Spinal Cord Stroke Presenting With Acute Monoplegia in a 17-Year-Old Tennis Player.

BACKGROUND: Acute monoplegia is a rare presentation for spinal cord stroke, which usually presents with paraplegia or paraparesis. PATIENT DESCRIPTION: We describe an athletic girl who presented after a week of heavy athletic activity complaining of back and left leg pain, followed by flaccid left leg paralysis. RESULTS: The prothrombotic evaluation was unremarkable. Cerebrospinal fluid studies demonstrated elevated myelin basic protein but no oligoclonal bands. Magnetic resonance imaging revealed a lesion in the anterior cord from T9 to T11 with T2 hyperintensity, contrast enhancement, and diffusion restriction, suggesting infarction. There was a herniated disc at T10-T11 contacting the spinal cord and Schmorl's nodes at T11 and T12. Magnetic resonance angiography of the spinal cord was limited by movement artifact. CONCLUSIONS: The combination of our patient's clinical presentation, imaging studies, and laboratory evaluation suggests that our patient had a spinal cord infarct. A fibrocartilaginous embolism was the likely mechanism of infarct due to the presence of Schmorl's nodes and disc herniation on imaging. In addition to spinal cord stroke, other possible mechanisms leading to presentation with monoplegia, such as transverse myelitis, neuromyelitis optica, and multiple sclerosis, are discussed.

CSF proteomics of secondary phase spinal cord injury in human subjects: perturbed molecular pathways post injury.

Recovery of sensory and motor functions following traumatic spinal cord injury (SCI) is dependent on injury severity. Here we identified 49 proteins from cerebrospinal fluid (CSF) of SCI patients, eight of which were differentially abundant among two severity groups of SCI. It was observed that the abundance profiles of these proteins change over a time period of days to months post SCI. Statistical analysis revealed that these proteins take part in several molecular pathways including DNA repair, protein phosphorylation, tRNA transcription, iron transport, mRNA metabolism, immune response and lipid and ATP catabolism. These pathways reflect a set of mechanisms that the system may adopt to cope up with the assault depending on the injury severity, thus leading to observed physiological responses. Apart from putting forward a picture of the molecular scenario at the injury site in a human study, this finding further delineates consequent pathways and molecules that may be altered by external intervention to restrict neural degeneration.

Cerebrospinal fluid insulin-like growth factor 1 is low in acute and chronic white-matter diseases of children.

Insulin-like growth factor 1 increases both the number of oligodendrocytes and the amount of axonal myelin produced. The aim of this study was to see whether insulin-like growth factor 1 played a role in white-matter diseases of children. We studied insulin-like growth factor 1 in the cerebrospinal fluid of children with various white-matter diseases: (1) children with acute demyelinating events: acute disseminated encephalomyelitis (n = 5), acute transverse myelitis in multiple sclerosis (n = 1), and infarct of the medial cerebral artery causing secondary white-matter changes (n = 1), and (2) children with chronic diseases: delayed myelination (n = 3) and progressive leukodystrophies (n = 4). Insulin-like growth factor 1 was determined by radioimmunoassay with commercially available kits (Mediagnost, Tubingen, Germany). We found markedly lower concentrations of cerebrospinal fluid insulin-like growth factor 1 in the patients than in the 28 age-matched control children (P < .0005). Low cerebrospinal fluid insulin-like growth factor 1 can play a role in the pathology of both acute and chronic white-matter diseases of children.

Cerebral blood flow changes in pseudomigraine with pleocytosis analyzed by single photon emission computed tomography. A spreading depression mechanism?

Pseudomigraine with pleocytosis is a benign and autolimited syndrome. The etiology has been related to viral infection, but its pathophysiology is not yet well identified. To investigate this point, and to see if there were changes in cerebral blood flow (as in migraine), we performed single photon emission computed tomography (SPECT) studies in four patients who fulfilled the diagnostic criteria for this syndrome. This was done during the acute phase and we repeated SPECT after resolution of the syndrome in two of them. We found a reduction in brain blood flow on the side of origin of the neurological deficits during the acute phase. This normalized after recovery of the syndrome. The finding suggests that the neurological deficits in this syndrome could be produced by a spreading depression-like mechanism similar to that proposed for migraine with aura.

Varicella-zoster virus DNA in CSF and arteries in delayed contralateral hemiplegia: evidence for viral invasion of cerebral arteries.

A 78-year-old woman presented with a right basal ganglia infarct 6 weeks after a left herpes zoster ophthalmicus. MR angiography showed focal segmental stenosis of the proximal segments of the anterior, middle, and posterior cerebral arteries. Varicella DNA was detected in the CSF by polymerase chain reaction (PCR). Treated with dexamethasone and acyclovir without improvement, she died 1 month later. There was focal endarteritis in the left anterior, middle, and posterior cerebral arteries at autopsy. Varicella DNA was detected by PCR of extracts from these vessels but not from the arteries on the right side. This study provides further evidence that the vasculopathy after herpes zoster ophthalmicus results from direct viral invasion of the vessel wall.

Hemiplegic migraine with CSF abnormalities.

A 30-year-old woman with hemiplegic migraine and an elevated CSF protein level with considerable pleocytosis is described. Fourteen other cases of hemiplegic migraine with cerebrospinal fluid abnormalities reported in the literature are reviewed.

Metabolic approach for regulation of IL-1 beta in vivo.

IL-1 beta, the autoantibodies to IL-1 beta and IL-1 beta-containing immune complex in pleural effusion and cerebrospinal fluid were detected using anti-recombinant human IL-1 beta monoclonal antibody. The results indicate that IL-1 beta is detectable in some cases, and the amounts decrease gradually with the chemotherapy following the autoantibodies and the specific detectable immune complex. These autoantibodies may have a feedback effect, inhibiting the IL-1 beta activity, and forming the immune complex to speed the clearance of activated IL-1 beta.

[Cerebrospinal fluid therapy in patients with central motor disorders]. / O likvoroterapii bol'nykh s tsentral'nymi dvigatel'nymi narusheniiami.

The authors relate new concepts of the mechanisms of the pathogenesis and compensation of central motor disorders of organic origin, based on experimental exploits of the I.P. Pavlov Physiological Department of the Institute of Experimental Medicine. It is shown that in these mechanisms, of paramount importance is the neurochemical component determining a considerable part of the symptomatology of neurological disorders and process of disturbed functions recovery. Based on the regularities discovered and studies of the properties of the convalescents" CSF, a method of its use has been developed in order to treat residual phenomena after brain stroke or craniocerebral injury. The authors describe the results of the clinical testing of that method, demonstrating its effectiveness in the treatment of chronic neurological patients.

[The structural specificity of factors in the chemical regulation of muscle tonus at the spinal cord level]. / Strukturospetsifichnost' faktorov khimicheskoi reguliatsii myshechnogo tonusa na urovne spinnogo mozga.

The chemical factors of the postural asymmetry (FPA) were studied on the recipients without hemispheres. The structural specificity of the fore and hind limb spinal centers regulation in normal and damaged CNS was observed. In the normal CNS this structural specificity was displayed in the selective activation of the cross-situated hemicenters in the cervical and lumbal regions (for example in the left part of the cervical and in the right part of the lumbal region). In the case of the unilateral lesion of the central motor systems the normal pattern of chemical structural specificity was modified by activation of FPA selectively acting on the partly denervated regions of the spinal cord.

Hemiplegic migraine in childhood: diagnostic and therapeutic aspects.

Focal neurologic deficits, particularly hemiplegia, are occasionally observed in the pediatric migrainous population during the headache attack and are often mistaken for other neurologic or neurosurgical conditions. Clues to the correct diagnosis, illustrated by three patients in this report are: (1) rapid spontaneous recovery from the acute neurologic deficit, (2) striking electroencephalographic abnormalities, frequently consisting of focal slow waves during the acute stage, with rapid resolution, (3) significant past history of recurrent episodes, and (4) positive family history of migraine. Review of previously reported cases indicates that cerebral arteriography in the acute stage should be avoided if the clinical syndrome is typical. Preliminary results of prophylactic treatment with propranolol are encouraging; smaller dosage than those previously recommended sometimes can be effective.

Ophthalmic herpes zoster with contralateral hemiparesis: a case report.

Herpes zoster of the ophthalmic division of the left fifth cranial nerve with contralateral hemiparesis was observed in a 30-year-old man. Left carotid angiography showed segmental constrictions consistent with cerebral arteritis, possibly provoked by direct viral infection along the intracranial part of the ophthalmic nerve. An ischaemic lesion revealed by computed tomographic scan was considered secondary to arteritis and responsible for the hemiparesis. The presence of an immune response within the blood-CSF barrier was suggested by an increase of oligoclonal CSF IgG and IgA.

Hemiplegic migraine associated with an aseptic meningeal reaction.

A 21-year-old man had typical symptoms of hemiplegic migraine. A lumbar puncture demonstrated a significant lymphocytic response and an elevated CSF protein level on the day of and 24 days after the headache despite the absence of any other clinical symptoms. Other reported cases of CSF leukorrhaghia associated with hemiplegic migraine are briefly reviewed.