Aggressive vertebral hemangioma as a rare cause of myelopathy.

Vertebral hemangiomas (VHs) are common lesions in the adult population. They are usually asymptomatic and found incidentally on radiological imaging. New-onset back pain followed by subacute progression of thoracal myelopathy is the most common presentation in patients with neurological deficit. Differential diagnoses would include metastasis, multiple myeloma, lymphoma, Paget disease, osseous tumors such as Ewing sarcoma or hemangioblastoma and blood dyscrasia. We present a 41 year-old-male patient with thoracal VH causing myelopathy that completely improved after rehabilitation program with embolization and vertebroplasty procedures.

[Potential of combined physiobalneotherapy for the treatment of circulatory insufficiency in the vertebro-basiliar system].

The main causes of the development a nd subsequent chronization of circulatory insufficiency in the vertebro-basiliar system is the deficient blood flow in vertebral arteries (VA) resulting from extravasal effects of degenerative and dystrophic changes (DDC) in the cervical segment of the spinal column. The rehabilitative treatment of the patients presenting with these disorders including either radon or iodine-bromine baths in combination with low-frequency pulsed currents (LFPC) applied to the cervico-nuchal region was shown to produce a fairly good therapeutic effect. The proposed physiobalneological combination (radon baths + LFPC) proved more efficacious than treatment with iodine-bromine baths + LFPC for the patients with exacerbation of cervical dorsopathy. The latter combination gave better results when applied to the patients with circulatory insufficiency in the vertebro-basiliar system having the history of vegetovascular dystonia, craniocervical injury, and cervical dorsalgia.

Can patent foramen ovale affect rehabilitation? The uncommon association of platypnea-orthodeoxia syndrome and stroke.

Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea and deoxygenation induced by a change to a sitting or standing from a recumbent position. It is the result of posturally accentuated intracardiac or pulmonary right-to-left shunt leading to arterial oxygen desaturation. Only few cases of platypnea-orthodeoxia syndrome are reported in the literature and the association between stroke and platypnea-orthodeoxia syndrome with evidence of patent foramen ovale is extremely rare. We describe the case of a 67-year-old female admitted to our Rehabilitation Unit for disabling basilar stroke due to paradoxical embolism from patent foramen ovale that during the first days of rehabilitation showed signs and symptoms of platypnea-orthodeoxia syndrome. To remove a life-threatening condition for the patient and in order to develop the normal rehabilitation project, that was stopped by the platypnea-orthodeoxia syndrome, the patient fastly underwent to percutaneous closure of patent foramen ovale. The stabilization of oxygen arterial saturation with postural changes and the disappearance of symptoms of POS allowed to develop the rehabilitation project with progressive neurological improvement.

Manipulación cervical: aproximación anatómico-biomecánica frente a los posibles riesgos e implicaciones prácticas / Cervical manipulation: anatomical and biomechanical approach facing possible risks and practical implications

La manipulación articular es una técnica fisioterápica con cierto "estatus" dentro de nuestro arsenal terapéutico, fruto de la promesa de buenos resultados a muy corto plazo de tiempo, el halo de misticismo que la envuelve, el miedo desencadenado por reacciones adversas durante su aplicación y el tipo de impulso a desarrollar. Aunque la bibliografía especializada casi siempre evidencie un único tipo de manipulación, la rotatoria, la manipulación puede realizarse mediante movimientos translatorios de tracción o deslizamiento que ofrecen óptimos resultados en la ganancia de movimiento articular y minimizan el riesgo de sobreestresar las estructuras intraarticulares. Por lo tanto, un diagnóstico de hipomovilidad articular con una sensación terminal firme que indique la correcta aplicación de una manipulación translatoria evita desencadenar una reacción adversa a nuestro tratamiento. En la columna cervical, y en especial sobre la columna cervical superior, esta situación se magnifica, ya que las reacciones adversas pueden ser incluso fatales para el paciente. Conclusión. La eficacia y seguridad de la manipulación cervical depende de una apropiada indicación, un diagnóstico preciso, la elección adecuada del tipo de manipulación y su correcta aplicación

Joint manipulation is a physiotherapy technique with certain "status" inside our therapeutical tools due to the promise of good results in a very brief period of time, the halo of mysticism that surrounds it, the fear produced by side effects during its application and the type of impulse to be developed. Although literature almost always refers to only one kind of manipulation, the rotatoric one, manipulation can be made through translatoric movements of traction and gliding that offer optimal results in increasing joint movement and minimize the risk of excessive stress on the intraarticular structures. Therefore, a diagnosis of joint hypomobility with a firm end feel suitable for the indication of a correct application of translatoric manipulation avoids eliciting an adverse reaction to our treatment. In the cervical spine and specially in the upper cervical spine, this situation is magnified because adverse reactions in this region could be fatal for the patient. Conclusion. The effectiveness and security of cervical manipulation depends on an appropriate indication, a precise diagnosis, and adequate election of the type of manipulation and its correct application

Driving after cerebral ischemia--a driving simulator investigation.

UNLABELLED: Stroke patients with relevant deficits are not allowed to drive. This study tended to assess driving abilities in an early stage after cerebral ischemia with a driving simulator. METHODS: 32 patients (aged 54.9 +/- 14.8 years) with acute ischemia in the middle cerebral artery (MCA) (n = 24) and in the vertebral artery (VA) (n = 8) were investigated with reaction tests and a driving simulator. Controls were 12 healthy volunteers (aged 50.0 +/- 13.9 years). RESULTS: Compared to controls, the accident rate was increased only in patients with MCA-ischemia (2.9 +/- 3.6 vs. 1.3 +/- 1.4, p < 0.05). These patients also had poorer results in the driving simulator (p < 0.05) than patients with VA-ischemia. Driving simulator performance and neuropsychological test results did not correlate. CONCLUSION: All patients had only mild deficits and stated themselves able to drive. We could demonstrate the need to focus on driving skills especially in patients with MCA-infarctions. The driving simulator assesses various physical and neuropsychological functions influencing driving. It may especially be used for expert opinions regarding driving licence. It can also serve as a pre-driver evaluation before on road driving tests.

[Clinico-neurological and stabilometric analysis of betahistine (betaserc) efficacy in the patients with vertigo in the rehabilitation period of ischemic stroke].

A study of betahistine (betaserc) in 65 patients aged 59,48 +/- 8,63 years with vertigo in early rehabilitation period of ischemic stroke has been carried out. Thirty-five patients got atiplatelet and antihypertensive therapy and were also treated by betaserc--8-16 mg 3 times per day for 14 days per os, after meals. The control group of 30 patients received only atiplatelet and antihypertensive therapy. Both groups were similar in demographic and clinical characteristics. The treatment with betahistine reduced the intensity and duration of vertigo, led to improvement of coordination and equilibrium, increase stability of a vertical posture that was accompanied by significant (p<0,05) improvement of the values on the Hoffenberth and Bohannon scales. Betahistine treatment also resulted in marked authentic (p<0,05) improvement of stabilometric parameters in biological feedback task that might be explained by activation of the mechanisms maintaining vertical balance. An improvement of clinical and neurophysiologic traits was more pronounced in the group treated with betaserc as compared to the control group.

[EHF-puncture in combined rehabilitation of children with vertebrobasilar insufficiency syndrome in spinal deformities]. / KVCh-punktura v kompleksnoi reabilitatsii detei s syndromom vertebrobaziliarnoi nedostatochnosti pri deformatsiiakh pozvonochnika.

The results were compared of different programs of rehabilitation in 45 patients aged 5 to 18 years with spinal deformities and vertebrobasilar failure. Control patients received only basic therapy, the study group received also EHF-puncture. The efficacy of rehabilitation was confirmed by electropuncture diagnosis and rheoencephalogram. The patients with high tonicity of small vessels demonstrated a significantly improved regional circulation. This favours differential use of EHF puncture in the complex of rehabilitative measures.

Visuo-vestibular biofeedback in patients with peripheral vestibular disorders.

It is well known that diseases of the vestibular system can be compensated by increased spontaneous activity of other systems engaged in maintaining equilibrium, i.e. proprioceptive and visual systems. A complex approach using multisensory stimulation is the optimal way to achieve vestibular compensation. The aim of our study was to determine the effect of vestibular rehabilitation therapy as measured by posturography in a group of 72 patients suffering from vestibular disorders: Ménière's disease (n = 31), neuritis vestibularis (n = 21) and vertebrobasilar insufficiency (n = 20). Patients underwent the following examinations: electronystagmography; caloric, rotatory and optokinetic tests; computed posturography; craniocorpography; pure-tone audiometry; speech audiometry; and tinnitometry (tinnitus loudness, pitch). The instability in patients with Ménière's disease decreased 3 weeks after starting the therapy; nevertheless, the decrease in area (the surface formed by the movement of the patient's equilibrium point during a defined time) was transitory because of the increase in area values obtained between the 3rd and 6th weeks when measured with closed eyes. In the vestibular neuronitis patients, the measured values of area and the velocity of the patient's movement decreased continuously. The values measured in the patients suffering from vertebrobasilar insufficiency decreased continuously, the absolute values remaining pathological.

[The characteristics of the effect of point and classical massage on the hemodynamics of patients with a history of transient ischemic attacks in the vertebrobasilar system]. / Osobennosti vliianiia tochechnogo i klassicheskogo massazha na gemodinamiku bol'nykh, perenesshikh tranzitornye ishemicheskie ataki v vertebrobaziliarnom basseine.

Clinical and instrumental studies have revealed differences in effects of nerve ending and classic massage on hemodynamics in 41 patients early after transitory ischemic attacks in the vertebrobasilar area. Point massage produced more potent vasotropic effect, contraindications to it are minimal. It can be considered as a pathogenetic therapy aimed at correction of cerebral circulation in patients with vertebrobasilar area applicable early after acute cerebrovascular episodes.

"Dolichoectatic" intracranial vertebrobasilar dissecting aneurysm.

We report five patients with intracranial vertebrobasilar dissecting aneurysms, all of whom had ischemic symptoms. Angiographically, four of the five cases revealed distention and elongation of the vertebrobasilar artery like dolichoectasia and one irregular stenosis, the so-called "string sign". Magnetic resonance imaging disclosed all dolichoectatic dissecting lesions by demonstrating intimal flaps, double lumen, or subacute clot in the false lumen. We also present a successful demonstration of slow flow in the false lumen by gradient refocused magnetic resonance imaging scan with partial flip angle by the cardiac gating method. It is suggested that many of the classical "dolichoectasia" may include dissecting lesions.

Magnetic resonance imaging for vertebral-basilar system infarction.

The rehabilitative course for patients who have suffered vertebral-basilar vascular lesions is often interrupted by intermittent episodes of increasing dizziness, nausea, vomiting, and ataxia. Since CT studies of the brain do not always visualize these lesions reliably, the rehabilitation specialist has been without a diagnostic tool to distinguish between progressive and stable vertebral-basilar system infarctions. Magnetic resonance imaging (MRI) offers a safe, noninvasive, sensitive means of monitoring vascular lesions in the posterior fossa. The purpose of this study was to use MRI to evaluate patients with suspected vertebral-basilar vascular lesions. In three patients studied, MRI was superior to CT scan. Advantages of MRI included lack of artifact due to bone scattering from ionizing radiation, ability to image directly in the sagittal plane, visualization and localization of pathologically smaller lesions, and potential for performing serial studies without exposing patients to large doses of radiation. In each case, MRI data yielded valuable adjunctive information that aided further rehabilitation evaluation and management. We conclude that MRI may be a useful diagnostic and prognostic tool in evaluating and managing rehabilitation patients with vascular lesions involving the vertebral-basilar system.

[Various indices of mental deficiencies in patients with chronic circulatory disorders in the vertebrobasilar system]. / Nekotorye pokazateli psikhicheskoi nedostatochnosti u bol'nykh s khronicheskimi narusheniiami krovoobrashcheniia v vertebrobaziliarnoi sisteme.

Using clinical procedures and psychological tests, the authors studied intellectual and emotional characteristics in 75 patients with nonpsychotic forms of psychic pathology caused by chronic circulatory insufficiency in the vertebro-basilar system. Psychic disorders in such patients included asthenic, astheno-depressive and neurasthenic symptom-complexes. Their intellectual abilities were somewhat decreased and psychic activity was lowered. However, poor self-esteem and a low level of ambitions observed in such patients resulted in subjective underestimation of their intellectual potential which should be taken into account while determining the degree of their working ability and elaborating therapeutic and socio-readaptation measures.