Vertebral Pain in Acute COVID-19—Cases Report

Pain is one of the most common complaints among patients infected by SARS-CoV-2. While headache and chest pain are reported widely among COVID-19 presentations, there are only scarce reports about vertebral pain. This study aims to describe cases of four healthy and physically active adults, in whom the new onset of back pain was the early or only sign of COVID-19 and the reason for seeking medical outpatient care. The vertebral pain showed great variability and changed dramatically during the course of disease. Pseudoradicular symptoms were present inconstantly and variably; in some patients they varied through the day from left to right side and irradiated from various sensory root segments. Clinical symptoms did not correspond with minor morphological changes presented on MRI scans. Our experience indicates that new onset of vertebral algic syndrome should be considered as an initial indicator of novel coronavirus infection in healthy and physically active adults. There is a pressing need for attention to be paid in the examination of patients with new vertebral pain onset in the coronavirus pandemic.

CISP-Plus: Expanding the Spectrum of Chronic Immune Sensory Polyradiculopathy (CISP)

Objectives:Sensory loss with normal nerve conduction studies (NCS) from focal sensory root inflammatory demyelination is characteristic of chronic immune sensory polyradiculopathy (CISP). However, non-pure cases involving motor and distal sensory nerves exist (CISP-plus). We hypothesize that CISP-plus and CISP are fundamentally part of the same syndrome through comparison of clinical, neurophysiological and pathological features.Methods:CISP-plus (primary dorsal root with lesser motor and sensory nerve involvement) and CISP cases were retrospectively analyzed (1986-2019).Results:We identified 44 CISP-plus and 28 CISP cases (n=72) with 86% (38/44) of CISP-plus and 79% (22/28) of CISP patients experiencing imbalance. On examination, large fiber sensory loss was present in 98% (43/44) of CISP-plus and 96% (27/28) of CISP. Gait ataxia was evident in 93% (41/44) of CISP-plus and 79% (22/28) of CISP. Mild distal weakness was common in CISP-plus (75%, 33/44). NCS showed mild abnormalities in all CISP-plus and were normal (by definition) in all CISP. Elevated cerebral spinal fluid (CSF) protein, slowing of somatosensory evoked potentials and MRI root enhancement occurred in most CISP-plus and CISP cases. Eleven CISP-plus nerve biopsies showed loss of large myelinated fibers and onion-bulb formation most prominent in rootlet biopsies. Immunotherapy resulted in marked improvement of gait ataxia in 84% (27/32) of CISP-plus and 93% (14/15) of CISP cases with return to normal neurological examination in half (25/46).Conclusion:The recognition of CISP-plus expands the spectrum of CIDP by combining CISP-plus (predominant sensory polyradiculopathy with mild motor and sensory nerve involvement) with pure-CISP (focal sensory polyradiculopathy) together as proximal sensory CIDP.

Clinical Effect of Partial Sensory Root Rhizotomy on Recurrence of Multiple Sclerosing Trigeminal Neuralgia After Percutaneous Balloon Compression

Objective To investigate the Clinical effect of partial sensory root rhizotomy(PSR) on recurrence of multiple sclerosing trigeminal neuralgia(TN-MS) after percutaneous balloon compression(PBC). Methods A retrospective analysis of the clinical data of 21 cases of recurrent multiple sclerosis trigeminal neuralgia after PBC who were treated with PSR in the Department of Neurosurgery of Xinxiang Central Hospital from January 2012 to July 2018; The diagnosis of MS was made by McDonald criteria, and using MRI to exclude REZ Regional blood vessels compress nerves; analysis of patients' preoperative and postoperative Visual Analogue Score (VAS), VAS 0-3 points means effective, 4 points and above means invalid or recurrence.Results Preoperative VAS: 8 -10 points in 21 cases, 1 day and 6 months after surgery VAS: 0-3 points in 21 cases, effective rate 100%; 12 months after surgery: 4 points in 2case, effective rate 95%, recurrence rate 5%; 18 months after surgery, 4 cases scored above 4, the effective rate was 81%, and the recurrence rate was 19%. The average point of VAS after PSR at 1 day, 6M, 12M, and 18M were lower than PBC, P<0.05, and the difference was statistically significant. The postoperative recurrence rate of PSR at 6M, 12M, and 18M is lower than that of PBC, P<0.05, and the difference is statistically significant. All 21 patients had facial sensation loss after surgery without major complications such as intracranial hemorrhage, facial palsy, and cerebrospinal fluid leakage. 1 case of intracranial infection. Conclusion PSR is effective in the treatment of TN-MS and can be used as a treatment for recurrence after PBC.

Nerve Splitting and Vascular Transposition for Trigeminal Neuralgia Attribute to Nerve Penetrating Trigeminocerebellar Artery: 2-Dimensional Operative Video

The trigeminocerebellar artery (TCA) is an infrequent anatomic anomaly of the branches originating from the basilar artery. It is clinically identifiable by the presence of the ipsilateral superior cerebellar artery and the anterior inferior cerebellar artery, and its course from the basilar artery to the cerebellar hemisphere. Because of its anatomic proximity to the trigeminal nerve root, the TCA often causes trigeminal neuralgia (TGN). Unlike other common arteries, repositioning the TCA is not always feasible when it penetrates the trigeminal nerve root (the intraneural type of TCA). In addition, the rich perforators originating from the TCA may limit its movability. The nerve decompression technique in such a rare condition has not yet been fully assessed. In this video, we present the nerve-splitting method for the intraneural type of TCA, in which sufficient isolation of the sensory root is achieved. The motor root of the trigeminal nerve originates from the brainstem slightly rostral of the root entry zone of the sensory root. Dissecting the motor root from its exit to the porous trigeminus allows mobilization of the root together with penetrating TCA away from the sensory root. The movability of the TCA increases by dissecting its perforators to the nerve root and brain stem. Sufficient separation of the sensory root contributes to ensuring the surgical result of nerve decompression and reducing the risk of recurrence due to adhesion. No complications of motor root retraction, such as masseter weakness and malocclusion, were noted in our experience. All data identifying the patients were anonymized. All procedures performed in this study were in accordance with the ethical standards of our institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study also obtained approval from the ethics committee of our institution. Written informed consent was obtained from all individual participants, as well as their first-degree relatives, included in this study.

Imaging of Mouse Brain Fixated in Ethanol in Micro-CT

Micro-CT imaging is a well-established morphological method for the visualization of animal models. We used ethanol fixation of the mouse brains to perform high-resolution micro-CT scans showing in great details brain grey and white matters. It was possible to identify more than 50 neuroanatomical structures on the 5 selected coronal sections. Among white matter structures, we identified fornix, medial lemniscus, crossed tectospinal pathway, mammillothalamic tract, and the sensory root of the trigeminal ganglion. Among grey matter structures, we identified basal nuclei, habenular complex, thalamic nuclei, amygdala, subparts of hippocampal formation, superior colliculi, Edinger–Westphal nucleus, and others. We suggest that micro-CT of the mouse brain could be used for neurohistological lesions evaluation as an alternative to classical neurohistology because it does not destroy brain tissue.

Spinal Cord Tumor

Most intradural extramedullary tumors are histologically benign. The three most common intradural extramedullary tumors encountered are meningiomas, schwannomas, and neurofibromas. Excision of intradural meningiomas can be achieved via an en bloc fashion by utilizing a split-thickness durotomy or by ultrasonic aspiration and piecemeal removal. Patients often become symptomatic from spinal cord compression earlier than mass effect upon the brain. Therefore, surgical resection may be undertaken before pial penetration occurs. Neurofibromas commonly arise as a fusiform enlargement of the nerve, making it necessary to sacrifice the root during excision of the tumor. Schwannomas arise from the nerve root of origin, which is usually a nonfunctional dorsal sensory root that can be sacrificed; there is always a corresponding nerve root, which is typically a functional ventral motor root, that needs to be dissected off the tumor.