[Idiopathic spinal epidural hematoma in patients with sudden paraplegia: a case report]. / Hematoma epidural espinal idiopático en pacientes con paraplejía súbita: a propósito de un caso.

INTRODUCTION: Spontaneous spinal epidural hematoma (SEH) represents 0.3-0.9% of spinal epidural space-occupying lesions, and most surgeons advocate aggressive and early surgical intervention. In this paper we describe a patient with SEH with sudden paraplegia. CASE REPORT: This 30-year-old man had experienced one prior episode of sudden dorsal pain two days before the current admission and while he waited medical attendance, his legs suddenly became weak, and immediately afterwards, he became completely paraplegic in minutes. The patient had complete paraplegia, analgesia below the T4 level and urinary retention. He had no anticoagulant agent and no coagulopathic disease. He was submitted to computerized tomography that demonstrated a dorsally located epidural hematoma extending from the T3 to the T6 level with spinal cord compression. A laminectomy from T3 to T7 was performed four hours after the onset of the symptom. In postoperative time the patient presented the partial sensorial recovery and motor force grade II. The patient was directed to a neurorehabilitation program and in the last medical evaluation he presented recovery for motor grade III-IV, without pain. CONCLUSION: The SHE is rare, with severe neurological consequences for patients and early surgical treatment persist as essential for motor recovery.

Phrenic paresis and respiratory insufficiency associated with cervical spondylotic myelopathy.

Cervical spondylotic myelopathy is a common disease caused by chronic segmental compression of the spinal cord. Despite the fact that the columns of the nuclei of the phrenic nerve are located between the 3rd and 5th cervical nerve segments, phrenic nerve paresis is not usually clinically significant. We present one case of cervical spondylotic myelopathy with bilateral phrenic paresis in whom magnetic resonance imaging and surgical findings confirmed intrinsic cord disease as being the cause of this syndrome. This case report suggests that one pathophysiology of clinical phrenic nerve paresis may be segmental damage to the anterior horns caused by cervical spondylosis.

[Constrictive arachnoiditis after pantopaque myelography causing syringomyelia and paraparesis: case report]. / Aracnoidite constritiva causada por pantopaque resultando em siringomielia e paraparesia: relato de caso.

We present an unusual case of thoracic constrictive arachnoiditis after pantopaque myelography, used 10 years before in the diagnosis of intradural arachnoid cyst.

Paroxysmal atrial fibrillation and insidious neck pain.

Paroxysmal atrial fibrillation (AF) is an arrhythmia usually secondary to autonomic imbalance, and it may occur in the absence of any structural heart disease. The case of a patient with paroxysmal AF, in whom the arrhythmia may have been a presenting symptom of a later diagnosed cervical schwannoma, is reported.

Intravascular papillary endothelial hyperplasia causing cauda equina compression: case report.

OBJECTIVE AND IMPORTANCE: Intravascular papillary endothelial hyperplasia (Masson's vegetant hemangioendothelioma) is a rare condition affecting the neuraxis. In the literature, only one case of this lesion involving the vertebral canal with spinal cord compression has been reported. We present a case of cauda equina compression due to this abnormality. CLINICAL PRESENTATION: A 17-year-old boy was admitted at our hospital with pain, numbness, paresis of the left lower extremity, and bladder dysfunction of approximately 1 month's duration. Computed tomography and magnetic resonance imaging of the spine revealed a tumor within the spinal canal at the T12-L1 level. INTERVENTION: The patient underwent a T12-L1 laminectomy. An epidural red nodular tumor was visualized and totally resected. The findings of the pathological examination were compatible with intravascular papillary endothelial hyperplasia. At follow-up examination 1 month after the operation, the patient had complete resolution of the pain, and the motor deficit and bladder dysfunction had improved significantly. CONCLUSION: This rare benign vascular lesion may be clinically and histopathologically mistaken for an angiosarcoma. Because the intravascular papillary endothelial hyperplasia can be cured by complete surgical resection, it is important to distinguish between these two lesions to avoid inappropriate aggressive treatment.

Hereditary multiple exostoses and cervical ventral protuberance causing dysphagia. A case report.

STUDY DESIGN: A case report of a patient with hereditary multiple exostosis and who presented with cervical ventral protuberance causing dysphagia. OBJECTIVES: To present this rare situation and to discuss the treatment and the result obtained. SUMMARY OF BACKGROUND DATA: We found in the literature only one case of exostosis of the cervical spine causing dysphagia. METHODS: The patient, a 16-year-old girl, was affected by hereditary multiple exostosis, as was her father. The diagnosis was confirmed by radiograph, computed tomography, and magnetic resonance imaging, which showed a tumor in the anterior arch of the atlas. The patient was submitted to a transoral approach, and the tumor was excised. RESULTS: The patient had a good evolution 2 years after the surgery without sign of recurrence. CONCLUSIONS: This was a very rare situation, and the result validated the treatment used.

[Cerebellar abscess by Nocardia: a case report]. / Abscesso cerebelar por Nocardia: relato de caso.

The authors describe a case of cerebellar abscess by Nocardia in a patient with the acquired immunodeficiency syndrome (AIDS) that was submitted to a posterior fossa craniectomy for diagnosis and treatment. Pathological and neuroimage findings are discussed as well as the surgical approach taking into account literature data on the subject.

Corpectomy and anterior plating in cervical spine fractures with tetraplegia.

Between 1980 and 1989, 68 tetraplegic patients (69 males and 8 females) with cervical spine fractures were treated with corpectomy, iliac bone grafting and anterior plating. The average age was 27 years (15-58 years). The resected vertebrae was C4 in 4 cases, C5 in 24, C6 in 32 and C7 in 8. The injuries were classified according to Allen et al. in: compressive flexion in 47 cases, vertical compression in 20 and distractive flexion in 1. The neurologic deficit was complete in 30 patients and incomplete in 38 patients. The surgery was performed 7 days (average) (1-28 days) after the trauma. The mean follow-up was 2.8 years (1-9 years). In the postoperative period early mobilization was permitted with a plastic collar. There were 6 deaths that were not related to the technique in the first 4 weeks; the results of the remaining 62 patients are presented hereafter. In the final follow-up we observed that 56 patients had no complications related to the procedure and the spine was stabilized. The following complications were observed in the remaining patients: 5 partial loosening of the plate, but the patients were asymptomatic and 1 complete loosening that was reoperated after 2 weeks. The motor indices improved from 12.4 points initially to 23.7 in the complete tetraplegics and from 30.2 points to 72.5 in the incomplete tetraplegics. We conclude that the anterior plate fixation after anterior decompression for cervical spine fractures avoids the extrusion of the graft and provides immediate stabilization of the spine, permitting early mobilization of the patients.

[Traumatic disk hernia of the cervical spine]. / Hérnia discal traumática da coluna cervical.

The authors present 26 cases of traumatic disc herniation in the cervical spine submitted to anterior discectomy. All of the patient presented neurologic deficit, being 18 classified as Frankel A, three as Frankel B, 2 Frankel C and 3 Frankel D. There were observed three deaths in the immediate post-operative period due to respiratory insufficiency in patients classified as Frankel A. The other 23 cases have a follow-up of 14 months (6-84 months), presenting improvement of the neurologic deficit in six patients classified as Frankel B, C and D and only one as Frankel A. The authors emphasize the importance of the image methods in the diagnosis of this lesion.

[Epidemiological study of patients with spinal cord injuries and neurologic deficit, admitted to the Institute of Orthopedics and Traumatology at the Hospital das Clinicas of the School of Medicine of the University of São Paulo]. / Estudo epidemiológico dos pacientes com traumatismo da coluna vertebral e déficit neurológico, internados no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP.

The authors present an epidemiologic study concerning the spinal cord injuries treated at the Department of Orthopaedics and Traumatology of the School of Medicine of the University of São Paulo from 1982 to 1987. Out of 428 patients 94.3% were male, their age being mainly between 21 and 30 years. The segment more frequently affected was the cervical spine. The more frequent causes were the gunshot wounds and the traffic accidents. The incidence of death was 21%, caused mostly by respiratory failure.

Artrodese occipitocervical em fratura-luxacao cronica atlas-axis. / Occipito-cervical arthrodesis in chronic atlas-axis fracture-dislocation

Sao apresentados 6 casos de artrodese occipitocervical em fratura-luxacao cronica do processo odontoide realizados no Instituto de Ortopedia e Traumatologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo no periodo de 1971 a 1983, tendo ocorrido consolidacao em 5 dos 6 casos operados. As varias forma de tratamento descritas no literatura sao discutidas, optando os autores pela artrodese occipitocervical sem a inclusao do atlas (quando a artrodese C1-C2 nao for possivel)

Fratura-luxacao do processo odontoide / Chronic fracture-dislocation of the odontoid process

Os autores apresentam 5 casos de fratura-luxacao cronica de processo odontoide observados no Instituto de Ortopedia e Traumatologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, no periodo de 1971 a 1980. Sao discutidas as varias formas de tratamento descritas na literatura, optando os autores pela artrodese occipto-cervical quando a artrodese C1-C2 for impossivel ou muito problematica

[Intra- and extradural surgical approach to meningoencephaloceles of the anterior floor]. / Abordagem cirúrgica intra e extradural das meningoencefaloceles do andar anterior.

Surgical treatment of ethmoidal encephalomeningoceles: intra and extra dural approach. The intra and extra dural approach for the treatment of ethmoidal encephalomeningoceles is described. A comparation with other surgical approaches is made and good results obtained in 5 cases are reported.