A great misfortune: second traumatic spinal cord injury.

OBJECTIVE: A second and a separate traumatic spinal cord injury, which results in neurological deterioration, is very rare. In this report we describe a patient who became tetraplegic after sustaining a second spinal trauma. CASE REPORT: A 27-year-old female had a C(7)-T(1) dislocation after a motor vehicle accident. She was neurologically intact and she had undergone a posterior fusion between C(6)-T(2). She made a complete recovery. Eight months after her initial trauma, she sustained a second motor vehicle accident causing a C(5) burst fracture. CONCLUSION: Second traumatic spinal cord injury is a rare entity. Motor vehicle accidents are the most common cause of this type of injury. Whatever the treatment strategy is, the best treatment modality for traumatic spinal cord injury is prevention.

Spinal cord injury caused by gunshot wound during pregnancy.

We report a case of a pregnant woman with acute spinal cord injury (C5) caused by gunshot wound and discuss the respective maternal and fetal considerations. Neither decompressive surgery nor corticosteroid protocols were used. At 37 weeks, the patient delivered a normal female infant after induction of labor and epidural anesthesia, with no medical or obstetrical complications. With conservative management and rehabilitation, this patient had significant recovery of function.

Quality of life of primary caregivers of spinal cord injury survivors living in the community: controlled study with short form-36 questionnaire.

OBJECTIVE: To compare the quality of life scores of primary caregivers of spinal cord injury survivors living in the community with healthy age matched-population based controls and to determine the relationship between some severity parameters related with spinal cord injury and the quality of life scores of primary caregivers. SETTING: University hospital, rehabilitation centre. METHODS: Fifty primary caregivers of spinal cord injured patients living in the community and 40 healthy age-matched controls completed SF-36 (short form-36) questionnaire forms. Questionnaires were administered by interviewers who were physiatrists and the authors of the present study. All the patients were rehabilitated by the authors and data about the duration of injury, lesion levels, ASIA scores, degree of spasticity, presence of bladder and bowel incontinence and pressure sores were gathered from the hospital recordings and/or by physical examinations during control visits when the primary caregivers were administered the questionnaires. RESULTS: Quality of life scores measured by SF-36 were significantly low in the primary caregivers group compared to age-matched healthy population based controls. No significant relation was demonstrated between the quality of life scores of primary caregivers and parameters such as the duration of injury, lesion levels, ASIA scores, degree of spasticity, bladder and/or bowel incontinence and pressure sores respectively. CONCLUSION: According to the results of the present study, being a primary caregiver of a spinal cord injured victim significantly interferes with quality of life; some severity parameters related to the injury however do not seem to have an additional impact on the primary caregiver's life quality.

Effects of some nonsteroidal anti-inflammatory drugs on articular cartilage of rats in an experimental model of osteoarthritis.

We evaluate the chondrotoxic effects of some nonsteroidal anti-inflammatory drugs (NSAIDs) on articular cartilage in an experimental model of osteoarthritis (OA). Each of 40 Sprague-Dawley rats weighing 0.250 kg and 12 weeks old received weekly injections of sodium iodoacetate (1 mg/0.1 ml NaCl) in the right knees for 8 weeks to induce an experimental model of OA. The left knees served as controls. Four groups were formed of ten rats each. The control group received no medicine. In the other three groups, tiaprofenic acid, diclofenac, and indomethacin were given orally for 12 weeks. At the end of the 20th week, the complete groups were sacrificed and histologic evaluation performed. In the right knees of the control group, specific morphologic changes for OA were observed. Of the three NSAIDs tested, indomethacin was found to have deleterious effects on articular cartilage of both left and right knees. Diclofenac caused a statistically significant increase in the severity of most of the osteoarthritic parameters that were examined in the right knees, whereas tiaprofenic acid was observed to have some beneficial influences on the articular cartilage of right knees. Both diclofenac and tiaprofenic acid displayed the same deleterious effects on articular cartilage of left knees. We conclude that, in the prescription of NSAIDs for OA, it would be appropriate to choose a drug with a protective effect on chondrocytes and articular cartilage.

Syringomyelia--as a late complication of tuberculous meningitis.

The aim of this paper is to demonstrate the unusual MR features of thoracic syringomyelia following TB meningitis and to discuss the neurosurgical aspect of the treatment of this rare entity. Four years after a TB meningitis episode, a 30 year-old female patient developed a progressive spastic paraparesis. MR studies revealed multiloculated syrinxes throughout the thoracic cord. She had a syringo-subarachnoid shunt with a silastic "T" tube inserted. On the first postoperative day, she showed a dramatic neurological improvement, but unfortunately her paraparesis progressed to the preoperative level within a month despite diminished size of the syrinxes on the control MRI examination. Two and a half years after the operation the patient complained of having a burning type of central pain, and further deterioration in neurological function. Thoracic spinal MRI examination demonstrated enlarged syringomyelic cavities. At the second operation syringo-peritoneal shunt insertion was performed via right T10-11 hemilaminectomy using a "T" tube. At present, 4 months after the second operation, the patient's neurological examination demonstrated decreased spasticity, and improved strength in the legs compared to the preoperative level. MRI is the first choice of investigation in detecting TB related myelopathy as it provides a greater detail of pathological changes within and around the spinal cord such as syrinx formation and arachnoiditis. The MR findings are also helpful in deciding the management and predicting the outcome. Presence of multifocal loculations and arachnoid adhesions is the likely cause of treatment failures and poor prognosis.

Pain following spinal cord injury.

Some patients with spinal cord injury (SCI) complain of severe pain. The purpose of this study was to investigate the prevalence and classification of SCI-related pain, in terms of severity, location, aggravating and alleviating factors. 47 SCI individuals were studied between 15 and 67 years of age. Sixty-one percent of subjects experienced pain of moderate to severe intensity. 32 subjects complained of pain in the lower limbs, five patients had pain in the visceral region, eight in the pelvic and perineal areas. The pain duration was for a median of 5 weeks. The patients with pain were older (median 41 years) than those without pain (median 23 years). Pain was reported to be more intense in the evening and at night. The incidence of pain was higher in patients with thoracolumbar and incomplete spinal cord lesions. Inactivity, stress, weather change, overactivity were identified as aggravating factors. Sleep and rest were demonstrated as alleviating factors.