Acute Myelopathy Research Articles

Recurring Polysomatic Hemangiomatosis: A New Syndrome?

Systemic hemangiomatosis is extremely rare in adolescents and adults. The authors describe a 37-year-old man with a history of hepatic, splenic, cerebral, and multiple recurring osseous hemangiomas since age 14. After a 9-year period without disease progression, the patient presented with an acute bilateral lower extremity myelopathy. This was secondary to a T11 vertebral hemangioma that compressed the spinal cord. A 2-week course of radiation therapy failed to alleviate the patient's symptoms. Successful T11 vertebrectomy was then performed to decompress the spinal cord. The many organs and serially involved bones may represent a distinct variant of hemangiomatosis not previously described in the literature.

Ossification of the proximal thoracic ligamenta flava causing acute myelopathy in a Caucasian: case report and literature review

Case report and literature review. To illustrate that ossification of the proximal thoracic ligamenta flava can be a rare cause of acute myelopathy in a Caucasian patient and that timely surgery can lead to a good outcome. Nottingham, UK. Proximal multiple contiguous ossified thoracic ligamenta flava from T3/T4 to T5/T6 causing acute myelopathy was diagnosed in a Caucasian man based on history and examination followed by magnetic resonance imaging and computed tomography scanning. The literature is reviewed for all reported cases of ossified ligamenta flava causing myelopathy in Caucasians. Following prompt diagnosis and T3 to T5 laminectomies, our patient made near-complete neurological recovery over a 10-month period. This condition usually affects the lower thoracic spine. Although chronic and subacute myelopathy secondary to this circumstance has been reported in Caucasians, acute myelopathy has not been reported and proximal thoracic involvement has been reported twice. Ossification of the proximal thoracic ligamenta flava can be a rare cause of acute myelopathy in Caucasians. Prognosis following decompressive surgery is usually good.

Acute myelopathy characterized by crus spasm and periodic foot bounce after cervical epidural anesthesia

Acta Anaesthesiologica ScandinavicaVolume 50, Issue 5 p. 639-640 Acute myelopathy characterized by crus spasm and periodic foot bounce after cervical epidural anesthesia W. Zhao, W. ZhaoSearch for more papers by this authorL. Zhao, L. ZhaoSearch for more papers by this author W. Zhao, W. ZhaoSearch for more papers by this authorL. Zhao, L. ZhaoSearch for more papers by this author First published: 25 April 2006 https://doi.org/10.1111/j.1399-6576.2005.00972.xCitations: 1 Dr Weijiang ZhaoBeijing Neurosurgical Institute Capital University of Medical Sciences Beijing, 100050 China e-mail: neuromancn@yahoo.com.cn Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume50, Issue5May 2006Pages 639-640 RelatedInformation

Transverse Myelitis in Children: Long-Term Urological Outcomes

Urological complications are well documented in patients with traumatic spinal cord injury. We examined the long-term urological outcomes in a large population of children affected by transverse myelitis. We retrospectively reviewed the medical history, imaging studies and urodynamic findings in 22 children with transverse myelitis. Age at disease onset ranged from 3 months to 18 years (average 8.8 years). At a mean followup of 7.1 years 19 patients (86%) had persistent bladder dysfunction and 17 (77%) had persistent bowel dysfunction. Initial evaluation at least 1 month after disease onset revealed detrusor overactivity in 59% of patients, detrusor external sphincter dyssynergia in 41%, low compliance in 47% and detrusor leak point pressure greater than 40 cm water in 12%. Functional motor recovery and absence of lower extremity spasticity did not reflect normal urodynamic findings. Of the 19 patients with imaging available for review 5 (26%) had upper tract changes. One patient had development of chronic renal insufficiency. Low compliance (p = 0.02) and upper tract changes (p = 0.1) were more frequent in patients who started clean intermittent catheterization more than 2 years after disease onset. Persistent bowel and bladder dysfunction is common in transverse myelitis. Urodynamic abnormalities may be present despite normal neurological examination and absence of urinary symptoms. All pediatric patients with transverse myelitis require baseline renal ultrasound and urodynamic evaluation to guide treatment. Early institution of clean intermittent catheterization appears to preserve bladder compliance and decrease upper tract disease, and should be instituted at disease onset.

Acute myelopathy of unknown aetiology: A follow-up investigation

Acute myelopathy refers to acute or subacute spinal cord dysfunction secondary to various causes. Recent studies suggest a number of distinct clinical, laboratory, MRI and outcome profiles for the various aetiologies. Nevertheless, the aetiology of acute myelopathy remains unknown in up to 60% of the patients. The probability of establishing the correct diagnosis increases with the duration of clinical and MRI follow-up. This paper presents the results of a follow-up of nine cases of acute myelopathy of unknown aetiology. One patient was lost during follow-up. Mean age of patients at the time of the follow-up interview was 48 years (±12). Average time from discharge to follow-up interview was 3.6 (±0.5) years. In four patients (mean age 45 ± 13 years) the origin of acute myelopathy remained unclear after an average follow-up of 3.3 years. In one patient the diagnosis of multiple sclerosis was established during follow-up. In another patient the clinical course was suggestive for multiple sclerosis. One patient was diagnosed with systemic collagen vascular disease and in one patient a diagnosis of non-Hodgkin’s lymphoma was established. It is unclear whether the patients in whom the aetiology of acute myelopathy remained unknown, even after several years of follow-up, are at a higher risk of developing progressive disease. Larger studies with longer follow-up periods and clear clinical, laboratory and MRI criteria should help to shed some light on this issue.

Manipulation in the Presence of Cervical Spinal Cord Compression: A Case Series

Objective The purpose of this study is to present information from a series of patients with imaging findings of encroachment on the cervical spinal cord who were treated with chiropractic cervical manipulation. Case Series There were 27 patients (18 females, 9 males; age range, 23-65, mean age, 44.3 years) with neck and/or arm pain with findings of cervical spinal cord encroachment on magnetic resonance imaging. None of these patients had severe or acute myelopathy or advanced signal changes in the spinal cord indicative of myelomalacia. These patients were treated with a variety of approaches that included some form of cervical manipulation. The mean number of treatments that included manipulation was 12 (range, 2-32). Nineteen patients were treated with high-velocity, low-amplitude “thrust” manipulation, 9 patients were treated with low-velocity muscle energy technique, and 1 patient was treated with both methods. The mean patient-rated subjective improvement at the last follow-up reexamination was 70.0% (range, 10%-100%). From baseline to the last follow-up examination, the mean improvements in outcome measures were as follows: Bournemouth Neck Disability Questionnaire, 23.7 points (31%); Neck Disability Index, 6.4 points; and Numerical Pain Rating Scale, 3.9 points. In 3 patients, there was increased pain after manipulation that lasted from 1 to 4 days. There were no major complications, and in no patient did any increased pain after treatment last more than 4 days. No new neurologic symptoms or signs were seen in any of these patients. Conclusion The finding of cervical spinal cord encroachment on magnetic resonance imaging, in and of itself, should not necessarily be considered an absolute contraindication to manipulation. However, because radicular and myelopathic complications to cervical manipulation have been reported in the literature, great care should be taken in all cases, particularly those in which anatomic conditions such as cord encroachment are present.

Acute Myelopathy due to Ruptured HNP in Cervical OPLL Patient - Case Report -

Acute Myelopathy due to Ruptured HNP in Cervical OPLL Patient - Case Report -

December 27 Highlights

Ceravolo et al. studied four fragile X premutation carriers with parkinsonism using SPECT with 123I-FP-CIT. There was evidence of preserved presynaptic nigrostriatal function. see page 1971 Cerebral microbleeds, detected by gradient-echo MRI, may be associated with fragile, bleeding-prone small vessels. Werring et al. found microbleeds in 24% of patients with ischemic stroke, but in only 2% of patients with TIA. see page 1914 Barkovich et al. propose a revised classification of malformations of cortical development. This revision updates and expands the classification using genotype as the basis for classification when the genotype-phenotype is adequately understood. A section on genetic testing is also included. see page 1873 De Seze et al. studied 45 patients with idiopathic acute transverse myelopathy (ATM) in a group of 288 patients with ATM (15.6%). These patients …

Acute transverse myelitis

Acute noncompressive myelopathies were first recognized in the 19th century, and early pathologic studies identified both inflammatory and vascular etiologies.1–3 The terms acute transverse myelitis (ATM) and acute transverse myelopathy have been used interchangeably to describe a syndrome characterized by anterior and posterior (hence transverse) spinal cord impairment resulting in weakness, a sensory level, and autonomic dysfunction. Possible causes include vascular, infectious, neoplastic, collagen vascular, iatrogenic, and autoimmune etiologies.4 In addition, the syndrome can occur as part of CNS demyelinating disease such as neuromyelitis optica (NMO) or, uncommonly, typical multiple sclerosis (MS). Once such recognized causes are excluded, the question remains as to whether there exists a unique disease entity “idiopathic ATM.” Based on expert opinion, the Transverse Myelitis Consortium Working Group (TMCWG) proposed diagnostic criteria for idiopathic ATM.5 The clinical requirements include bilateral sensory, motor, or autonomic dysfunction referable to the spinal cord, with a clearly defined sensory level that progresses to the nadir over 4 to 21 days from onset. Neuroimaging, preferably MRI, is used to eliminate structural causes. …

Acute myelopathy in association with heroin addiction

Acute myelopathy in association with heroin addiction

Myélopathies aiguës

Acute myelopathy (AM) (or acute transverse myelitis) is characterised by motor, sensory, and autonomic dysfunction. Acute myelopathies are rare diseases. Rapid and precise diagnosis must differentiate idiopathic AM from AM that occur secondary to a known underlying disease. Identifying the cause of secondary MA is useful for specific treatment selection, whereas no clearly established medical treatment currently exists for idiopathic AM.

Segmental cutaneous hemangioma and spinal arteriovenous malformation (Cobb syndrome)

The discovery of either a dermatomal cutaneous nevus or a spinal arteriovenous malformation (AVM) should raise the suspicion of Cobb syndrome. The Cobb syndrome is a neurocutaneous syndrome in which there are metameric cutaneous and spinal AVMs. The authors present the case of a patient with acute cervical myelopathy and subtle cutaneous hemangiomas in whom a cervical perimedullary fistula was discovered. They also acknowledge Harvey Cushing's contribution to the recognition of this syndrome.

Symptomatic atlantoaxial instability in Down syndrome

The aim of this study was to audit the treatment of symptomatic atlantoaxial instability in Down syndrome and to assess factors associated with fusion failure in this group of patients. The authors reviewed the cases of 12 children with Down syndrome presenting with symptomatic atlantoaxial instability who underwent surgery for internal fixation and fusion. A review of clinical histories, radiological investigations, and details of operative interventions was also performed. The mode of presentation was acute spinal cord injury (five cases), progressive myelopathy (four cases), and neck pain or stiffness (three cases). The atlantodental interval ranged from 5 to 13 mm. The posterior atlantodental interval at the C-1 level was 9.5 mm (range 6-11 mm). In 10 patients an os odontoideum was present. Translocation of the odontoid process occurred in one patient, and occipitoatlantal instability was also identified in two cases. Twenty-four operations were performed in the 12 patients. A transoral odontoidectomy was required in four children. Successful fusion was demonstrated in seven patients at the first operation. Three of the five patients with acute cord injury made significant functional recovery and were left with no or mild disability. Additional bone abnormalities at the CVJ are common in the Down syndrome population. Young age at the time of fusion and multiple osseous anomalies pose a higher risk factor in fusion failure. The authors recommend an aggressive surgical approach for management of symptomatic cases of CVJ instability.

Neuroschistosomiasis due to Schistosoma mansoni: a review of pathogenesis, clinical syndromes and diagnostic approaches

Neuroschistosomiasis (NS) is the second most common form of presentation of infection by the trematode, Schistosoma mansoni. Granulomatous inflammatory reaction occurs as a result of schistosome eggs being transmitted to spinal cord or brain via the vascular system, or by inadvertent adult worm migration to these organs. The two main clinical syndromes are spinal cord neuroschistosomiasis (acute or subacute myelopathy) and localized cerebral or cerebellar neuroschistosomiasis (focal CNS impairment, seizures, increased intracranial pressure). Presumptive diagnosis of NS requires confirming the presence of S. mansoni infection by stool microscopy or rectal biopsy for trematode eggs, and serologic testing of blood and spinal fluid. The localized lesions are identified by signs and symptoms, and confirmed by imaging techniques (contrast myelography, CT and MRI). Algorithms are presented to allow a stepwise approach to diagnosis.

Acute multifocal CNS demyelination as first presentation of systemic malignancy

We present a patient with adenocarcinoma of the lung, without CNS metastases, who developed progressive quadreparesis like that seen in the paraneoplastic syndrome acute necrotic myelopathy.1 Pathologic examination revealed only areas of brainstem and spinal cord demyelination resembling the acute lesions of multiple sclerosis (MS). A 66-year-old man was hospitalized after 4 weeks of persistent cough and 10 days of weakness and paresthesias of the legs. Over the next 5 days, his weakness progressed to paralysis of all extremities, dysphagia, and respiratory failure. He developed bilateral Babinski signs. Cognition and vision were unaffected and the sensory examination remained normal despite paresthesias. Chest CT scan revealed a hilar mass and abnormal masses in the liver and an adrenal gland, but biopsies of the hilar mass and the liver nodule were nondiagnostic. MRI of the brain and cervical spinal cord showed increased T2 signal in the medulla, extending into the upper cervical cord and a separate focus of T2 hyperintensity in the spinal cord …

Myélopathies aiguës transverses : myélopathie inflammatoire ou ischémique ?

The rapid development of paraparesis or tetraparesis combined with a bilateral sensory deficit that has a clearly defined rostral border and bladder dysfunction are the principal features of acute transverse myelopathy. Acute partial transverse myelopathy is far much more frequent: its symptoms are asymmetric, sometimes unilateral, and sensory deficit may predominate. An urgent MRI is required to exclude acute spinal cord compression. Diagnosis of ischemic acute transverse myelopathy includes the following elements: sudden onset, neurologic symptoms compatible with infarction in the anterior spinal artery area (by far the most frequent location for spinal cord infarction), and presence of a specific cause of spinal cord ischemia. In all other cases where it is difficult to distinguish spinal cord infarction from myelitis, analysis of the cerebrospinal fluid is essential. Most cases of inflammatory acute transverse myelopathy can be linked to a defined cause. Multiple sclerosis is a major cause of partial acute transverse myelopathy. MRI lesions are usually small, located in the lateral or posterior part of the spinal cord. Diagnostic elements include multiple lesions of multifocal demyelination on the cerebral MRI, oligoclonal bands in the cerebrospinal fluid, and the absence of clinical or laboratory abnormalities that suggest systemic disease. Neuromyelitis optica, also known as Devic's disease, has often been considered a variant form of multiple sclerosis. Recent immunologic studies confirm the hypothesis that it is a distinct entity. Infectious transverse acute myelitis is often of viral origin. It may result from direct viral stress but more frequently follows immunologically-mediated indirect stress. This acute parainfectious myelitis, like postvaccinal myelitis, may be considered as a spinal single-focus form of acute disseminated encephalomyelitis (ADEM). It is important to distinguish the latter from an initial episode of multiple sclerosis, because their prognosis and treatment differ.

Non-traumatic acute myelopathy due to cervical disc herniation in contiguous two-level disc spaces: a case report

Non-traumatic acute myelopathy caused by cervical disc herniation is rare, and no case has been reported which the disease was caused by the extrusion or migration of a cervical disc herniation of contiguously-located two-level disc space. In this report, the disease is described, and the direction of migration and surgical treatment of the disease are discussed.

Diagnosis and Management of Acute Myelopathies

Acute myelopathies represent a heterogeneous group of disorders with distinct etiologies, clinical and radiologic features, and prognoses. Transverse myelitis (TM) is a prototype member of this group in which an immune-mediated process causes neural injury to the spinal cord, resulting in varying degrees of weakness, sensory alterations, and autonomic dysfunction. TM may exist as part of a multifocal CNS disease (eg, MS), multisystemic disease (eg, systemic lupus erythematosus), or as an isolated, idiopathic entity. In this article, we summarize recent classification and diagnostic schemes, which provide a framework for the diagnosis and management of patients with acute myelopathy. Additionally, we review the state of current knowledge about the epidemiology, natural history, immunopathogenesis, and treatment strategies for patients with TM. Our understanding of the classification, diagnosis, pathogenesis, and treatment of TM has recently begun to expand dramatically. With more rigorous criteria applied to distinguish acute myelopathies and with an emerging understanding of immunopathogenic events that underlie TM, it may now be possible to effectively initiate treatments in many of these disorders. Through the investigation of TM, we are also gaining a broader appreciation of the mechanisms that lead to autoimmune neurologic diseases in general.

1616 Acute bulbospinal myelopathy secondary to the intracranio-dural burrow: case report and literature review

1616 Acute bulbospinal myelopathy secondary to the intracranio-dural burrow: case report and literature review

Myélopathies infectieuses : profils cliniques, paracliniques et évolutifs

Serological confirmation of an infectious acute myelitis injury is difficult to confirm as it is sometimes due to a post-infectious etiology. The aim of this study was to define the clinical, biological and prognostic patterns of infectious myelitis. This retrospective study included 153 subjects hospitalized in the department of neurology between 1993 and 2002 for treatment of a noncompressive acute myelopathy. Biological confirmation of recent infection was obtained in 12 patients (8 p. 100). An infectious syndrome, beginning prior to the neurological symptoms, was found in 67 percent of patients. The clinical symptoms were severe with loss of sensoromotor and sphincter functions and ascending spinal cord dysfunction (acute transverse myelopathy). Spinal cord MRI showed extended centromedullar high intensity signals with rapid and complete regression. CSF analysis cell count was above 30/mm3 with hyperproteinorachia, in 75 percent and 58 percent of patients respectively. CSF electrophoresis did not detect oligoclonal bands. Clinical outcome was good in all patients except one, however sphincter disorders recovered slowly. Our study illustrates a stereotypical clinical, biological and prognostic pattern for infectious acute myelitis. These findings contribute significantly to therapeutic decision making and establishing prognosis at the initial phase of acute myelopathy.