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Nervous system involvement in ankylosing spondylitis.

In a review of 45 patients with ankylosing spondylitis 10 had neurological symptoms and signs and three of them had two separate neuropathological disorders. The neurological profiles fell into five main categories-multiple sclerosis, the cauda equina syndrome, focal epilepsy, vertebrobasilar insufficiency, and peripheral nerve lesions. An association between ankylosing spondylitis and multiple sclerosis is suggested, possibly due to an immunological defect or to one being a complication of the other.

Adult↗

[Tethered cord syndrome in adults as a cause of disorders of bladder function].

The histories of two adults with tethered cord syndrome are presented. Slowly increasing bladder dysfunction, dysraphic disorder and increasing sensorimotor deficits gave rise to the suspicion of tethered cord syndrome. The release of the cauda equina by transsection of the thickened filum terminale and in one case removal of lipomatous tissue in addition improved the bladder function and the sensorimotor function substantially. Diagnostic procedures and aspects of the prognosis are discussed.

Adult↗

Migratory redundant lumbar nerve roots. A case report.

A case of migratory redundant cauda equina nerve roots is presented. The redundant roots, seen initially below a spinal stenosis, were shown on repeat study after a short interval to have migrated above the level of stenosis, leaving the lower nerve roots with a normal appearance.

Cauda Equina↗

[Intradural metastasis. Value of magnetic resonance imaging].

Imaging a 70 year old man with lymph node metastases from an adenocarcinoma developed cauda equina syndrome. The diagnosis of intradural metastatic disease was established on the basis of magnetic resonance imaging with gadolinium injection which visualized diffuse nodules in contact with the nerve roots.

Adenocarcinoma↗

Tophaceous gout of the lumbar spine mimicking an epidural abscess: MR features.

We present the MR findings in a case of tophaceous gout of the lumbar spine with cauda equina compression, mimicking an epidural abscess. The diagnosis was clinically unsuspected and confirmed at laminectomy. Tophus material in the paraspinal soft tissues appeared intermediate in signal intensity and showed heterogeneous contrast enhancement.

Abscess↗

The nerve root entry zone is highly vulnerable to intrathecal tetracaine in rabbits.

It has been speculated that the nerve root entry zone in the spinal cord, known as the Obersteiner-Redlich zone, may be more sensitive to large concentrations of local anesthetics administered intrathecally. However, there has been no morphological evidence for this. In the present study, we examined morphological changes of nerve fibers at the nerve root entry zone after administration of intrathecal tetracaine in rabbits. Rabbits were assigned to 4 groups (n = 6 in each) and received intrathecal 0.3 mL saline (control), or 1%, 2%, or 4% tetracaine. Neurological and histopathological assessments were performed 1 wk after the administration. Tetracaine 1% selectively injured the myelin sheaths made by oligodendrocytes at the nerve root entry zones of both ventral and dorsal roots, although neurological dysfunction could not be detected. With tetracaine 2% and 4%, histopathological damage extended to the dorsal funiculus, distal part of roots, and cauda equina and neurological dysfunction became apparent. These results demonstrate that the myelin sheaths made by oligodendrocytes at the nerve root entry zone are highly vulnerable to large concentrations of tetracaine given intrathecally.

Anesthetics, Local↗

Expansive laminoplasty for lumbar intradural lipoma.

We evaluated the pre- and postoperative neurological state of 3 patients with lumbar intradural lipoma. Total resection of the lipoma in the cauda equina was impossible, and partial resection and expansive laminoplasty was carried out. Subsequent neural involvement may depend on the duration of symptoms rather than the extent of resection. Expansive laminoplasty is appropriate in these circumstances since decompression is combined with spinal stabilization.

Adult↗

Spinal malignant lymphoma appearing after radiation and chemotherapy of a pineal region tumor.

The occurrence of malignant lymphoma in the pineal region is very rare. We experienced a case of pineal region tumor that was treated by radiation and chemotherapy. After 1 year, the tumor metastasized to the cauda equina and was operated on. The diagnosis was malignant lymphoma. Although the incidence of intracranial malignant lymphoma is known to be on the increase recently, malignant lymphoma should be considered in the differential diagnosis of pineal region tumors.

Adolescent↗

Spinal subarachnoid hematomas: clue to a source of bleeding in traumatic lumbar puncture.

Although damage to the veins of Batson's epidural plexus is usually considered the origin of bleeding in traumatic lumbar puncture, a lesion of these veins would not explain the cases in which postmortem examination shows blood confined to the subdural and subarachnoid spaces. In two patients who had lumbar punctures a few days before death, there was subarachnoid hematoma of the cauda equina at autopsy. In one of these cases, the radicular vessels were shown to be the source of bleeding. Spinal subarachnoid and subdural hemorrhages after lumbar puncture may be due to laceration of radicular vessels by the spinal needle.

Adult↗

[Paralysis following Dimer X radiculography].

The authors report four cases of cauda equina syndrome following Dimer X radiculography. The cases are described and commented upon. The conclusion is that Dimer X is a substrate associated with a certain degree of toxicity. Indications for and technique in sacroradiculography should be rigorous.

Adult↗

Atypical spinal tuberculosis.

The familiar picture of spinal tuberculosis is one of destruction of adjacent vertebral bodies and of the intervening disc. There are, however, other patients without these radiographic changes and with no clinical deformity who present with symptoms and signs of compression of the spinal cord or cauda equina. These patients fall into two different groups: those with tuberculosis of the neural arch; and those with extra-osseous extradural tuberculosis. Both may require laminectomy, but whereas the first has bony involvement and a cold abscess, the second has neither.

Adult↗

Upper lumbar disc herniation.

Herniations of the upper lumbar disc have often been overlooked due to a relatively low incidence we had 457 lumbar disc surgeries from January 1978 to June 1987. Twenty-two of them were of the upper three lumbar discs. We analyzed these patients according to their clinical syndromes, radiological findings and surgical results. The characteristic features of anterior thigh pain from upper lumbar disc herniation were different from the more commonly seen fourth and fifth lumbar disc herniation which resulted in sciatica. The incidence of cauda equina syndrome was relatively high in our series (36%). All the 22 cases had correlated X-ray findings. Satisfactory operative results for upper lumbar disc herniation were achieved in 20 of 22 (90%).

Cauda Equina↗

Spinal intradural extramedullary haemangioma: MRI and neurosurgical findings.

Haemangiomas, have rarely been encountered in the spinal intradural extramedullary space and the MRI findings of this entity have been described only in a few cases. We present the Magnetic Resonance Imaging (MRI) and surgical findings of a rare case of intradural extramedullary cavernous angioma located at the T1-T2 level in a 65-year-old man presented progressive paraparesis and upper thoracic back pain. On MRI, a well-circumscribed intradural solid mass, 1 cm in diameter, was detected and another enhancing nodular mass was found at the nerve roots of the cauda equina. The thoracic spinal lesion was removed and the histological diagnosis confirmed cavernous haemangioma. Although very uncommon, haemangioma should be included in the differential diagnosis when a spinal intradural extramedullary lesion is discovered and some neuroradiological findings could allow a presumptive diagnosis.

Aged↗

Sclerosing spinal pachymeningitis. A complication of intrathecal administration of Depo-Medrol for multiple sclerosis.

Reported complications of intrathecal steroid therapy include aseptic meningitis, infectious meningitis, and arachnoiditis. We report a case of sclerosing spinal pachymeningitis complicating the attempted intrathecal administration of Depo-Medrol for multiple sclerosis. The lesion is characterised by concentric laminar proliferation of neomembranes within the subdural space of the entire spinal cord and cauda equina, resulting from repeated episodes of injury and repair to the spinal dura mater by Depo-Medrol. There is clinical and laboratory evidence that Depo-Medrol produces meningeal irritation and that the vehicle is the necrotising fraction.

Adult↗

Renal cell carcinomatous meningitis: pathologic and immunohistochemical features.

We report the clinical, radiographic, pathologic, and immunohistochemical features of a patient with widespread meningeal carcinomatosis from renal cell carcinoma. Clear and spindle tumor cell subtypes infiltrated the meninges of the cauda equina, oculomotor nerve, spinal cord, and cerebral hemispheres, forming abortive glandular or tubular aggregates without evidence of parenchymal invasion. Cytokeratin epitopes were labeled immunohistochemically with Cam 5.2 antibodies, but epithelial membrane antigen and neuron-specific enolase were not present.

Carcinoma, Renal Cell↗

Giant gangliocytic paraganglioma of the filum terminale. Case report.

The clinical and pathological features of a giant cauda equina paraganglioma arising from the intradural filum terminale is described. Scattered mature large neurons characterized the tumor as a gangliocytic paraganglioma. Histologically, these neoplasms have considerable similarity with ependymoma and the diagnosis can be easily missed unless special techniques are employed.

Adult↗