A Single Dermatome Clinical Prediction Rule for Independent Walking 1 Year After Spinal Cord Injury.

OBJECTIVE: To derive and validate a simple, accurate CPR to predict future independent walking ability after SCI at the bedside that does not rely on motor scores and is predictive for those initially classified in the middle of the SCI severity spectrum. DESIGN: Retrospective cohort study. Binary variables were derived, indicating degrees of sensation to evaluate predictive value of pinprick and light touch variables across dermatomes. The optimal single sensory modality and dermatome was used to derive our CPR, which was validated on an independent dataset. SETTING: Analysis of SCI Model Systems dataset. PARTICIPANTS: Individuals with traumatic SCI. The data of 3679 participants (N=3679) were included with 623 participants comprising the derivation dataset and 3056 comprising the validation dataset. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported ability to walk both indoors and outdoors. RESULTS: Pinprick testing at S1 over lateral heels, within 31 days of SCI, accurately identified future independent walkers 1 year after SCI. Normal pinprick in both lateral heels provided good prognosis, any pinprick sensation in either lateral heel provided fair prognosis, and no sensation provided poor prognosis. This CPR performed satisfactorily in the middle SCI severity subgroup. CONCLUSIONS: In this large multi-site study, we derived and validated a simple, accurate CPR using only pinprick sensory testing at lateral heels that predicts future independent walking after SCI.

Intracranial malignant triton tumor in a patient with neurofibromatosis type 1: case report and review of the literature.

We report the fourth case of an intracranial malignant triton tumor not associated with a cranial nerve in a 26-year-old male with a clinical history of neurofibromatosis type 1. The patient was found unresponsive and displayed confusion, lethargy, hyperreflexia, and dysconjugate eye movements upon arrival at the emergency room. MRI revealed a large bifrontal mass. Biopsy demonstrated a high-grade spindle cell tumor with focal areas of rhabdomyoblasts that stained positive for desmin, myogenin, and muscle-specific actin. Electron microscopy showed skeletal muscle differentiation. Based on the clinical history of NF1 and the pathologic results, a diagnosis of malignant triton tumor was made. The differential diagnosis, immunohistochemistry, molecular genetics, and treatment of malignant triton tumor are reviewed.

Spinal cord compression from a foreign body reaction to spinal cord stimulation: a previously unreported complication.

STUDY DESIGN: Case study. OBJECTIVE: The study presents a complication that is thought to have never before been reported with this therapeutic intervention. Results from this report are discussed with intentions to inform the neurosurgery, spine and pain management community of an additional complication associated with spinal cord stimulation (SCS). SUMMARY OF BACKGROUND DATA: SCS is a common intervention used to treat refractory neuropathic pain. Complications from this procedure are uncommon, but they do occur. METHODS: A unique complication of SCS was identified and treated. A search of the entire PubMed/Medline database failed to find any similar such complication. RESULTS: An epidural mass which caused significant cervical stenosis and spinal cord compression at the site of a previous SCS electrode was identified. Decompressive laminectomies and resection of the mass were performed. The mass was characterized as fibrous tissue with foreign body giant cell reaction. CONCLUSION: This is a unique complication of SCS about which all professionals evaluating patients who have similar implanted devices, even if they have already been removed, should be made aware of.

Common chemical agent threats.

The events of September 11, 2001, highlight the fact that we live in precarious times. National and global awareness of the resolve and capabilities of terrorists has increased. The possibility that the civilian neurosurgeon may confront a scenario involving the use of chemical warfare agents has heightened. The information reported in this paper serves as a primer on the recognition, decontamination, and treatment of trauma patients exposed to chemical warfare agents.