Cervical spine intradural-extramedullary hematoma presenting as ipsilateral hemiparesis

A 75-year-old Taiwanese man suffered from acute onset of right-sided extremity weakness while talking to his neighbors. He was transferred to the hospital within three-hour time after symptom onset. Initial acute ischemic cerebral infarct was diagnosed based on his symptom and cerebral computed tomography. Thrombolytic therapy was held after his symptom improved promptly and could not excluded other etiology. Thorough history taking unraveled previous Chinese medicine clinic visit because of neck sore. However, he received limited improvement after several times of massage treatment. Magnetic resnance imaging (MRI) of the cervical spine demonstrated hematoma compressing right side intradural-extramedullary space at the C2/C3 level. Through his clinical course, muscle weakness was the sole neurological finding with sparing of sensory defects. Given the close anatomy relationship between sensory and motor lamina distribution in the cervical spinal cord, our patient presented a rare manifestation. Cases of cervical spine intradural-extramedullary hematoma are not often seen and only sporadic in the documented literature. We wish, through the report of this article, to inform the first- line physicians with the following information. Among the elderly, neck sore is a common symptom. Over- stretching or overt local massage is not suggested due to relatively fragile musculature. In the clinical diagnosis and localization of lesion, cerebral or cervical spine lesion could mimic with each other and manifest hemiparesis as their first symptom. Meticulous history taking, neurological/ physical examination and pertinent laboratory work-up should be done before initiation of intravenous thrombolytic therapy as it could cause catastrophic consequences if not used properly.

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Cervical Spine Motion in the Elderly

Case Medical Research ◽

10.31525/ct1-nct04222777 ◽

2020 ◽

Author(s):

Keyword(s):

Cervical Spine ◽

The Elderly ◽

Spine Motion

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Hypoglycemic Hemiparesis Masquerading As Ischemic Stroke: When Guideline Fails

Current Drug Therapy ◽

10.2174/1574885515666191227155624 ◽

2020 ◽

Vol 15 (4) ◽

pp. 420-422

Author(s):

Dhruvkumar M. Patel ◽

Mukundkumar V. Patel ◽

Jayanti K. Gurumukhani ◽

Maitri M. Patel ◽

Himal J. Mahadevia ◽

...

Keyword(s):

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Neurological Deficit ◽

Clinical Case ◽

Complete Recovery ◽

Acute Onset ◽

Diabetic Patients ◽

Focal Neurological Deficit ◽

Random Blood Sugar ◽

Resident Doctor

Background: Hypoglycemia may rarely present as hemiparesis and sometimes it is difficult to differentiate from ischemic stroke. When random blood sugar (RBS) value is between 50 and 80 mg % in patients presenting with focal neurological deficit, no guideline exists to consider the possibility of hypoglycemia before initiating thrombolytic therapy. Clinical Case: A 58-year-old male, who was a known case of diabetes and hypertension, was brought to the emergency room with acute onset of right hemiparesis and dysarthria of 90 minutes duration. His NIHSS Score was 9, blood pressure was 150/90 mm of Hg and RBS was 79 mg% on admission. His CT scan brain was normal and was considered for thrombolysis. Resident doctor not aware of previous sugar repeated RBS before thrombolysis which was surprisingly 60 mg% 60 minutes after the first RBS. Even though he was a candidate for thrombolysis, intravenous 25 % dextrose was administered considering the possibility of hypoglycemia. He made a complete recovery within 20 minutes and thrombolytic therapy was withheld. : In Diabetic patients with focal neurological deficit and RBS less than 80 mg% on admission, RBS should be rechecked and in appropriate cases should be challenged with IV dextrose considering the possibility of hypoglycemia before commencing thrombolytic therapy.

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Subarachnoid diverticulum associated with feline infectious peritonitis in a Siberian cat

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116920941477 ◽

2020 ◽

Vol 6 (2) ◽

pp. 205511692094147

Author(s):

Christopher Hoey ◽

George Nye ◽

Angela Fadda ◽

Janet Bradshaw ◽

Emi N Barker

Keyword(s):

Cervical Spinal Cord ◽

Serum Biochemistry ◽

Acute Onset ◽

Neurological Deficits ◽

Rt Pcr ◽

Feline Infectious Peritonitis ◽

Case Summary ◽

Choroid Plexitis ◽

The Brain ◽

Feline Coronavirus

Case summary A 7-month-old Siberian cat was presented for investigation of acute onset multifocal neurological deficits. Neurological examination documented dull mental status and an ambulatory left hemiparesis. Serum biochemistry documented marked hyperglobulinaemia. MRI of the brain identified marked leptomeningeal contrast enhancement extending along the brainstem caudally to involve the cranial cervical spinal cord. MRI of the cervical spine further identified a subarachnoid diverticulum that extended from the level of the obex to the C2–C3 vertebrae. Cerebrospinal fluid quantitative RT-PCR was positive for the presence of feline coronavirus. Histopathology revealed pyogranulomatous meningitis and choroid plexitis, uveitis and nephritis. Relevance and novel information This article describes the first reported case of a subarachnoid diverticulum associated with feline infectious peritonitis.

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Assessment of Functions of the Autonomic Nervous System in the Elderly with Different Comorbid Factors

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1718854 ◽

2020 ◽

Author(s):

Sushma S. ◽

Medha Y Rao ◽

Shaikh Mohammed Aslam

Keyword(s):

Elderly Patients ◽

Predictive Value ◽

The Elderly ◽

Common Symptom ◽

Deep Breathing ◽

Isometric Handgrip ◽

Male Predominance ◽

Healthy Elderly ◽

Sensitivity Specificity ◽

Deep Breathing Test

Abstract Background Studies in healthy elderly patients have shown the prevalence of autonomic dysfunction (AD) in the range of 20 to 30%. However, there is paucity in data pertaining to AD in the elderly in the Indian context. Objective To assess the prevalence of AD in the elderly irrespective of their comorbidity status. Methods A total of 141 elderly patients with or without comorbidities/symptoms of AD were included. Demographic and clinical details of the patients were recorded. Autonomic function tests (AFTs) such as deep breathing test, Valsalva ratio, orthostatic heart rate (OHR), isometric handgrip test, and orthostatic blood pressure were performed based on Ewing’s battery of tests. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of AFTs were evaluated. Results Most patients (n = 85) were aged between 60 and 69 years, with a male predominance (58.87%). Hypertension and diabetes mellitus were the most common comorbidities. Postural hypotension was the most common symptom of AD. With advancing age, symptoms of AD manifested significantly more. Overall, 73.8% of patients had AD, of whom 45.4% had early AD. Number of AD symptoms, glycated hemoglobin (HbA1c) level, and comorbid factors (diabetes and hypertension) were significantly associated with the results of AFTs (p < 0.05). AFTs were highly significant with respect to the results obtained (p < 0.001). Deep breathing test, abnormal in majority of study patients, has a sensitivity of 93.3% and OHR has a specificity of 81.1% to determine AD. Conclusion The study concludes that age itself is an independent predictor of AD, which increases in severity if associated with comorbidities.

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Outcome of Cervical Spine Trauma Patients Admitted to the Intensive Care Unit at a Tertiary Government Referral Trauma Center in Nepal

Global Spine Journal ◽

10.1177/2192568220980703 ◽

2021 ◽

pp. 219256822098070

Author(s):

Gyanendra Shah ◽

Gaurav Raj Dhakal ◽

Anil Gupta ◽

Pawan Kumar Hamal ◽

Siddhartha Dhungana ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cervical Spine ◽

Cervical Spinal Cord ◽

Limited Resource ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Resource Setting ◽

Cord Injury ◽

Huge Impact

Study Design: Retrospective study. Objectives: Cervical spinal cord injury (SCI) is a devastating event for patient and family. It has a huge impact on society because of intensive resources required to manage the patient in both acute and rehabilitation phases. With the limited resource setting in underdeveloped countries like Nepal, questions are often raised regarding whether the outcome justifies the expenses of their care. The objective was to assess the outcomes of cervical SCI patients admitted to intensive care unit (ICU). Methods: All cervical SCI admitted in ICU during May 2017 to August 2018 were included in this study. Demographic details, mode, morphology, and neurological level of injury, intervention performed and outcomes of ICU stay were analyzed. Results: Out of 48 patients, 36 (75%) were male and 12 female with mean age 43.9 ± 15.9 years. Fall injury was the commonest mode of injury (83.3%). Most patients presented within 1 to 3 days of injury and C5-C6 (33.3%) was the most common involved level and 75% presented with ASIA A neurology. Mechanical ventilation was required in 95.8% of the patients and 22 patients were operated upon. The average stay in ICU was 15 days and 13 patients died in the ICU. Conclusions: Majority of cervical SCI with complete motor paraplegia required ICU care. Inspite of the intensive care, a subset of these patients succumbed to the complications of the injury. Therefore, it is essential to establish trauma ICU care with specific protocols on managing cervical spine injuries.

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Intradural extramedullary tanycytic ependymoma of the cervical spine: A case report

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2021.101319 ◽

2021 ◽

pp. 101319

Author(s):

Mahmoud M. Taha ◽

Mazen M. Taha ◽

Mohamed Kh. Elbadawy ◽

Mohammad Ezzat

Keyword(s):

Case Report ◽

Cervical Spine ◽

Tanycytic Ependymoma ◽

Intradural Extramedullary

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Pathophysiology and Treatment of Pruritus in Elderly

International Journal of Molecular Sciences ◽

10.3390/ijms22010174 ◽

2020 ◽

Vol 22 (1) ◽

pp. 174

Author(s):

Bo Young Chung ◽

Ji Young Um ◽

Jin Cheol Kim ◽

Seok Young Kang ◽

Chun Wook Park ◽

...

Keyword(s):

Skin Diseases ◽

Unknown Origin ◽

The Elderly ◽

Common Symptom ◽

Multiple Factors ◽

Signaling Mechanisms ◽

Novel Drugs ◽

Neuropathic Pruritus ◽

Chronic Pruritus

Pruritus is a relatively common symptom that anyone can experience at any point in their life and is more common in the elderly. Pruritus in elderly can be defined as chronic pruritus in a person over 65 years old. The pathophysiology of pruritus in elderly is still unclear, and the quality of life is reduced. Generally, itch can be clinically classified into six types: Itch caused by systemic diseases, itch caused by skin diseases, neuropathic pruritus, psychogenic pruritus, pruritus with multiple factors, and from unknown causes. Senile pruritus can be defined as a chronic pruritus of unknown origin in elderly people. Various neuronal mediators, signaling mechanisms at neuronal terminals, central and peripheral neurotransmission pathways, and neuronal sensitizations are included in the processes causing itch. A variety of therapies are used and several novel drugs are being developed to relieve itch, including systemic and topical treatments.

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Resection of 2 Intradural Extramedullary Cervical Spine Tumors in a Patient With Neurofibromatosis Type 2: 3-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy149 ◽

2018 ◽

Vol 16 (2) ◽

pp. 274-274

Author(s):

Simone E Dekker ◽

Chad A Glenn ◽

Thomas A Ostergard ◽

Osmond C Wu ◽

Fernando Alonso ◽

...

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Treatment Options ◽

Tumor Resection ◽

Neurofibromatosis Type ◽

Cord Compression ◽

Neurofibromatosis Type 2 ◽

3 Dimensional ◽

Intradural Extramedullary

Abstract This 3-dimensional operative video illustrates resection of 2 cervical spine schwannomas in a 19-yr-old female with neurofibromatosis type 2. The patient presented with lower extremity hyperreflexity and hypertonicity. Magnetic resonance imaging (MRI) demonstrated 2 contrast-enhancing intradural extramedullary cervical spine lesions causing spinal cord compression at C4 and C5. The patient underwent a posterior cervical laminoplasty with a midline dural opening for tumor resection. Curvilinear spine cord compression is demonstrated in the operative video. After meticulous dissection, the tumors were resected without complication. The dural closure was performed in watertight fashion followed by laminoplasty using osteoplastic titanium miniplates and screws. Postoperative MRI demonstrated gross total resection with excellent decompression of the spinal cord. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.

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Intradural Dirofilariasis in a Dog with Chronic Cervical Pain

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6450 ◽

2017 ◽

Vol 53 (1) ◽

pp. 59-63

Author(s):

Kathleen Ann Bonawandt ◽

Jason M. Berg ◽

Richard J. Joseph ◽

Joseph D. Stefanacci

Keyword(s):

Magnetic Resonance Imaging ◽

Cervical Spine ◽

Magnetic Resonance ◽

Spinal Pain ◽

Resonance Imaging ◽

Male Adult ◽

Normal Limits ◽

History Of ◽

C2 Vertebra ◽

Intradural Extramedullary

ABSTRACT A 7 yr old female spayed Yorkshire terrier was referred to the author's institute for a 5 mo history of recurrent cervical spinal pain. Neurologic examination did not reveal any deficits. Hematologic and serum analyses were within normal limits. Thoracic radiographs that incorporated the cervical spine did not show structural abnormalities. Magnetic resonance imaging of the cervical spine demonstrated a contrast enhancing, intradural extramedullary lesion at the level of the C2 vertebra. Hemilaminectomy was performed, during which a long, narrow nematode was visualized upon opening of the dura mater. The parasite was alive when removed during surgery, and the dog recovered with complete resolution of symptoms. The parasite was submitted and confirmed as a male adult Dirofilaria immitis. This is a novel case of an intradural D. immitis infection in the dog with a magnetic resonance imaging description of spinal D. immitis.

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