deficits ◽  
Bone Cysts ◽  
Complete Excision ◽  
Aneurysmal Bone Cysts ◽  
Special Factors

Object Aneurysmal bone cysts of the spine are benign, highly vascular osseous lesions of unknown origin that may present difficult diagnostic and therapeutic challenges. They are expansile lesions containing thin-walled, blood-filled cystic cavities that cause bone destruction and sometimes spinal deformity and neurological compromise. The treatment of aneurysmal bone cysts of the spine remains controversial according to the literature. In this review, the authors discuss the clinical manifestations, pathophysiological features, neuroimaging characteristics, and treatment strategies for these lesions. Methods Treatment options include simple curettage with bone grafting, complete excision, embolization, and radiation therapy. Reconstruction and stabilization of the spine may be warranted if deformity and instability are present. Special factors need to be considered in the management of these lesions. Conclusions Complete excision of aneurysmal bone cysts offers the best chance of cure and spinal decompression if neurological deficits are present.

scholarly journals Syringomyelia associated with intradural arachnoid cysts

2007 ◽  
Vol 22 (2) ◽  
pp. 111-116
Author(s):  
Langston T. Holly ◽  
Ulrich Batzdorf
Keyword(s):  
Arachnoid Cyst ◽  
Treatment Strategies ◽  
Tethered Cord ◽  
Arachnoid Cysts ◽  
Cavity Size ◽  
Neurological Improvement ◽  
Arm Pain ◽  
History Of ◽  
Intradural Arachnoid Cysts

Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity. Methods The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus. All patients underwent thoracic laminectomy and resection of the arachnoid cyst wall, and postoperative neurological improvement was documented in each case. The mean follow-up duration was 19 months (range 4–37 months). Follow-up magnetic resonance imaging demonstrated the disappearance of the arachnoid cyst and a significant decrease in syrinx cavity size in each patient. Conclusions Spinal arachnoid cysts can be associated with syringomyelia, likely due to alterations in normal CSF dynamics. In symptomatic patients these cysts should be resected and the normal CSF flow restored. The results of the present series indicate that neurological improvement and reduction in syrinx cavity size can be achieved in patients with syringomyelia associated with intradural arachnoid cysts.

Treatment of Female Sexual Dysfunction

2003 ◽  
Vol 37 (4) ◽  
pp. 546-555 ◽  
Author(s):  
Kelly R Ragucci ◽  
Nicole S Culhane
Keyword(s):  
Sexual Dysfunction ◽  
Female Sexual Dysfunction ◽  
Data Extraction ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Individual Characteristics ◽  
Treatment Modalities ◽  
Medline Search ◽  
Sexual Pain ◽  
Arousal Disorder

OBJECTIVE: To review the pathophysiology and psychology of female sexual dysfunction (FSD) and describe potential prevention and treatment strategies for the disorder. DATA SOURCES: Articles identified from a MEDLINE search (1966–June 2002) using the term female sexual dysfunction. Additional references were obtained from cross referencing retrieved articles. STUDY SELECTION AND DATA EXTRACTION: After evaluating various review articles, clinical trials, and investigational studies, all information that was deemed relevant by the reviewers was included. DATA SYNTHESIS: FSD is a multicausal and multidimensional problem combining biological, psychological, and interpersonal factors. The American Foundation for Urological Disease classifies FSD into 4 broad categories: sexual desire disorders, arousal disorder, orgasmic disorder, and sexual pain disorders. Depending on specific individual characteristics and category of disorder, a variety of potential treatments are available. Pharmacists can play a role in identifying and managing medication-related adverse effects that may be exacerbating FSD and educating women on treatment modalities. CONCLUSIONS: FSD is a complicated disorder that is often difficult to identify, classify, and treat appropriately. Pharmacists should have an understanding of the potential causes of FSD and the treatment options available so that they may make appropriate recommendations and counsel women effectively.

Spinal intradural arachnoid cysts located anterior to the cervical spinal cord

1999 ◽  
Vol 91 (2) ◽  
pp. 211-215 ◽  
Author(s):  
Saim Kazan ◽  
Özgür Özdemir ◽  
Mahmut Akyüz ◽  
Recai Tuncer
Keyword(s):  
Spinal Cord ◽  
Arachnoid Cyst ◽  
Cervical Spinal Cord ◽  
Arachnoid Cysts ◽  
Cervical Region ◽  
Diagnostic Tools ◽  
Content Type ◽  
Contrast Enhanced Ct ◽  
Intradural Arachnoid Cysts ◽  
Fine Print

✓ The authors describe two rare occurrences of radiographically, surgically, and pathologically confirmed spinal intradural arachnoid cysts (not associated with additional pathological entities) that were located anterior to the cervical spinal cord. These lesions have been reported previously in only eight patients. The patients described in this report were young adults who presented with progressive spastic tetraparesis shortly after sustaining mild cervical trauma and in whom no neurological deficit or bone fracture was demonstrated. The presence of an intradural arachnoid cyst was detected on postcontrast computerized tomography (CT) myelography and on magnetic resonance imaging; both diagnostic tools correctly characterized the cystic nature of the lesion. Plain radiography, plain tomography, and contrast-enhanced CT scans were not diagnostic. In both cases a laminectomy was performed, and the wall of the cyst was excised and fenestrated with subarachnoid space. Postoperatively, the patients made complete neurological recoveries. Based on a review of the literature, arachnoid cysts of the spinal canal may be classified as either extra- or intradural. Intradural arachnoid cysts usually arise posterior to the spinal cord in the thoracic spine region; however, these cysts very rarely develop in the cervical region. The pathogenesis of arachnoid cysts is unclear, although congenital, traumatic and inflammatory causes have been postulated. The authors believe that the formation of an arachnoid cyst cannot be explained by simply one mechanism because, in some reported cases, there has been accidental or iatrogenic trauma in association with congenital lesions. They also note that an intradural arachnoid cyst located anterior to the cervical spinal cord is an extremely rare disorder that may cause progressive myelopathy; however, the postoperative prognosis is good.

Spinal root arteriovenous malformations and same-segment cord cavernous malformation in familial cerebral cavernous malformation

2008 ◽  
Vol 9 (3) ◽  
pp. 249-252
Author(s):  
Jorge Marcondes De Souza ◽  
Flavio S. Domingues ◽  
Leila Chimelli ◽  
Judith Gault
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Novel Mutation ◽  
Vascular Malformations ◽  
Spastic Paraparesis ◽  
Treatment Strategies ◽  
Spinal Root ◽  
Her Family ◽  
Imaging Results ◽  
Spinal Cord Segment

Spinal vascular malformations are uncommon lesions, and controversy persists regarding optimal investigation, classification, and treatment strategies. The authors report on a patient with a spinal root arteriovenous malformation (AVM) associated with a parenchymal cavernous malformation (CM) in the same spinal cord segment and describe a complete familial and molecular investigation. This 35-year-old woman presented with symptoms of progressive clinical spastic paraparesis. Magnetic resonance imaging results were suggestive of a spinal cord cavernoma associated with cerebral CMs. Her family history included 2 sisters treated for epilepsy. At surgery an intraspinal root AVM was found at the same level of the cord CM, and both lesions were completely removed. Cerebral gradient echo MR imaging disclosed multiple cavernomas in her relatives, which prompted the molecular diagnosis. On sequence analysis, a novel mutation on the cerebral CM1 (CCM1) gene (c796insA) was found. The authors report on a unique case of familial cerebral CM in which a spinal root AVM was situated next to a cord CM, and discuss the concomitant occurrence of altered nervous system angiogenesis and vasculogenesis.

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