ABSTRACT
The possible causes of Brown-Sequard Syndrome (BSS) have been frequently observed with spinal trauma and extramedullary spinal tumors, but the cervical disc herniation to cause BSS is rare. The authors present five cases of patients who were diagnosed with BSS resulting from cervical disc herniation, and the results of the literature in view of their distinctive symptoms and clinical outcomes. Postoperatively, the patients showed complete or almost complete recovery from their motor and sensory deficits. On the basis of our cases, it is important to diagnose it early by cervical magnetic resonance imaging, especially in the absence of the typical symptoms of cervical disc herniation or other obvious etiology of extremity numbness. Immediate surgical treatment is also essential for a favorable functional neurological recovery.
Subject(s)
Humans , Brown-Sequard Syndrome , Extremities , Hypesthesia , Magnetic Resonance ImagingABSTRACT
OBJECTIVE: Peritumoral brain edema(PTBE) accounts for approximately 60% of meningiomas. It has not been identified why vasogenic edema, frequently shown in intra-axial tumors is also developed in extra-axial tumor such as meningiomas. Therefore, the authors assess the peritumoral brain edema of meningiomas with a focus on the angiographic pattern and expression of MIB-1 to clarify their correlation. METHODS: A total 32 cases of meningioma was studied. The authors attempted to identify 1) the location of PTBE and the edema index (EI), 2) the location and dominancy of pial supply compared with meningeal supply, 3) the biological activity of meningiomas indicated by the MIB-1 LI (labeling index), 4) their interaction. RESULTS: No PTBE was observed in the meningiomas without pial arterial supplement from internal carotid artery (ICA) and vertebral artery (VA). The PTBE of meningiomas with pial supply was developed intensely along the pial arterial supplement, and increased statistically in proportion to the extent of pial supply from ICA or VA rather than meningeal supply. Also, the MIB-1 LI in meningiomas tended to be larger in the tumors of the larger EI and the dominancy of pial supply. CONCLUSION: A strong correlation is found between the extent of PTBE in meningiomas and the dominancy of pial supply. The MIB-1 LI also tend to be associated with the PTBE. Therefore, the MIB-1 LI in benign meningiomas may represent not only the proliferative potential of the tumor, but also the biological activity like angiogenesis.
Subject(s)
Brain Edema , Brain , Carotid Artery, Internal , Edema , Meningioma , Vertebral ArteryABSTRACT
To determine the effects of decompressive surgery on neurological outcome following incomplete cord injury of the mid and lower cervical spines, 44 patients(decompression and stabilization group: stabilization or conservative treatment group=21:23) who underwent operations between 1993 and 1995 were retrospectively reviewed. We compared neurological outcome by Frankel's grade, Prolo economic and functional rating scale, and final ambulatory status between two groups. Also, we analysed MRI findings related to neurologic outcome in these cervical cord injured patients. With regard to upgrading scale by Frankel's grade, decompressive surgery group was more improved(98% vs 78%). With regard to Prolo's scale, decompressive surgery group were excellent in 24%, good in 52%, and fair in 24%. Stabilization only or conservative treatment group were as follows: excellent(22%), good(39%), fair(30%), and poor (9%). In the viewpoint of walking status, the result of decompressive surgery group was better(90% vs 74%). Initial MRI findings and neurological assesment correlated with neurological recovery. In conclusion, decompressive surgery may be more effective in patients with incomplete cord injury on mid or lower cervical spines when there are cord compressive lesions such as traumatic disc herniation, spondylotic spur, bony impingement in the spinal canal, and irreducible spinal malalignment unless major intramedullary hemorrhage is present.