Neurological complications of cervical spine manipulation.
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To obtain preliminary data on neurological complications of spinal manipulation in the UK all members of the Association of British Neurologists were asked to report cases referred to them of neurological complications occurring within 24 hours of cervical spine manipulation over a 12-month period. The response rate was 74%. 24 respondents reported at least one case each, contributing to a total of about 35 cases. These included 7 cases of stroke in brainstem territory (4 with confirmation of vertebral artery dissection), 2 cases of stroke in carotid territory and 1 case of acute subdural haematoma. There were 3 cases of myelopathy and 3 of cervical radiculopathy. Concern about neurological complications following cervical spine manipulation appears to be justified. A large long-term prospective study is required to determine the scale of the hazard. (+info)
Outcome of cervical spine surgery in patients with rheumatoid arthritis.
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OBJECTIVES: Cervical spine instability in patients with rheumatoid arthritis (RA) may lead to cervical myelopathy or occipital neuralgia, or both. Morbidity and mortality in patients with RA treated with cervical spine surgery during two years of follow up were evaluated. METHODS: Between 1992 and 1996 55 patients with RA underwent cervical spine surgery because of occipital neuralgia or cervical myelopathy, or both. Patients were classified according to the Ranawat criteria for pain and neurological assessment before operation and three months and two years postoperatively. For occipital neuralgia a successful operation was defined as complete relief of pain and for cervical myelopathy as neurological improvement. RESULTS: Occipital neuralgia was present in 17 patients, cervical myelopathy in 14 patients, and 24 had both. Surgical treatment in the patients with symptoms of occipital neuralgia who were still alive two years after surgery was successful in 18/29 (62%). In the surviving patients with cervical myelopathy neurological improvement of at least one Ranawat class was seen in 16/24 (67%). Postoperative mortality within six weeks was 3/51 (6%). Within two years after the operation 14 /51 (27%) of the patients had died; in most patients the cause of death was not related to surgery. The highest mortality (50%) was found in the group of six patients with quadriparesis and very poor functional capacity (Ranawat IIIB). CONCLUSION: Cervical spine surgery in patients with RA performed because of occipital neuralgia or cervical myelopathy, or both, is successful in most patients who are alive two years after surgery. However, the mortality rate during these two years is relatively high, which seems to be largely related to the severity of the underlying disease and not to the surgery itself. (+info)
An unusual spinal presentation of Whipple disease.
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SUMMARY: When Whipple disease (WD) is confined to the CNS, diagnosis may be difficult. We report a case of WD with spinal presentation in an otherwise healthy woman who had a 5-year history of relapsing-remitting cervico-thoracic myelopathy. We suggest that the diagnosis of WD should be considered in the presence of an enlarged and enhancing spinal cord even in the absence of any systemic involvement. (+info)
Inhibition of electromyographic activity in human triceps surae muscles during sinusoidal rotation of the foot.
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Torque and electromyographic (EMG) responses to sinusoidal rotations of the foot were measured. The frequency range of the movements was 0.5 Hz to 15 Hz at amplitudes ranging between 1 and 10 degrees. At frequencies above 7 Hz, the EMG activity did not follow individual foot rotation cycles. The EMG activity was inhibited whenever the peak torque was large with respect to the first cycle peak torque. Dantrolene sodium reduced the torque developed in triceps surae, allowing the EMG activity to follow individual stretch cycles. As the drug was metabolized, the EMG activity returned to the character seen in the pre-drug control--that is, inhibition on alternate stretch cycles. It is concluded that the EMG inhibition phenomenon can be attributed in part to force receptors in muscle but that these receptors are not the sole contributors to the inhibition. (+info)
Upper limb involvement in cervical spondylosis.
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Analysis of 200 cases reveals that the two neurological syndromes, brachial neuritis and myelopathy, associated with cervical spondylosis are distinct with relatively little overlap. While upper limb motor and sensory loss are doubtless due to nerve root compression in cases of "pure' brachial neuritis, they are more likely to be due to cord damage in cases with myelopathy (with spastic paraparesis of lower limbs). In either group of cases, neurological features in the upper limbs are not very helpful in localizing the level of significant intervertebral disc pathology. Contrast radiology (myelography and possibly discography) is a reliable guide judging by the excellent results obtained by anterior route (Cloward's) operation at specific disc levels in a series of cases with longstanding complaints unrelieved by conservative treatment. Pathological data provide a rational basis for interpretation of clinical observations and for surgical treatment. (+info)
MIP-1alpha, MCP-1, GM-CSF, and TNF-alpha control the immune cell response that mediates rapid phagocytosis of myelin from the adult mouse spinal cord.
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The slow immune response in the adult mammalian CNS results in slow myelin phagocytosis along degenerating white matter after injury. This has important consequences for axon regeneration because of the presence of axon growth inhibitors in myelin. In addition, abnormal immune cell responses in the CNS lead to demyelinating disease. Lysophosphatidylcholine (LPC) can induce an inflammatory response in the CNS, producing rapid demyelination without much damage to adjacent cells. In this study, we searched for the molecular switches that turn on this immune cell response. Using reverse transcription PCR analysis, we show that mRNA expression of macrophage inflammatory protein-1alpha (MIP-1alpha), macrophage chemotactic protein-1 (MCP-1), granulocyte macrophage-colony stimulating factor (GM-CSF), and tumor necrosis factor-alpha (TNF-alpha) in the spinal cord is rapidly and transiently upregulated after intraspinal injection of LPC. Neutralizing these signaling molecules with function-blocking antibodies suppresses recruitment of T-cells, neutrophils, and monocytes into the spinal cord, as well as significantly reduces the number of phagocytic macrophages and the demyelination induced by LPC. These findings will have important implications for CNS regeneration and demyelinating disease. (+info)
Primary spinal intradural hydatid cyst--a short report.
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Primary spinal hydatid cysts are uncommon. Among these, intradural presentation is very rare. A case of primary spinal intradural hydatid cyst presenting as incomplete dorsal cord compression is reported here for its rarity. (+info)
A 48-year-old male presented with progressive leg weakness. Magnetic resonance imaging and computed tomography myelography showed an extradural arachnoid cyst extending from the T-12 to L-2 levels in the thoracolumbar region. The cyst was confirmed at surgery and completely removed. This surgical intervention achieved improvement in the neurological symptoms. (+info)