The neurological examination, developed and tested since the 1800s has provided physicians with a vital tool to rapidly assess and provide clues to many of the pathological processes lurking inside the brain and spina...The neurological examination, developed and tested since the 1800s has provided physicians with a vital tool to rapidly assess and provide clues to many of the pathological processes lurking inside the brain and spinal cord. With the advent of magnetic resonance imaging, physicians are able to visualize the precise location of the abscess before surgical intervention. In this case report, we present a 51-year-old male with an epidural abscess with multifocal compressive myelopathy, resulting in a complicated neurological examination, making localization a diagnostic challenge. With this case, we would like to stress that complicated multifocal lesions of the cord may present with a large variation in examination findings. This patient’s neurological exam was complicated secondary to a ventrally as well as dorsally located epidural abscess with superimposed spinal shock sequelae. We would like to highlight the importance of a thorough history and the neurological examination but also mention some of its limitations. It is crucial to use clinical judgement to navigate the patient’s history, presentation, and examination to accurately diagnose and treat, particularly so in cases involving compressive myelopathies of the spinal cord.展开更多
Precise assessment of spinal cord cystic lesions is crucial to formulate effective therapeutic strategies,yet histological assessment of the lesion remains the primary method despite numerous studies showing inconsist...Precise assessment of spinal cord cystic lesions is crucial to formulate effective therapeutic strategies,yet histological assessment of the lesion remains the primary method despite numerous studies showing inconsistent results regarding estimation of lesion size via histology.On the other hand,despite numerous advances in micro-computed tomography(micro-CT)imaging and analysis that have allowed precise measurements of lesion size,there is not enough published data on its application to estimate intraspinal lesion size in laboratory animal models.This work attempts to show that micro-CT can be valuable for spinal cord injury research by demonstrating accurate estimation of syrinx size and compares between micro-CT and traditional histological analysis.We used a post-traumatic syringomyelia rat model to compare micro-CT analysis to conventional histological analysis.The study showed that micro-CT can detect lesions within the spinal cord very similar to histology.Importantly,micro-CT appears to provide more accurate estimates of the lesions with more measures(e.g.,surface area),can detect compounds within the cord,and can be done with the tissue of interest(spinal cord)intact.In summary,the experimental work presented here provides one of the first investigations of the use of micro-CT for estimating the size of intraparenchymal cysts and detecting materials within the spinal cord.All animal procedures were approved by the University of Akron Institutional Animal Care and Use Committee(IACUC)(protocol#LRE 16-05-09 approved on May 14,2016).展开更多
Background Anorectal malformation(ARM)have a high association with spinal cord anomaly(SCA)impacting bladder and bowel function.This study aims to report the diagnostic accuracy of ultrasound(US)and MRI to detect SCA ...Background Anorectal malformation(ARM)have a high association with spinal cord anomaly(SCA)impacting bladder and bowel function.This study aims to report the diagnostic accuracy of ultrasound(US)and MRI to detect SCA in children with ARM.Method A systematic review was performed as per PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)guidance.Search terms used were broadened in three consecutive searches to find papers investigating outcomes from spinal imaging in ARM,with four author search validation.Study quality was assessed as per Quadas 2 score.Meta-analysis comparing US diagnosis to MRI findings was performed using random effects model,including only clinically relevant SCA and considering children who did not develop negative outcomes as a true negative.Results Eight studies were included,six reporting US outcomes,and two MRI.All studies but one were retrospective studies.Overall,the included studies were applicable,but all suffered risk of bias with incomplete and non-protocolized follow-up.Pooled analysis for MRI compared with surgery found a sensitivity of 97%and a specificity of 94%,with one false positive and one false negative in an 8-month-old baby.When clinically relevant diagnoses were extracted and meta-analysis performed,a sensitivity of 33%and a specificity of 87%were found for infant US diagnosis of SCA.Conclusion The normal US spine in early infancy does not have diagnostic weight.A positive early scan will allow you to stream into active surveillance.Mandated MRI of infants will depend on the local approach to prophylactic de-tethering surgery.展开更多
Thirteen cases of intramedullary hemangioblastoma of the spinal cord were studied radiologically, especially with magnetic resonance imaging (MRI). Microsurgery was used to remove the tumors in all cases. Signs and sy...Thirteen cases of intramedullary hemangioblastoma of the spinal cord were studied radiologically, especially with magnetic resonance imaging (MRI). Microsurgery was used to remove the tumors in all cases. Signs and symptoms were improved in 84.6% of the cases after operation. The diagnosis and microsurgical techniques for excision of intramedullary hemangioblastoma of the spinal cord are discussed. This dis-ease should be differentiated from hydromyelia, intramedullary ependymoma, and vascular malformation of the spinal cord. Total removal of the tumor is recommened.展开更多
文摘The neurological examination, developed and tested since the 1800s has provided physicians with a vital tool to rapidly assess and provide clues to many of the pathological processes lurking inside the brain and spinal cord. With the advent of magnetic resonance imaging, physicians are able to visualize the precise location of the abscess before surgical intervention. In this case report, we present a 51-year-old male with an epidural abscess with multifocal compressive myelopathy, resulting in a complicated neurological examination, making localization a diagnostic challenge. With this case, we would like to stress that complicated multifocal lesions of the cord may present with a large variation in examination findings. This patient’s neurological exam was complicated secondary to a ventrally as well as dorsally located epidural abscess with superimposed spinal shock sequelae. We would like to highlight the importance of a thorough history and the neurological examination but also mention some of its limitations. It is crucial to use clinical judgement to navigate the patient’s history, presentation, and examination to accurately diagnose and treat, particularly so in cases involving compressive myelopathies of the spinal cord.
基金This study was financially supported by Conquer Chiari.
文摘Precise assessment of spinal cord cystic lesions is crucial to formulate effective therapeutic strategies,yet histological assessment of the lesion remains the primary method despite numerous studies showing inconsistent results regarding estimation of lesion size via histology.On the other hand,despite numerous advances in micro-computed tomography(micro-CT)imaging and analysis that have allowed precise measurements of lesion size,there is not enough published data on its application to estimate intraspinal lesion size in laboratory animal models.This work attempts to show that micro-CT can be valuable for spinal cord injury research by demonstrating accurate estimation of syrinx size and compares between micro-CT and traditional histological analysis.We used a post-traumatic syringomyelia rat model to compare micro-CT analysis to conventional histological analysis.The study showed that micro-CT can detect lesions within the spinal cord very similar to histology.Importantly,micro-CT appears to provide more accurate estimates of the lesions with more measures(e.g.,surface area),can detect compounds within the cord,and can be done with the tissue of interest(spinal cord)intact.In summary,the experimental work presented here provides one of the first investigations of the use of micro-CT for estimating the size of intraparenchymal cysts and detecting materials within the spinal cord.All animal procedures were approved by the University of Akron Institutional Animal Care and Use Committee(IACUC)(protocol#LRE 16-05-09 approved on May 14,2016).
文摘Background Anorectal malformation(ARM)have a high association with spinal cord anomaly(SCA)impacting bladder and bowel function.This study aims to report the diagnostic accuracy of ultrasound(US)and MRI to detect SCA in children with ARM.Method A systematic review was performed as per PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)guidance.Search terms used were broadened in three consecutive searches to find papers investigating outcomes from spinal imaging in ARM,with four author search validation.Study quality was assessed as per Quadas 2 score.Meta-analysis comparing US diagnosis to MRI findings was performed using random effects model,including only clinically relevant SCA and considering children who did not develop negative outcomes as a true negative.Results Eight studies were included,six reporting US outcomes,and two MRI.All studies but one were retrospective studies.Overall,the included studies were applicable,but all suffered risk of bias with incomplete and non-protocolized follow-up.Pooled analysis for MRI compared with surgery found a sensitivity of 97%and a specificity of 94%,with one false positive and one false negative in an 8-month-old baby.When clinically relevant diagnoses were extracted and meta-analysis performed,a sensitivity of 33%and a specificity of 87%were found for infant US diagnosis of SCA.Conclusion The normal US spine in early infancy does not have diagnostic weight.A positive early scan will allow you to stream into active surveillance.Mandated MRI of infants will depend on the local approach to prophylactic de-tethering surgery.
文摘Thirteen cases of intramedullary hemangioblastoma of the spinal cord were studied radiologically, especially with magnetic resonance imaging (MRI). Microsurgery was used to remove the tumors in all cases. Signs and symptoms were improved in 84.6% of the cases after operation. The diagnosis and microsurgical techniques for excision of intramedullary hemangioblastoma of the spinal cord are discussed. This dis-ease should be differentiated from hydromyelia, intramedullary ependymoma, and vascular malformation of the spinal cord. Total removal of the tumor is recommened.
