Quadriplegia caused by cervical hyperextension injury and intramedullary spinal cord tumour: a case report of autopsy

STUDY OBJECTIVE: To determine whether an association exists between individual anesthesiologists and nonpatient care time in the operating room (OR). DESIGN: Retrospective chart review. SETTING: Cardiac surgery operating theatre in a University Hospital. PATIENTS: 312 elective coronary artery bypass procedures over 2 years. MEASUREMENTS AND MAIN RESULTS: The time interval between cases, as defined by the time between the first patient out and the second patient in, was compared. Six anesthesiologists, labelled 1 to 6, were involved in the 156 data points analyzed. The mean (+/- SD) time interval between cases, in minutes, for anesthesiologists 1 to 6 were, respectively: 24 +/- 9, 25 +/- 8, 27 +/- 8, 29 +/- 5, 30 +/- 4, 31 +/- 7. The difference among the anesthesiologists' mean time interval between cases was significant (p < 0.01). The mean time interval between cases was significantly different between anesthesiologists 1 and 6 (p < 0.01) and between anesthesiologists 2 and 6 (p < 0.05). CONCLUSION: The impact of a shorter time interval between cases on OR efficiency remains unknown. Further education and investigation of this issue are warranted.     

Acute spinal cord and head injury: case report and discussion of cardiac, respiratory and endocrine abnormalities

We report a male patient who after a fall suffered high cervical spinal cord and head (cerebral) injuries. These injuries led to spinal shock, marked sinus bradycardia and asystolic cardiac and respiratory arrests, recalcitrant central traumatic diabetes insipidus, and death within approximately seven weeks. Temporary transvenous cardiac pacing proved useful in the management of this patient.     

Gas in the spinal canal associated with injury of the cervical spinal cord: a diagnostic dilemma. A case report

This pilot study compared haloperidol, fluoxetine, and placebo for reduction of agitation in 15 outpatients with AD. The two drugs were no more effective than placebo at reducing agitation in these subjects; however, both drugs produced more toxicity than did placebo.     

Motor recovery following spinal cord injury associated with cervical spondylosis: a collaborative study

A prospective multicenter study was conducted within the National Model Spinal Cord Injury System program to examine neurological deficits and recovery patterns following spinal cord injury (SCI) in individuals with cervical spondylosis and without a spinal fracture. Nineteen patients were evaluated. Sixty-eight percent presented initially with motor incomplete lesions. Of those who presented with motor incomplete injuries at their initial examination, 69 percent had less deficit in the lower than in the upper extremities, indicative of a central cord syndrome. At follow-up, 12 subjects were unable to ambulate, four required assistance and three were able to ambulate independently. On the average, subjects doubled their initial Asia Motor Score (AMS) scores by one year following injury. Residual upper extremity weakness, however, limited the ability to ambulate. Recovery of motor strength in this group is comparable to that of individuals with incomplete tetraplegia in general but the proportion who regain ambulatory function is less.     

Quantitative assessment of respiratory function following contusion injury of the cervical spinal cord

A prerequisite for higher-level visual tasks such as object recognition is a segmentation of the image into distinct two-dimensional regions. While it has long been assumed that the human visual system jointly exploits region and boundary cues for image segmentation, we report the results of psychophysical experiments which suggest that the visual system relies on geometric properties of bounding contours such as closure and not on the texture of the two-dimensional regions they partition. These findings suggest that the visual system may code and links contours into coherent shapes before surface properties are conjoined.     

Hallerman-Streiff syndrome: case report and recommendations for dental care

Hallerman-Streiff syndrome is a rare congenital anomaly characterized by a peculiar bird facies, mandibular and maxillary hypoplasia, dyscephaly, cataracts, microphtalmia, hypotrichosis, skin atrophy, and short stature. Dental abnormalities are present in 80 percent of the cases and include malocclusion, crowding, severe caries, supernumerary and neonatal teeth, enamel hypoplasia, hypodontia, premature eruption of primary dentition, agenesis of permanent teeth, and anterior displacement or absence of condyles. Very few cases have been described in the dental literature. The predisposition to severe caries, together with other problems, makes it imperative that young patients be started in a strong prevention program as early as possible. This is a case report of a five-year-eleven-month-old white male who presented for a dental examination at The Children's Hospital in Denver, CO. The findings and recommendations for treatment are discussed.     

Hermansky-Pudlak syndrome: a case report and discussion

Hermansky-Pudlak syndrome is a rare, inherited, autosomal recessive disease. Diagnosis is based on a triad of signs: oculocutaneous albinism, a hemorrhagic tendency due to a platelet disorder, and an accumulation of lipopigments in different organs, particularly the medullary macrophages. We describe a child with the characteristic findings of this syndrome, which often goes unrecognized because of the discrete nature of the cutaneous and hemorrhagic manifestations. This diagnosis is important because of the risk not only of hemorrhage but also of granulomatous colitis and long-term pulmonary fibrosis.     

儿童伤害的类型、危险因素及预防措施

伤害属于一类疾病,国际疾病分类(ICD-10)已将其单独列为一类.凡因为能量(机械能、热能、化学能等)的传递或干扰超过人体的耐受性造成组织损伤,或窒息导致缺氧,影响正常活动,需要医治或看护,均称为伤害[1].伤害是全球各国面临的一个重要的公共卫生问题.     

The syndrome of acute central cervical spinal cord injury after gunshot lesion. Case report

The authors describe a unique case in which a bullet was lodged in the spinal canal at the C2-3 level. The patient exhibited clinically the syndrome of acute central cervical spinal cord injury. The pathogenesis is discussed with reference to three similar cases in the literature.     

Treatment of progressive cervical spinal instability secondary to hydatid disease. A case report

STUDY DESIGN: A case report of a patient with progressive cervical spinal instability secondary to hydatid disease and the operative therapy. OBJECTIVE: To document how the combination of contemporary imaging, medical, and operative methods has obviated severe neurologic sequelae in a patient's cervical spine ravaged by hydatidosis. SUMMARY OF BACKGROUND DATA: The incidence of hydatid disease in the vertebral column is unusual and rare in the cervical spine. Until recently, patients with spinal hydatid disease have had guarded prognoses, because the various medical and surgical therapies could not effect curative or even palliative results. METHODS: The use of contemporary imaging methods, including computed tomography and magnetic resonance imaging, is described, in conjunction with current anthelminthic therapy and operative spinal instrumentation in this patient with recurrent quadriparesis from progressive hydatid spinal erosion. RESULTS: With the operative and medical therapies described in this case report, the patient has had six successful operative results in 6 years for cervical spinal hydatidosis and remains neurologically normal, with a stable cervical spine. CONCLUSIONS: It is hoped that this case presentation will justify a spirit of guarded optimism in the patient whose spine has been rendered unstable by hydatid disease and that, though a cure is still not likely, at least the past inexorable prognosis of paralysis and death is ameliorated.     

Ivory osteoma of the cervical spine: case report

OBJECTIVE AND IMPORTANCE: We report a unique case of ivory osteoma of the cervical spine. CLINICAL PRESENTATION: The clinical presentation was one of polyradicular deficit without myelopathy after trauma. The imaging characteristics and histology of the lesion were those of a classic ivory osteoma. INTERVENTION: A complete surgical excision of the lesion was accomplished. CONCLUSION: We think we have recorded the only well-documented case of ivory osteoma affecting the spine.     

Intrathecal clonidine and baclofen in the management of spasticity and neuropathic pain following spinal cord injury: a case study

Spasticity and pain are common disabling sequelae following spinal cord injury (SCI) and are often difficult to manage. The two problems are also not infrequently related. A variety of pharmacological and other approaches have been described for management of these problems in SCI. This case study reports a 32-year-old woman with an established incomplete C5 tetraplegia (anterior cord syndrome) who developed severe, intractable anal spasm following a hemorrhoidectomy, which persisted despite very good healing. This prevented evacuation of her bowels and resulted in severe rectal pain and episodes of autonomic dysreflexia. Attempts to modify the rate and mode of delivery of intrathecal baclofen through an existing programmable infusion pump failed to reduce anal sphincter spasm or improve symptoms. A right-sided pudendal block with lignocaine provided some relief. Clonidine was added to baclofen in the pump reservoir and both drugs were administered intrathecally in combination. This resulted in an immediate improvement in anal sphincter spasm and pain relief, allowing rapid reestablishment of her normal bowel pattern without need for any supplemental analgesia. It appears that intrathecal clonidine may have an important role in the treatment of spasticity, either as a single or an adjuvant agent, when intrathecal baclofen alone is ineffective or there is increasing tolerance to baclofen. Intrathecal clonidine may also prove useful in the management of intractable neuropathic pain.     

Compression of the upper cervical spinal cord causing symptoms of brainstem compromise. A case report

STUDY DESIGN: A case is reported in which a flexion-induced compression of the upper cervical spinal cord caused symptoms of brainstem compromise in the absence of radiographic evidence of osseous instability. OBJECTIVES: A 41-year-old woman developed postoperative cervical instability with flexion-induced neurologic symptoms referable to the brainstem. The instability was caused by direct compression at the third cervical vertebral body, which in turn was caused by differential movements between the neuraxis and skeletal elements in the upper cervical spine. SUMMARY OF BACKGROUND DATA: Pathologic processes at the craniocervical junction may cause brainstem compromise with neurologic symptoms. The mechanism of brainstem involvement is usually either vertebrobasilar insufficiency or direct mechanical compression. In cases where the brainstem is compressed by skeletal elements, the compressing osseous structures usually are the walls of the foramen magnum or the odontoid process, or, less frequently, the atlas or axis vertebrae. Symptoms of brainstem dysfunction caused by dynamic compression at the level of the third cervical vertebra in the absence of hindbrain herniation are unusual and, to the best of the authors' knowledge, have not been described previously. METHODS: The patient underwent initial examination, evaluation, and periodic follow-up examination with magnetic resonance imaging from the time of her first visit until 26 months after the surgical treatment. The patient experienced postsurgical instability with dynamic compression by the C3 vertebral body, which caused brainstem compromise. Surgical treatment consisted of decompressive C3 corpectomy and fusion of C2 to C6, supplemented by anterior fixation. RESULTS: After undergoing surgical decompression of C3, reconstruction, and anterior internal fixation of C2 to C6, the patient had dramatic neurologic improvement. Diplopia, paresthesia, and nystagmus disappeared immediately after surgery. Swallowing difficulties, hoarseness, and vertigo improved gradually. At follow-up examination 26 months after surgery, the patient was asymptomatic. Magnetic resonance imaging showed good position of the construct, with no evidence of compression of the spinal cord or brainstem. CONCLUSIONS: Instability of the cervical spine may result in symptoms of brainstem dysfunction, even in the absence of hindbrain herniation. This instability is explained by the differential movement between the bony structures and neuraxis in the upper cervical region. Diagnosis and adequate management of this instability alleviates the neurologic symptoms and prevents possible hazardous complications.     

Coping and adaptation following acute spinal cord injury: a theoretical analysis

Coping and adaptation theory is used to synthesis existing data concerning psychological recovery from acute spinal cord injury. Psychological reactions to spinal cord trauma are similar to those of mourning and other situations of severe loss. Each reaction plays a specific role in fostering or hindering recovery depending upon when it occurs. Premorbid personality and the influence of significant others play a central role in coping with injury. These factors partly explain why some patients cope better than others to equally serious disability. A critique of research methodologies and suggestions for new studies are provided.