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At least 631 records · Page 35Linked to original sources
PubMed2003

Hypertransfusion: a successful method of treatment in thalassemia intermedia patients with spinal cord compression secondary to extramedullary hematopoiesis.

SUMMARY OF BACKGROUND DATA: Extramedullary hematopoiesis is a common compensatory phenomenon to chronic hemolytic anemias including thalassemia. Several sites can be involved including the liver, the spleen, the lymph nodes, and other less common locations. Spinal cord compression may result in the rare cases wherein the hematopoietic develops intraspinally. Treatment of such conditions still is controversial. OBJECTIVE: This article reviews the literature and reports two cases of thalassemia intermedia involving patients who presented with neurologic symptoms after acute spinal cord compression secondary to extramedullary hematopoiesis. METHODS: The diagnosis was established by magnetic resonance imaging. Hypertransfusion therapy was used as our first-line treatment method. RESULTS: Complete neurologic recovery was achieved. Improvement in the neurologic status started as soon as the first week of treatment. CONCLUSIONS: Clinical awareness is important for early diagnosis and prevention of irreversible neurologic complications in such cases. Magnetic resonance imaging is the radiologic method of choice for diagnosing extramedullary hematopoietic masses and for delineating the extent of spinal cord involvement. Hypertransfusion seems to be a promising treatment method that should be recommended as a first-line approach or as an adjuvant therapy to other methods.

Adult↗
PubMed1986

Spinal cord compression secondary to kyphosis associated with radiation therapy for metastatic disease.

Three patients were treated for pathologic fractures of the thoracolumbar spine causing progressive neurologic deficit. An anterior decompression with partial removal of the diseased vertebra was performed with improvement of neurologic function in each patient. Active tumor was not found, but necrotic bone with collapse and secondary kyphosis were the causes of anterior compression of the spinal cord. In two patients, the spine was stabilized with an anterior fibular strut graft that initially provided stability; later collapse progressed and deformity recurred. In the third patient, stabilization was secured with internal fixation that has prevented a recurrent deformity. Late collapse of a vertebral body after irradiation for tumor may be secondary to necrosis resulting from tumor infiltration and/or radiotherapy. Anterior decompression and stabilization with adjunctive internal fixation can be beneficial in selected cases.

Bone Neoplasms↗
PubMed1991

[Spinal cord compression by epidural metastases of urologic tumors].

We report our experience of 5 consecutive cases of acute spinal cord compression from epidural metastasis of genitourinary tumors seen over a period of 14 months. Three patients developed paraplegia and the remaining two patients developed paraparesis of the lower extremities. Four patients underwent emergency decompression laminectomy and the remaining patient received spot radiotherapy to the metastatic vertebral lesion. The degree of neurologic deterioration and its rapid progression to the more severe forms have significantly influenced patient quality of life and survival. The literature is reviewed highlighting the epidemiological, physiopathological, clinical, diagnostic and therapeutic aspects of this condition.

Adenocarcinoma↗
PubMed1999

[Spinal cord compression caused by metastasis of soft tissue hepatocarcinoma].

More than 90% of hepatocellular carcinoma (HCC) arise in a chronical hepatitis. When HCC is diagnosed, most of the patients have symptoms in relation to cirrhosis of the liver. Spread metastases are not frequent and the extension to soft tissues is exceptional. We reported a 55 year old patient who had alcoholic cirrhosis and HCC with quickly development. The onset was a spinal cord compression due to soft tissues epidural metastases, seated at paravertebral zone. Plain radiographs and radionuclide bone scans were normal; diagnosis was achieved by magnetic resonance imaging and fine-needle aspiration cytology of the tumor. We have found no bibliographic reference on spinal cord compression due to soft tissues metastases from HCC. We want to point out the importance of including soft tissues metastases in differential diagnosis for radiculopathies with normal radiography and radionuclide scanning in patients at risk, considering also patients with hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMed2004

Paraplegia due to spinal cord compression by extramedullary erythropoietic tissue in a thalassaemia intermedia patient with gynecomastia secondary to cirrhosis: successful treatment with hydroxyurea.

We report a 24 years old patient with thalassaemia intermedia and gynecomastia, complicated by paraplegia and urinary/fecal incontinence due to spinal cord compression by an extramedullary erythropoiesis (EE) mass, treated with long-term hydroxyurea (HU). Neurological improvement occurred during the first 6 weeks of HU therapy (1,000 mg/day) and magnetic resonance imaging showed a reduction in EE mass. HU dosage was reduced to 500 mg/day after 5 months, and treatment was discontinued after 25 months. Five months later there was a partial recurrence of neurological symptoms, which responded to radiotherapy. HU may have a role in the symptomatic treatment of spinal cord compression due to EE, particularly when radiotherapy is unavailable.

Adult↗
PubMedDate not supplied

Hematological neoplasms with first presentation as spinal cord compression syndromes: a 10-year retrospective series and review of the literature.

CONTEXT: The epidural space is a well-known, albeit uncommon, location for lymphomatous involvement, estimated to occur in less than 3% of all systemic lymphomas. Initial presentation of the patient with disease in this site (i.e. primary spinal epidural lymphoma) has been considered to be "rare". When it has been reported, many studies have emphasized the occurrence of aggressive lymphomas with a poor prognosis. DESIGN: A 10-year retrospective search of our files generated 7 patients who presented initially with back pain, incontinence and/or lower extremity weakness, and by neuroimaging studies were found to have masses causing spinal cord compression syndromes necessitating neurosurgical intervention. RESULTS: The 7 patients included 4 males and 3 females with thoracic and lumbar epidural masses. Tumor types included high-grade non-Hodgkin lymphoma, B cell type (n = 4), indolent B cell lymphoma (n = 1), nodular sclerosing Hodgkin lymphoma (n = 1) and plasmacytoma (n = 1). Advanced disease (stage 4) was subsequently identified in all 7 patients. Despite this, survival varied greatly with therapy, from 3 weeks to almost 6 years, underscoring the need for correct classification of the lymphoma in order to optimize chemotherapeutic choices. The epidural space was the site of presentation of disease in 4% of all lymphomas diagnosed at our institution. CONCLUSIONS: Combining all reports in the literature, epidural presentation of lymphoma is not rare. Epidural lymphomas are distinct from both primary central nervous system lymphomas and from primary dural lymphomas. A broad range of systemic hematological tumor types can present as epidural masses. A full work-up for lymphoma classification may only be possible from the tissues received at the time of the neurosurgical decompression or biopsy procedure.

Adult↗
PubMed1996

Thoracic spinal cord compression caused by hypophosphataemic rickets: a case report and review of the world literature.

Vitamin D resistant hypophosphataemic rickets is a rare cause of spinal cord compression. The compression is caused by a combination of thickening of the laminae and calcification of the ligamentum flavum. Modern imaging techniques including CT and MRI provide excellent detail of both the level and degree of compression. MRI is particularly useful for examining the rest of the spinal cord for areas of impending compression and for postoperative follow-up. With careful surgical decompression a full neurological recovery can be achieved.

Female↗
PubMed1995

Isolated muscle atrophy of the distal upper extremity in cervical spinal cord compressive disorders.

The purpose of this article is to clarify one mechanism of muscular atrophy of the distal upper extremity that we attribute to cervical compression (Hirayama-type amyotrophy) by medical imaging and anatomical studies of the cervical spine. Five young male patients (mean age: 22.6 years) with this disorder showed characteristic findings to include an abnormal anterior displacement of the posterior dura wall in flexion that resulted in an anteroposterior compression of the spinal cord segment from C7 to C8. To identify an anatomical relationship to this disorder, the lower cervical spine was studied using 11 embalmed adult human cadavers. Abundant posterior epidural ligaments were observed between the posterior dura mater and the ligamentum flavum. Posterior epidural ligaments in the cervical spine have not been reported previously. The anterior displacement of the dura mater may be attributed to a lack of and/or insufficiency of the posterior epidural ligaments.

Adolescent↗
PubMed1983

Spinal cord compression and hindlimb paresis in cats with mucopolysaccharidosis VI.

Six cats with mucopolysaccharidosis VI had hindlimb paresis and other clinical signs associated with compression of the thoracolumbar spinal cord. In 5 cats, the neurologic abnormality progressed over 2 to 4 weeks to loss of thoracolumbar spinal cord function. In 1 cat, the hindlimb paresis remained stable for 18 months. In the cats with progressive worsening of hindlimb function, the abnormality was caused by compression of the spinal cord from proliferation of bony tissue in the thoracolumbar region. In all affected cats, the compression occurred from T12 to L2. In 1 cat, an attempt to relieve the clinical signs by surgery was unsuccessful.

Animals↗
PubMed1996

Radiotherapy without steroids in selected metastatic spinal cord compression patients. A phase II trial.

A phase II trial was planned to investigate the feasibility of radiotherapy (RT) without steroids in 20 consecutive patients with metastatic spinal cord compression (MSCC), no neurologic deficits, or only radiculopathy, and no massive invasion of the spine at magnetic resonance imaging (MRI) or computed tomography (CT). Aiming at an early diagnosis, MRI or CT was prescribed for all cancer patients with back pain and osteolysis, even when there were no signs of neurologic spinal compression. All patients were given 30 Gy in 10 fractions over 2 weeks with no steroids. Back pain and motor capacity were the parameters adopted to verify response to RT. Sixteen of 20 patients (80%) were able to walk without support, and 14 (70%) had no radiculopathy. Seventeen of 20 cases (85%) achieved relief from back pain. Regarding motor function, all patients (100%) responded to RT because the 16 patients able to walk without support at diagnosis did not deteriorate and the other 4, who needed support, became ambulatory without motor impairment. Median survival time was 14 months. Eight of 20 (40%) treated patients are still alive (14 to 36 months after end of RT), fully ambulatory, and free from relapse in the treated spine. Acute side effects were documented in only 2 patients (10%) and were managed without steroids. The results of this study suggest that RT without steroids is a feasible regimen for MSCC patients with good motor function. Elimination of steroids from the standard treatment for MSCC avoids cortisone side effects above all in those patients with diabetes, hypertension, peptic ulcer, and other steroid-sensitive medical problems.

Adult↗