Syringomyelia Coexisting With Guillain-Barre Syndrome

Guillain-Barre syndrome (GBS) and syringomyelia are diseases of different entities. GBS is an acute post-infectious autoimmune disease which is mediated by autoantibodies against the myelin of peripheral nerves. Syringomyelia is a chronic disease characterized by a cavity extending longitudinally inside the spinal cord. A 67-year-old man is being hospitalized due to severe numbness and ascending weakness in all limbs. On neurological examination, the motor power of all limbs are decreased and show absence of deep tendon reflexes (DTRs). The patient is being diagnosed with GBS on the basis of the acute clinical course, nerve conduction studies of segmental demyelinating polyneuropathy, and a finding of albuminocytologic dissociation in the cerebrospinal fluid. The patient is presented with a new set of symptoms thereafter, which composes of sensory changes in the upper extremities, the urinary dysfunction including frequency and residual urine, spastic bilateral lower extremities, and increased reflexes of the knee and the biceps at follow-up examinations. The spinal magnetic resonance imaging in the sagittal section revealed a syrinx cavity between the fifth cervical and the first thoracic vertebral segment in the cord. The somatosensory evoked potential show sensory pathway defects between both the brachial plexus and the brain stem. Thus, this patient is being diagnosed with both GBS and syringomyelia. We report a case of symptomatic syringomyelia coexisting with GBS. Since the GBS is presented with a progressive muscle weakness and reduced DTRs, the muscle weakness and stiffness in the extremities suggests a concurrent syringomyelia might be easily overlooked.

Spinal Cord Injury due to the Giant Cell Tumor of the Second Thoracic Vertebra: A Case Report

Giant cell tumor (GCT) is a relatively rare neoplasm. In GCT, the bone affection of the axial skeleton is extremely rare. Most GCT arises in the meta-epiphyseal ends of the long bones. Its peak incidence is between 30 to 40 years of age. GCT is usually classified as benign, but shows locally aggressive behavior and may occasionally undergo a malignant transformation. The patients with GCT in the spine often complain of the lower back pains, as the tumors primarily involve the sacrum. We report a case of an adolescent female complaining of the upper back pain with a sudden weakness of the lower extremities, later diagnosed with the GCT of the T2 vertebra. The present patient showed American Spinal Injury Association Impairment Scale (AIS) D before the surgery, which changed to AIS E after the treatments including the surgery, radiation therapy and rehabilitation.

Clinical Implication of Long-Standing Delayed Plantar Reflex after Spinal Cord Injury: Case report

When recovery of specific reflexes after acute spinal cord injury are delayed or absent, we should consider an acute local complication or other factors that influence reflex function. We observed three spinal cord injury cases with a long-standing delayed plantar reflex and no evolution of Babinski sign despite enough recovery time had passed for the flexor spasm and all deep tendon reflexes of the lower extremities. In these cases we confirmed common peroneal nerve neuropathy at the fibular head by the nerve conduction study and electromyography. Long-standing delayed plantar reflex without evolution of Babinski sign, beyond expected recovery period, would be considered as a sign of local complication such as common peroneal nerve injury.

Comparison between Conventional Cystometry and Diuretics Stimulated Filling Cystometry in Neurogenic Bladder after Spinal Cord Injury

OBJECTIVE: To determine whether cystometry performed by bladder filling stimulation using furosemide (DCMG) reveals different findings compared to conventional cystometry (CCMG) in the neurogenic bladder. METHOD: The maximum intravesical pressure (MPves) and compliance of the bladder in CCMG and DCMG were compared in 24 patients with neurogenic bladder after spinal cord injury. The MPves was estimated by urethral leak pressure or intravesical pressure at 600 ml filling. Compliance was calculated from the cystometric bladder capacity and the MPves. For CCMG, the bladder was filled with 32oC normal saline via 10 F urethral catheter at 50 ml/min until the patient leaked or filled 600 ml. Three hours later, 20 mg of furosemide was injected intravenously after intravenous infusion of 300 ml normal saline for DCMG. Ultrasound measuring of filled urine volume was made at least every 5 minutes until defined MPves. RESULTS: Significant differences were found between DCMG and CCMG in hyperreflexic neurogenic bladders with respect to: decrease in MPves (p0.05). CONCLUSION: We have found DCMG provides a more effective and near physiological diagnostic method of detrusor characteristics than CCMG in evaluating both genuine MPves and compliance in patients with hyperreflexic neurogenic bladder.