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PubMedDate not supplied

Paraplegia following intraoperative celiac plexus injection.

The technique for percutaneous and open neurolytic celiac plexus injection, using ethanol or phenol, for relief of intractable pancreatic cancer pain has been well described. Prospective randomized studies, demonstrating safety and efficacy with few complications, have led to widespread acceptance and use of this palliative procedure. The complications of neurolytic celiac plexus injection are rare, and are usually minor. However, transient or permanent paraplegia has been reported previously in 10 cases. The case described herein represents the third reported case of permanent paraplegia following open intraoperative neurolytic celiac plexus injection using 50% ethanol. The literature surveying the indications for this procedure, routes of administration, known complications, and their pathophysiology are reviewed.

Adult↗
PubMed1999

Congenital paraplegia following maternal hypotension.

Congenital paraplegia, with partial improvement over the first months of life, occurred in a female neonate born at 35 weeks' gestation, whose mother had suffered hypotension and hypoxaemia due to anaphylaxis 12 weeks earlier. Our patient subsequently had an acute encephalopathy during a respiratory illness with later developmental delay. We speculate that the baby's paraplegia resulted from spinal-cord ischaemia in utero. The aim of this report is to describe the spinal presentation.

Adult↗
PubMed1999

Paraplegia after thoracotomy--not caused by the epidural catheter.

BACKGROUND: Paraplegia and peripheral nerve injuries may arise after general anaesthesia from many causes but are easily ascribed to central block if the latter has been used. CASE REPORT: A 56-yr-old woman, with Bechterev disease but otherwise healthy, was operated with left-sided thoracotomy to remove a tumour in the left lower lobe. She had an epidural catheter inserted in the mid-thoracic area before general anaesthesia was started. Bupivacaine 0.5% 5 ml was injected once and the infusion of bupivacaine 0.1% with 2 micrograms/ml fentanyl and 2 micrograms/ml adrenaline (5 ml/h) started at the end of surgery. The patient woke up with total paralysis in the lower limb and sensory analgesia at the level of T8, which remained unchanged at several observations. Laminectomy, performed 17 h after the primary operation, showed a large piece of a haemostatic sponge (Surgicel) compressing the spinal cord, which was then decompressed but the motor and sensory deficit remained virtually unchanged both then and a year later. CONCLUSIONS: This case shows--once again--that although central blocks may cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly.

Anesthesia, Epidural↗
PubMed2002

Paraplegia associated with combined spinal-epidural anaesthesia caused by preoperatively unrecognized spinal vertebral metastasis.

We describe a case of paraplegia following combined spinal-epidural anaesthesia. It was postoperatively determined that a tumour of the vertebrae which was compressing the spinal cord was responsible for this complication. We suggest that the pre-existing pathology of the spine must be borne in mind as a differential diagnosis of acute postoperative paraplegia.

Acute Disease↗
PubMed2000

Recessively inherited spastic paraplegia associated with ataxia, congenital cataracts, thin corpus callosum and axonal neuropathy.

We investigated a consanguineous Japanese family with a complicated form of familial spastic paraplegia (FSP). Three siblings were affected, probably by autosomal recessive inheritance. All showed ataxia, subnormal mentality, congenital cataracts, and slight cerebellar atrophy on CT scans. Spastic paraplegia was predominant in 2 siblings, while ataxia was more marked in the other. Slight but definite atrophy of the corpus callosum and axonal neuropathy were demonstrated in 1 sibling who underwent detailed investigation. Review of similar cases reported in the literature indicates that this recessively inherited disorder probably represents a homogeneous group within the heterogeneous cluster of complicated FSP.

Adult↗
PubMed2002

Hereditary spastic paraplegia with thin corpus callosum and cataract: a clinical description of two siblings.

We report two siblings with autosomal recessive hereditary spastic paraplegia and thin corpus callosum. These patients had a similar history of progressive spastic gait, followed by mental impairment in the second decade. In addition to rigospasticity, ataxia, and foot deformity, both patients had congenital cataract on ophthalmologic examination. The association of cataract and thin corpus callosum suggests a distinct genetic disorder involving these structures in complicated spastic paraplegia.

Abnormalities, Multiple↗
PubMed1975

Osteopetrosis associated with familial paraplegia: report of a family.

A clinical analysis of three members of a family with documented osteopetrosis and familial paraplegia is presented. All patients had a long history of increased bone density and slowly progressing paraparesis of both legs. A thorough review of the literature has revealed no other cases which presented with paraplegia without spinal cord compression. Although the etiologic factor or factors remain unknown, our review supports the contention that this is a distinct clinical entity.

Adult↗
PubMed1978

Actual concept of osteoporosis in paraplegia.

The osteoporosis which appears in paraplegics below the neurological lesion has been studied in 100 patients with the following parameters: quantitative X-rays, urinary hydroxyproline excretion, kinetic study of calcium metabolism by 45Ca, serum phosphorus and calcium, parathormone and calcitonin radio-immunoassay, quantitative histology, density fractionation of bone and amino-acid composition of fractionated bone analysis. All our results show that the important bone resorption occurring very early in the paraplegia is immediately followed by an increase of the bone repair. This osteoporosis below the neurological lesion in paraplegia represents an unbalance between the synthesis and the resorption of bone which possesses a large degree of activity. Furthermore, we demonstrated that the collagen of this bone is underhydroxylated. Following the quantitative X-rays and intraosseous phlebography results we have considered the aetiopathogenesis of this osteoporosis. It seems that vascular modifications due to the lesion of the autonomic nervous system play an important role and furthermore we believe that immobilisation represents only a minor factor in the aetiology of this osteoporosis.

Amino Acids↗
PubMed1980

Paraplegia during skin-diving. (13 cases).

Thirteen paraplegias after decompression have been treated in the 5 centres of Lyons, Geneva, Mulhouse, Basel and Strasbourg. All these cases are somehow comparable: 12 males, 1 female, skilled and well-trained divers are involved from 27 to 50 years. Submersion between 30 and 42 metres, during 15 to 30 minutes. Ascension with or without decompression stops. Beginning with sudden posterior thoracic, 4 feeling sick, 2 becoming briedly unconscious, paralysis after a while (until 1 hour). All have received hyperbaric oxygenation (from 1 to 5 hours later), with an improvement for 10. Neurological findings. 5 tetraplegics, 7 para-(5 with Brown-Sequard), and one LI. Quickly, the tetraplegics improved to a thoracic level. In two cases, paraplegia remained complete at thoracic level. The others had a better evolution; the paralysis improved slowly, with marked spasticity, impaired sensation did not improve to such an extent, often localised at a lower level, with sexual impotence. Micturitions became normal but with often urine leakages. This rather favourable evolution allowed 11 to go back to work.

Adult↗
PubMed1981

A survey of non-traumatic paraplegia.

A survey of cases of non-traumatic acquired paraplegia over a 30-year period revealed an admission rate of about 30 per cent of all new admissions to the Unit. Whereas the usual sex ratio of traumatic cases remained constant at 4.5 males to one female the ratio in non-traumatic paraplegia was almost equal between the sexes, five males to four females, thereby influencing the bed allocations between the sexes. Iatrogenic cases formed a very small part of the survey.

Female↗
PubMed1981

The impact on marriages of adult-onset paraplegia.

Paraplegia does not seriously impair marital functioning according to a critical review of the English-language literature from the last three decades on the marital impact of adult-onset paraplegia. The review focuses on what is currently known about three aspects of marital functioning in paraplegics: marital stability, sexual interaction and marital satisfaction. The discussion highlights implications for health care personnel who advise or counsel paraplegic patients or their spouses about marital concerns.

Adult↗
PubMed1982

An outbreak of hysterical paraplegia.

The diagnosis of hysterical paraplegia, following injury, has only rarely been made, and no report of such cases has been recorded in the recent textbooks by Guttmann, Bedbrook and other authors. In a review of non-traumatic paraplegia, treated at the Sheffield Unit, the diagnosis was not made during a period of 15 years, until the winter of 1977/78 when four such cases were confidently recognised in a short period of time. This surprising development encouraged me to review these cases to ascertain whether there were any common factors to explain such an unusual outbreak. The patients were all young men engaged in heavy physical work and other circumstances common to most of them were service in a uniformed organisation; with psychiatric illness, and marriage breakdown as principal features. Fortunately recovery was rapid and complete in most cases.

Adult↗
PubMed1984

Traumatic cerebral flaccid paraplegia.

Two cases of paraplegia caused by head injuries sustained in recent military conflicts are presented. The underlying pathological disturbances could be related to the CT scan appearances and are discussed in the light of previously reported series. Both cases were remarkable for an early and prolonged paraplegia which was flaccid, rather than spastic, and for the sensory impairment produced.

Adult↗
PubMed1986

Pott's paraplegia: an account of the treatment of 89 consecutive patients.

The results of the treatment of 89 consecutive cases of Pott's paraplegia admitted to care in Korea are reported. Eighty-five patients were treated conservatively. Four patients underwent costo-transversectomy, three of them in the later stages of treatment without apparent benefit. All patients were followed-up for more than one year, 22 (25%) of them for five years or more. 75 patients (84%) recovered sufficiently to walk unaided. 74 patients (83%) returned to normal life and full activity. 64 of these (72%) were neurologically and functionally completely normal and, at the end of follow-up, the other ten (11%) had minimal persistent neurological signs not affecting life and activity. 54 patients (61%) spent less than six months in hospital and 56 (63%) returned to normal activity within one year of the start of treatment. There were two deaths. 41 patients (46%) deteriorated neurologically during the first two months of treatment, but 37 of these recovered completely. The place of chemotherapy as the basis of the treatment of Pott's disease is emphasised. A comparison is made with the published results of other series. The place of operative intervention is discussed and it is argued that the case for urgent early surgical intervention in the treatment of Pott's paraplegia may have been overstated.

Abscess↗
PubMed1989

Minitracheotomy in the early respiratory management of patients with spinal injuries.

Minitracheotomy is a new technique of tracheal suction by the introduction under local anaesthetic of a small bore tube into the trachea through the cricothyroid membrane. The use of minitracheotomy in the early management of respiratory problems in patients with spinal injuries is described with a few illustrative cases. This technique is an adjunct to good physiotherapy in clearing secretions from the trachea. Its advantages and disadvantages are discussed.

Adult↗
PubMed1991

Post-operative paraplegia with spinal myoclonus possibly caused by epidural anaesthesia: case report.

We report a patient who developed paraplegia following percutaneous nephrolithotresis of the left kidney under epidural anaesthesia. The cause of the paraplegia was unknown, but occlusion of the anterior spinal artery or central arteries and arachnoiditis, possibly due to the epidural anaesthesia, may have taken part in the onset and progression of the paralysis. The patient had spinal myoclonus corresponding to the spinal levels where myelomalacia was found by magnetic resonance (MR) imaging.

Anesthesia, Epidural↗
PubMed1991

The weight-bearing upper extremity in women with long term paraplegia.

Bilateral upper limb pain, isokinetic strength, grip strength, range of motion, and activities of daily living (ADL) performance were compared in 11 women with long term paraplegia and 11 activity-level matched able-bodied women of similar age, to determine whether long term wheelchair use is associated with pain and altered function in the upper extremities. The results suggest that the development of pain in the upper limbs is clearly associated with paraplegia in women (p less than 0.01). Pain was reported most frequently by the paraplegics in the shoulders and secondly in the wrists and hands. ADL where the paraplegics experienced pain most often were work/school, outdoor wheeling, household work/childcare, and loading the wheelchair to and from the car. Whilst paraplegics reported intermittent rather than constant pain, the groups' relatively young age (mean = 43 years) and average duration of injury of only 15 years suggests that preventative and management steps are required to ensure continued independence and quality of life of this group as they age.

Activities of Daily Living↗
PubMed1992

Symptomatic postprandial hypotension in high paraplegia. Case report.

Symptomatic postprandial decrease in blood pressure has been described in patients with various autonomic disorders, but not in patients with spinal injuries. Presented herein is a 31 year old female patient with traumatic complete paraplegia under the T3 level, in whom postprandial hypotension (PPH) was observed. The PPH was preceded by an increase in insulin level and was followed by an acceleration of heart rate. Oral caffeine prevented the hypotension and alleviated the symptoms. It is suggested that the PPH might be manifested as a result of damage to an upper thoracic spinal baroreflex. Clinical investigation of PPH is recommended for patients with high paraplegia.

Adult↗