scholarly journals Spinal Subdural Hematoma With Paraplegia Mimicking Dorsolumbar Prolapsed Disc: A Case Report

2021 ◽  
Vol 7 (2) ◽  
pp. 113-118
Author(s):  
Vishal Singh ◽  
◽  
Sajad Hussain Arif ◽  
Keyword(s):  
Subdural Hematoma ◽  
Hormone Secretion ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Conus Medullaris ◽  
Lower Limbs ◽  
Metabolic Encephalopathy ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Spinal Subdural Hematoma ◽  
Prolapsed Disc

Background and Importance: Spinal Subdural Hematoma (SSH) is a rare condition with an unknown incidence in the general population. Iatrogenic spinal subdural hematoma radiologically mimicking a prolapsed dorsolumbar disc has not been published in the literature. Case Presentation: A 65-year-old female presented with altered sensorium and generalized weakness for 3 days evaluated by a neurologist who diagnosed it as a metabolic encephalopathy with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) with severe anemia and hypothyroidism. She underwent a diagnostic lumbar puncture and following which, within 24 hours, she developed weakness of both the lower limbs. MRI of dorsolumbar spine was done which revealed D12-L1 extruded disc causing severe compression to the conus medullaris with D12-L2 subarachnoid lesion and cord edema. On opening the dura, a large organized hematoma on the anterior aspect of the conus was seen and evacuated. Conclusion: Spinal subdural hematoma presents with a spectrum of signs and symptoms. Although MRI is the investigation of choice but SSH presenting like a prolapsed intervertebral disc on MRI is one of its kinds and should be kept in mind since it carries a grave prognosis if not treated early with emergency decompression.

scholarly journals Uncommon manifestations of a rare disease: a case of autoimmune GFAP astrocytopathy

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong Di ◽  
Yue Yin ◽  
Ruxuan Chen ◽  
Yun Zhang ◽  
Jun Ni ◽  
...  
Keyword(s):  
Rare Disease ◽  
Hormone Secretion ◽  
White Matter Lesions ◽  
Signs And Symptoms ◽  
Careful Examination ◽  
Case Presentation ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Contrast Enhanced ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri

Abstract Background Manifestations of intractable hyponatremia and hypokalemia in autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy have been rarely reported. Case presentation A 75-year-old male patient presented as the case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) and intractable hypokalemia, showed fever, fatigue, and mental disorders. Signs and symptoms of meningoencephalitis, ataxia, and cognitive abnormalities. Magnetic resonance imaging (MRI) revealed multiple white matter lesions of the central nervous system. He had GFAP-IgG in the cerebrospinal fluid (CSF). After treatment with corticosteroids, his symptoms were alleviated gradually, and the level of electrolytes was normal. However, head contrast-enhanced MRI + susceptibility-weighted imaging (SWI) showed a wide afflicted region, and the serum GFAP-IgG turned positive. Considering the relapse of the disease, ha was treated with immunoglobulin and mycophenolate mofetil (MMF) to stabilize his condition. Conclusion This case showed a rare disease with uncommon manifestations, suggesting that careful examination and timely diagnosis are essential for disease management and satisfactory prognosis.

scholarly journals A spinal subdural hematoma induced by guidewire-based lumbar drainage in a patient with ruptured intracranial aneurysms

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 247-250
Author(s):  
Meng Qi ◽  
Tao Huang ◽  
Lei Xu ◽  
Ning Wang ◽  
Peipei Zhang ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Muscle Tension ◽  
Lower Limbs ◽  
Lumbar Drainage ◽  
Spinal Hematoma ◽  
Hematoma Evacuation ◽  
Ruptured Intracranial Aneurysm ◽  
Close Observation ◽  
Spinal Subdural Hematoma ◽  
Ruptured Intracranial Aneurysms

AbstractWe present a rare case of spinal subdural hematoma induced by guidewire-based lumbar drainage in a subarachnoid hemorrhage patient with a ruptured intracranial aneurysm. Decreased muscle strength and muscle tension of bilateral lower limbs were noted, and an MRI confirmed the spinal subdural hematoma from the sacral to the thoracic segments. The spinal subdural hematoma evacuation and spinal canal decompression were performed by laminectomy. However, the patient did not benefit from the surgery and developed lower limb muscle atrophy. The complication of the spinal subdural hematoma after lumbar drainage is extremely rare; only limited approaches are available for the treatment of spinal hematoma to improve the outcome and avoid severe consequences. Thus, the present case might suggest refraining from use of a guidewire during lumbar drainage for the prevention of spinal subdural hematoma and close observation of the related symptoms and signs for the early detection of spinal hematoma after the procedure. In addition, full decompression can be performed by complete hematoma evacuation and laminectomy of related segments for the treatment of spinal subdural hematoma induced by lumbar drainage.

Intramedullary Endometriosis of the Conus Medullaris

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. E428-E428 ◽  
Author(s):  
Amit Agrawal ◽  
Bellore J.P. Shetty ◽  
Jagadeesh H. Makannavar ◽  
Lathika Shetty ◽  
Jayaprakash Shetty ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Back Pain ◽  
Relevant Literature ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Conus Medullaris ◽  
Resonance Imaging ◽  
Acute Hemorrhage ◽  
Neurological Signs ◽  
Lower Back

Abstract OBJECTIVE: Intraspinal endometriosis is an extremely rare condition with characteristic symptoms, including lower back pain that increases in severity during each menstrual cycle. METHODS: Here, we report a case of endometriosis involving the conus cauda region. This patient presented with acute deterioration secondary to hemorrhage. We also review the relevant literature. RESULTS: Magnetic resonance imaging scans of the dorsolumbar region showed a mass lesion within the spinal canal at the L1–L2 level with evidence of acute hemorrhage. The patient underwent an emergency D12–L2 laminectomy and microdecompression of the lesion. The histological and immunohistochemical features were characteristic of intraspinal endometriosis. CONCLUSION: Intraspinal endometriosis must be recognized as a potential cause of periodic neurological signs and symptoms in young and middle-aged women.

scholarly journals Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-12
Author(s):  
Leigh A. Rettenmaier ◽  
Marshall T. Holland ◽  
Taylor J. Abel
Keyword(s):  
Systematic Review ◽  
Subdural Hematoma ◽  
Rare Condition ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Unknown Etiology ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome ◽  
Spinal Subdural Hematoma ◽  
Significant Disability

Spontaneous spinal subdural hematoma (sSDH) is a rare condition outright. Moreover, cases that occur spontaneously in the absence of an identifiable etiology are considerably less common and remain poorly understood. Here, we present the case of a 43-year-old man with spontaneous sSDH presenting with acute onset low back pain and paraplegia. Urgent magnetic resonance imaging identified a dorsal SDH from T8 to T11 with compression of the spinal cord. Emergent T8–T10 laminectomies with intradural exploration and hematoma evacuation were performed. However, despite prompt identification and appropriate action, the patient’s recovery was modest and significant disability remained at discharge. This unique and unusual case demonstrates that spontaneous sSDH requires prompt surgical treatment to minimize associated morbidity and supports the association between the presence of severe neurological deficits upon initial presentation with less favorable outcomes. We performed a comprehensive systematic review of spontaneous sSDH of unknown etiology, which demonstrates that emergent surgical intervention is indicated for patients presenting with severe neurological deficits and the presence of these deficits is predictive of poor neurological outcome. Furthermore, conservative management should be considered in patients presenting with mild neurological deficits as spontaneous resolution followed by favorable neurological outcomes is often observed in these patients.

scholarly journals Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist

2021 ◽  
pp. svn-2021-001230
Author(s):  
Kevin C J Yuen ◽  
Valerie Sharf ◽  
Elizabeth Smith ◽  
Minhwan Kim ◽  
Alissya S M Yuen ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Clinical Relevance ◽  
Current Knowledge ◽  
Hormone Secretion ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Signs And Symptoms ◽  
Clinical Practices ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Hospitalised Patients

Sodium and water perturbations, manifesting as hyponatraemia and hypernatraemia, are common in patients who had an acute stroke, and are associated with worse outcomes and increased mortality. Other non-stroke-related causes of sodium and water perturbations in these patients include underlying comorbidities and concomitant medications. Additionally, hospitalised patients who had an acute stroke may receive excessive intravenous hypotonic solutions, have poor fluid intake due to impaired neurocognition and consciousness, may develop sepsis or are administered drugs (eg, mannitol); factors that can further alter serum sodium levels. Sodium and water perturbations can also be exacerbated by the development of endocrine consequences after an acute stroke, including secondary adrenal insufficiency, syndrome of inappropriate antidiuretic hormone secretion and diabetes insipidus. Recently, COVID-19 infection has been reported to increase the risk of development of sodium and water perturbations that may further worsen the outcomes of patients who had an acute stroke. Because there are currently no accepted consensus guidelines on the management of sodium and water perturbations in patients who had an acute stroke, we conducted a systematic review of the literature published in English and in peer-reviewed journals between January 2000 and December 2020, according to PRISMA guidelines, to assess on the current knowledge and clinical practices of this condition. In this review, we discuss the signs and symptoms of hyponatraemia and hypernatraemia, the pathogenesis of hyponatraemia and hypernatraemia, their clinical relevance, and we provide our recommendations for effective treatment strategies for the neurologist in the management of sodium and water perturbations in commonly encountered aetiologies of patients who had an acute stroke.

Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated with Head and Neck Cancers: Review of the Literature

1997 ◽  
Vol 106 (10) ◽  
pp. 878-883 ◽  
Author(s):  
Alfio Ferlito ◽  
Alessandra Rinaldo ◽  
Kenneth O. Devaney
Keyword(s):  
Head And Neck ◽  
Antidiuretic Hormone ◽  
Malignant Tumors ◽  
Hormone Secretion ◽  
Neck Region ◽  
Signs And Symptoms ◽  
Mass Effect ◽  
Tissue Type ◽  
Hormone Production ◽  
Inappropriate Antidiuretic Hormone Secretion

In a minority of patients with malignant tumors, signs and symptoms develop that cannot be explained on the basis of the mass effect produced by the primary tumor or its metastases, or production of a hormone normally associated with the tissue type that has given rise to the malignant tumor; these peculiar symptom complexes are known as paraneoplastic syndromes, and may be divided into endocrinologic, dermatologic, hematologic, neurologic, and osteoarticular manifestations. In the head and neck region in particular, the syndrome of inappropriate antidiuretic hormone production (SIADH, or Schwartz-Bartter syndrome) is a well-recognized form of paraneoplastic syndrome that may accompany head and neck malignancies. Most of such tumors are squamous carcinomas, with lesser numbers of olfactory neuroblastomas, small cell neuroendocrine carcinomas, adenoid cystic carcinomas, and undifferentiated carcinomas; sarcoma was reported in only a single instance. The lesions associated with the development of SIADH have most often been located in the oral cavity, and less often in the larynx, nasopharynx, hypopharynx, nasal cavity, maxillary sinus, parapharyngeal space, salivary glands, and oropharynx. Key features of SIADH include serum hypo-osmolality; an unexpectedly high urinary specific gravity; an absence of edema or dehydration; normal adrenal, thyroid, and renal function; hyponatremia; and an elevation of plasma vasopressin.

scholarly journals Meningitis retention syndrome caused by varicella zoster virus in a patient without a rash: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tsuneaki Kenzaka ◽  
Ken Goda ◽  
Ayako Kumabe
Keyword(s):  
Varicella Zoster Virus ◽  
Urinary Retention ◽  
Aseptic Meningitis ◽  
Acute Urinary Retention ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Lower Limbs ◽  
Viral Origin ◽  
Varicella Zoster ◽  
Intravenous Acyclovir

Abstract Background Meningitis retention syndrome (MRS) is a rare condition that presents with acute urinary retention as a complication of aseptic meningitis. Cases of MRS due to varicella zoster virus (VZV) infection without a rash are rare. We report the case of a patient who had no signs of meningitis or VZV infection, including a rash. Case presentation A 58-year-old man presented with dysesthesia of the lower limbs and acute urinary retention. He had fever but no rash and no signs of meningitis. He was diagnosed to have VZV infection based on the detection of VZV DNA in the cerebrospinal fluid. He responded satisfactorily to a course of intravenous acyclovir and experienced no sequelae during a 2-year follow-up period. Conclusion MRS due to aseptic meningitis of viral origin should be considered in the differential diagnosis of acute urinary retention even in the absence of specific signs and symptoms of meningitis or a suggestive rash.

scholarly journals Serological screening for syphilis in non-compressive spinal injuries

2021 ◽  
Author(s):  
Bianca Frigo Pires ◽  
Osmi Hamamoto
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Transverse Myelitis ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Lower Limbs ◽  
Intramedullary Tumors ◽  
Serological Screening ◽  
Chronic Myelopathy ◽  
Syphilis Serology

Background: Syphilis is an infectious disease that can present systemic symptoms during its progression, reaching the central nervous system, causing neurosyphilis, combined include involvement of the meninges and spinal cord. Objectives: to review information on meningomyelitis in patients with positive syphilis serology, assessing the need for serological screening for syphilis knowledge and the importance of the clinician for an accurate diagnosis, preventing major sequelae or fatalities Methods: We analyzed 14 clinical cases of syphilitic myelitis from January 2000 to January 2021. Documents were resolved to determine clinical issues, apparent symptoms, radiological findings, penal treatment and complications. Results: 85.7% suffered from chronic myelopathy and 14.3% revealed subacute transverse myelitis. The most common clinical condition of chronic myelopathy was tabes dorsalis, present in 50%, afterwards it was syphilitic meningomyelite, present in 33.3%. Conclusion: Syphilitic myelitis is a rare condition, but there are studies that prove an increase in cases of myelopathy in patients with positive syphilis serology. The condition manifests itself with weakness of the lower limbs, sensory disturbance and urinary and fecal incontinence, in addition to long spinal cord injuries and abnormal enhancement, predominantly in the superficial parts of the spinal cord, in imaging exams. There is a differential diagnosis with multiple pathologies, such as intramedullary tumors, herniated intervertebral disc, myelopathy caused by HIV, among others. Therefore, it is important to know the signs and symptoms and an approach to serological screening for syphilis in patients with neurological disorders and non-compressive medical injuries.

scholarly journals Acute spinal cord compression due to spinal subdural hematoma after spinal anaesthesia in-patient under anticoagulant drug

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Moussa Denou ◽  
Nourou Dine Adeniran Bankole ◽  
Mustapha Hamama ◽  
Nizare El Fatemi ◽  
Moulay Rachid El Maaqili
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Spinal Anaesthesia ◽  
Rare Condition ◽  
Cord Compression ◽  
Good Prognosis ◽  
Conus Medullaris ◽  
Immediate Recovery ◽  
Spinal Subdural Hematoma ◽  
Anticoagulant Drug

Abstract Background Subdural spinal cord hematomas are very rare condition. They most often occur in patients with primary or secondary blood haemostasis disorders and following lumbar punctures. Early diagnosis and management preserve functional prognosis. Case description We report the case of a female 69-year-old patient on oral anticoagulant, Acenocoumarol 4 mg (SINTROM) for previous aortic prosthesis. The patient had undergone surgery for appendicitis under spinal anaesthesia 2 days before her admission in neurosurgery department. She was admitted in emergency for 1/5 central flaccid paraplegia with sensitive umbilical level. A spinal MRI performed showed a collection intradural in intermediate signal in T1 and hyposignal in T2 with echo gradient of 8 mm thickness extended from D8 to L2 compressing the marrow with anomalies of intramedullary signal extended from D8 to the conus medullaris. We retained indication to operate the patient early in emergency because of acute spinal cord compression. We performed T12-L2 laminectomy, durotomy and evacuated hematoma. Postoperative marked by an immediate recovery of sensitivity and an onset of motor recovery from 1/5 to 2/5 and 4/5 follow up at on year with physiotherapy. Conclusion Spinal cord compression due to subdural spinal hematomas not often described especially in patients with haemostasis blood disorders due to anticoagulants drugs. In addition, we should pay attention with lumbar puncture in these patients. Emergency surgery allows a good prognosis about recovery of neurological disorders.

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