Cochlear implantation of a patient with multiple sclerosis: case report and systematic review.

BACKGROUND: Cochlear implantation can be used when a patient's hearing cannot satisfactorily be improved after optimised hearing aid fitting. However, in patients with a cochlear nerve or brain disorder affecting hearing, the benefits of cochlear implants are not so straightforward. METHODS: This paper describes a 58-year-old patient suffering from multiple sclerosis and profound sensorineural hearing loss, rehabilitated with a cochlear implant. Literature concerning cochlear implantation in demyelinating conditions was systematically reviewed using PubMed/Medline and Web of Science databases. RESULTS: The patient's cochlear implantation was successful, with speech discrimination scores remaining above 90 per cent for eight years post-operatively. No previous cases of cochlear implantation with multiple sclerosis related hearing loss have been reported, despite the high incidence of hearing loss in multiple sclerosis patients. CONCLUSION: This paper demonstrates that multiple sclerosis lesions should not be an exclusion criterion in an otherwise suitable candidate for cochlear implantation.

Evaluation of flexion/extension of the upper cervical spine in patients with rheumatoid arthritis: an MRI study with a dedicated positioning device compared to conventional radiographs.

PURPOSE: Using flexion/extension magnetic resonance imaging (MRI) with a dedicated positioning device, our purpose was to analyze pathologic cranio-vertebral joint anatomy and motion in patients with rheumatoid arthritis in comparison to normal patients, and to compare flexion/extension MRI with conventional radiographs (CRs) in patients with rheumatoid arthritis. MATERIAL AND METHODS: The 31 patients with rheumatoid arthritis and 20 healthy subjects included in the study were imaged in an open MRI scanner during flexion/extension. A dedicated positioning device was used. Additionally, we compared flexion/extension MRI with CRs in patients with rheumatoid arthritis. In MRI, the orientation and segmental motion of C0, C1, and C2 were assessed and structure of the dens and amount of pannus tissue were observed. Configuration of the cerebrospinal fluid space and the cord was evaluated in each position. In both MRI and CRs, anterior atlanto-axial subluxation and vertical dislocation were assessed and sagittal diameter of the dural sac was measured. RESULTS: In the neutral position, C1 of the patients was oriented in a more flexed position in relation to both C0 and C2 compared to that in healthy subjects. The patients had more extension in the upper cervical spine than did healthy subjects. In flexion, atlantoaxial subluxation was greater in CRs than in MRI. In MRI, the amount of vertical dislocation did not depend on position. In the patients, there was considerably more cord impingement in flexion than in other positions. CONCLUSION: Evaluation of the rheumatoid cervical spine is optimized using MR images in the neutral, flexed, and extended positions. Measurements and relationships between structures should be compared in all positions. CRs with flexion-extension views are recommended as the first imaging method.

Kinematic magnetic resonance imaging of the upper cervical spine using a novel positioning device.

STUDY DESIGN: The development of a novel positioning device for magnetic resonance imaging of the upper cervical spine and an evaluation of motion patterns of the craniovertebral junction in asymptomatic volunteers as a part of the whole cervical spine motion. OBJECTIVES: To design and construct a positioning device that enables magnetic resonance imaging of the cervical spine in rotation, lateral bending, flexion, and extension in a horizontally open magnetic resonance scanner, and to define reference values for movements of the occiput (C0), the atlas (C1), and the axis (C2) in asymptomatic volunteers. SUMMARY OF BACKGROUND DATA: In previously used devices, the direction of motion is limited usually to flexion-extension, or the position of the head and neck are adjusted without a positioning device using semihard wedges or pillows. METHODS: Magnetic resonance imaging of the upper cervical spine in 20 asymptomatic individuals (10 men and 10 women) was performed in a horizontally open 0.23-T magnetic resonance imager in progressive steps during rotation, lateral bending, and flexion-extension using axial, coronal, and sagittal imaging planes, respectively. The positions of C0, C1, and C2 were measured, and pattern of motions between segments analyzed. Lateral displacement of the atlas during lateral bending and cranial migration distance during flexion-extension were assessed. RESULTS: The nonferromagnetic positioning device was designed and constructed. The motion patterns of the craniovertebral junction during rotation did not differ between the men and women, but in lateral bending there was a small difference between genders at C1-C2. In men, the position of C1 during flexion-extension was consistently more extended in relation to C0 and C2 than in women. CONCLUSIONS: The new positioning device allows magnetic resonance imaging of the upper cervical spine during flexion, extension, rotation, and lateral bending. To assess the relationship between C0-C1 and C1-C2 in flexion and extension, separate reference values for men and women are recommended.