Spinal Cord Hemorrhage Research Articles

Magnetic resonance imaging of traumatic intervertebral disc extension in dogs

This retrospective study evaluated the magnetic resonance (mr) images of traumatic disc extrusions in 11 dogs. The findings included a reduction in the volume and signal intensity of the nucleus...

Acute Cervical Traumatic Spinal Cord Injury: MR Imaging Findings Correlated with Neurologic Outcome—Prospective Study with 100 Consecutive Patients1

To prospectively evaluate whether quantitative and qualitative magnetic resonance (MR) imaging assessments after spinal cord injury (SCI) correlate with patient neurologic status and are predictive of outcome at long-term follow-up. The study included 100 patients (79 male, 21 female; mean age, 45 years; age range, 17-96 years) with traumatic cervical SCI. Ethics committee approval and informed consent were obtained. The American Spinal Injury Association (ASIA) motor score was used as the outcome measure at admission and follow-up. The ASIA impairment scale was used to classify patients according to injury severity. Three quantitative (maximum spinal cord compression [MSCC], maximum canal compromise [MCC], and lesion length) and six qualitative (intramedullary hemorrhage, edema, cord swelling, soft-tissue injury [STI], canal stenosis, and disk herniation) imaging parameters were studied. Data were analyzed by using the Fisher exact test, the Mantel-Haenszel chi(2) test, analysis of variance, analysis of covariance, and stepwise multivariable linear regression. Patients with complete motor and sensory SCIs had more substantial MCC (P=.005), MSCC (P=.002), and lesion length (P=.005) than did patients with incomplete SCIs and those with no SCIs. Patients with complete SCIs also had higher frequencies of hemorrhage (P<.001), edema (P<.001), cord swelling (P=.001), stenosis (P=.01), and STI (P=.001). MCC (P=.012), MSCC (P=.014), and cord swelling (P<.001) correlated with baseline ASIA motor scores. MSCC (P=.028), hemorrhage (P<.001), and cord swelling (P=.029) were predictive of the neurologic outcome at follow-up. Hemorrhage (P<.001) and cord swelling (P=.002) correlated significantly with follow-up ASIA score after controlling for the baseline neurologic assessment. MSCC, spinal cord hemorrhage, and cord swelling are associated with a poor prognosis for neurologic recovery. Extent of MSCC is more reliable than presence of canal stenosis for predicting the neurologic outcome after SCI.

The Impact of Methylprednisolone on Lesion Severity Following Spinal Cord Injury

Retrospective study comparing spinal cord injury (SCI) lesion characteristics in methylprednisolone (MPS) treated versus untreated patients as demonstrated by magnetic resonance (MR) imaging. Determine if the administration of MPS immediately following SCI affects lesion severity. The administration of MPS in the setting of acute SCI has become controversial. Since magnetic resonance imaging (MRI) is sensitive for the detection of spinal cord edema and hemorrhage, changes in lesion characteristics would support a biologic effect due to MPS. Patients with cervical spinal injury treated with the recommended dose of methylprednisolone (bolus 30 mg/kg + 5.4 mg/kg per hour over 24 hours) initiated within 8 hours of injury were compared to historical controls that did not receive steroids. All patients (n = 82) sustained clinically complete SCI (ASIA Grade A) and underwent MRI on the same 1.5 Tesla unit. The length of spinal cord edema, presence/absence of intramedullary hemorrhage, and length of intramedullary hemorrhage were measured on T2-weighted and gradient echo MR images. Comparisons of lesion severity were then made between untreated and treated subjects. Forty-eight of 82 patients with complete injuries received MPS therapy. After accounting for differences in the mean age of the treatment and control groups, multiple regression analysis demonstrated a persistent reduction in the mean length of intramedullary hemorrhage, 2.6 U in the treatment group versus 4.4 U in the control group (P = 0.04). Although there was a reduction in the number of patients exhibiting spinal cord hemorrhage in the treated group compared with the untreated group (65% vs. 91%), this result was not statistically significant (P = 0.16). There was no statistically significant effect of MPS treatment on the mean length of the spinal cord edema between treated versus untreated subjects (10.3 vs. 12.0, respectively, P = 0.85). MRI suggests MPS therapy in the acute phase of spinal cord injury may decrease the extent of intramedullary spinal cord hemorrhage.

MR Imaging of Traumatic Spinal Injuries

Plain films form the initial evaluation in all cases of spinal trauma. In cases of indeterminate or incomplete plain radiographs, further evaluation should be performed by multiplanar computed tomography (CT) and/or magnetic resonance imaging (MRI). Rapid triage is important to distinguish surgical and nonsurgical cases, as this has implications in terms of relief of cord compression and long-term prognosis. CT is unparalleled in its capacity to demonstrate bony abnormalities. MRI is the modality of choice in the evaluation of soft tissue injuries, in particular where there is a suspicion of ligamentous or intervertebral disc injury and spinal cord injury. MRI has the ability to distinguish between spinal cord edema and hemorrhage, which has important prognostic significance.

Epidermal nevus syndrome and intraspinal hemorrhage

The epidermal nevus syndrome (ENS) is a rare neurocutaneous disease characterized by extensive epidermal nevi and a wide variety of abnormalities involving brain, eyes, and skeleton. Neurological symptoms in ENS include seizures, paresis, and mental retardation and are usually ascribed to hemimegalencephaly and various migration disorders. It was suggested that in some patients neurological symptoms might be secondary to vascular abnormalities. We report a case of a patient with diagnosed ENS without any primary CNS lesions, who developed paraplegia resulting from spinal cord hemorrhage. The patient presented many vascular and skeletal anomalies.

Predicting Neurologic Recovery in Cervical Spinal Cord Injury With Postoperative MR Imaging

Prospective, nonrandomized, observational cohort study. To determine whether the presence of spinal cord hemorrhage and length of hematoma on magnetic resonance imaging (MRI) is predictive of recovery in cervical spinal cord injury (SCI). A clear picture of the location, extent, and severity of traumatic cervical cord injury can be obtained with MRI. Several prognostic studies looked for an association between the degree of SCI, as depicted by MRI, and neurologic outcome. Up to now, an association between the length of hemorrhage and the extent of SCI and motor recovery could not be demonstrated. Twenty-nine patients with acute traumatic cervical spinal cord injury underwent surgery within 2 to 9 hours. MRI was performed within 2 weeks of injury. Neurologic impairment was classified using the ASIA classification. The effects of hemorrhage and length of hematoma on changes in the neurologic impairment were assessed at time of MRI and at median follow-up in 35 months (range, 24-65 months). Patients with hemorrhage were much more likely to have a complete injury at time of follow-up (odds ratio = 2.33, 95% confidence interval, 1.42-3.82). Patients admitted with complete SCI, ASIA A, showed a median length of hematoma of 10.5 mm and a median length of edema of 66.5 mm and no change at follow-up. Patients with incomplete SCI showed a median length of hematoma of 4 mm and small edema. Presence of hemorrhage less than 4 mm was associated with good prognosis. This study indicates that presence of hemorrhage of less than 4 mm was not associated with complete SCI and showed good prognosis.

The spectrum of postmortem ocular findings in victims of shaken baby syndrome

Background: Ophthalmologists and ocular pathologists are called on to help identify children who have undergone violent shaking. The objective of this study was to describe the spectrum of postmortem ocular findings in victims of shaken baby syndrome and to correlate the ocular findings with the nonocular features found at autopsy.Methods: The ocular pathology registry at the University of Ottawa Eye Institute was reviewed to identify all victims of fatal shaken baby syndrome whose eyes had been submitted for examination between Apr. 1, 1971, and Dec. 31, 1995. Autopsy reports were accessed from the hospital charts of the identified patients.Results: Six patients, aged I to 34 months, were identified. Intraocular findings ranged from a focal globular hemorrhage at the posterior pole to extensive intraocular hemorrhage involving the entire retina with perimacular folds. All the children had evidence of optic nerve sheath hemorrhage. Nonocular findings included intracranial hemorrhage (in all cases), skull fracture (in two), rib fractures (in three) and high spinal cord hemorrhage (in four). The extent of the intraocular hemorrhage was not consistent with the nonocular findings.Interprétation: Abused children may display a range of postmortem ocular findings, with intraocular hemorrhage varying from minimal to severe. These findings may not correlate with the severity of the child's other injuries. The presence of any retinal or optic nerve sheath hemorrhage in an infant, in the absence of an appropriate explanation for these findings, should raise suspicion of child abuse.

Hemorrhages of Dorsal Root Ganglia and Spinal Cord in Congenitally Hydrocephalic HTX Rat

The effects on the brain caused by hydrocephalus have been examined in detail. However, only little attention has been paid to the possibility that hydrocephalus may affect the spinal cord and the spinal ganglia via the spinal canal. Therefore, the present study focused on the pathological changes seen in the spinal cord and the dorsal root ganglia. A total of 651 congenitally hydrocephalic HTX rats were used in this study. The age ranged from postnatal day 0 to postnatal day 520. All of the HTX rats were from littermates raised in our laboratory. Macroscopic and microscopic investigations demonstrated hemorrhages of the dorsal root ganglia in 134 rats among the 235 affected HTX rats. The hemorrhages of the dorsal root ganglia were observed most frequently in the lumbar ganglia and, less frequently, in the cervical ganglia. Of the 134 rats with hemorrhages in the dorsal root ganglia, 34 rats had hemorrhages both in the spinal cord and in the dorsal root ganglia. The spinal cord hemorrhages were distributed mainly around the central canal and in the ventral parts of the posterior funiculus at the lower thoracic and upper lumbar cords. These hemorrhages were seen only in those rats having progressive hydrocephalus. These findings suggest that increased cerebrospinal fluid pressure can cause congestion of the radicular veins, leading to hemorrhages of the spinal cord and the dorsal root ganglia.

Facet Joint Injuries in Acute Cervical Spine Trauma: Evaluation with CT and MRI

Purpose : To evaluate injury patterns of facet joints and associated soft tissue injuries in patients withacute traumatic cervical facet joint injuries. Materials and Methods : From among patients with cervical spinetrauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzedwith regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, andother associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury,intervertebral disc herniation, and spinal cord injury. Results : The most common location of facet joint injurywas C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) hadbilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fractureof inferior facet was more frequent than superi-or. Patterns of fracture were vertical, transverse, or comminuted,but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facetfractures. Fractures other than facet includ-ed pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13),and spinous process(n=3). On MR im-ages, anterior longitudinal ligament injury was found in 8 patients(30%),posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelvepatients(44%) had spinal cord injuries includ-ing edema(n=8) and hemorrhage(n=4). Among patients with discabnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine.Conclusion : Traumatic cervical facet joint injuries were manifested as various patterns and frequentlyassoci-ated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patternshelped formulate a therapeutic plan and determine of prognosis.

Anaesthetic management of a woman who became paraplegic at 22 weeks' gestation after a spontaneous spinal cord haemorrhage secondary to a presumed arteriovenous malformation

A 19-yr-old woman developed a paraplegia with a T10 sensory level at 22 weeks' gestation. The spinal injury was caused by spontaneous bleed of a presumed arteriovenous malformation in the spinal cord. She presented for Caesarean section at term because of the breech position of her fetus. The successful use of a combined spinal epidural-regional anaesthetic is described and the risks of general and regional anaesthesia are discussed.

ATRAUMATIC FETAL CERVICAL SPINAL CORD INJURY AND CRUCIATE PARALYSIS

In Brief Background Congenital cervical spinal cord injury usually is attributed to intrapartum mechanical trauma. Case A fetal cervical spinal cord hemorrhage presented as congenital isolated upper extremity (“cruciate”) paralysis and muscle atrophy after an atraumatic delivery. Timely neonatal diagnosis and surgery resulted in complete recovery. Conclusion Paralysis may result from atraumatic spinal cord injuries occurring in the antepartum period. A case of fetal cervical spinal cord injury after an atraumatic delivery is presented with a review of the literature.

Atraumatic Fetal Cervical Spinal Cord Injury and Cruciate Paralysis

Background: Congenital cervical spinal cord injury usually is attributed to intrapartum mechanical trauma.Case: A fetal cervical spinal cord hemorrhage presented as congenital isolated upper extremity (“cruciate”) paralysis and muscle atrophy after an atraumatic delivery. Timely neonatal diagnosis and surgery resulted in complete recovery.Conclusion: Paralysis may result from atraumatic spinal cord injuries occurring in the antepartum period.

Forecasting motor recovery after cervical spinal cord injury: value of MR imaging.

To determine whether magnetic resonance (MR) imaging quantification of cervical spinal cord damage improves the prediction of motor recovery after spinal cord injury. The extent of cervical spinal cord injury was measured on MR images obtained in 104 patients (aged 17-70 years) within 72 hours of spinal cord injury. The effects of hemorrhage and edema length on motor outcome were examined for at least 12 months. Patients with spinal cord hemorrhage had significantly lower upper and lower extremity motor scores at the time of injury and at 12 months than did patients without hemorrhage (P < .001). There was little recovery of lower extremity function even in patients without hemorrhage. Upper extremity motor function improved significantly in all patients (P < .001); patients without hemorrhage showed the largest improvements. The motor recovery rates for patients without hemorrhage were 0.74 (upper extremities; range, 0-1) and 0.55 (lower extremities; range, 0-1); those for patients with hemorrhage were 0.31 (range, 0-1) and 0.091 (range, 0-1). Stepwise multiple regression analyses indicated that MR information on hemorrhage and the length of edema increases the ability to predict clinical outcome by 16%-33% over that with initial clinical scores alone. An initial MR imaging evaluation of the spinal cord after spinal cord injury provides supplemental prognostic information on the recovery of motor function in the upper and lower extremities.

Traumatismes médullaires périnatals

Background. - Injury to the spinal cord is still observed in the neonate. Its prognosis is poor. Case reports. - The first neonate was delivered by cesarean section for breech presentation with hyperextension of the neck. She rapidly developed acute respiratory distress and paraplegia. MRI showed spinal cord hemorrhage involving the cervical and upper thoracic cord with rupture of the cord. The patient died a few weeks later. The second neonate was delivered vaginally in breech presentation without any difficulty. She progressively developed tetraplegia evolving into spasticity. MRI showed stretching of cervical spinal cord. The patient later developed sphincter disturbances, repeated urinary and pulmonary infection and severe scoliosis. Conclusions. - Early prenatal damage to the spinal cord was possible in the first patient. Ultrasonography could help to evaluate the extent of damage. The condition leads to difficult ethical and therapeutic problems.

Central nervous system arteriovenous malformations with hereditary hemorrhagic telangiectasia: Report of a family with three cases

A family with central nervous system (CNS) arteriovenous malformations (AVMs) and hereditary hemorrhagic telangiectasia (HHT) is reported. A 46-year-old man had an intracerebral hemorrhage. Cerebral angiography showed one AVM and two angiomas. The HHT was diagnosed because of the concomitant existence of cutaneous telangiectasia. The patient's brother had HHT and paraplegia since the age of 21. Magnetic resonance imaging revealed an old spinal cord hemorrhage. The patient's son with HHT had an intracerebral hemorrhage at age 6. Angiograms showed two AVMs and one angioma. Familial CNS AVMs with HHT are extremely rare. The loci for human leukocyte antigen of the affected cases with HHT were evaluated, and the management of CNS AVMs with HHT is discussed.

Spinal cord hemorrhage secondary to tissue plasminogen activator therapy for acute myocardial infarction

Spinal cord hemorrhage secondary to tissue plasminogen activator therapy for acute myocardial infarction

Spinal cord hemorrhage secondary to tissue plasminogen activator therapy for acute myocardial infarction

Spinal cord hemorrhage secondary to tissue plasminogen activator therapy for acute myocardial infarction

Evaluation of the toxicity, pathology, and treatment of cyclohexylmethylphosphonofluoridate (CMPF) poisoning in rhesus monkeys.

Cyclohexylmethylphosphonofluoridate (CMPF) is an organophosphate cholinesterase inhibitor with military significance. The purpose of these studies was 1) to determine the acute toxicity of CMPF in the male rhesus monkey, 2) to evaluate the efficacy of pyridostigmine (PYR) pretreatment plus atropine and oxime (2-PAM or H16) treatment, and 3) to evaluate the pathological consequences of acute poisoning. An i.m. LD50 of CMPF was estimated using an up-and-down dose selection procedure and 12 animals. The 48-h and 7-day LD50 was 46.6 micrograms/kg, i.m. In the protection experiments, pyridostigmine (0.3-0.7 mg/kg/24 h) was administered by surgically implanted osmotic minipumps for 3-12 days resulting in 21-65% inhibition of erythrocyte acetylcholinesterase activity. Animals were challenged with 5 x L50 CMPF (233 micrograms/kg) and treated with atropine (0.4 mg/kg) and either 2-PAM (25.7 mg/kg) or HI6 (37.8 mg/kg) at the onset of signs or 1 min after challenge. Osmotic pumps were removed within 30 min after agent challenge. Pyridostigmine, atropine, and either 2-PAM or H16 were completely effective against CMPF, saving ten of ten animals in each group. In comparison, three of five animals challenged with 5 x LD50 of soman and treated with atropine and 2-PAM survived 7 days. The primary histologic lesions in the acute toxicity group were neuronal degeneration/necrosis and spinal cord hemorrhage. The CMPF treated groups (total of 20 animals) had minimal nervous system changes with no significant lesion difference resulting from the different oxime therapies. The primary non-neural lesions were degenerative cardiomyopathy and skeletal muscle degeneration which occasionally progressed to necrosis and mineralization.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraspinal hemorrhage in a child with factor XIII deficiency

The rarity of spinal cord injuries and hemorrhages and of fibrin-stabilizing factor XIII deficiency during childhood has induced us to report the case of this two-year-old boy with factor XIII deficiency who presented with cervical intraspinal hemorrhage between the C4 and C7 levels as well as paraplegia presumably following a minor trauma. The findings in this patient, who was brought in two weeks after the appearance of the first symptoms, indicate the importance of early diagnosis and early intervention to minimize the extent of the damage from the injury in such cases. The case also points to the need for close follow-up of patients with factor XIII deficiency for CNS bleeding.

Brain and spinal cord hemorrhage in long‐term survivors of malignant pediatric brain tumors

Three children with malignant primary CNS tumors treated with craniospinal radiotherapy developed intraparenchymal hemorrhages a median of 5 years following therapy in sites distant from the primary tumor. Radical surgical procedures disclosed fresh and old hematoma, gliosis, and necrosis in all 3 patients and an aggregation of abnormal microscopic blood vessels in two. No tumor was found. All 3 patients remain in long-term (greater than 10 years) continuous remission.