scholarly journals Spinal cord compression secondary to vertebral echinococcosis

2016 ◽  
Vol 7 (01) ◽  
pp. 143-146 ◽  
Author(s):  
Abat Sahlu ◽  
Brook Mesfin ◽  
Abenezer Tirsit ◽  
Knut Wester
Keyword(s):  
Muscular Strength ◽  
Cord Compression ◽  
Lower Limbs ◽  
Resonance Imaging ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Anterior Plating

ABSTRACTWe describe a patient with progressive lower limb weakness and paresthesia 3 days after falling from a considerable height. Magnetic resonance imaging and computed tomography revealed collapsed Th2 and Th3 vertebrae. A tuberculous (TB) spondylitis was suspected, and anti-TB medication was started however with no clinical improvement. She was referred to our center and operated. A 3 level discectomy and 2 level corpectomy were performed with iliac bone grafting and anterior plating via an anterior cervical approach. The patient developed an esophagocutaneous fistula that was repaired and cured. The biopsy specimen showed a hydatid cyst of the vertebra as the cause of the lesion. After the result, she was started on oral albendazole. At follow-up nearly 4 months after surgery, the patient had regained significant power in her lower limbs with a muscular strength of 5/5 in both legs, thus making it possible to walk without support.

scholarly journals Surgical Experience in Pediatric Patients with Chiari-I Malformations Aged ≤18 Years

2019 ◽  
Vol 10 (01) ◽  
pp. 85-88 ◽  
Author(s):  
Ghanshyam Das Singhal ◽  
Shakti Singhal ◽  
Gunjan Agrawal ◽  
Deepti Singhal ◽  
Vipin Arora
Keyword(s):  
Pediatric Patients ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Surgical Experience ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Chiari I

ABSTRACT Objective: The objective of this study was to retrospectively study Chiari I malformation patients (<18 years) treated surgically. Materials and Methods: Chiari I malformation patients (<18 years) treated surgically at our institute were retrospectively studied. Results: During the study period between January 1999 and June 2011, fifty patients, aged ≤18 years with Chiari malformation, were treated surgically and formed the basis for this series. There were 21 female children (42%) and 29 male children (58%), with a female-to-male ratio of 1:1. At the last follow-up, oropharyngeal symptoms were improved in 33% (n = 3/9). Headache/neck/back pain improved in 69.56% of children (n = 16/23). Upper-extremity pain/weakness/numbness improved in 73.91% of children (n = 17/23). Ataxia improved in 66.66% of children (n = 4/6). Lower-limb weakness/hyperreflexia improved in 83.33% of children (n = 5/6). At follow-up, magnetic resonance imaging for patients with syrinx was available for 75% of patients (n = 30/50) and not available for 25% of patients (n = 10/40). Syrinx was diminished in size or resolved in 66.33% of patients (n = 19/30) and the remaining was same for 36.66% of patients (n = 11/30). Conclusions: The main goal of surgery is to arrest the progression of neurological deficits. Foramen magnum decompression with a lax duroplasty is the surgical procedure of choice.

scholarly journals Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India

2015 ◽  
Vol 9 (11) ◽  
pp. 1289-1293 ◽  
Author(s):  
Kavitha Saravu ◽  
Rajagopal Kadavigere ◽  
Ananthakrishna Barkur Shastry ◽  
Rohit Pai ◽  
Chiranjay Mukhopadhyay
Keyword(s):  
Lower Limb ◽  
Corticosteroid Treatment ◽  
Conus Medullaris ◽  
Subdural Empyema ◽  
Lower Limbs ◽  
High Dose ◽  
Limb Weakness ◽  
Subdural Collection ◽  
Lower Limb Weakness ◽  
Left Lower Limb

Two distinct and potentially deceitful cases of neurologic melioidosis are reported. Case 1: A 39-year-old alcoholic and uncontrolled diabetic male presented with cough, fever, and left focal seizures with secondary generalization. An magnetic resonance imaging (MRI) brain scan revealed a small peripherally enhancing subdural collection along the interhemispheric fissure suggestive of minimal subdural empyema. Blood culture grew Burkholderia pseudomallei. Patient was diagnosed with disseminated bacteraemic melioidosis with subdural empyema. He was successfully treated with ceftazidime-cotrimoxazole-doxycycline. Case 2: A 45-year-old male presented with left lower limb weakness, difficulty in passing urine and stool, and back pain radiating to lower limbs. Neurological examination revealed flaccid left lower limb with absent deep tendon reflexes and plantar reflex. Spinal MRI showed T2 hyperintensity from D9 to L1 suggestive of demyelination. Patient was treated with high dose methylprednisolone. By day 3 of steroid treatment, lower limb weakness progressed. Subsequent MRI showed extensive cord hyperintensity on T2 weighted sequence extending from C5 to conus medullaris consistent with demyelination. Cerebrospinal fluid (CSF) culture grew B. pseudomallei, and the patient was given meropenem-cotrimoxazole. After three weeks of parenteral treatment, the lower limbs remained paralyzed. Patient was discharged on oral cotrimoxazole-doxycycline. Conclusions: Melioidosis should be considered as a differential in focal suppurative central nervous system (CNS) lesions, meningoencephalitis, or encephalomyelitis in endemic areas. CNS infections must be ruled out prior to steroid administration. The role of corticosteroids in demyelinating CNS melioidosis has been refuted. This is a rare documentation of effect of unintentional corticosteroid treatment in melioidosis.

Extradural developmental dural root sleeve cyst presenting as a lumbar paraspinal mass with renal compression in an infant

2010 ◽  
Vol 5 (6) ◽  
pp. 586-590 ◽  
Author(s):  
Balaji Srinivas ◽  
Vivek Joseph ◽  
Geeta Chacko ◽  
Vedantam Rajshekhar
Keyword(s):  
Marked Reduction ◽  
Left Kidney ◽  
Lower Limbs ◽  
Resonance Imaging ◽  
Abdominal Organs ◽  
Left Lower Limb ◽  
Extradural Cyst ◽  
The Right ◽  
Slow Growing

Spinal extradural cysts do not normally present as a visible paraspinal mass or cause compression of the abdominal organs. The authors describe the case of a 9-month-old boy with multiple spinal extradural cysts. The largest of these cysts was along the right L-2 nerve root with significant extraspinal extension resulting in a visible slow-growing swelling in the right paraspinal region and radiological evidence of compression of the right kidney with hydronephrosis. Another large cyst along the left T-12 root caused radiologically evident compression of the left kidney but to a lesser degree. The patient also had monoparesis of the left lower limb and phenotypic features of Noonan syndrome. The authors performed marsupialization of the cysts, as well as repair of the fistula between the subarachnoid space and the cyst on the right side along the L-2 root and on the left side along the T-12 root. At 1-year follow-up, there was no paraspinal mass and the lower limbs exhibited normal power. Magnetic resonance imaging confirmed marked reduction in the size of the cysts and relief of the renal compression. To the authors' knowledge, their patient is the youngest reported in literature to have a spinal extradural cyst and also the first with the cyst presenting as a paraspinal mass.

Distal-type cervical spondylotic amyotrophy: incidence and outcome after central corpectomy

2009 ◽  
Vol 10 (4) ◽  
pp. 374-379 ◽  
Author(s):  
Nooti Venkata Srinivasa Rao ◽  
Vedantam Rajshekhar
Keyword(s):  
Motor Neuron ◽  
Motor Neuron Disease ◽  
Cord Compression ◽  
Lower Limbs ◽  
Upper Limbs ◽  
Rare Form ◽  
Japanese Orthopedic Association ◽  
Cervical Spondylotic Amyotrophy ◽  
Male Patients

Object Distal-type cervical spondylotic amyotrophy (CSA) is a rare form of cervical spondylotic myelopathy (CSM). The authors documented the incidence, clinical presentation, radiological features, and outcome following central corpectomy (CC) in patients with this entity. Methods The authors performed a retrospective institutional database search of patients who underwent decompressive surgery for CSM between 1992 and 2006 to identify patients with distal-type CSA. Distal-type CSA was defined as weakness and wasting of hands and forearms without gait impairment (Nurick Grades 0 and 1) nor any sensory symptoms or signs in the lower limbs. Results The authors identified 7 male patients (1.1%) with distal-type CSA from among 653 patients who underwent either cervical laminectomy (135 patients) or CC (518 patients). There were sensory symptoms or signs in the upper limbs in all but 1 of the patients. Increased signal intensity in the cord was demonstrated on T2-weighted MR images in all patients. The compression was mainly at the C-6 vertebral level. At a mean follow-up of 46.5 months (range 12–98 months), 6 patients had improved by a mean patient perceived outcome score of 66.7% (range 20–100%). Patients' modified Japanese Orthopedic Association scores improved from a preoperative mean (± SD) of 16.1 ± 0.7, to a follow-up mean of 17.4 ± 0.5 (p = 0.004, paired t-test). One patient whose condition worsened 7 months after CC received a diagnosis of a coexistent motor neuron disease. Conclusions Distal-type CSA is a rare form of CSM that should be differentiated from motor neuron disease on the basis of subtle sensory symptoms or signs in the upper limbs, and the presence of significant cord compression on the MR imaging. Patient outcome after central corpectomy is good and long lasting.

scholarly journals Retropharyngeal Abscess in an adult with Pneumonia during COVID-19 Outbreak in China

2020 ◽  
Author(s):  
Tianyu Wang ◽  
Haibin Liu ◽  
Caiquan Liang ◽  
Hang Zhang ◽  
Jianchun Liao ◽  
...  
Keyword(s):  
Foreign Body ◽  
Chest Ct ◽  
Retropharyngeal Abscess ◽  
Surgical Drainage ◽  
Case Presentation ◽  
Raising Awareness ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Chest Ct Scan

Abstract Background: Retropharyngeal abscesses are rarely reported in adults and occur mostly in patients with immunocompromise or as a foreign body complication. Admittedly, the treatment of retropharyngeal abscesses frequently involves surgical drainage to achieve the best results. However, when retropharyngeal abscesses occurred in a highly suspected patient with COVID-19, the managements and treatments should be caution in order to prevent the spread of the virus. Case presentation: On Feb. 13, a 40-year-old male with retropharyngeal abscesses turned to our department complaining dyspnea and dysphagia. In addition, his chest CT scan shows a suspected COVID-19 infection, thus making out Multiple Disciplinary Team (MDT) determine to perform percutaneous drainage and catheterization through left anterior cervical approach under the guidance of B-ultrasound. Finally, the patient recovered and was discharged from the hospital on Feb. 27 after 14 days of isolation. There was no recurrence after half a year follow-up. Conclusions: By presenting this case, we aim at raising awareness of different surgical drainage methods and summarizing our experience in the management of retropharyngeal abscesses during the outbreak of COVID-19.

scholarly journals Degenerative cervical myelopathy presenting as subjective lower limb weakness could be a trap towards misdiagnosis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Chi-An Luo ◽  
Meng-Ling Lu ◽  
Arun-Kumar Kaliya-Perumal ◽  
Lih-Huei Chen ◽  
Wen-Jer Chen ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Functional Recovery ◽  
Lower Limb ◽  
Cervical Myelopathy ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Tandem Spinal Stenosis ◽  
Degenerative Cervical Myelopathy

AbstractWhen patients presenting with subjective lower limb weakness (SLLW) are encountered, it is natural to suspect a lumbar pathology and proceed with related clinical examination, investigations and management. However, SLLW could be a sign of degenerative cervical myelopathy (DCM) due to an evolving cord compression. In such circumstances, if symptoms are not correlated to myelopathy at the earliest, there could be potential complications over time. In this study, we intend to analyse the outcomes after surgical management of the cervical or thoracic cord compression in patients with SLLW. Retrospectively, patients who presented to our center during the years 2010–2016 with sole complaint of bilateral SLLW but radiologically diagnosed to have a solitary cervical or thoracic stenosis, or tandem spinal stenosis and underwent surgical decompression procedures were selected. Their clinical presentation was categorised into three types, myelopathy was graded using Nurick’s grading and JOA scoring; in addition, their lower limb functional status was assessed using the lower extremity functional scale (LEFS). Functional recovery following surgery was assessed at 6 weeks, 3 months, 6 months, one year, and two years. Selected patients (n = 24; Age, 56.4 ± 10.1 years; range 32–78 years) had SLLW for a period of 6.4 ± 3.2 months (range 2–13 months). Their preoperative JOA score was 11.3 ± 1.8 (range 7–15), and LEFS was 34.4 ± 7.7 (range 20–46). Radiological evidence of a solitary cervical lesion and tandem spinal stenosis was found in 6 and 18 patients respectively. Patients gradually recovered after surgical decompression with LEFS 59.8 ± 2.7 (range 56–65) at 1 year and JOA score 13.6 ± 2.7 (range − 17 to 100) at 2 years. The recovery rate at final follow up was 47.5%. Our results indicate the importance of clinically suspecting SLLW as an early non-specific sign of DCM to avoid misdiagnosis, especially in patients without conventional upper motor neuron signs. In such cases, surgical management of the cord compression resulted in significant functional recovery and halted the progression towards permanent disability.

scholarly journals Spinal angiolipoma: a report of two cases and review of the literature

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095469
Author(s):  
RuiDeng Wang ◽  
Hai Tang
Keyword(s):  
Standard Treatment ◽  
Clinical Presentation ◽  
Cord Compression ◽  
Benign Tumors ◽  
Fatty Tissue ◽  
Resonance Imaging ◽  
Total Resection ◽  
Vascular Channels ◽  
Spinal Angiolipomas

Spinal angiolipomas (SALs) are extremely rare benign tumors composed of both mature fatty tissue and anomalous vascular channels. We present two cases of SALs and review the clinical presentation, radiological appearance, pathological aspects, and treatment of this distinct clinicopathological mass. The patients’ neurologic symptoms improved postoperatively and follow-up revealed no signs of tumor recurrence or neurological deficit. SAL should be considered as a differential diagnosis in patients with spinal cord compression. Magnetic resonance imaging is important for detecting and characterizing SALs. The gold standard treatment modality should be total resection.

ORGANOPHOSPHATE INDUCED DELAYED NEUROPATHY-A CASE REPORT

2021 ◽  
pp. 31-32
Author(s):  
Sarita J. Parmar ◽  
Harsh A. Patel ◽  
Vraj Rathod ◽  
Kapil Parmar ◽  
Minakshi Chauhan ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Lower Limb ◽  
Electrophysiological Study ◽  
Lower Limbs ◽  
Limb Weakness ◽  
Axonal Polyneuropathy ◽  
Lower Limb Weakness ◽  
Severe Motor ◽  
History Of ◽  
Indian Male

Organophoshate induced delayed polyneuropathy (OPIDP) is a rare clinical condition associated with ingestion of organophosphate. Clinically the patient presents with distal lower limb weakness mainly along with paraesthesia and other symptoms of neuropathy. Nerve conduction study shows motor axonal neuropathy.Here, we are presenting a case of 23 years old INDIAN male who presented with pain and tingling sensations in lower limbs along with bilateral upper limb and lower limb paresis with difculty in getting up and walking. He had history of Dichlorvos based organophosphate ingestion around 45 days before. Electrophysiological study suggestive of Severe motor axonal polyneuropathy affecting all four limbs. No central nervous system signs were present.

scholarly journals Tuberculous lumbar spinal epidural abscess in a young adult (case report)

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 5
Author(s):  
Ghazwan Abdulla Hasan ◽  
Saif Mohammed Kani ◽  
Ahmed Alqatub
Keyword(s):  
Case Report ◽  
Lower Limb ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Mri Scan ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Lumbar Spinal ◽  
Spinal Epidural

Introduction: Spinal Epidural abscess (SEA) is an uncommon pathology that needs an urgent intervention to decompress the pressure on the spinal epidural sac, cord, and roots. The authors report a rare case of a young adult with lumbar spinal epidural tuberculous abscess occupying the spinal canal from L2–L5 vertebrae with extesion to the posterior paraspinal muscles and presenting with bilateral progressive lower limb weakness.   Case report: A 42 years old male teacher presented with a 15-day history of progressive difficulty to walking and bilateral lower limb weakness associated with fever, malaise and later on urinary incontinence. A magnetic resonance imaging (MRI) scan revealed a paraspinal intermuscular abscess and an abscess occupying the spinal canal compressing the dural sac from L2–L4/5, without any signs of vertebral involvement. Surgery was done by a posterior midline incision. Pus was evacuated from multiple pockets through the paraspinal muscle layers. Laminectomy for L3/4, and hemilaminectomy for L2/3, and L4/5 were performed. Pus and bone specimens were negative for acid-fast bacilli. However, both histopathological studies and Polymerase Chain Reaction (PCR) testing confirmed the presence of tuberculosis (TB). The patient received TB antibiotics, and a follow-up MRI scan at 2 months showed complete evacuation of the abscess. However, signs of L5 spondylitis were evident. No further surgery was needed as there was no vertebral collapse or neural compression and the patient's clinical condition was improving. He had normal right lower limb power and sensation and grade 4+ motor power of the left lower limb. Bowels and bladder function was normal. Conclusion: Isolated tuberculous spinal epidural abscess is a rare disease and should be treated urgently with evacuation and decompression. Signs of spondylitis or spondylodiscitis may appear later and therefore long follow up is recommended in tuberculous cases presenting with an isolated epidural abscess.

Spinal intradural myxoid chondrosarcoma

2012 ◽  
Vol 17 (4) ◽  
pp. 280-284 ◽  
Author(s):  
Ganeshwaran Shivapathasundram ◽  
Vanessa Sammons ◽  
Balsam Darwish
Keyword(s):  
Adjuvant Radiotherapy ◽  
Rare Case ◽  
Spinal Tumor ◽  
Rare Entity ◽  
Resonance Imaging ◽  
Limb Weakness ◽  
Myxoid Chondrosarcoma ◽  
Lower Limb Weakness ◽  
Intradural Extramedullary ◽  
Multiple Recurrences

The authors present a rare case of intradural extramedullary spinal chondrosarcoma. This 38-year-old man presented with urinary retention and lower-limb weakness. Magnetic resonance imaging demonstrated a thoracic intradural extramedullary spinal tumor, which was resected. Histopathology revealed a meningeal myxoid chondrosarcoma. Despite adjuvant radiotherapy, the patient had multiple recurrences and metastases and died 18 months following his first surgery. The management of the rare entity of spinal canal chondrosarcoma is discussed.

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