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PubMed2004

[Urinary infection in patients with the condition of paraplegia].

The data were retrospectivelly analyzed conserning the frequency of uroinnfect in person with the paraplegia condition at the institute for physiatry and rehabilitation--the Center for paraplegia of the Clinical center of University in Sarajevo. The analysis was involved 71 (10%) of the patients chosen by the method of the casual choice. Males 57 (80.28%), females 14 (19.71%) of the examimnees. Urolitiazation was found in 22 (30.98%), without urolitization was 49 (69.01%) of patients. The sterile urinoculture were found in only 4 (5.63%) of the patients. The greatest number of the patients 34 (47.88%) he had three and more bacteria in urinoculture. Per two bacterias had 18 (25.35%), with the a one bacteria was 15 (21.12%) of patients. That the degree of the education and enabling of the activities of every day life (AEL) has no essential influence on the seizures of uroinfect shows the result of the research of Barther index where we found 59 (83.09%) of the examinees independent in movement. What are social consequences of this condition when the complications by uroinfect and urocaliculosys can be seen by the hospitalization number at the Institute for the rehabilitation where 29 (40.84%) of the examinees was hospitalized more than three times, 12 (16.90%) three times, 16 (22.90%) and only 14 (19.71%) once. It is considered that the persons with the paraplegia condition if they have no the acute becoming works should perform at least the essential control examinations every six months.

Adult↗
PubMed2004

Sudden onset of paraplegia after total hip replacement surgery in a patient with hepatocellular carcinoma--a case report.

Postoperative paraplegia is a major complication, of which the pathogenesis is usually multifactorial. This report is to discuss the case of a 36-year-old male patient who, after total hip replacement (THR), right, sustained a sudden-onset postoperative paraplegia. On subsequent examination, it was discovered that the patient had multiple vertebral metastases from hepatocellular carcinoma (HCC) resulting in thecal sac compression at L1 and S1 levels. This instance of distal spinal metastasis from HCC, with initial presentation of a sudden onset of paraplegia immediately after THR surgery, is worth reporting because of its being a rare occurrence and traumatizing effects on the patient, family members, and the surgical team. More importantly, we bring forth this case in order to advance an opinion concerning prevention of this devastating complication. Hence, we discuss the contributory factors and the appropriate perioperative survey and management relevant to cancer patients who are to undergo a non-cancer surgery.

Adult↗
PubMed1992

Coronary artery disease: metabolic risk factors and latent disease in individuals with paraplegia.

Individuals with spinal cord injury (SCI) currently have a longer life span as a result of recent improvements in medical care. As in the able-bodied population, cardiovascular disease is the leading cause of death in persons with SCI, but it appears to occur at younger ages in those with SCI than in the able-bodied population. The reduction in level of activity and adverse changes in body composition caused by SCI have profound metabolic consequences that may influence the progression and severity of coronary artery disease. Metabolic sequelae of SCI include disorders of carbohydrate and lipid metabolism. Almost half of the 45 active, healthy subjects with paraplegia we studied have a disorder of carbohydrate tolerance, 1 in 5 subjects having a diabetic oral glucose tolerance test. Hyperinsulinemia is found in those with abnormal glucose tolerance. Subjects with paraplegia having impaired glucose tolerance or diabetes mellitus are significantly older than those with normal glucose tolerance. High-density lipoprotein cholesterol is markedly depressed, and low density lipoprotein is relatively elevated. Radionuclide myocardial perfusion imaging after upper body ergometry exercise reveals latent coronary artery disease in 12 of 19 subjects with paraplegia.

Adult↗
PubMed2005

[Therapeutic effects of anterolateral decompression and fixation on thoracolumbar fractures complicated with incomplete paraplegia].

OBJECTIVE: To investigate the clinical effects of anterolateral decompression and fixation on thoracolumbar fractures complicated with incomplete paraplegia. METHODS: Thirty-six patients with thoracolumbar fractures complicated with incomplete paraplegia were treated with anterolateral decompression and fixation. RESULTS: The patients were followed up for an average of 18 months, which showed satisfactory recovery of the intervertebral space height and thoracolumbar vertebral curvature. The average Cobb's angle, spinal canal index and Frankel were improved remarkably, and none of the patients developed such complications as break or mobilization of the plate screw. CONCLUSION: Anterolateral decompression and fixation can directly and completely decompress the vertebral canal, promote the functional recovery of the spinal nerves and reconstruct the alignment of the spine as an ideal approach for treatment of thoracolumbar fractures with obvious spinal canal-occupying lesions or severe kyphos complicated with incomplete paraplegia.

Adolescent↗
PubMed1991

[Congenital autosomal-recessive familial spastic paraplegia].

The authors describe a family living in the Dagestan where three relative sibs, girls, suffered from familial spastic paraplegia. The variety described is marked by early debut, pronounced intrafamilial polymorphism of the disease course, autosomal recessive type of inheritance which, according to the reported data, is marked by frequently occurring combination with damage to other organs and systems (the familial spastic paraplegia "plus"). The "pure" disease variety seen in autosomal recessive type of inheritance, detection of the disease symptoms since the birth indicate that the case in question is a rare clinical variety of familial spastic paraplegia.

Child↗
PubMed2006

[Cerebrospinal fluid drainage to treat delayed paraplegia after stent grafting of the descending thoracic aorta].

Delayed onset of paraplegia secondary to spinal cord ischemia is a rare but serious complication that can appear after endovascular repair of an aneurysm in the descending thoracic aorta, although this complication is significantly less frequent after stent grafting than after conventional surgical repair. We report the case of a man who developed paraplegia 36 hours after insertion of 4 stents in the descending thoracic aorta. The paraplegia reversed after a spinal catheter was placed to monitor cerebrospinal fluid pressure and to provide drainage.

Aged↗
PubMed2006

[Allogenous bone plate reconstructing spinal channel and grafting in treatment of thoracolumbar burst fracture with paraplegia].

OBJECTIVE: To evaluate the method of the allogenous bone plate reconstructing the spinal channel and grafting in treatment of thoracolumbar burst fracture with paraplegia. METHODS: Thirty-six patients with thoracolumbar burst fracture with paraplegia were included in this study. Their ages ranged from 18 to 56 (average, 38). The vertebral injury involved T11 in 3 patients, T12 in 10 patients, L1 in 14 patients, L2 in 7 patients, and L3 in 2 patients. Neurological deficits were classified by the Frankel grading. There were 9 patients in grade A, 11 patients in grade B, 13 patients in grade C, and 3 patients in grade D. All the patients were treated with the anterior approach, decompression of the spinal channel, interbody graft, and internal fixation. The grafting materials consisted of the allogenous femoral bone plate that was decreased in advance and implanted in the intervertebral posterior region, with cut ribs and bone mills during the decompression. RESULTS: Postoperative CT scanning showed clearance of the spinal cord compression and expansion of the spine channel. During the follow-up period averaged 2 years, almost all the patients showed an improvement in the neurological function. Spinal fusion occurred in 32 patients. There was no screw loosened or broken. Only 1 patient failed to achieve the fusion. CONCLUSION: The anterior approach, allograft bone plate reconstructing the spine channel is a safe and effective method in treatment of the thoracolumbar burst fracture with paraplegia, which may be a replacement of the autogenous iliac bone graft.

Adolescent↗
PubMed2005

Unusual presentation of sickle cell anaemia--paraplegia in a fifty year old man.

A fifty-year-old male patient presented with bilateral lower limb paraplegia. He was subsequently found to have sickle cell anaemia. The patient showed good response to treatment. Central nervous system complications in sickle cell anaemia are well known. However paraplegia has rarely been documented in sickling disorders. We report this case because of rarity of sickle cell anaemia presenting in old age with paraplegia.

Anemia, Sickle Cell↗
PubMed2006

Paraplegia and paraparesis after descending thoracic aortic aneurysm repair: a risk factor analysis.

BACKGROUND: The risk factors of paraplegia and paraparesis (P/P) after surgical repair of descending thoracic aortic aneurysm (TAA) are controversial. PATIENTS AND METHODS: Seventy five patients underwent surgical repair of descending TAA from 2001 through 2002. The mean age was 64.2+/-5.2 years old (range; 26-81) and 58 patients (77.3%) are male. There were 47 patients (62.7%) with nondissecting aortic aneurysm and 28 patients (37.3%) with chronic dissecting aortic aneurysm. Emergent operation was performed in 13 cases (17.3%). Retrospective analysis based on data of these 75 patients was performed to determine the risk factors of P/P. RESULTS: 30-days hospital mortality was 2.7%. The overall incidence of P/P was 12.0% (9/75) overall (immediate paraplegia; 4 (5.3%), delayed paraplegia; 1 (1.3%), immediate paraparesis; 3 (4.0%), delayed paraparesis; 1 (1.3%)). Logistic regression analysis revealed that predictive factors of the development of P/P were; cases in which the distal part (below Th9) of the descending thoracic aorta was included in the extent of graft replacement (P=0.020; odds ratio (OR), 7.981) and nondissecting aneurysm (P=0.029; OR, 12.109). CONCLUSION: There was an increased risk of P/P after descending TAA repair in cases in which the extent of graft replacement included below the Th9 or in cases with nondissecting aortic aneurysm.

Adult↗
PubMed2006

Non-traumatic paraplegia in Nigerian children presenting at the University College Hospital, Ibadan.

A review of the presentation, management and outcome in all children presenting with non-traumatic paraplegia managed by the paediatric neurology team at the University College Hospital Ibadan, Nigeria from June 1989 to May 2004 is presented. Of the 110 patients, there were 54 males and 56 females giving a M:F ratio of 1:1. The mean age of the group was 5.3 (SD = 3.1) years, with a range from 9 months to 11 years. Infections and infectious processes caused the paraplegia in 102 (92.7%) of the cases with poliomyelitis and tuberculosis (TB) of the spine accounting for 88 (80%) of cases. The study period was divided into three 5 year periods. While poliomyelitis was the commonest cause of paraplegia (60%) in the first 5 years: TB spine was responsible for most cases (40%) in the last 5-year period of the study. There was a significant reduction in the total number of cases seen when the initial 5-year period was compared with the last (45 and 26 respectively, P = 0.001). Overall mortality among the 110 admitted patients was 7.2% being highest (50%) in malignant disorders and none was recorded in TB spine. Prognosis for eventual ability to walk was best in cases of TB spine where 37 of the 39 patients (95%) were ambulant by discharge after 60 days of anti-TB treatment. The 2 non-ambulant patients eventually walked within 3 months of discharge while on maintenance treatment for TB. Only 2 of the 51 non-ambulant patients obtained wheelchairs at discharge. The implications of inadequate facilities for investigation and treatment as well as the lack of financial and social support for the families of affected children are discussed.

Child↗
PubMed1991

Longitudinal study of cerebral spinal fluid drainage in polyethylene glycol-conjugated superoxide dismutase in paraplegia associated with thoracic aortic cross-clamping.

It has been hoped that pharmacologic prophylaxis in thoracic aortic cross-clamping may avert the unpredictable complication of spinal cord paraplegia, may avoid the mechanical difficulties associated with shunts, partial bypass, or monitoring devices, and may serve as a substitute for or as an adjunct to cerebral spinal fluid drainage. Toward this end 21 mongrel dogs were studied in four groups and underwent 60 minutes of thoracic aortic cross-clamping: group I, five with thoracic aortic cross-clamping; group II, five with thoracic aortic cross-clamping and cerebral spinal fluid drainage; group III, five with thoracic aortic cross-clamping, cerebrospinal fluid drainage and intravenous administration of a single dose (5000 units/kg) of polyethylene glycol-conjugated superoxide dismutase (PEG-SOD) given 15 to 20 minutes before thoracic aortic cross-clamping; and group IV, six with thoracic aortic cross-clamping and PEG-SOD. Paraplegia was graded by the Tarlov method at 24 hours and up to 5 days after thoracic aortic cross-clamping. The carotid and femoral artery pressures, the central venous pressure, and core temperature, taken during the experiment and at the time the dogs were killed, were found to be similar between groups. At 24 hours all dogs in group I were paraplegic; groups II and III had no paraplegic dogs (p less than 0.01), and group IV had fewer paraplegic dogs (two of six) than group I (p less than 0.05). Paraplegia was averted in all dogs treated with cerebral spinal fluid drainage, even 5 days after thoracic aortic cross-clamping.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Spinal cord ischemia: an evaluation of pharmacologic agents in minimizing paraplegia after aortic occlusion.

Superoxide dismutase (SOD), barbiturates, and hypothermic crystalloid were evaluated for their effectiveness in minimizing ischemic damage to the spinal cord at 40 minutes of aortic occlusion. Forty-two dogs underwent proximal and distal thoracic aortic occlusion for 40 minutes with infusion of test agents into the occluded segment. The dogs were divided into six groups. Group 1 (n = 6) served as control. Group 2 (n = 6) received hypothermic crystalloid. Group 3 (n = 6) animals received thiopental. Group 4 (n = 7) received SOD. Group 5 (n = 9) received hypothermic crystalloid and thiopental. Group 6 (n = 8) received hypothermic crystalloid, thiopental and SOD. The animals were observed for neurologic deficit for 72 hours. In group 1, six of six dogs showed complete paralysis. Five of six dogs from group 2, five of six dogs from group 3, and five of seven dogs from group 4 showed complete paraplegia. The remaining dogs in these groups showed varying degrees of recovery. Four of nine dogs in group 5 had complete paraplegia, three dogs showed varying degrees of recovery, and two dogs had no neurologic deficit. In group 6, one dog had complete paraplegia, three had partial recovery, and four had no neurologic deficit. Group 6 was the only group that showed significantly less late neurologic impairment than the control group. We concluded that although cold perfusion, barbiturates, and SOD are not protective when used alone, they are effective when all are used in combination. The combination of cold perfusion, barbiturates, and SOD significantly decreases neurologic deficit after 40 minutes of aortic occlusion.

Animals↗
PubMed1988

[Paraplegia following pneumonectomy. An anesthesiological or a surgical complication?].

A case of postoperative paraplegia after pneumonectomy of the left lung is presented. The patient received thoracic epidural anaesthesia for postoperative pain relief. The etiological role of epidural blockade in paraplegia is discussed. After consideration of differential diagnosis, postpneumonectomy paraplegia was diagnosed. The neurological sequelae were caused when the arterial blood supply to the spinal cord was compromised during surgery. However, to rule out epidural hematoma in such patients, a CAT scan of the spine must be performed immediately.

Aged↗
PubMed1988

Paraplegia and quadriplegia after intrathecal chemotherapy.

Transient or permanent paraplegia after the use of intrathecal (IT) methotrexate (MTX) or cytosine arabinoside (Ara-C) for treatment or prophylaxis of patients with meningeal leukemia is an unusual complication, with an incidence of less than 3% among such patients. Only 15 cases involving IT MTX have been documented and even fewer with IT Ara-C. Three patients were studied who developed permanent or ascending myelopathy from treatment of their leukemia or rhabdomyosarcoma with IT chemotherapy. The patients' ages ranged from 7 to 62 years. Two of the three patients had electromyographic examinations. These revealed a primary motor neuron degeneration or a polyradiculopathy, superimposed on a mild axonal peripheral neuropathy associated with vincristine therapy. This is consistent with other electromyographic studies. Two of the patients showed an elevation of the cerebral spinal fluid (CSF) protein before development of paraplegia; one also showed a rise in myelin basic protein associated with his myelopathy. Neuropathologic findings suggest demyelination as the primary process leading to myelopathy. Increasing evidence has shown that total CSF protein, or more specifically, the myelin basic protein, may be elevated before development of paraplegia. Routine serial testing of the CSF for total protein could be used as a screening test during therapy.

Adult↗
PubMed1988

Results of surgical decompression in chronic tuberculous paraplegia.

The results of surgical decompression in 117 patients with chronic tuberculous paraplegia, defined as paraplegia persisting for more than 3 months, were reviewed. After surgery 90 patients were able to walk. Significant findings at surgery were marked extradural fibrosis with very little caseation and pus. The study showed that paraplegia of greater than 6 months' duration was associated with a poor result. There were no cases of reactivation of the disease in the follow-up period ranging from 1 year to 4 years.

Adolescent↗
PubMed1987

Paraplegia in the rat induced by aortic cross-clamping: model characterization and glucose exacerbation of neurologic deficit.

Spinal cord damage caused by ischemia is a serious, underappreciated, and relatively refractory problem in clinical practice. Research is hampered by a lack of experimental models that appropriately mimic clinical situations. A new model of paraplegia in the rat is presented and evaluated by standard neurologic deficit scoring (1, 4, 18, and 24 hours after occlusion) and by computerized activity monitoring (1 and 18 hours after occlusion). Rats underwent temporary occlusion of the thoracic aorta for 10, 15, or 20 minutes. Experimental groups received glucose (2 gm/kg) and demonstrated a significant elevation in blood glucose (p = 0.001) and were significantly more neurologically impaired at all four time periods (p less than or equal to 0.005) than the ischemic control group, which received equivalent volumes of normal saline solution. Significant differences in neurologic deficit were noted with direct clinical examination and computerized activity monitoring. With the use of the latter system, statistical differences were detected in total distance traveled and number of vertical movements. We conclude the following: (1) Paraplegia is reliably and reproducibly achieved in this rat model; (2) because of the rat's more extensive behavioral repertoire when compared with other models of spinal ischemia (e.g., rabbit), more end points can be monitored and more subtle behavioral deficits discerned; (3) computerized activity monitoring can distinguish varying degrees of neurologic deficit and correlates with clinical neurologic deficit scoring; and (4) glucose exacerbates paraplegia in this model.

Animals↗
PubMedDate not supplied

Prevention of paraplegia secondary to operations on the aorta.

Prevention of paraplegia during operations on the aorta requires knowledge of the blood supply to the spinal cord. The great radicular artery of Adamkiewicz (RAD) plays a major role in the supply to the anterior spinal artery which nourishes the anterior two-thirds of the cord. The RAD usually arises from an intercostal artery between T9-T12 but may arise higher or in 10% of patients from a lumbar artery. Temporary interruption of flow by crossclamping, hypotension, or permanent interruption of the RAD are factors in the etiology of paraplegia. In resection of descending thoracic aortic aneurysms, the thoracic aorta should not be crossclamped without an external bypass. The bypass should be nonthrombogenic to avoid necessity for anticoagulation and attendant hemorrhagic problems. Bypass flow is ideally controlled by a pump with continuous monitoring of the proximal and distal pressures to provide normal distal flow to the cord. As many intercostal and high lumbar arteries as possible should be preserved by retaining the distal posterior wall of the aneurysm. Preoperative selective catheterization of the distal thoracic intercostal or proximal lumbar vessels can delineate critical supply to the cord and should become part of the routine workup of patients being considered for surgery of the distal thoracic and thoraco-abdominal aorta. Knowledge of the location of the RAD may permit its avoidance or reinsertion into a graft. Avoidance of the RAD may be particularly applicable with infrarenal aneurysms when a large lumbar artery is seen just above or below a renal artery. Here, avoidance of all but brief suprarenal clamping and resection of the aneurysm below the feeding RAD may help to avoid paraplegia.

Aorta, Thoracic↗
PubMed1985

Paraplegia following epidural anesthesia. A case report and a literature review.

This article reports the case of a man who developed a pure motor paraplegia following epidural anesthesia with a pattern of slow recovery over subsequent months. Reviewing the available literature on post-epidural paraplegia we noted a number of potential etiologies and analyzed their role in its causation. On the basis of this analysis we have identified five distinct clinical groups and a constellation of factors which can lead to an increased risk of post-epidural paraplegia in susceptible surgical patients.

Aged↗