A rare case as different cause of retropharyngeal and spinal epidural abscess: spondylodiscitis

Background Retropharyngeal abscess (RPA) is a life-threatening, dangerous condition and uncommon in adults. The coexistence of RPA, cervical spinal epidural abscess (CSEA), and spondylodiscitis is extremely rare. Case presentation We present a case with a retropharyngeal and epidural abscess caused by spondylodiscitis. A 61-year-old man was referred to our clinic with the complaints of sore throat, limitation in neck range of motion, numbness, and weakness in the left arm and the left ear for one month. The airway was not obstructed. Neurological deficits were detected in his left arm. Cervical computed tomography revealed a 50 × 30 × 15 mm retropharyngeal abscess. Cervical magnetic resonance imaging showed abscess, C5–6 spondylodiscitis and epidural abscess, and myelopathic signal changes in the C3–7 spinal cord. The abscess was drained, and C5–6 discectomy was performed. The patient was discharged with cervical collar and antibiotics. Conclusions Multidisciplinary approach that consists of otolaryngologist, neurosurgeon, and infectious disease specialist is needed to avoid complications and any delay.

Cervical intra-extradural meningioma with en-plaque, dumbbell-shaped, and an unusual calcified pattern in a young patient

Background: Most spinal meningiomas primarily grow in the intradural extramedullary location. Epidural meningiomas are uncommon; if detected, they usually coexist with intradural lesions. They inhere more aggressive and invasive characteristics compared with their counterparts inside the dura. Case Description: We report a 22-year-old female who was admitted to the hospital with weakness and numbness in both lower limbs. Her cervical magnetic resonance imaging revealed an en-plaque and dumbbell-shaped lesion located from C5 to C8. After gadolinium injection, the whole mass was enhanced and unveiled two portions: intradural and extradural. The bone window of the computed tomography scan revealed calcification inside the lesion. The patient underwent tumor removal surgery. The pathology findings showed a psammomatous meningioma. After 6 months of surgery, the patient has been able to walk with walkers. Conclusion: We should consider spinal meningioma as a differential diagnosis when encountering an extradural lesion in the cervical region. The optimal surgical treatment for young patient with epidural meningiomas is radical surgery with dura attachment removal.

Para-Infectious Acute Transverse Myelitis Following Sars-Cov2 Infection: A Case Report

Introduction: The new pandemic has highlighted new ways of clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) including a possible link to central nervous system (CNS) manifestation. Case report: We present a case of acute transverse myelitis following a SARS-CoV 2 infection in a 34-year-old man who presented with bilateral lower-extremity weakness and acute urinary retention. Cervical magnetic resonance imaging showed a T2 hyperintense signal abnormality at C3-C6 and D3-D7 levels consistent with acute myelitis. Conclusion: SARS-CoV 2 can cause myelitis by immune-mediated mechanisms, therefore it is extremely important for the clinicians to recognise the signs and promptly treat this neurological complication.

Amyotrophic Monoplegia Secondary to Posttraumatic Rupture of the Brachial Plexus’s Roots: A Case Report and Review of the Literature

Brachial plexus lesions most often occur in multiple trauma. We report a case of a 37-year-old patient who presented an upper left limb total sensitivomotor deficit and amyotrophy after a cervical and upper limb trauma. Cervical magnetic resonance imaging (MRI) was performed. It noted pseudomeningoceles at the levels of C6-C7, C7-D1, and D1-D2 in T1 hyposignal , T2 and STIR hypersignal , not enhanced by the injection of Gadolinium extending in foraminal and extraforaminal spaces without visualization of the corresponding rootlets. Traumatic brachial plexus injury is a potentially serious debilitating injury which can be well explored on MRI.

Older-age onset of Kimura’s disease

A 60-year-old man was admitted to our hospital with bilateral post auricular masses, first noticed 1 year earlier. Blood tests showed eosinophilia and high immunoglobulin E (IgE) levels, and cervical computed tomography showed 10-mm soft tissue masses with scattered lymphadenopathy. The tumors showed intermediate and high signal intensity on T1- and T2-weighted cervical magnetic resonance imaging, respectively. After mass resection, the tumors were diagnosed as Kimura’s disease (KD). Generally, KD affects young men; however, even in older patients, KD should be included as a differential diagnosis for head and neck tumors in patients with eosinophilia and high IgE.

CERVICAL NEURENTERIC CYST: A CASE REPORT

ABSTRACT Objective Neurenteric cysts account for 0.7–1.3% of all spinal cord tumors. These rare lesions are composed of heterotopic endodermal tissue. Methods A 26-year-old woman with a 13-month history of severe cervicalgia and brachial paresthesia. Clinically she had mildbilateral brachial paresis (4/5), generalized hyperreflexia and a left Babinski Sign. Past medical history was significant for a cervical fistula closure when she was 1yearold. The superior somatosensory evoked potentials revealed medullary axonal damage with a left predominance. A cervical magnetic resonance imaging of the neck was performed showing a dorsal homogeneous cystic intradural extramedullary lesion with high signal intensity on T2. Computed tomography revealed a Klippel-Feil syndrome. Results A posterior laminectomy and surgical excision were performed without complications. Post-operative follow-up showed a complete recovery of arm strength. The histopathological report confirmed the preoperative diagnosis of neurenteric cyst. Most neurenteric cysts are located in the spine, mainly in a ventral position. A total of 95% of neurenteric cysts are found in the intradural/intramedullary compartment. Symptomatic neurenteric cysts typically appear in the second and third decades of life and are 1.5 to 3 times more common in men. In 50% of the cases, other vertebral malformations have also been reported. In this case, a congenital dorsal enteric cyst and a Klippel-Feil syndrome were observed. Conclusions The intraspinal neurenteric cysts are rare lesions that must be included in the differential diagnosis of a dorsal, intradural cystic structure. The diagnosis may be overlooked, especially in cases of chronic neck pain without neurological deficit. Level of evidence V; Expert Opinion.

Existence of Cervical Discopathy in Non-Cyclic Mastodynia

Background: Mastodynia is a subjective symptom that impairs the quality of life. It may be directly related with breast disorders. Moreover, a substantial rate is caused of reflective pain. Objectives: Non-cyclic mastodynia is multifactorial, and treatment should be planned according to the underlying cause. In this study, we aim to evaluate the existence of cervical discopathy via cervical magnetic resonance imaging (MRI) in the etiology of non-cyclic mastodynia. Methods: The study included 60 patients with normal physical examination results and imaging findings. Management was determined individually in patients. Patients with pathological MRI findings were evaluated by physical therapy, rehabilitation, and neurosurgery specialists, and appropriate treatment was planned. Patients were evaluated with the visual analogue scale (VAS) scoring system at initial presentation and after 1 and 3 months of treatment. Results: The majority of patients had positive findings on MRI (53 [88.4%] vs. 7 [11.6%]). The mean VAS scores at the time of presentation, after 1, and after 3 months of treatment were 7.41, 6.39, and 3.35, respectively. The decrease in the scores was statistically significant (p ≤ 0,01). Conclusions: We suggest that cervical discopathy should be kept in mind in cases of idiopathic non-cyclic mastodynia. Furthermore, cervical discopathy-related mastodynia seems to have a good response to appropriate treatment.

A case involving a giant aberrant craniocervical arteriovenous malformation

Background: Spinal cord arteriovenous malformations (AVMs) comprise about 3%–4% of primary intraspinal masses and are only rarely found external to the C2–C7 cervical vertebral foramen. Case Description: A 21-year-old female presented with neck pain and a spastic quadriparesis of 1 year duration. The cervical magnetic resonance imaging and three-dimensional computed tomography angiograms documented an AVM/dural arteriovenous fistula on the right fed by multiple arteries located in the C5–C6 and C6–C7 foramen intervertebralis; utilizing a laminectomy, the large feeding arteries were double-clipped. This allowed for devascularization of the AVM and facilitated resection while preserving the aberrant vertebral artery. The patient was discharged within 1 week and, 2 months later, was able to ambulate to the outpatient clinic. Conclusion: Double clipping of the two main right-sided arterial feeders at the C5–C6 and C6–C7 levels allowed for devascularization and resection of this large cervical AVM while carefully preserving the aberrant vertebral artery.

Juvenile Muscular Atrophy of the Proximal Upper Extremity as So-Called Proximal-Type Hirayama Disease: Case Report and Review of the Literature

Hirayama disease is a distinct type of cervical myelopathy characterized by juvenile onset of unilateral muscular atrophy of a distal upper extremity. We report herein a case with Hirayama disease-like juvenile muscular atrophy involving proximal muscles in the upper extremities. In this case, in the flexion position of the neck, cervical magnetic resonance imaging revealed that the spinal cord was compressed by expansion of the posterior extradural space with forward displacement of the dura matter. These neuroimaging results are identical to those of Hirayama disease. However, the involved muscles in this case were the proximal muscles, unlike Hirayama disease. Five previous cases have displayed this rare subtype of Hirayama disease. The cause of the unique phenotype may be abnormal cervical column alignment, with upper cervical kyphosis producing a higher apex of the vertebral level in a cervical flexion position, resulting in mid-cervical segmental myelopathy.