Hyperreflexia Research Articles

Cortical anarthria post ischemic stroke: first reported case in an arabic unilingual

A 59-year-old, right handed Arabic speaking lady, known to have ischemic heart disease and hypertension, presented to the emergency department with sudden onset anarthria and right upper limb weakness. Her language examination revealed anarthria manifested in her speech being limited to rare unintelligible single syllables. She had intact comprehension. Her writing was intact and smooth except for a few spelling mistakes in long sentences, however she could not verbalise object names and could not read aloud. Physical examination revealed right upper limb weakness associated with hyper reflexia, and was otherwise unremarkable. MRI revealed a left corona radiata lesion and subcortical white matter hyper intensities bilaterally. A diagnosis of acute ischemic stroke was established, and routine antithrombotic treatment was started. On the second day of admission, the patient started producing single words slowly and effortfully characterised by abnormally long vowels. Additionally, she could write long sentences normally. The next day, she was producing normal single words with long pauses between each word when constructing sentences. By the sixth day of admission, she was saying single words and short sentences normally. The patient's approval for the case publication was obtained. Up to our knowledge, this is the first reported case of cortical anarthria in an Arabic speaking unilingual.

Guillain-Barré syndrome with hyperreflexia precipitated by Lyme’s disease

Guillain-Barré syndrome with hyperreflexia precipitated by Lyme’s disease

Dominant hemisphere and upper cervical cord tumefactive multiple sclerosis in a Nigerian teenager initially misdiagnosed and managed

A 13-year old right handed Nigerian girl presented with eleven weeks history of progressive visual loss, three weeks right hemi-body weakness which progressed to quadriparesis, dysphasia, severe headache, tonic-clonic seizures, neck pain, vomiting and fever.Examination revealed Glasgow Coma Score (E4M6V2), expressive dysphasia and depressed mood. Visual Acuity was counting finger bilaterally. Neck was supple. She had global hypotonia, grade 3 hyper-reflexia and extensor Babinski bilaterally. Power was 0/5 in the right upper limb and right lower limb, 2/5 in the left lower limb and 4/5 in the left upper limb. Other examinations were unremarkable.Contrast enhanced brain MRI revealed three cystic ring enhancing masses at left fronto-parieto-occipital region, associated oedema, midline shift and C2-C4 intramedullary mass with cord oedema. The ring enhancement was incomplete towards the cortex.Following initial suspicions of cystic brain tumour with spinal cord metastasis, she had decompression biopsy. Histology was inflammatory lesion, clinically assumed to be from brain abscess. Failure of antibiotic treatment and the deteriorating neurology prompted mini-craniectomy and biopsy of the cyst wall. Final diagnosis was tumefactive multiple sclerosis. She was successfully managed with methylprednisolone. Follow-up clinical condition has been satisfactory.Keywords: TMS, cranial masses, multiple sclerosis, visual loss

The “gold” standard? A 4-year-old boy with somnolence and focal weakness

Case Report: A 4-year-old previously healthy male presented with headache, abdominal pain, unresponsiveness, left-sided weakness, and right eye deviation. Vital signs were T 37.1°C, BP 126/80, and HR 61. Exam showed somnolence, rightward eye deviation, left-sided hyperreflexia, and a benign abdomen. Brain MRI demonstrated multi-focal ischemic infarcts and leptomeningeal enhancement. CSF revealed WBC 66 (52L/46N), protein 41, and glucose < 20. Ceftriaxone, vancomycin, and fluconazole were empirically started; blood, urine, and CSF cultures remained negative. MRA, echo, HIV, HSV, hypercoagulability labs, and autoimmune labs were unrevealing. Further history revealed patient had lived …

Cortical Anarthria in An Arabic Speaking Unilingual: A Case Report

A 59-year-old, Arabic, right handed female with history of hypertension and ischemic heart disease presented with sudden onset anarthria associated with right arm weakness. Language examination showed Anarthira with inability to produce more than rare unintelligible single syllables. Comprehension was intact. She correctly wrote but could not verbalize object names nor read aloud. She wrote easily but made spelling mistakes with long sentences. Motor exam only revealed slight hyper-reflexia and weakness of right upper extremity. Imaging showed a lesion in the left corona radiata and bilateral subcortical white matter hyper intensities. She was diagnosed with acute ischemic stroke and received routine antithrombotic treatment. Within two days, she started producing single words, with slow, effortful and abnormal long vowels. This report describes the clinical and radiological aspects of a case of cortical anarthria in an Arabic-speaking subject.

Progressive Cervical Spondylotic Myelopathy: A Case Report Describing Evaluation and Management for a Patient in an Acute Care Inpatient Setting

The patient was an 80 year old woman admitted to the hospital in an inpatient setting for pain control and further evaluation after a fall at home which resulted in severe low back pain and difficulty walking. Physical therapy was consulted to assess gait and transfer capabilities. At the time of initial physical therapy examination, the patient demonstrated poor bed mobility and transfer capabilities. She also demonstrated poor to fair upper or lower extremity strength with more pronounced weakness on the right. General hyperreflexia was noted (hyperactive bilateral deep tendon reflexes, positive bilateral Hoffman reflex, bilateral Babinski sign). A computed tomography scan of the head and magnetic resonance imaging of the cervical spine were ordered to assess for a cerebrovascular accident and cervical myelopathy, respectively. The cervical magnetic resonance imaging confirmed the diagnosis of cervical spondylotic myelopathy (Figure 1). The patient subsequently underwent successful surgical decompression laminoplasty from C3 to C6.

Non-Surgical Treatment for Tempromandibular Joint Disorder-A Review

To study about the relaxants are useful in treating the TMJ disorders. Various mechanism behind the relaxants like diazepam, metaxalone, alprazolam, carisprodol and cyclobenzaprine are useful in treating tempromandibular joint disorder. A is a drug which affects skeletal function and decreases the tone. It may be used to alleviate symptoms such as spasms, pain, and hyper reflexia. The term muscle relaxant is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics. The relaxants are used in treating tempromandibular disorder are carisprodol, cyclobenzaprine, diazepam, metaxalone, alprazolam and tizanidine. Diazepam appears to reduce spasticity by enhancing the inhibitory effects of neurotransmitter GABA. It also exerts some supraspinal sedative effect. Diazepam has efficacy in patients with spinal cord injury, hemiplegia, and multiple sclerosis. Carisoprodol is a carbamate derivative. Since, tempromandibular disorder is a common disease, this study is aimed to treat the tempromandibular disorder using the relaxants and bring the overall awearness.

The significance of urodynamic analysis in evaluating neurogenic vesicoureteral reflux in patients with thoracolumbar spinal cord injury

Objective To investigate the utility of urodynamic testing in the evaluation of neurogenic vesicoureteral reflux in patients with thoracolumbar spinal cord injury at the T10 to L2 level. Methods Twenty-six patients with thoracolumbar spinal cord injury at the T10 to L2 level and who displayed vesicoureteral reflux were enrolled and divided into a detrusor hyper-reflexia group (n=21) and a detrusor a-reflexia group (n=5) according to their cystourethrograms and urodynamic test results. Their bladder volume, detrusor pressure (Pdet) and compliance were observed and analyzed at the vesicoureteral reflux point and the leak point. Results The bladder volume and compliance of the detrusor hyper-reflexia group at the vesicoureteral reflux point were (122.46±87.89) ml and (5.94±4.96) ml/H2O respectively, significantly different from the detrusor a-reflexia group (P<0.01). At the leak point, the average bladder volume of the detrusor hyper-reflexia group was (210.81±69.72)ml, while the average bladder compliance was (9.53±5.43)ml/H2O and the average detrusor pressure was (42.29±9.57)cm H2O. All were significantly different from the detrusor a-reflexia group's averages. Moreover, there was a significant difference in the Pdet between the leak point and the vesicoureteral reflux points in the detrusor hyper-reflexia group. Conclusions Patients with thoracolumbar spinal cord injuries at the T10 to L2 level with neurogenic bladder and detrusor hyper-reflexia have low bladder volumes and compliance, and vesicoureteral reflux tends to occur at an early stage after injury with a destrusor pressure lower than 40 cm H2O. For patients with detrusor a-reflexia, vesicoureteral reflux and bladder leakage may occur when detrusor pressure is low. Key words: Spinal cord injury; Neurogenic bladder dysfunction; Vesicoureteral reflux; Urodynamics

Upper motor neuron involvement in Kennedy disease evaluated by triple stimulation technique

To explore the presence of subclinical upper motor neuron (UMN) dysfunction in Kennedy disease (KD) patients with triple stimulation technique (TST). At our hospital from July 2013 to July 2014, a total of 20 KD patients with clinical manifestations, genetic testing and routine electrophysiological tests were examined by triple stimulation technique (TST) combining transcranial magnetic stimulation (TMS) of motor cortex with peripheral collision studies. And the results were expressed by TST amplitude ratio (TST test/TST control). All patients had typical presentations and were genetically proved. The expansion size of polymorphic tandem cytosine-adenine-guanine (CAG) repeat in the first exon of androgen receptor gene was (44 ± 5). Electromyography showed acute and chronic neurogenic damage. Sensory nerve action potentials declined in amplitude. TST amplitude ratio was normal for 13 KD patients and 7 cases were significantly altered. Tendon hyperreflexia was found in 1 patient with normal TST. In patients with abnormal TST, central motor conduction time (CMCT) was normal in 4 patients and tendon hyperreflexia was found in 5 patients. The possible reasons for 7 patients with abnormal TST were concurrent lacunar infaction (n = 2), concurrent spondylotic myelopathy (n = 2) and KD alone (n = 3). Subclinical involvement of UMN may be present in KD patients while other potential causes must be excluded.

A case report of spinal intramedullary lipoma

3 months old boy presented with inablility to move upper limb and cries on touching the upper limb from 1 week of age. On examination reflexes were absent in upper limb but hyper reflexia was found in lower limb. Cervical and brain MRI revealed expansion of the cervical spinal canal with smoothly marginated mass within the cervical cord which is hyperintense in T1WI, T2WI and completely loses its signal intensity in FS and gradient weighted sequences. There was no diffusion restriction and appears mostly intramedullary. MRI features were consistent with intramedullary lipoma in cervical spinal cord.Pulse Vol.7 January-December 2014 p.50-52

Black henbane and its toxicity - a descriptive review.

Black henbane (BH) or Hyoscyamus niger, has been used as a medicine since last centuries and has been described in all traditional medicines. It applies as a herbal medicine, but may induce intoxication accidentally or intentionally. All part of BH including leaves, seeds and roots contain some alkaloids such as Hyoscyamine, Atropine, Tropane and Scopolamine. BH has pharmacological effects like bronchodilating, antisecretory, urinary bladder relaxant, spasmolytic, hypnotic, hallucinogenic, pupil dilating, sedative and anti-diarrheal properties. Clinical manifestations of acute BH poisoning are very wide which include mydriasis, tachycardia, arrhythmia, agitation, convulsion and coma, dry mouth, thirst, slurred speech, difficulty speaking, dysphagia, warm flushed skin, pyrexia, nausea, vomiting, headache, blurred vision and photophobia, urinary retention, distension of the bladder, drowsiness, hyper reflexia, auditory, visual or tactile hallucinations, confusion, disorientation, delirium, aggressiveness, and combative behavior. The main treatment of BH intoxicated patients is supportive therapies including gastric emptying (not by Ipecac), administration of activated charcoal and benzodiazepines. Health care providers and physicians particularly emergency physicians and clinical toxicologists should know the nature, medical uses, clinical features, diagnosis and management of BH poisoning.

Changes of urodynamics and P2X1 receptor expression in bladder detrusor of rats with neurogenic bladder induced by spinal cord injury after the spinal shock stage

Objective To build the rat animal model of neurogenic bladder induced by spinal cord injury and investigate the changes of urodynamics and P2X1 receptor expression in bladder detrusor after the spinal shock stage. Methods A total of 40 female Wistar rats were randomly allocated into control group, suprasacral injury group and sacral injury group. Complete spinal cord transection was established by cutting out of dura at T10-L2 in suprasacral injury group. The sacral injury group was done by cutting out of dura at S2-4. Urodynamic monitor was performed on rats after the spinal shock stage(6 weeks after operation). The P2X1 receptor expression in bladder detrusor among the 3 groups was checked by using immunohistochemical method. Results The suprasacral injury group exhibited detrusor hyperreflexia during bladder filling, elevated leak point pressure and compliance. The sacral injury group exhibited detrusor lower reflection, reduced leak point pressure and elevated compliance. The level of P2X1 receptor expression in rats' detrusor of suprasacral injury group was increased, and the level of sacral injury group was reduced. Conclusions Neurogenic bladder induced by spinal cord injury reveals significant changes in urodynamic after the spinal shock stage. The enhancement of the P2X1 receptor expression in detrusor may be one of the mechanisms of detrusor hyperreflexia. Key words: Spinal cord injury; Neurogenic bladder; Animal model; Urodynamics; P2X1 receptor

UNNOTICED IN CHILDHOOD, DISABLING IN ADULTHOOD: A PROGRESSIVE BUT TREATABLE DISEASE…

A 64 year old Caucasian man presented with subtle cognitive decline of uncertain duration and a six month history of progressive difficulty mobilising with falls. He reported increasing stiffness in...

Clinical analysis of 13 patients with primary intraocular lymphoma

Objective To observe the clinical features of primary intraocular lymphoma (PIOL).Methods The clinical data of 13 patients (24 eyes) of PIOL were retrospectively analyzed.In addition to routine ophthalmic examination,auxiliary examination including fluorescein fundus angiography (FFA) and optical coherence tomography (OCT) were carried out in patients without opacity of refractive media.All the patients were underwent diagnostic vitreous surgery. Eleven patients were confirmed by cellular pathology analysis,one patient was confirmed by retinal biopsy,and one patient was confirmed by neurology biopsy.The clinical features of these patients were observed.Results There were 16 eyes of nine patients (66.7％) with primary central nervous system lymphoma and PIOL,and eight eyes of four patients (33.3％) with PIOL only.The patients included five males and eight females,with a mean age of (55.7±12.6) years.Two patients were affected unilaterally and 11 patients affected bilaterally.Their visual acuity ranged from light perception to 1.0. Fourteen eyes (58.3％) were classified as isolated vitreous inflammation type and 10 eyes (41.7％) were classified as vitreous retinal type.FFA results showed that there was no abnormalities in PIOL patients of isolated vitreous inflammation type,but there were extensive lesions of retinal pigment epithelium (RPE) observed in PIOL patients of the vitreous retinal type.OCT results showed that there were no abnormalities in PIOL of patients of isolated vitreous inflammation type,but hyperreflexia between RPE and Bruch's membrane was observed in PIOL patients of vitreous retinal type.Conclusion The clinical manifestation of PIOL are diversified,mostly in bilaterally affected cases.There are extensive lesions of RPE in patients of vitreous retinal type. Key words: Lymphoma, non-hodgkin/diagnosis; Central nervous system neoplasms/complications; Eye manifestations

Recombinant TSH and Lithium Overcomes Amiodarone-Induced Low Radioiodine Uptake in a Thyrotoxic Female

Introduction:Recombinant human thyroid-stimulating hormone(rhTSH) increases radioactive iodine uptake(RAIU) in selected populations, while lithium is used as an adjunct to radioactive iodine (RAI) therapy in Graves’ disease with low RAIU. In this report, both drugs used in combination, overcame low iodine-131 uptake in a Graves’ patient.Clinical Case:A 39-year old female with Graves’ disease, acquired thionamide-induced agranulocytosis, and severe hypokalemia, subsequently went into cardiorespiratory arrest. On resuscitation, she had ventricular tachyarrhythmias which were cardioverted using amiodarone. She was subsequently placed on IV hydrocortisone amiodarone and propranolol. On admission, she was normotensive, tachycardic, and afebrile. She had fine tremors, hyper reflexia, and diffuse, non-tender thyromegaly. Initial investigations showed normal complete blood count, hypokalemia and elevated alanine transaminase levels. Levels of thyroid stimulating hormone were low (0.03 uIU/L, N = 0.27-3.75). Thyroid ultrasound showed diffuse thyromegaly with uniform echopattern and normal color flow Doppler, radioiodine uptake showed low uptake at 0400h and 2400h (6% and 7%, respectively). In preparation for RAI therapy, she was given lithium 900mg/day for 12 days to increase RAI retention. To increase iodine-131 uptake, two doses of 0.9mg rhTSH were injected intramuscular, 24 hours apart, before RAI therapy. Repeat RAIU after the second dose of rhTSH showed more than a 5-fold increase in 0400h uptake compared with the baseline (32% vs. 6%). Exactly 24 hours after the second dose of rhTSH, she was given 25mCi of iodine-131. Thereafter, the patient’s clinical and biochemical markers continued to improve. She became hypothyroid and is currently on levothyroxine replacement therapy.Conclusions:This case demonstrates the efficacy of combining rhTSH and lithium to overcome amiodarone-induced low iodine-131 uptake in Graves’ disease.

Treating urination disorders after stroke with electroencephalographic biofeedback, cognitive intervention and intermittent catheterization

Objective To analyze the abnormal urodynamics of urination disorders after stroke and evaluate the treatment effects of a combination of electroencephalagraphic biofeedback ( EEGBF),cognitive intervention and intermittent catheterization.Methods Ninety-eight patients with urination disorders after stroke were selected and randomly divided into a treatment group ( n =49 ) which was treated with EEGBF and a cognitive intervention and intermittent catheterization group ( n =49) which was only given routine stroke treatment.Urodynamic examination was carried out before and 2 weeks after treatment to analyze the functions of the bladder and urethral canal.Results The patients' urination disorders manifested abnormal urine flow dynamic changes mainly as detrusor urinae hyperreflexia and urethral external sphincter uninhibited relaxation.The urodynamic examination results of the treatment group improved significantly compared with before treatment.The maximum urine flow rate of the bladder,maximum capacity of the bladder,urethral closing pressure,functional urethral length,leak point pressure of the detrusor urinae and residual urine volume all decreased compared with before treatment and bladder compliance increased.The excellent efficacy in the treatment group was remarkably higher than that in the control group.Conclusion Common urodynamic abnormalities after stroke are mainly detrusor urinae hyperreflexia and uninhibited urethral external sphincter relaxation.Routine treatment combined with EEGBF,cognitive intervention and intermittent catheterization had excellent treatment effects. Key words: Stroke; Urination disorders; Urodynamics; Electroencephalagraphic biofeedback; Cognitive interventions ; Intermittent catheterization

Urodynamic analysis on spinal cord injury patients with urinary voiding dysfunction

Objective To find the differences of bladder and urethra dysfunction between sacral spinal cord injury and Thoracolumbar spinal cord injury.Methods According to the criteria of inclusion and exclusion, we collected 30 patients in the study group.There were 22 males and 8 females, aged 17 -74 ( mean, 47 ) years, with duration between 7 - 36 ( mean, 18) months.There were nineteen cases of thoracolumbar spinal cord injury and 11 cases of sacral spinal cord injury in the study group.We conducted a retrospective analysis of the urodynamic data of the 30 patients in the group.They were divided into a sacral spinal cord injury group and a thoracolumbar spinal cord injury group according to the location of the site of injury.The urodynamic findings of the two groups were comparable.SPSS 16.0 was used to compare the differences between the groups by ANOVA/rank sum test.Results We measured the free flow rate parameters between thoracolumbar and sacral spinal cord injury groups.The maximum free flow rate was ( 13.0 ±5.1 ) vs ( 13.0 ±5.8) ml/s, the free flow rate at 2 s was (6.5 ±5.1 ) vs (6.9 ±6.4) ml/s, the mean free flow rate was (5.4± 2.4) vs ( 3.4 ± 0.5 ) ml/s, urine output volume was ( 279.1 ±131.1 ) vs (450.0 ± 26.6) ml and the residual urine volume was (209.5 ± 180.7 ) vs (434.0 ± 215.0) ml.The residual urine volume and urine output volume of sacral the spinal cord injury group was higher than the thoracic spinal cord injury group (P ＜ 0.05).We also measured the the cystometric parameters.The maximum urinary flow rate was (16.0±23.3) vs (7.1 ±3.3) ml/s, average flow rate was (4.6 ±2.3) vs (3.9 ± 2.3) ml/s, the flow rate after voiding 2 s was (4.6 ± 3.1 ) vs (2.2 ± 3.2) ml/s, urine output volume was (268.4 ± 113.9) vs ( 129.0 ± 97.9) ml, detrusor pressure of maximum flow rate was (58.8 ± 22.0) vs (56.5 ± 14.5) cm H2 O, flow rate of maximum detrusor pressure was (4.8 ± 2.0) vs (4.8 ± 4.4) ml/s,the maximum detrusor pressure was (68.0 ± 31.0) vs (54.6 ± 20.2) cm H2O and the average pressure of voiding period was (47.4 ±20.0) vs (42.6 ± 13.9) cm H2O.The urine output volume of the thoracolumbar spinal cord injury group was lower than sacral spinal cord injury group ( P ＜ 0.05 ).There were no significant differences in bladder sensation and coordination of bladder/urethra between the thoracolumbar spinal cord injury group and the sacral spinal cord injury group (P ＞ 0.05).The incidence of low compliance bladder in the thoracolumbar spinal cord injury patients (4/11) was higher than the sacral spinal injury group, the incidence of high compliance bladder in the sacral spinal cord injury patients (11/19) was higherthan the thoracolumbar group.Conclusions The urodynamics' difference between the sacral spinal cord injury group and thoracolumbar spinal cord injury group was observed in bladder compliance and bladder detrusor contractility changes.Relatively, the incidence of decreased detrusor contractility and high compliance bladder in sacral spinal cord injury patients was higher, and the cidence of detrusor hyperreflexia and low compliance bladder in thoracolumbar spinal cord injury patients was higher. Key words: Urodynamics; Spinal cord injury; Voiding dysfunction

Bilateral Finger Jerks as a Useful Sign for Diagnosis of Cervical Compressive Myelopathy

Background : Bilateral finger jerks are very frequently observed when we examine cervical compressive myelopathy patients. It is very important to determine what sign or symptom is useful for the early diagnosis of cervical compressive myelopathy. Methods : We studied 24 patients with cervical compressive myelopathy. We studied neurological signs and symptoms (bilateral finger jerks, the attitude of deep tendon reflexes, patients’ complaints especially tingling sensations of hands, Hoffmann’s signs) and compared with level diagnoses made by T2-weighted MRI. Results : Eleven patients showed bilateral finger jerks: among these 11 patients, seven patients showed hyperreflexia of biceps and brachioradial reflexes and four patients showed hyporeflexia (inverted radial reflex). All patients with bilateral finger jerks showed lesions at the C5-6 or C4-5 intervertebral levels (C7 or C6 spinal cord levels) on MRI. Among four patients who showed bilateral finger jerks with hyporeflexia (inverted radial reflexes), two patients showed lesions at C5-6 intervertebral level (C7 spinal cord level). Nine patients showed generalized hyperreflexia. 14 patients developed tingling sensations of the hands: among these 14 patients, five patients were affected unilaterally and nine patients were affected bilaterally. Among these 14 patients with tingling sensations of the hands, seven had lesions at the C4-5 intervertebral levels and six had C5-6 intervertebral levels. Sensory levels were observed in five patients. Hoffmann’s signs were not observed in any patients. Therefore, 23 of 24 (96%) cervical compressive myelopathy patients showed bilateral finger jerks or generalized hyperreflexia or complained tingling sensations of hands. Conclusions : We must conclude that deep tendon reflex examination especially the observation of bilateral finger jerks or generalized hyperreflexia and history taking of tingling sensations of hands are useful for the screening of cervical compressive myelopathy. doi:10.4021/jnr15w

The relationship between the imaging features and prognosis in the patients with cervical spinal stenosis and cervical spondylotic myelopathy

Objective To investigate the relationship between the cervical MR images and pathological changes, prognosis in patients with cervical spinal stenosis and cervical spondylotic myelopathy. Methods From Nov. 2006 to Nov. 2009, 286 patients with cervical spondylotic myelopathy were included through retrospective analysis. All patients were divided into two groups according to whether there was cervical stenosis, the grade of increased signal intensity (ISI) in spinal cord and the degree of spinal cord compression was evaluate in T2-weighted MR images of midian sagittal slices. JOA scale, duration of disease,Hoffmann sign, Babinski sign, sensory loss or hypoesthesia, and lower-extremity/upper-extremity hyperreflexia were recorded. Results The incidence rate of cervical spinal stenosis was 33.6% in patients with cervical spondylotic myelopathy. The study showed that the age was smaller (P＜ 0.001 ), preoperative JOA score was higher(P=0.0018), duration of disease was longer(P=0.009), and the recovery rate was lower(P＜ 0.001 )in cervical spinal canal narrowing group comparing with control group. There was no significant difference between the two groups in gender (x2=0.006,P=l.00). There was significant difference between two groups in the incidence of ISI in spinal cord through x2 test(x2=62.396,P＜ 0.001 ). Multivariate analysis indicated that the likelihood of the recovery rate of cervical myelopathy decreased with the presence of cervical spinal stenosis, duration of dieaase, number of neurological signs, age (R2=0.565). Conclusion Patients with congenitally narrow cervical spinal canal have to suffer severe spinal cord compression and high incidence of ISI in spinal cord. The duration of disease is long, and prognosis is poor. Key words: Cervical vertebrae; Spinal stenosis; Spinal cord compression; Magnetic resonance imaging

Pre-and postoperative changes of urodynamic characteristics of patients with tethered cord syndrome

Objective To evaluate the pre-and postoperative changes of urodynamic characteristics in patients with tethered cord syndrome(TCS).Methods A series of 21 patients with TCS surgically treated in our institute were prospectively analyzed from 2006 to 2007.The preoperative and postoperative(2 weeks) urodynamic indexes included bladder volume at the first desire to void,bladder compliance,bladder leak point pressure,maximum flow rate,residual volume,detrusor reflexia were measured and evaluated.Results There were 19 patients (91%) presented with abnormal urodynamic results.Among those 19 cases,14 patients demonstrated with lower motor nerve bladder and 5 higher motor nerve bladder.There were 13 patients with normal bladder compliance,4 lower compliance and 2 higher compliance.There were 3 patients presented with normal detrusor reflexia,8 detrusor areflexia,5 hyperreflexia and 3 patients with hyporeflexia.There was significant improvement of the postoperative bladder residual volume(P＜0.05).Otherwise,there was no significant difference in terms of the volume at the first desire to void,bladder compliance,detrusor reflexia,maximum flow rate and bladder leak point pressure.Conclusion Urodynamic study is an effective method to evaluate neuropathic characteristics of lower urinary tract symptom in patients with TCS.Microsurgical treatment could prevent the symptoms from deterioration.The urodynamic study also could be used to evaluate the symptoms and prognosis of patients with TCS. Key words: Tethered cord syndrome; Urodynamics; Neurogenic bladder