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Spinal cord injury as a result of Staphylococcus aureus pyogenic spinal infection complicating infected atopic eczema: two case reports. 感染性特应性湿疹并发金黄色葡萄球菌化脓性脊髓感染导致脊髓损伤:两例报告。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-08-14 DOI: 10.1038/s41394-023-00599-x
K MacKay, E J McCaughey, N Fullerton, M Purcell

Introduction: Pyogenic spinal infections (PSI) are a rare cause of spinal cord injury (SCI). These most often affect the lumbar spine, followed by the thoracic spine and least commonly the cervical spine, with Staphylococcus aureus being the most common causative organism. Atopic eczema is a dermatological condition which can lead to a breakdown of the skin's natural barrier function, allowing bacterial colonisation and infection. Haematological seeding of bacteria from a distant source of infection, including the skin and soft tissues, is a recognised aetiology of PSI.

Case presentation: We present two patients who sustained a SCI as a result of PSI secondary to infected atopic eczema. Methicillin-sensitive Staphylococcus aureus (MSSA) was identified as the causative organism in both patients. The two patients required prolonged courses of intravenous followed by oral antibiotics. Neurological outcomes varied between the two patients. One patient had incomplete tetraplegia (C3 AIS C), and upon discharge required hoisting from their bed to a power chair, had an indwelling urethral catheter and required bowel care. The other patient had incomplete paraplegia (L3 AIS D), and at discharge was independent with activities of daily living and was mobile with two elbow crutches.

Discussion: We believe that the two cases presented here represent the only examples of secondarily infected atopic eczema causing PSI and resultant SCI in the published literature. As SCI is a serious and potentially life-altering complication, medical professionals treating patients with atopic eczema should be aware of this risk.

导言:化脓性脊柱感染(PSI)是脊髓损伤(SCI)的罕见病因。最常见的感染部位是腰椎,其次是胸椎,最不常见的是颈椎,最常见的致病菌是金黄色葡萄球菌。特应性湿疹是一种皮肤病,可导致皮肤的天然屏障功能被破坏,从而导致细菌定植和感染。从远处感染源(包括皮肤和软组织)进行血液学细菌播种是 PSI 的公认病因:我们介绍了两名因特异性湿疹继发 PSI 而导致 SCI 的患者。两名患者的致病菌均为对甲氧西林敏感的金黄色葡萄球菌(MSSA)。这两名患者需要长期静脉注射抗生素,然后再口服抗生素。两名患者的神经系统结果各不相同。其中一名患者为不完全四肢瘫痪(C3 AIS C),出院时需要从床上抬到电动椅上,留置尿道导尿管,并需要肠道护理。另一名患者为不完全截瘫(L3 AIS D),出院时能独立进行日常生活活动,并能使用双肘拐杖移动:我们认为,这里介绍的两个病例是已发表文献中唯一一个二次感染特应性湿疹导致 PSI 并导致 SCI 的病例。由于 SCI 是一种严重且可能影响生命的并发症,因此治疗特应性湿疹患者的医务人员应了解这一风险。
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引用次数: 0
Bilateral phrenic nerve palsy after posterior cervical decompression and fusion surgery: a rare event after surgery. 颈椎后路减压融合手术后双侧膈神经麻痹:术后罕见病例。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-08-12 DOI: 10.1038/s41394-023-00595-1
Glenn A Gonzalez, Jingya Miao, Guilherme Porto, James Harrop

Introduction: Delayed C5 weakness is a known entity in cervical spine surgery, although with varied clinical presentation and poorly understood mechanism of action. We describe the first case in the literature of a bilateral C5 palsy leading to bilateral phrenic nerve dysfunction following a posterior cervical decompression and fusion.

Case report: A 76-year-old male presented with low back pain and was diagnosed as myelopathic. On initial neurological examination, he could not ambulate without assistance and was unsteady on tandem gait. The initial cervical MRI and CT scan showed advanced multilevel degenerative changes of the cervical spine with severe cord compression and myelomalacia. The patient underwent C3-C6 posterior cervical decompression & fusion (PCDF). He awoke with his baseline examination without neurophysiological monitoring changes intraoperatively or C5 root EMG activity. Post-operative MRI of the cervical spine was performed and showed an excellent decompression. The patient was neurologically stable and discharged to a rehabilitation facility. Patient developed a delayed bilateral C5P on postoperative day (POD) 74. Delayed bilateral C5P and phrenic nerve damage was determined to cause this patient's dyspnea. PM&R consult recommended placement of diaphragmatic pacers. However, clinically his respiratory function, as well as motor deficits, have gradually improved.

Conclusion: Bilateral diaphragmatic paralysis, a severe complication of cervical spine surgery, may cause respiratory distress and upper limb weakness. C5P, the underlying cause, may arise from various factors. Early detection and management of diaphragmatic weakness with physical therapy and pacers are crucial, emphasizing the need for vigilance by healthcare professionals and surgeons.

简介延迟性 C5 无力是颈椎手术中的一个已知病例,但其临床表现各不相同,作用机制也鲜为人知。我们描述了文献中第一例颈椎后路减压融合术后双侧 C5 麻痹导致双侧膈神经功能障碍的病例:一名 76 岁的男性因腰痛前来就诊,被诊断为脊髓病。在最初的神经系统检查中,他在没有人搀扶的情况下无法下地行走,双腿步态不稳。最初的颈椎 MRI 和 CT 扫描显示,颈椎出现晚期多层次退行性病变,伴有严重的脊髓压迫和髓鞘病变。患者接受了 C3-C6 颈椎后路减压融合术(PCDF)。他醒来后进行了基线检查,术中没有神经电生理监测变化,也没有 C5 根 EMG 活动。术后对颈椎进行了核磁共振检查,结果显示减压效果良好。患者神经功能稳定,已出院前往康复机构。患者在术后第 74 天(POD)出现延迟性双侧 C5P。延迟的双侧 C5P 和膈神经损伤被确定为导致该患者呼吸困难的原因。PM&R 顾问建议放置膈肌起搏器。然而,在临床上,他的呼吸功能和运动障碍已逐渐改善:结论:双侧膈肌麻痹是颈椎手术的严重并发症,可能导致呼吸困难和上肢无力。C5P是其根本原因,可能由多种因素引起。早期发现膈肌无力并通过物理疗法和起搏器进行治疗至关重要,这强调了医护人员和外科医生保持警惕的必要性。
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引用次数: 0
Comparison of two inspiratory muscle training protocols in people with spinal cord injury: a secondary analysis. 脊髓损伤患者两种吸气肌训练方案的比较:二次分析。
IF 1.2 Q4 CLINICAL NEUROLOGY Pub Date : 2023-08-12 DOI: 10.1038/s41394-023-00594-2
Anne E Palermo, Jane E Butler, Claire L Boswell-Ruys

Study design/setting: Secondary analysis.

Objectives: To compare the change in maximal inspiratory pressure (PImax) over the first 4 weeks of two different inspiratory muscle training (IMT) protocols and explore if either method is more effective for people with spinal cord injury.

Methods: Data originated from two published studies. Participants completed flow-resistive IMT (F-IMT) at 80% daily PImax, 7 days/week (supervised weekly), or threshold IMT (T-IMT) at 30-80% weekly PImax, twice-daily, 5 days/week (supervised every session). Seven participants from each trial were matched by training adherence, level of spinal cord injury, impairment grade (A-C), and height. Differences between F-IMT and T-IMT groups in training intensity, breaths taken, inspiratory work, and the change in the PImax from baseline at the end of week four were analysed.

Results: Over 4 weeks, there was no difference in the change in PImax between groups (Absolute change in PImax (cmH2O): p = 0.456, Percent change in PImax relative to baseline: p = 0.128). F-IMT participants trained at a higher intensity (median: 77 vs 22 cmH2O, p = 0.001 and 80% baseline vs 61% baseline, p = 0.038) but took fewer breaths (840 vs 1404 breaths, p = 0.017) than T-IMT participants. Inspiratory work was similar between groups (64,789 vs 65,910 (% PImax × number of breaths), p = 0.535).

Conclusions: Our findings support both methods of IMT as the change in PImax and inspiratory work were similar between groups. However, daily high-intensity F-IMT with intermittent supervision, required fewer breaths and less participant and therapist time. Future studies should examine optimal dosage and supervision required to achieve increased PImax.

研究设计/设置:二次分析。目的:比较两种不同的吸气肌训练(IMT)方案前4周最大吸气压力(PImax)的变化,并探讨哪种方法对脊髓损伤患者更有效。方法:数据来源于两项已发表的研究。参与者完成流动阻力IMT (F-IMT)在80%的每日PImax,每周7天(监督每周),或阈值IMT (T-IMT)在30-80%的每周PImax,每天两次,每周5天(监督每次)。每个试验的7名参与者按照训练依从性、脊髓损伤程度、损伤等级(A-C)和身高进行匹配。分析F-IMT组和T-IMT组在训练强度、呼吸量、吸气功以及第四周结束时基线的PImax变化方面的差异。结果:在4周内,两组间PImax的变化无差异(PImax的绝对变化(cmH2O): p = 0.456, PImax相对于基线的百分比变化:p = 0.128)。F-IMT参与者训练强度更高(中位数:77 cmH2O vs 22 cmH2O, p = 0.001, 80%基线vs 61%基线,p = 0.038),但比T-IMT参与者呼吸次数更少(840对1404次呼吸,p = 0.017)。两组之间的吸气功相似(64,789 vs 65,910 (% PImax ×呼吸次数),p = 0.535)。结论:我们的研究结果支持两种IMT方法,因为两组之间PImax和吸气功的变化相似。然而,每日高强度的间歇监督的F-IMT需要更少的呼吸和更少的参与者和治疗师的时间。未来的研究应检查最佳剂量和所需的监督,以达到增加PImax。
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引用次数: 0
Posterior cervical congenital dermal sinus tract: case report and review of literature. 颈后先天性真皮窦道:1例报告及文献复习。
IF 1.2 Q4 CLINICAL NEUROLOGY Pub Date : 2023-08-02 DOI: 10.1038/s41394-023-00575-5
Amir Vokshoor, Harseerat Jajj, Tiffany Grunwald, Steven Kolker, Jack Petros

Background and importance: Congenital dermal sinus tract (DST) is a rare spinal dysraphism characterized by a persistent tract lined by epithelial cells, beginning at the epidermis and terminating in deeper tissue layers. With 1% of all congenital DST cases found in the cervical region, only 4% of all cases are diagnosed after the age of 20.

Clinical presentation: In this case, a 65-year-old woman with a congenital DST at the cervical level presented with symptoms of neck and some arm pain, suboccipital headaches, and unique external characteristics. Neck Disability Index and visual analog scale were used to assess the patient's preoperative and postoperative pain, and quality of life. Patient underwent an operative intervention, where the DST was surgically removed followed by interlaminar decompression at C1-C2, excision of the epidural component, and biopsy followed by plastic surgical repair. Pathology analysis indicated a squamous epithelial-lined sinus tract interacting with the dura. Most notably, a meningothelial proliferation with associated psammomatous calcifications was identified, similar to a meningioma.

Conclusion: A review of literature was conducted to further discuss clinical and radiological presentation as well as to document the novel appearance of this congenital DST. As one of the oldest cases of DST, it demonstrated unusual pathological characteristics with a meningothelial proliferation, compatible with meningioma, reported at the epidural level.

背景和重要性:先天性真皮窦道(DST)是一种罕见的脊柱异常,其特征是由上皮细胞排列的持续性通道,始于表皮,终止于更深的组织层。1%的先天性DST病例发现于宫颈区域,只有4%的病例在20岁以后被诊断出来。临床表现:本例患者为65岁女性,颈段先天性DST,表现为颈部和部分手臂疼痛,枕下头痛,并有独特的外部特征。采用颈部残疾指数和视觉模拟量表评估患者术前、术后疼痛及生活质量。患者接受手术干预,其中手术切除DST,然后在C1-C2椎板间减压,切除硬膜外成分,活检后进行整形手术修复。病理分析显示鳞状上皮排列的窦道与硬脑膜相互作用。最值得注意的是,发现脑膜上皮增生并伴有沙质钙化,类似脑膜瘤。结论:回顾文献,进一步讨论临床和影像学表现,并记录这种先天性DST的新外观。作为最古老的DST病例之一,它表现出不同寻常的病理特征,在硬膜外水平报道了脑膜上皮增生,与脑膜瘤相容。
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引用次数: 0
The temporal burden of preparing catheters for re-use in adults with spinal cord injury: a cross-sectional study. 成人脊髓损伤患者准备重复使用导管的时间负担:一项横断面研究。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-08-01 DOI: 10.1038/s41394-023-00596-0
T Miller, L J Roik, T Kalimullina, S Samejima, C Shackleton, R N Malik, R Sachdeva, A V Krassioukov

Study design: Cross-sectional OBJECTIVES: Neurogenic lower urinary tract dysfunction is common among people with spinal cord injury (SCI). Although single-use clean intermittent catheterization is recommended to facilitate routine bladder emptying, catheter re-use is common. Barriers associated with the preparation (i.e., cleaning) of catheters for re-use are unknown. This study examined barriers to catheter re-use in adult individuals with SCI by assessing (1) the time needed to clean a catheter, and (2) the perceived difficulty of the catheter cleaning routine.

Setting: Laboratory METHODS: Twenty individuals with chronic SCI ( ≥ 1 year since injury; Group 1 = 10 with tetraplegia; Group 2 = 10 with paraplegia) completed the study. Using a standardized cleaning procedure (i.e., Milton method), catheter cleaning was timed for each participant. Perceived difficulty was assessed using a 5-point Likert scale. Functional impairment was assessed with the Upper Extremity Motor Score (UEMS).

Results: Significant between-group differences were observed for total cleaning time (Group 1 = 1584.1 ± 179.8 s; Group 2 = 1321.0 ± 93.8 s, p = 0.004) and perceived difficulty [Group 1 = 2.6 (2, 3); Group 2 = 2 (1.7, 2.3), p = 0.028]. Total cleaning time was significantly correlated with UEMS (ρ = -0.709, p ≤ 0.001) and perceived difficulty (ρ = 0.468, p = 0.037). UEMS emerged as an independent predictor of total cleaning time (R2 = 0.745, β = -0.833, p ≤ 0.001).

Conclusions: Preparing catheters for re-use is time-intensive and difficult for people with higher SCI level, severity and more pronounced upper limb motor impairment, which was independently associated with total cleaning time. Performing this routine on a consistent basis would require a substantial time commitment and would have a profoundly negative impact on overall quality of life.

研究设计:横断面 研究目的:神经源性下尿路功能障碍在脊髓损伤(SCI)患者中很常见。虽然建议使用一次性清洁间歇性导尿管来促进常规膀胱排空,但导尿管重复使用的情况很普遍。与导尿管重复使用的准备(即清洁)相关的障碍尚不清楚。本研究通过评估 (1) 清洁导尿管所需的时间,以及 (2) 对导尿管清洁工作难度的感知,对患有 SCI 的成人再次使用导尿管的障碍进行了研究:实验室 方法:20 名慢性 SCI 患者(受伤后≥ 1 年;第 1 组 = 10 名四肢瘫痪患者;第 2 组 = 10 名截瘫患者)完成了这项研究。采用标准化清洁程序(即米尔顿法),对每位参与者的导管清洁进行计时。采用 5 点李克特量表对感知难度进行评估。功能障碍用上肢运动评分(UEMS)进行评估:总清洁时间(第 1 组 = 1584.1 ± 179.8 秒;第 2 组 = 1321.0 ± 93.8 秒,p = 0.004)和感知难度[第 1 组 = 2.6 (2, 3);第 2 组 = 2 (1.7, 2.3),p = 0.028]在组间存在显著差异。总清洁时间与 UEMS(ρ = -0.709,p ≤ 0.001)和感知难度(ρ = 0.468,p = 0.037)明显相关。结论:UEMS 是总清洁时间的独立预测因子(R2 = 0.745,β = -0.833,p ≤ 0.001):对于 SCI 水平较高、严重程度较高、上肢运动障碍较明显的患者来说,准备导管以备再次使用既费时又费力,这与总清洁时间有独立关联。持续执行这一例行工作需要投入大量时间,并对整体生活质量产生深远的负面影响。
{"title":"The temporal burden of preparing catheters for re-use in adults with spinal cord injury: a cross-sectional study.","authors":"T Miller, L J Roik, T Kalimullina, S Samejima, C Shackleton, R N Malik, R Sachdeva, A V Krassioukov","doi":"10.1038/s41394-023-00596-0","DOIUrl":"10.1038/s41394-023-00596-0","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional OBJECTIVES: Neurogenic lower urinary tract dysfunction is common among people with spinal cord injury (SCI). Although single-use clean intermittent catheterization is recommended to facilitate routine bladder emptying, catheter re-use is common. Barriers associated with the preparation (i.e., cleaning) of catheters for re-use are unknown. This study examined barriers to catheter re-use in adult individuals with SCI by assessing (1) the time needed to clean a catheter, and (2) the perceived difficulty of the catheter cleaning routine.</p><p><strong>Setting: </strong>Laboratory METHODS: Twenty individuals with chronic SCI ( ≥ 1 year since injury; Group 1 = 10 with tetraplegia; Group 2 = 10 with paraplegia) completed the study. Using a standardized cleaning procedure (i.e., Milton method), catheter cleaning was timed for each participant. Perceived difficulty was assessed using a 5-point Likert scale. Functional impairment was assessed with the Upper Extremity Motor Score (UEMS).</p><p><strong>Results: </strong>Significant between-group differences were observed for total cleaning time (Group 1 = 1584.1 ± 179.8 s; Group 2 = 1321.0 ± 93.8 s, p = 0.004) and perceived difficulty [Group 1 = 2.6 (2, 3); Group 2 = 2 (1.7, 2.3), p = 0.028]. Total cleaning time was significantly correlated with UEMS (ρ = -0.709, p ≤ 0.001) and perceived difficulty (ρ = 0.468, p = 0.037). UEMS emerged as an independent predictor of total cleaning time (R<sup>2</sup> = 0.745, β = -0.833, p ≤ 0.001).</p><p><strong>Conclusions: </strong>Preparing catheters for re-use is time-intensive and difficult for people with higher SCI level, severity and more pronounced upper limb motor impairment, which was independently associated with total cleaning time. Performing this routine on a consistent basis would require a substantial time commitment and would have a profoundly negative impact on overall quality of life.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"9 1","pages":"39"},"PeriodicalIF":0.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10393987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10307013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Para-spinal abscess presenting with abdominal pain-a case report of 'red herring' symptoms. 伴有腹痛的脊柱旁脓肿--"红线 "症状的病例报告。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-31 DOI: 10.1038/s41394-023-00598-y
Mayya Vorona, James Livingstone, Farzan Dholoo

Introduction: Paraspinal abscesses are rare infections affecting the paraspinal muscles and soft tissues. An evolving abscess may pose a threat to the spinal cord via the compressive effect which can manifest as impaired motor or sensory function at the corresponding vertebral level. Paraspinal abscess is often a late diagnosis due to non-specific symptoms at presentation. This results in high morbidity and mortality.

Case presentation: We describe the case of a 59-year-old female with a paraspinal abscess presenting with epigastric pain who was initially worked up for a suspected intra-abdominal pathology, however computerised tomography of the chest, abdomen, and pelvis (CTCAP) revealed no abnormality. Later, rising inflammatory markers, accompanied by worsening cervicalgia, prompted a CT of the head, neck and thorax which revealed a soft tissue abscess compressing the thecal sac at cervical levels 1 to 3 (C1-3). This was successfully managed with radiologically guided drainage and long-term intravenous antibiotics. Our patient made a full recovery and a repeat MRI demonstrated resolution of the abscess.

Conclusion: We demonstrate that spinal abscess can present with a misleading combination of symptoms and highlight the importance of considering rarer differentials in the face of an evolving clinical picture. Our case also demonstrates that once the correct diagnosis is reached, patients can make an excellent recovery from uncomplicated spinal abscesses.

简介脊柱旁脓肿是一种影响脊柱旁肌肉和软组织的罕见感染。不断发展的脓肿可能通过压迫效应对脊髓构成威胁,表现为相应椎体水平的运动或感觉功能受损。由于出现非特异性症状,脊柱旁脓肿通常诊断较晚。这导致了高发病率和高死亡率:我们描述了一例 59 岁女性脊柱旁脓肿患者的病例,她因上腹疼痛而就诊,起初怀疑是腹腔内病变,但胸部、腹部和盆腔计算机断层扫描(CTCAP)未发现异常。后来,炎症标志物升高,并伴有颈痛加重,促使患者进行头颈部和胸部 CT 检查,结果发现颈椎 1-3 级(C1-3)处有软组织脓肿压迫椎囊。通过放射引导引流和长期静脉注射抗生素,脓肿得到了成功控制。患者完全康复,复查磁共振成像显示脓肿已消退:我们的病例表明,脊柱脓肿可表现为一系列令人误解的症状,并强调了在临床症状不断变化的情况下考虑罕见鉴别的重要性。我们的病例还表明,一旦诊断正确,无并发症的脊柱脓肿患者也能很好地康复。
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引用次数: 0
Spinal Rosai-Dorfman disease-a report of 2 cases and review of literature. 脊髓罗赛-多夫曼病--2 例病例报告和文献综述。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-29 DOI: 10.1038/s41394-023-00600-7
Saumyajit Basu, Rohan Gala, Kushal Gohil

Introduction: Rosai-Dorfman Disease (RDD) is a rare benign histiocytic disease that infrequently affects the spine. We report two cases of spinal RDD and review the relevant literature. This report addresses the various diagnostic dilemmas related to the evaluation of Spinal RDD and its treatment.

Case presentation: Case 1: A 32-year-old male presented with low back pain and left anterior thigh for last 8 months. On examination, there was sensory diminution on inner aspects of the thigh with an absent left knee jerk. CT/MRI scans revealed an extradural lesion at L2/3 with neural compression. PET scan showed several hypermetabolic lesions in ribs, humerus, femur, and vertebrae. He underwent en bloc excision of the extradural mass with L2-3 pedicle screw-rod fixation and was later managed with chemotherapy. Case 2: A 42-year-old male presented with spastic paraparesis with urinary incontinence for the last 4 weeks. On examination, he had a neurological level of T6. MRI scan revealed a lesion in posterior elements of T6-7 compressing the spinal cord. He underwent T6-7 laminectomy with decompression. In both cases, the diagnosis was confirmed by histopathology and further managed by Hemato-oncologist. They both did well at 1-year follow-up with improvement in neurology.

Discussion: Spinal RDD to date remains a large diagnostic dilemma with no pathognomonic clinical or radiological features; mimicking many osteolytic lesions in the spine. The diagnosis is purely histopathological and immunological. The lesion's complete surgical excision is the mainstay of treatment with a better prognosis and decreased chances of recurrences.

简介罗赛-多夫曼病(RDD)是一种罕见的良性组织细胞疾病,很少累及脊柱。我们报告了两例脊柱 RDD 病例,并回顾了相关文献。本报告探讨了与脊柱 RDD 评估和治疗相关的各种诊断难题:病例 1:一名 32 岁男性,因腰痛和左大腿前侧疼痛就诊 8 个月。经检查,大腿内侧感觉减退,左膝抽搐消失。CT/MRI 扫描显示 L2/3 硬膜外病变,神经受压。正电子发射计算机断层扫描显示,肋骨、肱骨、股骨和椎骨有多处高代谢病变。他接受了硬膜外肿块全切术,并用椎弓根螺钉固定 L2-3,随后接受了化疗。病例 2:一名 42 岁的男性患者,因痉挛性截瘫伴尿失禁就诊 4 周。经检查,他的神经水平为 T6。核磁共振扫描显示,T6-7 后部有病变,压迫脊髓。他接受了 T6-7 椎板切除减压术。两个病例均经组织病理学确诊,并由血液肿瘤专家进一步处理。随访1年后,两人的神经功能均有所改善:讨论:迄今为止,脊柱 RDD 仍是一个巨大的诊断难题,它没有任何临床或放射学特征,与脊柱中的许多溶骨性病变相似。诊断完全依靠组织病理学和免疫学。病变完全手术切除是治疗的主要方法,预后较好,复发几率较低。
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引用次数: 0
Intermittent colonic exoperistalsis for chronic constipation in spinal cord-injured individuals. A long-term structured patient feedback survey to evaluate home care use. 间歇性结肠外蠕动治疗脊髓损伤患者的慢性便秘。一项评估家庭护理使用的长期结构化患者反馈调查。
IF 1.2 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-29 DOI: 10.1038/s41394-023-00597-z
Jana Bremer, Jörn Bremer, Maike König, Peter Koßmehl, Ines Kurze, Jeannette Obereisenbuchner, Elisabeth Weinschenk, Immaculada Herrero-Fresneda

Study design: Structured patient feedback survey evaluating real-world home care use.

Objectives: To assess the long-term effectiveness, tolerability, and satisfaction with the intermittent colonic exoperistalsis (ICE) treatment device MOWOOT in spinal cord-injured (SCI) individuals with chronic constipation.

Setting: Four specialized German hospitals.

Methods: SCI individuals with chronic constipation were invited to use MOWOOT 10-20 min daily and answer a questionnaire about their bowel situation before treatment (feedback 1, F1) and after ≥10 months of use (feedback 2, F2). Collected variables were device use, bowel function effectiveness, chronic constipation symptoms, concomitant use of laxatives and evacuation aids, and satisfaction with bowel function and management, which were compared between time points. At F2, participants reported efficacy, tolerability/side effects, and ease of use.

Results: Eleven participants used the device for a mean (SD) of 13.27 (4.03) months. From F1 to F2, mean time per evacuation decreased by 24.5 min (p = 0.0076) and the number of failed attempts to evacuate/week, by 1.05 (p = 0.0354) with a tendency toward increased bowel movements and softer stool consistency, and decreased incomplete bowel movements. Participants experienced decreased difficulty/strain (p = 0.0055), abdominal pain (p = 0.0230), bloating (p = 0.0010), abdominal cramps (p = 0.0019), and spasms (p = 0.0198), without significant changes in the use of laxatives and evacuation aids. Satisfaction with bowel function and management improved (p = 0.0095) and more participants reported being very satisfied/satisfied (p = 0.0300). Most reported tolerability, efficacy, and ease of use as very good/good.

Conclusion: Long-term in-home ICE treatment improved bowel function and chronic constipation symptoms in SCI individuals, providing clinical benefits to this population.

Sponsorship (mowoot devices lending): 4 M Medical GmbH, Norderstedt, Germany.

研究设计:结构化的患者反馈调查,评估真实世界的家庭护理使用情况。目的:评价间歇性结肠外肠(ICE)治疗装置MOWOOT对脊髓损伤(SCI)慢性便秘患者的长期疗效、耐受性和满意度。环境:四家德国专科医院。方法:邀请慢性便秘的SCI患者每天使用MOWOOT 10-20分钟,并回答治疗前(反馈1,F1)和使用≥10个月后(反馈2,F2)的肠道情况问卷。收集的变量包括器械使用情况、肠功能有效性、慢性便秘症状、同时使用泻药和排便辅助剂、肠功能和管理满意度,并在不同时间点之间进行比较。在F2时,参与者报告了疗效、耐受性/副作用和易用性。结果:11名参与者使用该设备的平均(SD)为13.27(4.03)个月。从F1到F2,平均每次排便时间减少了24.5分钟(p = 0.0076),排便失败次数减少了1.05 (p = 0.0354),排便增加,大便粘稠度变软,排便不完全减少。参与者经历了困难/紧张(p = 0.0055)、腹痛(p = 0.0230)、腹胀(p = 0.0010)、腹部痉挛(p = 0.0019)和痉挛(p = 0.0198)的降低,在使用泻药和排泄辅助剂方面没有显著变化。对肠道功能和管理的满意度提高(p = 0.0095),更多的参与者报告非常满意/满意(p = 0.0300)。大多数报告的耐受性,疗效和易用性为非常好/好。结论:长期在家ICE治疗可改善脊髓损伤患者的肠功能和慢性便秘症状,为该人群提供临床益处。赞助(mowoot设备出借):4 M Medical GmbH, Norderstedt, Germany。
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引用次数: 0
A curious cervical spine case: multiple, primary CNS leiomyosarcomas presenting with rapid growth in the immunocompromised patient. 一个奇特的颈椎病例:免疫力低下患者中出现的快速生长的多发性原发性中枢神经系统白肌瘤。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-28 DOI: 10.1038/s41394-023-00588-0
Aleka Scoco, Kainaat Javed, Reza Yassari

Introduction: Primary CNS leiomyosarcomas are rare, dural-based intracranial or intravertebral tumors seen in immunocompromised patients and are associated with latent EBV infection. They may mimic a meningioma or schwannoma on imaging but their clinical presentation progresses much more rapidly. Often times, these tumors are hard to distinguish from secondary, metastatic leiomyosarcoma.

Case presentation: A 30-year-old female with congenital HIV presented to clinic with shoulder pain, paresthesias of the right upper extremity and gait instability. She was noted to have a contrast enhancing dural-based spinal canal lesion measuring 1.5 cm at the C1 vertebral level on MRI. Surgery was proposed but patient deferred. She represented to our Emergency Department 1 month later with right-sided hemiparesis and difficulty with ambulation. On repeat MRI, the lesion had grown to 2.6 cm. She was taken to the OR emergently for gross total tumor resection. The histopathology demonstrated a primary CNS leiomyosarcoma. MRI scan of the brain revealed an extra-axial right frontal lobe lesion measuring 1.8 cm which was also treated with subtotal surgical resection followed by proton beam radiotherapy.

Discussion: Primary CNS leiomyosarcomas should be considered in young immunocompromised patients presenting with dural-based spinal cord tumors. Histopathological studies including EBV testing can definitively make the diagnosis. These tumors have an aggressive nature and need to be treated with complete surgical resection to prevent severe neurological deterioration and adjuvant therapy to prevent recurrence.

导言:原发性中枢神经系统良性肉瘤是一种罕见的硬脑膜颅内或椎管内肿瘤,多见于免疫功能低下的患者,与潜伏的EB病毒感染有关。它们在影像学上可能与脑膜瘤或分裂瘤相似,但临床表现进展更快。很多时候,这些肿瘤很难与继发性、转移性骨髓瘤区分开来:一名患有先天性艾滋病的 30 岁女性患者因肩部疼痛、右上肢麻痹和步态不稳前来就诊。核磁共振检查发现,她的C1椎体位置有一个造影剂增强的硬脊膜椎管病变,大小为1.5厘米。医生建议进行手术治疗,但患者拒绝了。一个月后,她因右侧肢体偏瘫和行走困难到我院急诊科就诊。再次进行核磁共振检查时,病灶已增大到 2.6 厘米。她被紧急送往手术室进行肿瘤全切。组织病理学显示,这是一种原发性中枢神经系统良性肉瘤。脑部核磁共振成像扫描显示,右额叶轴外病变达1.8厘米,也进行了次全切手术,随后进行了质子束放疗:讨论:对于出现硬脊膜脊髓肿瘤的免疫功能低下的年轻患者,应考虑原发性中枢神经系统白肌瘤。组织病理学研究包括 EBV 检测可明确诊断。这些肿瘤具有侵袭性,需要进行彻底的手术切除治疗,以防止严重的神经功能衰退,并进行辅助治疗以防止复发。
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引用次数: 0
Clinical profile of COVID-19 infection among persons with spinal cord injury: a case series. 脊髓损伤患者感染 COVID-19 的临床概况:病例系列。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-18 DOI: 10.1038/s41394-023-00592-4
Chinzah Zonunsanga, Vanlal Hruaii, Joseph Chhakchhuak Vanlalsanga, Lalnuntluanga Sailo, Asem Rangita Chanu

Study design: Retrospective case series.

Objective: To report the clinical features and outcomes of spinal cord injury (SCI) patients with COVID-19 and to see if they are any different from COVID-19 in the general population.

Setting: A tertiary care hospital in North-East India.

Methods: Data of already diagnosed traumatic SCI patients with COVID-19 infection reporting to the COVID-19 management team (from June 2021 to November 2021) were collected. The source of data was hospital records (admitted patients) and home visits and teleconsultation logs (home isolation patients).

Results: There were eight traumatic SCI patients (five admitted, three in home isolation) with COVID-19 infection. Four patients had complete injury with American Spinal Injury Association Impairment Scale (AIS) Grade A, two with AIS Grade C, and one each of Grade B and D respectively. Five patients were cervical level injuries, and others were T10 level and below. Six patients were categorized as mild clinical illness and one each as moderate and severe illness. Cough was the most common symptom which was seen in seven patients. Only two patients needed oxygen therapy. All eight traumatic SCI patients recovered eventually from COVID-19 symptoms and regained their pre-COVID-19 functional status, 1 month after being free from COVID-19 symptoms.

Conclusion: The COVID-19 infection did not result in a worsening of functional ability among SCI people after 1-month post-recovery. It also did not affect the SCI patients in doing activities such as rehabilitation exercises at 6 months follow up.

研究设计回顾性病例系列:报告患有COVID-19的脊髓损伤(SCI)患者的临床特征和预后,并观察其与普通人群中的COVID-19是否存在差异:地点:印度东北部的一家三甲医院:收集向COVID-19管理小组报告的已确诊感染COVID-19的外伤性SCI患者的数据(2021年6月至2021年11月)。数据来源为医院记录(入院患者)和家访及远程会诊记录(家庭隔离患者):共有八名创伤性 SCI 患者(五名入院,三名在家隔离)感染了 COVID-19。四名患者为完全损伤,美国脊柱损伤协会损伤量表(AIS)为A级,两名为AIS C级,B级和D级各一名。五名患者为颈椎水平损伤,其他患者为 T10 及以下水平损伤。六名患者被归类为轻度临床疾病,中度和重度疾病各一名。咳嗽是最常见的症状,出现在 7 名患者身上。只有两名患者需要接受氧气治疗。所有 8 名创伤性 SCI 患者最终都从 COVID-19 症状中恢复过来,并在摆脱 COVID-19 症状 1 个月后恢复到 COVID-19 前的功能状态:结论:COVID-19 感染并没有导致 SCI 患者在康复 1 个月后功能恶化。结论:COVID-19 感染并未导致 SCI 患者在康复 1 个月后的功能能力恶化,也未影响 SCI 患者在 6 个月随访期间进行康复锻炼等活动。
{"title":"Clinical profile of COVID-19 infection among persons with spinal cord injury: a case series.","authors":"Chinzah Zonunsanga, Vanlal Hruaii, Joseph Chhakchhuak Vanlalsanga, Lalnuntluanga Sailo, Asem Rangita Chanu","doi":"10.1038/s41394-023-00592-4","DOIUrl":"10.1038/s41394-023-00592-4","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case series.</p><p><strong>Objective: </strong>To report the clinical features and outcomes of spinal cord injury (SCI) patients with COVID-19 and to see if they are any different from COVID-19 in the general population.</p><p><strong>Setting: </strong>A tertiary care hospital in North-East India.</p><p><strong>Methods: </strong>Data of already diagnosed traumatic SCI patients with COVID-19 infection reporting to the COVID-19 management team (from June 2021 to November 2021) were collected. The source of data was hospital records (admitted patients) and home visits and teleconsultation logs (home isolation patients).</p><p><strong>Results: </strong>There were eight traumatic SCI patients (five admitted, three in home isolation) with COVID-19 infection. Four patients had complete injury with American Spinal Injury Association Impairment Scale (AIS) Grade A, two with AIS Grade C, and one each of Grade B and D respectively. Five patients were cervical level injuries, and others were T10 level and below. Six patients were categorized as mild clinical illness and one each as moderate and severe illness. Cough was the most common symptom which was seen in seven patients. Only two patients needed oxygen therapy. All eight traumatic SCI patients recovered eventually from COVID-19 symptoms and regained their pre-COVID-19 functional status, 1 month after being free from COVID-19 symptoms.</p><p><strong>Conclusion: </strong>The COVID-19 infection did not result in a worsening of functional ability among SCI people after 1-month post-recovery. It also did not affect the SCI patients in doing activities such as rehabilitation exercises at 6 months follow up.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"9 1","pages":"34"},"PeriodicalIF":0.7,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10354026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Spinal Cord Series and Cases
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