Discectomía, artrodesis intersomática y estabilización en mielopatía espondilótica cervical. Presentación de un caso / Discectomy, artrodesis and stabilization in cervical spondylotic myelopathy. Presentation of a case

RESUMEN Las alteraciones degenerativas de la columna se engloban en el término de espondilosis cervical. La mielopatía espondilótica cervical (MEC) es la forma más común de disfunción del cordón espinal en mayores de 55 años. Se considera la intervención quirúrgica en la mayoría de los casos de mielopatía cervical espondilótica evidente desde el punto de vista clínico, dado el riesgo de deterioro neurológico. En la mayoría de los casos de mielopatía cervical, la descompresión de la médula espinal genera estabilización o mejoría de la función de los haces largos medulares. La función es mejor cuando se restablecen bien las dimensiones del conducto vertebral después de la descompresión, cuando la descompresión es más precoz y cuando no hay comorbilidad considerable.

ABSTRACT The degenerative alterations of the column are included in the term of cervical espondilosis. The cervical spondylotic myelopathy it is the form more common of disfuntion of the spinal cord in bigger than 55 years. It is considered the surgical intervention in most of the cases of cervical spondylotic myelopathy evident from the clinical, given point of view the risk of neurological deterioration. In most of the cases of cervical myelopathy, the decompression of the spinal marrow generates stabilization or improvement of the function of the medullary long sheaves. The function is better when they recover well the dimensions of the vertebral conduit after the decompression, when the decompression is more precocious and when there is not considerable comorbility.

Caso Clínico: Paraparesia Espástica Tropical Asociada a Infección por HTLV-1 / Case Report: Spastic Tropical Paraparesis Associated with HTLV-1

INTRODUCCIÓN: La mielopatía asociada al virus linfotrópico de células T humano tipo 1 o llamada comúnmente paraparesia espástica tropical, constituye un síndrome espástico caracterizado por una evolución insidiosa, crónica, lentamente progresiva y muy variable; es considerada por algunos autores como una patología desmielinizante que afecta la médula espinal. CASO CLÍNICO: Paciente de sexo femenino de 53 años de edad, procedente de Manabí y residente en Santo Domingo de los Tsáchilas, que acudió con un cuadro de 10 meses de evolución caracterizado por parestesias en miembro inferior derecho que progresó a temblores, parestesias, hiperalgesia y pérdida de fuerza muscular de las cuatro extremidades más afectación esfinteriana. Se realizaron los estudios necesarios para estudiar las causas más comunes de paraparesia; finalmente, se detectó infección por virus linfotrópico de células T humano tipo I. EVOLUCIÓN: ELa paciente permaneció hospitalizada durante 28 días y fue dada de alta en condiciones estables con los déficits neurológicos previamente establecidos. Se mantuvo en seguimiento durante 4 años posterior al diagnóstico con deterioro progresivo de la fuerza muscular en sus cuatro extremidades hasta la monoplejía con espasticidad de miembro inferior derecho. Se han reportado episodios de disartria y disnea que han remitido espontáneamente. CONCLUSIÓN: La mielopatía asociada a infección por HTLV-1 o paraparesia espástica tropical es una enfermedad de baja prevalencia, debe ser sospechada y estudiada en pacientes con un cuadro crónico de paraparesia, alteraciones sensitivas y disfunción vesical.(au)

BACKGROUND: The human T lymphotropic virus type-I associated myelopathy or also called spastic tropical paraparesis, is a spastic syndrome characterized by a slow progressive, insidious and chronic evolution. It is considered by some authors as a demyelinating spinal cord disease. CASE REPORT: 53-year-old female patient, born in Manabi and residing in Santo Domingo de los Tsáchilas. With 10 months history of right lower limb paresthesias that progressed to tremor, paresthesias, hyperalgesia and four limb muscle weakness plus sphincter disorders. An appropriate workup were performed in order to study the most common causes of paraparesis, infection with HTLV-1 was detected finally. EVOLUTION: The patient remained hospitalized for 28 days; she was discharged in stable conditions with all the prior established neurological deficits. A 4-year follow up was registered after diagnosis; muscle weakness progressed in four limbs causing right lower limb monoplegia. Dysarthria and dyspnea have been also reported, with spontaneous recovery. CONCLUSION: Human T lymphotropic virus type-I associated myelopathy or spastic tropical paraparesis is a low frequency disease, must be suspected and studied in patients with chronic paraparesis with sensory loss and sphincter disorders.(au)

Idiopathic Spinal Cord Herniation­Case Report

Idiopathic spinal cord herniation is a rare cause of progressivemyelopathy, especially in the absence of a history of spinal or surgical trauma. The radiological diagnosis ismade through a myelography or an MRI exam. The spinal cord is pushed anteriorly, buffering the dural defect and leading inmost cases to Brown-Séquard syndrome. The present study describes the case of a male patient with a clinical picture of progressive thoracicmyelopathy. In the clinical and radiological investigation, an idiopathic spinal cord herniation on the chest level was identified. During the surgery, the spinal cord was reduced to the natural site, taking its usual elliptical shape, and the dural defect was repaired with a dural substitute. The numbness of the patient improved, and the shocks in the lower limbs disappeared. A postoperative MRI confirmed the surgical reduction of the herniation and the restoration of the anterior cerebrospinal fluid (CSF) column to the spinal cord. The authors describe the clinical, radiological, intraoperative, and postoperative evolution.

Myelopathy in systemic lupus erythematosus: clinical, laboratory, radiological and progression findings in a cohort of 1,193 patients / Mielopatia no lúpus eritematoso sistêmico: achados clínicos, laboratoriais, radiológicos e evolutivos em uma coorte de 1. 193 pacientes

Abstract Objective To describe clinical, laboratory, radiological and progression characteristics of myelopathy in systemic lupus erythematosus (SLE). Patients and methods A retrospective analysis was performed on a cohort of 1193 patients with SLE (ACR criteria) in order to identify patients with myelopathy (neuropsychiatric ACR). Disease activity was assessed by the SLE activity index (SLEDAI) on the date of the event and functional capacity was assessed by the Expanded Disability Status Scale (EDSS) at the last visit. Results We identified 14 (1.2%) patients with myelopathy. All were women with a mean age of 30 ± 11.5 years. Myelopathy occurred at the diagnosis of SLE in four (28%) patients; and nine (64%) patients had another type of neuropsychiatric manifestation associated. Neurological recurrence was observed in one (7%) patient. Disease activity was observed in 2 (14%) patients. Cerebrospinal fluid presented pleocytosis on 7 (53%) patients; antiphospholipid antibodies were positive in 5 (45%). Magnetic resonance imaging (MRI) showed T2 hyperintensity with a predominance of longitudinal involvement in 6 (86%) patients. Most were treated with intravenous corticosteroids and cyclophosphamide. No patient had full recovery and four (36%) had high EDSS scores. Three (21%) patients died from sepsis early in the course of their myelopathy, during or after immunosuppressive therapy. Conclusions Myelopathy occurred in 14 (1.2%) of the patients in our cohort and this may be the first manifestation of the disease occurring independently of systemic disease activity. Although rare, myelopathy shows great morbidity and mortality, can be recurrent and MRI is critical for diagnosis.

Resumo Objetivo Descrever características clínicas, laboratoriais, radiológicas e evolutivas de mielopatia no lúpus eritematoso sistêmico (LES). Pacientes e métodos Foi feita análise retrospectiva de uma coorte de 1.193 pacientes com LES (critérios ACR) para identificar os pacientes com mielopatia (ACR neuropsiquiátrico). A atividade de doença foi analisada pelo Índice de Atividade do LES (Sledai) na data do evento e a capacidade funcional pela Escala Expandida do Estado de Incapacidade (EDSS) na última consulta. Resultados Foram identificados 14 (1,2%) pacientes com mielopatia. Todas eram mulheres com média de 30 anos (DP ± 11,5 anos). A mielopatia ocorreu no diagnóstico do LES em quatro (28%) e em nove (64%) havia outro tipo de manifestação neuropsiquiátrica associada. Recorrência do quadro neurológico foi observado em uma (7%) paciente. Atividade de doença foi observada em dois (14%) pacientes. O líquido cefalorraquidiano apresentava pleocitose em sete (53%) pacientes anticorpos antifosfolípides eram positivos em cinco (45%). A ressonância magnética (RM) demonstrou hipersinal em T2 com predomínio do comprometimento longitudinal em seis (86%) pacientes. A maioria foi tratada com corticosteroides e ciclofosfamida endovenosos. Nenhuma paciente teve completa recuperação e quatro (36%) tinham escores altos da EDSS. Óbito foi observado em três (21%) durante episódio de mielopatia, por septicemia durante ou após terapia imunossupressora. Conclusões A mielopatia ocorreu em 14 (1,2%) dos pacientes da nossa coorte e pode ser a primeira manifestação da doença e ocorrer independentemente de atividade sistêmica da doença. Embora rara, é de grande morbimortalidade, pode ser recorrente e a RM é fundamental para o diagnóstico.

Reporte de 2 casos de mielopatía progresiva tardía posradiación / Report of two cases of late progressive myelopathy postradiation

Las complicaciones de la radioterapia se pueden presentar de manera aguda, subaguda o retardada y son diferentes en sus manifestaciones, según afecten al cerebro, la médula espinal o los nervios periféricos. Se presentaron 2 pacientes que recibieron tratamiento con radioterapia y después de un año del proceder terapéutico desarrollaron manifestaciones clínicas e imaginológicas compatibles con una mielopatía posradiación. Ninguno ha tenido progresión de la enfermedad con el uso de los esteroides aplicados...

Complications of radiation therapy can occur in acute, subacute or delayed manner and they are different in manifestations, as they affect the brain, spinal cord or peripheral nerves. Two patients who were treated with radiotherapy were presented and after a year of therapeutic procedure, they developed clinical manifestations and imaging features consistent with a post-radiation myelopathy. None had disease progression with the use of steroids...

Conducta sexual en hombres con lesión medular traumática / Sexual behavior in men with spinal cord injury

Introducción: Los trastornos sexuales en lesionados medulares y su terapéutica es un problema de salud manifestado desde tiempos remotos. Objetivo: describir el comportamiento sexual en hombres con lesión medular traumática. Metodología: se realizó un estudio descriptivo transversal a una muestra de 50 hombres. Se aplicó una entrevista clínica y un examen físico exhaustivo que incluyó la escala de American Association Spinal Injuries. Resultados: predominaron pacientes jóvenes y la mayoría después de la lesión tuvo como una de las consecuencias el divorcio. Relacionado con el nivel de intensidad de la lesión prevaleció la lesión medular completa por encima de D10 y el deseo sexual se mantuvo intacto en casi todos los pacientes. La mayoría de ellos no experimentó erección, emisión, eyaculación y orgasmo, además la frecuencia del coito disminuyó en casi todos los pacientes, el tiempo demorado en iniciar el coito fue entre 1 y 2 años de la lesión. La variante sexual más usada fue el sexo oral. Conclusiones: se mostraron alteraciones sexuales debido a causas orgánicas en la totalidad de la muestra. Todos los pacientes consideraron necesario incluir la orientación sexual en el programa de rehabilitación.

Background: Sexual disorders in spinal cord injured patients and their therapy is a health problem stated since ancient times. Objective: to describe sexual behavior in men with spinal cord injury ( SCI). Methodology: a descriptive cross-sectional study was made on a sample of 50 men. A clinical interview and a thorough physical examination including the scale of American Association Spinal Injuries were applied. Results: young patients predominated and most had the divorce as a consequence after injury. According to the intensity level of the lesion complete spinal cord prevailed above D10 and sexual desire remained intact in almost all patients. Most patients had no erection , emission, ejaculation and orgasm, coital frequency also decreased in almost all patients, delayed start time intercourse was between 1 and 2 years of the injury. The most used sexual variant was oral sex. Conclusions: sexual dysfunction due to organic causes in the whole sample was shown. All patients considered necessary to include sexual orientation in the rehabilitation program.

Associação dos genes KIR2DL2K/KIR2DL3 e alelos de HLA-C do grupo 1 com a mielopatia associada ao HTLV-1/Paraparesia espástica tropical (HAM/TSP) / Association of KIR2DL2K / KIR2DL3 genes and HLA-C group 1 alleles with HTLV-1 associated myelopathy / Tropical spastic paraparesis (HAM / TSP)

O controle da carga proviral do HTLV-1 depende em parte da lise de células infectadas por células citotóxicas mediada pelos linfócitos T CD8⁺ e pelas células NK (Natural killer). A família de receptores KIR (killer-cell immunoglobulin-like receptor) interage com as moléculas de HLA de classe I, principalmente os alelos do HLA C do grupo 1 (C*01, C*03, C*07, C*08, C*12, C*13, C*14 e C*16), ativando ou inibindo a função destas células.O objetivo do presente estudo foi avaliar se os genes KIR2DL2/KIR2DL3 e os alelos de HLA-C do grupo 1 estão associados ao controle da carga proviral do HTLV-1 e ao diagnóstico de HAM/TSP. O estudo foi realizado no Centro de HTLV da Escola Bahiana de Medicina e Saúde Púbica, em Salvador-Bahia. A presença dos genes KIR2DL2 e KIR2DL3 foi determinada por PCR em tempo real (Syber Green). Foram incluídos 248 indivíduos infectados pelo HTLV-1 (161 assintomáticos e 87 com HAM/TSP) cujos alelos de HLA de classe I haviam sido previamente determinados. A carga proviral (quantificada por PCR em tempo real) e as frequências de indivíduos assintomáticos e com diagnóstico de HAM/TSP (Possível, Provável e Definido) foram comparadas de acordo com a presença ou ausência dos genes KIR avaliados. As frequências dos genes KIR2DL2 e KIR2DL3 foi 84,3% e 96,8%...

The control of proviral load of HTLV-1 depends in part of the lysis of infected cells mediated by cytotoxic CD8⁺T lymphocytes and NK (Natural killer) cells. The family of KIR (killer-cell immunoglobulin-like receptor) interacts with HLA class I molecules, especially those HLA-C alleles in-group 1 (C*01, C*03, C*07, C*08, C*12, C*13, C*14 and C*16) by activating or inhibiting the function of these cells. The aim of this study was to evaluate if the KIR2DL2, KIR2DL3 genes and group 1 HLA-C alleles are associated with the control of proviral load of HTLV-1 and the diagnosis of HAM/TSP. The study was performed at Bahiana School HTLV Center of Medicine and Health Public, in Salvador, Bahia. The presence of KIR2DL2 and KIR2DL3 genes was determined by real-time PCR (Syber Green). The study included 248 subjects infected with HTLV-1(161 and 87 asymptomatic with HAM/TSP) whose HLA class I alleles were previously determined. The proviral load (quantified by real-time PCR) and the frequency asymptomatic individuals diagnosed with HAM/TSP (possibly, probably and definitive) were compared according to the presence or absence of KIR genes evaluated. The frequencies of KIR2DL2 and KIR2DL3 genes were 84.3% and 96.8%...

Sequential Magnetic Resonance Imaging Finding of Intramedullary Spinal Cord Abscess including Diffusion Weighted Image: a Case Report

Intramedullary spinal cord abscess (ISCA) is a rare infection of the central nervous system. We describe the magnetic resonance imaging (MRI) findings, including the diffusion-weighted imaging (DWI) findings, of ISCA in a 78-year-old man. The initial conventional MRI of the thoracic spine demonstrated a subtle enhancing nodule accompanied by significant edema. On the follow-up MRI after seven days, the nodule appeared as a ring-enhancing nodule. The non-enhancing central portion of the nodule appeared hyperintense on DWI with a decreased apparent diffusion coefficient (ADC) value on the ADC map. We performed myelotomy and surgical drainage, and thick, yellowish pus was drained.

Avaliação autonômica cardiovascular em indivíduos portadores de lesão medular completa submetidos ao teste de ortostatismo / Cardiovascular autonomic assessment in individuals with full spinal cord injury submitted to the ortostatism test

O objetivo do presente estudo foi avaliar e comparar através do teste de ortostatismo a função autonômica cardiovascular em indivíduos portadores de lesão medular completa. A amostra foi constituída por 32 indivíduos com idade média de 34,54 ± 11,26 anos, sendo 24 do sexo masculino e 08 do sexo feminino. O primeiro grupo constituiu-se por 13 indivíduos tetraplégicos com níveis de lesão entre C4 a C7; o segundo constituído de 08 indivíduos paraplégicos com níveis de lesão entre T9 a L5 e o grupo controle foi constituído por 11 indivíduos aparentemente saudáveis. Para a análise do ritmo cardíaco em tempo real foi utilizado um monitor cardíaco (Polar Vantage) interligado a um computador portátil (Pentium 100), registrando gravações on-line dos intervalos R-R em tempo real do ritmo cardíaco do eletrocardiograma com uma freqüência de 500 Hz e resolução temporal de 1 ms. O ortostatismo foi obtido de forma passiva, com o pesquisador elevando progressivamente a angulação de uma mesa ortostática até 70º em aproximadamente 30 s. Para quantificação da resposta cronotrópica, utilizou-se o índice RRmax/RRmin que considera a duração do maior e menor intervalo R-R da manobra para a análise dos dados. A verificação da PA foi realizada no braço esquerdo em três situações: PA em repouso, após 1 min e 30 s e após 2 min e 30 s desde a adoção da posição ortostática. O teste de Kolmogorov-Smirnov para verificação da distribuição normal. A ANOVA simples foi utilizada para variáveis com mais de três grupos e para variáveis com duas situações e três grupos utilizamos ANOVA de dois fatores. Os resultados foram apresentados em forma de média e desvio-padrão, e valores de p ≤ 0,05 foram considerados estatisticamente significantes. Os resultados mostraram uma disfunção autonômica em tetraplégicos e resultados em paraplégicos equivalentes ao grupo controle. Esta disfunção está caracterizada por uma grande diminuição ou mesmo ausência da modulação simpática.

The purpose of this study was to evaluate and compare through the orthostatic test the autonomic cardiovascular function in individuals with complete spinal cord injury. The sample consisted of 32 individuals with average age 34.54 ± 11.26 years, being 24 males and 08 females. The first group was composed of 13 quadriplegic individuals with levels of injury between C4 to C7, the second consisting of 08 paraplegic individuals with levels of injury between T9 and L5 and the control group was composed of 11 apparently healthy individuals. For the analysis of cardiac rhythm in real time was used a heart monitor (Polar Vantage) linked to a laptop computer (Pentium 100), registering on-line recordings of real time RR intervals in heart rate of the electrocardiogram with a frequency of 500 Hz and temporal resolution of 1 ms. The orthostatism was obtained in a passive manner, with the researcher progressively increasing the angle of an orthostatic table up to 70° in approximately 30 s. To quantify the chronotropic response, the index RRmax / RRmin was used, which considers the duration of greater and lesser RR interval of maneuver for the data analysis. The blood pressure was held in the left arm in three situations: BP at rest, after 1 min 30 s, and after 2 min 30 s since the adoption of orthostatic position. The simple ANOVA was used for variables with more than three groups and for variables with two situations and three groups, we utilized ANOVA of two factors. The results were presented as mean and standard deviation, and values of p ≤ 0.05 were considered statistically significant. The results showed an autonomic dysfunction in quadriplegic patients and results equivalent to the control group in paraplegic patients. This dysfunction is characterized by a large decrease or even absence of sympathetic modulation.

Simultaneous occurrence of brain tumor and myeloradiculopathy in schistosomiasis mansoni: case report / Ocorrência simultânea de tumor cerebral e mielorradiculopatia na esquistossomose mansoni: relato de caso

Simultaneous occurrence of brain tumor and myeloradiculopathy in cases of Manson's schistosomiasis have only rarely been described. We report the case of a 38-year-old man who developed seizures during a trip to Puerto Rico and in whom a brain tumor was diagnosed by magnetic resonance imaging: brain biopsy revealed the diagnosis of schistosomiasis. He was transferred to a hospital in the United States and, during hospitalization, he developed sudden paraplegia. The diagnosis of myeloradiculopathy was confirmed at that time. He was administered praziquantel and steroids. The brain tumor disappeared, but the patient was left with paraplegia and fecal and urinary dysfunction. He has now been followed up in Brazil for one year, and his clinical state, imaging examinations and laboratory tests are presented here.

Tem sido descrita, raramente, na esquistossomose mansônica, a ocorrência simultânea de tumor cerebral e mielorradiculopatia. Relatamos aqui o caso de um homem de 38 anos que desenvolveu convulsões, durante viagem a Porto Rico, e um tumor cerebral foi diagnosticado à ressonância magnética: a biópsia do cérebro revelou o diagnóstico de esquistossomose. Ele foi transferido para hospital na América do Norte e durante a hospitalização desenvolveu súbita paraplegia. O diagnóstico de mielorradiculopatia foi confirmado na ocasião. Ele recebeu praziquantel e esteróides. O tumor cerebral desapareceu, mas o paciente permaneceu com paraplegia, disfunção urinária e fecal. Ele tem sido acompanhado no Brasil no último ano e o seu estado clínico, os métodos de imagem e os exames de laboratório são apresentados aqui.

Spinal intramedullary neuroepithelial (ependymal) cyst. A rare cause of treatable acute para paresis.

An 8-yr-old female child presented with acute onset of severe pain in the lower limbs and difficulty in walking. Spine MRI showed hyperintense signals on T2 weighted images at T2-T3 level, which was intramedullary in location. The patient was operated and histopathology reported as neuroepithelial cyst. Spinal intramedullary neuroepithelial cysts are rare. Spinal cord compression due to the cyst is very uncommon and because of its rarity the present case is being reported. The clinical features, embryogenesis and literature were reviewed briefly.

Ventral extradural spinal meningeal cyst causing cord compression: neurosurgical treatment

Spinal extradural meningeal cysts are typically formed by a thin fibrotic membranous capsule, macroscopically similar that of an arachnoid membrane, filled by cerebro spinal fluid and related to a nerve root or to the posterior midline. Ventral location is extremely rare and when it occurs they usually cause spinal cord herniation through the ventral dural gap. A 61 year-old man who began with a two years long history of insidious tetraparesis, spasticity and hyperreflexia in lower extremities, and flaccid atrophy of upper limbs, without sensory manifestations, is presented. Investigation through magnetic resonance imaging demonstrated an extensive spinal ventral extradural cystic collection from C6 to T11. The lesion was approached through a laminectomy and a cyst-peritoneal shunt was introduced. The cyst reduced in size significantly and the patient is asymptomatic over a 48 months follow-up. This is the first reported case of a spontaneous ventral extradural spinal meningeal cyst causing cord compression. Cyst-peritoneal shunt was effective in the treatment of the case and it should be considered in cases in which complete resection of the cyst is made more difficult or risky by the need of more aggressive surgical maneuvers.

Cistos meníngeos extradurais espinhais são formados tipicamente por estreita cápsula membranosa fibrótica, macroscopicamente semelhante a uma membrana de aracnóide, repleta de líquor e relacionada com uma raiz nervosa ou com a linha média posterior. Eles são extremamente raros em posição anterior e, quando ocorrem, habitualmente causam herniação da medula espinhal pela falha dural ventral. O caso de um homem de 61 anos de idade que iniciou com tetraparesia, espasticidade e hiperreflexia em membros inferiores, e flacidez com hipotrofia nos membros superiores, sem manifestação sensitiva, é apresentado. A investigação com ressonância magnética demonstrou extensa coleção cística extradural ventral à medula de C6 a T11. A lesão foi abordada diretamente via laminectomia com introdução de derivação cisto-peritoneal, reduzindo o cisto e tornando o paciente assintomático com um seguimento de 48 meses. Este é o primeiro caso relatado de cisto meníngeo extradural ventral espontâneo causando compressão medular. A derivação cisto-peritoneal se mostrou eficaz no tratamento do caso e deve ser considerada em situações em que a ressecção completa do cisto esteja impossibilitada, ou dificultada pela necessidade de manobras cirúrgicas mais agressivas e arriscadas.

Role of clinical neurophysiological tests in evaluation of erectile dysfunction in people with spinal cord disorders.

BACKGROUND: While erectile dysfunction is frequent among people with disorders of the spinal cord, the role of various clinical neurophysiological tests in assessment is not clear. AIMS: To study the role of clinical neurophysiological investigations in assessing erectile dysfunction among men with spinal cord disorders. SETTING: National Institute of Mental Health and Neurosciences, India. DESIGN: Survey. MATERIALS AND METHODS: Subjects with a score of 21 or less on the International Index of Erectile Function-5 were classified as with erectile dysfunction and with a score of more than 21 as without erectile dysfunction. Clinical neurophysiological studies done were Sympathetic Skin Response from limbs, posterior tibial sensory evoked potential, pudendal sensory potential and bulbocavernous reflex. STATISTICAL ANALYSES: Chi-square test. RESULTS: Among 40 subjects 26 had erectile dysfunction. The frequency of abnormalities in clinical neurophysiological studies were: pudendal sensory evoked potentials--16, posterior tibial sensory evoked potentials--26, bulbocavernous reflex--5, sympathetic skin response from sole--24 and, sympathetic skin response from palm--18. Significant associations were noted between erectile dysfunction and abnormal pudendal sensory evoked potentials (P=0.0479), and absent sympathetic skin response from palm (P=0.0279) and sole (P< 0.001). There was no correlation between erectile dysfunction and posterior tibial sensory evoked potentials (P=0.133) or bulbocavernous reflex (P=0.418). Sympathetic skin response from sole was most sensitive (80.8%) and had best positive (87.5%) and negative predictive (68.8%) values. The specificity of these three tests was 78.6%. CONCLUSIONS: Sympathetic skin response from the sole of the foot was the most sensitive and specific clinical neurophysiological test for erectile dysfunction in spinal cord disorders.

Concurrent intra-medullary and intra-cranial tuberculomas.

Although tuberculosis of the central nervous system is well known, the incidence of intra-medullary tuberculomas is low and a combination of intra-medullary with intra-cranial tuberculomas is extremely rare. This communication reports a case of disseminated (intra-medullary, intra-cerebellar and intra-cerebral) tuberculomas in a six-year-old girl initially presenting with a spinal tumour syndrome. Conservative treatment with anti-tuberculous medications and a short course of injectable steroids resulted in complete resolution of her symptoms.

Enfermedades de la médula espinal en el curso de la infección por el virus de la inmunodeficiencia humana / Spinal cord diseases in the course of the HIV infection

Se hizo una revisión sobre las complicaciones neurológicas en los pacientes con SIDA, se comprobó que son diversas, frecuentes e incluyen infecciones oportunistas y linfoma, así como neuropatía periférica, mielopatía y demencia relacionadas con el virus de la inmunodeficiencia adquirida (VIH). Las lesiones de la médula espinal aparecen, generalmente, en un estadio tardío de la enfermedad y no pocas veces cursan de modo inadvertido por los facultativos no habituados a su atención. Su aparición como primer signo de la enfermedad es muy rara. Las afecciones medulares más comunes en estos casos son la mielopatía vacuolar y la mielitis. Se ha señalado una estrecha similitud patológica entre las mielopatías asociadas al SIDA y la vacuolar con los hallazgos detectados en la deficiencia de vitamina B12 lo cual ha hecho sugerir que una anormalidad en el metabolismo de esta vitamina dependiente de la vía de la transmetilación pudiera ser importante en la génesis de la mielopatía en el SIDA. Basados en la probable asociación entre la carga viral VIH-1 en el líquido cefalorraquídeo con los trastornos cognitivos se ha avanzado la hipótesis de un mecanismo similar con la mielopatía, pero no se ha podido establecer una correlación de esta entidad con la carga viral. El diagnóstico se establece por el cuadro clínico de lesión de médula espinal, sobre todo de trastornos motores, con signos piramidales y disfunción esfinteriana. Se ha señalado una elevada incidencia de paraparesia, parestesias, espasticidad y dolor de espalda. Se desconoce realmente la génesis de la mielopatía en esta entidad. Los beneficios de la profilaxis y de la terapia antirretroviral han modificado el enfoque de la atención de las enfermedades neurológicas en el curso del SIDA

Spinal intramedullary tuberculoma and abscess: a rare cause of paraparesis.

Five cases of spinal intramedullary tuberculomas (IMT) and one case of spinal intramedullary tuberculous abscess (ITA) are presented. Gd enhanced MRI revealed ring enhancing lesion with central hypodensity, suggesting granulomatous pathology. Surgical excision of the intramedullary lesions was carried out in four cases, while two patients received presumptive anti-tuberculous chemotherapy only. Repeat MRI after completion of anti-tuberculous therapy showed total resolution of the lesion. In other cases following surgical excision, the patients improved significantly. The management of these rare lesions is discussed and the literature reviewed.

Primary spinal intradural hydatid cyst--a short report.

Primary spinal hydatid cysts are uncommon. Among these, intradural presentation is very rare. A case of primary spinal intradural hydatid cyst presenting as incomplete dorsal cord compression is reported here for its rarity.

Dor em doentes com lesöes raquimedulares / Pain in soine injuried patients

A dor crônica é u sintoma comum em doentes que sofrem lesöes raquimedulares. Os autores apresentam osmaspectos demográficos, as características clínicas e os resultados do tratamento de 155 doentes com dor causada por lesão raquimedular. A mediana das idades foi 47,1 anos, o período de duração da dor teve mediana de 61,7 meses. As causas mais comuns das lesöes foram ferimentos por projéteis de arma de fogo (30,3 por cento), traumatismos fechados (28,4 por cento) e as iatrogenias (18,7 por cento). Os segmentos mais frequentemente acometidos foram o torácico (43,2 por cento), seguindo-se a região lombar e a cervical. A dor localizou-se predominantemente nos membros inferiores 75,4 por cento. A dor fantasma foi observada em 88,3 por cento dos doentes e a miofascial em 25 por cento. Os padröes mais comuns de dor foram o queimor (32,3 por cento) e o queimor choque (29,0 por cento). O fator que mais condicionou a mehora da dor foi o repuso (44,5 por cento) e o mais relacionado à piora foram os exercícios (65,9 por cento) e os estresses psíquicos (61,9 por cento). Todos os doentes foram tratados com medicina física e com antidepressivos tricíclicos, fenotiazinas e analgésicos antiinflamatórios não-hormonais; cerca de 1/3 dos doentes foi medicado com diazepínicos, morfínicos, baclofeno, carbamazepina ou outros agentes. O tratamento farmacológico e fisiátrico proporcionou resultados satisfatórios em 62 por cento dos doentes...