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PubMed1998

Lower urinary tract dysfunction in children with central nervous system tumours.

The findings in 10 children with neuropathic vesicourethral dysfunction after the onset of a central nervous system tumour are presented. Eight had a spinal tumour and two a brainstem tumour. Bladder dysfunction occurred late in most children except in those with neoplastic infiltration of the conus and cauda equina. Moreover, tumour recurrence was often heralded by loss of bladder control before other neurological signs became obvious. Videourodynamics (VUD) showed various combinations of "filling" and "voiding" dysfunction in tumours extending from the pons to the cauda equina, whereas an isolated "filling" dysfunction was evident in the patient with a suprapontine tumour. Urinary incontinence and recurrent urine infection can be immensely distressing to children and their families, particularly when they have had to cope with the stress of diagnosis and treatment of the underlying tumour. Different management strategies, based on VUD findings, are discussed highlighting the impact these have on the children's quality of life.

Brain Neoplasms↗
PubMed1990

Aneurysm, arachnoiditis and intrathecal Au (gold).

This report is a 20-year follow-up of 14 patients treated with external beam craniospinal irradiation and intrathecal gold (10-45 mCi) for medulloblastoma. Six of the patients died within 2 years of treatment from persistent disease. No patients are alive without complications. Six of eight surviving patients developed arachnoiditis and cauda equina syndrome within 5 to 10 years of treatment. Seven of eight survivors developed aneurysms and/or cerebrovascular accidents 9 to 20 years after treatment. Four of the cerebrovascular events were fatal. Intrathecal gold pools in the basal cisterns and cauda equina delivering an extremely inhomogeneous dose throughout the neuroaxis. Its use is discouraged.

Adolescent↗
PubMed2000

Bladder neck incompetence in patients with spinal cord injury: significance of sympathetic skin response.

PURPOSE: We investigated whether recording the perineal sympathetic skin response, which reflects the sympathetic function of the thoracolumbar spinal cord, represents a reliable and accurate diagnostic tool for assessing bladder neck competence and incompetence. MATERIALS AND METHODS: We compared the sympathetic skin response recorded from the hand, foot and perineal skin with urodynamic findings in 90 patients with neurogenic bladder dysfunction, including 66 with spinal cord injury and 24 with cauda equina lesions. RESULTS: Video urodynamics revealed an incompetent bladder neck in 11 of 32 patients (34%) with complete and 7 of 34 (21%) with incomplete spinal cord injury but in only 1 of 24 (4%) with the conus-cauda equina syndrome. This association significantly correlated with the lesion level at T10 to L2 in 12 of 26 cases (46%) as well as with the loss of perineal but preserved hand and foot sympathetic skin response in 13 of 18 (72%). CONCLUSIONS: Recording the perineal sympathetic skin response in addition to that of the hand and foot represents a sensitive diagnostic tool for assessing sympathetic nerve function within the thoracolumbar spinal cord. It is of diagnostic value for evaluating neurogenic bladder neck incompetence in spinal cord injured patients.

Adult↗
PubMed2006

Symptomatic Tarlov cyst: report and review.

Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion. The cysts are relatively rare and most of them are asymptomatic. Some Tarlov cysts can exert pressure on nerve elements resulting in pain, radiculopathy and even multiple radiculopathy of cauda equina. There is no consensus on the appropriate therapeutic options of Tarlov cysts. The authors present a case of two sacral cysts diagnosed with magnetic resonance imaging. The initial symptoms were low back pain and sciatica and progressed to cauda equina syndrome. Surgical treatment was performed by sacral laminectomy and wide cyst fenestration. The neurological deficits were recovered and had not recurred after a follow-up period of nine months. The literature was reviewed and discussed. This is the first reported case in Thailand.

Adult↗
PubMed1997

Evoked potential abnormalities in postoperative patients with biliary atresia.

The somatosensory evoked potentials from the lower extremities were measured postoperatively in 15 patients with biliary atresia to investigate whether they were free of neurologic dysfunction. Because long-standing cholestasis causes progressive neuropathy due to malabsorption of vitamin E, the serum vitamin E, D, and A levels were also examined to evaluate the fat-soluble vitamin status. The cerebral evoked potentials to posterior tibial nerve stimulation were recorded in all 15 patients as well as in 45 controls, but spinal evoked potentials examined at the level of the cauda equina could not be recorded in five patients more than 8 years of age with long-standing icterus. The remaining 10 patients exhibited spinal evoked potentials as observed in the controls, but the mean neural conduction velocity at the cauda equina was significantly lower than that of the 45 controls (42.0 +/- 5.1 m/s vs 52.3 +/- 6.8 m/s, P = .0002). The serum vitamin E, D, and A levels were within the normal range in 13, 9, and 1 of 15 patients, respectively. These results suggest that the patients with long-term follow-up are still at risk of developing neural disturbances even with normal serum vitamin E status.

Adolescent↗
PubMed1997

[A case of rapidly progressive T cell type malignant lymphoma which started with multiple cranial neuropathy].

A 35-year-old man had suffered from recurrent right trigeminal nerve palsy and flaccid paraparesis for about five months. Cerebrospinal fluid (CSF) showed a marked increase of protein (400 mg/dl) and mononuclear cells (146/mm3), but there were no malignant cells. Antibiotic therapy remitted his inguinal and mediastinal lymph nodes swelling, and trigeminal nerve palsy had recovered spontaneously. Then he developed left trigeminal and facial nerve palsy, mononeuropathy multiplex, and cauda equina syndrome. Nerve conduction studies revealed delayed velocity and reduction of amplitude. Enhanced magnetic resonance imaging showed increased signal intensity in bilateral trigeminal nerves, left internal auditory meatus, and meninges of the basal cistern. Also, there were two mass lesions in cauda equina. They were operated by orthopedist, and were not malignant. After that, CSF cells of malignant lymphoma were elevated and revealed T cell type (large cell). Then the patient exacerbated in bulbar palsy and died. When there is lymph node swelling with multiple neurological deficits, despite remission of lesions and signs, biopsies should be positively pursued early in the patient's clinical course.

Adult↗
PubMed1984

Individual motor unit analysis in the diagnosis of disorders of urethral sphincter innervation.

A technique is described for recording the electromyographic activity of striated muscle in the urethral sphincter. Using a concentric needle electrode and an oscilloscope with a delay line and trigger, individual motor units were isolated and measured. To validate the method as a means of detecting pathology, the results are presented of analysis of the motor units of a group of patients with disturbances of micturition, known to have either cauda equina lesions or pelvic nerve injury. These results are compared with those from a group of controls. In the control group 93% of the motor units were less than 6 ms in duration and 2.0 mv in amplitude. Of motor units recorded from patients with cauda equina or pelvic nerve injury 59% exceeded the control ranges for amplitude or duration. It is concluded that quantitative analysis of individual motor units may be a helpful technique in the investigation of patients with disorders of micturition.

Adult↗
PubMed2004

The pathology of ligamentum flavum in degenerative lumbar disease.

STUDY DESIGN: A pathologic study of the ligamentum flavum in degenerative lumbar disease. OBJECTIVES: To elucidate the clinical significance of each pathologic finding of the ligamentum flavum. SUMMARY OF BACKGROUND DATA: In many reports, researchers observed the ligamentum flavum removed partially during surgery and did not evaluate the whole image of the ligamentum flavum. In addition, there are only a few reports that examined the possible association between various histologic findings and clinical findings. And, thus, there are many unclear points in the clinical significance indicated by each pathologic finding. METHODS: The study participants were 50 patients with degenerative lumbar diseases who underwent surgical decompression with removal of the ligamentum flavum of the affected spinal level. Tissue specimens of the removed ligamentum flavum in cross section were prepared, and changes in the elastic fibers and collagen fibers were evaluated in three grades to evaluate the whole image. In addition, we observed the presence or absence of any focal lesions and statistically analyzed the possible association between these histologic findings and clinical symptoms or image findings. RESULTS: In regard to the association between histologic findings and clinical symptoms or image findings, calcification was observed in significantly older patients, who tended to have low scores in preoperative JOA score, and was frequently observed in patients with cauda equina symptoms. Patients with ossification had a significantly greater % slip, and chondroid cells were frequently observed in patients with spondylolisthesis. CONCLUSION: Various pathologic findings provided important foundations for discussing the pathogenesis of lesions in ligamentum flavum. Calcification was frequently observed in elderly patients and those with cauda equina symptoms, and these patients tended to have severer preoperative symptoms. Chondroid cells were frequently observed in patients with spondylolisthesis, and patients with ossification had a greater % slip, suggesting involvement of mechanical load in ossification of ligaments. The pathologic findings were significantly related to the clinical features, and these findings will be profitable for understanding the pathogenesis of degenerative lumbar disease.

Aged↗
PubMed1998

[Clinical application of TMS-MEP in spinal cord injury].

OBJECTIVE: To evaluate transcranial magnetic stimulation motor evoked potential (TMS-MEP) in the diagnosis of spinal cord injury. METHOD: 56 patients with injury of the spinal cord and cauda equina were examined using TMS-MEP and followed up. RESULT: In 21 patients with complete paralysis, TMS-MEP of bilateral tibialis anterior and gastrocnemius disappeared and paralysis did not recover. Abnormal was noted TMS-MEP and paralysis not recovered in 2 patients with injury of conus medullaris and cauda equina. Incomplete paralysis occurred in 35 patients. TMS-MEPs of more than one muscle in every patient were recorded. Paralysis and TMS-MEPs recovered in different degree in the 33 patients, in which the strength was 0 class and TMS-MEPs were abnormal in 25 target muscles before operation whereas their strength obviously recovered or even normalized after operation except two muscles. CONCLUSION: TMS-MEP is an effective method for diagnosis and prognosis of spinal cord injury.

Adolescent↗
PubMedDate not supplied

[Coccygodynia disclosing Tarlov's cysts].

In a 63-year old male patient coccygodynia, initially isolated then complicated by incomplete cauda equina syndrome, could be attributed to large perineurel meningeal cysts on the sacral nerve roots. The diagnosis was suspected at computerized tomography and nuclear magnetic resonance and confirmed by sacculoradiculography. Intradural injections of corticosteroids provided lasting pain relief. Arachnoid cysts are often asymptomatic, by they may be responsible for coccygodynia and/or incomplete cauda equina syndrome. Their presence is suggested by the characteristics of the symptoms which are paroxysmal, exacerbated in standing position, relieved in dorsal position and revived by percussing the sacrum. Treatment is medical in most cases. The decision to operate depends on the persistence and intensity of pain and on whether signs of neurological defecit are present.

Arachnoid Cysts↗
PubMed1997

Lumbar root stimulation for restoring leg function: results in paraplegia.

We have implanted an intradural array of 12 tripolar electrodes on the anterior roots L2-S2, left and right, at cauda equina level, in a 33-year-old woman with a complete T9 cord lesion of 3 years' duration. They are driven by an implanted multiplexed stimulator system using radio frequency (RF) power and control signals. All channels generate movements, in patterns that might be predicted from the known anatomy of the cauda equina. In particular, stimulation of L2 and L3 gives hip adduction; L3, L4, and L5 gives quadriceps femoris movements; L5, S1, and S2 gives hamstrings movement; and S1 and S2 give plantar flexion. Stimulation of L5 gives mixed movements at the ankle. Surprisingly, stimulation of the L2 roots has not given strong hip flexion. Responses have been stable. Some thresholds have varied, probably as a result of tissue encapsulation. The moment generated within each degree of freedom of the legs has been measured for each root, using a specially designed multimoment measurement apparatus. For several roots, a movement of lower threshold may be accompanied by a second movement of higher electrical threshold, suggesting that different muscles may have fiber populations that differ in their diameter or their location in the root. The use of stimulus forms that enable selective anodal block may, in the future, enable separation of two distinct movements from a single motor root.

Adult↗
PubMedDate not supplied

[Myelopathy due to Schistosoma mansoni. A description of two cases and review of the literature].

INTRODUCTION: Schistosomiasis is a parasitic infection caused by Schistosoma sp that affects over 200 million people worldwide. The neurological manifestations, caused by the eggs or by anomalous migration of the parasite, can be epileptic seizures and myeloradicular syndromes. S. mansoni is endemic in Brazil and is an underdiagnosed cause of transverse myelitis and myeloradiculopathy. CASE REPORTS: We present the cases of two Brazilian women, aged 28 and 32, who suffered from conus medullaris and cauda equina syndrome, and a thoracolumbar myelopathy, respectively. Diagnosis was based on the epidemiological exposure, suggestive neurological syndrome and positive serological studies in blood or cerebrospinal fluid (CSF) by means of indirect immunofluorescence (IFI) for S. mansoni. Other causes of myeloradiculopathy were dismissed. The first patient presented progressive sphincteric, motor and dysesthetic symptoms that suggested cauda equina and conus medullaris syndrome. Examination of the CSF revealed pleocytosis, eosinophils and high protein levels; (IgG) IFI was positive for S. mansoni. Spinal cord magnetic resonance imaging showed an increased volume in the conus and epiconus, areas of hypersignal in T2 and heterogeneous contrast enhancement. Case 2 presented an acute picture of paresthesias and myoclonias in the lower limbs. Serological analysis for S. mansoni in blood was positive. S. mansoni eggs were found in faeces. Results of the CSF study were normal. Both patients were treated with praziquantel and prednisone and responded well both clinically and radiologically. CONCLUSIONS: In patients with epidemiological evidence of exposure to S. mansoni, lumbosacral myeloradiculopathy is suggestive of neuroschistosomiasis.

Adult↗
PubMed2004

Ultrasound measurement of lumbosacral spine in children.

The aim of this study was to establish normal ultrasound measurements of lumbosacral spine in children as a screening assessment of tethered cord or postoperative retethering of cord. Sonography of lumbosacral spine was performed in 108 neurologically normal children (mean age = 2.1 years) using 5- to 12-MHz linear transducer. M-mode was applied at the posterior and anterior subarachnoid spaces just below the conus medullaris and at the L(5)/S(1) dural sac to document cerebrospinal fluid pulsation of the cauda equina. The oscillation rate and amplitude were measured. Sixteen children with spinal cord anomalies (6 with low tethered cord and 10 postoperative cases of low tethered cord) were also examined. The mean posterior/anterior subarachnoid spaces of normal children were 2.6 mm/1.8 mm at the terminal dural sac. The mean oscillation amplitude and rate of the cauda equina were 0.52 mm and 121/min at the L(5)/S(1) dural sac. The oscillation amplitude at this level demonstrated a statistically significant difference between normal and abnormal groups. In conclusion, we recommend taking the fifth percentile of the normal oscillation amplitude at the L(5)/S(1) dural sac as a reference. Any oscillation amplitude of less than 0.3 mm in a symptomatic patient should alert the clinician to possible cord abnormality, cord tethering, or retethering in postoperative cases.

Chi-Square Distribution↗
PubMed1991

[Postoperative prognostic factors in patients with spinal cord tumors].

This study is to analyse the prognostic factors of the patients with spinal cord tumors, consisted of intramedullary tumor (33 patients), multiple extramedullary tumor (15), solitary cauda equina tumor (22), and solitary extramedullary tumor (48). The significant prognosis of intramedullary tumors depends on the histopathological type, the tumor margin, and the extramedullary tumor extension. Multiple extramedullary tumors had a tendency to recur at the different spinal cord levels; poorer long-term clinical results than those with solitary spinal cord tumor. Solitary cauda equina tumor cases showed good clinical course except for the bladder disfunction. Prognostic factors for solitary extramedullary tumors were the preoperative neurological status, the duration of myelopathy prior to surgery, the age at surgery, the tumor size, tumor location along the spinal axis, and the site of tumor in relation to the spinal cord.

Adolescent↗
PubMed1997

Serious complications related to regional anesthesia: results of a prospective survey in France.

BACKGROUND: Serious complications related to regional anesthesia have previously been described primarily in case reports and retrospective surveys. The authors prospectively evaluated a multicenter series of regional anesthetics, using preplanned criteria to measure the incidence and characteristics of associated serious complications. METHODS: Requests were sent to 4,927 French anesthesiologists in advance of a subsequent 5-month study period. Participating anesthesiologists were asked for detailed reports of serious complications occurring during or after regional anesthetics performed by them during the study interval. Details regarding each complication then were obtained via a second questionnaire. RESULTS: The number of responding anesthesiolgists was 736. The number of regional anesthetics performed was 103,730, corresponding to 40,640 spinal anesthetics, 30,413 epidural anesthetics, 21,278 peripheral nerve blocks, and 11,229 intravenous regional anesthetics. Reports of 98 severe complications were received, with follow-up information being obtained for 97. In 89 cases, complications were attributed fully or partially to regional anesthesia. Thirty-two cardiac arrests, seven of which were fatal, occurred during the study. Of these, 26 occurred during spinal anesthesia, with 6 being fatal, 3 occurred during epidural anesthesia, and 3 more occurred during peripheral blocks. The higher incidence of cardiac arrest during spinal anesthesia (6.4 +/- 1.2 per 10,000 patients) compared with all other regional anesthesia (1.0 +/- 0.4 per 10,000 patients) was statistically significant (P < 0.05). Of 34 neurologic complications (radiculopathy, cauda equina syndrome, paraplegia), 21 were associated either with paresthesia during puncture (n = 19) or with pain during injection (n = 2), suggesting nerve trauma or intraneural injection. Twelve patients who had neurologic complications after spinal anesthetics had no paresthesia during needle placement and no pain on injection. Of these 12 patients (7 with radiculopathy and 5 with cauda equina syndrome), 9 received intrathecal hyperbaric lidocaine, 5%. The incidence of neurologic injury was significantly greater after spinal anesthesia (6 +/- 1 per 10,000 cases; P < 0.05) than after each of the other types of regional procedures (1.6 +/- 0.5 per 10,000 cases for the weighted average). Seizures attributed to elevated serum levels of local anesthetics occurred in 23 patients, but none suffered a cardiac arrest. CONCLUSIONS: (1) The incidence of cardiac arrest and neurologic injury related to regional anesthesia were very low, but both were more than three SDs greater after spinal anesthesia than after other regional procedures. (2) Two thirds of the patients with neurologic deficits had either a paresthesia during needle placement or pain on injection. (3) Seventy-five percent of the neurologic deficits after nontraumatic spinal anesthesia occurred in patients who had received hyperbaric lidocaine, 5%.

Adult↗
PubMed1998

[Spinal cord injuries in Senegal: 16 cases].

Penetrating spinal cord injuries (P.S.C.I.) are rarely described in Sub Saharian countries in spite of an increasing number of wars. To study epidemiology management and prognosis of P.S.C.I. in Senegal, population of 16 patients collected from Fann Hospital in Dakar has been studied. 9 cases were related on gunshot or shrapnel injuries and 6 were stab-wounded. 8 came from war practice and 7 from civilian practice. The point of entry was at the posterior or lateral part of the body and continuous leaking of cerebral spinal fluid from this point was founded only in one patient. Patients showed a clinical picture of a complete spinal cord section syndrome, 3 spinal cord hemisection Brown Sequard syndromes, 3 cauda equina syndromes and 1 monoradicular syndrome. Spinal X-rays or myelography may lead to an accurate evaluation of the extent of bone tissue destruction. Anatomical evaluation of roots and spinal cord lesions were more difficult when C.T. scan or R.M.I. is not available. Penetrating spinal cord injury with foreign body included or myelography stop or showing cauda equina syndrome should be operated on. 9 of our patients has benefited of spine surgical posterior approach (laminectomy). Immediate vital prognosis is good regarding the fact that visceral associated lesions were rare (2 cases). Functional recovery is fair only 46.6% of patients expressed partial or complete recovery. Prognosis factors such as injuring agent and initial neurological status has been discussed. Prognosis of penetrating spinal cord injuries could be improved by immediate and multidisciplinary management.

Adolescent↗
PubMed1975

[The neurologic complications of Paget's disease].

There are several neurological complications of Paget's disease. They may concern the medulla, the cauda equina, and also the cerebral trunk, the cranial nerves, and the brain. Complications are rare when the great frequency of Paget's disease is considered. But they should be recognized because they constitute an aspect of the disease the treatment of which is usually well tolerated of even negligible. The signs of involvement of the medulla, of the cauda equina, and those which complicate the basilar impressions usually develop in a progressive and not very spectacular fashion. Nevertheless, they should be recognized as soon as possible so that therapeutic measures may be taken. The results of modern medical treatments, calcitonin, cellulolytic medications, and possibly others are already sufficiently established to justify their use initially. Indications for surgical treatment appear when a check in medical therapy is observed after three months of treatment.

Calcitonin↗
PubMed1977

Harrington instrumentation and spine fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine.

Of forty patients with unstable fractures and fracture-dislocations of the thoracic or lumbar spine treated with Harrington instrumentation and spine fusion, thirty-five had a neural deficit (twenty-three with incomplete or cauda equina lesions and twelve with complete lesions). Laminectomy or posterolateral decompression was performed prior to instrumentation and fusion in twenty-three patients and at the time of stabilization, in thirteen. Solid fusion was obtained in all but one patient. Back pain persisted in four. No patient had residual spinal deformity. Twenty-one patients with incomplete or cauda equina lesions regained some neural function, while all twelve with complete lesions remained unchanged. The advantages of this technique include effective stabilization of the spine, early mobilization and rehabilitation, and prevention of late deformity.

Adolescent↗