Improvement In Motor Strength Research Articles

Resection of intradural intramedullary subependymoma of the cervicothoracic spine: 2-dimensional operative video.

This video presents the case of a 44-year-old male with a 2-year history of pain in the left upper extremity that had worsened over the course of the last 6 months with associated weakened grip strength and had extended into his right arm. T2-weighted sagittal and axial MRI demonstrated an expansive nonenhancing solid intramedullary lesion extending from C5 to T1. The patient underwent a C5-T1 laminectomy and laminoplasty with near-complete resection of the intradural intramedullary subependymoma. At 3 months' follow-up, he reported doing well and had experienced significant improvement in motor strength with ongoing therapies.

Cryoglobulinemia and Neuromyelitis optica: a case of progressive weakness and neurocognitive decline (P10-5.026)

<h3>Objective:</h3> Describe a case of a woman with mixed cryoglobulinemia who presented with progressive weakness and biopsy proven systemic vasculitis in the setting of Hepatitis C virus (HCV) negative serology. <h3>Background:</h3> The disease expression of mixed cryoglobulinemia vasculitis caused by HCV infection triggers the downstream B-cell arm of autoimmunity. <h3>Design/Methods:</h3> A 61 year old woman with a history of HCV infection, mixed cryoglobulinemia, mononeuritis multiplex secondary to nervous system vasculitis affecting peripheral nerves and hypertension presented with weakness that progressed to quadriparesis and neurocognitive decline over a period of eight months. <h3>Results:</h3> MRI examination of the brain showed bilateral ventral pontine lesions extending into the middle cerebellar peduncles, ventrolateral midbrain and cerebral peduncles as well as bilateral cortical frontal lobe lesions. Also present were intrinsic mixed intensity DWI/ADC lesions of undetermined etiology and extensive subcortical and periventricular white matter hyperintensities. CT angiography of her head and neck showed large vessel intracranial vasculopathy involving the bilateral MCA branches. Conventional angiogram, however, did not show any evidence of angiographic vasculitis. MRI spectroscopy was non-diagnostic. MRI of the neuroaxis showed a small focus of linear non-enhancing hyperintense lesion at the level of C3. EMG demonstrated severe generalized sensory-motor polyneuropathy with severe axonal loss. EEG showed mild to moderate diffuse slowing. CSF evaluation was negative, HCV viral load was undetectable, connective tissue markers (Anti-dsDNA, Anti-SCL70, Anti-CENTR, Anti-RNP, Anti-Smith, Anti-SSA/SSB, ANCA) were negative and the remaining serology was significant for elevated ESR, CRP, low C4 complements, positive anti-AQP4 antibodies titers (1:2560) and positive myelin basic protein. Brain biopsy showed perivascular lymphocytic inflammation, confirming vasculitis. Our patient completed courses of high dose steroids, IVIG and Rituximab with mild improvement in motor strength. <h3>Conclusions:</h3> Although an atypical feature of NMO, cryoglobulinemia with production of anti-AQP4 antibodies may, in part, contribute to development of a demyelinating process. <b>Disclosure:</b> Dr. Esechie has nothing to disclose. Dr. Harazeen has nothing to disclose. Dr. Rivera Vega has nothing to disclose. Dr. Thottempudi has nothing to disclose. Dr. Chhabra has stock in Pfizer. Dr. Chhabra has stock in Biogen. Dr. Chhabra has stock in Johnson and Johnson. Dr. Chhabra has stock in Medtronic. Dr. Shaltoni has nothing to disclose. Muhammad Zeeshan Memon, MD has nothing to disclose. Dr. Patel has nothing to disclose. Dr. Wu has nothing to disclose.

Upper Limb Nerve Transfer Surgery in Patients With Tetraplegia

Cervical spinal cord injury (SCI) causes devastating loss of upper extremity function and independence. Nerve transfers are a promising approach to reanimate upper limbs; however, there remains a paucity of high-quality evidence supporting a clinical benefit for patients with tetraplegia. To evaluate the clinical utility of nerve transfers for reanimation of upper limb function in tetraplegia. In this prospective case series, adults with cervical SCI and upper extremity paralysis whose recovery plateaued were enrolled between September 1, 2015, and January 31, 2019. Data analysis was performed from August 2021 to February 2022. Nerve transfers to reanimate upper extremity motor function with target reinnervation of elbow extension and hand grasp, pinch, and/or release. The primary outcome was motor strength measured by Medical Research Council (MRC) grades 0 to 5. Secondary outcomes included Sollerman Hand Function Test (SHFT); Michigan Hand Outcome Questionnaire (MHQ); Disabilities of Arm, Shoulder, and Hand (DASH); and 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS) scores. Outcomes were assessed up to 48 months postoperatively. Twenty-two patients with tetraplegia (median age, 36 years [range, 18-76 years]; 21 male [95%]) underwent 60 nerve transfers on 35 upper limbs at a median time of 21 months (range, 6-142 months) after SCI. At final follow-up, upper limb motor strength improved significantly: median MRC grades were 3 (IQR, 2.5-4; P = .01) for triceps, with 70% of upper limbs gaining an MRC grade of 3 or higher for elbow extension; 4 (IQR, 2-4; P < .001) for finger extensors, with 79% of hands gaining an MRC grade of 3 or higher for finger extension; and 2 (IQR, 1-3; P < .001) for finger flexors, with 52% of hands gaining an MRC grade of 3 or higher for finger flexion. The secondary outcomes of SHFT, MHQ, DASH, and SF36-PCS scores improved beyond the established minimal clinically important difference. Both early (<12 months) and delayed (≥12 months) nerve transfers after SCI achieved comparable motor outcomes. Continual improvement in motor strength was observed in the finger flexors and extensors across the entire duration of follow-up. In this prospective case series, nerve transfer surgery was associated with improvement of upper limb motor strength and functional independence in patients with tetraplegia. Nerve transfer is a promising intervention feasible in both subacute and chronic SCI.

Trajectory-Based Classification of Recovery in Sensorimotor Complete Traumatic Cervical Spinal Cord Injury.

To test the hypothesis that sensorimotor complete traumatic cervical spinal cord injury (SCI) is a heterogenous clinical entity comprising several subpopulations that follow fundamentally different trajectories of neurologic recovery. We analyzed demographic and injury data from 655 patients who were pooled from 4 prospective longitudinal multicenter studies. Group-based trajectory modeling was applied to model neurologic recovery trajectories over the initial 12 months postinjury and to identify predictors of recovery trajectories. Neurologic outcomes included upper extremity motor score, total motor scores, and American Spinal Injury Association Impairment Scale (AIS) grade improvement. The analysis identified 3 distinct trajectories of neurologic recovery. These clinical courses included (1) marginal recovery trajectory, characterized by minimal or no improvement in motor strength or change in AIS grade status (remained grade A); (2) moderate recovery trajectory, characterized by low baseline motor scores that improved approximately 13 points or AIS conversion of 1 grade point; (3) good recovery trajectory, characterized by baseline motor scores in the upper quartile that improved to near maximum values within 3 months of injury. Patients following the moderate or good recovery trajectories were younger, had more caudally located injuries, had a higher degree of preserved motor and sensory function at baseline examination, and exhibited a greater extent of motor and sensory function in the zone of partial preservation. Cervical complete SCI can be classified into one of 3 distinct subpopulations with fundamentally different trajectories of neurologic recovery. This study defines unique clinical phenotypes based on potential for recovery, rather than baseline severity of injury alone. This approach may prove beneficial in clinical prognostication and in the design and interpretation of clinical trials in SCI.

Surgery for Vertebral Hemangioma in Resource-Constrained Environment

Background: Vertebral hemangiomas are benign, highly vascular lesions of the vertebra. Asymptomatic hemangiomas are common, but they rarely enlarge in size and present with myelopathy. The aim of this study was to analyze the long-term outcome of patients of vertebral hemangioma presenting with myelopathy who were managed in a resource-constrained environment, the majority of whom were treated by our novel three-pronged strategy of alcohol injection, posterior decompression, and short segment fixation. Methods: All patients of symptomatic vertebral hemangioma with myelopathy treated at our hospital from 2001 to 2015 with follow up till January 2018, with at least 2 year follow up were included. The operative procedure, blood loss and complications were recorded. Clinical outcomes were measured using ASIA score. Results: Out of 60 patients operated, 44 (26 males, 18 females) fulfilled the inclusion criteria. 41 hemangiomas were located in the thoracic spine two in lumbar spine and one in cervical spine. Upper thoracic spine involvement was more common than lower thoracic spine involvement. Mean age was 29.34 years (range 10 - 68 years). Mean follow up was 74.63 months (range 24 - 180 months). All patients had improvement in motor strength postoperatively. Local pain, which was present in two patients resolved, bladder symptoms present in 13 patients also resolved. Conclusions: Our experience in treating symptomatic vertebral hemangiomas, along with the long term follow up data suggests that good postoperative results can be achieved with minimal complications, in carefully selected patients. Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: Approval for the study was taken from the institutional ethical board.

Long-Term Outcome of Surgical Management in Symptomatic Pediatric Vertebral Hemangiomas Presenting With Myelopathy.

Vertebral hemangiomas are benign, highly vascular lesions of the vertebra, rarely seen in the pediatric age group. To analyze the long-term (>3 yr) outcome of patients of pediatric vertebral hemangioma presenting with myelopathy and to describe our surgical strategy to treat such cases. All patients up to 18 yr of age with a symptomatic vertebral hemangioma treated at our hospital from May 2003 to August 2016, with at least 3-yr follow-up were included. Functional clinical outcomes were measured using American Spinal Injury Association (ASIA) score. There were 7 male and 7 female patients. All hemangiomas were located in the thoracic spine with single-level involvement. Upper thoracic spine involvement was more common (12 cases: 85.71%) than lower thoracic spine involvement (2 cases: 14.29%). All patients had features of myelopathy. The mean age was 14.57 yr, ranging from 10 to 18 yr. The mean follow-up was 62.21 mo, ranging from 36 to 90 mo. All patients had improvement in motor strength of both lower limbs postoperatively. Local pain, which was present in 1 patient, resolved, and the bladder symptoms present in 5 patients also resolved. Our experience in treating symptomatic pediatric vertebral hemangiomas, along with the long-term follow-up data, suggests that good postoperative results can be achieved with minimal complications in carefully selected patients.

A Rare Case of Chronic Intracerebral Foreign Body

Introduction: Intracranial foreign bodies are usually caused by trauma that penetrates the cranium. Gunshot wounds are the most common cause, while non-missile intracranial penetration is rare. The patient’s clinical condition highly depends on the mechanism, anatomical location of the lesion, and related injuries. Possible complications include intracerebral hemorrhage, contusion, major injury on the vascular, and meningitis. In this article, we report case of intracerebral nail extraction from a patient with right cerebral foreign body.&#x0D; Case presentation: A 22-year-old man with a history of unspecified schizophrenia reported with reduced awareness accompanied by weakness of his left limb. During a head CT scan of the head, there are several tubular foreign bodies in the right cerebral. Craniotomy for foreign body extraction and drainage of the cerebral abscess is immediately performed. Four days after surgery, the patient had increased awareness, although there was no significant improvement in motor strength. One month after discharged from hospital there was slight improvement in motor strength.&#x0D; Conclusion: Extraction of foreign bodies by a surgical procedure is mandatory and should be performed thoroughly. The administration of antibiotics, anticonvulsants, physiotherapy, and psychiatric follow-up should be added to the treatment of this patient.

Surgical Results of Common Peroneal Nerve Neuroplasty at Lateral Fibular Neck.

Common peroneal nerve (CPN) compressive neuropathy is the most common lower-extremity entrapment neuropathy. A retrospective review of a prospectively maintained single-institution database of all patients with CPN palsy who underwent decompression and neuroplasty over a 5-year period was performed. Thirty patients underwent a neuroplasty of the CPN over a 5-year period (2010-2015) at our institution. The median age was 45 years, and there was a male preponderance. The average time between first onset of symptoms to surgery was 122.9 weeks and between first clinic visit and surgery was 21 weeks. The etiology of the CPN neuropathy was as follows: in 12 patients, it followed a surgical procedure and in 14 patients, it occurred after a trauma to the lower extremity. In 2 patients, it occurred as a result of a mass lesion compromising the nerve and in 1 patient, a local infection predisposed to CPN palsy. Right and left lower extremities were equally involved. The median body mass index was 28.6. The most common presentation was weakness of the tibialis anterior (TA) and extensor hallucis longus (EHL) and loss of sensation in the distribution of the CPN or one of its major branches. Pain was a presenting symptom in 16 patients. Only 12 of the 30 patients had a positive Tinel's sign at the site of compression over the lateral fibular neck. Preoperative electrophysiologic confirmation of CPN neuropathy was available in all patients. Mean follow-up was 52 weeks. Prone positioning and selective use of the operating microscope provided excellent visualization and surgical exposure of the CPN from the lower popliteal region to the peroneal tunnel. Average operating room time was 170 minutes and average skin-to-skin time 91 minutes. Clinical improvement after surgery in terms of motor function was noted in 24 of the 26 patients who presented with a motor deficit. The most consistent improvement was noted in the TA and EHL; a trend toward greater improvement with shorter time to surgery was noted. No complications related to the surgical site or CPN were encountered, and no patient had a decline in their neurologic examination as a consequence of the surgery. One patient developed a positioning-related right upper-extremity brachial plexus neuropraxic injury after surgery that recovered completely. Common peroneal neuropathy usually presents with weakness of the TA and EHL and decreased sensation or pain in the distribution of the CPN. Microscope-assisted surgical neuroplasty of the CPN at the lateral fibular neck with the patient in a prone position allows decompression of the nerve from the lower popliteal region to the peroneal tunnel. Significant improvement in motor strength after surgery, particularly of the TA and EHL, was observed in this series.

Nerve Decompression Surgery After Total Hip Arthroplasty: What Are the Outcomes?

BackgroundThe purpose of our study was to compare (1) muscle strength; (2) pain; (3) sensation; (4) various outcome measurement scales between post-total hip arthroplasty (THA) patients who had a sciatic nerve injury and did or did not receive decompression surgery for this condition; and (5) to compare these findings with current literature. MethodsNineteen patients who had nerve injury after THA were reviewed. Patients were stratified into those who had a nerve decompression (n = 12), and those who had not (n = 7). Motor strength was evaluated using the Muscle Strength Testing Scale. Pain was evaluated by using the visual analogue scale. Systematic literature search was performed to compare the findings of this study with others currently published. ResultsThe decompression group had a significant improvement in motor strength and the visual analog scale scores as compared with nonoperative group. Patients in decompression group had a significant larger increase in the mean Harris hip score and University of California Los Angeles score. There was no significant difference in the increase of Short Form-36 physical and mental scores between the 2 groups. Literature review for nonoperative management yielded 5 studies (93 patients), with 33% improvement. There were 7 studies (81 patients) on nerve decompression surgery, with 75% improvement. ConclusionThis study demonstrates the benefits of nerve decompression surgery in patients who had sciatic nerve injury after THA, as evidenced by results of standardized outcome measurement scales. It is possible to achieve improvements in terms of strength, pain, and clinical outcomes. Comparative studies with larger cohorts are needed to fully assess the best candidates for this procedure.

아급성기 뇌졸중 환자에서의 로봇 보조 보행훈련 효과

본 연구는 아급성기 뇌졸중 환자에서 로봇 보조치료법이 운동능력 및 기능적인 회복에 미치는 효과를 알아보고자 하였다. 환자 53명이 연구에 참여하였다. 로봇보조 보행치료군은 고식적인 치료에 추가로 Lokomat<TEX>$^{(R)}$</TEX> 이용하여 하루에 삼십분씩, 일주일에 5회, 4주 동안 시행하였으며, 대조군은 고식적인 치료에 추가로 하루에 삼십분씩 고식적인 치료를 시행 받았다. 모든 환자들은 임상지표의 비교를 위해, 치료 전과 4주간의 치료 후 Fugl-Meyer assessment, Motricity index, functional ambulation category, Berg balance scale, 10m 보행검사, 한국판 수정 바델지수, 한국판 간이 정신 상태검사와 벡 우울증 척도를 평가 받았다. 환자들은 기능회복과 체성 감각 유발전위 검사 결과의 관계를 알아보기 위해 유발 전위 검사를 시행하였다. 아급성기 뇌졸중 환자에서 로봇 보조 보행치료군에서 대조군에 비해 하지의 운동기능, 보행 능력, 일상생활능력의 유의한 호전이 나타났다. 체성 감각 유발 전위 검사의 결과는 임상 지표들의 관련성 분석에서 Motricity index와 한국판 수정 바델지수와 관련이 있는 것으로 나타나 아급성기 뇌졸중 환자의 기능을 예측하는데 유용할 것으로 생각된다. 로봇 보조 보행치료는 아급성기 뇌졸중 환자의 운동기능과 보행기능의 회복을 촉진하는 것으로 생각된다. This study examined the effects of robot-assisted therapy on the motor and functional recovery of the lower limbs in 53 subacute stroke patients. Robot-assisted therapy was performed using Lokomat? (Hocoma AG, Zurich, Switzerland) for thirty minutes per day, five times a week for four weeks. The outcome measures used were the Fugl-Meyer assessment, Motricity index(MI), Functional ambulation category(FAC), Berg balance scale(BBS) for gait function and balance ability, 10m walking test, K-Modified Barthel Index(K-MBI) for the activities of daily living and Mini mental state examination (MMSE), and Beck's depression inventory(BDI) for depression. All patients recruited underwent these evaluations before and after the four week robot-assisted therapy. For the evaluation, the somatosensory evoked potentials were used to assess the functional recovery. Robot-assisted therapy on the lower limb after subacute stroke showed improvement in motor strength, gait function, and the activities of daily living. All changes in terms of MI, FAC, BBS, and K-MBI exhibited a statistically significant difference after the four weeks robot-assisted therapy. The somatosensory evoked potential result showed a correlation with the MI and K-MBI. Robot-assisted therapy is believed to facilitate the motor and functional recovery of the lower limb in subacute stroke patients.

Preoperative Donor Nerve Electromyography as a Predictor of Nerve Transfer Outcomes

We hypothesized that health of the donor nerve and corresponding muscle, as assessed by electromyography (EMG), could predict the outcome of nerve transfer surgery. A retrospective review was performed to investigate outcomes of nerve transfers for elbow flexion and shoulder abduction. Motor strength was graded preoperatively and after a minimum 1-year follow-up. Preoperative EMG results were classified as functionally normal or affected based on motor unit recruitment pattern and correlated with follow-up motor strength and range of motion. Forty nerve transfers were identified: 27 were performed for elbow flexion and 13 for shoulder abduction. Overall, the 29 transfers in the normal EMG cohort showed significantly greater postoperative improvement in motor strength (Medical Research Council grade 0.2-4.1) than the 11 transfers in the affected EMG cohort (grade 0.0-3.0). In the shoulder cohort, normal donor nerves resulted in greater strength (grade 4.0 vs. 2.4) and active motion (83° vs. 25°) compared with affected donor nerves. Double fascicular transfers with 2 normal donor nerves demonstrated improved strength compared with double nerve transfers when 1 donor nerve was affected (grade 4.5 vs. 3.2). Our findings demonstrate that a simple EMG classification that describes the quality of donor nerves can predict outcome as measured by postoperative motor strength and range of motion. Preoperative EMG evaluation should be considered a valuable supplementary component of the donor nerve selection process when planning brachial plexus reconstruction. Prognostic II.

Variety of spinal vascular pathology seen in adult Cobb syndrome

Cobb syndrome is a rare clinical entity that includes the combination of a vascular skin nevus and an angioma in the spinal canal present at identical dermatomal level(s) (cutaneomeningospinal angiomatosis). To date, 38 cases have been reported, only 18 of which are in adults (> 18 years of age). The majority of these cases have been described in the era predating current neuroimaging techniques, and most authors have assumed that each case involves similar vascular pathology. This report highlights 2 patients presenting with similar thoracic cutaneous vascular nevi yet with markedly differing spinal vascular pathology. A 29-year-old man presented with cutaneous hemangioma and a progressive paraparesis and paresthesia of the lower extremities. A 20 x 20-cm port-wine stain over his right upper midback (T6-10) correlated precisely with MR imaging that demonstrated an enhancing epidural mass between T-6 and T-10 causing compression of the cord and cord edema. A 34-year-old man also presented with progressive myelopathy and a 15 x 20-cm port-wine stain within the same dermatomal region as a Type III spinal arteriovenous malformation. Workup for each patient included pre- and postoperative contrast-enhanced MR imaging with vascular sequencing and spinal angiography. The first patient was treated with bilateral laminectomy at the T6-10 levels, with significant postoperative improvement in motor strength. The second patient underwent coil embolization of an intranidal aneurysm, with follow-up embolization 8 years later. Cobb syndrome is an unusual entity in the adult population and should be considered when there is a constellation of cutaneous manifestation and underlying neurological deficit. The vascular skin nevus associated with Cobb syndrome is accompanied by a wide variety of vascular pathologies.

Intradural Extramedullary Tuberculoma of the Thoracic Spine: Paradoxical Response to Antituberculous Therapy

Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a rare complication of tuberculosis, which can occur as a paradoxical response to antituberculous therapy. A 46-year-old woman with tuberculosis meningitis developed an acute sensory disturbance and paraplegia eight weeks after the antituberculous treatment was started. MRI revealed a cystic lesion at the Th 2 and 3 vertebrae levels, and continuous dural thickening. Laminectomy was performed; soft granulomas were unexpectedly observed inside the dura matter. After the operation, the patient experienced progressive improvement in motor strength. IETSC should be known as rare but possible complication of tuberculous meningitis.

Translaminar Microsurgical Approach for Lumbar Herniated Nucleus Pulposus (HNP) in the “Hidden Zone”

Clinical series. To describe an alternative surgical approach for disc herniations in the "hidden zone." Many spine surgeons have suggested different surgical approaches for symptomatic preforaminal and foraminal disc herniations. However, almost every surgical approach has certain shortcomings when it comes to exposing the "hidden zone" without causing some degree of spinal instability. Twenty-four patients with preforaminal and foraminal disc herniation underwent surgical treatment via a translaminar microsurgical approach. RESULTS.: Excellent results were obtained in all patients in terms of pain relief, and all had improvement in motor strength except for 1 patient. No spinal instability was seen at the latest follow-up. A classic interlaminar interspace approach combined with a very limited translaminar fenestration seem to be an acceptable surgical method for accessing a preforaminal disc herniation, and this technique has proven to be safe and did not cause any instability at the latest follow-up.

Clinical outcome differences for lipomyelomeningoceles, intraspinal lipomas, and lipomas of the filum terminale.

Failure to differentiate between the different types of lumbosacral lipomas may lead to inaccurate assumptions and inappropriate management of patients. The goal of this study was to determine whether there is a difference in clinical outcome between patients with lipomyelomeningocles, intraspinal lipomas, and lipomas of the filum terminale. One hundred and fourteen patients with spinal dysraphism were seen at Duke University Medical Center between 1995-1999. All patients who had undergone previous operative intervention for these lesions were excluded. Twenty-two patients with intradural lipomas were identified. Of these, 14 (64%) had lipomyelomeningoceles and 8 (36%) had intraspinal lipomas. Twenty-five patients had filum terminale lipomas. Operative management consisted of lumbosacral laminectomies with microsurgical resection of the lipoma and division of the fatty filum. Average age at presentation in symptomatic patients with lipomas of the filum terminale was 17.7 years, and 23 years in the symptomatic intraspinal lipoma group. Patients with lipomyelomeningoceles ranged in age from 1 day to 18 years, with the majority being younger than 2 years. After an average follow-up of 8 months all patients showed improvement in motor strength following operative intervention. Greater improvements in sensory, bladder, and pain scores were associated with filum terminale lipomas. The least improvements in these categories were seen in the lipomyelomeningocele group. Motor strength is the most likely deficit to improve following operative intervention. Lipomyelomeningoceles, intraspinal lipomas, and filum termniale lipomas have different clinical outcomes following operative intervention.

Intradural Metastasis Mimicking Nerve Sheath Tumor

This is a case report. This is an unusual case of a 69 year-old man with metastatic carcinoma to the C8 and T1 intradural roots, with extension through the intervertebral foramen of C7-T1 mimicking a nerve sheath tumor clinically and radiologically. This report reviews the clinical features, radiology, pathology, and pathogenesis of these metastatic lesions. Nerve sheath tumors are the most common primary spinal tumors. In contrast, metastasis to the spinal nerve roots is very rare. Metastatic tumors may clinically simulate other diseases and, as in this case, a nerve sheath tumor. A review and discussion of the case facts are presented. Metastatic carcinoma to C8 and T1 nerve roots was diagnosed intraoperatively during C7-T1 laminectomy and partial tumor debulking. The patient had a satisfactory recovery, with symptomatic relief of painful radiculopathy, but with no improvement in motor strength. Metastasis to spinal nerve roots can clinically mimic other diseases. As in this case, the proper diagnosis may be possible only at surgery.

Plasma exchange as a therapy for Guillain-Barré syndrome with immune complexes.

Small volume plasma exchange (PE) was evaluated in 6 patients with acute Guillain-Barré syndrome (GBS) and in 1 with its chronic relapsing type. Patients were treated during the onset or progression of their neurologic involvement and no other combined therapy was provided. 6 of our patients had clear benefit following the first session. Two procedures on alternate days were carried out in 4 patients while a third procedure was performed in 3 due to insufficient exchange or to equivocal improvement. After PE, patients showed moderate to marked improvement in motor strength, in their ventilatory function and in their sensory symptoms, which improved definitely but more slowly than motility. Each patient showed, prior to therapy, high levels of immune complexes; their level was clearly reduced by PE and clinical results correlated with this removal. No relapse was observed during 5-15 months of appropriate follow-up.

Plasma Exchange as a Therapy for Guillain-Barré Syndrome with Immune Complexes

Small volume plasma exchange (PE) was evaluated in 6 patients with acute Guillain-Barré syndrome (GBS) and in 1 with its chronic relapsing type. Patients were treated during the onset or progression of their neurologic involvement and no other combined therapy was provided. 6 of our patients had clear benefit following the first session. Two procedures on alternate days were carried out in 4 patients while a third procedure was performed in 3 due to insufficient exchange or to equivocal improvement. After PE, patients showed moderate to marked improvement in motor strength, in their ventilatory function and in their sensory symptoms, which improved definitely but more slowly than motility. Each patient showed, prior to therapy, high levels of immune complexes; their level was clearly reduced by PE and clinical results correlated with this removal. No relapse was observed during 5-15 months of appropriate follow-up.