جستجوی مقالات مرتبط با کلیدواژه "paraplegia" در نشریات گروه "پزشکی"

Spinal Subdural Hematoma (SSH) is a rare condition with an unknown incidence in the general population. Iatrogenic spinal subdural hematoma radiologically mimicking a prolapsed dorsolumbar disc has not been published in the literature.

A 65-year-old female presented with altered sensorium and generalized weakness for 3 days evaluated by a neurologist who diagnosed it as a metabolic encephalopathy with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) with severe anemia and hypothyroidism. She underwent a diagnostic lumbar puncture and following which, within 24 hours, she developed weakness of both the lower limbs. MRI of dorsolumbar spine was done which revealed D12-L1 extruded disc causing severe compression to the conus medullaris with D12-L2 subarachnoid lesion and cord edema. On opening the dura, a large organized hematoma on the anterior aspect of the conus was seen and evacuated.

Spinal subdural hematoma presents with a spectrum of signs and symptoms. Although MRI is the investigation of choice but SSH presenting like a prolapsed intervertebral disc on MRI is one of its kinds and should be kept in mind since it carries a grave prognosis if not treated early with emergency decompression.

Idiopathic intracranial hypertension (IIH) is defined as increased cerebrospinal fluid (CSF) opening pressure and abnormal fundoscopy, when other causes of increased intracranial pressure are ruled out.

We present a patient with primary diagnosis of IIH who had undergone lumboperitoneal shunt. Later she was treated with shunt revision, anti-tuberculosis drugs and intravenous immunoglobulin. Acute lymphoblastic leukemia (ALL) was diagnosed after bone marrow biopsy. Initial response to chemotherapy was promising.

Careful history taking, avoidance of unnecessary repetition of diagnostic procedures, avoidance of a tunneled vision and a strong clinical suspicion is important to see the hidden causes underlying a difficult case of pseudotumor cerebri.

Acute lymphoblastic leukemia and carcinomatous meningitis should be sought in IIH patient with abnormal presentation and unusual response to the known treatments.

Medulloblastoma is one of the most common malignancies in children. Common clinical symptoms of patients are related to the symptoms due to tumor in the posterior cranial fossa. Presentation of patients with symptoms related to metastatic tumors in the spinal canal are unusual.
We present a 6-year-old child with symptoms of lower back pain and Paraplegia as early symptoms of medulloblastom. The Magnetic Resonance Image (MRI) of spinal cord revealed multiple tumors in the spinal canal (initially diagnosed). A biopsy of the tumor was also performed. Then, whole CNS (Central Nervous System) imaging revealed tumor in the posterior cranial fossa. He had a dramatic improvement after treatment and returned to normal in all clinical signs. Four years have passed from his treatment and he is symptom free.
Presentation of Medulloblastoma with widespread spinal canal drop metastases is rare. However, spinal drop metastasis should be considered to prevent a suboptimal management in child. These patients did not consider in aspect of the treatment outcome as hopeless.

Paraplegia is an exceedingly rare neurologic complication after off-pump coronary artery bypass graft (OPCAB) surgery commonly caused by spinal cord ischemia (SCI). SCI is not a well unknown clinical phenomenon in the postoperative course. SCI has been reported after noncardiac surgery in otherwise healthy subjects in whom only one risks factor i.e. severe hypotension has been documented. SCI has also been reported as a rare complication among the other neurologic sequels of cardiac surgery. We report a case of paraplegia in a patient with metabolic syndrome and multiples risk factors after an OPCAB. This patient may be considered as an interesting case as no any ischemic event was found in the imaging modalities and culprit lesion may be attributed to 1-left internal thoracic artery use as an important blood perfusion to anterior spinal artery vasculature and 2-Disc herniation at intervertebral space of T as a culprit lesion 3-transient intraoperative hypotension. The patient was managed by lower extremities physiotherapy and skin care, however, after 3months of follow-up, no evidence of recovery was detected.

We present a case of paraplegia due to cord compression from epidural hematoma following an uneventful epidural catheter insertion in a patient with ankylosing spondylitis.
A 65-year-old gentleman was scheduled for a major laparotomy for abdominal wall reconstruction. He has a past medical history of mild asthma, ankylosing spondylitis, duodenal ulcer and a superior mesenteric artery thrombosis in the past which led to bowel ischemia and intestinal failure. His drug allergies included Oxycodone. The anaesthetic plan was to do an awake epidural with catheter insertion followed by a general anaesthetic. The insertion of the epidural and the catheter was uneventful with the space identified in first attempt and no bloody tap. Intra-operative analgesia was maintained by a continuous epidural infusion of low dose local anaesthetic and opioid. The total operative time was eight hours and the patient was extubated at the end of the surgery. Following extubation, the motor block was checked in recovery using the modified Bromage scale. A dense block was noted and the epidural infusion was stopped. An MR scan was performed immediately, which showed an epidural hematoma in T5 - T11 segments. An urgent decompressive laminectomy was performed to evacuate the haematoma. However, neurological recovery was minimal with persistent paraplegia.
The increased incidence of epidural haematoma in patients with ankylosing spondylitis is well documented . Earlier detection and decompression can help in preserving neurological function. We recommend being more cautious when the decision for epidural analgesia is made in patients with higher grades of ankylosing spondylitis. If an epidural is considered necessary, use of x-ray guidance and some form of intra-operative neurological monitoring should be considered, particularly in prolonged surgeries which last over several hours.

The decrease in bone mass in paraplegic spinal cord injured persons increases the risk factors for fractures.

The aim of the present study was to evaluate the effects of progressive locomotor treadmill training (LT) on muscle mass, bone mineral density, and bone remodeling in paraplegia patients.

The subjects investigated in this research included seventeen paraplegic spinal cord injured persons who were divided randomly into two groups: LT group (n = 10) and conventional exercise group (n = 7). The exercise training protocol was performed during 12 weeks, 3 days a week, 60 minutes a session. LT included 15 minutes warm-up on stationary bike plus 45 minutes LT with 50 percent body-weight support and finally 10 minutes cool-down as an adjunct to a conventional physiotherapy program. 10 percent loading weight was added per week for LT. Conventional exercise training incorporated 15 minutes warm-up plus 45 minutes over-ground training such as stretch exercise and resistance training.

The obtained results showed that there were significant differences in serum alkaline phosphatase levels (P < 0.001), osteocalcin levels (P = 0.003), bone mineral content (BMC) of the femoral neck (P < 0.001), bone mineral density (BMD) of femoral neck (P < 0.001), bone mineral content (BMC) of the lumbar spine (P < 0.001), and bone mineral density (BMD) of the lumbar spine (P = 0.000) between LT and conventional exercise regimes.

LT training, in addition to improvement of motor function and reduction of bone loss, can be prescribed as an effective exercise intervention for the treatment of osteoporosis in incomplete spinal cord injured persons.

An aortic saddle embolus causing cauda equine syndrome followed by paraplegia is an exceedingly rare phenomenon in post-operative period in coronary artery bypass grafting. In non-CABG cases, reported documentation of neurological recovery from this event is even rarer. A 57-year-old male 8 days after uneventful OPCAP presented with severe lower extremity pain and sudden fecal and urinary incontinence, followed by the absence of pulsations in the lower limbs and paraplegia, during 20-minute period. He underwent immediate bilateral transfemoral embolectomy. The postoperative period was uneventful. The paraplegia recovered immediately after embolectomy and recovery from anesthesia. An angiography has been made to verify that a high origin of the great radicular artery above T12 level may be responsible for better recovery of paraplegia when its ostium obstructed by a saddle embolus relieved using embolectomy. Early surgical intervention in restoring the blood flow into the great radicular artery may prevent severe histological changes hitherto responsible for non-recovery from paraplegia in the earlier reports. Three unique characteristics of this article are as follows: 1) Occurrence of this complication in the post-operative period in off-pump CABG surgery; 2) Commencing of emboli with bizarre symptoms of double incontinence; 3) Combination of cauda equine syndrome and complete paralysis.

Ischemic injury of the spinal cord during the surgical repair of thoracoabdominal aortic aneurysms might lead to paraplegia. Although a number of different mechanisms have been proposed, the exact cause of paraplegia has remained unknown, hampering the development of effective pharmacologic or other strategies for prevention of this condition. A number of studies suggested that cyclooxygenases (COX) contribute to neural breakdown; thus, COX inhibitors might reduce injury.. We aimed to assess the preventive effect of intrathecal (IT) pretreatment with paracetamol on spinal cord injury in a rat model.. This experimental study was performed in Ataturk University Animal Research Laboratory Center, Erzurum, Turkey. Adult male Wistar rats were randomly allocated to three experimental groups (n = 6) to receive IT physiologic saline (controls), 50 µg of paracetamol, or 100 µg paracetamol one hour before induction of spinal cord ischemia. Six other rats were considered as the sham group. For the assessment of ischemic injury, motor functions of the hind limbs and histopathologic changes of the lumbar spinal cord were evaluated. Additional 20 rats were divided into two equal groups for the second part of the study where the survival rates were recorded in controls and in animals receiving 100 µg of paracetamol during the 28-day observation period.. Pretreatment with 100 µg of paracetamol resulted in a significant improvement in motor functions and histopathologic findings (P < 0.05). Despite a higher rate of survival in 100 µg of paracetamol group (70%) at day 28, the difference was not statistically significant in comparison with controls.. Our results suggest a protective effect of pretreatment with IT paracetamol on ischemic spinal cord injury during thoracolumbar aortic aneurysm surgery..

During the last few decades, focus of rehabilitation outcome has been redirected to the lifetime monitoring of quality of life. The purpose of this study was to investigate the differences in quality of life perceptions between participants with spinal cord injury and participants of typical population. This cross-sectional controlled study of 100 adults aged 18–65 years was based on two questionnaires, Short Form-36 Health Survey (SF-36) and Spinal Cord Injury Quality of Life Questionnaire (QL-23), completed by 23 participants with paraplegia, 21 participants with tetraplegia, and 56 participants of typical population. Mann-Whitney U-test for planned comparison between groups and χ2 test were used to analyze the differences between research groups. Participants from control group perceived their general quality of life at higher level in comparison to participants with spinal cord injury (U=415.000, z=-5.804, P<0.000). Negative influence of spinal cord injury was detected in six domains (physical functioning, physical role, bodily pain, vitality, social functioning, mental health). Statistical differences between participants with paraplegia and participants with tetraplegia only in domain of functional limitations (U=103.000, z=-3.256, P<0.005). The participants with spinal cord injury perceived both health-related and general quality of life at a lower level in comparison to controls. However, the injury level only partially determined the estimated quality of life.

Current treatment for extensive thoracoabdominal aortic aneurysms (TAAAs) involves high-risk surgical and endovascular repairs, with a hospital mortality exceeding 20%, and a postoperative paraplegia rate beyond 10.5%.. The aim of this study was to present an estimation of the economic impacts of surgical and endovascular treatments of types II and III TAAAs in the US as well as the economic consequences of the elimination of spinal cord injury and mortality via an endovascular repair of extensive TAAAs (1).. We compared the current hospital charges of endovascular and surgical repair of extensive TAAAs, also provided a cost analysis of health care charges resulting from paraplegia in the United States, and determined the prevalence of extensive TAAAs found yearly during autopsies in the U.S. Based on the figures gathered and the frequency of Thoracic Aortic Aneurysms per year, we were able to calculate the nationwide inpatient hospital charges, the total average expenses affected by paraplegia during the first 12 months after the repair, the total average expenses after paraplegia for each subsequent year, mortality rate at 30 days and one year, and the number of extensive TAAAs ruptures.. The current nationwide inpatient hospital charges for type II or III TAAA repair cost $12484324 and $37612665 for endovascular repair and surgical repair respectively, and the total average expenses for patients affected by paraplegia during the first 12-month were $4882291 and $23179110 after endovascular repair and surgical repair respectively. The nationwide average expense after 10 years for patients undergoing surgical repair and affected by paraplegia is $33421910 and $6,316,183 for patients undergoing endovascular repair. Moreover, 55 patients with a type II or type III TAAA died after 30 days, and 100 after 1 year. The potential risk of type II or III TAAA ruptures is totally 1637 in a year.. Major economic impacts of type II or III TAAA repairs in the United States have been identified. An endovascular repair excluding spinal cord injury and mortality with the same average costs as present endovascular treatments makes it possible to save at least $53189742 after one year, 100 lives of operated patients would be saved after one year, and 1637 type II and III TAAA ruptures would be avoided yearly..

Wheelchairs are the prime mobility aid of persons with spinal cord injuries. Manual wheelchair propulsion puts a lot of demand on the cardiopulmonary as well as the skeletal system. The main purpose of the study was to compare the effects of both arm ergometry training and progressive resistance exercise training of upper limbs on resting heart rate and distance covered during wheelchair propulsion in paraplegics. A convenience sample of 30 male subjects took were randomly assigned to two groups. Participants were spinal cord injured patients recruited from the Indian Spinal Injuries Centre, New Delhi. Each group consisted of 15 subjects. Group 1 received arm ergometrytraining and group 2 received progressive resistance exercise training. The resting heart rate and distance covered during wheelchair propulsion in a 3 minutes task ofthe wheelchair circuit was measured before and after 4 weeks of training. The post intervention resting heart rate and distance covered during wheelchair propulsion after 4 weeks between the two groups showed significant differences. In group 1, resting heart rate was 77.53±3.52 beats/min and in group 2 resting heart rate was 82.33±3.69 beats/min (mean±SD). In group 1, the distance covered during wheelchair propulsion was 305.19±17.21 meters and in group 2 it was 250.71+20.59 meters. The arm ergometry training may be a better choice of exercise for improving the cardiovascular and functional aspect of spinal cord injury patients who are dependent on wheelchairs for mobility.

Gorham’s disease is a rare musculoskeletal disease of unknown etiology characterized by progressive osteolysis and massive bone destruction. Here, we report an extremely rare case of Gorham’s disease involving two far sites in the lumbar spine and trochanteric region, gradually resulting in paraplegia. The patient underwent cord decompression and chemotherapy, and resumed her normal life; she was followed up for nearly five years.