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  • ISSN: 2373-9479
    Volume 4, Issue 3
    Case Series
    Hyun-Kyoon Lim*, William B. McKay, Walter H. Wade, and Arthur M. Sherwood
    An acute patient with the complete spinal cord injury (SCI) experiences urinary tract infection and enterocystoplasty. We attempted to determine the feasibility of assessment of subclinical motor control ability using multichannel surface EMG. A serial quantitative observation of motor control was recorded from a complete spinal cord injury patient: beginning 52 days post T10 SCI and continuing to 298 days. He experienced one urinary tract infection (67th day post injury) and enterocystoplasty (194th day post injury). EMG data of Tendon tap increased from 57 μV (52nd day post injury) and showed peak value 1,827 μV (67th day post injury). Ankle clonus increased to 2.6 seconds post the infection. sEMG increases were strongly associated with a urinary tract infection. These results suggest that electrophysiological information could be the useful evaluation method with the satisfactory resolution in monitoring treatment based on medication amount in the acute phase of SCI.
    Review Article
    Massimo Miscusi*, Lucia Merlo, Alfredo Conti, Giorgio Scivoletto, Alessandro Ramieri, Giorgio Ippolito, Filippo Maria Polli, Giuseppe Costanzo, and Antonino Raco
    European scientists gave a fundamental contribution to a better understanding of the pathophysiology of spinal cord injury (SCI), and consequently defined the best-suited treatment for this disease. The historical course of the management of SCI during the last two centuries goes through intuitive open-minded practicioners, physicians, neurologists, orthopedics, and neurosurgeons, which lived and operated on in the European countries. Starting from a purely conservative approach, advocated since the dawning of civilization, they deepened their anatomical knowledge overcoming the initial therapeutic nihilism and improving the dismal prognosis ascribed to damage to the spinal cord. Their achievements have driven to the actual managing protocols for the victims of this disabling disease.
    Schadler Paul, Shue Jennifer, and Girardi FP*
    Introduction: Traumatic central cord syndrome is the most common clinical syndrome encountered in the setting of incomplete spinal cord injury and is vaguely defined as by disproportionately more impairment in the upper than the lower extremities.
    Methods: A MEDLINE database search was conducted to review the epidemiology, treatment and prognostic factors of this clinical entity.
    Results and Discussion: Central cord syndrome typically occurs in white, middle-aged men. Symptoms can be mild to severe, ranging from burning of hands and feet to disproportionate weakness of the upper extremities, variable sensory loss and bladder or bowel dysfunction. The pathogenic mechanism can involve fractures, dislocation and disc herniation caused by hyperextension or flexion injuries of the cervical spine. The prognosis is benign in most cases and the majority of patients, particularly the young, have a high recovery rate. While there is a trend towards surgical intervention in the United States, the management of this syndrome remains controversial due to weak and conflicting evidence. Several prognostic factors have been described, including age and baseline neurologic function. Studies on blood tests and electrophysiological measurement show promising results in predicting a favorable outcome.
    Conclusion: There are currently no evidence-based guidelines for surgical treatment or the timing of intervention. Future research, conducted as prospective trials of large populations, may provide further insight into this vaguely defined entity.
    Case Report
    Andres Barriga-Martin*, Angel Garcia-Forcada, and Luis M. Romero-Munoz
    Neuropathic Charcot spinal arthropathy (CSA) is a rare and destructive process that develops in the absence of deep sensation and that affects the intervertebral discs and adjacent vertebral bodies. Initially and for many cases, with a long time asymptomatic evolution, diagnosis is usually made at an advance stage of bone destroying lesions with spine dislocation. The differential diagnosis of CSA includes infection (bacterial, fungal and tuberculosis) tumor, aseptic spondylodiscitis in spondyloartropathies and Paget disease. Disc puncture can be done to obtain cultures and reject disc space infection. In our opinion, surgical treatment for spine stabilization by circumferential fusion is indicated in patients with instability or failure of conservative treatment that could be probed in non-aggressive cases. We describe a quickly progressive case of CSA in a non-traumatic SCI patient and make a review of literature.
    Gregory J. Imbarrato, Bernd W. Scheithauer, Jason K. Waddell and Emilio M. Nardone*
    Perineuriomas are rare tumors arising in either a soft tissue or an intraneural form. We report the first case of intracranial dural-based perineurioma. Following histological confirmation of diagnosis, a rigorous literature review was undertaken for intracranial dural-based perineuriomas. Finding no previous such reports a case review and literature review of perineuriomas as a whole, and specifically intracranial perineuriomas, was undertaken. Mimicking a meningioma, a large left frontal dural-based tumor occurred in a 63-year-old woman experiencing personality change. The diagnosis on this gross totally resected tumor was based on its histologic features (spindle cells with long narrow processes), the finding of EMA, GLUT-1, and claudin-1 immunoreactivity, and the ultrastructural presence of surface micropinocytotic vesicles, partial basal lamina, and of simple intercellular junctions. Soft tissue perineurioma is rarely encountered in the intracranial space. Radiographically, the present tumor mimicked a meningioma with its well defined extra-axial location. The gross totally resected tumor was examined histologically, as well as by immunocytochemistry and electron microscopy.
    Review Article
    Oliver C. Sax, Stephan Salzmann, Jennifer Shue, and Federico P. Girardi*
    Thoracic myelopathy is defined as a dysfunction of the spinal cord secondary, but not limited to, fracture, compression, and ischemic changes. Several studies have reviewed patients with thoracic myelopathy but incidence rates are unclear due to low sample size and improper diagnosis. Idiopathic thoracic spinal cord herniation (ISCH) and ossification of the ligamentumflavum (OLF) is reported to be more prevalent among the middle-aged and females, however males predominated in larger reviews of patients with thoracic spinal stenosis (TSS) and surgical treatment of OLF secondary to thoracic myelopathy. Common causes of thoracic myelopathy include ossification of the ligamentumflavum, posterior spur, and disc herniation. Possible etiologies for acute worsening of the spinal cord include iatrogenic cord insult, transient ischemia, reperfusion of neural tissue, microthrombi of spinal arterial supply, neuropraxia, and sudden decrease in blood pressure. Congenital kyphosis has also been implicated as a cause of thoracic myelopathy. Treatment varies widely from non-operative conservative measures to prompt surgical treatment with decompression via laminectomy, fenestration, and herniotomy. Treatment depends on the degree of mechanical stress leading to degenerative changes of the facet joints and thoracolumbar intervertebral discs. There is a paucity of literature on thoracic myelopathy secondary to acute worsening of the spinal cord and further clinical research is warranted to accurately diagnose and treat patients.
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