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Query: UMLS:C1762617 (weakness)
 37,932 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The protrusion of cervical intervertebral discs was divided into three pathological entities by Spurling; soft disc, hard disc and spondylosis. We applied these concept to the dorsal intervertebral disc disease and treated two cases of thoracic spondylosis. Case 1. A 41-year-old male entered the hospital because of the gradual progression of weakness of both legs of two months' duration. Since ten days before admission he had not had an errection and had not been to able to walk and micturate. He also complained of paresthesia radiating down the abdomen into both legs. There were no visceral complaints. Neurological examination revealed severe weakness of both legs with bilateral impairment of deep sensations and hypalgesia up to the level of T6. Reflexes in both legs were hyperactive with sustained clonus. Plantar responses were extensor bilaterally. Though plain X-rays showed no changes, tomography revealed a calcified intervertebral spur formation at the T5-6 interspace. A myelogram showed a complete block of the contrast medium at the level of the upper part of T6. The patient underwent a complete laminectomy from T3 through T6 and extradural anterior decompression with the removal of the calcified disc at the T5-6 interspace using an air drill. Postoperatively, he demonstrated an immediate improvement in sensation and a gradual recovery in motor power. At his follow-up examination 14 months after surgery he could walk without assistance. Case 2. A 47-year-old dwarfish woman (130 cm) with a low back pain and difficulty in walking for a few years duration was admitted. A few months before admission she felt pain at her left lateral abdomen. There was weakness of both legs, greater in the left. Reflexes in her left lower extremity were hyperactive with sustained clonus. Plantar responces were flexor bilaterally. Palin X-rays showed scoliosis of thoracic spine with the top at T7 level and calcified intervertebral masses at T10-11, T11-12 and T12-L1, extending into the canal that were confirmed more clearly by tomography. Myelography by a cisternal puncture disclosed a complete block at the level of T10. The patient underwent total laminectomy of T9 through L2 and extradural anterior decompression with the removal of calcified discs. At her follow-up examination 12 months after surgery she could walk for herself with some residual neurological signs, minimal weakness in the right leg and hypesthesia up to the level of T12 in the left. We have discussed the incidental, related diagnostic and operative problems of this disease.
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PMID:[The protrusion of thoracic intervertebral disc-thoracic spondylosis (author's transl)]. 123 40

A rare case of achondroplasia showing diffuse spinal canal stenosis is presented. A 39-year-old woman was admitted to our hospital because of numbness of lower extremities and intermittent claudication. The patient's height was 121cm and she had the typical clinical features of an achondroplastic dwarf. Neurological examination revealed spastic paraparesis, and sensory impairment below the level of T11 in the left side and L1 in the right. A plain X-ray feature of the spine showed spinal canal stenosis. The interpedicular distances were short in all vertebrae, and especially more prominent in the caudal lumbar region. The sacrum laid horizontally and the sacral angle was narrower than normal case. Myelography and computed tomographic myelography demonstrated severe stenosis of the subarachnoid space at the level of T9-11. Laminectomy was performed from the inferior half of T9 to T11. The yellow ligaments were prominently hypertrophic and these were removed as far as possible. Postoperatively, the weakness of the lower extremities was improved immediately, but numbness remained. Five months after the operation, she suffered from urinary dysfunction, so further laminectomy from T12 to L5 was performed. Also in this operation, hypertrophic yellow ligament was pathognomonic. Following this operation the patient had a good recovery course and returned to work.
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PMID:[A case of achondroplasia showing diffuse spinal canal stenosis]. 221 74

Thoracic spondylotic myelopathies are exceptional, only 29 observations could be found in the literature; we intend to describe three new cases here. The patients, two women and one man, 64, 69 and 72 years old, complained of weakness of the lower limbs, more marked on one side, which had been progressing slowly from several months to eight years. Examination revealed asymmetrical paraparesis with distal sensitivity deficits without thoracic sensory level. In the first case, the myelography remained virtually unchanged in front of T11, T12; in the second and third cases, there was slight extradural compression at T9 and T10 respectively. Magnetic Resonance Imaging (M.R.I.) performed in two patients was evocative of a thoracic disk herniation. A chest CT scan enabled us to establish correct diagnosis: in the three cases irregular hypertrophy of the posterior elements was evident at T11 and T12, T9 and T10, T10 and T11 respectively, with osteophytes originating in the articular process and deeply embedded in the spinal canal. Decompressive laminectomy associated with medial facetectomy resulted in the gradual improvement of walking in all three patients. Myelography and MRI are both useful in demonstrating the level compression, usually situated in the low thoracic spine, however only the CT allows differential diagnosis with other etiologies, especially anterior compression such as disk herniation.
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PMID:[Myelopathies caused by dorsal spinal canal spondylotic stenosis. 3 cases and a review of the literature]. 269 79

A case of polymyositis with repeated dysphagia and muscle weakness associated with peculiar findings of skin was reported. The patient was a 67-year-old man. His birth and development was normal. There was no family history of neuromuscular disease. On 26th March 1987 he was admitted to a hospital because of dysarthria and dysphagia after fever and diagnosed as having viral myositis. His conditions improved spontaneously with bed rest and he left hospital on 14th April. On 23rd April he had chill and sore throat with fever. On 27th he was admitted to the same hospital because of dysarthria and muscle weakness of the proximal portion of the upper limbs. These symptoms also improved with bed rest. He had repeated these symptoms several times and then he was admitted to our hospital on 12th June. On examination he showed the skin pigmentation under the right eye and the eruption in the back of hands and the buttocks. Muscle weakness was observed in the proximal portion of the upper limbs and the neck flexor. Laboratory tests in admission were as follows: sGOT 49 mU/ml, sGPT 104 mU/ml, LDH 1064 mU/ml, CPK 565 mM/ml, aldolase 25.2 IU/1/37 degrees C. Electromyography showed the typical myogenic changes and biopsy of left biceps brachii revealed inflammatory cells in the muscle fiber which are specific to polymyositis. Immuno-histochemical study is performed to analyse the subpopulation of mononuclear cells in biopsied muscle and skin. Mononuclear cells infiltrated into perimysium, endomysium and epidermis were positive for T11 and T8, but less positive for T4, B1 and Leu11. On the basis of these findings he was diagnosed as having "polymyositis syndrome".
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PMID:[A case of polymyositis with repeated dysphagia and muscle weakness associated with peculiar findings of skin]. 280 15

4 cases of syringomyelia with type I Arnold Chiari malformation was seen presenting mainly with dissociated sensory loss, weakness of hands and upper motor neurone signs in the lower limbs. The first patient improved with posterior fossa decompression. The second and fourth patient appeared not to have improved after surgery, and the third case refused operation. One patient showed cord atrophy on myelogram presumably due to a collapse of the syrinx. One of the patients was unusual in that the syrinx extended down to segment T11. Magnetic resonance imaging of the posterior fossa and the cervical cord, to date, is the most useful procedure for diagnosis.
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PMID:Syringomyelia with Arnold Chiari I malformation: a report of four cases. 281 42

A case of spinal dumbbell shaped melanotic schwannoma was reported. A 58-year-old housewife had a 3-months history of progressive gait disturbance. She also complained of mild backache and numbness in both legs. Her family history was not remarkable. When examined on admission, October 10, 1982, mild weakness of both legs with spasticity and sensory impairment below the level of T10 dermatome without sacral sparing were evident. Her deep tendon reflexes were hyperactive on both sides and plantar responses were extensor bilaterally. Sphincteric disturbance was not significant. The function of her cranial nerves was intact. She had neither cutaneous lesions, abdominal mass nor organomegaly. Thoracic plain X-rays revealed erosion of the right side vertebral body and pedicle of the 10th thoracic vertebra. Myelography disclosed a complete block at the same level by an epidural mass. On CT-myelogram, soft tissue density mass compressing the thoracic cord was apparent in the right epidural space of the spinal canal which extended to the paravertebral region through the right intervertebral foramen. Partial destruction of the body and the right side pedicle was easily recognized. Laminectomy from T9 to T11 exposed a large extradural mass which was encapsulated, elastic soft and pigmented in nature. The tumor was dumbbell shaped and extended to the right paravertebral region through the intervertebral foramen. Costotransversectomy was performed to excise the mass entirely. Following the total removal of the tumor, internal fixation was carried out by means of Harrington instrumentation with methylmethacrylate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Spinal melanotic schwannoma: report of a case]. 306 Jul 51

A 36 year old woman was admitted to the hospital in November 1983 because of her inability to walk. For 3 months prior to admission, she took oral contraceptives (OCs) as a treatment for amenorrhea. 2 months prior to admission, she had general malaise, anorexia, and unsteady gait. 1 month before her admission, tingling and numbness began in the fingertips and spread up to the forearms, a tight feeling around the waist developed, and walking became ataxic. On admission to the hospital, she was thin and pale with greying hair. Her mind was clear and there were no abnormalities of the cranial nerves. Her extremities were hypotonic but not wasted. Slight muscle weakness of the hands and feet was noted. There was myokymia in both legs. Deep tendon reflexes of the extremities were absent. The plantar responses were extensor and lack of coordination in the extremities was noted. There was a definite glove and stocking type of hypesthesia to pinprick and cotton wool. Vibration sense was decreased below T11 and lost in both legs. There was a marked loss of position sense to passive movement in the legs and some impairment in the hands. Laboratory examination revealed mild magaloblastic anemia, elevated LDH, borderline low concentration of vitamin B12 in the serum, increased excretion of methylmalonate in the urine, achylia, positive antiparietal cell antibody and positive anti-intrinsic factor antibody. Cyanocobalamin absorption by the Schilling test was 5.6% after intrinsic factor, 11.3%. The diagnosis of pernicious anemia was made. Upper gastrointestinal studies showed typical carcinoid tumors of the stomach. Cerebrospinal fluid was normal. Peripheral nerve conduction studies demonstrated normal or slightly decreased motor conduction velocities and absent sensory action potential. Sural nerve biopsy was performed. Myelinated fibers were moderately decreased in number to 5554/mm squared and pronounced loss of large myelinated fibers was demonstrated in fiber histogram. Teased method of the single fiber showed mainly axonal degeneration. Anemia and neurologic function improved rapidly with parenteral hydroxocobalamin therapy and 1 month after treatment commenced, she was able to walk without assistance. The clinical significance of peripheral nerve involvement of subacute combined degeneration of the spinal cord was discussed, as the peripheral nerve affection is only poorly understood in contrast to the myelopathy. This was followed by discussion of the possible effect of the OCs and gastric carcinoid to neurological manifestation of pernicious anemia. (author's modified)
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PMID:[Subacute combined degeneration of spinal cord. Significance of peripheral nerve involvement]. 401 64

Tuberculosis (TB) remains endemic in many parts of the world. In developing countries, TB of the spine remains a major, expensive health problem. Tanzania has therefore since the 1970s reinforced its district and regional TB control efforts. The Ministry of Health has nonetheless reported a recent increase in the incidence of TB in the country. The authors have also noted an increase over the past several years in the number of pediatric patients with TB in the spine. They report retrospectively on 22 consecutive patients aged 3-13 years with TB of the spine who were managed at the Pediatric Surgical Unit of Muhimbili Medical Center in Dar es Salaam, Tanzania, over the period 1988-93. 12 subjects are male and 10 are female. The majority presented with back pain and/or deformity and weakness in the legs associated with difficulty in walking. The diagnosis was based upon radiological as well as hematological findings. Two patients had associated lung lesions and gave AFB-positive sputum. 63.5% were thoracolumbar T11-L2. All patients received chemotherapy, with two also undergoing simple drainage of paravertebral abscesses, and two debridement and bone grafting. There was no formal immobilization except that the children had to sleep on hard beds. All gave a history of BCG vaccination scars. Mantoux or Heaf test was performed on 16 of the 22, 11 of whom were positive. One patient resulted with paraplegia, one with marked paraparesis, and in 17 of 22 the kyphosis/gibbus increased. The authors conclude that laxity in the TB control programs and the widespread extent of HIV could be contributory factors in what appears to be an increase in TB infection in recent years.
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PMID:Tuberculosis of the spine in children at Muhimbili Medical Centre, Dar es Salaam. 778 56

Sciatic nerve entrapment in an osseous tunnel has only been reported twice previously. We describe a 19-year-old man evaluated for left lower limb pain and weakness that began one and one half years after sustaining stab wounds to the left buttock and midline back near the T11 vertebrae. The patient had sciatica and demonstrated motor and sensory deficits on physical exam. Electrodiagnostic studies demonstrated a localized injury to the sciatic nerve in the proximal thigh. Radiographic studies of the left pelvis and femur showed an 8 to 10cm linear opacification overshadowing the left femoral head and anatomic neck. An arteriogram of the left leg demonstrated a 3 x 4cm lobulated aneurysm arising from the distal portion of the inferior gluteal artery. Surgical exploration revealed the sciatic nerve to be encased in cylindrical bone. The ectopic bone was removed and the sciatic nerve released. The patient had gradual improvement with a nearly complete neurological recovery by three months after surgery.
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PMID:Posttraumatic osseous tunnel formation causing sciatic nerve entrapment. 848 70

Osteoporotic vertebral crush fractures with neurologic complications are rarely reported in the literature. We report six new cases particularly severe in which death occurred in two cases. The study group included four women and two men with a mean age of 75 years (range: 72-79). Vertebral collapse causing neurological deficit was T5, T9, T11 in two cases, L1 and L3. The mean number of vertebral collapses was three per patient (range: 1-9). Back pain appeared without traumatism 6 weeks before admission (range: 1-24). Neurological complications appeared 2.5 weeks after back pain (range: 1-8). One patient suffered from a paraplegia, three from a paraparesia with bladder dysfunction (n = 1). In one case there was a severe weakness of the levator muscles of the foot and in another a L3 femoral neuralgia with severe bowel and bladder dysfunction. X-rays demonstrated backwards displacement of the posterior cortex in three cases, an intravertebral vacuum phenomenon in two cases and a heterogeneous appearance suggesting a malignancy in two cases. Computed tomography, performed in four patients and tomography in one patient, demonstrated fragmentation of the vertebral body in all the cases and vacuum phenomenon in four cases. Magnetic resonance imaging performed in four cases has confirmed the absence of epiduritis and a compression due to bony structures in two cases. A vertebral biopsy was performed in three cases. Osteoporosis was observed in all the cases and in two cases there was also an osteonecrosis. Surgical treatment was performed in three cases and conservative medical treatment in the other cases. After surgical treatment we have observed an absence of improvement of neurological complications in one case, an improvement in another and finally a full recovery in the last case. After conservative treatment we have noted in two cases an absence of improvement of neurological complications and in one case an improvement of neurological deficit. Two patients died (one after medical treatment and another after surgical treatment).
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PMID:[Osteoporotic vertebral crush fractures with severe neurologic manifestations. Apropos of 6 cases]. 857 Sep 51


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