Thoracic spinal cord injury without spine fracture in an adult: case report and literature review.

The syndrome of traumatic spinal cord injury without spinal column fracture is well known and predominantly involves the cervical spine of children. One case of a thoracic spinal cord injury without bony abnormalities in an adult is reported, and the pertinent literature is reviewed. Although spinal cord injury without radiographic abnormality may exist, such injuries without neuroimaging pathology may not.

Clinical clerkships in neurosurgery and neurology at United States medical schools.

The neurology and neurosurgery clinical clerkship experience (excluding lectures and conferences) of the students in U.S. allopathic medical schools during one of the academic years 1986 to 1987 or 1987 to 1988 was surveyed. Almost all schools have at least some students taking these clerkships. The majority of students (78%) have clinical exposure to neurology, but only a minority (28%) take a neurosurgical clerkship; however, far more schools require their students to take neurology clerkships (54%) than neurosurgical clerkships (12%). A few require that either be taken. Overall, 81% of schools require all students to take at least one of these clerkships. For the most part, students taking a clerkship in either specialty do not do so again. The initial and usually unique exposure averages 3.5 weeks in neurology and 2.4 weeks in neurosurgery. For each specialty, required clerkships tended to be shorter than selective clerkships, which in turn were shorter than elective ones. Furthermore, first clerkships offered in the fourth year, whether they were required, selective, or elective, tended to be longer than the corresponding third-year first clerkships at other schools. Whereas the average length of a first clinical clerkship in neurology is almost as long for schools requiring it (3.4 wk) as for those that offer it as an elective or selective (4.0 wk), required neurosurgical clerkships are much shorter (1.5 wk) than elective or selective rotations (3.1 wk). Schools with residency training programs more frequently required students to a clerkship and, consequently, had greater numbers of students taking a clerkship in the corresponding specialty.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolated symptomatic cervical spinous process fracture requiring surgery. Case report.

Isolated cervical spinous process fractures are common, but are usually considered to be inconsequential. Although such fractures may produce pain, complete recovery without residual symptoms is expected after conservative treatment, and neurological injury does not usually occur. The case of a patient with a persistently symptomatic C-2 spinous process fracture that required surgical treatment for pain relief is reported. A review of the pertinent literature illustrates with unusual clarity the interactions of social, political, and economic forces associated with this medical condition.

Malignant fibrous histiocytoma in a recurrent thoracic chordoma: case report and literature review.

Malignant transformation in a recurrent chordoma in the thoracic region is extremely uncommon. One new case, as well as a review of spinal chordomas that have undergone malignant transformation, is reported. Such cases emphasize the importance of the aggressive initial surgical treatment of spinal tumors.

Sudden loss of pain control with morphine pump due to catheter migration.

The use of implantable morphine pumps for the treatment of cancer pain is increasing. A sudden loss of previously adequate pain control should suggest pump malfunction. Pump revision should be considered, rather than automatically increasing oral analgesics. This case report details a rapid loss of pain control due to intraspinal catheter migration into the abdominal subcutaneous space.

Carpal tunnel syndrome. Avoiding poor treatment results.

Carpal tunnel syndrome is one of the most common causes of paresthesias, pain, and weakness of the hands. All physicians should be aware of the typical presentation of the syndrome, its differential diagnosis, and the various options for treatment. The prognosis with surgical treatment is excellent if significant muscle atrophy has not occurred.

The thoracic outlet syndrome. Meeting the diagnostic challenge.

Although arm and hand pain, paresthesias, and weakness are common complaints in thoracic outlet syndrome, only a small minority of patients presenting with these symptoms will be found to actually have this condition. Thus, the clinician should be familiar with the symptoms and signs of this syndrome and also be aware of the difficulties of objectively confirming the diagnosis. After a thorough history and physical examination, cervical spine radiographic and electromyographic study may be the most helpful first tests for exclusion of other common conditions causing similar symptoms, such as cervical degenerative arthritis and carpal tunnel syndrome. Arteriography may well be considered next if the patient does not respond to conservative treatment. Only when other, more common illnesses are excluded should the thoracic outlet be surgically explored. Results of surgical therapy should be good, especially if true pathologic compression of the neurovascular structure is present.

Ulnar nerve entrapment at the elbow. Tailoring the treatment to the cause.

Ulnar nerve entrapment at the elbow is a common cause of arm and hand pain, paresthesias, and weakness. Its characteristics and the appropriate diagnostic tests should be known to all primary care physicians. An understanding of the surgical treatment of this common disorder is helpful in providing informed medical care.

Primary spinal chondrosarcoma with eighteen-year follow-up: case report and literature review.

Although chrondrosarcomas are common primary bone tumors, their occurrence in the spine is very rare. Because total excision in such cases is seldom possible, few long term survivors have been reported. We are reporting one patient with a high thoracic spinal chondrosarcoma who survived with useful function for over 18 years because of repeated local tumor excisions. The literature is reviewed, and an aggressive surgical treatment of spinal chondrosarcoma is recommended.

Diabetic polyradiculopathy simulating lumbar disc disease. Report of four cases.

Most clinicians are aware of the common neurological effects of endocrine disorders. However, involvement of the spinal nerve roots is a poorly recognized complication of diabetes mellitus. Such involvement can closely simulate more common spinal diseases and thus lead to inappropriate therapy. Four cases of diabetic polyradiculopathy simulating lumbar disc disease are reported, and this distinctive entity is reviewed.

Spinal subdural metastatic adenocarcinoma: case report and literature review.

Metastatic spinal cancer is common and usually involves the bony spine or the epidural space. We are reporting a case of breast carcinoma metastatic to the spinal subdural space, and we review the literature concerning this unusual metastatic site. Unlikely metastatic locations should be suspected whenever myelography in cancer patients with spinal cord signs is confusing.

Chronic encapsulated intracerebral hematoma.

Intracerebral hematomas producing chronic neurological disability are reported rarely. Two cases of chronic intracerebral hematoma are described. Each case was associated with a thick, fibrous capsule found histologically to arise from an occult vascular malformation. When such encapsulation is discovered surgically, a vascular anomaly must be suspected.

Combined cavernous-arteriovenous malformation.

Cerebral angiomas consisting of two distinct types of malformations are rare. A case of combined arteriovenous and cavernous angioma is reported. For what is believed to be the first time, the cavernous portion of the angioma was clearly demonstrated by angiography and appeared similar to cavernous malformations occurring outside the central nervous system. This case emphasizes the continuous overlapping spectrum of cerebral vasculature anomalies.