A 13-year-old, Thoroughbred gelding presented with a 3-year history of progressive ataxia of all 4 limbs. Physical and neurological examinations indicated a compressive lesion affecting the cervical spinal cord. Radiographs confirmed a lesion, and a myelogram a narrowing of the spinal canal at cervical vertebrae (6-7). Necropsy confirmed cervical stenotic myelopathy. (+info)
Molecular basis of behavioral recovery following spinal cord decompression: an immunocytochemical study.
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OBJECTIVES: To examine whether the expression of choline acetyltransferase (ChAT), a marker for cholinergic neurons, and growth-associated protein (GAP-43), a marker for synaptogenesis, occurs differently following compression vs. decompression of spinal cord, and whether the reactions have any relationship with the time course of behavioral recovery. METHODS: A spinal cord compression model was studied quantitatively with an immunohistochemical method. The behavioral recovery of the rat was assessed by combined behavior score (CBS). RESULTS: The rebound in the ChAT-positive cell ratio was higher in decompressed cord than in compressed one. The time course of the change in the ChAT-positive cell ratio coincided with the recovery of CBS in the two models. Increased GAP-43 expression was found in the region of injured cord in the two models. Increased GAP-43 expression was partially parallel to the recovery of CBS, both in the decompression and continuous compression groups. CONCLUSIONS: The results indicate that there are ChAT reversible neurons in both the compressed and decompressed cord, the number of which is closely related to the recovery of behavior following cord injury. Synaptogenesis plays a limited role in behavior recovery. (+info)
Paraplegia in spondylitis: results of operative treatment.
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Thirty patients with spondylitis were treated by decompression of the cord (31 operations). The spondylitis was tuberculous in 28 of septic unspecific aetioloty in two cases. The results with respect to the neurological symptoms were complete recovery in 24 cases, imcomplete recovery in four cases, and failure in three cases, or in ten per cent. Transthoracic anterior decompression was found to be the safest and quickest way to obtain restitution. Out of the ten patients treated by this method, nine recovered completely. One post-operative death from pulmonary embolism occurred. One patient died because of adrenal insufficiency due to adrenal tuberculosis which could not be diagnosed during life. There were no other serious complications attributable to the operative interventions. (+info)
Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy.
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OBJECTIVES: Surgical treatment of complex cervical dystonia and of cervical dyskinesias associated with cervical myelopathy is challenging. In this prospective study, the long term effect of chronic pallidal stimulation in cervical dystonia and on combining the technique with spinal surgery in patients with severe cervical dyskinesias and secondary cervical myelopathy is described. METHODS: Eight patients with a history of chronic dystonia who did not achieve adequate benefit from medical treatment or botulinum toxin injection participated in the study. Five patients had complex cervical dystonia with tonic postures and phasic movements. Three patients had rapidly progressive cervical myelopathy secondary to severe cervical dyskinesias and dystonia in the context of a generalised movement disorder. Quadripolar electrodes were implanted in the posteroventral lateral globus pallidus internus with stereotactic CT and microelectrode guidance. In the three patients with secondary cervical myelopathy, spinal surgery was performed within a few weeks and included multilevel laminectomies and a four level cervical corporectomy with spinal stabilisation. RESULTS: Improvement of the movement disorder was noted early after pallidal surgery, but the full benefit could be appreciated only with a delay of several months during chronic stimulation. Three months after surgery, patients with cervical dystonia had improved by 38% in the severity score, by 54% in the disability score, and by 38% in the pain score of a modified version of the Toronto western spasmodic torticollis rating scale. At a mean follow up of 20 months, the severity score had improved by 63%, the disability score by 69%, and the pain score by 50% compared with preoperatively. There was also sustained amelioration of cervical dyskinesias in the three patients who underwent spinal surgery. Lead fractures occurred in two patients. The mean amplitude needed for chronic deep brain stimulation was 3.8 V at a mean pulse width of 210 micros, which is higher than that used for pallidal stimulation in Parkinson's disease. CONCLUSIONS: Chronic pallidal stimulation is effective for complex cervical dystonia and it is a useful adjunct in patients with cervical dyskinesias and secondary cervical myelopathy who undergo spinal surgery. (+info)
Cervical spinal cord compression and the Hoffmann sign.
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Little information exists about the ability of the Hoffmann sign to predict cervical spinal cord compression. The objective of this study was to determine the correlation between the Hoffmann sign and cervical spinal cord compression in a consecutive series of patients seen by a single spine surgeon. All new patients with complaints related to their cervical spine were included. Hoffmann sign was elicited by flicking the nail of the middle finger. Any flexion of the ipsilateral thumb and/or index finger was considered positive. All imaging studies were reviewed for spinal cord compression. Cord compression was defined as flattening of the AP diameter of the spinal cord coexisting with obliteration of CSF around the cord compared to normal levels. Of 165 patients, 124 patients had imaging of their spinal canal. Review by the spine surgeon found sensitivity of the Hoffmann sign relative to cord compression was 58%, specificity 78%, positive predictive value 62%, negative predictive value 75%. 49 studies were also read by a "blinded" neuroradiologist, the sensitivity was 33%, specificity 59%, positive predictive value, 26%, negative predictive value 67%. Although attractive as a simple method of screening for cervical spinal cord compression, the Hoffmann sign, in the absence of other clinical findings, is not in our experience a reliable test. (+info)
Oncologic emergencies for the internist.
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Most cancer patients experience at least one emergency during the course of the disease. This paper reviews the diagnosis and treatment of tumor lysis syndrome, hypercalcemia of malignancy, superior vena cava syndrome, spinal cord compression, strokes and seizures, and treatment-related emergencies. (+info)
Spinal cord compression due to extramedullary hematopoiesis associated with polycythemia vera--case report.
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A 69-year-old woman with a 14-year history of polycythemia vera suffered progressive paraparesis due to epidural involvement of hematopoietic tissue. Magnetic resonance (MR) imaging demonstrated extensive epidural masses. Decompressive surgery and radiotherapy were performed and she made an almost complete clinical recovery. Serial MR imaging showed no regrowth of the other epidural masses. Extramedullary hematopoiesis occurs in patients with various hematologic disorders involving a chronic increase in the production of red blood cells, and is often associated with thalassemia, but is less common with polycythemia vera. The most frequent sites are the spleen, liver, and kidney. Extramedullary hematopoietic tissue occurring within the spinal canal and causing cord compression is very rare. Total surgical excision is not usually feasible because of the diffuse nature of extramedullary hematopoietic tissue and the possibility of recurrence, but acute neurological deterioration does require emergency surgery. Extramedullary hematopoiesis is radiosensitive and displays a rapid response to low dosages, so radiation therapy is recommended for residual tumors. Considering the possibility of central nervous system extramedullary hematopoiesis in patients with polycythemia vera, an early diagnosis is necessary for a favorable prognosis. (+info)
Transient cervical neurapraxia associated with cervical spine stenosis.
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A 43 year old woman presented with a history of a hyperextension cervical injury resulting in transient quadriplegia. Cervical spine radiography revealed developmental spinal stenosis and magnetic resonance imaging demonstrated underlying spinal cord oedema secondary to contusion, with a herniated disc at C3-C4. The Torg ratio may be used to aid the initial diagnosis of cervical spine stenosis. Indications for operative treatment of these patients are controversial and these patients should receive further expert assessment. (+info)