Motor Weakness Of Extremities Research Articles

Nondysraphic Intramedullary Spinal Cord Lipomas in the Adult Population

ObjectiveIntramedullary spinal cord lipomas without spinal dysraphism are rare. Although they are benign tumors, they can cause significant neurological deficits. Their tight adherence to the spinal cord presents a challenge for resection. Therefore, we review our institutional experience treating adult patients with intramedullary lipomas in the absence of dysraphism and report long-term outcomes after resection. MethodsAll adult patients undergoing resection of intramedullary spinal cord lipomas at a comprehensive cancer center between June 2011 and June 2023 were retrospectively identified. Patients with spinal dysraphism or extramedullary lipomas were excluded. Patients were included if they had microscopic surgical debulking with tissue sampling confirming the diagnosis. ResultsSix patients were identified with a mean age of 35.0±11.5 years and 67% were female. Four cases localized to the thoracic spine. Symptoms included pain, numbness, and lower extremity motor weakness; only one patient reported bowel and bladder dysfunction. All patients experienced transient neurological decline in the immediate post-operative period. Five recovered to independent ambulation at long-term follow-up, including one recovering to full strength. One patient required a repeat resection after four years due to tumor progression and functional decline. Tumor progression was not recorded in the other patients. ConclusionsSubtotal resection is a safe and effective treatment. Detethering of the spinal cord, resection of exophytic components, and tumor debulking can improve symptoms and prevent further deterioration in most cases. The resection can be assisted using a laser to vaporize the fatty tissue of the lipoma without physical manipulation of the spinal cord.

Long Term Use of Benzodiazepines and Delayed Awakeness from General Anesthesia: A Case Report

We present two delayed awaken cases that underwent general anesthesia and showed altered mentality with unresponsiveness in the postanesthesia care unit (PACU) after successful extubation in the operating room. Both patients had been taking benzodiazepines chronically before surgery. In case 1, extubation was carried out without any problems and arrived at the PACU. After 15 minutes, she suddenly developed hyperventilation, shivering, and a state of consciousness that does not respond to verbal command. Eyes were kept closed and she showed decreased pain withdrawal response in all extremities. After 90 minutes at PACU, she was able to obey simple verbal instructions. All symptoms showed gradual improvement within 5-6 hours. In case 2, 20 minutes after transferal to PACU, the patient showed drowsy mentality with no response to verbal or pain stimuli. Altered mental state lasted 3 days and motor weakness of extremities lasted 5 days. Brain MRI and other examinations showed no abnormalities. They were discharged without any neurological complications.

Effect of Muscularity and Fatty Infiltration of Paraspinal Muscles on Outcome of Lumbar Interbody Fusion.

Lumbar paraspinal muscles play an important role in maintaining global spinal alignment and are associated with lower back pain; however, only a few studies on the effect of the paraspinal muscles on the surgical outcome exist. Therefore, this study aimed to analyze the association of preoperative muscularity and fatty infiltration (FI) of paraspinal muscles with the outcome of lumbar interbody fusion. Postoperative clinical and radiographic outcomes were analyzed in 206 patients who underwent surgery for a degenerative lumbar disease. The preoperative diagnosis was spinal stenosis or low-grade spondylolisthesis, and the surgery performed was posterior lumbar interbody fusion or minimally invasive transforaminal lumbar interbody fusion. Indications for surgery were a complaint of severe radiating pain that did not improve with conservative treatment and neurological symptoms accompanied by lower extremity motor weakness. Patients with fractures, infections, tumors, or a history of lumbar surgery were excluded from this study. Clinical outcome measures included functional status, measured using the Oswestry disability index (ODI) and visual analog scale (VAS) score for lower back and leg pain. Other radiographic parameters included measures of spinal alignment, including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, C7 sagittal vertical axis, and pelvic incidence-lumbar lordosis mismatch. Lumbar muscularity (LM) and FI were measured preoperatively using a lumbar magnetic resonance image (MRI). The high LM group showed more significant improvement in VAS score for lower back pain than the low LM group. In contrast, the VAS score for leg pain demonstrated no statistical significance. The high LM group showed more significant improvement in ODI postoperatively than the medium group. The severe FI group showed more significant improvement in ODI postoperatively, whereas the less severe FI group showed more significant improvement in the sagittal balance postoperatively. Patients with high LM and mild FI ratio observed on preoperative MRI demonstrated more favorable clinical and radiographic outcomes after lumbar interbody fusion. Therefore, preoperative paraspinal muscle condition should be considered when planning lumbar interbody fusion.

Spinal Epidural and Subarachnoid Abscess Due to Acute Pyelonephritis in a 56-Year-Old Woman: A Case Report and Literature Review

With recent advances in treatment technology, the mortality rate of spinal abscesses is decreasing. However, spinal abscesses are still unusual and difficult to treat. A 56-year-old woman presented with lower back pain and fever and chills that started two days before the visit. Initially, she showed lower limb extremity motor weakness. There was right focal acute pyelonephritis of the upper kidney portion with an associated complicated cyst on abdominal-pelvic computed tomography. Klebsiella pneumoniae was cultivated in blood and urine cultures. Spine magnetic resonance imaging with contrast enhancement was completed and the results showed epidural and subarachnoid space abscess formation in the whole lumbar space. The patient was treated with total laminectomy at L2-3 and laminotomy at L4-5 with epidural and subarachnoid abscess removal. After surgery, her back pain subsided enough that intravenous morphine was no longer needed. However, lower limb extremity motor weakness was not recovered. Antibiotics were administered to treat a potential cerebral nervous system infection for nine weeks. At the last follow-up, inflammation levels were normalized and the motor weakness in both legs was also normalized with active rehabilitation. This report described an epidural and subarachnoid abscess in a middle-aged woman due to urinary tract infection sepsis associated with acute pyelonephritis caused by Klebsiella pneumoniae. With proper surgery and adequate antibiotic treatment, the patient's symptoms improved significantly without any complications.

Preoperative Lower Extremity Motor Weakness Affects Deep Vein Thrombosis During the Perioperative Period of Lumbar Surgery.

Prospective cohort study. The aim of this study was to assess preoperative factors in the development/exacerbation of deep vein thrombosis (DVT) in lumbar surgery and selectively perform lower-extremity venous ultrasonography (US) in patients at risk of perioperative deep vein thrombosis (DVT). DVT is often present before lumbar surgery and also can develop or is exacerbated postoperatively. An elevated d-dimer level is predictive of DVT but not in all patients or during every operative period. The level of the thrombogenic marker soluble fibrin monomer complex (SFMC) peaks early postoperatively. The study enrolled 698 patients (396 males; 12- 91 years [346 patients aged ≥70 years] at surgery) undergoing surgery for lumbar degenerative diseases. Patients with d-dimer levels ≥0.5 μg/mL or with a lower-extremity manual muscle test (MMT) < grade 3 underwent preoperative US. All preoperative DVT-positive patients and patients with SFMC levels ≥20 μg/mL on postoperative day 1 (POD1) underwent US. Patients with pre- and postoperative femoral-vein DVT underwent screening for pulmonary embolism (PE). There were 251 patients with preoperative d-dimer levels ≥ 0.5 μg/mL, including 226 with MMT ≥ grade 3, 38 (16.8%) of whom were DVT-positive on US. In 48 patients with MMT <grade 3, DVT was detected in 16 of 25 patients with d-dimer levels ≥ 0.5 μg/mL (64.0%) and 10 of 23 with d-dimer levels <0.5 μg/mL (43.5%). Postoperatively, 26 of 64 preoperative DVT-positive patients (40.6%) had postoperative exacerbation of DVT; PE occurred in three. Among 100 of 634 preoperative DVT-negative patients, US revealed new DVT in 14 (2.2%) and PE in one. Preoperative DVT and new postoperative DVT were significantly more common in patients aged ≥70 years; postoperative DVT exacerbation was significantly more common in patients aged <70 years. A significantly higher proportion of patients with motor weakness had preoperative DVTs and postoperative exacerbated or new DVTs. Preoperative DVT screening by US is advisable for patients with elevated d-dimer levels, lower extremities with MMT < grade 3, or DVT positivity. Postoperative US is advisable for patients with elevated SFMC levels on POD1.Level of Evidence: 3.

Thoracic Spinal Schwannoma Simulating Lumbar Sciatica-like pain: A Case Report and Review of Literature

A 45-year-old man presented to our facility with predominantly Sciatica-like leg pain and lower extremity motor weakness, who did not get relief despite undergoing two consecutive lumbar surgeries for suspected lumbar disc herniation. Medical history, physical findings, and a magnetic resonance imaging scan revealed thoracic cord tumor as the underlying disease. Our patient had complete resolution of his back and leg pain following surgical resection of the thoracic Schwannoma. Thoracic cord compression often results in diffuse pain and myelopathic symptoms caused by the irritation of ascending spinothalamic tract, which causes a vague and burning pain that should be differentiated from nerve root lesions and can be the first presentation of a thoracic cord lesion.

Neurologic impairments from pediatric low-grade glioma by tumor location and timing of diagnosis.

The neurologic outcomes of low-grade gliomas (LGGs) according to tumor location and duration of presenting symptoms remain poorly characterized in children. We retrospectively reviewed neurologic impairments in 246 pediatric patients with LGGs (88 with optic pathway and midline tumors, 56 with posterior fossa tumors, 52 with cerebral hemisphere tumors, 35 with brainstem tumors, and 15 with spinal cord tumors) who were treated at St. Jude Children's Research Hospital between 1995 and 2005. We compared neurologic impairments (defined by Common Terminology Criteria for Adverse Events, version 4.03) by tumor location and prediagnosis symptom interval (PSI) (≥ 3 months or < 3 months) at first and last patient visits. The median age of diagnosis was 7.1 years; median PSI was 2.1 months; and median time to last follow-up was 11.6 years. LGGs in the cerebral hemispheres resulted in significantly fewer neurologic impairments, compared with that of other locations at baseline (P<0.001) and at last follow-up (P<0.001). In all patients, PSIs greater than 3 months resulted in a significantly higher incidence of ataxia and dysmetria at last follow-up (42%, P=0.003). Greater PSI was also significantly associated with worsening lower extremity motor weakness from cerebral hemisphere tumors; dysmetria from optic pathway and midline tumors; eye and visual dysfunction from posterior fossa tumors; and ear and vestibular disturbances from brainstem tumors (P ≤ 0.05). Neurologic impairment in pediatric LGGs varies by tumor location, and PSIs greater than 3 months affect some functionally important neurologic outcomes.

Traumatic Isolated Brain Stem Hematoma: A Case Report Presenting with Hemiparesis

Isolated brain stem hemorrhages are rare but have a high mortality rate after blunt head trauma. 56-year-old male admitted to the emergency room with weakness on the right side of his body, one day after the blunt head trauma. Right hemiparesis which is near to plegia lower extremity motor weakness level was higher than upper extremity was found on his neurological examination. T2-weighted images and susceptibility weighted images SWI of the magnetic resonance revealed heterogenous hyperintense lesion with hemorrhage at the left side of the pons. The patient was managed with conservative treatment; at three-month follow-up, near total recovery was observed on his neurological examination. As a conclusion, it could be said that brain stem contusion with hemorrhage could be kept in mind in patient with hemiparesis if the neurological deficit of the patient cannot be explained by supratentorial or spinal cord lesions

Clinical Study of 27 Patients with Medial Medullary Infarction

Medial medullary infarction (MMI) is a rare ischemic stroke. Frequency of each neurological finding in MMI was different in each study. We retrospectively evaluated the medical records of patients with cerebral infarction who were admitted between March 1998 and October 2015. Patients in our study were diagnosed as having MMI by magnetic resonance image examination. Of 2727 patients with ischemic stroke, 27 patients (20 males and 7 females) had MMI. The MMI was complicated by infarcts located in the pons (n = 6), cerebellum (n = 2), and lateral medulla (n = 1). One patient had bilateral MMI. Large-artery atherosclerosis was the most common etiology. Motor weakness of the extremities was the most common neurological finding. Diminished contralateral superficial sensation was more common than diminished contralateral vibratory sensation, and these 2 types of sensory disturbance were often complicated. The patients with large MMI significantly more often accompanied diminished touch (P = .003), pain (P = .017), and vibratory (P = .019) sensation. Facial weakness was shown more common contralateral to the infarcts than ipsilateral (n = 8 contralateral, n = 1 ipsilateral). Lingual palsy was also more common contralateral to the lesions (n = 3 contralateral, n = 1 ipsilateral). One patient alone fulfilled the classical Dejerine triad. In MMI, motor weakness of extremities was commonly shown, and complication of diminished sensations indicated the large infarcts. As for facial weakness and lingual palsy, the supranuclear type was more prominent than the infranuclear type.

Esophageal Perforation 2 Years After Cervical Hardware Implantation

A 44 year-old man presented to the emergency department with an 8-12 month history of progressive dysphagia to solids and liquids, 80 pound weight loss, odynophagia, and significant dyspepsia. Medical history included type 2 diabetes mellitus and a cerebral vascular accident 3 years prior with residual left-sided extremity motor weakness but no speech or swallowing dysfunction. Surgical history was significant for traumatic right arm amputation and multiple cervical spine surgeries, with most recent anterior fixation of C3-C7 two years prior. Initial plain films and computed tomography (CT) imaging of head and neck showed surgical fixation of C3-C7 with anterior displacement of C6/C7 hardware and screws into the prevertebral soft tissue without frank intrusion in the esophagus. Barium esophagram and flexible laryngoscopy the following day showed no focal abnormalities to the esophagus, nasopharynx, hypopharynx, and larynx. Endoscopy found surgical hardware visualized at the level of the cricopharyngeus. Six days after presentation, the patient underwent removal of cervical hardware and repair of esophageal perforation with placement of percutaneous endoscopic gastrostomy (PEG), tracheostomy, and salivary bypass. Purulent fluid was found surrounding the cervical hardware, and cultures isolated viridans streptococci, Candida albicans and Methicillin-resistant Staphylococcus aureus. He was treated with a total course of four weeks with IV vancomycin and oral fluconazole. Post-operative course was unremarkable and he reported no dysphagia by follow-up. Anterior cervical spinal fixation has become a common management modality for multiple spinal pathologies. While esophageal perforation most often occurring in the early post-operative phase, lateonset cases have been reported occurring more than 10 years after the initial surgery. Common symptoms include neck and throat pain, odynophagia, dysphagia, hoarseness, and aspiration. Less-common presenting symptoms include recurrent pneumonia, fever, cough, and subcutaneous emphysema. Prompt detection and intervention is crucial as mortality and complication rates rise significantly with delayed detection and intervention. Multiple modalities including CT imaging, endoscopy, and even surgical exploration may be required for diagnosis. Negative imaging should not be used as the sole means to rule out esophageal erosion or perforation. Esophageal perforation is most common at the C5/C6 or C6/C7 level. Essential components of therapy include surgical removal of hardware, abscess drainage with culture-directed parental antibiotics, and salivary fluid diversion. Swallowing function has been reported within 10-14 days after the surgical repair.Figure 1Figure 2Figure 3

A Case of Cerebral Venous Thrombosis in a 77-Year-Old White Man

A Case of Cerebral Venous Thrombosis in a 77-Year-Old White Man

Terminal ventriculostomy as an adjuvant treatment of complex syringomyelia: a case report and review of the literature

Complex syringomyelia is multifactorial, and treatment strategies are highly individualized. In refractory cases, sectioning of the filum terminale, also known as terminal ventriculostomy, has been described as a potential adjuvant treatment to alleviate syrinx progression. A 10-year-old boy with a history of arachnoiditis presented with complex syringomyelia, progressive lower extremity motor weakness, and spasticity. Previously, he had failed spinal cord detethering and direct syrinx shunting. Imaging studies demonstrated a holocord syrinx extending to the level of his conus medullaris and into the filum terminale. The patient underwent an uncomplicated lumbar laminectomy and transection of the filum terminale. Operative pathologic specimens demonstrated a dilated central canal within the filum. Postoperative imaging demonstrated significant reduction in the diameter of the syrinx. At follow-up, the patient's motor symptoms had improved. Terminal ventriculostomy may be a useful adjuvant in treating caudally placed syringes refractory to other treatments. This procedure carries low neurological risk and involves no hardware implantation. In select cases, terminal ventriculostomy may help preserve neurological function in the face of otherwise progressive syringomyelia.

Spinal Cord Monitoring for Scoliosis Surgery in Rett Syndrome

A level III retrospective comparative study. Assess the clinical efficacy of somatosensory-evoked potential (SSEP) spinal cord monitoring (SCM) in Rett syndrome patients undergoing scoliosis surgery. The role of SCM in neuromuscular scoliosis is less accurate compared with idiopathic scoliosis because of the nature of the neuropathic or myopathic disorder. Currently, there are no studies that have specifically addressed the accuracy of SCM in Rett syndrome. A retrospective study to assess the clinical efficacy of SSEP SCM in Rett syndrome patients undergoing scoliosis surgery. Somatosensory-evoked potentials were monitored in 7 patients (8 procedures) with Rett syndrome undergoing scoliosis surgery. Transcranial motor-evoked potentials were not performed because of a concomitant history of seizures. The specific methods of anesthesia and SSEP monitoring were standardized for all patients. Adequate baseline and intraoperative SSEP measurements could be obtained in all patients. There were no false-negative or false-positive results. There were 7 true-negative and 1 true-positive results during surgery. The latter was a signal amplitude decrease that did not immediately resolve with standard interventions. Consequently, a Stagnara wake-up test was performed that showed spontaneous muscle activity in both lower extremities. No intravenous steroids were given, and the procedure was completed. The patient had transient unilateral lower extremity motor weakness postoperatively, but recovered preoperative muscle function within 24 hours. Patients with Rett syndrome undergoing scoliosis surgery can be successfully monitored with SSEPs. A history of seizures is a relative contraindication to transcranial motor-evoked potentials. Monitoring can accurately alert the surgeon to potential intraoperative spinal cord compromise and, therefore, decrease postoperative morbidity.

Low Extremity Weakness after Cervical Epidural Steroid Injection in Previous Spinal Surgery Patient - A case report -

A 46-year-old woman received one cervical epidural injection for the management of her neck and shoulder pain. The patient was placed in the prone position without sedation. By using the “loss of resistance to injection of air” technique, the epidural space was identified at the level of C7-T1 inter-laminar space. After needle placement was confirmed by biplanar fluoroscopy and contrast dye, mixture composed of 20 mg of triamcinolone acetonide and 0.125% chirocaine (6.5 ml total volume) was injected. The patient reported no reaction or signs of spinal cord irritation during needle placement attempt. She was developed both low extremity motor weakness and the repeated MRI of the cervical spine indicated right focal cervical myelopathy. It is unknown whether the neurologic injury sustained by patient was the result of spinal cord penetration by the needle, adverse effects from neural tissue exposure to the injected drug, or a combination of both factors.

Spontaneous Spinal Epidural Hematoma in an Infant : A Case Report and Review of the Literature

Spontaneous spinal epidural hematoma (SSEH) is rare in children, especially in infants, in whom only 12 cases have been reported. Because of the nonspecificity of presenting symptoms in children, the diagnosis may be delayed. We report herein a case of SSEH in a 20-month-old girl who initially presented with neck pain, and developed lower extremity motor weakness and symptoms of neurogenic bladder 2 weeks prior to admission. The magnetic resonance imaging showed an epidural mass lesion extending from C7 to T4, and the spinal cord was severely compressed by the mass. After emergency decompressive surgery the neurologic function was improved immediately. Two months after surgery, the neurological status was normal with achievement of spontaneous voiding. We suggest that surgical intervention can provide excellent prognosis in case of SSEH in infants, even if surgery delayed.

Nelarabine Can Be Safely Incorporated into an Intensive, Multiagent Chemotherapy Regimen for the Treatment of T-Cell Acute Lymphocytic Leukemia (ALL) in Children: A Report of the Children's Oncology Group (COG) AALL00P2 Protocol for T-Cell Leukemia.

Nelarabine(araG), is an agent that has shown significant clinical activity in relapsed T-ALL, but has been associated with increased incidence of neurotoxicity. AALL00P2 was a two-stage pilot study designed to assess the feasibility and safety of adding Nelarabine to an intensive modified BFM chemotherapy regimen in children with T-ALL. Ninety-two patients (89 eligible, 87 evaluable) were accrued from April 2001 to October 2005. In stage 1 of the trial, patients with a slow early response, defined as either (a) ≥ 1000 peripheral blood blasts on day 8 of a prednisone prephase or (b) minimal residual disease (MRD) level ≥1% at day 36 of induction therapy, were assigned to receive chemotherapy that included five 5-day courses of Nelarabine 400mg/m2/day, while other patients received chemotherapy without Nelarabine. After 10 patients were assigned to receive Nelarabine, the study was temporarily halted and post-induction toxicities were compared between the regimens with/without Nelarabine. Of 30 (27 eligible) patients in the first stage, 12 (11 evaluable) were assigned to Nelarabine. Stage 2 of the study was limited to T-ALL patients with NCI high risk features. In stage 2, all patients received chemotherapy with five courses of Nelarabine, at either the phase II recommended dose of 650mg/m2/day (slow early response patients defined above) or 400mg/m2/day (others). After ten patients assigned to receive Nelarabine 650mg/m2/day were accrued, the study was closed and analysis of toxicities was conducted. Stage 2 accrued 61 patients with 10 patients receiving Nelarabine 650mg/m2 and 51 receiving Nelarabine 400mg/m2. Toxicities were compared between the regimens with (71 evaluable pts) and without Nelarabine (16 evaluable pts). There were no differences in the incidence of pre-defined targeted neurotoxicities of peripheral neuropathy (PNS; 5/71 Nelarabine vs 1/16 no Nelarabine p=1.000) and central neurotoxicity (CNS; 2/71 Nelarabine vs 2/16 no Nelarabine p=0.1526). Additional toxicities including decrease in hemoglobin, platelets and neutropenia (60/71 vs 16/16 p= 0.2043), AST/ALT elevations (29/71 vs 9/16 p=0.2799) and pancreatitis (4/71 vs 1/16 p=1.000) were similar in the regimens with/without Nelarabine. The only difference in toxicities between the regimens was a decrease in neutropenia with infection in the with Nelarabine arms (27/71 vs 13/16 p=0.0021). In comparison between the two different dosing levels (400mg/m2 vs. 650mg/m2 ) there were no differences in any of the targeted or non-targeted toxicities. Adverse events were reported for 12 of 71 patients on Nelarabine-containing and 5 of 16 patients on the no-Nelarabine regimens. There were two CNS adverse events reported for the 16 patients treated without Nelarabine; CNS hemorrhage and cerebellar infarct. There were 4 CNS adverse events reported among the 71 patients that received Nelarabine: two seizures and one CNS hemorrhage not attributed to Nelarabine and mild leukoencephalopathy possibly attributed to Nelarabine. There were 2 PNS adverse events reported on the Nelarabine regimens, both at 400mg/m2. One patient had lower extremity motor weakness and one patient developed ascending polyneuropathy Guillain Barre-like syndrome, both attributed to Nelarabine. In conclusion, it is feasible with acceptable toxicity to add Nelarabine to an intensive chemotherapy regimen for children with T-ALL.

Sub-acute neuropathy in patients with African tick bite fever

African tick bite fever (ATBF) caused by Rickettsia africae is an emerging health problem in travellers to sub-Saharan Africa. We here present 6 patients with evidence of long-lasting sub-acute neuropathy following ATBF contracted during safari trips to southern Africa. Three patients developed radiating pain, paresthaesia and/or motor weakness of extremities, 2 had hemi-facial pain and paresthaesia, and 1 developed unilateral sensorineural hearing loss. When evaluated 3-26 months after symptom onset, cerebrospinal fluid samples from 5 patients were negative for R. africae PCR and serology, but revealed elevated protein content in 3 and mild pleocytosis in 1 case. Despite extensive investigations, no plausible alternative causes of neuropathy could be identified. Treatment with doxycycline in 2 patients had no clinical effect. Given the current increase of international safari tourism to sub-Saharan Africa, more cases of sub-acute neuropathy following ATBF may well be encountered in Europe and elsewhere in the y to come.

Histopathologic changes in primate spinal cord after single and repeated epidural phenol administration.

Epidural phenol for control of pain and spasticity has been advocated for clinical use. This study determined the histopathologic changes that follow single and repeated epidural administration of phenol in saline in nonhuman primates. Nine primates received 0.5 mL of either 3% phenol in saline (n = 4) or 6% phenol in saline (n = 5) via lumbar epidural injection. Two additional primates received three consecutive daily epidural doses of 0.5 mL of 3% phenol in saline. Finally, 5 unoperated primates and 5 primates that received only 2 mL of radiographic contrast material served as control subjects. Two weeks after the epidural injection, spinal cords were removed and processed for histopathologic study by a neuropathologist blinded to the solution administered. None of the control animals demonstrated histopathologic changes. One animal that received 6% phenol died 3 days after injection. All phenol-treated animals demonstrated predominantly posterior root damage. Spinal cord damage was seen in all animals receiving 6% phenol, in 2 animals receiving 3% phenol single doses, and in neither animal receiving 3% phenol multiple doses. Anterior root damage occurred in all phenol-treated animals except the 4 that received single 3% phenol injections. Animals that received 6% phenol demonstrated greater lower extremity motor weakness than those in the other groups, but no clear correlation existed between extent of histopathologic changes and motor weakness. Motor weakness, anterior root damage, and direct cord injury were noted in primates following epidural administration of phenol in concentrations below what has been reported for clinical use in humans. Since it is more difficult to control the spread of epidural versus subarachnoid phenol, the risks of epidural phenol may outweigh the benefits relative to subarachnoid administration.

聴神経腫ようを伴う原発性異種多発性脳腫よう ２症例の神経耳科学的検討と文献的考察

Case 1 : right acoustic neurinoma and cerebellar tentorial meningioma. Chief complaints were dizziness, right tinnitus, right deafness and headache. Neurotological examination revealed bilateral hearing disturbance, more prominent on the right side, decreased caloric reaction on the right and defect of waves on the right side after I on an ABR. These results suggested a right acoustic neurinoma. But spontaneus downbeat nystagmus could not be explained by a unilateral cerehellopontine angle tumor, so the presence of an other lesion was suspected.Bilateral acoustic neurinoma and multiple meningiomas were found in Case 2.Our diagnosis was neurofibromatosis 2 (NF-2). The only complaint was left tinnitus. Neurotological examination revealed left hearing disturbance, decreased caloric reaction on the left, spontaneous nystagmus directed to the right, defect of waves on the left side after I and prolongation of waves I-V IPL on the right side on an ABR. The ETT and OKIN tests were normal. The x-ray findings revealed dilatation of the left internal auditory canal. Neurological examination revealed a decreased gag reflex on the left, and mild right lower extremity motor weakness. Examinations were initiated because of a suspicion of left acoustic neurinoma. Many of the test results, however, could not be explained by a left acoustic reurinoma alone, suggesting multiple lesions even before CT and MRI were performed.In general clinical medicine, the possibility of multiple lesions, as seen in the present cases, should be kept in mind during the process of neurotological and neurological examination, even in cases in which a unilateral acoustic neurinoma is suspected. Diagnostic imaging procedures, such as CT and MRI, should also be repeated until all clinical findings are explained.