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PubMed1988

Insulin administration protects from paraplegia in the rat aortic occlusion model.

The effect of insulin induced hypoglycemia was evaluated in a rat aortic occlusion model of ischemic paraplegia. One hour before aortic occlusion, 200-250 g Sprague-Dawley rats received either 1 cc of saline or 0.5 units regular insulin in 1 cc saline. Rats were then anesthetized, intubated, and ventilated with halothane (1-1.5%). The aortic arch was exposed and snares were placed on the right and left subclavian arteries and the aorta distal to the left subclavian. The three vessels were occluded for 10 min. Lower extremity neurologic deficit was evaluated at 1, 4, 18, and 24 hr postocclusion based on a 15-point scale (0 = normal, 15 = severe deficit). Lower extremity neurologic deficit was significantly decreased in the insulin-treated group at 18 and 24 hr postocclusion (P = 0.005 and 0.006, respectively, Student's test). Blood glucose concentration was significantly lower at the time of occlusion in the insulin-treated group when compared to the saline-treated group (P = 0.001). We conclude that in this rat model of paraplegia, insulin induced hypoglycemia is associated with a reduction in lower extremity neurologic deficit produced by temporary aortic occlusion.

Animals↗
PubMed1975

Protein patterns of cerebrospinal fluid in hereditary ataxias and hereditary spastic paraplegia.

The CSF findings in hereditary ataxias and allief disorders have hitherto mostly been reported as normal if one excludes Refsum's syndrome. The CSF-protein patterns found on isoelectric focusing and quantitative paper electrophoresis were studied in 12 patients with hereditary ataxias and hereditary spastic paraplegia. Using a recently-developed technique of isoelectric focusing of CSF-proteins in flat beds of polyacrylamide gel, the authors could show abnormal CSF-protein patterns in all but 1 of the present cases. The aberrant CSF-protein patterns found showed differences between the syndromes studied. Two unique patterns with conspicuous fractions in the acid range were observed in patients with Marie-Sanger-Brown's ataxia (mother and daughter) and Holmes' ataxia. A third CSF-protein pattern was found in a sibship with Friedreich's ataxia including a double fraction in the acid region (pI 5.9-6.1) in all 4 subjects and a highly alkaline fraction (HAF) with pI about 9.3, in 3 of them. Similar acid fractions (pI 5.9-6.1) were also detected in 3 of 4 patients with hereditary spastic paraplegia, a brother and sister showing a very similar CSF-protein pattern. Double fractions with pI 5.9-6.1 and/or HAF may also occur in other neurological diseases, mostly, however, associated with other distinctive features of their CSF-protein patterns. A possibility in the future of distinguishing hereditary CNS-diseases by examination of the CSF-protein pattern is suggested.

Abetalipoproteinemia↗
PubMed1994

Disorders of carbohydrate and lipid metabolism in veterans with paraplegia or quadriplegia: a model of premature aging.

One hundred veterans with paralysis due to spinal cord injury (SCI), equally divided between those with paraplegia and quadriplegia, and 50 able-bodied veteran controls underwent a 75-g oral glucose tolerance test (OGTT). In subjects with SCI, 22% were diabetic by criteria established by the World Health Organization (WHO), whereas only 6% of the control group were diabetic. Eighty-two percent of the controls had normal (NL) oral glucose tolerance, compared with 38% of those with quadriplegia and 50% of those with paraplegia. Subjects with diabetes mellitus (DM) were older in both the SCI and control groups, but those with SCI developed carbohydrate disorders at younger ages than did the control group. SCI subjects had significantly higher mean glucose and insulin values at several points during the OGTT when compared with controls, suggesting an accentuated state of insulin resistance in those with SCI. Mean fasting plasma glucose (FPG) values for both SCI and control groups were significantly higher in subjects with DM compared with those with NL glucose tolerance. When the FPG value was compared between SCI or control subjects with abnormalities in glucose tolerance, the subgroups with SCI and NL or impaired glucose tolerance (IGT) had significantly lower FPG levels than the respective control subgroups, suggestive of decreased hepatic glucose output in SCI.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Composition↗
PubMed1995

Luteinizing hormone-releasing hormone antagonist cetrorelix as primary single therapy in patients with advanced prostatic cancer and paraplegia due to metastatic invasion of spinal cord.

OBJECTIVES: To assess the clinical response to luteinizing hormone-releasing hormone (LH-RH) antagonist cetrorelix (SB-75) in patients with advanced carcinoma of the prostate and paraplegia due to metastatic invasion of spinal cord. METHODS: Cetrorelix was given at two different dose regimens to 5 patients with prostatic cancer Stage D2 and paraplegia. Urologic and neurologic examinations, laboratory studies, radiography (myelography), and prostate ultrasonography were carried out. Prostate-specific antigen (PSA) and free testosterone were also measured. RESULTS: In all patients, the neurologic symptoms regressed. The recovery of the thermic and vibratory sensation and motility of the toes was observed. The neurologic improvement continued during the treatment and at 3 months all the patients were able to walk with the aid of a cane. In 1 patient, the myelography showed that the spinal cord compression had disappeared and prostate volume assessed by ultrasonography showed a significant decrease. The bladder function greatly improved in all 5 patients during the treatment with cetrorelix. Baseline levels of luteinizing hormone fell from 9.28 to 1.0 IU/L and those of follicle-stimulating hormone (FSH) fell from 18.28 to 12 IU/L (P < 0.05) after the first day of therapy with cetrorelix. Mean levels of free testosterone were reduced from 52.4 to 14.7 pmol/L (P < 0.005) at 12 hours and to 13.1 pmol/L (P < 0.005) 3 days after the first injection of cetrorelix. A persistent inhibition of gonadotropins and testosterone was maintained during the subsequent 3 months of therapy. The high levels of PSA gradually decreased. CONCLUSIONS: Our results show that LH-RH antagonist cetrorelix causes an immediate lowering of the serum testosterone levels in patients with prostate cancer and metastases in the spinal cord, in whom the LH-RH agonists cannot be used as single drugs because of the possibility of flare-up and appears to be appropriate for long-term therapy.

Aged↗
PubMed1982

Recessively inherited 'pure' spastic paraplegia: case study.

Two brothers with 'pure' spastic paraplegia are presented. Inheritance of their condition probably was autosomal recessive. Clinical onset was in the first decade. Peripheral nerve conduction, visual and brain stem auditory evoked potentials were normal. Somatosensory evoked potentials suggested involvement of the cuneate tract. The relevance of neurophysiological evaluation in familial spastic paraplegia is discussed.

Adolescent↗
PubMed1989

Perspectives in anatomy and pathology of paraplegia in experimental animals.

Three models of inducing spinal trauma in experimental animals--weight-dropping model, severance-by-knife model, and laceration-type-lesions model--are reviewed critically. Contributions by these models in understanding paraplegia in anatomical and pathological terms are brought out. Important distinctions between subthreshold traumas vs. threshold and suprathreshold traumas, transient and permanent paraplegic syndrome, and regeneration of served axonal fibers vs. prevention of development of permanent paraplegia, are stressed while evaluating each model of spinal trauma. Conceptual contributions by these three models and their bearing on the potential clinical applications are discussed.

Animals↗
PubMedDate not supplied

Attenuated SEPs with no latency shifts in a family with hereditary spastic paraplegia.

Five siblings with hereditary spastic paraplegia of autosomal-dominant inheritance were studied with somatosensory evoked potentials. Somatosensory evoked potentials were recorded from Cz', T12, and the left popliteal fossa following left posterior tibial nerve stimulation. The latency and amplitude of the corresponding potentials (i.e., P37, N20, and N7) were compared with normal values obtained from age- and height-matched controls. There was no significant difference in the values of N7, suggesting an intact afferent peripheral pathway; in contrast, the amplitudes of P37 and N20 were decreased with normal latencies. The degree of amplitude decrease correlated with the severity of vibration sense impairment in the lower limbs. These results appear to support selective axonopathy of the centrally directed axons of the dorsal root ganglion cells. Furthermore, our results suggest that different degrees of dorsal column involvement in hereditary spastic paraplegia can cause different types of somatosensory evoked potential abnormalities, namely, attenuated amplitudes with no latency shifts, as recorded in this family, and the prolonged latencies, as reported previously.

Adolescent↗
PubMed2005

Fitness, inflammation, and the metabolic syndrome in men with paraplegia.

OBJECTIVE: To determine the relations among peak aerobic capacity, physical activity, functional ability, components of the metabolic syndrome (high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], glucose, insulin, abdominal obesity, high blood pressure), and inflammatory factors (interleukin-6 [IL-6], C-reactive protein [CRP]) in men with paraplegia. DESIGN: Cross-sectional exploratory design. SETTING: University research laboratory. PARTICIPANTS: Twenty-two men (age, 39+/-9y; duration of injury, 17+/-9y; level of injury, T2-L2) with functionally complete paraplegia volunteered to participate. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak aerobic capacity was measured using a graded peak exercise test with an arm ergometer, and physical activity was assessed by the Physical Activity and Disability Scale. Functional ability was assessed by the Self-Report Functional Measure. Circulating glucose, insulin, HDL-C, TG, total cholesterol, IL-6, and CRP levels were determined by specific enzyme or immunologic assays. Body fat was determined by dual-energy x-ray absorptiometry, and central obesity was estimated from abdominal sagittal diameters. RESULTS: Lower peak aerobic capacities were associated with lower HDL-C and lower physical activity levels ( P <.014). Lower physical activity levels were associated with higher fasting glucose, lower HDL-C level, and larger abdominal sagittal diameters ( P <.036). Larger abdominal sagittal diameters were associated with higher fasting glucose, higher fasting and postload insulin, lower HDL-C, higher TG, and higher CRP levels ( P <.05). CONCLUSIONS: Diet and exercise trials are needed to determine the efficacy and effectiveness of lifestyle interventions aimed at slowing the progression of the metabolic syndrome in people with spinal cord injury.

Abdomen↗
PubMed2005

Relation between muscular strength and cardiorespiratory fitness in people with thoracic-level paraplegia.

OBJECTIVES: To determine the relation between muscular strength, aerobic power (V O2 peak), submaximal blood lactate accumulation, and endurance performance in people with thoracic-level paraplegia. DESIGN: Participants performed tests of isokinetic strength, a graded exercise test, and 2 endurance performance tests. A Latin square counterbalanced design was used to determine the order of testing. SETTING: Research laboratory in a university setting. PARTICIPANTS: Ten adult male volunteers with thoracic-level paraplegia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The relations between strength, V O2 peak, submaximal blood lactate accumulation, and endurance were determined by correlation analysis. RESULTS: Shoulder flexion strength correlated with V O2 peak and power output at V O2 peak. Shoulder strength accounted for 68.4% of the variation in performance time. Greater isokinetic elbow flexion and extension strength was associated with higher V O2 and power output at a blood lactate concentration of 4 mmol/L (flexion) and with a greater power output at V O2 peak (extension). CONCLUSIONS: These findings suggest that in this population, greater muscular strength is associated with greater aerobic power and endurance. Greater muscular strength could exert a positive influence on exercise performance by enabling higher levels of cardiorespiratory stress as the result of reduced or delayed local muscle fatigue.

Adult↗
PubMed2005

Glenohumeral contact forces and muscle forces evaluated in wheelchair-related activities of daily living in able-bodied subjects versus subjects with paraplegia and tetraplegia.

OBJECTIVE: To estimate the differences in glenohumeral contact forces and shoulder muscle forces between able-bodied subjects and subjects with paraplegia and tetraplegia during wheelchair-related activities of daily living (ADLs). DESIGN: Kinematics and external forces were measured during wheelchair ADLs (level propulsion, weight-relief lifting, reaching) and processed by using an inverse dynamics 3-dimensional biomechanical model. SETTING: Biomechanics laboratory. PARTICIPANTS: Five able-bodied subjects, 8 subjects with paraplegia, and 4 subjects with tetraplegia (N = 17). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Glenohumeral contact forces and shoulder muscle forces. RESULTS: Peak contact forces were significantly higher for weight-relief lifting compared with reaching and level propulsion (P < .001). High relative muscle force of the rotator cuff was seen, apparently needed to stabilize the joint. For weight-relief lifting, total relative muscle force was significantly higher for the tetraplegia group than for the able-bodied group (P = .022). CONCLUSIONS: Glenohumeral contact forces were significantly higher for weight-relief lifting and highest over the 3 tasks for the tetraplegia group. Without taking paralysis into account, more muscle force was estimated for the subjects with tetraplegia during weight-relief lifting.

Acceleration↗
PubMed2004

Hereditary sensory neuropathy with spastic paraplegia.

We report the case of a 4-year-old boy with hereditary sensory neuropathy manifesting as insensitivity to pain in all four limbs and associated with spastic paraplegia. The patient was referred with multiple injuries to his fingers suggestive of self-mutilation and attributed to psychiatric disturbance. Clinical examination corrected the diagnosis by revealing insensitivity to pain in all four limbs, associated with spastic paraplegia. The histamine test reaction was positive, nerve biopsy and electrophysiological investigations confirmed sensory nerve involvement and the diagnosis of hereditary sensory neuropathy. Classification and treatment of such rare diseases is difficult and a multidisciplinary approach is often necessary.

Child, Preschool↗
PubMed2006

Acute paraplegia following chiropractic therapy.

We report a 44-year-old man suffering complete paraplegia due to paraspinal and epidural abscess, following chiropractic therapy for severe back pain and whose diagnosis was delayed. He received an immediate laminectomy from T3 through T6 to decompress the full extent of the abscess and appropriate antibiotic therapy for 4 weeks postoperatively for the identified microorganism (Staphylococcus aureus). After 3 months of rehabilitation, he had recovered bladder function with moderate left lower extremity paresis. We emphasise the importance of urgent spinal gadolinium-enhanced MRI in those patients with localised back pain and raised inflammatory markers (including erythrocyte sedimentation rate). Furthermore, it is necessary to be aware of the risk of acute paraplegia after forceful massage to the back.

Acute Disease↗
PubMed2002

State-of-the-art of neuromonitoring for prevention of immediate and delayed paraplegia in thoracic and thoracoabdominal aorta surgery.

BACKGROUND: The prevention of immediate and delayed paraplegia after thoracoabdominal aorta surgery relies on hemodynamic maneuvers (aimed at restoration of an adequate spinal cord perfusion pressure) and cytoprotective measures (hypothermia, drugs). METHODS: The indications for implementing these measures can be provided by motor-evoked potential (MEP) or somatosensory-evoked potential (SEP) monitoring. RESULTS: Intraoperative interactions between the surgeon and the neurophysiologist can be described by algorithms to be applied in the presence or absence of intraoperative MEP or SEP changes. CONCLUSIONS: It should be noted that normal SEPs or MEPs at the end of surgery do not systematically guarantee the nonoccurrence of delayed paraplegia, especially when segmental arteries have been ligated, in which case postoperative SEP monitoring is indicated.

Algorithms↗
PubMed2003

Prevention of postoperative paraplegia during thoracoabdominal aortic surgery.

BACKGROUND: We present data showing the impact of sequential multisegmental aortic clamping accompanied by reimplantation of as many segmental arteries as possible on the prevention of postoperative paraplegia or paraparesis during thoracoabdominal aortic graft replacement. METHODS: Since 1987 we have performed graft replacements in 51 individuals undergoing thoracoabdominal aortic surgery using the technique of normothermic partial bypass with sequential multisegmental aortic clamping. The procedure was performed emergently in 10 patients and electively in 41 patients. The patients ranged in age from 22 to 82 years (mean, 57.6 +/- 13.8 years). Indications for surgery included dissecting thoracoabdominal aortic aneurysm (n = 19) and nondissecting thoracoabdominal aortic aneurysm (n = 32). The extent of aneurysm was Crawford type I in 19 patients, type II in 7 patients, type III in 12 patients, and type IV in 13 patients. Along the entire extent of aneurysm to be replaced, we reimplanted as many of the patent segmental arteries as feasible. RESULTS: Five patients died during hospitalization, for an in-hospital mortality rate of 9.8%. The number of aortic clampings per patient ranged from one to five (median, three). A total of 124 segmental arteries were reimplanted in 44 (86.3%) of 51 patients. Of the 124 arteries, 90 (72.6%) were distributed between T9 and L2. Postoperative paraplegia or paraparesis did not develop in any of the patients. CONCLUSIONS: Our results demonstrate that extensive reimplantation of segmental arteries using sequential multisegmental aortic clamping, accompanied by adequate intraoperative distal aortic perfusion, is effective in preventing spinal cord ischemia.

Adult↗
PubMed1985

Epidural hematoma as a cause of postpneumonectomy paraplegia.

Postpneumonectomy paraplegia developed in a woman admitted for resection of bronchogenic carcinoma. Postpneumonectomy paraplegia is an uncommon, but catastrophic, event that is thought to be caused primarily by ischemia to the spinal cord; in this instance an epidural hematoma was the cause. Recommendations for prevention are presented.

Carcinoma, Squamous Cell↗
PubMed1997

Effect of spinal cord preconditioning on paraplegia during cross-clamping of the thoracic aorta.

BACKGROUND: Paraplegia is a devastating complication of operations for thoracic or thoracoabdominal aneurysms. Preconditioning the brain with sublethal ischemia induces resistance to subsequent ordinarily lethal ischemia (ischemic tolerance). We investigated whether ischemic tolerance could be induced by preconditioning canine spinal cord. The role of heat-shock proteins (HSP) in this process was investigated. METHODS: In experiment 1, the preconditioning group (n = 6) had aortic cross-clamping for 20 minutes, whereas controls (n = 6) had no cross-clamping. After 48 hours the aorta was cross-clamped for 60 minutes in both groups. Neurologic examination was performed 24 hours later and the spinal cord was studied for immunohistochemically. In experiment 2, either 48 hours after 20 minutes of clamping or after sham operation (n = 4), HSP were investigated immunohistochemically. RESULTS: In experiment 1, 3 of 6 controls became paraplegic but none of the 6 preconditioning group dogs became paraplegic. The HSP appeared on sections from all 6 PC dogs and 3 control dogs that did not exhibit paraplegia. In experiment 2, HSP were present in clamped animals but could not be detected after sham operation. CONCLUSIONS: Ischemic tolerance was induced by preconditioning the canine spinal cord, in which HSP are believed to be involved.

Animals↗
PubMed1998

Reversal of renal failure and paraplegia after thoracoabdominal aneurysm repair.

Repair of ruptured thoracoabdominal aortic aneurysms is complicated by high rates of perioperative paraplegia, renal insufficiency, and mortality. This report describes a patient with a ruptured thoracoabdominal aortic aneurysm in whom preoperative acute renal failure was reversed with hemodialysis, aortic replacement, and renal revascularization. Prompt cerebrospinal fluid drainage reversed delayed-onset postoperative paraplegia and led to immediate, complete neurologic recovery.

Acute Kidney Injury↗