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Sensorimotor integration in the trunk system is poorly understood despite its importance for functional recovery after neurological injury. To address this, a series of mapping studies were performed in the rat. First, the receptive fields (RFs) of cells recorded from thoracic dorsal root ganglia were identified. Second, the RFs of cells recorded from trunk primary sensory cortex (S1) were used to assess the extent and internal organization of trunk S1. Finally, the trunk motor cortex (M1) was mapped using intracortical microstimulation to assess coactivation of trunk muscles with hindlimb and forelimb muscles, and integration with S1. Projections from trunk S1 to trunk M1 were not anatomically organized, with relatively weak sensorimotor integration between trunk S1 and M1 compared to extensive integration between hindlimb S1/M1 and trunk M1. Assessment of response latency and anatomical tracing suggest that trunk M1 is abundantly guided by hindlimb somatosensory information that is derived primarily from the thalamus. Finally, neural recordings from awake animals during unexpected postural perturbations support sensorimotor integration between hindlimb S1 and trunk M1, providing insight into the role of the trunk system in postural control that is useful when studying recovery after injury.

Introduction: This case report outlines a 38 week gestation, multigravida woman scheduled for elective caesarean section, with a history of spina bifida, associated neurological deficit, and a history of difficult intubation during her previous caesarean. This case describes successful anaesthesia for subsequent elective Caesarian section using an epidural technique with no associated complications. Case report: 36-year-old woman, G3P2, whose obstetric history included two prior emergency caesarean sections for IUGR and major placenta praevia. During her second caesarean, difficulty was encountered during intubation, where anaesthetists were able to obtain a view using the CMAC D-blade but difficulty feeding the endotracheal tube. She was seen at a tertiary hospital obstetric anaesthesia high risk clinic and both general anaesthesia (GA) and epidural options discussed. An MRI of her lumbosacral spine showed a low tethered cord, with the lowest margin of the cord at the mid-S2 level. On the day of surgery an epidural technique was agreed upon by the patient and anaesthetic team, after informed consent was obtained. After preparing the patient's back with antiseptic wash, and local anaesthesia was applied to skin, an 18gauge Touhy needle was used to locate the epidural space using a loss of resistance to saline technique. After single pass, the space was located at 5.5cm, and the catheter fed and secured. After negative aspiration of cerebrospinal fluid or blood was confirmed, a test dose of 0.2% Ropivacaine was injected via an epidural filter. Further increments of 5mL of 0.2% Ropivacaine + 2mcg/mL Fentanyl was used until adequate block was obtained to the T4 dermatome. A total of 15mL of solution provided adequate anaesthesia. Surgery was completed with no associated complications. Discussion(s): Spina bifida occulta is the most common neural tube defect, with an incidence of roughly 20%, and often is an incidental finding. Features of the disease that can impact ou

Introduction: This case report outlines a 38 week gestation, multigravida woman scheduled for elective caesarean section, with a history of spina bifida, associated neurological deficit, and a history of difficult intubation during her previous caesarean. This case describes successful anaesthesia for subsequent elective Caesarian section using an epidural technique with no associated complications. Case report: 36-year-old woman, G3P2, whose obstetric history included two prior emergency caesarean sections for IUGR and major placenta praevia. During her second caesarean, difficulty was encountered during intubation, where anaesthetists were able to obtain a view using the CMAC D-blade but difficulty feeding the endotracheal tube. She was seen at a tertiary hospital obstetric anaesthesia high risk clinic and both general anaesthesia (GA) and epidural options discussed. An MRI of her lumbosacral spine showed a low tethered cord, with the lowest margin of the cord at the mid-S2 level. On the day of surgery an epidural technique was agreed upon by the patient and anaesthetic team, after informed consent was obtained. After preparing the patient's back with antiseptic wash, and local anaesthesia was applied to skin, an 18gauge Touhy needle was used to locate the epidural space using a loss of resistance to saline technique. After single pass, the space was located at 5.5cm, and the catheter fed and secured. After negative aspiration of cerebrospinal fluid or blood was confirmed, a test dose of 0.2% Ropivacaine was injected via an epidural filter. Further increments of 5mL of 0.2% Ropivacaine + 2mcg/mL Fentanyl was used until adequate block was obtained to the T4 dermatome. A total of 15mL of solution provided adequate anaesthesia. Surgery was completed with no associated complications. Discussion(s): Spina bifida occulta is the most common neural tube defect, with an incidence of roughly 20%, and often is an incidental finding. Features of the disease that can impact ou

Disseminated herpes zoster is defined as the presence of more than 20 lesions outside the dermatome. This unusual presentation is more common in immunosuppressed patients. Complications such as hepatitis, encephalitis, and pneumonitis are more likely in individuals with disseminated varicella zoster virus infection.A 63-year-old woman being treated for breast cancer developed multiple pustules and vesicles days after starting doxorubicin and cyclophosphamide chemotherapy. Ten individual lesions appeared on her chest, abdomen, back, and leg. Non-dermatomal disseminated herpes zoster was suspected. She was treated with oral antiviral therapy, as well as with oral and topical antibiotics. Varicella zoster virus infection was confirmed by direct fluorescent antibody staining. After one month, her skin lesions had resolved and she resumed chemotherapy.In a setting of immunosuppression, the rare presentation of disseminated herpes zoster without dermatome should be considered. Appropriate antiviral therapy should be administered while waiting for confirmation of the diagnosis, so as to reduce the risk of visceral dissemination of the varicella zoster virus infection.

Disseminated herpes zoster is defined as the presence of more than 20 lesions outside the dermatome. This unusual presentation is more common in immunosuppressed patients. Complications such as hepatitis, encephalitis, and pneumonitis are more likely in individuals with disseminated varicella zoster virus infection.A 63-year-old woman being treated for breast cancer developed multiple pustules and vesicles days after starting doxorubicin and cyclophosphamide chemotherapy. Ten individual lesions appeared on her chest, abdomen, back, and leg. Non-dermatomal disseminated herpes zoster was suspected. She was treated with oral antiviral therapy, as well as with oral and topical antibiotics. Varicella zoster virus infection was confirmed by direct fluorescent antibody staining. After one month, her skin lesions had resolved and she resumed chemotherapy.In a setting of immunosuppression, the rare presentation of disseminated herpes zoster without dermatome should be considered. Appropriate antiviral therapy should be administered while waiting for confirmation of the diagnosis, so as to reduce the risk of visceral dissemination of the varicella zoster virus infection.