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OBJECTS: We report a case of epidural cerebrospinal fluid (CSF) leak after lumbar puncture caused by CSF dissecting into the spinal epidural space. The incidence of this phenomenon may be higher than suspected, although most cases may remain asymptomatic. MATERIALS AND METHODS: A 4-year-old girl with new-onset seizure underwent a diagnostic lumbar puncture, the results of which were normal; 3 h later, she began experiencing severe low-pressure headaches and lower back pain, bilateral lower extremity weakness, numbness, and pain, and urinary retention when upright. Spinal MRI demonstrated extensive epidural CSF collection posterior to the thecal sac extending from the cervicothoracic junction to the sacrum. After 48 h in the supine position and gradual mobilization, the patient had complete resolution of symptoms and no neurological sequelae. CONCLUSION: Patients usually recover without any neurological deficits after conservative treatment. Prone or lateral decubitus positioning immediately after lumbar puncture may decrease the incidence of this phenomenon.
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The result of the DREZotomy procedure used for the treatment of chronic intractable neuropathic pain caused by injuries at the T9-L4 spine level in 26 patients has been reported. For the purpose of identifying the most favorable pain pattern for DREZ surgery we retrospectively analyzed the effectiveness of surgical treatment on different forms of pain in the follow-up period of 13-50 months, 37 months on average. All pain forms were classified according to subjective sensory pain expression including the rhythm and topography of the pain. Three groups of pain were formed according to subjective sensory equivalents: pain of thermal quality (burning, boiling, baking, warm etc.), pain of mechanical-nonthermal quality (shooting, cutting, stabbing, sharp, incisive, cramping, constriction, distraction, throbbing etc.). The third group was the combination of the previous two. Success in pain relief has been defined as a 50% or greater reduction in pain after surgery such that pain no longer interferes with patient activities of daily living and sleeping pattern and no longer requires routine analgesic pain medication. Our results revealed that the pain of mechanical-nonthermal nature and intermittent rhythm, confined to segmental topography was the most responsive to the DREZ surgical treatment so that 90% patients suffering from this pain pattern experienced a good long-term pain relief (70% had complete long term pain relief). Neuropathic pain of thermal quality with the diffuse infralesional distribution and steady rhythm was the most resistant to the DREZ surgical treatment: neither patient had long-term relief of this pain pattern. In the group of patients suffering from pain consisting of combined mechanical and thermal sensory components with confined pain territory, 75% experienced a good long-term pain relief (50% had complete long-term pain relief). Immediate pain relief was obtained in 88% of patients and was long lasting in 69% of the total series. Our results pointed to confined territory, intermittent rhythm and mechanical nature of the pain as the most relevant predictors of the expected pain relief achieved by the DREZ surgery.
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Narrowing of the vertebral canal, the lateral recess, or the neural foramina causes lumbar spinal stenosis. Stenosis results from degenerative changes that usually are superimposed on a congenitally narrowed spinal canal and can result in significant pain and disability, especially in the elderly. Signs and symptoms are related to the compression of neural and vascular elements from the limited canal space. The article reviews the anatomy and pathophysiology, clinical syndrome, diagnostic workup, and natural history of lumbar spinal stenosis to aid in proper diagnosis and treatment.
Patients with beta-globin disorders show amelioration of clinical condition by sustained synthesis of fetal haemoglobin in adult life. We report data on a patient with beta(o)-thalassaemia genotype and thalassaemia intermedia clinical phenotype. He received therapy with hydroxyurea (20 mg/kg/d) because of the presence of extramedullary masses causing paraparesis, neurogenic bladder and impotence. During therapy, the patient showed an improved clinical picture and a significant increase in total Hb (from 71.8 to 103.2 g/L) and a gamma/alpha globin synthetic ratio (from 0.39 to 0.68). The myelosuppressive effect of hydroxyurea was revealed by a decrease in CFU-GEMM, BFU-E, and CFU-GM. Therefore hydroxyurea can be effective in the treatment of patients with extramedullary haematopoiesis (EMH) who are not transfusion-dependent and cannot be treated with radiotherapy.
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Double level compression of nerve roots has been known to exist for a long time, but only in recent years the clinical significance of such conditions has been discussed. In the current study, nerve root function in double level compression was analyzed by measurements of tail muscle electromyogram, after stimulations of 1) the intermediate segment between the compression sites and 2) cranial to the two compression sites in a pig model. The electromyogram-amplitudes were more reduced after intermediate, than cranial stimulation. This difference was suggested to be based on an additional increasing threshold to elicit an action potential within the intermediate segment due to a nutritional deficit at this location. The results further stress the importance of local changes within the intermediate segment in double level nerve root compression.