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compressive myelopathy, Spinal Shock, and a Complicated Neurological Exam

Surgical Science 2023年第10期14卷 609-617页

作者： Haroutiun Hamzoian Christine Ochoa Lekhraj Patel Kwabena Ayesu Orlando Health Orlando Regional Medical Center Orlando Florida USA

The neurological examination, developed and tested since the 1800s has provided physicians with a vital tool to rapidly assess and provide clues to many of the pathological processes lurking inside the brain and spinal cord. With the advent of magnetic resonance imaging, physicians are able to visualize the precise location of the abscess before surgical intervention. In this case report, we present a 51-year-old male with an epidural abscess with multifocal compressive myelopathy, resulting in a complicated neurological examination, making localization a diagnostic challenge. With this case, we would like to stress that complicated multifocal lesions of the cord may present with a large variation in examination findings. This patient’s neurological exam was complicated secondary to a ventrally as well as dorsally located epidural abscess with superimposed spinal shock sequelae. We would like to highlight the importance of a thorough history and the neurological examination but also mention some of its limitations. It is crucial to use clinical judgement to navigate the patient’s history, presentation, and examination to accurately diagnose and treat, particularly so in cases involving compressive myelopathies of the spinal cord.

关键词： compressive myelopathy Spine Spinal Epidural Abscess Spinal Imaging Neurological Examination Neurology Neurosurgery Abscess Neuroimaging

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Aggressive Dorsal Vertebral Hemangioma Causing compressive Mielopathy

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Open Journal of Medical Imaging 2021年第3期11卷 85-91页

作者： Ana Carla Farias Pimentel Mariana Santos Leite Pessoa Francisca Estefânia Mesquita Maciel de Lima Manuel Joaquim Diógenes Teixeira Cláudio Régis Sampaio Silveira Ana Carla Farias Pimentel MD Radiologist Hospital Geral de Fortaleza (HGF) Fortaleza-CE Brazil Mariana Santos Leite Pessoa MD Radiology Resident Hospital Geral de Fortaleza (HGF) Fortaleza-CE Brazil Francisca Estefania Mesquita Maciel de Lima MD Pathologist Laboratório Mikros Fortaleza-CE Brazil Manuel Joaquim Diógenes Teixeira MD Orthopedist Hospital Geral de Fortaleza (HGF) Fortaleza-CE Brazil Cláudio Régis Sampaio Silveira MD Radiologist Hospital Geral de Fortaleza (HGF) Fortaleza-CE Brazil Hospital S?o Carlos Fortaleza-CE Brazil

Vertebral hemangiomas are common benign lesions of the spine, characterized by abnormal vascular proliferation, being commonly asymptomatic incidental findings, presenting symptoms in only a small portion of affected individuals. In a smaller number of cases, however, hemangiomas can present an expansive effect and extra-osseous extension, determining a mass effect and neurological symptoms, being therefore called aggressive hemangiomas. On MRI, aggressive hemangiomas are characterized by having a larger vascular component and a smaller fat component, thus producing a low signal on T1-weighted images. We illustrate the case of a young male patient who presented with pain in the upper thoracic spine, who developed paraparesis and ascending sensory deficit and progressive lower limbs, progressing to paraplegia and loss of sphincter control.

关键词： Aggressive Vertebral Hemangioma compressive myelopathy Magnetic Resonance Imaging

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