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paraplegia from spinal intramedullary tuberculosis:A case report

World Journal of Clinical Cases 2020年第24期8卷 6353-6357页

作者： Li-Mei Qu Di Wu Liang Guo Jin-Lu Yu Department of Pathology The First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina Department of Neurosurgery The First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina

BACKGROUND Tuberculosis (TB) mostly attacks the lungs, and extrapulmonary TB involving thecentral nervous system is uncommon;among these cases, spinal intramedullaryTB is even more rare. The clinical manifestations of spinal intramedullary TB aresimilar to those of intramedullary spinal cord tumors. Therefore, it is necessary tomake a careful differential diagnosis of spinal intramedullary lesions to achievethe appropriate treatment and favorable prognosis. We report a rare case of ayoung male patient with paraplegia due to spinal intramedullary TB, which isuncommon and *** SUMMARY A 23-year-old male presented with fever accompanied by nausea and vomitinglasting for 2 mo and was then diagnosed with tubercular meningitis. After anti-TBtreatment, his symptoms were significantly improved. However, 2 mo after thediagnosis of tubercular meningitis, the patient felt numbness below the costal archlevel, which lasted for 1 wk, and he paid no attention to this symptom. Whatfollowed was paraplegia and urine/fecal incontinence. Magnetic resonanceimaging of the thoracic spine showed a ring-enhanced intramedullary cord lesionat T8-T9. Lesion exploration showed enlargement of the spinal cord at T8-T9, andthe lesion could be observed by incision. The lesion was adhered to the peripheraltissue and was grayish-white and tough with a poor blood supply and a diameterof approximately 0.8 cm. The lesion was resected completely. The results ofpathological examination by both hematoxylin-eosin staining and acid-fast bacillistaining confirmed TB, accompanied by acute and chronic suppurativeinflammation and granulation tissue formation. The patient was instructed tocontinue anti-TB treatment after the operation, but he did not follow the medicaladvice. Follow-up continued for ten years, the patient had persistent paraplegia,the numbness disappeared and urine/fecal sensation *** Although TB is a kind of benign disease, some cases progress rapidly. Moreover,spina

关键词： Tuberculosis Intramedullary Extrapulmonary Central nervous system paraplegia Case report

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Novel ATL1 mutation in a Chinese family with hereditary spastic paraplegia: A case report and review of literature

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World Journal of Clinical Cases 2019年第11期7卷 1358-1366页

作者： Xue-Wen Xiao Juan Du Bin Jiao Xin-Xin Liao Lu Zhou Xi-Xi Liu Zhen-Hua Yuan Li-Na Guo Xin Wang Lu Shen Zhang-Yuan Lin Department of Neurology Xiangya Hospital Central South University Changsha 410008 Hunan Province China National Clinical Research Center for Geriatric Disorders Xiangya Hospital Central South University Changsha 410008 Hunan Province China Key Laboratory of Hunan Province in Neurodegenerative Disorders Central South University Changsha 410008 Hunan Province China Department of Geriatrics Neurology Xiangya Hospital Central South University Changsha 410008 Hunan Province China Key Laboratory of Organ Injury Aging and Regenerative Medicine of Hunan Province Changsha 410008 Hunan Province China Department of Orthopedics Xiangya Hospital Central South University Changsha 410008 Hunan Province China

BACKGROUND Hereditary spastic paraplegias (HSPs) refer to a group of heterogeneous neurodegenerative diseases characterized by lower limbs spasticity and weakness. So far, over 72 genes have been found to cause HSP (SPG1-SPG72). Among autosomal dominant HSP patients, spastic paraplegia 4 (SPG4/SPAST) gene is the most common pathogenic gene, and atlastin-1 (ATL1) is the second most common one. Here we reported a novel ATL1 mutation in a Chinese spastic paraplegia 3A (SPG3A) family, which expands the clinical and genetic spectrum of ATL1 mutations. CASE SUMMARY A 9-year-old boy with progressive spastic paraplegia accompanied by right hearing loss and mental retardation for five years was admitted to our *** history was unremarkable. The family history was positive, and his grandfather and mother had similar symptoms. Neurological examinations revealed hypermyotonia in his lower limbs, hyperreflexia in knee reflex, bilateral positive Babinski signs and scissors gait. The results of blood routine test, liver function test, blood glucose test, ceruloplasmin test and vitamin test were all normal. The serum lactic acid level was significantly increased. The testing for brainstem auditory evoked potential demonstrated that the right side hearing was impaired while the left was normal. Magnetic resonance imaging showed mild atrophy of the spinal cord. The gene panel test revealed that the proband carried an ATL1 c.752A>G ***251Arg (p.Q251R) mutation, and Sanger sequencing confirmed the existence of family co-segregation. CONCLUSION We reported a novel ATL1 Q251R mutation and a novel clinical phenotype of hearing loss in a Chinese SPG3A family.

关键词： Hereditary spastic paraplegia SPG3A Atlastin-1 (ATL1) gene Hearing loss Case report

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Clinical presentation of gastric Burkitt lymphoma presenting with paraplegia and acute pancreatitis:A case report

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World Journal of Gastroenterology 2021年第45期27卷 7844-7854页

作者： Ying Lin Yu-Hang Pan Ming-Kai Li Xiao-Dan Zong Xue-Mei Pan Shu-Yan Tan Yun-Wei Guo Department of Gastroenterology The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630Guangdong ProvinceChina Department of Pathology The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630Guangdong ProvinceChina

BACKGROUND The incidence of gastric Burkitt lymphoma(BL),presenting as paraplegia and acute pancreatitis,is extremely *** is a great masquerader that presents in varied forms and in atypical locations,and it is prone to misdiagnosis and missed *** prognosis of BL remains poor because of the difficulty in early diagnosis and the limited advances in *** SUMMARY A 53-year-old man was referred to our hospital from the local county hospital due to abdominal pain for two weeks and weakness in the lower extremities for one *** resonance imaging of the abdomen and lumbar spine showed a swollen pancreas and gallbladder,with peripancreatic exudation and liquid collection,indicating acute pancreatitis and acute ***,we observed abnormally thickened lesions of the gastric wall,multiple enlarged retroperitoneal lymph nodes and a well-demarcated,posterolateral extradural mass lesion between T9 and T12,with extension through the spinal foramen and definite bony destruction,suggesting metastasis in gastric *** whole-body positron emission tomography/computed tomography examination showed multifocal malignant lesions in the stomach,pancreas,gallbladder,bone,bilateral supraclavicular fossa,anterior mediastinum,bilateral axillary and retroperitoneal lymph *** endoscopy revealed primary BL with massive involvement of the gastric body and *** patient refused chemotherapeutic treatment and died one week later due to upper gastrointestinal ***,we reviewed the characteristics of 11 patients with BL involving the stomach,pancreas or spinal *** Clinicians should be aware that BL can be the potential cause of acute pancreatitis or a rapidly progressive spinal tumor with accompanying *** gastric BL,gastroscopy biopsies and pathology are necessary for a definite diagnosis.

关键词： Burkitt lymphoma paraplegia Acute pancreatitis Case report

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Diagnosis and treatment of spinal fractures combined with paraplegia and diaphragm injury

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Chinese Journal of Traumatology 2001年第3期4卷 168-171页

作者：俞学中梁刚柴莹 DepartmentofOrthopaedics SecondAffiliatedHospitalMedicalCollegeZhejiangUniversityHangzhou310009

Objective: To study the mechanism and treatment principle of spinal fractures combined with paraplegia and diaphragm injury. Methods: A total of 16 patients (14 males and 2 females, aged from 18 to 50 years) with spinal fractures combined with paraplegia and diaphragm injury, receiving emergency treatment and admitted to our hospital in the past 20 years, were retrospectively analyzed in this study. Results: The injuries were caused by direct or indirect violence. Six cases were of fractures of cervical spine combined with paraplegia and diaphragm injury, 2 of fractures of thoracic vertebra combined with paraplegia and diaphragm injury, and 8 of thoracolumbar fractures combined with paraplegia and diaphragm injury. Six cases received non operative treatment, but died finally. Ten cases received spine surgical treatment, of which 4 died and 6 were improved. The total mortality rate was 62.5 %. Conclusions: Spinal fractures combined with paraplegia and diaphragm injury are one of the most severe traumas in departments of orthopaedics. paraplegia can be found easily, but diaphragm injury is often neglected and missed. When a patient suffers from both of them, he is in danger of death. What measures should be taken to rescue the patients life depends on the severity of the wounds.

关键词： Spinal fractures paraplegia Diaphragm

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ACUPUNCTURE TREATMENT OF COMPLETE TRAUMATIC paraplegia——Analysis of 261 Cases

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Journal of Traditional Chinese Medicine 1996年第2期16卷 134-137页

作者：高锡朋高晨明高金翠韩成刚韩飞韩冰韩凌 Paralysis Institute Yuci 030610 Shanxi Province Shanxi Medical College Guangzhou College of TCM

Traumatic paraplegia is commonly seenin cases with the spinal cord injured. Basedon the significant therapeutic effectivenessobtained from our acupuncture treatment offacial paralysis. monoplegia. hemiplegia andmultip... 详细信息

关键词： Acupuncture Therapy Acupuncture Points Adolescent Adult Aged Child Child, Preschool Female Humans Infant Male Middle Aged paraplegia Spinal Cord Injuries Yang Deficiency

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paraplegia by Acute Cervical Disc Herniation after Shoulder Arthroscopic Surgery in Beach-Chair Position

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Open Journal of Anesthesiology 2018年第11期8卷 280-283页

作者： Hye Young Kim Gang Han Jung Anesthesiology and Pain Medicine College of Medicine Chungju Hospital Konkuk University Seoul South Korea

paraplegia after non-cervical spine surgery under general anesthesia is a rare devastating postoperative complication [1]. A patient with shoulder pain was scheduled for shoulder arthroscopy due to rotator cuff repair. Arthroscopic shoulder surgery was performed with the patient in the beach-chair. Postoperatively, patients complained the weakness of both lower leg and marked numbness and tingling in the both arms. MRI showed a herniated intervertebral disc between C6 and C7 with spinal cord compression. Despite urgent discectomy, the patient remained dysesthesia of both upper extremities for 6 months. The purpose of this report is to introduce our case with a paraplegia observed after arthroscopic shoulder surgery in beach-chair position because of acute cervical herniation.

关键词： Beach Chair Position paraplegia Shoulder Arthroscopy

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Acute paraplegia following embolization of spinal dural arteriovenous fistula

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Chinese Medical Journal 2011年第4期124卷 634-636页

作者： HUANG Cheng-guang QI Xiang-qian CHEN Huai-rui LU Li-quan WU Xiao-jun BAI Ru-lin LU Yi-cheng Department of Neurosurgery Shanghai Changzheng HospitalShanghai 200003 China

Embolization therapy has been used as the initial treatment for spinal dural arteriovenous fistula （SDAVF） only for certain patients or in certain medical institutions due to its minimal invasiveness, but the recurrence of embolization remains a clinical challenge. The recurrent patient usually exhibits a gradual onset of symptoms and progressive deterioration of neurological function. Developing paraplegia several hours after embolization is commonly seen in patients with venous thrombosis-related complications, for which anticoagulation therapy is often administered. This article reports on a SDAVF patient who had weakness of both lower extremities before embolization and developed complete paraplegia several hours after embolization therapy, later confirmed by angiography as fistula recurrence. The symptoms were relieved gradually after second embolization. The pathophysiology of this patient is also discussed.

关键词： spinal cord arteriovenous fistula paraplegia embolization, therapeutic recurrence

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paraplegia due to ossification of the ligamentum flavum and calcified spinal meningioma in a scoliotic patient:a first-time report

Paraplegia due to ossification of the ligamentum flavum and ...

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浙江省神经科学学会-神经外科分会成立大会&2015钱江...

作者：周衡俊钟江涛郑杰胜巴晓群詹仁雅浙江大学医学院附属第一医院神经外科浙江大学医学院附属第一医院病理科

Background:Ossification of the ligamentum flavum(OLF) was first described by Polgar;subsequently,many cases of myelopathy caused by OLF have been reported,particularly in the past 30 *** spinal meningioma(CSM) resulting in myelopathy is an extremely rare and infrequently reported *** our knowledge,there are no previous reports of cases involving both OLF and CSM resulting in *** report:A 70-year-old female presenting with progressive numbness of the lower extremities and walking difficulties was diagnosed with occupying lesions inside the spinal canal.T10-11 decompressive laminectomy with ossified ligamentum flavum(OLF) excision and T7-8 laminotomy with complete tumor excision were performed.A postoperative neurological examination revealed marked *** examination revealed chondrocyte-like cells in the OLF and very large,calcified psammoma bodies in the spinal *** patient was able to walk with a crutch at the 1-year ***:The coexistence of OLF and CSM resulting in myelopathy is extremely *** manifestations of OLF and CSM include lower extremity weakness,back and leg pain,and gait *** and CT are recommended for the detection of *** resection,such as decompressive laminectomy,is effective for decompressing the spinal cord;however,the exact pathophysiology of coexisting OLF and CSM requires further research.

关键词： paraplegia ossification of ligamentum flavum(OLF) calcified spinal meningioma(CSM)

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A Case of Cerebrospinal Drainage for paraplegia Complicated by Acute Aortic Dissection (Stanford B) Followed by TEVAR in the Subacute Phase

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Case Reports in Clinical Medicine 2023年第5期12卷 133-138页

作者： Masatsugu Shimizu Toshifumi Saga Ryuji Tominaga Department of Cardiovascular Surgery Shin-Kuki General Hospital Saitama Japan

The patient is 50-year-old man. He was admitted to our hospital with a strong back pain and diagnosed as an acute type B aortic dissection. On the second day of hospitalization, he developed symptoms of paraplegia, and we considered TEVAR, but we were concerned that TEVAR intervention in the acute phase might worsen the dissection, so we first placed a cerebrospinal drainage (CSFD) device, which resulted in improvement of his symptoms. Thereafter, although his lower limb mobility was fine, he underwent thoracic stent graft aortic repair (TEVAR) in the subacute phase due to worsening ULP. The patient had a good postoperative course and was discharged home unassisted. The initial placement of CSFD was effective in reducing the incidence of paraplegia as a complication of TEVAR and in bringing the timing of TEVAR intervention from the acute phase to the subacute phase.

关键词： Aortic Dissection paraplegia Cerebrospinal Drainage TEVAR

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Unexpected Postoperative paraplegia after Thoracotomy in Lung Cancer: Incidental Migration of Oxidized Regenerated Cellulose Used for Hemostasis of Intercostal Space Bleeding

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Surgical Science 2017年第8期8卷 365-374页

作者： Takanori Ayabe Masaki Tomita Shigeko Shimizu Etsuko Yokoyama Manabu Okumura Koichiro Itai Kunihide Nakamura Division of Thoracic and Breast Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan Division of Patient Safety Management University of Miyazaki Hospital Miyazaki Japan Division of Clinical Ethics University of Miyazaki Hospital Miyazaki Japan Division of Cardiovascular Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan

Background: We experienced a very rare complication, that is, an unexpected postoperative paraplegia due to the incidental migration of oxidized regenerated cellulose used for hemostasis of intercostal space bleeding. Patients and Methods: The objective is to analyze the cause and to take measures against the very rare complication from an empirical analysis and the literature. For a 78-year-old male with suspected lung cancer in the right upper lobe (S1), a thoracotomy was performed. For hemostasis of the bleeding from the 5th intercostal thoracotomy space, we used and placed oxidized regenerated cellulose at the continuous oozing bleeding sites. On the 3rd postoperative day, paralysis beneath thoracic vertebrae level 6 was observed. Immediate computed-tomographic (CT) scanning and magnetic resonance imaging (MRI) displayed a 17 × 9 × 14 mm epidural hematoma in the spinal canal at level 5 of the thoracic vertebrae. An emergent laminectomy for the thoracic vertebra was performed to remove the oxidative cellulose and haematoma, and the compression was released. The paraplegia gradually began to recover and maintain a standing position. After 1 year from the event, the patient can walk by himself with a crutch. Results: The causes were that the oxidative cellulose materials were used for the intercostal bleeding at the open thoracotomy. The migration of the oxidative cellulose materials into the epidural space and into thoracic spinal canal through the intervertebral foramen, or gradual penetration of the oxidative cellulose materials into the spinal canal due to respiratory costal movement. As a measurement of prevention, the hemostat materials should be completely removed after finishing of the hemostasis. In the case of a difficult hemostasis, consultation of an orthopedist or neurosurgeon to perform the appropriate hemostasis in good cooperation is required. Conclusion: If postoperative paraplegia is suspected, immediate CT scanning and/or MRI examination would be

关键词： Lung Cancer Incident Oxidized Regenerated Cellulose Migration Thoracotomy Intercostal Space Bleeding paraplegia

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