Three cases of dorsal intramedullary cysticercosis presenting as spastic paraparesis or paraplegia are reported. A definite preoperative diagnosis, using MRI, was made in two cases while in the third it was strongly suspected. One paraplegic patient regained full function whereas in the other two the deficit persisted even after successful cyst excision. The pathogenesis and recovery are discussed in the light of the MRI findings. (+info)
Atlas hypoplasia manifesting as myelopathy in a child--case report.
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A 14-year-old Japanese boy presented with myelopathy due to atlas hypoplasia with complete posterior arch. Decompressive laminectomy of the atlas produced good neurological recovery, and follow-up T2-weighted magnetic resonance imaging showed disappearance of spinal cord edema. Congenital atlas stenosis may be symptomatic even in children, with no accompanying cervical spondylotic change. Such cases have previously occurred only in Asian adults. A radiological study of the patient's brother showed median cleft formation of the posterior arch of atlas, indicative of a wide spectrum of atlas anomalies and a possible genetic relationship between these anomalies. (+info)
Flaccid paraplegia: a feature of spinal cord lesions in Holmes-Adie syndrome and tabes dorsalis.
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In a patient with Holmes-Adie syndrome, and in another with tabes dorsalis, a transverse cord lesion resulted in a severe, but flaccid paraplegia with absent tendon reflexes. Flexor spasms were severe in both patients, but spasticity was absent. The significance of these observations is discussed in relation to the functional and anatomical disorder in these two syndromes. (+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)
Spinal cord and cauda equina compression in 'DISH'.
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Diffuse idiopathic skeletal hyperostosis (DISH) has long been regarded as a benign asymptomatic clinical entity with an innocuous clinical course. Precise information is lacking in the world literature. Authors report the results of a retrospective analysis of 74 cases of DISH. Eleven patients presented with progressive spinal cord or cauda equina compression. In nine cases ossified posterior longitudinal ligament (OPLL) and in two cases ossified ligamentum flavum (OLF) were primarily responsible. Surgically treated patients (eight) had far better outcome as compared to the patients managed conservatively, as they had refused surgery. 'DISH' is neither a benign condition, nor it always runs a innocuous clinical course. In fact, in about 15% of the cases, serious neurological manifestations occur, which may require a major neurosurgical intervention. (+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)
Cervical myelopathy due to compression by bilateral vertebral arteries--case report.
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A 69-year-old man presented with progressive cervical myelopathy due to vascular compression of the upper cervical spinal cord. Vertebral angiography and magnetic resonance imaging revealed that the elongated bilateral vertebral arteries (VAs) had compressed the spinal cord at the C-2 level. The spinal cord was surgically decompressed laterally by retracting the VAs with Gore-Tex tape and anchoring them to the dura. The patient's symptoms improved postoperatively. Decompression and anchoring of the causative vessels is recommended due to the large size of the VAs. (+info)
Factors predictive of subsequent deterioration in rheumatoid cervical myelopathy.
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OBJECTIVE: To identify the features of rheumatoid cervical spine disease associated with deterioration resulting in the need for surgical intervention or death. PATIENTS AND METHODS: Patients with rheumatoid cervical myelopathy who underwent cervical spine magnetic resonance imaging (MRI) between 1991 and 1996 were identified. Patients requiring immediate surgical intervention were excluded. The remainder were divided into two groups. Deterioration group: patients requiring surgical intervention during the follow-up period and deaths resulting from cervical myelopathy. Conservative group: all other patients. Relevant clinical features and radiology reports were extracted retrospectively from the casesheet. RESULTS: The deterioration group comprised 11 patients (12%), median time to deterioration 15 months (range 4-84 months). The conservative group included 82 patients. Initial clinical features did not differ significantly between the two groups. Sixty per cent of those patients with compression or impingement at the atlanto-axial level on first MRI deteriorated over a median of 12 months (range 4-36 months). CONCLUSION: Deterioration is likely if there is evidence of cord compromise at the atlanto-axial level on MRI regardless of initial clinical and plain X-ray features. (+info)