Cervical Intumescence Research Articles

Outcomes of various surgical techniques used in patients with closed traction injuries of the brachial plexus

Introduction Traumatic lesions of the brachial plexus and analysis of the outcomes of various surgical techniques in patients with this pathology are the relevant challenges in neurosurgery, neurology, traumatology, orthopedics and rehabilitation due to the high social and economic significance, incidence and poor short- and long-term outcomes in this cohort of patients. This study was aimed at comparing the outcomes of various surgical techniques in patients with closed injuries of the brachial plexus.Material and methods The study involved 96 patients with closed injuries of the brachial plexus divided into three groups according to the method of their surgical treatment. Patients of Group I (n = 33) underwent microsurgical neurolysis of their brachial plexus trunks; patients of Group II (n = 28) had microsurgical neurolysis of their brachial plexus trunks with stimulating multichannel electrodes implanted on the trunks of their brachial plexus; patients of Group III (n = 35) had microsurgical neurolysis with stimulating multichannel electrodes implanted on the trunks of their brachial plexus as well as the segmental spinal cord apparatus at the level of the cervical intumescence. The clinical status and functionality of the upper limb were assessed after 6 months with clinical and neurological tests, scoring methods, and electrophysiological monitoring.Results We analyzed the outcomes of various surgical techniques in patients with closed injuries of the brachial plexus to prove a significant improvement in the outcomes of Group III patients who featured a faster rate of pain regression in the injured upper limb as well as significantly positive changes in clinical, neurological and electrophysiological indicators.Discussion The reduction in the total regional pain syndrome and restoration of the affected limb function was more evident in Group III patients what supports the favor of microsurgical neurolysis in combination with two-level electrical stimulation for closed injuries of the brachial plexus.Conclusions The analysis of various surgical techniques in patients with closed injuries of the brachial plexus revealed a significant efficacy of microsurgical neurolysis in combination with electrostimulation of the injured nerve trunk and segmental spinal cord apparatus (Group III). It improves the outcomes in this cohort of patients.

Motor and somatosensory degenerative myelopathy responsive to pantothenic acid in piglets.

This report describes 2 events of degenerative myelopathy in 4- to 27-day-old piglets, with mortality rates reaching 40%. Sows were fed rations containing low levels of pantothenic acid. Piglets presented with severe depression, weakness, ataxia, and paresis, which were more pronounced in the pelvic limbs. No significant gross lesions were observed. Histologically, there were degeneration and necrosis of neurons in the spinal cord, primarily in the thoracic nucleus in the thoracic and lumbar segments, and motor neurons in nucleus IX of the ventral horn in the cervical and lumbar intumescence. Minimal-to-moderate axonal and myelin degeneration was observed in the dorsal funiculus of the spinal cord and in the dorsal and ventral nerve roots. Immunohistochemistry demonstrated depletion of acetylcholine neurotransmitters in motor neurons and accumulation of neurofilaments in the perikaryon of neurons in the thoracic nucleus and motor neurons. Ultrastructurally, the thoracic nucleus neurons and motor neurons showed dissolution of Nissl granulation. The topographical distribution of the lesions indicates damage to the second-order neurons of the spinocerebellar tract, first-order axon cuneocerebellar tract, and dorsal column-medial lemniscus pathway as the cause of the conscious and unconscious proprioceptive deficit, and damage to the alpha motor neuron as the cause of the motor deficit. Clinical signs reversed and no new cases occurred after pantothenic acid levels were corrected in the ration, and piglets received parenteral administration of pantothenic acid. This study highlights the important and practical use of detailed neuropathological analysis to refine differential diagnosis.

Central nervous system development in rabbits (Oryctolagus cuniculus L. 1758).

The present study describes the embryonic and fetal development of the central nervous system in rabbits from the seventh day after conception until the end of the full-term fetal period. A total of 19 embryonic and fetal samples were carefully dissected and microscopically analyzed. Neural tube closure was observed between 7.5 and 8 days of gestation. Primordial encephalic vesicle differentiation and spinal canal delimitation were observed on the 12th day of gestation. Histologically, on the 15th day of gestation, the brain, cerebellum, and brain stem were delimited. On the 18th day of gestation, the cervical and lumbar intumescences of the spinal cord were visible. On the 28th day of gestation, four-cell layers could be distinguished in the cerebral cortex, while the cerebellar cortex was still differentiating. Overall, the morphological aspects of the embryonic and fetal developmental phases in rabbits were highly similar to those in humans. Thus, the present study provides relevant information highlighting rabbits as an excellent candidate animal model for preclinical research on human neurological diseases given the high adaptability of rabbits to bioterium conditions and the similarity of morphological events between rabbits and humans.

Flourine-18 fluorodeoxyglucose positron emission tomography imaging exhibits increased SUVmax at the level of the spinal intumescence in normal dogs.

Positron emission tomography (PET) imaging utilizing fluorine-18 labeled fluorodeoxyglucose is a relatively new imaging modality in veterinary medicine that is becoming more common for oncological staging and for musculoskeletal imaging. Thus, it is important to identify the normal variations on PET imaging that may be mistaken for pathology. Variation in standardized uptake values (SUVmax) have been anecdotally identified in the spinal cord of dogs undergoing fluorodeoxyglucose (FDG) PET-CT examinations for oncological staging, with notable increase in SUVmax values identified in the region of the cervical and lumbar spinal intumescences. The aim of this retrospective, analytical study was to compare the SUVmax values at four different locations throughout the spinal cord (C3, C5-T1, T13, and L3-S1) of a group of dogs with no evidence of neurologic disease and compare those findings to histologic specimens from dogs euthanized for unrelated disease. SUVmax values were significantly higher at the cervical and lumbar intumescences in comparison to the control regions (P<.0001 and P<.0001, respectively). Neuronal count and spinal cord gray matter area were also significantly greater at the cervical and lumbar intumescences (neuronal count P=.0025 and P=.0001; area P=.0004 and P=.0009, respectively) while overall neuronal density was lower (P=.003 and P=.028, respectively). We presume the increased SUVmax values at the spinal cord intumescences are the result of overall increased neuron count, increased proportion of gray matter, and increased spinal cord gray matter area. These findings will aid in the interpretation of future PET-CT studies and hopefully prevent the misdiagnosis of spinal cord disease in normal canines.

Vertebromedullary Topography of the Red‐Rumped Agouti (Dasyprocta leporina Linnaeus, 1758)

The agouti is a wild rodent located almost throughout the Brazilian territory, with great scientific importance and high reproductive potential when farmed. In the clinical routine, clinical and surgical procedures are performed on the nervous system of these animals, such as epidural anesthesia and cerebrospinal fluid (CSF) collection; however, data available are limited in literature on the main points of these procedures in this species. In this aspect, the objective was to describe the vertebromedullary topography of the agouti in order to identify and quantify it, with the intention of expanding the information regarding the clinical-surgical procedures in this system. Ten animals were incised longitudinally in the dorsal median line, removing the skin, the musculature, and dorsal fascia of the vertebral column; then, removed the vertebral arches and consequent exposure of the spinal cord and meninges. The morphometry of the animals was done by obtaining the total length, body length, and crown-rump length, as well as the total length of the spinal cord and its segments. The cervical intumescence in the agouti is located between C4-T1 and measures 2.45 cm. The lumbar intumescence is between L5-L7 and is 2.52 cm long. The cauda equina arises from S2 and the filum terminale from S3. As for the medullary cone, it is located between L7-S1 and is 2.52 cm long. The suggested localization for epidural anesthesia or CSF puncture for laboratory tests in agoutis is the lumbosacral space, with the insertion of the needle to be carried out at angle of 90° in the sphinx position. Anat Rec, 303:1472-1477, 2020. © 2019 American Association for Anatomy.

Anatomy of the spinal cord of Alouatta belzebul

The genus Alouatta hosts species popularly known as red-handed howler, presenting wide geographic distribution and being found in several biomes. The objective was describe the anatomy of spinal cord of Alouatta belzebul specimens, focusing on the topography of medullary cone, stressing the cervical and lumbar intumescences and cauda equina, to provide anatomical data and compare it with other species to assist in anesthetic and surgical procedures. Four animals were received for scientific research, post mortem, from the fauna rescue program of Hydroelectric Plant of Belo Monte, Para, and they were fixed in 10% formaldehyde solution. Structures such as the medullary cone, cervical and lumbar intumescence, and cauda equina were photographed (Sony α200-10.2 mpx). After thawing, we measured the specimens and observed a size of 80 to 82 cm from head to toe. After the skin and musculature were removed, it was observed that the spine of all specimens presented 7 cervical, 13 thoracic, 5 lumbar and 3 fused sacral vertebrae. The spinal cord was exposed after the removal of vertebral arches, it has 22 cm length in all animals, presenting the cervical intumescence between C3 and C6 vertebrae, with average of 2.2 cm and lumbar intumescence between T11 and T12 vertebrae, with average of 1.65 cm. The medullary cone is located between T12 and L1 vertebrae, with average of 1.5 cm, and the cauda equina between L1 and S3, with an average of 15 cm. This study has an important role as the basis for epidural anesthesia in the species.

Multifocal Spinal Cord Nephroblastoma in a Dog

A 1-year-old male American pit bull terrier was presented with a history of proprioceptive deficits and mild lameness of the right hindlimb, which progressed after 5 months to paraparesis, culminating in tetraparesis after 2 weeks. Necropsy findings were limited to the spinal cord and consisted of multiple, intradural, extramedullary, slightly red masses which produced segmental areas of medullary swelling located in the cervical intumescence, thoracolumbar column, sacral segment and cauda equina. Histological evaluation revealed a tumour, composed of epithelial, stromal and blastemal cells, with structures resembling tubules, acini and embryonic glomeruli. Immunohistochemical labelling for vimentin, cytokeratin and S100 was positive for the stromal, epithelial and blastemal cells, respectively. A final diagnosis of multifocal spinal cord nephroblastoma was established. This is the first report of such a tumour showing concomitant involvement of the cervicothoracic, thoracolumbar, sacral and cauda equina areas of the spinal cord.

Experimental and iatrogenic poisoning by sodium selenite in pigs

ABSTRACT: Following a case of iatrogenic selenium poisoning in a young pig, an experimental study was carry out. Sodium selenite was orally and parenterally administered to 13 pigs that were subdivided into three groups (G1, G2 and G3). The animals in groups G1 and G3 received sodium selenite intramuscularly (IM), G1 received a comercial formula, and G3 received sodium selenite mixed with distilled water at different dosages, and those in group G2 were fed commercial sodium selenite. Acute and subacute poisoning was observed in both groups, although the onset of clinical signs was slower in group G2. Only one pig (in group G1) that had received the highest dose showed a peracute course. Apathy, anorexia, dyspnea, vomiting, muscular tremors, proprioceptive deficit, ataxia and paresis of the hind limbs progressing to the front limbs evolving to tetraplegia were observed. Postmortem findings differed whether the animals received the injected (G1 and G3) or oral (G2) sodium selenite. The liver was moderately atrophic in some animals of G2. Some of the animals in groups G1 and G3 presented with lung edema. One pig in G3 had yellowish-brown areas in the ventral horns of the cervical intumescences of the spinal cord. The most important histological changes were present in the ventral horns of the cervical and lumbar intumescences of the spinal cord. In one animal, changes were present in the brainstem and mesencephalon. The initial lesion was a perivascular and astrocyte edema that progressing to lysis and death of astrocytes and neurons. In the chronic stage of the lesions, there were extensive areas of liquefaction necrosis with perivascular lymphocytic and histiocytic infiltration and occasional eosinophils. It seems that disruption of the blood-brain barrier due to astrocyte edema is the most likely mechanism of CNS lesion.

Intoxicação por selênio em suínos no Sul do Brasil

São descritos dois surtos de intoxicação por selênio em suínos na região Sul do Brasil. Foram acometidos leitões em fase de creche, entre 27 e 22 dias, com mortalidade variando de 16% a 15,3% (Surto 1 e 2 respectivamente). Os suínos apresentaram poliomielomalacia simétrica focal e lesões de casco, que inicialmente eram caracterizadas por uma linha avermelhada na borda coronária que evoluía nos suínos sobreviventes para desprendimento do casco. Os sinais clínicos iniciaram após seis dias (Surto 1) e 30 horas (Surto 2) da introdução da ração com alto teor de selênio. O surgimento dos sinais foi abrupto, caracterizado por andar cambaleante, com evolução para paralisia dos membros pélvicos e posteriormente tetraparesia. Macroscopicamente observaram-se focos circulares amarelados com áreas deprimidas mais escuras, restritas ao corno ventral da substância cinzenta em intumescências cervical e lombar. Microscopicamente essas áreas corresponderam à malacia da substância cinzenta, caracterizada por microcavitações, perda neuronal, cromatólise, neuronofagia, infiltrado de células Gitter, microgliose, astrócitos de Alzheimer tipo II e proliferação de células endoteliais evidenciadas na imunohistoquímica (IHQ) para fator de von Willebrand. Ainda, no segundo surto, dois animais apresentaram vacuolização difusa do citoplasma de neurônios e em um suíno foram observados astrócitos gemistocíticos. Na IHQ para GFAP ficou evidenciada uma astrocitose e astrogliose. Além dessas alterações medulares, em dois suínos observou-se, polioencefalomalácia simétrica no tronco encefálico. Em amostras de ração, detectou-se 3,38ppm (Surto 1) e 154ppm (Surto 2) de Se/kg e em amostras de fígado foram encontradas dosagens superiores a 3,34ppm (variando de 3,34 até 10ppm). No Surto 2, após 44 dias da retirada da ração, foi realizada eutanásia de seis suínos para monitoramento de níveis hepáticos de selênio (dois suínos controles e quatro sobreviventes ao surto) e todos apresentaram níveis normais de selênio no fígado.

Damages of spinal cord in newborns after intraventricular hemorrhage.

We studied the spinal cords of 14 dead premature newborn with intraventricular hemorrhages. In all cases, grade III intraventricular hemorrhage was followed by the translocation of blood into the subarachnoid space of the cervical, dorsal, and lumbar parts of the spinal cord. Ischemic changes were found in neurons of the cervical intumescence and other parts of the spinal cord. These changes are important during thanatogenesis. Three stages in the development of intraventricular hemorrhage were distinguished. Imperfections of clinical classification of this pathology were demonstrated.

Cervical Myelomalacia in a Lamb (Ovis aries) and an Alpaca (Vicugna pacos) after Attempted Intramuscular Injection

Cervical Myelomalacia in a Lamb (<i><scp>O</scp>vis aries</i>) and an Alpaca (<i><scp>V</scp>icugna pacos</i>) after Attempted Intramuscular Injection

Morphology and topographic anatomy of the spinal cord of the red-footed tortoise (Geochelone carbonaria Spix, 1824)

The aim of this study was to describe the topography of the spinal cord of the red-footed tortoise to establish a morphological basis for applied research in anesthesiology and morphology. Six tortoises from the state of Maranhão (Brazil) that had died of natural causes were used. The common carotid artery was used to perfuse the arterial system with saline solution (heated to 37ºC) and to fix the material with a 20% formaldehyde solution. The specimens were then placed in a modified decalcifying solution for 72 hours to allow dorsal opening of the carapace with a chisel and an orthopedic hammer. Dissection of the dorsal musculature and sectioning of the vertebral arches were performed to access the spinal cord. The results revealed the spinal cord of G. carbonaria to be an elongated, whitish mass that reached the articulation between the penultimate and last caudal vertebrae. The cervical intumescence (Intumescentia cervicalis) was located between vertebral segments C5 and T1, whereas the lumbosacral intumescence (Intumescentia lumbalis) was located between T6 and Ca1.

Topographic anatomy of the spinal cord and vertebromedullary relationships in Mazama gouazoubira Fisher, 1814 (Artiodactyla; Cervidae)

ABTRACT. To gain an understanding of the detailed anatomical aspects of Mazama gouazoubira (brocket deer), this paper describes the relationships between its spinal cord and the vertebral canal, adding information with a clinical and surgical approach. Three specimens of M. gouazoubira were prepared following the methods normally used in anatomy. The epaxial muscles and vertebral arches were removed to expose the spinal cord and the spinal nerve roots. The dimensions of the medullary segments were measured using a pachymeter with 0.05 mm precision. The spinal cord is cylindroidal, dorsoventrally flattened, with an average craniosacral length of 656.27 mm, and has two dilatations corresponding to the cervical and lumbar intumescences. The cervical, thoracic, lumbar and sacrocaudal segments showed an average length of 175.07, 226.03, 123.47 and 43.63 mm, with indices of 28.02, 35.34, 19.68 and 6.93%, respectively. The medullary cone, whose average length is 46.27 mm, begins between L2 and L3 and ends between S1 and S2, with a mean index of 7.53%. The overall average distance between the nerve roots of the cervical, thoracic and lumbosacral segments was 2.23, 2.06 and 1.98 cm, respectively.

IMAGING DIAGNOSIS—SPLIT CORD MALFORMATION

The features of a calf with a split cord malformation are described. Clinically, there was severe cervicothoracic kyphoscoliosis and an interscapular dermal sinus associated with cerebrospinal fluid drainage. Using magnetic resonance imaging, complete duplication of the spinal cord at the cervical intumescence was detected. There was associated syringohydromyelia, multiple cervicothoracic vertebral malformations resulting in kyphoscoliosis and rachischisis, herniation of the cerebellar vermis, meningoencephalocele, and calvarial defects.

TOPOGRAFIA DAS INTUMESCÊNCIAS CERVICAL E LOMBAR EM GATOS SEM RAÇA DEFINIDA (Felis catus Linnaeus, 1758)

There were analyzed the cervical (CI) and lumbar intumescences (IL) of 30 post mortem domestic without race cats of both sexes. The dorsal skin and muscles from the vertebral column were removed to expose the spinal cord and its wrappers were visualized when the vertebral arcs were sectioned, exposing the CI and LI. The CI and LI where measured up and their relationship with cervical (C), thoracic (T) and lumbar (L) vertebrae were analyzed to get their skeletopy. The length of the CI presented a variation from 3.30-8.00 cm, with a higher frequency of 9 animals (30.00 ± 8.36%) presenting 5.00-5.50 cm. The length of the LI presented a variation from 2.90-5.70 and the higher frequency observed was 21 animals (70.00 ± 8.36%) presenting 3.00-4.50 cm. Their skeletopy were also variable: in 16 animals (53.33 ± 9.10%) the CI began at the C3 and the LI began at the L4 in 23 animals (76.67 ± 7.72%). Their ends were also variable, since the CI and the LI ended in 12 animals (40.00 ± 8.94%) the T1 and in 24 (80.00 ± 7.30%) at the L6 vertebrae, respectively. KEY WORDS: Cats, intumescences, spinal cord, topography.

Peripheral neuromotor status in convalescents after tick-borne encephalitis

Complex electromyographic examinations of 57 patients with different forms of tick-borne encephalitis were carried out during acute and delayed periods. Abnormalities of the peripheral neuromotor system were detected in patients with all forms of the disease; the most characteristic were pronounced electrogenesis disorders in the proximal part of motor nerve axons, particularly in the upper limbs, and of the spinal anterior horn motoneurons at the level of the cervical intumescence.

Clinical, Pathological and Toxicological Findings of a Iatrogenic Selenium Toxicosis Case in Feeder Pigs

Histopathological and toxicological analyses confirmed a clinical diagnosis of selenium (Se) intoxication in pigs from a farm in Spain. After an initial episode of diarrhoea, animals presented both dermatological and neurological signs; the most obvious sign was a marked hind limb paresis. Cutaneous lesions consisted on diffuse alopecia, multifocal skin necrosis and coronary band necrosis of the hooves. Central nervous system lesions involved the cervical and lumbar intumescences of the spinal cord and consisted of a severe, bilateral symmetrical poliomyelomalacia of the ventral horns; pons and medulla oblongata also presented lesions of polioencephalomalacia. Analyses of feed and sera from clinically affected pigs revealed a marked increase in Se concentration. Clinical investigations indicated that a failure in Se dosage in feed was the cause of the toxicosis.

MRI characteristics of suspected acute spinal cord infarction in two cats, and a review of the literature

A 10-year-old neutered male Persian cat and a 4-year-old spayed female domestic shorthair (DSH) cat were evaluated for acute-onset severe lateralising tetraparesis and hemiplegia, respectively. Both cats also had left-sided Horner's syndrome. Neurological examination of the cats localised the lesion to cranial to C5 in the Persian and the left cervical intumescence (C6-T2) in the DSH. Physical examinations were otherwise generally unremarkable. Routine laboratory tests and spinal radiography were normal for the Persian cat and were not performed for the DSH cat. A cerebrospinal fluid (CSF) tap was attempted for the Persian cat but aborted because of gross blood contamination, and was not performed for the DSH cat. Magnetic resonance imaging (MRI) of the Persian cat revealed a lesion within the spinal parenchyma at segments C1 to C3 (slightly more left-sided) which was iso- to hypointense on T1-weighted scans and hyperintense on T2-weighted scans, and which enhanced slightly with gadolinium. MRI of the DSH cat revealed a lesion within the spinal parenchyma at segment C7 (predominantly left-sided) which was hypointense on T1-weighted scans and hyperintense on T2-weighted gradient echo scans. Contrast was not administered. The MRI findings in both cases were highly suggestive of acute spinal cord infarction, based upon comparison to human cases. Both cats made full neurological recoveries with supportive treatment only. This paper describes two cases of suspected acute spinal cord infarction in the cat, demonstrates the potential diagnostic value of MRI, and discusses the clinical syndrome of this condition with a brief review of published cases.

Selenium elimination in pigs after an outbreak of selenium toxicosis.

In May 1996, 150 grower pigs in 5 California counties were exposed to selenium-contaminated feed distributed by a single feed company. Feed samples from 20 herds had a mean selenium concentration of 121.7 ppm dry weight (range, 22.1-531 ppm). In San Luis Obispo County, 52 pigs in 24 herds were exposed to the feed, and 8 pigs died with signs of paralysis. Bilateral symmetrical poliomyelomalacia involving the ventral horns of the cervical and lumbar intumescence was evident on histologic examination of spinal cord from affected pigs. Of 44 surviving exposed pigs, 33 (75%) exhibited signs of selenosis, including anorexia, alopecia, and hoof lesions. Thirty-nine of 44 pigs (88.6%) had elevated (>1 ppm) blood selenium concentrations. Surviving exposed pigs were changed to a standard commercial ration containing approximately 0.5 ppm (dry weight) selenium. Blood selenium concentrations were determined weekly for 46 days following removal of the contaminated feed and were compared with values of 20 control pigs fed a standard commercial ration. Mean (+/-SD) blood selenium concentrations of exposed pigs were 3.2 +/- 2.6 ppm at the initial sampling and 0.4 +/- 0.1 ppm after 46 days. Mean blood selenium concentrations of < or = 0.3 ppm for control pigs at all samplings were significantly lower (P < 0.001) than concentrations for exposed pigs. Muscle and liver samples of 22 of the 44 exposed pigs were collected at slaughter approximately 72 days after withdrawal of the selenium-contaminated feed. Muscle samples had a mean selenium concentration of 0.36 ppm (wet weight). Liver samples had a mean selenium concentration of 1.26 ppm (wet weight). One liver sample had a selenium value in the toxic range for pigs (3.3 ppm wet weight; reference range, 0.4-1.2 ppm). A 1-compartment pharmacokinetic model of selenium elimination in exposed pigs was generated, and the geometric mean blood selenium elimination half-life was estimated to be 12 days. The 60-day withdrawal time recommended by the Food Animal Residue Avoidance Database was considered sufficient to allow safe human consumption of tissues from exposed pigs.

Doença do neurônio motor dos eqüinos: relato dos primeiros casos na América do Sul

Foram realizados estudos dos casos de 6 eqüinos de raças e idades diferentes, apresentando um quadro clínico caracterizado principalmente por emagrecimento progressivo, atrofia e fraqueza muscular generalizada, fasciculações e tremores musculares, alternância constante de apoio dos membros posteriores, deslocamento do apoio dos membros anteriores caudalmente e dos membros posteriores cranialmente, decúbito lateral prolongado e morte. A confirmação do diagnóstico ocorreu mediante exames histopatológicos da medula espinhal, observando-se uma degeneração e perda dos neurônios localizados no corno ventral do H medular, sendo a lesão mais grave na região das intumescências cervical e lombar. As biópsias musculares revelaram alterações neuromusculares caracterizadas por atrofia neurogênica, complementando o diagnóstico de doença do neurônio motor. A atrofia e fraqueza muscular progressiva, assim como a degeneração dos neurônios motores, são similares àquelas descritas em humanos com esclerose lateral amiotrófica esporádica ou doença de Lou Gehrig’s.