Analysis of Electrophysiological Parameters as an Early Indicator for Nerve Root Involvement among the Patients with Acute Lumbar Radiculopathy

Electrophysiological parameters especially the late responses which include H reflex analysis are of great significance and importance in diagnosing and predicting the level of nerve root involvement radiculopathy patients. The main objective of the present study was to analyse the electrophysiological parameters like amplitude and latency for prediction of nerve root involvement in lumbar radiculopathy patients. The present research project study was undertaken on 50 diagnosed patients of lumbar radiculopathy. The study participants were between the age group of 30-60 years and were having the low back pain ranging from 30-60 days. The bilateral nerve conduction studies were performed for posterior tibial nerve, sural nerve, and late responses like H waves were studied and analysed for amplitude and latency for all the patients. Patients with radiculopathy showed significant reduction in the amplitude of sural sensory nerve, the latencies were prolonged among the patients with L5-S1 root involvement based on the MRI findings. H wave’s amplitude asymmetry was significantly noted among the patients with L5-S1 root involvement suggesting the axonal compression at nerve root level earlier than the changes in the latencies for H waves. Prolonged latencies is reduction in the amplitude of sural nerve as well as, the amplitude asymmetry for late responses like H waves can be considered as one of the earlier signs of compression of the nerve roots in lumbosacral radiculopathy.

Microsurgical Resection of Cervical Intradural Juxtamedullary Solitary Fibrous Tumor: 2-Dimensional Operative Video

Solitary fibrous tumors (SFTs) are uncommon mesenchymal lesions originally described as pleura-based neoplasms. Intradural juxtamedullary SFTs are rare, hard, and scarcely vascularized and generally present a conspicuous extramedullary exophytic component without dural attachment and nerve root involvement. Gross-total resection is the mainstay of treatment, although the absence of an arachnoidal plane and the firm adherence to the spinal cord make resection challenging. We describe the case of a 74-yr-old female patient presenting with a history of progressive spastic tetraparesis due to a cervical juxtamedullary SFT. The patient was not able to walk and magnetic resonance imaging (MRI) of the cervical spine demonstrated a possible intramedullary lesion at C2-C3 with homogeneous enhancement after gadolinium injection. Given the progressive nature of symptoms, the patient elected to have surgical resection of the tumor. The patient underwent C2-C3 laminoplasty and tumor resection under neurophysiologic monitoring. The tumor presented extremely hard without dural attachment or nerve root involvement and was progressively debulked using microsurgical techniques and ultrasonic aspirator. The identification of a plane between the mass and the spinal cord white matter allowed for a gross total resection. Permanent pathological analysis eventually demonstrated SFT. The patient's neurological condition was unchanged postoperatively. MRI performed 2 mo after the operation demonstrated gross total resection of the lesion. At the 6-mo follow-up visit, the patient was able to walk with assistance. The patient signed the Institutional Consent Form to undergo the surgical procedure and to allow the use of her images and videos for any type of medical publications.

Rosai-Dorfman Disease: A Less Common Cause of Leptomeningeal and Nerve Root Enhancement

A 46-year-old male experienced progressive neurocognitive decline, weight loss, intermittent headaches, and weakness over 6 months. Magnetic resonance imaging of the brain revealed hydrocephalus and the spinal cord imaging showed diffuse leptomeningeal enhancement with prominent nerve root involvement. Intradural biopsy of lumbar arachnoid tissue found mixed inflammatory infiltrate consisting predominantly of histiocytes, S100 and CD68 positivity, and lymphocytophagocytosis (emperipolesis) consistent with extranodal Rosai-Dorfman disease. Rosai-Dorfman disease, a non-Langerhans cell histocytic disorder, can mimic the appearance of neurosarcoidosis and leptomeningeal carcinomatosis and should remain on the differential of a patient presenting with diffuse leptomeningeal enhancement, a common occurrence on a neurohospitalist service.

Dorsal cauda equina nerve root enhancement on magnetic resonance imaging due to ANNA-1-associated paraneoplastic polyneuropathy

A 69-year-old female presented with subacute onset ascending weakness and paraesthesias. She was initially diagnosed with Guillain–Barré syndrome (GBS) based on her clinical presentation and cerebrospinal fluid (CSF) analysis showing albuminocytological dissociation. However, she was later found to have anti-neuronal nuclear antibody 1 (ANNA-1/anti-Hu)-positive CSF and was subsequently diagnosed with small-cell lung cancer. Her neurological symptoms were ultimately attributed to ANNA-1/anti-Hu-associated paraneoplastic polyneuropathy. During the course of her evaluation, she had magnetic resonance imaging findings of dorsal predominant cauda equina nerve root enhancement, which has not been previously described. The only previously reported case of cauda equina enhancement due to ANNA-1-associated polyneuropathy described ventral predominant findings. The distinction between ventral and dorsal enhancement is important, since it suggests that different patterns of nerve root involvement may be associated with this paraneoplastic syndrome. Therefore, ANNA-1-associated paraneoplastic inflammatory polyneuropathy can be considered in the differential diagnosis of cauda equina nerve root enhancement with ventral and/or dorsal predominance. This can potentially be helpful in differentiating ANNA-1 polyneuropathy from GBS, which classically has ventral predominant enhancement.

Spinal Arachnoid Cyst in Children

Spinal arachnoid cyst is rarely seen in children. The presenting features can be mistakenly assumed as myelitis or Guillan-Barre syndrome. Intermittent weaknesses of the leg, progressive ascending weakness of the leg, sensory disturbance, and altered physiological reflexes are the hallmark of the disease. Nabors classified the pathology of the spinal arachnoid cyst into three types: extradural without nerve root involvement; extradural with nerve root; and intradural. It is mostly located in mid- to lower thoracic. The causes and natural history of pediatric arachnoid cysts are unclear. They usually are associated with trauma, surgery, arachnoiditis, and neural tube defects. MRI is a useful diagnostic tool. We present two cases of extradural and intradural arachnoid cysts in children. The follow-up and surgical results are reviewed. The surgical therapy itself is straightforward. However, the wrong conclusion might cause a financial burden and may cause preventable sequel.

Spinal Arachnoid Cyst in Children

Spinal arachnoid cyst is rarely seen in children. The presenting features can be mistakenly assumed as myelitis or Guillan-Barre syndrome. Intermittent weaknesses of the leg, progressive ascending weakness of the leg, sensory disturbance, and altered physiological reflexes are the hallmark of the disease. Nabors classified the pathology of the spinal arachnoid cyst into three types: extradural without nerve root involvement; extradural with nerve root; and intradural. It is mostly located in mid- to lower thoracic. The causes and natural history of pediatric arachnoid cysts are unclear. They usually are associated with trauma, surgery, arachnoiditis, and neural tube defects. MRI is a useful diagnostic tool. We present two cases of extradural and intradural arachnoid cysts in children. The follow-up and surgical results are reviewed. The surgical therapy itself is straightforward. However, the wrong conclusion might cause a financial burden and may cause preventable sequel.