CIDP PRESENTING AS MYELORADICULOPATHY

2021 ◽  
pp. 50-51
Author(s):  
Sundarachary. N.V ◽  
Mythri. A.
Keyword(s):  
Peripheral Nerves ◽  
Urge Incontinence ◽  
Cauda Equina ◽  
Cord Compression ◽  
Nerve Conduction Studies ◽  
Lower Limbs ◽  
Sensory Level ◽  
Nerve Roots ◽  
Sensory Disturbances ◽  
Progressive Disorder

Chronic inammatory demyelinating polyradiculoneuropathy (CIDP) is a relapsing or chronic progressive disorder which is one of the causes of hypertrophic neuropathy. Enlarged nerve roots were identied in few patients. We now report a case of CIDP with highly thickened or enlarged nerve roots severe enough to cause cord compression and myelopathy. A 38 year old woman presented with weakness and sensory disturbances in lower limbs with sensory level at L1 and bladder disturbances in form of urgency and urge incontinence . MRI showed a non enhancing isointense mass lesion from L1 to S1 causing compression over conus . During surgery the cauda equina nerve roots were found to be thickened , entangled with ' bag of worms' appearance. Nerve conduction studies showed all her peripheral nerves to be inexcitable. Her CSF protein was mildly elevated. Diagnosis of CIDP with thickened nerve roots was considered and she was started on steroids and subsequently showed improvement. Thus, CIDP may present with symptoms of myeloradiculopathy due to thickened nerve roots causing cord compression.

Radiculopathies and Neuropathies

2015 ◽  
Author(s):  
Kathy Chuang ◽  
William S David
Keyword(s):  
Nervous System ◽  
Peripheral Nerves ◽  
Cauda Equina ◽  
Clinical Manifestations ◽  
Cervical Radiculopathy ◽  
Lumbosacral Spine ◽  
Ultrasound Images ◽  
Spinal Segment ◽  
Nerve Roots ◽  
Pain Medications

“Radiculopathies” are disorders of nerve roots, whereas “neuropathies” are disorders of the peripheral nerve. These disorders may involve single roots or nerves, multiple roots or nerves, and even other aspects of the nervous system. This chapter reviews the anatomy and pathophysiology of the peripheral nervous system; the general approach to radiculopathies and neuropathies, including clinical manifestations and localization, diagnostic studies, and treatment; radiculopathies, including anatomy, cervical radiculopathy, lumbosacral radiculopathy, thoracic radiculopathy, and cauda equina syndrome; and neuropathies, including  mononeuropathies and polyneuropathies. Tables describe the innervation of select nerve roots and peripheral nerves, differences between root and nerve lesions, commonly used neuropathic pain medications, distinctive patterns of neuropathy with limited differential diagnoses, differential diagnosis of demyelinating polyneuropathy, drugs that may cause polyneuropathy, and neuropathies associated with diabetes mellitus. Figures show the anatomy of a spinal segment, nerve fascicles, ultrasound images of the median nerve, magnetic resonance imaging of the lumbosacral spine, the Spurling maneuver, and physical examination maneuvers for lumbosacral radiculopathies. This review contains 6 highly rendered figures, 8 tables, and 77 references.

scholarly journals Cervical Cord Compression With Lower Limbs Sensory Disturbance Presentation: Three Case Reports and Literature Review

2021 ◽  
Author(s):  
Yafei Cao ◽  
Yihong Wu ◽  
Weiji Yu ◽  
Weidong Liu ◽  
Shufen Sun ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Lower Limb ◽  
Cord Compression ◽  
Lower Limbs ◽  
Anterior Cervical Discectomy ◽  
Cervical Cord ◽  
Sensory Disturbance ◽  
Cervical Discectomy ◽  
Sensory Disturbances

Abstract Background: Lower limb sensory disturbance presentation can be a false localizing cervical cord compressive myelopathy (CSM). It may lead to delayed or missed diagnosis, resulting in the wrong management plan, especially in the presence of concurrent lumbar lesions.Case presentation:Three Asian patients with lower limb sensory disturbances presentation were treated ineffectively in the lumbar. Magnetic resonance imaging (MRI) showed cervical disc herniation and cervical level spinal cord compression. Anterior cervical discectomy surgery and zero-p interbody fusion were performed. After operations, imagings showed that the spinal cord compression were relieved, and the lower limbs sensory disturbances were also relieved. Three-months follow-up after operation showed good recovery.Conclusions:These three cervical cord compression cases of lower limb sensory disturbance presentation were easily misdiagnosed with lumbar spondylosis. Anterior cervical discectomy and fusion operation had a good therapeutic effect. Therefore, cases that present with lower limb sensory disturbance, but in a non-radicular classical pattern, should always alert a suspicion of a possible cord compression cause at a higher level.

scholarly journals Does gender have a significant effect on normal nerve conduction studies values?

2019 ◽  
Vol 9 (6) ◽  
Author(s):  
Kawthar AL-Salmi ◽  
Farook S Wali ◽  
Ahmed SM Nadeem ◽  
Abdullah AL-Salti
Keyword(s):  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Peripheral Nerves ◽  
Normative Data ◽  
Tertiary Care ◽  
Nerve Conduction Studies ◽  
Lower Limbs ◽  
Care Hospital ◽  
Upper Limbs ◽  
Conduction Velocities

Background: nerve conduction study (NCS) is a neurophysiologic medical diagnostic test used commonly to evaluate the function of the peripheral nerves. It is an extension to the clinical examination and extremely useful to diagnose and document a peripheral nerve disorder, localize the lesion, and to establish underlying pathophysiology. Objective: The aim of this study is to evaluate the influence of gender on nerve conduction study values and to generate reference nerve conduction studies (NCS) data for the commonly tested nerves among healthy adults in Oman. Subjects and methods: This study was conducted in the Neurology Department at the Royal Hospital, a tertiary care hospital in Muscat-Oman, for a period of four years (from March 2015 until May 2019) which included a total of 143 (80 females and 63 males) healthy Omani subjects. Sensory and motor nerve conduction studies were performed to the Median, Ulnar, Peroneal and Tibial nerves to establish the normative data. Statistical analysis was performed using Minitab comparing the mean values of all NCS parameters for both genders. Results: Gender comparison concluded that Omani males have longer distal motor latencies for all of the tested nerves and slower motor conduction velocities for the lower limbs’ nerves (p <0.005) than the females. While sensory latencies were significantly delayed in males as compared to Omani females for the upper limbs’ nerves and the ensory nerve potential amplitudes in the upper limbs were greater in females (p<0.0001) than males. A normative data for distal latencies, conduction velocities and responses amplitudes for motor and sensory nerves were sat up for the first time for normal adult Omani population. Conclusion: Gender has a significant influence on distal latencies and conduction velocities of some peripheral nerves in healthy Omani adult subjects, suggesting that different cut-off values for the two genders may be needed for interpreting such studies. These differences could be related to anatomical (height and limbs’ length gender differences) and/or physiological factors. Our normative data for nerve conduction study values are comparable to other published studies in the literature.

scholarly journals A Case of Acute Aortoiliac Occlusive Disease Presenting as Cauda Equina Syndrome and Fournier´s Gangrene

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Rosalba Paone ◽  
Pekka Romsi
Keyword(s):  
Spinal Cord ◽  
Erectile Dysfunction ◽  
Spinal Cord Ischemia ◽  
Cauda Equina ◽  
Cord Compression ◽  
Occlusive Disease ◽  
Lower Limbs ◽  
Careful Examination ◽  
Diagnostic Challenge ◽  
Aortoiliac Occlusive Disease

Aortoiliac occlusive disease presents itself more frequently as chronic claudication, erectile dysfunction, and absent femoral pulses. Its acute manifestation is less frequently encountered in a clinical practice; hence, it presents sometimes as a diagnostic challenge. We illustrate a case of acute aortoiliac occlusive disease presenting with spinal cord ischemia and gluteal and scrotal necroses, which was initially diagnosed and treated as spinal cord compression. In order to avoid misdiagnosis, careful examination of peripheral pulses of both lower limbs should always be part of the initial evaluation of cauda syndrome and paraplegia and when Fournier’s gangrene is suspected.

scholarly journals Compressive Dorsal Myelopathy Secondary to Extramedullary Hematopoiesis in a Thalassemic Patient

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Ismail Ibrahim Ismail ◽  
Fathi Massoud ◽  
K. J. Alexander ◽  
Jasem Youssef Al-Hashel
Keyword(s):  
Extramedullary Hematopoiesis ◽  
Cord Compression ◽  
Lower Limbs ◽  
Beta Thalassemia ◽  
Sensory Level ◽  
Compensatory Mechanism ◽  
Hematopoietic Tissue ◽  
Thalassemic Patient ◽  
Low Dose Radiotherapy ◽  
Magnetic Resonance Imaging Mri

Background. Extramedullary hematopoiesis (EMH) is one of the rare causes of spinal cord compression (SCC). It results from noncancerous proliferation of hematopoietic tissue outside the bone marrow as a compensatory mechanism for ineffective erythropoiesis. It occurs in the paraspinal area in 11–15% of thalassemic patients in intermediate and severe cases causing a paraspinal compressive mass. We present a rare case of spinal EMH with thoracic cord compression in a 22-year-old female with beta thalassemia who presented with paraparesis and we provide a review of literature. Case Report. A 22-year-old female patient with a known history of beta thalassemia presented with subacute onset of weakness and numbness of both lower limbs with a sensory level at T6. Magnetic resonance imaging (MRI) of the dorsal spine showed cord compression secondary to paraspinal EMH from T2 to T9 with most prominent compression over T5. She was managed with blood transfusion and low-dose radiotherapy. Conclusion. Although rare, EMH should be suspected in thalassemic patients presenting with paraplegia. Treatment with blood transfusions is usually effective. Other options include radiotherapy, surgery, hydroxyurea or a combination of these modalities.

Functional variability of sacral roots in bladder control

2014 ◽  
Vol 21 (6) ◽  
pp. 961-965 ◽  
Author(s):  
Lore Carlucci ◽  
Thomas Wavasseur ◽  
Antoine Bénard ◽  
Musa Sesay ◽  
Claire Delleci ◽  
...  
Keyword(s):  
Cauda Equina ◽  
Lower Limbs ◽  
Nerve Roots ◽  
Bladder Control ◽  
Bladder Contraction ◽  
Functional Distribution ◽  
Forensic Implications ◽  
The Right ◽  
Common Association ◽  
Stimulation Of

Object Sacral roots are involved in sensory, autonomic, and motor innervation of the lower limbs and perineum. Theoretically, it can be assumed that the S-3 root level innervates the bladder; however, clinical practice shows that this distribution can vary. Few researchers have studied this variability. Methods The authors conducted a retrospective study involving 40 patients who underwent surgery requiring an electrophysiological exploration of the sacral roots. They performed stimulations for the monitoring of muscular (3 Hz, 1 V) and bladder responses under cystomanometry (30 Hz, 10 V). Results Although the S-3 roots were involved in bladder innervation in all cases, they were exclusively involved (i.e., the only nerve roots involved) in only 8 of 40 cases. In the remaining 32 cases, other sacral nerve roots were involved. The most common association was S-3+S-4 (12 cases), followed by S-2+S-3 (6 cases), S-2+S-3+S-4 (5 cases), and S-3+S-4+S-5 (2 cases). Stimulation of S-2 could sometimes induce bladder contraction (15 cases, 40%); however, the amplitude was often low. S-4 nerve roots were involved in 24 of 40 cases (60%) in the bladder motor function, whereas S-5 roots were only involved 7 times (17%). Occasionally, we noticed a horizontal asymmetry in the response, with a predominant response from the right side in 6 of 7 cases, always with a major S-3 response. Conclusions This is the first study showing a significant horizontal and vertical variability in the functional distribution of sacral roots in bladder innervation. These results show the variability of cauda equina syndromes and their forensic implications. These data should help with the monitoring of sacral roots and the performance of several tasks during surgery, including neurostimulation and neuromodulation.

Radiculopathies and Neuropathies

2015 ◽  
Author(s):  
Kathy Chuang ◽  
William S David
Keyword(s):  
Nervous System ◽  
Peripheral Nerves ◽  
Cauda Equina ◽  
Clinical Manifestations ◽  
Cervical Radiculopathy ◽  
Lumbosacral Spine ◽  
Ultrasound Images ◽  
Spinal Segment ◽  
Nerve Roots ◽  
Pain Medications

“Radiculopathies” are disorders of nerve roots, whereas “neuropathies” are disorders of the peripheral nerve. These disorders may involve single roots or nerves, multiple roots or nerves, and even other aspects of the nervous system. This chapter reviews the anatomy and pathophysiology of the peripheral nervous system; the general approach to radiculopathies and neuropathies, including clinical manifestations and localization, diagnostic studies, and treatment; radiculopathies, including anatomy, cervical radiculopathy, lumbosacral radiculopathy, thoracic radiculopathy, and cauda equina syndrome; and neuropathies, including  mononeuropathies and polyneuropathies. Tables describe the innervation of select nerve roots and peripheral nerves, differences between root and nerve lesions, commonly used neuropathic pain medications, distinctive patterns of neuropathy with limited differential diagnoses, differential diagnosis of demyelinating polyneuropathy, drugs that may cause polyneuropathy, and neuropathies associated with diabetes mellitus. Figures show the anatomy of a spinal segment, nerve fascicles, ultrasound images of the median nerve, magnetic resonance imaging of the lumbosacral spine, the Spurling maneuver, and physical examination maneuvers for lumbosacral radiculopathies. This chapter contains 6 highly rendered figures, 8 tables, 77 references, and 5 MCQs.

scholarly journals Double neurophysiological certification of the filum terminale during sectioning surgery in pediatric population

2020 ◽  
Vol 11 ◽  
pp. 229
Author(s):  
Juan P. Cabrera ◽  
Sebastián Vigueras ◽  
Rubén Muñoz ◽  
Eduardo López
Keyword(s):  
Anal Sphincter ◽  
Pediatric Population ◽  
Cauda Equina ◽  
Lower Limbs ◽  
Constant Current ◽  
Neurophysiological Monitoring ◽  
Filum Terminale ◽  
Nerve Roots ◽  
Short Period ◽  
Mapping Techniques

Background: Surgery of thickened-fibrolipoma filum terminale (FT) is performed routinely and without conflict but is not a risk-free surgical procedure. Intraoperative neurophysiological monitoring with mapping techniques can help to certify the FT before sectioning. However, a tailored surgical approach to cauda equina and a low threshold of surrounding nerve roots can confuse the final surgical decision. The aim is to demonstrate the usefulness of this double methodology for FT certification. Methods: A prospective study collected and reviewed retrospectively, from 2015 to 2018, 40 patients undergoing an FT surgery section were included in the study. After opening the dura mater and under the microscope, the cauda equina mapping is performed and the recording of muscles of the lower limbs and the external anal sphincter. In addition, a high-intensity stimulation of constant current of an isolated FT for a short period of time and in a dry surgical field, obtaining a bilateral-polyradicular-symmetrical response of cauda equina nerve roots. Results: Traditional motor mapping identified FT in 65% (26/40) of patients. Although, 35% (14/40) of the patients still have low-intensity stimuli response (<1 mA) of a muscle, especially anal sphincter. When this happens, the optimization of the dissection around FT is performed. After that, 25% (10/40) of the patients still having a muscle response in spite of seem isolated FT. Increasing the stimulation intensity up to 20 mA evoked a cauda equina response in all cases. No postoperative neurological impairment was observed in this series. Conclusion: This proposed methodology accurately confirms the FT so that it can be safely found and cut. The Double Neurophysiological Certification improves the gap of the traditional mapping techniques of cauda equina and can be used in a variety of more complex surgeries in this area.

scholarly journals Neurological Manifestations of Mycetoma

2021 ◽  
Author(s):  
Elkhansa.A.Ali ◽  
Khabab Abbasher Hussien Mohamed Ahmed ◽  
Radi Tofaha Alhusseini ◽  
Abdallah M. Abdallah ◽  
Muaz A. Ibrahim ◽  
...  
Keyword(s):  
Cord Compression ◽  
Lower Limbs ◽  
Neurological Involvement ◽  
Cervical Cord ◽  
Sensory Level ◽  
Neurological Manifestations ◽  
Spastic Paraplegia ◽  
Community Based ◽  
Cross Sectional ◽  
White Nile

Abstract Introduction: Mycetoma is a chronic specific granulomatous progressive and disfiguring subcutaneous inflammatory disease. It is caused by true fungi (Euomycetoma) or by higher bacteria (Actinomycetoma).Mycetoma mainly affects lower limbs, followed by upper limbs, back and rarely head and neck. Mycetoma is mainly transmitted through trauma with infected sharp objects. Objectives: To determine the neurological manifestations of mycetoma. Methodology: A descriptive cross-sectional community based study included 160 patients with mycetoma seen in White Nile state. Results: Almost 160 patients were included in the study, 90% of them were male. Two patients presented with entrapment neuropathy, one presented with proximal neuropathy, one has peripheral neuropathy, one has dorsal spine involvement presented with spastic paraplegia with sensory level, one has cervical cord compression, and one patient has repeated attacks of convulsion. Conclusion: Although it is rare, clinicians should highly suspect neurological involvement in mycetoma patients.

ROSAI-DORFMAN DISEASE CAUSING SPINAL CORD COMPRESSION

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. E977-E978 ◽  
Author(s):  
Grégory Dran ◽  
David Rasendrarijao ◽  
Fanny Vandenbos ◽  
Philippe Paquis
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Central Nervous System Involvement ◽  
Cervical Lymphadenopathy ◽  
Cord Compression ◽  
Lower Limbs ◽  
Pathological Examination ◽  
Magnetic Resonance Imaging Scan ◽  
Sensory Level ◽  
Rosai Dorfman Disease

Abstract OBJECTIVE Rosai-Dorfman disease is a rare idiopathic, histiocytic, proliferative disease characterized by massive, painless cervical lymphadenopathy. Extranodal involvement is rare and central nervous system involvement is unusual. We present a patient with Rosai-Dorfman disease with spinal cord compression. Very few cases have been reported in the literature. CLINICAL PRESENTATION A 17-year-old man presented with a 1-month history of progressive fatigue of the legs. His medical history was significant for Rosai-Dorfman disease diagnosed 7 months earlier. Clinical examination was consistent with a pyramidal syndrome and proprioceptive disturbances on his lower limbs without sensory level. A magnetic resonance imaging scan revealed an intradural extramedullary space-occupying lesion at the T1-T4 level with dural insertion and spinal cord compression. INTERVENTION A T1–T4 laminotomy was performed. Upon opening the dura, a reddish-gray mass was encountered, which encased the dorsal and lateral arachnoidal membrane. The lesion was relatively well circumscribed and was easily dissected from the underlying arachnoid. Pathological examination of the compressive soft tissue was consistent with Rosai-Dorfman disease. Postoperatively, the patient showed substantial improvement in neurological function. He was followed for 18 months with no complaints and no recurrence. CONCLUSION Neurosurgeons should consider this rare etiology of spinal cord compression. They must be aware that this lesion can occur in front of an intraspinal lesion, mimic meningiomas, occur in young people, and can potentially be associated with other locations of disease, including intracranial lesions. Surgery is the treatment of choice.

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