Cord Edema Research Articles

Radiology diagnostics of spinal corel injury in early children: a prospective study

INTRODUCTION: Spinal cord injury (SCI) in young children includes a relatively higher prevalence of cervical spine injury, multiple thoracic vertebral compression fractures, and spinal cord injury. Spinal cord injuries without radiological changes/signs of fractures or dislocations (SCIWORA) also occur in young children. X-ray assessment of damage to immature vertebrae and cartilage in young children is difficult, since incompletely formed vertebral bodies can be confused with fractures. Accordingly, an MRI is required, which provides a detailed anatomical image of all structures of the spinal column and also diagnoses damage to the spinal cord, ligaments and muscles.OBJECTIVE: To investigate the possibilities of methods of radiation diagnosis of spinal cord injury in young children (up to 3 years).MATERIAL AND METHODS: 20 children aged from 11 months up to 3 years old were studied with spinal cord injury. X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) were performed. The standard MRI protocol for SCI in children under 3 years of age included: MR myelography in the coronary and sagittal projections, sagittal projection STIR, DTI and T2WI FS SE, axial projection T2WI FS SE or T2*WI FS GE; coronary projection T2WI SE; 3D T1WI FS GE before and after contrast enhancement.RESULTS: An analysis of the data of patients included in the category of polytrauma was carried out. The causes of SCI in these patients were road accidents and falls from various heights. X-ray and CT scans were uninformative, and had large discrepancies with MRI results. All anatomical and morphological changes revealed by MRI correlated well with clinical manifestations and corresponded to the classification of the level and severity of spinal cord injury (ASIA). An increase in the volume and change in the signal of the spinal cord due to edema and / or hemorrhage in the spinal cord is the main sign of damage to the spinal cord, and is best indicated on T2WI and STIR, as a hyperintense signal.DISCUSSION: MRI is critical in the emergency assessment of spinal cord injury or compression to predict the outcome of SCI. There is currently no spinal cord imaging technique that can compete with MRI. Increased volume and signal changes in the spinal cord due to edema and/or hemorrhage are a sign of spinal cord injury and are best demonstrated on T2WI and STIR as a hyperintense signal. Incomplete spinal cord injury is also manifested by a hyperintense signal on T2WI and/or FLAIR, which in intensity and extent correlates with the degree of injury. Hemorrhagic injuries are better detected using T2*GRE or SWI, and spinal cord edema is better detected using T2WI SE and STIR. In addition, STIR can identify bone marrow edema in injured vertebrae, even when the injury is not detected on CT.CONCLUSION: When performing MRI in patients with SCI, three quantitative parameters should be assessed: the maximum damage to the spinal cord, the maximum compression of the spinal cord, and the length of the affected area. In addition to the results of quantitative parameters, potential predictive qualitative MRI findings should be evaluated such as intramedullary hemorrhage, focal and diffuse spinal cord edema, soft tissue injury, probable stenosis before injury, and disc herniation.

RADT-48. RADIATION MYELOPATHY AFTER STANDARD DOSE RADIATION: POTENTIAL RADIATION SENSITIZING EFFECTS OF SYSTEMIC THERAPY

Abstract Radiation myelopathy is an uncommon adverse effect of spinal irradiation. It is especially rare following conventional palliative fractionation regimens for vertebral metastasis. We present two cases of delayed thoracic radiation myelopathy in patients with breast cancer. In both cases, palliative radiation of 30 Gy in ten fractions was administered to thoracic spinal metastases. Neither patient received concurrent systemic therapy. One began trastuzumab emtansine nine days after finishing radiation and the other started palbociclib three months afterwards, which was switched to capecitabine at disease progression. Each patient developed progressive leg weakness and numbness, ten months following radiation and eleven months following radiation (four weeks following capecitabine), respectively. MRI showed edema and focal contrast enhancement within the radiation field in each. Both were treated with high-dose corticosteroid, vitamin E, and pentoxifylline. Neither patient returned to their neurologic baseline and remain with significant deficits, requiring assistance with ambulation. Serial MRIs revealed eventual reduction in cord enhancement and edema, followed by cord atrophy in one case. The cumulative radiation dose of 30 Gy is typically within the safety tolerance of the spinal cord, so it is speculative if post-radiation systemic therapy played a role in the development of myelopathy. The timing is particularly convincing in the patient who developed symptoms within four weeks of starting capecitabine. These cases are similar to recently reported instances of radiation myelopathy after standard dose spinal radiation followed by chemotherapy or immunotherapy. Recognition of the potential radiation sensitizing effects of systemic therapy should lead clinicians to consider radiation myelopathy early if spinal cord symptoms develop and to consider the timing of initiation of potential sensitizing drugs when spinal radiation has been given.

Abstract 081: Clinical Presentation and Treatment of 26 Spinal Epidural Arteriovenous Fistulas: A Single Center Experience

Introduction Spinal epidural arteriovenous fistulas (SEAVFs) are rarely diagnosed vascular malformations that can cause spinal cord compression and congestive myelopathy. Methods This is a single center, retrospective case series of patients with SEAVF who underwent observation or treatment at UCLA medical center from 1993 to 2023. Results A total of 26 patients were found to have a SEAVF at UCLA from 1993 to 2023. The median age at treatment was 59 years (range 4 months to 91 years). 16 of 26 patients (55.2%) were male. 12 were located in the cervical spine, 2 in the thoracic spine, 11 in the lumbar spine, and 1 in the sacral spine. Sacral, lumbar, and thoracic SEAVFs demonstrated a strong male predominance (12 of 14, 85.7%), while cervical SEAVFs were more common in women (8 of 12, 66.7%). The median duration of symptoms prior to treatment was 6.5 months (range 1 day to 8 years). Possible triggers included prior spinal surgery (n=3), turning neck (n=1), trauma to the neck (n=1), lifting a heavy box (n=1), prolonged period of bending over (n=1). The remaining patients did not have any particular trigger. All patients with lumbar and thoracic SEAVFs (except the 3‐month‐old) demonstrated flow voids and cord edema. Patients with cervical SEAVF did not demonstrate cord edema and only 5 of 12 explicitly mentioned flow voids. 22 patients were treated strictly endovascularly, 1 patient endovascularly and then surgically, 1 patient surgically, and 2 patients refused treatment. No patients treated endovascularly experienced complications. 19 of 23 patients (82.6%) treated endovascularly received complete cure after the first treatment. 1 patient had a successful subsequent embolization 2 days later. Of the 3 other incomplete treatments, one patient received subsequent successful surgery, one patient was a 3‐month‐old patient with Parkes‐Weber syndrome who subsequently died of other medical issues, and one was lost to follow‐up. One patient underwent surgical treatment alone due to the feeding arteries being too small to catheterize and unfortunately experienced a failed surgery on the first attempt and developed a surgical site infection after the second successful attempt at treatment. Onyx was used in 10 cases (9 of 10 successful). 2 cases treated with NBCA were unsuccessful. Cervical and Sacral SEAVFs were treated successfully (mostly prior to 2006) with coils and/or detachable balloons. Conclusion SEAVF is a rare disease that can be treated effectively and safely with endovascular embolization in most cases. Pre‐operative MRI demonstrated abnormalities in all cases. We found a strong male predominance in our cohort.

Characteristics of Laryngopharyngeal Reflux in Patients with Chronic Cough Induced by Gastroesophageal Reflux Disease.

Objective: To summarize the characteristics of laryngopharyngeal reflux in patients with chronic cough induced by gastroesophageal reflux disease (GERD). Materials and Methods: The clinical data of patients with chronic cough induced by GERD treated at our hospital were retrospectively analyzed, including their reflux symptom index (RSI), reflux finding scores (RFS), and results of oropharyngeal pH monitoring. Results: There were 44 patients in total, including 21 males and 23 females. The average history of chronic cough was 29.60 (29.60 ± 37.60) months. In addition to coughing, all patients had at least 2 symptoms of laryngopharyngeal reflux disease (LPRD), and their RSI averaged 15.66 (15.66 ± 6.33). The most frequent symptoms were cough, throat clearing, excessive phlegm, or postnasal drip. All patients had LPRD signs, with an average RFS of 10.89 (10.89 ± 2.81). The most frequent signs were erythema or hyperemia/vocal cord edema, posterior commissure hypertrophy, and diffuse laryngeal edema. There were 42 patients (42/44, 95.45%) whose RSI and/or RFS were abnormal. Oropharyngeal pH monitoring identified 10 patients (10/44, 22.72%) with abnormal Ryan scores. Conclusions: All patients with chronic cough induced by GERD had symptoms and signs of LPRD, and most of them had an abnormal RSI and/or RFS and could be diagnosed with suspect LPRD. A part of the patients had LPR episodes according to Dx-pH monitoring, most of which occurred in the upright position. These results indicated that most patients with chronic cough induced by GERD may have suspected LPRD simultaneously and that cough was one of their LPRD symptoms.

Treg cells-derived exosomes promote blood-spinal cord barrier repair and motor function recovery after spinal cord injury by delivering miR-2861

The blood-spinal cord barrier (BSCB) is a physical barrier between the blood and the spinal cord parenchyma. Current evidence suggests that the disruption of BSCB integrity after spinal cord injury can lead to secondary injuries such as spinal cord edema and excessive inflammatory response. Regulatory T (Treg) cells are effective anti-inflammatory cells that can inhibit neuroinflammation after spinal cord injury, and their infiltration after spinal cord injury exhibits the same temporal and spatial characteristics as the automatic repair of BSCB. However, few studies have assessed the relationship between Treg cells and spinal cord injury, emphasizing BSCB integrity. This study explored whether Treg affects the recovery of BSCB after SCI and the underlying mechanism. We confirmed that spinal cord angiogenesis and Treg cell infiltration occurred simultaneously after SCI. Furthermore, we observed significant effects on BSCB repair and motor function in mice by Treg cell knockout and overexpression. Subsequently, we demonstrated the presence and function of exosomes in vitro. In addition, we found that Treg cell-derived exosomes encapsulated miR-2861, and miR-2861 regulated the expression of vascular tight junction (TJs) proteins. The luciferase reporter assay confirmed the negative regulation of IRAK1 by miR-2861, and a series of rescue experiments validated the biological function of IRAKI in regulating BSCB. In summary, we demonstrated that Treg cell-derived exosomes could package and deliver miR-2861 and regulate the expression of IRAK1 to affect BSCB integrity and motor function after SCI in mice, which provides novel insights for functional repair and limiting inflammation after SCI.

Clinical manifestations and magnetic resonance imaging features of spinal cord infarction

Background and ObjectiveSpinal cord infarction (SCI) is a rare type of stroke, with no proposed classification or diagnostic criterium widely accepted and used in daily clinical practice currently. We try to explore the clinical manifestations and MRI features of SCI for improving the accurate diagnosis of SCI. MethodsRetrospectively analyzed the clinical data, MRI features, laboratory findings and outcomes of 40 patients who had been consecutively diagnosed with SCI in our hospital from June 2016 to January 2022. ResultsMost of the SCI (92.5%) occurred at the level of T8-L2 and C4-T4. Transverse infarction (52.5%) and ASA territory infarction (27.5%) were the most common patterns. Longitudinally extensive lesions were noticed in 67.5% of the SCI and it might be a risk factor of poor prognosis (OR=21.11, 95%CI 2.14-208.29). Restricted diffusion of the SCI lesion occurred in 8h and a few lasted up to 60 days. All SCI showed spinal cord edema, accompanied by enhancement of the ventral cauda equina (13.8%), weakened enhancement of the dorsal venous plexus (44.8%), and vertebral infarction (25%). Most patients developed a stroke-like onset (92.5%) after movement (57.5%), with definite pain in the trunk or limbs (67.5%) and dissociative sensory disturbance (60.0%). The main etiologies of them include vascular abnormalities (45%) and iatrogenic injuries (15%). ConclusionAn MRI classification of SCI based on the spinal cord blood supply was proposed. Restricted diffusion and co-existing abnormality of vertebral body and cauda equina may be the key neuroimaging feature for SCI diagnosis. Detailed history of vascular diseases or triggering factors are also helpful.

A Case Report of Spinal Cord Edema and Cervical Spondylosis Masquerading as Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

A 64-year-old previously-healthy male presented with 2-year history of progressive neurological symptoms of numbness and muscle weakness involving all 4 limbs. There was gait disturbance, urinary and fecal incontinence. On examination, the left upper limb had normal tone, diminished deep tendon reflexes and power of 4/5 with wasting both in proximal and distal muscles. There were reduced pinprick pain and temperature sensations below the elbow bilaterally with intact vibration and proprioception. Both lower limbs had increased tone, diminished deep tendon reflexes, power of 3/5 with wasting both in proximal and distal muscles with unequivocal plantar reflex bilaterally. There were reduced pinprick pain and temperature sensations below the knee on right and below the ankle on left with intact vibration and proprioception. Nerve Conduction Studies (NCS) were done which showed axonal type of denervation in all limbs. MRI scan of Cervical Spine showed T2W hyperintense signals and narrowing of spinal canal from C3 to C7 region. The final diagnosis was spinal cord edema in the cervical region and cervical spondylosis causing spinal cord compression. Keywords: Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Spinal cord edema, Cervical spondylosis, Nerve Conduction Studies (NCS), MRI scan, Case report.

A Comparative Study of Fiberoptic Laryngoscopy (FOL) and Indirect Laryngoscopy in the Diagnosis of Patients with Vocal Cord Lesions

Background: Change of voice is one of the common complaints in ENT practice and hoarseness of voice is the commonest symptom of changed voice quality. Hoarseness is invariably the earliest manifestation of conditions directly or indirectly affecting the voice apparatus. Though most common causes of hoarseness are benign and vocal abuse is the commonest among them, but we should always investigate for more sinister pathology like malignancy. The aim of this study was to compare the diagnostic yields of fibreoptic laryngoscopy (FOL) with that of indirect laryngoscopy in the diagnosis of vocal cord lesions. Objectives: To compare fibreoptic laryngoscopy (FOL) and indirect laryngoscopy in the diagnosis of vocal cord lesions as the cause of voice change. Methods: This is a cross-sectional study which has been conducted in the Department of ENT and Head Neck Surgery, SSMC Mitford Hospital with a sample size of 87 cases for a period of six months from 10th February’ 2020 to 9th August’ 2020. The patients with vocal cord lesions were selected according to the eligibility criteria by purposive sampling. Results : On indirect laryngoscopic examinations, 29.89% were vocal cord polyp, 16.09% suspected vocal cord neoplasm, 14.94% vocal cord edema, 11.49% vocal cord nodule, 5.74% vocal cord palsy and 2.61 were ulcerative lesion of vocal cords whereas poor view were in 18.39% cases. On fibreoptic laryngoscopy (FOL), 29.89% were vocal cord polyp, 19.54% suspected vocal cord neoplasm, 17.24% vocal cord edema, 16.09% vocal cord nodule, 8.04% vocal cord palsy and 6.90% were ulcerative lesion of vocal cord. 2.30% revealed normal study. Study showed that fibreoptic laryngoscopic examination is superior to indirect laryngoscopy in diagnosing vocal cord lesions. Conclusion : Fibreoptic laryngoscopy (FOL) is significantly superior to indirect laryngoscopy in the diagnosis of vocal cord lesions. Indirect laryngoscopy sometimes may miss to diagnose a sinister disease like malignancy. Bangladesh J Otorhinolaryngol 2023; 29(1): 24-31

Student Competition (Knowledge Generation) ID 1984525

Background Drug-induced myelopathy has been reported widely for heroin use, but less frequently for amphetamines or fentanyl. Hyperglycemia-induced acute myelopathy has not previously been described. Methods We present a case of toxic/metabolic myelopathy secondary to the aforementioned results in a patient presenting for tertiary inpatient rehabilitation. Results A 28-year-old man with Type 1 Diabetes without complications and polysubstance use (fentanyl and crystal methamphetamine) presented to hospital with quadriparesis and anesthesia. Patient reported he fell down a flight of stairs while using substances and remained on the ground for hours-days as he was acutely paralyzed when he awoke. Initial examination demonstrated a C5 motor level. Pan-CT demonstrated no intracranial or spinous abnormalities. MRI with gadolinium showed cord edema from C1-T4 and patchy enhancement from C4-C7 without cord compression. Diffusion restriction and hemorrhagic transformation were later seen in C4-C7. Initial blood glucose was 66 with no serum ketones. Serum toxicology was negative and urine toxicology was positive for amphetamines and fentanyl. Autoimmune and infectious workups were negative. He received 5 days of pulse steroids and 7 sessions of plasmapheresis with minimal functional or neurological improvement. He was admitted to rehabilitation as a C5 AIS-B and did not exhibit further improvement in motor or sensory function over 3 months of active inpatient rehab. Conclusions Given the pattern of cord enhancement with hemorrhagic transformation, this injury most likely represents acute myelitis induced by hyperglycemia and amphetamines/fentanyl. To our knowledge, this is the first case report where hyperglycemia may have contributed to acute myelopathy.

Xenon postconditioning attenuates neuronal injury after spinal cord ischemia/reperfusion injury by targeting endoplasmic reticulum stress-associated apoptosis.

The purpose of the study is to explore the underlying mechanisms of xenon (Xe) which protects against spinal cord ischemia/reperfusion injury (SCIRI). A SCIRI rat model was induced by abdominal artery occlusion for 85 min and reperfusion. Xe postconditioning (50% Xe) was administered 1 h after 1 h of reperfusion. At reperfusion time points (2, 4, 6, and 24 h), rats were treated with spinal cord scans by MRI to assess the time of peak spinal cord injury after SCIRI. Subsequently, endoplasmic reticulum (ER) stress inhibitor sodium 4-phenylbutyrate (4-PBA) was administered by daily intraperitoneal injection (50 mg/kg) for 5 days before SCIRI. At 4 h after reperfusion, motor function, immunofluorescence staining, hematoxylin and eosin (HE) staining, Nissl staining, TUNEL staining, real-time reverse transcription polymerase chain (RT-PCR) reaction, and western blot analyses were performed to investigate the protective effects of Xe against SCIRI. In the rat I/R model, spinal cord edema peaked at reperfusion 4 h. SCIRI activated ER stress, which was located in neurons. Xe postconditioning remarkably alleviated hind limb motor function, reduced neuronal apoptosis rate, increased the number of normal neurons, and inhibited the expression of ER stress-related protein in spinal cord. Furthermore, the administration of the ER stress inhibitor 4-PBA strongly decreased ER stress-induced apoptosis following SCIRI. Xe postconditioning inhibits ER stress activation, which contributes to alleviate SCIRI by suppressing neuronal apoptosis.

92. Intrathecal pressure, spinal cord compression and edema following traumatic spinal cord injury in a porcine model

92. Intrathecal pressure, spinal cord compression and edema following traumatic spinal cord injury in a porcine model

Analysis of factors associated with the umbilical cord pitch value by ultrasound measurement in late pregnancy

BackgroundThis study aimed to investigate the factors associated with the antenatal umbilical cord pitch value by ultrasound measurement in late pregnancy. We investigated the factors associated with the umbilical cord pitch value under prenatal ultrasound measurement.MethodsThis study included 528 pregnant women who underwent routine antenatal ultrasound examinations in Ningbo Women and Children’s Hospital from December 2020 to August 2021. Their umbilical cord pitch values and diameter, Wharton’s jelly thickness, amniotic fluid indexes, umbilical artery blood flow parameters, and other relevant data, such as ages and gestational ages, were measured. Information about delivery methods, placenta, umbilical cord, and neonatal weight were recorded during follow-up. Statistical analysis was performed on the above data, and the factors associated with the pitch values were analyzed by linear regression.ResultsThis study revealed that cord torsion (p < 0.001, 95% confidence interval [CI]=-34.81 to -19.01), cord entanglement (p < 0.001, 95% CI = 10.71 to 20.11), thickening of Wharton’s jelly (p = 0.001, 95% CI = 5.39 to 20.24), and cord edema (p = 0.015, 95%CI = 2.09 to 19.44), gestational age (p = 0.024, 95%CI = 0.14 to 1.89), age of pregnant woman (p = 0.009, 95%CI= -1.15 to -0.16), and neonatal weight (p = 0.011, 95%CI = 0.002 to 0.012) were significantly correlated with the pitch values.ConclusionThe umbilical cord pitch value significantly correlated with cord entanglement, cord torsion, cord edema, Wharton’s jelly thickening, gestational age, age of the pregnant woman, and neonatal weight. Notably, the pitch value by prenatal ultrasound measurement is predictive of cord morphological abnormalities such as cord entanglement, cord torsion, cord edema, and Wharton’s jelly thickening.

Laryngeal Complications of Prolonged Cricothyroidotomy by Misplaced Percutaneous Dilatational Tracheostomy

Despite several advantages, percutaneous dilatational tracheostomy (PDT) performed by physicians who are unfamiliar with head and neck anatomy can result in malpractice and cause significant complications although laryngeal complications due to prolonged cricothyroidotomy caused by malpractice PDT have not been reported. Here we report a 64-year-old female who complained of dysphonia while receiving a fenestrated tube. The tube was mispositioned tube caused by malpractice PDT; the tube was placed at the cricothyroid membrane for four months without awareness. To correct subglottic stenosis and vocal cord edema, the patient underwent tracheostomy conversion and suspension laryngomicrosurgery. Although her voice slightly improved after the operation, she was unable to decannulate the tube and developed laryngeal web and subglottic stenosis. To reduce complications, PDT must be performed with accurate knowledge of anatomy

Hematomyelia associated with coronavirus disease 2019: A rare case report.

Coronavirus disease 2019 (COVID-19) can damage the central nervous system. Although there have been reports of cerebral hemorrhage and infarction caused by COVID-19, hematomyelia due to COVID-19 has never been reported. A 40-year-old male was admitted to the hospital with positive nucleic acid detection for COVID-19 after experiencing fever for 2 weeks, urinary retention, fecal retention, and pain in both lower extremities for a week. The patient diagnosis was established using thoracic and lumbar magnetic resonance imaging (MRI). Contrast-enhanced thoracic and lumbar MRI revealed subdural (dorsal predominant) short T1 and slightly long T2 bands in the T12-S2 infundibular canal in the scan field, and the subdural hematoma was yet to be distinguished from other diseases. Spinal cord edema was observed in the left vertebral plate and facet joint of the T11 vertebral body, indicative of inflammation. The cerebrospinal fluid (CSF) was positive for COVID-19 nucleic acid. Antiinfection, immunomodulation, correction of acid-base balance and electrolyte disorders, improvement of circulation, nerve nutrition, and other symptomatic supportive treatments were administered to the patient. The patient symptoms significantly improved after 4 weeks of anti-infection and immunomodulatory therapy. Repeat thoracolumbar MRI revealed absorption of the spinal cord hematoma, and the patient was discharged from the hospital. To date, COVID-19-related hematomyelia has not been reported and anti-infective and immunomodulatory therapies may be effective. COVID-19 not only easily leads to brain injury but can also cause spinal cord injury and even spinal cord hemorrhage. When patients with COVID-19 experience symptoms and signs of spinal cord injury, spinal cord injury and bleeding caused by COVID-19 should be considered, and MRI and lumbar puncture should be performed as soon as possible to make a clear diagnosis.

Cervicothoracic translational injury: Radiological analysis and risk factors of spinal cord injury

Abstract Purpose: To determine various radiological parameters predicting spinal cord injury (SCI) in patients with cervicothoracic translational injury. Materials and Methods: Forty-four patients operated for cervicothoracic (C7-T1) translational injury between January 2009 and 2019 were reviewed to obtain demographic details, mechanism of injury (based on Allen Ferguson classification), and neurology at the time of presentation (American Spinal Injury Association [ASIA] grade). Preoperative computed tomography scans were used to measure parameters like anterior translation, local kyphotic angle, residual canal diameter (RCD) at injury level/cranial level/caudal level, and magnetic resonance imaging scans were used to measure maximum canal compromise (MCC), maximum spinal cord compression (MSCC), and length of cord edema. Patients were divided into group 1 (complete neurodeficit), group 2 (incomplete neurodeficit), and group 3 (normal neurology), and the radiological predictors were compared. Results: In our study, anterior translation (P &lt; 0.001), RCD at the injury level (P &lt; 0.001), RCD at the caudal level (P &lt; 0.001), MSCC (P &lt; 0.001), and MCC (P &lt; 0.001) were associated with the increased risk of SCI at the time of presentation. Comparison among all three patient groups showed significant differences in the above parameters. The optimal cutoff for risk of SCI is 7.8 mm for anterior translation, 8.6 mm for RCD at the injury level, 11.9 mm for RCD at the caudal level, 30% for MCC, and 24% for MSCC. Conclusion: Our data highlight that in addition to the amount of anterior translation, canal diameter, and the degree of spinal cord compression at the injury level, the RCD at the caudal level also determines the incidence of SCI in cervicothoracic translational injuries.

Exclusive Spinal Epidural Arteriovenous Malformation: Taming the Serpent in the Canal

Most spinal arteriovenous malformations (AVMs) are dural arteriovenous fistulas in which a singularly intradural venous drainage emanates from an extradural nidus. A pure extradural spinal arteriovenous malformation (E-AVM), in the absence of a vertebral body (cavernous) hemangioma, is extremely rare, and full clinical, radiological, and operative descriptions are scant. We report this case and review the relevant literature to document the rare occurrence of a symptomatic E-AVM producing compressive spinal myelopathy like symptoms. Adult patient presented with 7-month progressive spastic quadriparesis, hypertonia in lower limbs and graded sensory loss below c6 level. Magnetic resonance imaging revealed a T2 hypointese extradural lesion at C4-5 level and CT angiography revealed an epidural vascular malformation.DSA revealed a Type A epidural AVM. Preoperative embolisation of the AVM with Onyx and coils was done and later a C4-5 laminectomy with excision of the entire Epidural AVM nidus with prolapsed coils was done. Surgical excision was done in view of compressive symptoms Post operatively patient had considerable improvement in power as well decrease in hypertonia. Postoperative MRI imaging after 3 months of surgery revealed complete excision of the malformation and resolution of cord edema. Based on the literature review done, ours is a first of its kind case of Exculsive Epidural AVM (EEAVMs) presenting with symptoms suggestive of Compressive spinal myelopathy. To conclude, E-AVMs may present with compressive myelopathy like symptoms. Treatment should be by tailored to benefit the patient like in our case.

B-Cell Lymphoma Intramedullary Tumor: Case Report and Systematic Review.

Intramedullary tumors represent the major cause of spinal cord injuries, and its symptoms include pain and weakness. Progressive weakness may concomitantly occur in the upper and lower limbs, along with lack of balance, spine tenderness, sensory loss, trophic changes of extremity, hyperreflexia, and clonus. The study protocol was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of the MEDLINE electronic database was performed to identify the studies reporting the clinical features of children and adults who presented with an intramedullary lymphoma. Twenty-one studies were included, reporting 25 cases. Manuscripts were excluded if the full-text article was not available, original data were not reported (e.g., review articles), or if the main disease was not intramedullary lymphoma. A structured data extraction form was employed to standardize the identification and retrieval of data from manuscripts. To enlighten the discussion, a case is also presented. An 82-year-old woman with Fitzpatrick skin type II, diagnosed and treated for non-Hodgkin's lymphoma 7 years ago, was admitted with mental confusion and memory loss for the past 2 months-evolving with recurring falls from her own height. One day before admission, she displayed Brown-Séquard syndrome. An expansive lesion from C2 to C4 in the cervical spinal cord was found and a hypersignal spinal cord adjacent was described at the bulb medullary transition to the C6-C7 level. A primary spinal cord tumor was considered, as well as a melanoma metastasis, due to the lesion's flame pattern. The patient presented a partial recovery of symptoms and a reduction of the spinal cord edema after being empirically treated with corticosteroids, but the lesion maintained its extent. Subsequently, a large diffuse B-cell lymphoma with nongerminal center was found in open body biopsy, infiltrating neural tissue. The main objective of the present study is to report a surgical case treated for a large diffuse B-cell lymphoma, in addition to presenting the results of a systematic review of primary intramedullary spinal cord lymphoma.

Astaxanthin ameliorates spinal cord edema and astrocyte activation via suppression of HMGB1/TLR4/NF-κB signaling pathway in a rat model of spinal cord injury.

Spinal cord edema is a quick-onset phenomenon with long-term effects. This complication is associated with inflammatory responses, as well as poor motor function. No effective treatment has been developed against spinal edema, which urges the need to provide novel therapies. Astaxanthin (AST) is a fat-soluble carotenoid with anti-inflammatory effects and a promising candidate for treating neurological disorders. This study aimed to investigate the underlying mechanism of AST on the inhibition of spinal cord edema, astrocyte activation, and reduction of inflammatory responsesin a rat compression spinal cord injury (SCI) model. Male rats underwent laminectomy at thoracic 8-9, and the SCI model was induced using an aneurysm clip. After SCI, rats received dimethyl sulfoxide or AST via intrathecal injection. The effects of AST were examined on the motor function, spinal cord edema, integrity of blood-spinal cord barrier (BSCB), and expression of high mobility group box 1 (HMGB1), toll-like receptor 4 (TLR4), nuclear factor-kappa B (NF-κB), glial fibrillary acidic protein (GFAP), and aquaporin-4 (AQP4), and matrix metallopeptidase- 9 (MMP-9) post-SCI. We showed that AST potentially improved the recovery of motor function and inhibited the spinal cord edema via maintaining the integrity of BSCB, reducing the expression of HMGB1, TLR4, and NF-κB, MMP-9 as well as downregulation of astrocyte activation (GFAP) and AQP4 expression. AST improves motor function and reduces edema and inflammatory responses in the spinal tissue. These effects are mediated by suppression of the HMGB1/TLR4/NF-κB signaling pathway, suppressing post-SCI astrocyte activation, and decreasing AQP4 and MMP-9 expression.

Cervical Instability and Quadriparesis Requiring Stabilization in Pediatric Patient Caused by a Mutation in COL2A1

A 3-year-old male with no past medical history presented with flaccid plegia of his upper extremities and significant weakness in his lower extremities after wrestling with his brother. Cervical spine magnetic resonance imaging was consistent with cord edema and intraparenchymal hemorrhage at C1-C2. A nonossified tissue mass at the expected location of the upper dens created narrowing of the canal at the C1-2 level and mass effect on the cord. Head computed tomography showed periventricular leukomalacia. Initial findings favored dysplasia of the odontoid with associated soft tissue mass/pannus caused by a possible underlying genetic or metabolic bone dyscrasia. The patient underwent suboccipital craniotomy/C1 laminectomy and occiput to C4 fusion, for decompression and stabilization. Genetic testing showed a COL2A1 collagen disorder, with the child harboring a de novo mutation for c.3455 G>T (p.G1152V). The patient was discharged to inpatient acute rehabilitation, with gradual improvement in strength in all 4 extremities.

Outcome of Single Stage Anterior and Posterior Surgery for Tuberculous Paraplegia.

Morbidity and mortality from tuberculosis, a significant infectious illness, are expected to rise worldwide. The projected number of new cases rose from 7.5 million in 1990 to 11.9 million in 2005, a 58.6% increase in 2011. The widespread belief that TB is no longer a public health concern is unfounded; on the contrary, the link between HIV/AIDS and antibiotic resistance has further exacerbated the crisis that already existed. Similar to the nations in sub-Saharan Africa, India is now considered a Group IV country, with an annual risk of infection between 1% and 2.5%. 2. Although 60% of TB cases occur in people who are HIV-positive, only 3-5% of cases in HIV-negative individuals are skeletal. The most frequent type of articuloskeletal tuberculosis is spinal tuberculosis. 1. The goal of this study is to evaluate the neurological outcome of anterior debridement, fusion, posterior instrumentation, and early rehabilitation in individuals with spinal cord injuries. 2. The goal of this study is to determine the prevalence of pressure ulcers, hypostatic pneumonia, and urinary tract infections urinary tract infections (UTIs) among these individuals. 3. The goal of this study is to determine the frequency of graft-related problems. 4. See how well these individuals are able to keep their corrected deformities from returning. Patients who had simultaneous anterior (anterior debridement and bone grafting) and posterior (posterior instrumentation and fusion) procedures were followed prospectively. Thirty patients' films were examined. In addition, cord edema was suggested in 13 of the patients based on the presence of strong signal intensities there. Myelomalacia signs were seen in one patient, but he or she went on to make a complete neurological recovery. The average duration of operation was 355 minutes, and this included the time needed to position the patient for the two separate procedures. There was an 89.5% rate of neurological recovery with an average corrected loss of 6.98 degrees (0.20 degrees to 35.90 degrees), and the complication rate was acceptable in the group analyzed.