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Fractures of the sacrum are rare and generally accompany fractures of the pelvis. Isolated transverse sacral fractures are even less frequent, and extensive neurologic deficits may accompany these injuries. This report describes an unusual case of extradural hemorrhage accompanying a complex fracture of the sacrum. The reversal of a serious neurologic deficit was notably aided by sacral laminectomy.
A typical case of pseudoclaudication syndrome (neurogenic intermittent claudication), where the cause of the lumbar spinal canal narrowing was an intraspinal neoplasm, is reported. A neoplasm as the cause of this syndrome seems to be very rare, possibly because of the progressive nature of the space-occupying lesion and hence the rapid development of other predominant symptoms.
The authors describe atypical magnetic resonance imaging (MRI) findings for pathologically proven paraganglioma of the filum terminale in a 27-year-old man. MRI showed an intradural tumour, which enhanced after administration of gadolinium and which showed evidence of cystic areas. Hemosiderin rings and vessels were not observed.
Paraganglioma of the filum terminale is a rare tumor but well described in the neurosurgery and pathology literature. Few MRI reports are mentioned. Paraganglioma, often misdiagnosed with ependymoma or schwannoma on MRI images, must be kept in mind, when a highly vascular lesion with serpentine vessels is observed.
A 16-year-old girl had an ependymoma at the L2 and L3 level that bled into the dural sac, presenting clinically as intracranial subarachnoid hemorrhage. MR depicted the tumor and hemorrhage on both T1- and T2*-weighted images. The blood in the dural sac appeared hyperintense on the T1-weighted images.
Intracranial hypertension is a rare phenomenon in the development of intra-spinal neoplasm. In the present case, it occurred without ventricular dilatation raising the problem of the underlying mechanism. Perturbations in the CSF reabsorption would appear less likely than an increase in brain volume, where cerebral edema may play an important role.
A case of giant schwannoma occurring in a woman 23 years of age with deformity of the foot developing at the age of five years is reported. The gross radiological changes of increased interpedicular distance and erosion of the posterior surface of the vertebra suggested the massive size of the tumour (6'' x 21/2'' x 11/2''). Successful surgical excision of such a large size schwannoma has not been reported previously.
Epidural and subdural spinal hematomas are unusual complications of diagnostic lumbar punctures. A renal allograft recipient on anticoagulant therapy underwent lumbar puncture. Urinary retention and evidence of an S2, S3, and S4 neurologic deficit developed subsequently. A myelogram showed a defect of the posterior lumbosacral spinal canal. Urodynamic investigation demonstrated normal sympathetic innervation of the proximal urethra and impaired parasympathetic and pudendal innervation of the detrusor and external urethral sphincter, respectively.
Six cases of intraspinal ependymoma metastasizing outside the central nervous system have been reported. This report documents a seventh case. This patient received multiple courses of combination and single-agent chemotherapy without evidence of tumor regression. All seven patients had four things in common: early onset of disease, numerous operations, massive local recurrence at the time distant metastases were noted, and a long time period from diagnosis to death.
The case is described of a 52 year old patient admitted for acauda equina compression syndrome (flaccid paraplegia of the lower limbs, bilateral lumbar and sciatic pains, urinary incontinence) of rapid onset and due to narrowing of the lumbar canal from tabetic arthropathy. These vertebral manifestations occur in a low percentage of tabetic arthropathies, which are relatively rare, and are not often accompanied by severe neurological disturbances. Decompressive laminectomy afforded rapid and lasting relief.
Infants afflicted with meningomyelocele are paralyzed as a result of physiologic disconnection of the neural plate from the spinal cord. Intact neural elements within the placode often maintain segmental reflex innervation of paralyzed lower extremity muscles. It was hypothesized that bridging this central peripheral gap with viable intercostal nerves would restore limited voluntary movement to paralyzed muscles. The surgical technique and initial results are the subject of this report.
Neurophysiological tests that asses afferent or efferent pathways of the spinal cord and of nerve roots are used for clinical diagnosis, intraoperative monitoring, and judgement of prognosis. Most tests can readily be performed in awake subjects, whereas many difficulties arise in anesthetized patients in whom neurophysiological testing is the only way of monitoring functional integrity of neural tissue. The research, therefore, that has been carried out in this field during the past year is of special interest.
Infants afflicted with meningomyelocele are paralyzed as a result of the physiological disconnection of the neural plate from the spinal cord. Intact neural elements within the placode often maintain segmental reflex innervation of the paralyzed lower extremity muscles. It was hypothesized that bridging this central-peripheral gap with vaible intercostal nerves would restore limited voluntary movement to the paralyzed muscles. This procedure has been performed on four infants and seems promising.
The authors describe five cases of an uncommon complication after Dimer X Myelography consisting in a more or less complete lesion of the caudia equina. Up to the present only seven similar cases have been reported in the literature. The evolution and the clinical symptoms of these cases were similar to those reported by others. While in the cases presented the clinical outcome was favourable, with complete recovery in all cases, less favourable evolutions with definitive neurological symptoms are described by others.
In oder to reduce surgical trauma to the lumbar spine during a multilevel laminectomy procedure we performed a multilevel, bilateral and interlaminar approach, with microsurgical and endoscopic techniques for removal of a large ependymoma of the lumbar spine in a 33-year-old female patient. Complete tumor removal has been achieved, while at the same time, the major elements that form the posterior spinal column could be preserved. The follow-up time is 4 years.
We report the case of a young girl with recurrent bladder dysfunction. Magnetic resonance imaging performed for evaluation of initial urologic symptoms revealed a low-lying conus medullaris. She underwent an L5 laminectomy and cord untethering by sectioning of the filum terminale. After initial improvement of bladder function, her symptoms returned 4 years later. Repeat magnetic resonance imaging demonstrated a new intradural lesion at L2. At surgery she was found to have an untethered, thickened, coiled filum terminale at L2.
The authors stress the importance of sphincter disorders especially bladder, in these patients. These disorders may compromise the vital prognosis. An accurate neuro-urological work-up is absolutely necessary. It will guide the functional rehabilitation. Which, as a rule, will improve the patients' comfort and prevent the occurrence of urinary complications, with the use, as in the case reported, of non-sterile intermittent self-catheterization.
Intermittent claudication is known as a specific symptom in patients with chronic occlusive arterial lesions. Clinically it is important that neurogenic intermittent pseudo-claudication should be differentiated from true intermittent claudication. Nevertheless confusion still exists in differential diagnosis between these two entities. This paper deals with general review of intermittent pseudo-claudication and a particular emphasis is placed on the different concepts of the pathophysiology and the differential diagnosis from the standpoint of vascular surgery. Recently one case of the neurogenic intermittent pseudo-claudication was encountered and presented in this paper.