Spinal cord compression by spontaneous spinal subdural haematoma in polycythemia vera

A woman with an eight-year history of polycythemia vera presented with numbness and weakness of both legs. A large spinal haematoma was revealed on magnetic resonance imaging which was treated clinically and which subsequently resolved.     

Spinal cord compression in metastatic cervical cancer

Spinal cord compression secondary to metastatic cervical cancer may not be considered as a possible cause of neurologic symptoms by primary care physicians who do not often treat these patients. Delays in diagnosis and treatment may result in irreversible but potentially preventable neurologic changes. This report describes 5 cases of spinal cord compression in patients with metastatic cervical carcinoma, 2 of whom were previously undiagnosed with cervical cancer. These 2 patients represent 1.6% (2 of 121) of all new cervical cancer cases diagnosed during this time period. Two of 5 patients (40%) with spinal cord compression showed improvement following therapy by regaining the ability to walk, while none of the remaining patients had further acute deterioration of neurologic function. The mean survival of patients presenting with spinal cord compression from cervical cancer in this series was 4 months (maximum 6 months). This series illustrates the relative frequency with which spinal cord compression is seen in patients with a new diagnosis of invasive cancer. This diagnosis should be considered when evaluating neurologic complaints in known cervical cancer patients or any woman with apparent pelvic pathology. Rapid diagnosis and treatment of these lesions, while not likely to improve overall survival significantly, can improve function and alleviate symptoms.     

Angiographic changes following acute spinal cord compression: an experimental study in monkeys

Acute paraplegia was produced in monkeys by abruptly inflating a balloon catheter within the epidural space. The arteriographic and epidural venous changes following such trauma were serially evaluated. Spinal-cord arteriograms following cord injury remained normal during an acute (four-hour) follow-up. Serial epidural venograms demonstrated obstruction of epidural veins within four hours at the site of contusion in less than half of the animals studied. Neither spinal arteries nor epidural showed consistent diagnostic changes following trauma due to acute epidural compression.     

Spinal opioid mu receptor expression in lumbar spinal cord of rats following nerve injury

The oxidation of inulin with Pt/C as catalyst was studied. Methyl alpha-D-fructofuranoside was used as a model compound for the monomeric unit of inulin. Oxidation occurred selectively at the C-6 position in a high yield (79%). The rate of oxidation and the degree of oxidation obtained for inulin oligosaccharides decreased upon increase of the chain length of the substrate. Inulin could only be oxidized partially: the oxidation degree obtained was 20% of the primary hydroxy groups for inulin with an average dp 30. Possible explanations for these relatively low conversions are discussed. Adsorption and desorption phenomena appear to play and important role during the oxidation process.     

Intraoperative monitoring for spinal cord tumor by spinal cord evoked potential following unilateral spinal cord stimulation

We described our experiences with intraoperative spinal cord monitoring in 6 cases of spinal cord tumor. During the operation, spinal cord evoked potential following unilateral spinal cord stimulation was recorded from subdural monitoring electrodes. This series included two cases of intradural extramedullary tumor (one case each of neurinoma and of meningioma) and four cases of intramedullary tumor (2 cases of cavernous angioma, one case each of ependymoma, and of glioblastoma multiforme). Before the removal of the tumor, the spinal cord evoked potential showed lower amplitude or no response on the more affected side in all 6 cases. During the operation, the different intraoperative changes were shown on each side. The authors think that the detection of unilateral damage to the spinal cord is possible in spinal cord evoked potential using unilateral spinal cord stimulation.     

Spinal cord compression of sarcoidosis origin: a case

We report a case of marked cytomegalovirus (CMV)-antigenemia determined by direct immunoperoxidase staining using a peroxidase-labeled monoclonal antibody HRP-C7, after conventional chemotherapy for malignant lymphoma. A 65-year-old Japanese man suffered from unexplained fever, mild liver dysfunction and an abnormal shadow in the lung after hematopoietic recovery from intensive chemotherapy for T-cell non-Hodgkin's lymphoma in the leukemic phase. The assay for CMV-antigenemia revealed that he had an active CMV infection. After treatment with ganciclovir and gamma-globulin, his symptoms and signs improved with the decrease of CMV antigen-positive leukocytes. CMV disease should be considered in these situations, and the CMV antigen-detection assay is useful for rapid diagnosis of CMV infection.     

Magnetic resonance imaging in cervical spinal cord compression

In patients with cervical spondylotic myelopathy MRI sometimes shows increased signal intensity zones on the T2-weighted images. It has been suggested that these findings carry prognostic significance. We studied 56 subjects with cervical spinal cord compression. Twelve patients showed an increased signal intensity (21.4%) and a prevalence of narrowing of the AP-diameter (62% vs 24%). Furthermore, in this group, there was evidence of a longer mean duration of the symptoms and, in most of the patients, of more serious clinical conditions. The importance of these predisposing factors remains, however, to be clarified since they are also present in some patients without the increased signal intensity.     

Laminectomy for spinal cord compression from metastatic tumor

The blood pressure response to graded infusions of angiotensin II was assessed under control conditions and following short term (16 hour) indomethacin treatment utilizing normal men equilibrated on a constant diet of normal sodium and potassium content. Although basal mean blood pressure was unchanged, the increase in blood pressure with all rates of angiotensin II infusion ranging from 200 to 1000 ng/min was significantly greater with indomethacin treatment. Pre-infusion body weight and plasma renin activity were similar under the two conditions. These results suggest that prostaglandins modulate the systemic vasoconstrictor effects of angiotensin II.     

Adjustment following spinal cord injury.

Investigated specific coping strategies associated with psychological adjustment following spinal cord injury with a battery of assessments administered to 57 patients (median age 26.5 yrs) participating in a spinal cord injury rehabilitation program. Ss were divided into 3 groups based on degree of psychological distress. High-distress Ss reported using more Wish-Fulfilling Fantasy, Emotional Expression, Self-Blame, and Threat Minimization Coping strategies relative to the low and moderate distress groups. The Self-Blame Coping strategy was significantly correlated with psychological distress over and above age, time since injury, or level of injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Employment outcomes following spinal cord injury

PURPOSE: We determined the clinical utility of proton MR spectroscopy in defining the extent of disability in benign versus secondary-progressive multiple sclerosis (MS). METHODS: Thirty patients with clinically definite MS, including 16 patients with benign MS and 14 with secondary-progressive MS, and a group of 13 healthy volunteers were studied with combined stimulated-echo acquisition mode proton MR spectroscopy and MR imaging (all patients received contrast material). RESULTS: Acute enhancing lesions of benign and secondary-progressive MS were characterized by a reduction in N-acetylaspartate (NAA)/choline and NAA/creatine and an increase in inositol compounds/creatine as compared with normal white matter. Such variations were also detected in chronic unenhancing lesions in patients with secondary-progressive MS, although they were not found in chronic unenhancing lesions in patients with benign MS. Chronic lesions of the two forms of the disease have significative differences in NAA and inositol signals. CONCLUSION: Proton MR spectroscopy is able to show metabolic changes occurring in the white matter of patients with MS. Such changes differ according to the phase (acute versus chronic) and the clinical form (benign versus secondary-progressive) of the disease.     

Regional spinal cord blood flow in rats after severe cord trauma

Spinal cord blood flow (SCBF) was measured in 12 albino rats following acute cord injury produced by the extradural clip compression technique. Severe injury was produced with the clip compressing the cord with a force of 180 gm for 5 minutes, an injury previously shown to produce a severe functional deficit. Regional SCBF was measured 15 minutes, 2 hours, and 24 hours after injury by the 14C-antipyrine autoradiographic technique and a scanning microscope photometer. At 15 minutes and 2 hours, white and gray matter blood flow was severely diminished, and, at 24 hours, there was only minimal improvement. Focal decreases in blood flow were seen in white and gray matter for a considerable distance proximal and distal to the site of cord trauma. Thus, it has been confirmed in this model that severe cord compression injury produces severe posttraumatic ischemia in the cord which lasts for at least 24 hours.     

Circulatory disturbances following transient soft tissue compression trauma

Circulatory changes following standardized compression trauma to the hind leg in dogs were evaluated using an electromagnetic flow meter and repeated angiography. A transient increase of flow to the injured limb and within the traumatized region was observed. Good agreement was found between the electromagnetic flow recordings and estimates of relative changes in flow by the angiographic method.     

Magnetic resonance imaging of experimental subacute spinal cord compression

STUDY DESIGN: Subacute compression of the spinal cord was applied to rats. The animals were chronologically observed using magnetic resonance imaging for more than 8 weeks after surgery and were killed for histopathologic examination. OBJECTIVES: To investigate the correlation of changes in signal intensity on magnetic resonance images with those observed in histopathologic study and with the degree of spinal cord compression and paralysis. SUMMARY OF BACKGROUND DATA: No consensus has been reached concerning the correlation of magnetic resonance images to clinical symptoms of compressive myelopathy. Few reports are available in which magnetic resonance imaging findings are compared with histopathologic features in chronic or subacute experiments. METHODS: In rats under general anesthesia, the T11 lamina was thinned and a slow increase in volume was applied. Hind limb paralysis appeared 1 week after the procedure and spontaneously subsided thereafter. The degree of spinal compression and signal intensity was observed chronologically using magnetic resonance imaging. The signal intensity on the final MR images was rated on a four-point scale and compared with histopathologic findings. RESULTS: As spinal compression increased, the incidence of high signal intensity on long spin-echo images became higher. Low signal intensities on short spin-echo images were visible in animals in which compression and paralysis were the most severe. In these animals, cavitation and a dilated central canal were visible. High signal intensities on long spin-echo images reflected various pathologic changes. CONCLUSIONS: Changes in signal intensity on MR images are visible after the induction of myelopathy by high-pressure compression. These signal intensities may be useful in predicting the outcome of compressive myelopathy.     

Ultrastructure of the glial cells after spinal cord compression in rabbits

Sump syndrome is a rare complication of biliary-enteric anastomosis. Classically, the distal bile duct becomes obstructed by gastrointestinal debris after choledochoduodenostomy, resulting in cholangitis or, less commonly pancreatitis. Obstruction of the biliary tree by gastrointestinal contents after Roux-en-Y choledochojejunostomy or hepaticojejunostomy has not been described in the English-language literature. This report details the diagnostic and operative management of the first patient with sump syndrome after hepaticojejunostomy. The presumed pathophysiology was reflux of vegetable matter up the efferent limb, resulting in hepatic duct obstruction and cholangitis. The patient ultimately required complex choledochoscopic drainage of the intrahepatic biliary tree and revision of the previous Roux-en-Y hepaticojejunostomy.     

Viscoelastic relaxation and regional blood flow response to spinal cord compression and decompression

STUDY DESIGN: To better understand the relationships between primary mechanical factors of spinal cord trauma and secondary mechanisms of injury, this study evaluated regional blood flow and somatosensory evoked potential function in an in vivo canine model with controlled velocity spinal cord displacement and real-time piston-spinal cord interface pressure feedback. OBJECTIVES: To determine the effect of regional spinal cord blood flow and viscoelastic cord relaxation on recovery of neural conduction, with and without spinal cord decompression. SUMMARY OF BACKGROUND DATA: The relative contribution of mechanical and vascular factors on spinal cord injury remains undefined. METHODS: Twelve beagles were anesthetized and underwent T13 laminectomy. A constant velocity spinal cord compression was applied using a hydraulic loading piston with a subminiature pressure transducer rigidly attached to the spinal column. Spinal cord displacement was stopped when somatosensory evoked potential amplitudes decreased by 50% (maximum compression). Six animals were decompressed 5 minutes after maximum compression and were compared with six animals who had spinal cord displacement maintained for 3 hours and were not decompressed. Regional spinal cord blood flow was measured with a fluorescent microsphere technique. RESULTS: At maximum compression, regional spinal cord blood flow at the injury site fell from 19.0 +/- 1.3 mL/100 g/min to 12.6 +/- 1.0 mL/100 g/min, whereas piston-spinal cord interface pressure was 30.5 +/- 1.8 kPa, and cord displacement measured 2.1 +/- 0.1 mm (mean +/- SE). Five minutes after the piston translation was stopped, the spinal cord interface pressure had dissipated 51%, whereas the somatosensory evoked potential amplitudes continued to decrease to 16% of baseline. In the sustained compression group, cord interface pressure relaxed to 13% of maximum within 90 minutes; however, no recovery of somatosensory evoked potential function occurred, and regional spinal cord blood flow remained significantly lower than baseline at 30 and 180 minutes after maximum compression. In the six animals that underwent spinal cord decompression, somatosensory evoked potential function and regional spinal cord blood flow recovered to baseline 30 minutes after maximum compression. CONCLUSIONS: Despite rapid cord relaxation of more than 50% within 5 minutes after maximum compression, somatosensory evoked potential conduction recovered only with early decompression. Spinal cord decompression was associated with an early recovery of regional spinal cord blood flow and somatosensory evoked potential recovery. By 3 hours, spinal cord blood flow was similar in both the compressed and decompressed groups, despite that somatosensory evoked potential recovery occurred only in the decompressed group.     

Effect of thyrotropin-releasing hormone on Na(+)-K(+)-Adenosine triphosphatase activity following experimental spinal cord trauma

The mesencephalic trigeminal nucleus (Vme) neurons are primary sensory neurons transmitting orofacial proprioceptive sensation. The neurons innervating the periodontal ligaments and the masticatory muscles are intermingled with each other in the caudal part of the Vme. After fluorescent tracers, propridium iodide and bisbenzimide were applied to the inferior alveolar nerve and the masseter nerve on the same side of the rat, and a doubled-labeled neurons were observed in ipilateral Vme, mainly in the caudal part, and a few in the middle, rostral part. This reflects simultaneous innervation of both the periodontal ligaments and the masseter spindles by collaterals of peripheral process of single Vme neurons.