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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of acute aortic dissection (AAD) presenting as sudden, transient paraplegia and severe back pain is reported. The patient was a 66-year-old male with a 10-year-history of hypertension. The pain characteristically migrated from the back to the neck and then returned to the back. He showed complete transverse myelopathy at the level of the 9th thoracic cord. Computed tomography disclosed internal displacement of aortic intimal calcifications, without abnormalities in the spinal canal, and myelography showed no spinal canal block or stenosis. Electrocardiography and chest x-ray indicated nonspecific changes of high amplitudes and mild cardiomegaly, respectively. Together, these findings suggested acute aortic dissection with spinal cord ischemia. The initial systolic blood pressure of 220 mmHg was lowered with medication, and the pain was controlled with morphine. He recovered fully and was discharged 80 days after the onset of symptoms, with no neurological deficits. AAD carries a very poor prognosis unless treated immediately. Therefore, it is very important to promptly differentiate this disorder from spinal vascular conditions that also produce back pain and paraparesis.
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PMID:Transient paraplegia caused by acute aortic dissection--case report. 169 75

A 62-year-old male suddenly developed a severe paraparesis after epidural anaesthesia. He recovered gradually over the next few months. He had an acute relapse one year later and a selective spinal angiography showed a dural T8 arteriovenous fistula with large draining veins. Intravascular embolisation of the fistula produced immediate and sustained clinical improvement. The mechanism commonly held responsible for neurological disturbances in spinal dural arteriovenous fistulas is cord hypoxia secondary to venous hypertension. The 20-ml of local anaesthetic solution injected into a narrow spinal canal with osteophytosis may have caused further venous engorgement, cord hypoxia and acute neurological deficit.
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PMID:Spinal arteriovenous fistula. A possible cause of paraparesis after epidural anaesthesia. 258 7

Severe acute thallium poisoning in a young man is described. He presented with transient loss of consciousness and paraesthesiae of finger tips and lips, with a blood thallium concentration of 5750 micrograms/l (levels above 200 micrograms/l are toxic). He rapidly lost limb sensation and power and later required temporary mechanical ventilation and nasogastric feeding. The neurological sequelae one year afterwards are a flaccid paraparesis, cerebellar ataxia and mental impairment. Immediate cardiovascular complications included hypertension, sinus tachycardia, ECG abnormalities and an episode of ventricular fibrillation. We were able to assess the relative merits of different methods advocated for enhancing thallium excretion. Oral Prussian blue, forced diuresis and haemodialysis were found to be the most effective: 2000 mg of thallium were eliminated over 20 days, 820 mg over 46 days and 225 mg over 25 days respectively by these methods. Haemofiltration was ineffective. Diethyldithiocarbamate, a chelating agent, brought about a rise in serum thallium concentration accompanied by clinical deterioration and its use should be abandoned.
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PMID:Clinical features and therapy of acute thallium poisoning. 327 37

Aortic replacement for thoraco-abdominal aneurysms remains a major challenge in vascular surgery. Related symptoms, maximal diameter > 6 cm, progression, aneurysm sac containing none or excentric thrombi and uncontrollable hypertension are factors in favour of surgery, if the general condition of the patient allows the operation. Patients with aneurysms < 5 cm maximal diameter, tube-size aneurysms, heavy calcification of the aortic wall, concentric thrombi within the aneurysmal sac and significant cardiopulmonary risks should be treated conservatively. Patients in good general condition with aneurysms around 5 cm maximal diameter should be controlled by computed tomography in 6 to 12 months intervals and in the case of progression surgery can be recommended despite missing symptoms. Crawford developed the 'graft-inclusion-technique', which combines the 'ingraft'-technique with reattachment of renal, visceral and segmental arteries. The 'clamp and repair' principle is used in patients with sufficient cardiac function. Otherwise shunt or left sided heart bypass are used to reduce cardiac afterload. According to the literature local cooling (flush perfusion), cytoprotective drugs and numerous methods to maintain or ameliorate distal aortic perfusion during clamping ischemia have been used in patients successfully for prevention of ischemic spinal complications. In physiological settings these methods may prove valuable, but under pathophysiological conditions of TAAA-repair one must doubt the efficacy, because the individual risk is difficult to assess. In our hands flush perfusion and cooling of the kidneys proved to be helpful. In animal experiments we have shown prolongation of ischemia tolerance time using eicosanoides to protect the kidneys and the spinal cord. If shunt or left-sided heart bypass can protect the spinal cord during clamping, is unknown, because the risk of paraplegia in the individual patient can be known only, if the function of the spinal cord is monitored. We have developed a spinal neuromonitoring system and found, that only one third of all TAAA-patients is at high risk to develop paraplegia during aortic clamping. The surgeon is guided by continuous recording of spinal evoked somatosensory potentials and can adapt the operative technique by early reimplantation and eventually subsequent separate reimplantation of segmental arteries supplying blood to the spinal cord, in order to reduce spinal ischemia time. Our results in 260 TAAA-patients are presented. In a high-risk population of patients with aneurysms type I-III (Crawford's classification) it was possible, to reduce the paraplegia rate from 7 to 3.5%, the risk of paraparesis from 15 to 6%, while the operative mortality was only reduced from 19 to 10%.
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PMID:[Surgical treatment of thoraco-abdominal aneurysm. Indications and results]. 758 56

The purpose of this paper is to report a case of medullary ischemia diagnosed by MRI and to determine any MRI characteristics that may be useful for the diagnosis in the light of the published data. The patient was a 60 year-old male with hypertension and diabetes, referred to us for flaccid paraparesis and sphincter disorders of acute onset. Physical examination revealed, beside flaccid paraparesis, both superficial and deep hypoesthesia at L1 level and greater on the right. MRI showed a small area of signal hyperintensity on T2 weighted images and in proton density localized in the posterior part of the spinal cord at the level of T12 body. The patient was treated with oral antidiabetic, antiaggregant and antihypertensive drugs as well as neuromotor rehabilitation, and his clinical conditions improved; a control MRI, six months later, showed disappearance of the previous finding and only mild medullary atrophy at the level of the lesion. Medullary ischemia has been observed in a variety of pathological conditions (inflammatory, neoplastic, traumatic degenerative and iatrogenic), and most frequently involves the dorsal portion of the spinal cord. Four clinical-pathological manifestations of medullary ischemia have been described: infarction from occlusion of the anterior spinal artery; "patchy" or "lacunae infarction"; "transverse ischemic infarction"; selective ischemia in the regions of the posterior spinal arteries. A review of the literature yielded 61 cases of spinal ischemia diagnosed by MRI for a total number of 80 MRI scans, 12 of which were long-term controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Spinal cord ischemia diagnosed by MRI. Case report and review of the literature. 762 69

Between 1978 and 1992, 70 patients were operated for type B aortic dissection (tear in the descending aorta without involvement of the ascending aorta). 15/70 (21%) patients had an acute dissection (onset of symptoms < 24 h), 19/70 (27%) a subacute dissection (onset of symptoms < 14 days), and 36/70 (51) a chronic dissection (onset of symptoms > 14 days). The indications for surgery in cases of acute dissection were: hematothorax, oliguria, leg ischemia and persistent pain. Persistent hypertension was an additional indication in cases of subacute dissection. In large majority (93%) of chronic dissections the indication for surgery was enlarged aortic diameter. In 86% (60/70) graft replacement of the aorta was performed, in 6% (4/70) extra-anatomic bypass, in 3% (2/70) fenestration, in 3% (2/70) thrombendarterectomy, in 3% (2/70). The overall mortality was 17% (12/70); 27% of acute dissection, 26% for subacute dissection, and 8% for chronic dissection. The morbidity for acute dissection was 73%, of subacute dissection 43%, and of chronic dissection 12%. The most frequent complications were: leg ischemia (8 patients), renal failure (4 patients), paraparesis (4 patients) and sepsis (2 patients). No paraparesis was encountered in surgery of the chronic dissection. Conservative treatment was tried in all acute B-dissections, with surgical therapy being reserved for complications of the dissection, such as rupture, such as rupture, risk of rupture (hematothorax, large aortic diameter resp. expansion, persistent hypertension, persistent pain) or ischemia of distal vascular beds. Long-term survival for chronic type B dissections is good. Strong control of risk factors (hypertension) is essential.
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PMID:[Type B aortic dissections: surgical technique and results]. 787 97

Between 1981 and 1987, 88 consecutive patients were operated on for a thoracoabdominal aortic aneurysm by simple crossclamping and a graft inclusion technique (without shunts or heparin). This article presents an analysis of the operative outcome and long-term follow-up. Patient- and operation-related variables are age (mean 64.3 years, range 28 to 82 years), sex (82% men), rupture (20.5%), diabetes (2.3%), renal insufficiency (34.1%), chronic obstructive pulmonary disease (27.3%), previous aortic operation (31.8%), arterial hypertension (66%), postdissection (18.2%) versus degenerative (80.7%) origin, preoperative shock (11.4%), ischemic cerebrovascular (12.5%) or ischemic heart (17%) disease, peripheral vascular disease (14.8%), renal (mean 48 minutes, range 0 to 83 minutes) and lower spinal cord (mean 21 minutes, range 0 to 68 minutes) ischemic time, number of reattached intercostals, blood loss, and extent of the aneurysm (Crawford classification: type I, 16 patients [18.2%]; type II, 21 patients [23.8%]; type III, 29 patients [33%]; and type IV, 22 patients [25%]. Intraoperative mortality is 1.1% (n = 1). Thirty-day mortality is 5.9% (n = 5). Hospital mortality is 11.4% (n = 10): 7% for elective cases and 28% for ruptured aneurysms (p = 0.014). The survival at 2 years is 78% +/- (4.4%) and at 5 years 54% +/- (5.3%). Postoperative spinal cord injury occurred in 12 patients (13.8%) (5 had paraplegia and 7 had paraparesis) and postoperative renal dysfunction necessitating dialysis in 12 patients (14.1%). Risk stratification for hospital death, late death, renal failure, and spinal cord dysfunction was performed by means of multivariate logistic regression and Cox proportional hazard regression as appropriate. The best fitting model to predict hospital death includes preoperative shock (p = 0.02), female sex (p = 0.06), preoperative elevated serum creatinine level (p = 0.06), and preoperative myocardial infarction (p = 0.08). Variables predictive for late death are postoperative dialysis (p = 0.002), age (p = 0.008), and rupture (p = 0.04). The risk factors of postoperative dialysis are age (p = 0.003) and preoperative serum creatinine level (p = 0.04). The risk of postoperative spinal cord dysfunction increases with longer lower spinal cord ischemic time (p = 0.02) and with the presence of preoperative shock (p = 0.06).
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PMID:Surgical treatment of thoracoabdominal aortic aneurysms by simple crossclamping. Risk factors and late results. 828 76

We retrospectively reviewed all patients with a final diagnosis of spontaneous thoracic aortic dissection treated at Linkou Chang Gung Memorial Hospital between January 1989 and December 1994. There were a total of 109 patients with a mean age of 55 +/- 11 years ranging from 19 to 88 years. The male-to-female ratio was 2 to 1 (73 to 36). There was a predilection to present during the colder months, with 69% seen between September 1 and February 28 and only 31% during the warmer half of the year. In most patients, hypertension (85%) was the major predisposing factor with another 7% having Marfan syndrome. The remaining 8% had no obvious underlying disease except for one patient who had an atrial septum defect. Presenting chief complaints in order of frequency included: anterior chest pain 58.7% (64/109), back pain 19.2% (21/109), abdominal pain 10.1% (11/109), consciousness change 3.7% (4/109), neck pain 2.7% (3/109), paraparesis 2.7% (3/109), dyspnea 1.8% (2/109), and hemoptysis 0.9% (1/109). The diagnostic breakdown revealed 46% to be type A (50/109) and 54% type B (59/109). A total of 26 (24%) patients died in hospital (16% were type A and 8% were type B). (Type A included all proximal dissections and those distal dissections that extend retrograde to involve the arch and ascending aorta; Type B refers to the other distal dissections without proximal extension; proposed by Daily et al.) Thoracic aortic dissection remains an important concern in patients with a history of hypertension. Patients seem particularly susceptible during cold weather months. The average age of our patients was only 55 years and 24% of them died during hospitalization. Earlier identification and more aggressive antihypertensive treatment is required.
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PMID:Aortic dissection in Taiwan. 855 68

Clinical data, MR-scans, time-dose fractionation schemes and neuropathologic findings of two cases of delayed radiation myelopathy (DRM), are presented. Both patients, a 72-year-old diabetic woman with cervical lymphnode metastasis from a squamous cell carcinoma and a 46-year-old woman with tonsillar carcinoma, developed paraparesis followed by quadriplegia, at 7 and at 10 months following radiation. The spinal cord received 46 and 49 Gy. (Fraction dose 2.25 Gy and 2.0 Gy, 4 times/week). Serial MR-scans showed spinal cord enlargement and focally increased signal intensity (T1-gd). The second patient survived and stabilized following therapy with coumarins. The first patient died 13 months after radiotherapy. At autopsy necrosis, local calcium deposits, lipid macrophages and swollen astrocytes were observed in the white matter. There was slight hyalinosis of the intramedullary vessel walls. We conclude that serial MRI may be helpful to distinguish DRM from other causes of spinal cord injury. DRM may occur at a total dose less than 50 Gy. Additional risk factors (diabetes, hypertension), and fraction doses above 2 Gy contribute to the development of DRM.
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PMID:Delayed radiation myelopathy: serial MR-imaging and pathology. 883 1

A case of acromegaly associated with variegated spinal disorders was reported. The spinal disorders were multiple cervical disc herniations, spinal epidural cavernous angioma, multiple ossification of the spinal ligament and lumbar canal stenosis. A 51-year-old woman with acromegaly, complaining of disturbances of delicate hand movement and gate, consulted our department. Her past history included diabetes mellitus, hypertension and progressing enlargement of her extremities. Serum growth hormone level was 65.7 ng/ml and somatomedin-c level was 746 ng/ml. Brain MRI showed a pituitary tumor extending to the right cavernous sinus. Cervical MRI revealed disc herniations at C5/6 and C6/7. Thoracic MRI revealed osteoporosis, ossification of the posterior longitudinal ligament and multiple ossification of yellow ligament. Lumbar MRI disclosed ossification of yellow ligament and canal stenosis. Anterior fusion of C5-C7 and an intracapsular removal of the pituitary tumor were performed. Its pathology was that of eosinophilic adenoma. After 3 months, she suffered from paraparesis. On repeating MRI examination with Gd-DTPA, a spinal epidural mass was found at T4. Under laminectomy of Th3-5 and Th8-11, the epidural mass and ossified yellow ligament were removed. The epidural mass was cavernous angioma. She was able to walk without any assistance. An association of spinal canal stenosis with acromegaly is well known. But the association of disc herniation and with the ossification of spinal ligaments is rather rare in the literature. Spinal epidural cavernous angioma is very rare. We discussed the etiological aspects and the management of spinal disorders with acromegaly.
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PMID:[A case of acromegaly associated with variegated spinal disorders]. 891 52


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