Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over 4.5 years, 32 patients with spinal epidural metastases were decompressed and stabilized. Median survival was 9.5 months. Myelopathy was the predominant indication (41%) for the operation, intractable pain (microinstability) the second most important. The type of tumor spreading and biomechanics necessitated ventral decompression and stabilization in 65%. Corporectomy or extensive laminectomy was always combined with internal fixation and bone cement. With the exception of six patients (5 early deaths), all patients were able to walk after surgery. The Karnofsky index was improved significantly from 35 to 66%. The longest survival time was found in breast carcinomas and myelomas. Preoperative radiological embolization was a keystone in the treatment. Indication for surgery in spinal metastases is critical and needs an interdisciplinary approach. When the patient is suffering from higher degrees of paresis or even paralysis, he/she is no longer an ideal candidate for the operation. The same applies in the presence of uncontrolled primary tumors and neoplastic disease of the GI tract and the bronchus.
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PMID:[Spinal stabilization in extradural metastatic disease. Indications and follow-up of 32 cases]. 922 80

The authors present 3 rare cases of metastases to the spinal cord and cauda equina. In 2 cases the tumours were of epithelial, and in the third neuroepithelial origin. In one case the tumour was localized in the thoracic segment of spinal cord, and in the second case in the conus and cauda equina, whereas in the third at the cauda equina. The diagnosis was established by CT and myelography. Total removal of the tumour in the cauda equina was carried out. The most significant neurologic symptoms in the two cases were pain and paresis in one case. In our series the rate of metastases to intramedullary and cauda equina constitute 11.1% of all metastases to vertebral column and vertebral canal, and 8% of all epithelial metastases to central nervous system. Death were reported in all the patients within the 1st-5th month of diagnosis of tumour in the spinal cord.
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PMID:[Metastases to the spinal cord and cauda equina]. 944 52

Two patients, women of 85 and 76 years, presented with horizontal ocular paresis. The first patient had a palliative ileocecal resection for adenocarcinoma with metastases and developed the ocular paresis only after intravenous glucose infusion. The second had chronic haemolytic anaemia and weight loss due to malnutrition. The two women were also confused. In both patients acute Wernicke's encephalopathy was diagnosed, caused by thiamine deficiency. The disorder could easily have been missed because of confounding clinical problems. Early treatment of Wernicke's encephalopathy (thiamine 100 mg/day intramuscularly for 3 days) is of major importance in preventing permanent neurological damage or even death.
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PMID:[Eye paralysis and confusion]. 955 50

From Jan. 1993 to Sept. 1995 23 patients suffering from brain metastases from renal cell carcinoma were treated with the Leksell Gamma Knife at the University of Vienna. At the time of diagnosis 13 patients had single and 10 patients presented with multiple metastatic lesions with a total of 44 metastases in MRI scans. Median tumour volume was 5500 cmm (range 100-24000 cmm). Predominant neurological symptoms and signs were different forms of hemiparesis, focal and generalized seizures, cognitive deficit, headache, dizziness, ataxia and CN XII paresis. Fourteen patients received Gamma Knife Radiosurgery (GKRS) with a median dose of 22 Gy (range 8-30 Gy) at the tumour margin. Nine patients underwent a combined treatment of a radiosurgical boost with a median dose of 18 Gy (range 10-22 Gy) at the tumour margin followed by Whole Brain Radiotherapy (total dose 30 Gy/2 weeks). In 20 patients tumour volume reduction up to 30% of the primary tumour volume was found after 4 weeks, evaluated on CT or MRI. A total remission was seen in 4 cases 3 months after GKRS. We achieved a local tumour control of 96%. Rapid neurological improvement after GKRS was seen in 17 patients. The median survival time was 11 months; the one-year actual survival in this unselected group was 48%. Five long term survivors were still alive, 18 patients had subsequently died, 15 of them of general tumour progression. GKRS induces a significant tumour remission accompanied by rapid neurological improvement and therefore provides the opportunity for extended high quality survival. Neither local tumour control was improved nor CNS relapse free survival was prolonged significantly by additional WBRT.
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PMID:Gamma-knife radiosurgery for brain metastases of renal cell carcinoma: results in 23 patients. 975 21

We report a 61-year-old Japanese man who died of complications of esophagus cancer surgery. He was well until his 55 years of the age, when he had an onset of speech disturbance and hand writing. He was seen by a neurologist who prescribed Menesit 600 mg/day. His symptoms improved with this medication. In 1993, three years after the onset, he started to show gait disturbance and easy to fall. In 1995, he noted difficulty in eye opening. He visited our clinic on October 26, 1996. On examination, he showed vertical gaze paresis, masked face, nuchal rigidity, small step gait, freezing phenomena, and festination. His mental status was normal. He was treated with 800 mg/day of Menesit, 800 mg/day of L-dops, and 10 mg/day of bromocriptine with little improvement in his symptoms. Cranial CT scan revealed some dilatation of the third ventricle. Subsequent clinical course was one of the slow progression of his parkinsonism. In September of 1997, he noted difficulty in swallowing. He was admitted to the gastrointestinal service of our hospital on October 14, 1997. On admission, neurologic status was essentially similar to the previous one, but he showed more advanced state of his parkinsonism. Upper gastrointestinal series revealed a mass lesion of about 11.5 cm in length protruding into the lower esophagus lumen. Subtotal esophagus resection including the mass was performed on December 2, 1997. The stomach was elevated for anastomosis with the upper esophagus. No metastases were found in the mediastinum except for two lymph nodes in the para-esophageal region. The subsequent course was complicated by marked elevation of GOT, GPT, LDH, total bilirubin as well as direct bilirubin, alkaliphosphatase, and amylase starting in the evening of the surgery. On December 7, leukocytosis and pneumonic shadow were seen involving his right lung. On December 10, he developed cardiopulmonary arrest. He was once resuscitated; however, he developed cardiac arrest again seven hours later and pronounced dead. He was discussed in a neurologic CPC. The chief discussant arrived at the conclusion that the patient had PSP and the cause of the death was ascribed to circulatory disturbance to the liver. The discussant also thought that the terminal course was complicated by cholangitis or cholecystitis, sepsis, and pulmonary embolism. Surgical specimen of the esophagus tumor revealed carcinosarcoma. Postmortem examination revealed yellowish discoloration of the peritoneum and mesenterium, and accumulation of clouded ascites indicating the presence of peritonitis. Inflammatory change extended to the mediastinum. On microscopic examination, various kinds of bacilli and candida spores were seen. The liver was enlarged and a perforation was noted in the gallbladder causing biliary necrosis in the adjacent liver. An extensive infarct was seen in the left lobe of the liver; this was found to be due to obstruction of the hepatic artery at the site of the duodenohepatic mesenterium and obstruction of intrahepatic portal vein secondary to retrograde intrahepatic cholangitis in the left lobe. A piece of surgical threads was seen adjacent to the hepatic artery; foreign body granulomatous reaction was seen surrounding the surgical thread. The rupture of the gallbladder appeared to be due to the obstruction of the left branch of the hepatic artery. Neuropathologic examination revealed extensive degeneration of the pallidum, the substantia nigra, and the subthalamic nucleus and presence of neurofibrillary tangles in the remaining neurons. The neuropathologic findings were consistent with progressive supranuclear palsy, although the pathologic changes in the midbrain tegmentum was only mild gliosis.
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PMID:[A 61-year-old man with progressive gait disturbance, freezing, and vertical gaze paresis who developed esophagus cancer]. 986 33

From 1987 to 1996, 106 consecutive patients with metastatic disease of the spine who underwent palliative decompression from a dorsal approach and subsequent stabilisation with Cotrel-Dubousset instrumentation (CDI) were followed prospectively, and independent of the surgeons. Parameters evaluated were neurological function, perioperative complications, survival and rehabilitation. Following the Frankel system for the assessment of neurological disorder, 33 patients had a major deficit (grade A, B or C), 23 a minor deficit (grade D) and 50 no deficit. If there was no neurological dysfunction, the only patients who underwent operation were those graded as class IV according to Harrington. Our surgical strategy combined posterior decompression of the spinal cord followed by CD stabilisation without bone grafting. Of 56 patients who had a neurological deficit preoperatively, 35 enjoyed complete or partial recovery within the first 3 months after the operation. Of the 50 patients without neurological dysfunction, 3 developed an incomplete transient paresis. The rate of survival was 72% (76 of 106) at 6 months and 50% (53 of 106) at 12 months. At 12 months 42 of the 53 patients who were alive were still able to walk. All but 13 patients were able to return home. Overall survival time was 19.2 months, with 5 patients still alive. Six patients required re-operation for tumour recurrence at the same or at a new level. The results of this study show that neurological function, pain level and mobility can be enhanced by decompression and stabilisation through a posterior approach.
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PMID:Outcome after palliative posterior surgery for metastatic disease of the spine--evaluation of 106 consecutive patients after decompression and stabilisation with the Cotrel-Dubousset instrumentation. 1061 27

Treatment options in patients with bone metastases of differentiated thyroid carcinoma are limited and mostly aimed at palliation. Conventional treatment modalities are: radioiodine therapy, surgery or external irradiation. A lesser known option is selective embolization of tumour metastases. During selective catheterization of the arteries that feed the metastases embolization material (e.g. polyvinyl alcohol particles) is injected into the local vasculature under radiographic control. The embolization is immediately evaluated angiographically. This therapy was used in three patients with differentiated thyroid carcinoma, a 60-year-old man suffering from back ache, paresis and afterwards paralysis of the lower body parts with incontinence, and in two women aged 59 years (suffering from diplopia and a pelvic metastasis) and aged 27 years (suffering from neurological symptoms or pain of the right leg due to a pelvic metastasis). In all three the symptoms disappeared after the embolization and ensuing treatment with radioactive iodine. Due to recurrent increase in serum thyroglobulin concentration repeated re-embolization was necessary, but during a follow-up period of 3-5 years the palliation remained adequate. Selective embolization appears to be a safe and efficacious treatment, with good tolerability for the patient. Embolization alone or preferably preceded by radioiodine therapy may lead to decreased tumour progression and often gives rise to immediate relief of symptoms.
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PMID:[Embolization of skeletal metastases in patients with differentiated thyroid carcinoma]. 1092 50

An 8-year-old male Belgian Malinois was referred for evaluation of progressive caudal paresis of 2 to 3 weeks' duration. Radiography revealed a mottled appearance to the body of L4 and misshapen intervertebral foramen at L4-L5. Myelography revealed that the dye column terminated within the body of L4. Computed tomography revealed a soft tissue mass adjacent to or involving the spinal cord and L4, with complete destruction of a portion of the floor of the vertebral foramen. Small circular lesions were also noticed within the body of L3 and L5. A left-sided hemilaminectomy was performed. Histologic examination of a biopsy specimen revealed a high-grade sarcoma. Because of the poor prognosis, the dog was euthanatized. Necropsy examination revealed osteosarcoma, with lesions in L3 to L7, the sacrum, and the lungs. Metastatic lesions in adjacent bones have been termed skip metastases and the primary tumor is typically in long bones. Prognosis associated with skip metastases is similar to or even graver than that associated with pulmonary metastases. In the dog of the present report, the unusual finding of distinct foci of osteosarcoma within 5 adjacent lumbar vertebrae and the sacrum was consistent with skip metastases, potentially spread via the vertebral venous plexus.
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PMID:Osteosarcoma in adjacent lumbar vertebrae in a dog. 1101 12

A 22-year-old Dutch Warmblood mare was referred to Utrecht University with progressive left hind limb paresis and hyporeflexia. The preliminary clinical diagnosis was the neurological form of equine herpes virus (EHV-1) infection. Within 1 day of admission, the mare became recumbent and deteriorated rapidly. Postmortem examination revealed an adenocarcinoma of the caecum, with metastases in all regional lymph nodes and extending from the lumbar nodes into the vertebral canal, causing spinal cord compression and destruction of the left 4th and 5th lumbar nerves.
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PMID:Neurological signs in a horse due to metastases of an intestinal adenocarcinoma. 1120 3

Metastatic lesions are the most common spinal extradural tumours. Significant advances in their neurosurgical management have been made in the last two decades. This retrospective study was undertaken to summarise the long-term results of surgery and the outcome of patients with cervical spine metastases. Sixty-two patients with cervical spine metastases who underwent instrumented spinal surgery at a single centre in an 12-year period (1989-2000) were analysed. All patients presented with local pain and with either neurological deficits, spinal instability, or a combination of both. A standard anterior approach to the cervical spine was chosen, and a partial or total vertebrectomy and vertebral body replacement with subsequent anterior instrumented fusion were carried out in all cases. General and neurological status was evaluated at baseline and in regular intervals thereafter. Plain X-rays, CT, and MRI were used for preoperative planning. Postoperative follow-up was done by X-rays. The mean follow-up time for all patients was 1.5 years. A stable bony fusion of the cervical spine was achieved in 60 patients (96.8%), with two additional patients needing a further procedure for maintaining the mechanical stability of the spine. There was mild early surgery-related morbidity, and no mortality. The most frequent temporary surgery-related side effect was reversible vocal cord paresis in 5 cases (8.0%). There were 3 cases (4.8%) of early instrumentation failure. One of these was symptomatic and underwent second-look surgery. No late complications occurred due to instrumentation hardware failure. The 1-year survival rate of all patients after surgery was 58%, and the 2-year survival rate was 21%. Our results demonstrate that surgical removal of extradural metastases with subsequent instrumented fusion is a low-morbidity and low-complications procedure with high rates of permanent stabilisation of the compromised cervical spine. In addition, it improves the neurological deficits and relieves the local pain in a significant proportion of patients. Excellent local control of malignant disease can be achieved by the surgical procedure aided by subsequent local and systemic adjuvant therapy. Overall survival time and prognosis of the patients, however, are mainly depending on the type and the stage of the primary malignancy.
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PMID:Results and outcome of neurosurgical treatment for extradural metastases in the cervical spine. 1457 9


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