Conus Medullaris Syndrome Due to Posterior Spinal Artery Infarction

A 77-year-old female with a history of osteoarthritis visited our clinic complaining of lower back pain, paresthesia in both legs, and voiding difficulty. Her pain and temperature sensations were diminished below the L1 dermatome, and proprioception was decreased in both feet. The findings of a routine laboratory workup, echocardiogram, and cerebrospinal fluid studies were normal. Spine magnetic resonance imaging revealed high T2-weighted signal intensities and diffusion restriction in the posterior conus medullaris. The patient was diagnosed and treated for posterior spinal artery infarction.

Posterior Spinal Artery Infarction Presenting as a Sensory Ataxia

No abstract available.

Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis

Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature.

Idiopathic Spontaneous Intramedullary Hemorrhage: A Report of a Rare Case of Repeated Intramedullary Hemorrhage with Unknown Etiology

A 48-year-old woman presented with acute voiding difficulty, numbness and weakness of both lower extremities. Magnetic resonance imaging (MRI) showed an intramedullary hemorrhagic mass that extended from T9 to T10. T8-T10 laminotomy and surgical removal of the hemorrhagic mass was performed. The pathological diagnosis was hematoma. Her neurological status remained the same after the operation. At 5 days post-operation, the patient suddenly became paraplegic, and MRI that was immediately performed revealed a recurrent intramedullary hemorrhage. Emergent surgical evacuation was performed. Again, histological examination showed only hematoma, without any evidence of abnormal vessels or a tumor. A postoperative MRI revealed no abnormal lesions other than those resulting from postoperative changes. At a 9-month follow up, the patient could walk a short distance with the aid of a walker. Because spontaneous intramedullary hemorrhage with unknown etiology is very rare, it is essential to perform a meticulous inspection of the hemorrhagic site to find the underlying cause. Repeated hemorrhage can occur; therefore, close observation of patients after surgery is important in cases without an apparent etiology. Urgent surgical evacuation is important to improve outcomes in these cases.

Características da artéria de Adamkiewicz: comparação entre indivíduos com e sem aortopatia / Adamkiewicz artery characteristics: comparison between patients with and without aortopathy

Introdução: O presente estudo visa elucidar a apresentação anatômica da vasculatura medular em exame angiotomográfico e suas diferenças entre pacientes aortopatas e não aortopatas na população brasileira. Objetivos: Determinar as características da artéria de Adamkiewicz (AKA) e artéria espinhal anterior (ASA) por método não invasivo. Secundariamente, determinaremos a distribuição anatômica da AKA na população brasileira e a influência de determinadas aortopatias e comorbidades na identificação da AKA. Casuística: Cento e quinze angiotomografias elegíveis realizadas no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foram avaliadas e separadas entre pacientes aortopatas e não aortopatas. Trinta e dois (52,5%) homens e 29 mulheres constituíram o grupo não aortopata e 30 (56,6%) homens e 23 mulheres constituíram o grupo de aortopatas. Método: Análise prospectiva de angiotomografias realizadas em aparelho de 320 detectores através de software open-source OsiriX e identificação da AKA e ASA por reconstrução multiplanar tridimensional. Dados clínicos e sociodemográficos foram estratificados. Resultados: A AKA foi identificada em 78,7% dos integrantes do grupo não aortopata e em 40,7% dos pacientes aortopatas (p =< 0,0001). A ASA foi identificada em 80,3% dos integrantes do grupo não aortopata e em 46,3% dos pacientes aortopatas (p=0,0001). Em 53 (73,6%) casos a AKA originou-se do lado esquerdo. Discussão: A angiotomografia é exame de rotina no pré-operatório de doenças aórticas. O presente trabalho apresentou detecção da AKA em grupo não aortopata equiparável com a literatura, apesar do aumento de detectores no aparelho de tomografia e a identificação da AKA em grupo aortopata pouco abaixo da literatura, mas significativamente diferente do grupo não aortopata: maior proporção de identificação da AKA e ASA em pacientes não aortopatas. Houve diferença na distribuição da AKA em comparação com a literatura...

Introduction: This study investigated differences in spinal vasculature between healthy and diseased aortas among Brazilian population. Objective: The study aimed to identify and describe the spinal vascular anatomy, evaluate Anterior Spinal Artery (ASA) and Adamkiewicz artery (AKA) characteristics using non-invasive multidetector computed tomography (CT), as well as examine differences between groups with and without aortic disease. The secondary aim was to evaluate anatomic distribution of AKA level and side and the influence of clinical factors in its detection. Methods: CT scans of 115 patients from Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo were evaluated in terms of detection rate and AKA level and side. The results were also compared with data compiled from a review of the English language literature on this topic. We analysed 320-detector CT scans using OsiriX open source software. Furthermore, we identified the AKA and ASA using tridimensional multiplannar reconstruction. Clinical and demographics data were retrieved. Results: AKA identification showed higher detection rate in patients with healthy aortas (78.7%) compared to diseased aortas (40.7%) p < 0.0001. ASA was identified in 80.3% of the healthy aortas patients and 46.3% of the diseased aortas patients (p=0.0001). In 53 (76.6%) cases, the AKA originated from a left intercostal artery. Discussion: CT scan is a routine preoperative exam for aorta diseases. We observed a detection rate similar to that reported in previous literature on healthy aortas, in spite of the CT having more detectors. Furthermore, AKA identification in aorta diseased group was below literature, but statistically different from the healthy aorta group, higher AKA and ASA identification was found in healthy aorta group. The results indicated significant difference between previous literatures and our study in AKA detection. Conclusions: AKA...

Hemorragia intramedular (Hematomielia)no traumática: revisión / Non traumatic intramedullary hemorrhage (hematomyelia): a review

La hemorragia intramedular (hematomielia) no traumática es el sangrado producido en el interior del tejido medular en ausencia de trauma, su primera descripción clínica aparece reportada por Tellegen en 1850, se le considera la más infrecuente de las hemorragias intraespinales y rara si la comparamos con la frecuencia en que ocurren las hemorragias intracerebrales. La incidencia es alta en los varones (relación hombre-mujer 1,5:1) y muy relacionada con la entidad patológica condicionante. Esta obedece a múltiples causas: malformaciones arteriovenosas, cavernomas, tumores, cuagulopatias, inflamatoria, etc. La disfunción aguda del cordón espinal junto a las imágenes por resonancia magnética son elementos decisivos para el diagnóstico. El tratamiento aun sujeto de controversias, médico o quirúrgico (precoz o tardío), dependerá de la etiología del sangrado y del estatus neurológico en el momento del diagnóstico, hallándose los resultados más favorables en aquellos pacientes a los cuales se les realizó un pronto diagnóstico seguidos de una cirugía temprana.

Non traumatic intramedular hemorrhage (hematomyelia) is the blood found in the medullar tissues in absence of trauma, its first clinical description was reported by Tellegen in 1850.Is considered to be the most infrequent of intraespinales hemorrhage. The incidence is high in men and is related with conditionate pathological entity. Its do to multiples causes: Arteriovenos malformation, cavernomas, tumors, coagulopathies, inflammations, etc. The acute dysfunction of the spinal cord and magnetic resonance imaging are decisive in the diagnosis. The treatment though subject to controversies, medical or surgery (early or late), will depend on the bleeding etiology and the neurological status in the moment of the diagnosis, finding the most favorable result in those patients that were diagnosed earlier following an early surgery.

Intervention of Vascular Diseases of the Spine / 신경중재치료의학

Spinal AVMs consist of various congenital and acquired vascular diseases which may result in spinal neurological deficit. The anigoarchitecture of these diseases are often difficult to analyze while the risk of treatment is high due to the eloquence of the spinal cord. Recently, the understanding of the anatomy of the spinal vessels, the characteristics of the spinal vascular diseases, and the efficacy of endovascular management has grown. The purpose of this review is to introduce the latest understanding of these diseases and its management strategies.

Tratamento endovascular das malformações arteriovenosas raquimedulares: resultados clínicos e angiográficos / Endovascular treatment for spinal cord arteriovenous malformations: clinical and angiographic results

Trinta e cinco pacientes com malformações arteriovenosas raquimedulares foram submetidos a tratamento endovascular. Foram tratados 17 pacientes com fístulas arteriovenosas durais (FAD), 10 com malformações arteriovenosas intramedulares (MAI), 7 com fístulas arteriovenosas perimedulares (FAVP) e 1 com malformação arteriovenosa metamérica (MAVM). O tratamento das FAD e das MAI mostrou recidiva menor quando usada cola e melhora significativa no padrão da marcha após a embolização. O tratamento do paciente com MAVM objetivou a embolização parcial da lesão para alívio dos sintomas, resultado que foi obtido com sucesso. Nas FAVP, o tratamento mostrou ausência de recidiva e melhora clínica em todos pacientes / Thirty five patients with spinal cord arteriovenous malformations were submitted to endovascular treatment. Treatment was done in 17 patients with dural arteriovenous fistulas (DAVF), 10 with intramedullary arteriovenous malformations (IAVM), 7 with perimedullary arteriovenous fistulas (PAVF), and 1 with a metameric arteriovenous malformation (MAVM). Fewer recurrences occured in DAVF and IAVM when liquid tissue adhesive was used and there was significant improvement in the patients’ gait. Treatment for the patient with MAVM aimed partial lesion embolization and to mitigate symptoms, which was successfully achieved. Treatment in patients with PAVF revealed no recurrences and clinical improvement occurred in all of them...

Posterior Thoracic Spinal Cord Artery Infarction

No abstract available.

Venous hypertensive myelopathy caused by narrowing of ascending lumbar vein / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the diagnosis and treatment of venous hypertensive myelopathy (VHM) caused by narrowing of the ascending lumbar vein.</p><p><b>METHOD</b>The data from 3 patients with VHM caused by narrowing of the ascending lumbar vein were analyzed retrospectively.</p><p><b>RESULTS</b>Once the narrowed site of the lumbar ascending vein was determined by myelographic or angiographic technique, an undetachable balloon was introduced and advanced to the proximal part of the narrowed segment. Satisfactory results were obtained in these patients.</p><p><b>CONCLUSION</b>Narrowing of the ascending lumbar vein is one of the causes for VHM, and endovascular balloon angioplasty is an optimal treatment.</p>

Acute Paraplegia Secondary to Spontaneous Hematomyelia: A case report

Spontaneous hematomyelia (intramedullary spinal hematoma) is an uncommon event of an unknown cause. A 35-year-old man experienced sudden paresthesia over the chest, radiating pain, and motor weakness followed by complete paraplegia appeared after 1 hour. The preoperative diagnosis was made by magnetic resonance imaging which revealed hemorrhages from T4 to T9 cord segments. The selective spinal angiography, CSF study, blood laboratory, and pathology revealed no apparent cause for the hemorrhages.

Spontaneous Hematomyelia: Case Report

No abstract available.

A case Report of a Spontaneous cervical Hematomyelia

The spontaneous hematomyelia is an uncommon event and its predisposing conditions are vascular malformation, syringomyelia, pregnancy and delivery, angioma, hemophilia, anticoagulant therapy, etc. We have recently experienced the patient with spontaneous onset and resolving hematomyelia in the cervical spinal cord. A 30-year-old male patient with non-traumatic spinal shock was evaluated. On MRI, a hematomyelia along cervical spi-nal cord was revealed. A suspicious AV malformation was noticed at C3-4 level. Fol-low-up MRIs showed spontaneous resolution of the hematoma.

Spontaneous Thoracic Hematomyelia A Case Report

Spontaneous hematomyelia is an acute expanding lesion by the hemorrhage within the substance of the located primarily in the gray matter. It is necessary to have urgent operation to preserve the remainding cord function. We are reporting a rare case of spontaneous hematomyelia extending from T-8 to T-10 of unknown cause of which transverse symptoms have largely subsided after surgical evacuation of the liquefied hematoma.

A Case of Spontaneous Hematomyelia

This is a report of 23 year old soldier who developed sudden onset of flaccid paraplegia and loss of all sensory modalited below the level of T4. The clinical entities of hematomyelia were sudden onset of pain, repidly developing pyramidal signs and paraplegia. The mainly involving sites of this disease were cervical and thoracic regions. The causative factors were hemorrhagic diasthesis, vascular malformation and inflammatory process as well as trauma and neoplasms affecting the spinal cord. We experienced a case of hematomyelia which did not combine with vascular anomaly, inflammatory process, hemophilia or trauma history.