Progressive Quadriparesis and Cancer

A 67-year-old man with a history of cigarette smoking sought care at the emergency department for nonspecific dizziness and fatigue. During evaluation, chest radiography showed a right upper lobe mass, and he subsequently underwent right upper lobectomy. Histologic analysis of resected tissue showed the mass to be small cell lung carcinoma. Progressive myelopathy developed. Adjuvant chemotherapy with carboplatin and etoposide was begun. His neurologic symptoms continued to worsen, with gait imbalance, along with numbness and dysesthesias of the 4 limbs and trunk, with a sensory level at C3-C4. He also reported severe bowel and bladder dysfunction. At his neurologic nadir, he had severe quadriparesis and was wheelchair dependent. Cerebrospinal fluid analysis showed lymphocytic pleocytosis of 9 lymphocytes/µL, erythrocyte count of 2/µL, and normal protein and glucose values. Serum neural autoantibody screening revealed the presence of collapsin-response mediator protein 5–immunoglobulin G antibodies on both tissue-based indirect immunofluorescence assay and Western blot. The patient was diagnosed with paraneoplastic myelopathy. The patient was initially treated acutely with a combination of high-dose oral prednisone and plasmapheresis, without improvement. Subsequently, a combination of intravenous immunoglobulin and rituximab resulted in partial improvement. Soon after treatment discontinuation, his symptoms returned with worsening weakness, numbness, and neuropathic pain. Monthly intravenous immunoglobulin and rituximab were reinitiated, with improvement again noted. Oral corticosteroids, methadone, and high-dose gabapentin were also administered, with mild benefit for neuropathic pain. Follow-up spine magnetic resonance imaging 3 years after symptom onset showed evidence of spinal cord atrophy. At 5-year follow-up he remained in remission from small cell lung cancer but was wheelchair dependent. Paraneoplastic myelopathy is a rare and underrecognized neurologic disorder that most often manifests before cancer detection, Clinical presentation is generally subacute or slowly progressive over months, but acute onset is possible. Cerebrospinal fluid typically shows lymphocytic pleocytosis, as in this case patient.

A rare case of Diastematomyelia with syrinx and tethered cord in a newborn

Diastematomyelia or Split cord syndrome is a rare form of spinal dysraphism characterized by longitudinal splitting of spinal cord, conus medullaris or filum terminale to a variable extent. Presence of SCM is suggested by certain superficial markers like skin pigmentation, hemangioma, lipoma, dermal sinus and hypertrichosis. Meningocele or myelomenigocele may also be present. Affected children usually present with progressive sensorimotor symptoms and bowel and bladder dysfunction. Development of sensorimotor symptoms and progressive loss of function emphasis the need for antenatal diagnosis of the spinal deformities which paves way for early intervention and management thus minimizing the morbidity.

The association of selected multiple sclerosis symptoms with disability and quality of life: a large Danish self-report survey

Background People with multiple sclerosis (MS) experience a wide range of unpredictable and variable symptoms. The symptomatology of MS has previously been reported in large sample registry studies; however, some symptoms may be underreported in registries based on clinician-reported outcomes and how the symptoms are associated with quality of life (QoL) are often not addressed. The aim of this study was to comprehensively evaluate the frequency of selected MS related symptoms and their associations with disability and QoL in a large self-report study. Methods We conducted a cross-sectional questionnaire survey among all patients at the Danish Multiple Sclerosis Center, Copenhagen University Hospital, Denmark. The questionnaire included information on clinical and sociodemographic characteristics, descriptors of QoL and disability, as well as prevalence and severity of the following MS symptoms: impaired ambulation, spasticity, chronic pain, fatigue, bowel and bladder dysfunction, and sleep disturbances. Results Questionnaires were returned by 2244/3606 (62%). Participants without MS diagnosis or incomplete questionnaires were excluded, n = 235. A total of 2009 questionnaires were included for analysis (mean age 49.4 years; mean disease duration 11.7 years; and 69% were women). The most frequently reported symptoms were bowel and bladder dysfunction (74%), fatigue (66%), sleep disturbances (59%), spasticity (51%) and impaired ambulation (38%). With exception of fatigue and sleep disturbances, all other symptoms increased in severity with higher disability level. Invisible symptoms (also referred to as hidden symptoms) such as fatigue, pain and sleep disturbances had the strongest associations with the overall QoL. Conclusion We found invisible symptoms highly prevalent, even at mild disability levels. Fatigue, pain and sleep disturbances had the strongest associations with the overall QoL and were more frequently reported in our study compared with previous registry-based studies. These symptoms may be underreported in registries based on clinician reported outcomes, which emphasizes the importance of including standardized patient reported outcomes in nationwide registries to better understand the impact of the symptom burden in MS.

Myelopathies from Neoplasms

Benign and malignant tumors can be an important cause of myelopathy. Patients may present with a wide range of neurologic symptoms including back and neck pain, weakness, sensory abnormalities, and bowel and bladder dysfunction. Management can be challenging depending on the location and underlying biology of the tumor. Neuroimaging of the spine is an important component of diagnostic evaluation and patient management both during initial evaluation and when monitoring after treatment. This article provides a systematic and practical review of neoplasms that can cause myelopathy. Unique imaging and biological features of distinct tumors are discussed, and their management strategies are reviewed.

Erectile Dysfunction Is the Main Correlate of Depression in Men with Chronic Spinal Cord Injury

Depression is the most prevalent psychological issue after a spinal cord injury (SCI) and is associated with noticeable disability, mortality and health expenditure. As SCI mainly occurs in sexually active men at a young age, and can lead to them suffering from an organic neurogenic erectile dysfunction (ED), we supposed that ED could be a major correlate of depressive status in men with SCI. As documented by a Beck Depression Inventory-II (BDI-II) score ≥14, depression was reported in 17 out of 57 men with a chronic SCI (29.8%). They exhibited a significantly higher prevalence of ED and a more severe bowel and bladder dysfunction when compared to the group without depression. At the multiple logistic regression analysis, depression showed a significant independent association with ED (OR = 19.0, 95% CI: 3.1, 203.3; p = 0.004) and, to a lesser extent, with a severe impairment of bowel and bladder function (OR = 0.84; 95% CI: 0.72, 0.94; p = 0.01). Depression was observed in 43.7% of men with ED and only in 12.0% of those without ED (p = 0.002). In conclusion, healthcare providers should give the right level of importance to the management of ED in men with SCI, as this represents a major independent correlate of depression, which, in turn, might hinder physical rehabilitation and exacerbate physical health issues related to SCI.

Deep infiltrating endometriosis with bowel involvement. Literature review

Endometriosis is a prevalent disease in females of the childbearing age. It may be accompanied by bowel involvement. In such cases, the most frequently observed lesion locations are the rectum and the rectosigmoid with the occurrence rate of 3-37 %. Treatment of severe forms of deep infiltrating endometriosis with bowel wall involvement is one of the most challenging problems of modern gynaecology. Apart from general intra- and postoperative risks (haemorrhage, infection, direct damage to the organs) or bowel and bladder dysfunction, one of the most severe complications is the development of anastomotic leaks. This article presents a review of literatures dated 2010-2020 searched for in PubMed and Google Scholar databases and devoted to operative treatment of patients with deep infi ltrating endometriosis. We made an emphasis on the effi cacy of the multidisciplinary approach to operative treatment of patients with deep infiltrating endometriosis and bowel involvement. Multidisciplinary laparoscopic treatment has become a standard of medical aid in deep infiltrating endometriosis. Depending on the size of endometrial lesion and the location of bowel involvement, complete removal of the infiltrate or bowel resection is performed in cooperation with an experienced colorectal surgeon. The operative tactics in laparoscopic endometriosis resection, including bowel resection, may provide advantages for both the patients and the healthcare system. The optimal model is to be chosen drawing on the basis of the maximum benefit for the patient.

Metastatic spine oncology: symptom-directed management

Spinal tumors pose significant treatment challenges for the physicians treating them. Understanding the location of the tumor within the intramedullary, intradural extramedullary, or extradural (epidural) space is not only critical in determining a differential diagnosis but may also provide important information about current and future neurologic deficits. Despite significant advances in the treatment of spinal tumors over the past few decades, these patients may still experience significant symptoms related to the tumor or its treatment, such as pain, weakness, impaired sensation, and bowel and bladder dysfunction. Treatment of spinal tumors should involve a multidisciplinary team of neuro-oncologists, spine surgeons, medical and radiation oncologists, physiatrists, and pain specialists to provide comprehensive oncologic management, while optimizing the patient’s functional status and quality of life.

Isolated Bowel and Bladder Dysfunction following Single Level Lumbar Discectomy : A Rare Observation

Cauda equina syndrome is reported as a complication in 0.2% - 1% following lumbar disc herniation . The pathophysiologic mechanism of this complication and its management is yet poorly understood. Though some factors has postulated in different studies. In this case, patient’s back pain and leg pain is satisfactorily improved with newly onset retention of urine followed by overflow incontinence and constipation after a single level lumbar discectomy. No abnormalities were seen on the postoperative imaging studies. This is a retrospective analysis of records and radiographs in a patient who developed acute bowel and bladder dysfunction after surgery for lumbar disc herniation. Bang. J Neurosurgery 2019; 9(1): 54-56