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PubMedDate not supplied

Transient paraplegia following alcohol celiac plexus block.

BACKGROUND AND OBJECTIVES: A pancreatic cancer patient developing transient paraplegia compatible with spinal cord ischemia, following alcohol celiac plexus neurolysis, is described. METHODS: A 58-year-old man with metastatic pancreatic cancer underwent celiac (deep splanchnic) alcohol neurolysis for management of severe epigastric and midback pain. In spite of apparently adequate needle position, he developed transient paraplegia consistent with anterior spinal artery syndrome. RESULTS: The clinical findings suggest ischemia of the anterior spinal cord with complete motor and sensory paralysis to a T8 spinal cord level resulting from an anterior spinal artery syndrome. CONCLUSIONS: The cause of the limited bilateral transient paralysis following celiac plexus block in this patient may involve ischemia of the spinal cord associated with reversible arterial spasm following the injection of ethanol solution.

Celiac Plexus↗
PubMed1994

[Three patients of complicated form of autosomal recessive hereditary spastic paraplegia associated with hypoplasia of the corpus callosum].

We report three patients with slowly progressive spastic paraplegia and dementia; MRI on these patients revealed hypoplasia of the corpus callosum. The mode of inheritance was supposed to be autosomal recessive. Patient 1 (26-year-old man) is an elder brother of patient 2 (21-year-old man). Their parents are first cousins. Patient 3 (woman), a sporadic case, died of pneumonia at the age of 44. Their motor development after the birth was normal, but patient 3 was mildly mentally retarded. Gait disturbance due to spastic paraplegia developed at the age of nine (patient 2), fifteen (patient 1) and nineteen (patient 3), respectively. They also showed slowly progressive mental deterioration. Patient 1 has also suffered from mild amyotrophy and sensory disturbance in the distal part of the extremities since the age of 25. Patient 3 was bed-ridden at the middle of her thirty's because of generalized amyotrophy and sensory disturbance in addition to spastic quadriplegia and profound dementia. Their MRI reveal the thinning of the corpus callosum. We think the thinning must be hypoplasia of the corpus callosum, because the cerebrum showed normal appearance on MRI in patient 1 and patient 2. These clinical findings and imaging studies are essentially similar to those of the cases reported by Iwabuchi et al (1991). We propose autosomal recessive HSP associated hypoplasia of the corpus callosum as a new type of HSP.

Adult↗
PubMed1994

[Paraplegia and dissection of the abdominal aorta after closed trauma. Apropos of a case. Current review of the literature (1982-1993)].

A case of dissection with thrombosis of the subrenal abdominal aorta after blunt trauma led to paraplegia and bilateral ischaemia of the lower limbs in addition to acute abdominal signs. A review of the recent literature (1982-1993) revealed 32 reported cases. The patients were predominantly male and most often victims of an automobile accident (18 cases) or crushing trauma (6 cases). The clinical picture associated diverse degrees of abdominal signs, ischaemia and sensorial-motor impairment of the lower limbs. The diagnosis was established immediately on D0 in only 18 cases, early on days 1 to 7 in 4 cases and was late (day 8 to day 30) in 5 cases or very late (beyond day 30) in 6 cases. The difficulty in immediate diagnosis was related to the absent or incomplete vascular symptomatology or the late onset of the first signs. When a lesion of the aorta was suspected, an arteriography, angioscanner or peroperative exploration led to diagnosis. Neurological signs were frequent (10 cases including 8 with paraplegia) and generally related to ischaemia of the peripheral nerves. They may lead to denate from the diagnosis of vascular lesions. Fractures of the intima (17 cases) was the most frequent aortic lesion which also involved fracture of the media in a number of cases. Dissection was associated in 7 cases and complete or partial thrombosis of the aorta in 7. False aneurysms observed in 6 cases are the usual pathological form in cases of late diagnosis. Nearly all of the lesions were subrenal. Damage to abdominal organs was frequently observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1994

[Non-traumatic dissection of the thoracic aorta. A review with special emphasis on postoperative paraplegia].

Non-traumatic dissection of the thoracic aorta is a degenerative vascular disease with a high morbidity and mortality. The main symptom is stabbing thoracic pain, but the diagnosis is made difficult when the clinical picture is dominated by symptoms caused by the aorta's neighbouring structures. The definitive diagnosis is made by aortography. Treatment and prognosis depend on the anatomic placement of the dissection. In dissection of the ascending aorta (type A) the treatment is solely surgical, whereas a combined medical and surgical treatment is recommended for dissections of the descending aorta (type B). The most common postoperative complication in type B dissection is paraplegia, which occurs in up to 40% of cases. The cause of paraplegia is postoperative ischaemia of the spinal medulla. Many methods and treatments have been used to avoid medullary ischaemic damage. The most important ones are reducing the time length of aortic clamping, maintaining an adequate perfusion pressure, and the use of moderate hypothermia. Spinal drainage with or without pharmacological intervention possibly has a preventive effect, but convincing clinical documentation is lacking.

Aortic Dissection↗
PubMed1994

[Transient paraplegia following the epidural block].

A 44 year old man complained of a left flank pain. The epidural block was performed. After two hours he suddenly experienced severe back pain, lower limb numbness and weakness of the legs. The physical examination revealed the flaccid paraplegia and the disturbance of pain and touch sensation. But his proprioceptive sensation was preserved. The paraplegia gradually disappeared and he had no neurological deficit. Judging from the unique sensory disturbance, the anterior spinal artery syndrome was suspected.

Adult↗
PubMed1993

[Paraplegia, a catastrophic complication of interventions on the infrarenal aorta].

Damage to the spinal cord in course of the treatment of diseases of the infrarenal aorta is a rare but calamitous complication. The reported incidence is about 0.2%. The neurological loss is usually complete flaccid paraplegia with high mortality and rare full or partial recovery. Between 1980 and 1991, 1070 reconstructive procedures of the infrarenal aorta were performed: 821 due to aneurysm (316 elective procedures [mortality 1.6%] and 505 emergency procedures [mortality 24.5%]) and 249 due to aorto-iliac occlusive disease. Damage to the spinal cord occurred in 2 patients (2/1070, 0.19%). One patient had incomplete paraparesis following repair of an unruptured abdominal aortic aneurysm with gradual return of all neurological symptoms to normal. The second patient developed complete paraplegia following repair of a ruptured infrarenal aneurysm. There war no recovery of the symptoms. The patient died from septicaemia 4 months later.

Aged↗
PubMed1993

[A 24-year-old man presenting Garcin syndrome and paraplegia].

We report a 24-year-old man who presented unilateral multiple cranial nerve involvements followed by progressive paraplegia. The patient expired after developing DIC and pneumonia. Post-mortem examination revealed Ewing's sarcoma originated in the pubic bone with extensive metastases including the clivus which was responsible for his cranial nerve lesions. The patient was well until 24 years of age when he noted an onset of pain and a mass in the pubic region. The histology of the biopsy specimen of the tumor suggested Ewing's sarcoma. He was treated with chemotherapy and local radiation. A year after, he noted an onset of nuchal pain, difficulty in tongue movement, dysarthria, deafness in the left ear, and diplopia. On admission to our hospital in July 1990, neurological examination revealed an alert and intelligent Japanese male in no acute distress. The olfactory to the trigeminal nerves appeared intact. He showed complete abducens nerve palsy, facial weakness, mild deafness, and weakness of the soft palate, the sternocleidomastoid muscle and the tongue, all on the left side. The remainder of the neurological examination was unremarkable except for dysesthesia along the left C8 and Th1 dermatoms. Radiological examination revealed a 10 x 10 cm sclerotic mass in the public bone and a high signal mass lesion between the clivus and the pons in the T2-weighted MRI. His clinical course was complicated by acute paraplegia with anesthesia below the Th4 dermatom, DIC, and respiratory distress due to plural effusion. Post-mortem examination revealed a necrotic and hemorrhagic tumor in the pubic bone. The histology was consistent with Ewing's sarcoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Cardiovascular responses in persons with paraplegia to prolonged arm exercise and thermal stress.

The purpose of this study was to investigate cardiovascular responses in subjects with paraplegia (P) during prolonged upper body exercise in a hot environment. In addition, the effect of the level of the lesion on cardiovascular regulation of persons with paraplegia was studied. Four P with lesions between T2-T6 (P1), five P with T7-T8 lesions (P2), four P with lesions between T9-T12 (P3), and 10 control subjects (C) performed 45-min arm-cranking exercise at 40% of the individual peak power output, in a climatic room at 35 degrees C with a 70% relative humidity. From the 15th to the 45th min, cardiac output (Q) and oxygen uptake (VO2) remained unaltered in all subjects, except a significant decrease of Q in P1. Stroke volume (SV) decreased significantly in both P (-20%) and C (-18%) during the test. Heart rate (HR) increased in compensation for P2 (56%), P3 (65%), and C (55%), whereas HR in P1 did not increase significantly. Hemoglobin concentration changes, representing total plasma volume changes, increased significantly in P2, P3, and C but not in P1. Weight loss and sweat rate increased relative to the sensate skin area and, thus, to the level of the spinal cord lesion (P < 0.01). In conclusion, P with lesions below T6 are able to maintain a stable Q by increasing HR to compensate for the declining SV during exercise in a hot environment. P with lesions above T6 cannot fully compensate for the reduction in SV by an increase in HR, therefore, Q declines.

Adult↗
PubMed1995

Paraplegia following surgical correction of scoliosis with Cotrel-Dubousset instrumentation.

Three patients with paraplegia following corrective surgery for idiopathic scoliosis, using the Cotrel-Dubousset (CD) instrumentation, were admitted to our department over a period of 22 months. They were operated on by three different surgeons and they were the first serious neurological complications in these surgeons' careers. The monitoring method was the "wake-up" test, applied at the end of the correction maneuver with the instrument. One patient presented paraplegia at the "wake-up" test and the other two were paraplegic shortly after ceasing anesthesia. Electrophysiological spinal cord monitoring during surgery may reduce the risks of complications.

Adolescent↗
PubMed1996

[A case of thoracic meningioma presenting paraplegia at 4.5 years after removal of a falx meningioma].

A case of a thoracic meningioma presenting paraplegia 4.5 years after removal of a falx meningioma is reported. A 73-year-old woman, complaining of diplopia, was admitted to our department. Neurological examination revealed right abducens palsy. CT demonstrated a well-enhanced right frontal mass beneath the falx. The mass was totally removed under right frontal craniotomy. Its histology was transitional meningioma with rich fibroblasts. 4.5 years after craniotomy, she complained of progressing gait disturbance and nocturnal leg pain. Neurological examination revealed paraplegia, complete loss of leg sensation, loss of patellar and ankle reflex, bilateral positive Babinski reflex and urinary disturbance. Rectal function and anal reflex were preserved. Thoracic MRI demonstrated an intradural extramedullary mass which was well enhanced with Gd-DTPA at Th6-7. Under laminectomy, the mass was totally removed. Its histology was transitional meningioma with rich psammoma bodies and whirl formations. 4 months after removal, her palsy and sensory loss were almost completely recovered. We were able to find 15 cases of combined intracranial and spinal meningiomas in the literature. A young woman of neurofibromatosis suffered from tentorial, intraventricular and C1-2 meningiomas. Of 15 cases without neurofibromatosis including our case, 4 cases were of young boys and 11 cases were of women. Their initial symptoms originated from intracranial meningiomas in 8 cases. Multiple intracranial meningiomas were revealed in only 4 cases. In 9 cases, one case presented a combination of one intracranial meningioma and one spinal meningioma. Histology of intracranial meningioma was almost the same that of spinal meningioma in almost half of the 10 cases. These findings suggest the multi sentricity theory of multiple meningiomas originating in other neuroaxial compartments. Severe spinal dysfunction was recovered after removal in our case. Rectal function and anal reflex were preserved. These anorectal findings suggest that spinal dysfunction is either complete or incomplete. Motor evoked potentials are hopeful tools which can select reversible spinal motor dysfunctions.

Aged↗
PubMed1996

[Paraplegia following intrathecal chemotherapy].

The occurrence of major neurologic disturbances is a rare complication of intrathecal cytotoxic drug administration. We describe the case of a 30-year old man with relapsed lymphoblastic lymphoma and CNS involvement who was treated by systemic chemotherapy (ESHAP) and intrathecal injections of methotrexate, cytarabine, thiotepa and hydrocortisone. Thereafter he developed persistent paraplegia with sensory and sphincteric insufficiency. The role of the drug in causing this syndrome was suspected when more common causes, such as a meningeal carcinomatosis, had been excluded by means of CNF analysis and radiological examinations. We review this and other published cases and discuss the possible pathogenesis, as well as the clinical and paraclinical findings in paraplegia following intrathecal chemotherapy. Patients particularly at risk are those who receive intrathecal chemotherapy for over CNS disease rather than as prophylaxis, those who receive several injections and patients who are concomitantly treated with radiotherapy to the brain or systemic high-dose methotrexate or cytarabine.

Adult↗
PubMed1995

[A case of complicated form of hereditary spastic paraplegia associated with hypoplasia of the corpus callosum and cataracta].

Autosomal dominant, autosomal recessive and X-linked recessive varieties of spastic paraplegia have been recognized. Recently, Japanese patients with complicated form of autosomal recessive hereditary spastic paraplegia (HSP) associated with hypoplasia of the corpus callosum have been reported by Iwabuchi et al. We describe a patient with complicated HSP (Iwabuchi type) and cataracta. A 38-year-old man (his parents were a second cousin) was born uneventfully. His motor development was normal. Motor and mental dysfunctions were noticed during the lower classes of an elementary school. He could ride a bicycle at 18 years old but gradually developed galt disturbance and confined to wheelchair since 35 years. He was admitted to our hospital on February 25, 1994. A neurological examination showed mental retardation, dementia, cataracta, cerebellar ataxia, rigidity, spasticity, severe atrophy of the distal muscles of his extremities, paraparesis, hyperreflexia, positive Hoffmann reflexes and Babinski signs, pes cavus and hammer toes. Brain MRI showed thinning of corpus callosum. Clinical and laboratory findings did not support a diagnosis of metabolic disorders showing spastic paraparesis including adrenomyeloneuropathy, Globoid leukodystrophy, metachromatic leukodystrophy, cerebrotendinous xanthomatosis, Arginase deficiency. We considered that our patient was complicated form of HSP (Iwabuchi et al). However, cataract has not been found in Iwabuchi type of HSP. We discussed here other reports showing cataracta with spastic paraparesis.

Adult↗
PubMed1996

[Paraplegia following coeliac plexus block by anterior approach under direct vision].

We report here a case of paraplegia following coeliac plexus block by anterior approach under direct vision. Laparotomy was performed in a 62-year-old male patient with pancreatic cancer. Coeliac plexus block was undertaken in order to control his back pain, since the tumor was unresectable. The patient complained of numbness and weakness of his legs 14 hours later. The consequence of neurological events was diagnosed as ischemic infarct of the spinal cord by myelo-CT and MRI. He died of pancreatic cancer without recovery of neurological disturbances 4 months after the surgery. As demonstrated in this case, even when coeliac plexus block was performed by open anterior approach under direct vision, paraplegia might be a possible complication due to the anatomical proximity of coeliac plexus to the Adamkiewicz's artery.

Autonomic Nerve Block↗
PubMed1997

[Pleural B cell lymphoma presenting as paraplegia].

A 54-year-old man felt pain on the right side of his chest. Two months later, paraplegia developed. A chest CT scan revealed a pleural effusion and a mass lesion along the right parietal pleura. The lesion extended directly into the adjacent part of the spinal canal and compressed the spinal cord. Cytologic examination of the pleural effusion revealed atypical lymphoid cells, and examination of a transcutaneous biopsy specimen showed monotonous atypical B lymphocytes. The diagnosis was pleural malignant lymphoma. Chemotherapy induced a partial remission, but 14 months after the first examination he died of central nervous system involvement. Pleural lymphoma can directly compress the spinal cord and cause paraplegia. Early diagnosis and therapy greatly affect the outcome in patients with spinal cord compression.

Humans↗
PubMed1977

[Paraplegia and bilharziasis. A propos of 4 cases (including 2 confirmed cases of bilharzial myelitis].

Four observations of paraplegia of bilharzians are presented. In two of them the anatomical proof of medullar localization of parasitosis was obtained, once in vivo, only once after a post-mortem. Medical study enables us to spot 55 cases of bilharzian paraplegia, of which 25 sufficiently explicit on the clinical point of view, indicated medullar parasitosis. A parasitosis diagnosis must especially therefore be sought out with the greatest care so that the specific and remarkably active treatment may be started as soon as possible.

Adult↗
PubMed1997

[A case of paraplegia after graft replacement of the ascending aorta and the total aortic arch for the DeBakey type I acute aortic dissection].

A rare case of paraplegia after an emergency operation for DeBakey type I acute aortic dissection was reported. The patient was a 52-year-old female who complained of severe chest and back pain. She underwent graft replacement of the ascending aorta and the total aortic arch. No neurological symptoms were observed before the operation. The cause of the paraplegia was assumed to be a thrombotic occlusion of costal arteries which originated from the false lumen.

Aortic Dissection↗
PubMed1997

[An achondroplastic dwarf with paraplegia].

A 30-year-old female achondroplastic dwarf developed a progressive gait disturbance erroneously attributed to her hydrocephalus and deformities of both legs. Her condition deteriorated into flaccid paraplegia with anal and urinary incontinence. CT revealed extreme spinal stenosis typical in achondroplasia (shallow vertebral body, short pedicles, and hypertrophy of intervertebral joints) together with disc protrusions. Wide laminectomy of the lumbar vertebrae resulted in complete amelioration of all the neurological deficits. Progressive paraplegia is a rare complication of achondroplasia; its early recognition and surgical treatment is very rewarding.

Achondroplasia↗
PubMed1976

Paraplegia associated with umbilical artery catheterization in the newborn.

Major complications have followed the use of umbilical artery catheterization in the newborn. The procedure is often a vital part of the monitoring of the critically ill infant and efforts are therefore made to reduce these risks. Recently, we have encountered two newborn infants who developed paraplegia for which no definite etiology could be uncovered. However, their management was attended by the use of umbilical artery catheters and it is postulated that the etiology of paraplegia may have resulted from embolization from these potential thrombogenic sources. The blood supply of the spinal cord and the site of possible embolization are discussed.

Catheterization↗