Spontaneous chronic spinal epidural hematoma of the lumbar spine.
We report an exceptional description of a spontaneous chronic spinal epidural hematoma presenting as lumbar radiculitis. The computed tomographic, magnetic resonance imaging, and intraoperative findings are presented. We discuss anatomical and pathophysiological considerations that could lead to such a condition. We estimate that spontaneous spinal epidural hematomas located in the ventral space are in fact premembranous or posterior longitudinal ligament hematomas. (+info)
Migrated disc in the lumbar spinal canal--case report.
A 49-year-old man who had complained of back pain for 20 years presented with numbness and pain in his left leg persisting for 6 weeks. Magnetic resonance imaging demonstrated a peripherally enhanced intraspinal mass at the L-3 level. The mass was completely removed. The operative and histological findings revealed degenerated disc fragments surrounded by granulation tissue. His symptoms were completely relieved. Migrated disc should be included in the differential diagnosis of patients with a long history of back pain and an intraspinal mass. (+info)
Neurological complications of spinal tuberculosis in children.
Neurological complications of thoracic and lumbar spinal tuberculosis were studied in 32 patients under the age of 16 years. The majority had lesions involving three or more vertebral bodies. Paraplegia occurred in 8 patients and was always associated with bladder and bowel dysfunction. Lesions located at T4/5 were most commonly accompanied by paraplegia. Deterioration of the neurological status was related to the degree of spinal stenosis, whereas the degree of kyphosis was of less importance. Radiculopathy is rare in children with Pott's disease. (+info)
Cervical radiculopathy and myelopathy: when and what can surgery contribute to treatment?
Indications and timing of surgical treatment for cervical radiculopathy and myelopathy, and the long-term results for the conditions, were reviewed. Advances in spinal imaging and accumulation of clinical experience have provided some clues as to indications and timing of surgery for cervical myelopathy. Duration of myelopathy prior to surgery and the transverse area of the spinal cord at the maximum compression level were the most significant prognostic parameters for surgical outcome. Thus, when myelopathy is caused by etiological factors that are either unchangeable by nature, such as developmental canal stenosis, or progressive, such as ossification of the posterior longitudinal ligament, surgical treatment should be considered. When an etiology of myelopathy is remissible, such as soft disc herniation and listhesis, surgery may be reserved until the effects of conservative treatment are confirmed. When surgery is properly carried out, long-term surgical results are expected to be good and stable, and the natural course of myelopathy secondary to cervical spondylosis may be modified. However, little attention has been paid to the questions "When and what can surgery contribute to treatment of cervical radiculopathy?". A well-controlled clinical study including natural history should be done to provide some answers. (+info)
A 57-year-old male presented with a rare case of spontaneous vertebral arteriovenous fistula manifesting as radiculopathy of the right arm, subsequently associated with pulsating tinnitus and vascular bruit in the nape. He had a past history of chiropractic-induced vertebrobasilar infarction. Angiography showed a simple and direct fistula between the third segment of the right vertebral artery and the epidural veins at the C-1 level, where the artery runs backward above the arch of the C-1 just proximal to the penetration of the dura. The fistula was successfully obliterated by coil embolization, resulting in rapid improvement of the signs and symptoms. Mechanical compression to the nerve roots by the engorged epidural veins with arterial pressure was considered to be the major cause of radiculopathy. Vertebral artery dissection induced by chiropractic manipulation is most likely responsible for the development of the fistula. (+info)
Tuberculous radiculomyelitis complicating tuberculous meningitis: case report and review.
Tuberculous radiculomyelitis (TBRM) is a complication of tuberculous meningitis (TBM), which has been reported rarely in the modern medical literature. We describe a case of TBRM that developed in an human immunodeficiency virus (HIV)-infected patient, despite prompt antituberculous treatment. To our knowledge, this is the second case of TBRM reported in an HIV-infected patient. We also review 74 previously reported cases of TBRM. TBRM develops at various periods after TBM, even in adequately treated patients after sterilization of the cerebrospinal fluid (CSF). The most common symptoms are subacute paraparesis, radicular pain, bladder disturbance, and subsequent paralysis. CSF evaluation usually shows an active inflammatory response with a very high protein level. MRI and CT scan are critical for diagnosis, revealing loculation and obliteration of the subarachnoid space along with linear intradural enhancement. As in other forms of paradoxical reactions to antituberculous treatment, there is evidence that steroid treatment might have a beneficial effect. (+info)
Haemorrhagic lumbar synovial cyst. A cause of acute radiculopathy.
A total of 254 cases of synovial cysts of the spine have been reported in the English literature, but only eight have been associated with haemorrhage. We describe a 55-year-old man with acute radiculopathy resulting from haemorrhage involving a synovial cyst at a lumbar facet joint. Traumatic factors could have caused bleeding around or into the synovial cyst. Treatment by resection of the cyst and evacuation of the haematoma led to complete neurological recovery. (+info)
Neuroprotection by encephalomyelitis: rescue of mechanically injured neurons and neurotrophin production by CNS-infiltrating T and natural killer cells.
In experimental autoimmune encephalomyelitis (EAE), CD4(+) self-reactive T cells target myelin components of the CNS. However, the consequences of an autoaggressive T cell response against myelin for neurons are currently unknown. We herein demonstrate that EAE induced by active immunization with an encephalitogenic myelin basic protein peptide dramatically reduces the loss of spinal motoneurons after ventral root avulsion in rats. Both brain-derived neurotophic factor (BDNF)- and neurotrophin-3 (NT-3)-like immunoreactivities were detected in mainly T and natural killer (NK) cells in the spinal cord. In addition, very high levels of BDNF, NT-3, and glial cell line-derived neurotrophic factor mRNAs were present in T and NK cell populations infiltrating the CNS. Interestingly, bystander recruited NK and T cells displayed similar or higher neurotrophic factor levels compared with the EAE disease-driving encephalitogenic T cell population. High levels of tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) mRNAs were also detected, and both these cytokines can be harmful to several types of CNS cells, including neurons. However, treatment of embryonic motoneuron cultures with TNF-alpha or IFN-gamma only had a deleterious effect in cultures deprived of neurotrophic factors. These results suggest that the potentially neurodamaging consequences of severe CNS inflammation are curbed by the production of several potent neurotrophic factors in leukocytes. (+info)