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Regional gray matter abnormality in hepatic myelopathy patients after transjugular intrahepatic portosystemic shunt: a voxel-based morphometry study

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Neural Regeneration Research 2019年第5期14卷 850-857页

作者： Kang Liu Gang Chen Shu-Yao Ren Yuan-Qiang Zhu Tian-Lei Yu Ping Tian Chen Li Yi-Bin Xi Zheng-Yu Wang Jian-Jun Ye Guo-Hong Han Hong Yin Department of Radiology Xijing Hospital Air Force Military Medical University (Fourth Military Medical University) Department of Radiology Lanzhou General Hospital Lanzhou Military Command Xijing Hospital of Digestive Diseases Air Force Military Medical University (Fourth Military Medical University) Life Sciences Research Center School of Life Sciences and Technology Xidian University

Hepatic myelopathy is a complication seen in patients with chronic liver failure with physiologic or iatrogenic portosystemic shunting. The main symptom is progressive lower limb dyskinesia. The role of the brain motor control center in hepatic myelopathy is unknown. This study aimed to investigate the gray matter changes in patients with hepatic myelopathy secondary to transjugular intrahepatic portosystemic shunt and to examine their clinical relevance. This was a cross-sectional study. Twenty-three liver failure patients with hepatic myelopathy(hepatic myelopathy group), 23 liver failure patients without hepatic myelopathy(non-hepatic myelopathy group) after transjugular intrahepatic portosystemic shunt, and 23 demographically matched healthy volunteers were enrolled from March 2014 to November 2016 at Xijing Hospital, Air Force Military Medical University(Fourth Military Medical University), China. High-resolution magnetization-prepared rapid gradient-echo brain imaging was acquired. Group differences in regional gray matter were assessed using voxel-based morphometry analysis. The relationship between aberrant gray matter and motor characteristics was investigated. Results demonstrated that compared with the non-hepatic myelopathy group, gray matter volume abnormalities were asymmetric, with decreased volume in the left insula(P = 0.003), left thalamus(P = 0.029), left superior frontal gyrus(P = 0.006), and right middle cingulate cortex(P = 0.021), and increased volume in the right caudate nucleus(P = 0.017), corrected with open-source software. The volume of the right caudate nucleus in the hepatic myelopathy group negatively correlated with the lower limb clinical rating of the Fugl-Meyer Assessment(r = –0.53, P = 0.01). Compared with healthy controls, patients with and without hepatic myelopathy exhibited overall increased gray matter volume in both thalami, and decreased gray matter volume in both putamen, as well as in the globus pallidus, cerebellum, and

关键词： portosystemic shunt hepatic myelopathy hepatic encephalopathy magnetic resonance imaging gray matter lower limb Fugl-Meyer Assessment basal ganglia caudate nucleus voxel-based morphometry

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Tentorial dural arteriovenous fistula presenting as myelopathy: Case series and review of literature

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World Journal of Clinical Cases 2014年第12期2卷 907-911页

作者： Robert Gross Rushna Ali Max Kole Curtis Dorbeistein Mahesh V Jayaraman Muhib Khan Department of Neurology Warren Alpert Medical School of Brown University Providence RI 02903 United States Department of Neurosurgery Henry Ford Hospital Detroit MI 48202 United States Departments of Neurosurgery and Radiology Henry Ford Hospital Detroit MI 48202 United States Department of Neurosurgery Warren Alpert Medical School of Brown University Providence RI 02903 United States Departments of Diagnostic Imaging and Neurosurgery Warren Alpert Medical School of Brown University Providence RI 02903 United States

Dural arteriovenous fistula(DAVF) is a rare type of cerebral arteriovenous malformation. Common presenting symptoms are related to hemorrhage. However, rarely these patients may present with myelopathy. We present two cases of DAVF presenting as rapidly progressive myelopathy. Two treatment options are available: microsurgical interruption of the fistula and endovascular embolization. These treatment options of DAVFs have improved significantly in the last decade. The optimal treatment of DAVFs remains controversial, and there is an ongoing debate as to whether primary endovascular or primary microsurgical treatment is the optimal management for these lesions. However, despite treatment a high percentage of patients are still left with severe disability. The potential for functional ambulation in patients with DAVF is related to the time of intervention. This emphasizes the important of early diagnosis and early intervention in DAVF. The eventual outcome may depend on several factors, such as the duration of symptoms, the degree of disability before treatment, and the success of the initial procedure to close the fistula. The usage of magnetic resonance imaging and selective angiography has significantly improved the ability to characterize DAVFs, however, these lesions remain inefficiently diagnosed. If intervention is delayed even prolonged time in rehabilitation does not change the grave prognosis. This review outlines the presentation, classication and management of DAVF as well as discussing patient outcomes.

关键词： Dural arteriovenous fistula myelopathy Vascular malformation Cognard classification Microsurgery Onyx embolization

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Mechanical and cellular processes driving cervical myelopathy

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World Journal of Orthopedics 2016年第1期7卷 20-29页

作者： Roisin T Dolan Joseph S Butler John M O'Byrne Ashley R Poynton Department of Trauma and Orthopaedic Surgery Waterford Regional Hospital National Spinal Injuries Unit Department of Trauma and Orthopaedic Surgery Mater Misericordiae University Hospital Department of Trauma and Orthopaedic Surgery Royal College of Surgeons in Ireland Cappagh National Orthopaedic Hospital Department of Trauma and Orthopaedic Surgery Mater Private Hospital

Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies in severity and number of levels involved. The vast array of clinical manifestations of cervical myelopathy cannot fully be explained by the simple concept that a narrowed spinal canal causes compression of the cord, local tissue ischemia, injury and neurological impairment. Despite advances in surgical technology and treatment innovations, there are limited neuro-protective treatments for cervical myelopathy, which reflects an incomplete understanding of the pathophysiological processes involved in this disease. The aim of this review is to provide a comprehensive overview of the key pathophysiological processes at play in the development of cervical myelopathy.

关键词： Cervical myelopathy Cervical spine Neck pain

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myelopathy as a Presentation of Cervical Spine Metastasis: A Case Report

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Open Journal of Modern Neurosurgery 2024年第1期14卷 64-71页

作者： Ramin Shayan-Moghadam Mosayeb Soleymani Hassan Zolghadr Mohammad Hossein Nabian Saeed Reza Mehrpour Department of Orthopedic and Trauma Surgery Shariati Hospital Tehran University of Medical Sciences Tehran Iran Center for Orthopedic Trans-Deciplinary Applied Research Tehran University of Medical Sciences Tehran Iran

Cervical myelopathy is a consequence of spinal cord compression in the cervical spine. Degenerative cervical spondylosis, osteophytes, discosteophyte complex, degenerative spondylolisthesis and hypertrophy of ligamentum flavum are the main etiologies of cervical myelopathy. Metastasis to cervical spine could be a rare cause of cervical myelopathy. The present study is a case report;presented a 36-year-old male with severe pain in cervical region, gait disability and impairment in sensory and motor function of upper left extremity. The patient had a history of thyroidectomy and cervical lymph node dissection due to follicular thyroid carcinoma (FTC) with improper follow-ups. He was diagnosed with metastatic cervical myelopathy and underwent surgical treatment. Cervical myelopathy due to metastasis is a rare condition and only few cases have been reported so far. So myelopathies can be a complication of metastatic cancers, and it should be considered by health professionals.

关键词： myelopathy Metastasis Thyroid Cancer

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Effect of Exercise Program on the Rehabilitation of Patients with Cervical Spondylotic myelopathy

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Neuroscience & Medicine 2012年第1期3卷 54-59页

作者： N. Sundaramurthy Senthil Kumar Niyatee Lal Dharmarajan Rajalakshmi Faculty of Therapeutic sciences Masterskill University college of Health sciences Cheras Malaysia PMR Department Christian Medical College & Hospital India

Study Design: A clinical trial of 30 consecutive patients with cervical spondylotic myelopathy (CSM). Objectives: To evaluate the effect of directed physical exercise in patients with CSM and to measure severity of myelopathy before and after an exercise program. Setting: Christian Medical College and Hospital, India. Participants: Thirty patients with CSM (mean age-54.1 years) with Nuricks Grade 2 and 3. Background: myelopathy of the spinal cord can be caused by degenerative process of the cervical vertebrae and it is the most common type of dysfunction of the spinal cord in adult population. CSM usually develops insidiously and the natural history is not well understood, there is debate over the indication for operative Vs non operative management. Method: Patients participated in a 6-week exercise program, consisting of active exercises to upper and lower extremities, scapulothoracic muscles, and gentle stretches, sub maximal isometric exercises of the deep neck flexors, relaxation and immobilization with a cervical collar. Main Outcome Measures: The mJOA (modified Japanese orthopaedic association score) and ASIA motor and sensory scoring. The results were processed by using Wilcoxon sign rank test. Results: After comparing the values at the beginning and end of the program a satisfactory neurological result (sensorimotor/motor and sensory) was obtained in all thirty patients. Conclusion: The exercise program had a positive impact for most of the variables of the study. Exercise intervention with neck immobilization may be a treatment of choice in early stages of CSM. Future randomized controlled studies would provide insight into the effectiveness and clinical relevance of this intervention.

关键词： Cervical Spondylotic myelopathy Rehabilitation Exercise

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Clinical Factors Influencing the Neurological Recovery of Patients Operated for a Cervical myelopathy at the Teaching Hospital of Bouake

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Open Journal of Modern Neurosurgery 2023年第2期13卷 51-59页

作者： Derou Louis Dongo Soress Yao Konan Serge Teti Landry Keke Jean-Baptiste Fionko Yao Bernard Tokpa André Broalet Espérance Haidara Aderehime Neurosurgery Department Bouaké Teaching Hospital Bouaké Ivory Coast Neurosurgery Department Yamoussoukro Saint Joseph Moscatti’s Hospital Yamoussoukro Ivory Coast

Introduction: Cervical myelopathy is the most common myelopathy among people over 50 of age. Cervicosteoarthritis is the main etiology. The purpose of this work was to identify clinical factors that may influence neurological recovery in patients undergoing surgery for cervical myelopathy in our work setting. Materials and Methods: We performed a retrospective analytical study on patients operated on for cervical myelopathy at the teaching hospital of Bouake. The logistic regression model was used to identify the factors influencing post-operative neurological recovery. Results: 50 patients’ records have been enrolled in this study. The mean age of our patients was 53 years with extremes ranging from 25 to 78 years and 39 of our patients (62%) were male. The mean modified pre-operative JOA score was 11.62 versus 12.94 after the surgery. Age, sex, the number of levels operated on and the duration of the evolution of the signs showed no significant link with neurological recovery. Preoperative mild myelopathy (P = 0.0491) and post-operative functional rehabilitation (P = 0.0459) were identified as factors favouring neurological recovery after cervical myelopathy surgery. Conclusion: The good conducts of functional rehabilitation sessions as well as a mild myelopathy were the factors favouring neurological recovery.

关键词： Spinal Spondylosis Medullary Compression myelopathy

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Clinical Outcome after Laminectomy without Fusion for Cervical Spondylotic myelopathy

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Open Journal of Modern Neurosurgery 2015年第2期5卷 41-48页

作者： Kerstin Woernle Serge Marbacher Abdussalam Khamis Hans Landolt Javier Fandino Department of Neurosurgery Kantonsspital Aarau Aarau Switzerland

Dorsal decompression in patients, presenting with cervical spondylotic myelopathy with no signs of instability, is a standard surgical option. Laminectomy or laminoplasty is applied to reduce the pressure on the myelon. The aim of this study was to evaluate the clinical outcome in a consecutive series of patients. This retrospective study included a total of 65 patients who underwent laminectomy or laminoplasty at a single or more levels, without fusion for cervical spondylotic myelopathy, during an 8-year period (2000-2007). The clinical data evaluation included pre- and postoperative patient history and neurological and surgical variables. The radiological assessment included MRI, CT, and plain anterior-posterior, lateral, and lateral flexion-extension X-rays. The mean follow-up time was 15 months. Improvement of gait disturbance was documented in 74% of the patients concerned. Radicular pain in the upper limbs (UL) and lower limbs (LL) improved in 87% and 50% of the patients, respectively. Sensory deficits improved in the UL and LL in 76% and 54%, respectively. Motor deficits improved in the UL and LL in 70% and 56% of the patients, respectively. Clinical deterioration after surgery was documented in one patient. Based on our results, laminectomy without fusion can be advocated as a safe and effective surgical strategy to treat cervical spondylotic myelopathy in patients without preoperative instability. In these patients, the occurrence of post-procedural clinical deterioration and instability was low, and overall improvement of neurological deficits and amelioration of radicular pain can be expected in a significant number of patients.

关键词： Cervical myelopathy Cervical Spine Laminectomy Outcome Surgical Technique

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The Surgical Approaches of Cervical Spondylotic myelopathy and the Predictive Factors for the Surgical Outcomes

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International Journal of Clinical Medicine 2011年第2期2卷 158-165页

作者： Jia Liu Xi-jing He Li Zhang Hao-peng Li Si-yue Xu 不详

Objective To explore the efficacy and safety of different surgical approaches of cervical spondylotic myelopathy, and the predictive factors for the outcome of surgery. Methods Clinical data of 68 consecutive patients who underwent surgical treatment from 2003-08-01 to 2006-12-01 were collected. The quantization of the efficacy of operation was made by applying Japanese Orthopedic Association (JOA) scoring system, based on which the recovery rate and satisfaction rate were calculated. In the patients who underwent anterior approach, we compared the recovery rate among the subgroups of different duration of symptoms, age at surgery and the severity of diseases. Any surgery-related complications were also noted. Results 73.5% (50/68) patients underwent anterior approach, with an average recovery rate of (68.21 ± 10.06)% and the satisfaction rate of 88.00%;20.6% patients (14/68) underwent posterior approach, with an average recovery rate of (64.03 ± 7.07)% and the satisfaction rate of 100%. The recovery rate had no significant difference in the two approaches. Only 4 patients (5.9%) underwent anterior and posterior combined approach, and the recovery rate and the satisfaction rate were 65.10% and 100%, respectively. In the group of patients who accepted anterior approach, no significant differences were found in the recovery rates of different age subgroups and different duration of symptom subgroups;the significant differences recovery rates between the moderate and severe subgroups were identified. Minor complications, such as asymptomatic screw misplacement, transient dysphagia/odynophagia, pain related to the donor site and axial syndrome, were observed in a few patients. Conclusion The JOA score can be improved by applying the appropriate approaches and the high recovery and satisfaction rates can be achieved at the same time. The efficacies of anterior and posterior approaches were similar. The complications of surgery were minor. In the patients who underwent an

关键词： Cervical Spondylosis myelopathy Surgery Anterior Posterior

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Application of magnetic resonance imaging in cervical spondylotic myelopathy

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World Journal of Radiology 2014年第10期6卷 826-832页

作者： Chuan Zhang Sushant K Das Dong-Jun Yang Han-Feng Yang Department of Radiology Affiliated Hospital of North Sichuan Medical College

Cervical spondylotic myelopathy(CSM) is the most common cause of spinal cord dysfunction and is caused by static or dynamic repeated compression of the spinal cord resulting from degenerative arthritis of the cervical spine and some biological injuries to the cervical spine. The T2 signal change on conventional magnetic resonance imaging(MRI) is most commonly associated with neurological deficits. Diffusion tensor imaging and MR spectroscopy show altered microstructure and biochemistry that reflect patient-specific pathogenesis and can be used to predict neurological outcome and response to intervention. Functional MRI can help to assess the neurological functional recovery after decompression surgery for CSM.

关键词： Cervical spondylotic myelopathy Magnetic resonance imaging Diffusion tensor imaging Magnetic resonance spectroscopy Functional magnetic resonance imaging

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Human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis: Clinical presentation and pathophysiology

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World Journal of Neurology 2015年第3期5卷 68-73页

作者： Jean-Pierre Louboutin Department of Basic Medical Sciences University of the West Indies Mona Campus

Human T-cell lymphotropic virus type 1(HTLV-1)-associated myelopathy/tropical spastic paraparesis(HAM/TSP) is a slowly progressive neurodegenerative disorder in which lesions of the central nervous system cause progressive weakness, stiffness, and a lower limb spastic paraparesis. In some cases, polymyositis, inclusion bodymyositis, or amyotrophic lateral sclerosis-like syndromes are associated with HTLV-1. TSP was first described in Jamaica in 1888 and known as Jamaican peripheral neuritis before TSP was related to HTLV-1 virus, the first retrovirus being identified, and the disease is since named HAM/TSP. There is no established treatment program for HAM/TSP. Prevention is difficult in lowincome patients(i.e., HTLV-1 infected breast feeding mothers in rural areas, sex workers). Thus, there is a need for new therapeutic avenues. Therapeutic approaches must be based on a better understanding, not only of clinical and clinicopathological data, but also of the pathophysiology of the affection. Consequently, a better understanding of existing or newly developed animal models of HAM/TSP is a prerequisite step in the development of new treatments.

关键词： Tropical spastic paraparesis Human T-cell lymphotropic virus type-1 Polymyositis Animal models Retroviruses myelopathy Human T-cell lymphotropic virus type 1-associated myelopathy Pathogenesis

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