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)

From July 1984 to June 1990, seven cases of spontaneous spinal epidural hematoma (SSEH) were studied. The common clinical pictures in these cases were rather typical with an apoplectic onset of severe spinal pain followed in hours (median: four hours) by signs of progressive spinal cord compression. All cases underwent myelography and computed tomographic (CT)-myelographic studies which showed in all cases a block by a posterior extradural lesion in the spinal column; however, the correct diagnosis of SSEH was made preoperatively in only three cases. The neurologic deficits prior to surgery were complete or nearly complete paraplegia in five cases and a high grade of paraparesis in the other two. The median interval of paralysis or paresis before surgery was 28 hours. The final outcome was evaluated by the grade of functional recovery, and the following were found to be the favorable factors: 1) incomplete preoperative neurologic deficits; 2) a slow course of clinical progression, especially a long duration of pain before the onset of paralysis; 3) no delay in surgery; 4) involvement of short spinal segments; and 5) lumbosacral lesions. Particular emphasis is made on early diagnosis and prompt surgery for a favorable outcome.
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PMID:Spontaneous spinal epidural hematoma: report of seven cases. 136 22

Epidural application of local anesthetics or opiates is commonly used for treatment of severe pain or arterial obstruction. We discuss two cases of complications following peridural anesthesia. As an acute complication, a lumbar epidural hematoma developed hours after placement of the catheter and caused sciatic pain and nearly complete paraplegia. The hemorrhage might have been promoted by heparinization. After decompressive hemilaminectomy the patient recovered but was disabled by a persistent paresis. The second patient suffered from renal failure, arterial obstruction, and phantom limb pain. A peridural catheter was kept in place for 6 weeks. Five months later the patient developed severe sciatica. Spinal computed tomography showed compression of the cauda at the L4/5 level (Fig.4) caused by an abscess that was opened and drained. After insertion of a gentamicin - PMMA - chain (Septopal), the wound healed primarily but the patient suffered from persistent pain. The incidence of vessel puncture after insertion of a peridural catheter is about 1%-10%. The risk of hemorrhage, perforation of the dura, and nerve root irritation is increased in scoliotic or elderly patients with a narrow spinal canal. Persistent pain after removal of the catheter is the most important sign. Although paraplegias following peridural catheterization can occur without anticoagulants, even low-dose heparinization is potentially dangerous. The risk of infectious complications after long-term peridural catheterization may be up to 20%. Hematogenous metastatic infection is more common in patients with malignancies or multiple risk factors than continuous immigration of bacteria. Epidural hematomas and spinal abscesses can cause disability and persistent neurological deficit in spite of aggressive surgical and antibiotic therapy.
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PMID:[Lumbar epidural hematoma and spinal abscess following peridural anesthesia]. 368 76

Intrathoracic meningocele associated with neurofibromatosis is a rarity. We treated a 16-year-old boy with neurofibromatosis, marked kyphoscoliosis, and two right-sided intrathoracic meningoceles. Because his chief complaints of cough and chest pain were thought to be caused by the meningoceles, resection of these lesions was performed prior to correction of the spinal deformity. On the day after the resection, complete paraplegia developed, followed by recovery to paraparesis. Decompressive lumbar puncture was performed, but intraspinal pressure was normal. Postoperative spinal cord damage and consequent paresis may have resulted from a loss of pressure buffering by the meningocele, which rendered the cord vulnerable to injury. The possibility of a similar unusual complication should be borne in mind when treating patients with intrathoracic meningocele associated with neurofibromatosis.
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PMID:Paraparesis after excision of intrathoracic meningoceles in a patient with neurofibromatosis. 1181 47

We report a 44-year-old man suffering complete paraplegia due to paraspinal and epidural abscess, following chiropractic therapy for severe back pain and whose diagnosis was delayed. He received an immediate laminectomy from T3 through T6 to decompress the full extent of the abscess and appropriate antibiotic therapy for 4 weeks postoperatively for the identified microorganism (Staphylococcus aureus). After 3 months of rehabilitation, he had recovered bladder function with moderate left lower extremity paresis. We emphasise the importance of urgent spinal gadolinium-enhanced MRI in those patients with localised back pain and raised inflammatory markers (including erythrocyte sedimentation rate). Furthermore, it is necessary to be aware of the risk of acute paraplegia after forceful massage to the back.
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PMID:Acute paraplegia following chiropractic therapy. 1676 16