Metameric capillary hemangioma producing complete myelographic block in an infant

✓ A variety of lesions of ectodermal, mesodermal, (rarely) endodermal, or mixed-cell layer origin involve the region of the conus medullaris. Some of these abnormalities produce cord tethering and others, such as lipoma, frequently present as masses. In the present case, an infant was discovered to have a lesion most closely resembling a capillary hemangioma involving the skin of the midline and right buttock, the deep soft tissues of the right buttock, the dura, and the conus medullaris. The origin of this congenital spinal tumor from primitive mesoderm is proposed in light of its metameric pattern of distribution.

Treatment of spinal epidural metastases

✓ Metastases to the spinal epidural space with compression of the spinal cord or cauda equina are commonly encountered by physicians in a variety of clinical fields. In the recent past, decompressive laminectomy followed by radiotherapy was thought to be the best available treatment. More recently, radiotherapy alone has been advocated as an alternative treatment mode with a similar rate of effectiveness. This study compares laminectomy followed by radiotherapy to radiotherapy alone in the treatment of spinal epidural metastases in a randomized, prospective clinical trial. No significant difference was found in the effectiveness of the two treatment methods in regard to pain relief, improved ambulation, or improved sphincter function. Patients with an incomplete myelographic block fared well regardless of treatment, and those with a complete block fared poorly. Because of the limited size of this study and because of certain unforeseen design defects, the results are suggestive but not conclusive. Suggestions are made for a future randomized, prospective multicenter study that would conclusively answer the perplexing question as to the most efficacious method for treating spinal epidural metastases.

Myelographic block caused by redundant lumbar nerve root

✓ A patient with weakness and muscular atrophy of the right leg was shown to have a myelographic block caused by a redundant lumbar nerve loop. Decompressive laminectomy was followed by a marked degree of recovery.

Incomplete myelographic block with hypertrophic spinal pachymeningitis

✓ A case of hypertrophic spinal pachymeningitis with a symmetrical constriction of the cervical and upper dorsal subarachnoid space on myelography is reported. Previous reports have emphasized complete or partial block of contrast flow at one level. The extensive symmetrical compression of the subarachnoid space seen in this case represents the early changes seen with hypertrophic spinal pachymeningitis which result from widespread thickening of the dura.

Neurological dysfunction in Paget's disease of the vertebral column

✓ The authors report four cases of Paget's disease of the vertebral column causing neurological deficit, one with sarcomatous degeneration and one without compression of the spinal cord, and review 86 reported cases. Most cases responded well to decompressive laminectomy. The paradox of neurological deficit without myelographic block is discussed and the relatively common incidence of sarcomatous degeneration noted.

Cysticercosis of the nervous system: less frequent clinical forms III- spinal cord forms

The spinal forms of cysticercosis are rather rare (2.7% of 296 cases of neurocysticercosis recorded in the Department of Neurology of the University of São Paulo Medical School). In a survey of the literature only 42 cases were found, most of them associated with cerebral symptoms. The reasons for this low incidence, as well as the possible routes followed by the parasite in its approach to the spinal cord, are discussed. After a review of the first cases reported in the literature, the authors refer the main syndromes (meningomyelitides, tabetiform pictures and spinal cord compressions) and some of the clinico-pathologic features of spinal cysticercosis. Nine cases of spinal cysticercosis are reported. The diagnosis was based on laboratorial data (mainly the complement fixation test for cysticercosis in the cerebrospinal fluid) or in the results of surgical therapy. Other cerebrospinal fluid findings (presence of eosinophile cells, protein contents, and the results of the manometric tests) are discussed. Myelographic block was demonstrated in 5 cases. Three of these patients were submitted to laminectomy, with variable results. The prevailing neurological picture was that of spinal cord and/or root compression (4 cases). Two patients showed a dorsal funiculi syndrome closely simulating tabes dorsalis. Two other patients presented a picture of meningomyelitis with no systematization. One patient had a syndrome suggestive of subacute combined degeneration of the spinal cord, but the presence of cerebral symptoms and the laboratorial data pointed to cysti-cercosis as the main disease process.