Siringomielia: revisión a propósito de un caso / Syringomyelia: review, case and report

La siringomielia supone un desafío diagnóstico, ya que es una entidad poco reconocida si no se tiene conciencia de su existencia. Al ser un cuadro progresivo, cuya clínica puede presentarse de forma larvada y ser coincidente con otras patologías neurológicas tales como la esclerosis múltiple, su detección suele realizarse en etapas tardías sobre todo en población adulta y más aún cuando se presenta de forma adquirida. Por lo que el estudio imagenológico con Resonancia Magnética adquiere especial relevancia, permitiendo identificar y clasificar la enfermedad, lo que brindará la base para decidir terapía.

Syringomyelia is a diagnostic challenge, since it is a poorly recognized disease, especially if its existence remains unknown. Being a progressive disease, whose clinic can present in a latent way and be coincident with other neurological pathologies such as multiple sclerosis, its detection is usually conducted in late stages, especially in the adult population and even more when it presents in an acquired way. Therefore, the imaging study with Magnetic Resonance acquires special relevance, allowing to be identified and classified, which will provide the basis for deciding on therapy

Progressive Cervical Spondylotic Myelopathy Caused by Tic Disorders in a Young Adult with Tourette Syndrome / 대한신경손상학회지

Involuntary movement of the cervical spine can cause damage to the cervical spinal cord. Cervical myelopathy may occur at an early age in involuntary movement disorders, such as tics. We report the case of a 21-year-old man with Tourette syndrome, who developed progressive quadriparesis, which was more severe in the upper extremities. The patient had abnormal motor tics with hyperflexion and hyperextension of the cervical spine for more than 10 years. High-signal intensity intramedullary lesions were observed at C3-4-5-6 level on T2 weighted magnetic resonance imaging. Examinations were performed for high-signal intensity intramedullary lesions that may occur at a young age, but no other diseases were detected. Botulinum toxin injection to the neck musculature and medication for tic disorders were administered. However, the myelopathy was further aggravated, as the involuntary cervical movement still remained. Therefore, laminoplasty was performed at C3-4-5-6, with posterior fixation at C2-3-4-5-6-7 to alleviate the symptoms. The neurological signs and symptoms improved dramatically. The management of tic disorders should be the first priority during treatment. However, surgical treatment may be necessary, if symptoms worsen after appropriate treatment.

Caracterización de la mielitis transversa en un hospital referencia del sur colombiano / Characterization of patients with transverse myelitis in a referral hospital in southern Colombia

Objetivo: caracterizar a los pacientes con diagnóstico de mielitis transversa (MT) en un hospital de referencia del sur de Colombia durante los años 2007 a 2013. Materiales y métodos: Estudio transversal. Se incluyeron todos los pacientes con diagnóstico de MT, según los criterios The Transverse Myelitis Consortium Working Group. Resultados: En total 21 casos de MT (1,3 casos/10 000 ingresos), el 66,7% en edades entre 15-30 años, 57,1% de género femenino; 81,0% agudos. Todos presentaron déficit motor, 52,4% disfunción vesical autonómica, 81,0% nivel sensitivo. Se documentaron hallazgos imagenológicos de MT en resonancia magnética nuclear en el 71,4% de los casos e hiperproteinorraquia en 50%. En el 66,7% la etiología fue desconocida, en los casos en quienes se logró determinar la etiología fue: herpes simple tipo 1 (9,5%), varicela zoster (9,5%), leucemia mieloide aguda (4,8%), lupus eritematoso sistémico (4,8%) y deficiencia de vitamina B12 (4,8%). Conclusiones: La MT es un importante problema de salud pública, es necesario considerar sus características clínicas, establecer las formas idiopáticas y reconocer etiologías infecciosas dado el impacto terapeutico y pronóstico

Objective: To characterize patients with a diagnosis of transverse myelitis (TM) in a referral hospital in southern Colombia during years 2007 to 2013. Material and methods: This is a crosssectional study. All patients with a TM diagnosis were included, according to the criteria set by the Transverse Myelitis Consortium Working Group. Results: We had a total number of 21 cases of TM (1.3 cases/10,000 admissions). Two thirds (66,7%) of all patients were between 15-30 years of age, 57,1% were female; 81.0% had an acute presentation, 100% had motor deficit, 52.4% had autonomic bladder dysfunction, and 81.0% had sensitive level. MT findings were documented using magnetic resonance imaging in 71.4% of cases and 50% by high protein levels in the cerebrospinal fluid. Two thirds (66.7%) of the cases had an unknown etiology. In those cases in which their origin could be identified, the etiologies were: Type I Herpes Simplex (9.5%); Varicella Zoster (9.5%), acute myeloid leukemia (4.8%), systemic lupus erythematosus (4.8%) and vitamin B12 deficiency. Conclusion: MT is a major public health problem, and it is necessary to consider its clinical features, to establish its idiopathic forms and to recognize its infectious causes given their therapy impact and prognosis

Retrospective study of the clinical effects of acupuncture on cervical neurological diseases in dogs

This study was conducted to evaluate new acupuncture protocols for the clinical treatment of cervical spinal cord diseases in 19 dogs. Three treatment options containing Jing-jiaji (cervical jiaji) were developed to treat neck pain, hemiparesis, and tetraparesis depending on the severity. The interval between the neurological disease onset and treatment (duration of signs), time to improvement after treatment, and recovery time were compared in dogs by body weight, age, and dry needle acupuncture (AP) with or without electro-AP (EAP). The duration of signs was longer in dogs weighing greater than 10 kg than in those weighing less than 10 kg (p < 0.05). Improvement and recovery times did not vary by body weight. Additionally, improvement and recovery times did not vary by age. The improvement and recovery times were longer in the AP+EAP group than the AP group (p < 0.05). Acupuncture with Jing-jiaji was effective in cervical spinal cord diseases in different sized dogs and in middle-aged and senior dogs. This report standardized AP treatment containing Jing-jiaji for canine cervical problems and evaluated its effects. The newly standardized AP methodology offers clinical practitioners an effective way to improve the outcomes of cervical neurological diseases in dogs.

Characteristics of Coping Strategies for Dysesthesia in Preoperative Patients with Compressive Cervical Myelopathy

STUDY DESIGN: A cross-sectional study. PURPOSE: This study aimed to clarify the characteristics of coping strategies for dysesthesia in preoperative patients with compressive cervical myelopathy. OVERVIEW OF LITERATURE: Cognitive behavioral therapy is effective for patients with chronic pain in terms of modifying their negative behavior. To effectively perform cognitive behavioral therapy, it is necessary to assess coping strategies because of their important roles in health-related quality of life. METHODS: Sixty-one preoperative patients with compressive cervical myelopathy (men, 39; women, 22; 61.0+/-11.6 years) participated. Coping strategies for dysesthesia (coping strategies questionnaire) and subjective symptoms (numerical rating scale for dysesthesia intensity and Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire) were investigated. RESULTS: There were moderately significant correlations among the subcategory scores of the coping strategies questionnaire (Spearman's rank correlation coefficient [rs]< or =0.69, p<0.05); the praying/hoping and catastrophizing scores were significantly correlated with the numerical rating scale score of dysesthesia (both; rs=0.34, p<0.01); there were no correlations between the coping strategy scores and the cervical spine function and upper and lower extremity motor function scores of the Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire; and there were no significant associations between the coping strategy scores and age, sex, and symptom duration. CONCLUSIONS: Various combinations of coping strategies for dysesthesia were selected in patients with compressive cervical myelopathy, and frequency of use of the coping strategies was not related to the perceived severity of cervical myelopathy or demographic factors.

Hypertrophic Posterior Arch of Atlas Causing Cervical Myelopathy

Cervical stenosis, especially of the upper cervical spine, is quite rare which can be developmental or acquired. Clefts or aplasias of anterior and posterior arches of atlas, ossification of the transverse atlantal ligament, hypertrophy of the dens and os odontoideum are rare conditions causing cervical myelopathy reported either singly or in combination. Hypertrophy of the posterior arch of atlas in the absence of any ring hypoplasia as a cause of cervical myelopathy has not been reported earlier. The authors report a case of cervical myelopathy in a 26-year-old female due to hypertrophied posterior arch of atlas which was preoperatively diagnosed as a bony tumor. Being aware of such an entity may avoid diagnostic surprises and facilitate patient prognostication and management.

Formações císticas epidurais relacionadas a bursite interespinhosa, cisto sinovial e cisto discal / Epidural cystic masses associated with interspinous bursitis, synovial and discal cysts

Os autores apresentam casos de cistos epidurais, dentre eles os cistos sinoviais, discais, do ligamento amarelo e relacionados a bursite interespinhosa, todas essas condições determinando compressão radicular, do saco dural ou estenose do canal vertebral. Descrevem as características de imagem e localização na ressonância magnética nessas diferentes afecções.

The authors describe some cases of epidural cysts, namely synovial, discal, ligamentum flavum cysts, and cysts secondary to interspinous bursitis, all of these conditions determining radicular, dural sac compression or spinal canal stenosis. Magnetic resonance imaging findings and localization of these entities are described.

Reabilitação física em um paciente com mielopatia vacuolar: relato de caso / Physical rehabilitation in a patient with vacuolar myelopathy: case report

A AIDS é causada pelo vírus da imunodeficiência humana (HIV), um retrovírus que foi descoberto em 1983. Este estudo avaliou a associação do treinamento dos músculos inspiratórios e do treinamento de condicionamento físico à fisioterapia motora, em um paciente HIV positivo com o diagnóstico de mielopatia vacuolar e acometimento medular no nível de T7. A fisioterapia motora consistiu de exercícios de fortalecimento, equilíbrio e atividades funcionais. O protocolo de treinamento da fisioterapia respiratória consistiu de duas fases: treinamento da musculatura inspiratória e condicionamento físico realizado por meio de propulsão da cadeira de rodas. Foram realizadas as medidas da pressão inspiratória máxima (PImáx), pressão expiratória máxima (PEmáx), pico do fluxo expiratório (PFE) e a distância total de propulsão em cadeira de rodas durante 6 minutos, pré, após a quarta e a oitava semana de treinamento. A Escala de Borg Modificada foi utilizada para a avaliação da sensação de dispnéia. Antes do treinamento, os valores das medidas respiratórias foram PImáx 60 cm/H2O, PEmáx 90 cm/H2O e PFE 270l/min e a distância total de propulsão em cadeira de rodas durante 6 minutos foi de 100,2 metros. Na oitava semana os valores foram PImáx 120cm/H2O, PEmáx 100cm/H2O, PFE 350l/min e a distância total de propulsão em cadeira de rodas durante 6 minutos foi de 120m. Concluiu-se que a associação do protocolo de treinamento adotado à fisioterapia motora melhorou a força dos músculos respiratórios e o condicionamento físico do paciente.

AIDS is caused by human immunodeficiency virus (HIV), a retrovirus discovered in 1983. This study evaluated the association between inspiratory muscles training and physical conditioning training to motor physiotherapy in a patient with AIDS and vacuolar myelopathy diagnosis, at T7 level. Motor physiotherapy comprised strengthening exercises, balance and functional activities. The respiratory physiotherapy training protocol included: inspiratory muscle training and aerobic conditioning by wheelchair propulsion. The visual analog modified Borg scale was applied, before and after inspiratory muscle training and before and after wheelchair propulsion training, in order to measure the dyspnea levels at fourth and eighth week of training. The measures presented before training protocols were MIP 60cm/H2O, MEP 90cm/H2O, PEF 270l/min and the 6-minute total wheelchair propulsion resulted in a distance of 100.2 meters. After eight week, the following results were observed: MIP 120cm/H2O, MEP 100cm/H2O, PEF 350l/min, the 6-minute total wheelchair propulsion resulted in a distance of 120 meters. Inspiratory and expiratory muscles may be specifically trained in order to improve the muscle strength. Thus, we observed important increase of respiratory measures, total wheelchair propulsion and improvement of dyspnea sensation during functional activities after the treatment. Concluding, the association between the adopt training protocol to motor physiotherapy improved the respiratory muscle strength and physical conditioning in this patient.

Effect of Magnetic Stimulation of Sacral Roots on Detrusor Overactivity and Urge Incontinence / 中国康复理论与实践

@#Objective To observe the effect of magnetic stimulation of sacral roots on detrusor overactivity and urge incontinence after spinal cord disease.Methods 15 cases with detrusor overactivity and urge incontinence after spinal cord disease were treated with magnetic stimulation of sacral roots for 10 d.Voiding diary,quality of life scale and urodynamic investigation were applied to evaluate the effect.Results The mean frequency of voiding in 24 h after treatment decreased,urine volume increased,frequency of incontinence decreased and the quality of life score improved.Urge incontinence improved in 85.7% cases.The results of urodynamic investigation showed bladder capacity at first desire to void and maximum cystometric capacity significantly increased after stimulation,while the detrusor pressure at storage decreased.Conclusion Magnetic stimulation of sacral roots can improve urinary frequency and urge incontinence of patients with detrusor overactivity after spinal cord disease by inhibiting detrusor overactivity,increasing cystometric capacity.Magnetic stimulation of sacral roots may be an alternative promising rehabilitation technique.

Primarily results of the diagnosis of the spinal cord diseases by MRI in Huu Nghi Hospital

In presenting some patients with spine cord diseases detected by MR imaging in Huu Nghi Hospital, the author leads to remark that MRI has advantages in diagnosis of congenital malformations, degenerative diseases, syringomyelia and neoplasia of the spine and spinal cord. MRI indications for spine examination are suggested in conclusion.