Search

Background: Spinal epidural abscess (SEA) is a rare disease, difficult to detect, high defect rate, and can be lifethreatening. It is characterized by accumulation of pus in the epidural space causing suppression of the spinal cord and spinal roots. This study will describe a case of a 35-year-old man with SEA in Indonesia. Case presentation: A 35-year-old male with pain in the lumbar region 1, radicular pain according to thoracic dermatome 10, flaccid inferior paraplegia, hypoesthesia as high as thoracic dermatome 10, and retention of alviet uri due to SEA caused by Staphylococcus pseudintermedius confirmed by abscess culture. Management of this patient was through an operation, debridement, and administration of antibiotic. Conclusion: This patient was diagnosed with SEA from anamnesis, physical examination, laboratory finding, and radiology finding. This case is rarely found and is a big problem for neurologists due to the difficulty of early diagnosis.

We report the case of a 62-year-old Caucasian man, an ex-smoker, who presented to the emergency room complaining of intense lower back pain followed by immediate bilateral loss of inferior limbs motor function. Clinical examination showed complete paralysis and paranesthesia in both legs, while pain and temperature sensory examination revealed a sensory level at dermatome T6, with normal touch, vibration, and position senses. His blood pressure was 190∕100 mmHg. Computed tomography demonstrated dilated thoracic aorta (maximum diameter 44 mm) and abdominal aorta (maximum 58 mm), with extended intramural hematoma (IMH), thus establishing the diagnosis of type A aortic IMH complicated with paraplegia through spinal perfusion deficit. Due to the extension of the lesions, surgical intervention for aortic repair was considered at high risk while cerebrospinal fluid drainage was not recommended by the neurologist. The patient remained stable while hospitalized and was released from the hospital with mild improvement of neurological deficiencies.

Background: Traumatic neuromas are a result of abnormal neural regeneration after nerve injury. Neuropathic pain arising from neuroma can be debilitating. Methods: This was a retrospective review of a consecutive series of patients who presented with a painful cutaneous neuroma secondary to direct trauma or surgery. The diagnosis was made by the presence of neuropathic symptoms in the dermatome of a cutaneous nerve and a positive Tinel sign. Local anaesthetic injection was performed for confirmation of diagnosis. Each patient was offered optimisation of medical therapy and physiotherapy for desensitisation. Outpatient neuromodulation was offered as an alternative to neuroma surgery. The primary aim of treatment was symptom reduction such that neuroma surgery was no longer required. Results: This study included 50 patients with painful cutaneous neuromas. Surgery was the commonest cause. The most frequently injured nerves were superficial radial nerve, digital nerve and dorsal ulnar cutaneous nerve, together comprising over 60% of cases. After receiving neuromodulation, 18 (36%) patients experienced sufficient symptom relief and did not wish to pursue neuroma surgery. Conclusions: Surgery is the commonest cause of a painful cutaneous neuroma. Following optimisation of pharmacotherapy and physiotherapy, neuromodulation may offer symptom relief such that neuroma surgery may be avoided in approximately one third of cases.

Introduction Intramedullary spinal epidermoid cysts have a reported incidence of less than 1% of intramedullary spinal cord tumors; and out of these, intramedullary epidermoid lesions within the cervical spinal cord are even rarer. Here, we present the case of an adult patient with an infected intramedullary epidermoid cyst, identified on magnetic resonance imaging (MRI) at the C7–D1 level that was successfully excised without any worsening of neurological status. Case Presentation A 23-year-old female patient presented with history of moderate degree intermittent fever followed by gradually progressive right-sided weakness. She had paresthesia below C5 dermatome on the right side. On close inspection of the back, a tiny sinus opening was noted at the D2 level near the midline. MRI of the spine showed an intramedullary lesion at the C6–D1 level with the tract connecting to the subcutaneous lesion. Somatosensory evoked potential (SSEP) monitoring was done during the surgery with near total excision of the lesion. Conclusion Even though the location is rare, a differential diagnosis of the epidermoid should always be considered. A tiny dermal sinus opening helped us in proper diagnosis, along with surgical excision, by providing us a direct path to the intramedullary lesion. An early diagnosis and treatment with neurophysiological monitoring helped us in the maximum safe resection of the lesion without developing any new deficit.

Introduction: Herpes zoster is a very common clinical condition caused by varicella zoster virus. Few studies are done covering the aspects like clinical presentation, epidemiology of this very common yet old disease. Objective: To find out clinical presentation, morphological pattern, evolution of herpes zoster along with its comorbid conditions. Materials and Methods: This was an analytical study conducted from June 2008 to December 2016 based on a preformed proforma carried out at skin department of rural based tertiary health care center. We have used Chi square test to analyze and tabulate the data obtained. It is an Observational and cross-sectional study. Results: Total 938 patients of herpes zoster were enrolled in the study. The incidence of herpes zoster amongst skin OPD cases was found to be 0.38%. The male to female ratio was found to be 1.37:1. Herpes zoster was mainly seen in the age group of 40-60 years (33.8%). The most common prodromal symptom seen was itching in 458 cases (41.5%). Most common presenting complaint was pain in 458 patients (41.50%). The past history of chicken pox was present in 22.7% patients. The commonest segment affected was thoracic in 374 cases (38.9%). Unidermatomal involvement was seen in 886(94.5%) cases, while multidermatomal involvement was seen in 43(4.6%) cases and disseminated in 9 (0.9%) cases. All the cases were screened for HIV, out of them; 40 (4.3%) were seropositive for HIV. Conclusion: Herpes zoster more commonly occurs in the age group of 40-60 years. Most common presenting complaint is burning type of pain. Most common dermatome involved is thoracic dermatome. Keywords: Herpes Zoster, Varicella zoster virus, Dermatome.

Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis that presents with palpable purpura. The most common identified triggers of LCV are infection or exposure to a new medication. Herpes zoster (HZ) occurs as a result of the reactivation of the varicella-zoster virus (VZV). VZV is able to infect endothelial cells directly, producing a spectrum of vasculitides, including that of large and medium vessels. We report a case of a patient with synchronous HZ infection and segmental small-vessel vasculitis.

Introduction: Nuss procedure for repair of pectus excavatum leads to severe pain. The adequacy of analgesia has an influence on life quality, pain chronization and successfulness of rehabilitation.The aim of the study: comparing the effectiveness of different regional analgesia techniques in pain control after the Nuss procedure for pectus excavatum repair.Materials and methods: The observative prospective study inclueded 60 adolescents (boys/girls=47/13) randomized into three groups (n=20 in each) according to the perioperative analgesia technique: standart epidural anaesthesia in the dermatome of maximal deformity (SEA), high epidural anaesthesia in Th2-Th3 level (HEA) and bilateral paravertebral anaesthesia (PVA).Results and discussion: The average pain intensity during three postoperative days (mean [25-75 percentiles]) was in group SEA – 1,3 [0,9-1,5], in group HEA – 1,0 [0,6-2] and in group PVA – 1,2 [0,8-1,8]; and did not differ significantly between groups (Kruscal-Wallis test: Н=0,42; р=0,81). The number of episodes with pain intensity > 4 cm by 10 cm VAS, which required additive opioid analgesia, during three postoperative days was 7 in both SEA and HEA groups, and 10 – in PVA group (χ2 = 0.865, р=0,649). The deformity severity by Haller index in all patients was 3,9 [3,6-4,1]. The average pain intensity in all patients during three postoperative days was 1,22 [0,75-1,67]. There was a weak positive correlation between these two parameters (r=0,14; p=0,30). The pain intensity had no correlation with the patients age (r=0,036; p=0,78). We did not found any gender difference in pain intensity: the difference by Mann-Whitney test was insignificant (z=0,045; р=0,96).Conclusions: The standart epidural anaesthesia in the dermatome of maximal deformity, high epidural anaesthesia in Th2-Th3 level and bilateral paravertebral anaesthesia with 0,25% bupivacain in dose 4 ml/hour provide equally effective analgesia after the Nuss procedure for pectus excavatum repair. The pain intensity after Nuss procedure does not correlate with the severity of the deformity according to the Haller index.

1. Yonit Lax, MD*,† 2. Arunjot Singh, MD, MPH‡ 1. *Maimonides Medical Center, Brooklyn, NY 2. †State University of New York Downstate Medical Center, Brooklyn, NY 3. ‡Children’s Hospital of Philadelphia, Philadelphia, PA Abdominal pain is one of the most common and distressing presentations that pediatricians encounter. Up to 25% of school-age children report pain severe enough to interfere with their daily activity, requiring many to seek the assistance of their pediatrician. In approaching pain, the location, duration, onset, radiation, alleviating/exacerbating factors, and associated symptoms should all be considered. Abdominal pain is generally classified as visceral, somatoparietal, or referred. Pain may originate from intra-abdominal organs, surrounding structures, or areas outside the abdomen. Visceral pain receptors are located in the muscles and mucosa of organs and, therefore, sense an acute stretching of the structure’s wall experienced as a diffuse aching or cramping. Somatoparietal pain receptors are located in the peritoneum, muscle, and skin of the parietal region and are experienced as a sharp well-localized pain that may be alleviated in a position that relaxes the peritoneum or muscle. Referred abdominal pain occurs when the brain is unable to localize the source of discomfort due to nociceptive dorsal horn neurons receiving convergent inputs from different tissues. It is usually located in the cutaneous dermatome, sharing the same spinal cord level as the visceral inputs. This poses a diagnostic challenge because pain due to a gastrointestinal etiology may be experienced at a distant location; conversely, pain originating from a location outside the abdominal viscera may be experienced as abdominal pain. This In Brief reviews important concepts and etiologies of referred abdominal pain. Four common diagnoses that each highlight a type of referred abdominal pain are explored further: abdominal migraine, pelvic inflammatory disease (PID), peptic ulcer disease (PUD), and diabetic ketoacidosis (DKA). The Table provides a summary …

Objective To evaluate the safety and efficacy of a new topical skin ointment with natural ingredients (aloe vera, honey, and peppermint) for dressing skin graft donor sites. Design A double-blind, placebo-controlled, randomized clinical trial. Patients and intervention Researchers enrolled patients who were referred for split-thickness skin graft after burns or surgical wounds on the scalp or face area. For each patient, a thin layer of skin (depth, 0.04 mm; approximate size, less than 15 × 7 cm) was harvested from the thigh by a plastic surgeon with an electric or manual dermatome. The donor sites were divided and randomized to receive either natural ointment or petroleum jelly as a topical agent to dressing. Topical agents were applied on donor site wounds on days 0, 4, 7, and 14. Main outcome measures Wound size, pain, erythema, pruritus, patient discomfort, complications, and physician satisfaction were evaluated at each visit. Main results Among 28 patients, there was no significant difference between the two treatment agents regarding the rate of wound healing (P = .415), pain (P = .081), pruritus (P = .527), and patient discomfort (P = .616). The ointment was superior to petroleum jelly in reducing wound erythema (P = .001) and was associated with significantly better treatment satisfaction (P Conclusions The natural topical ointment investigated in this study may be an acceptable alternative to petroleum jelly in caring for split-thickness donor skin graft donor site wounds to effectively promote wound healing, prevent infection and scarring, reduce pain, and comfort the patient.

Background Spinal angiolipomas (SALs) are benign tumors that usually present a slow progressive spinal cord or radicular compression. Acute myelopathy or acute aggravated radicular syndrome are exceedingly rare. Case Description The authors report an original case with sudden aggravated radicular pain caused by hemorrhagic SALs. A 54-year-old woman presented with a 2-month history of mild back pain, and the pain was significantly aggravated after a therapeutic back massage. Neurologic examination showed pain and hyperalgesia between T4 and T7 dermatome, from back to front, just like a band. Spinal magnetic resonance imaging (MRI) showed a dorsally located epidural lesion (T4–T6) and a small intratumoral hemorrhage at the lower part of the tumor. A bilateral T4–T6 laminectomy was performed to achieve total excision of the tumors. Histologic examination showed that the tumors were composed of mature adipose tissue and vascular tissue as angiolipomas. The postoperative course was uneventful with complete neurologic recovery 4 days after the surgery. MRI at 1-year follow-up indicated no recurrence. Conclusions SALs are unusual benign tumors that are composed of mature fatty tissue and abnormal blood vessels; sudden aggravated spinal cord or radicular compression syndrome is rare. MRI is the best choice in the diagnosis of SALs. Surgery may be performed in different ways depending on the type of SALs, and the prognosis is generally good.

OBJECTIVEPostoperative C5 palsy affects 7%–12% of patients who undergo posterior cervical decompression for degenerative cervical spine pathologies. Minimal evidence exists regarding the natural history of expected recovery and variables that affect palsy recovery. The authors investigated pre- and postoperative variables that predict recovery and recovery time among patients with postoperative C5 palsy.METHODSThe authors included patients who underwent posterior cervical decompression at a tertiary referral center between 2004 and 2018 and who experienced postoperative C5 palsy. All patients had preoperative MR images and full records, including operative note, postoperative course, and clinical presentation. Kaplan-Meier survival analysis was used to evaluate both times to complete recovery and to new neurological baseline—defined by deltoid strength on manual motor testing of the affected side—as a function of clinical symptoms, surgical maneuvers, and the severity of postoperative deficits.RESULTSSeventy-seven patients were included, with an average age of 64 years. The mean follow-up period was 17.7 months. The mean postoperative C5 strength was grade 2.7/5, and the mean time to first motor examination with documented C5 palsy was 3.5 days. Sixteen patients (21%) had bilateral deficits, and 9 (12%) had new-onset biceps weakness; 36% of patients had undergone C4–5 foraminotomy of the affected root, and 17% had presented with radicular pain in the dermatome of the affected root. On univariable analysis, patients’ reporting of numbness or tingling (p = 0.02) and a baseline deficit (p < 0.001) were the only predictors of time to recovery. Patients with grade 4+/5 weakness had significantly shorter times to recovery than patients with grade 4/5 weakness (p = 0.001) or ≤ grade 3/5 weakness (p < 0.001). There was no difference between those with grade 4/5 weakness and those with ≤ grade 3/5 weakness. Patients with postoperative strength < grade 3/5 had a < 50% chance of achieving complete recovery.CONCLUSIONSThe timing and odds of recovery following C5 palsy were best predicted by the magnitude of the postoperative deficit. The use of C4–5 foraminotomy did not predict the time to or likelihood of recovery.

Highlights • Osteochondroma is the most common type of bone tumor. • It rarely arises on the cervical spine. • It rarely occurs in the elderly. • Although rare, it may be considered as a differential diagnosis of radiculopathy among the elderly., Introduction Osteochondroma is the most prevalent type of bone tumour, often arising in the long bones. Most are found in the third decade of life, and rarely in the axial skeleton of elderly patients. This case report aims to highlight the possibility of this differential diagnosis in an elderly patient with symptoms of radiculopathy, aside from degenerative cause. Presentation of case A 76-years-old woman presented to the authors’ hospital with complaints of pain and numbness of the left suboccipital and preauricular region. There was hypoesthesia of left C2 and C3 dermatome without any signs of myelopathy. CT-scan and MRI showed an expansile bone lesion from the posterior arch of C1 and lamina of C2. The patient underwent laminectomy of C1 and hemilaminectomy of C2. Postoperative histopathologic examination showed the features of osteochondroma. Radiologic follow-up after nine months showed no sign of recurrence. After eighteen months, the patient was ambulatory with complaints of fingers numbness and moderate neck pain. Discussion Osteochondroma usually arises in long bone metaphysis. This lesion normally ceases to grow with growth plate closure, but other findings suggest it may continue to grow beyond skeletal maturity. About 29.5% of all osteochondroma of the spine would cause radiculopathy, and 27% would cause myelopathy. The cervical spine osteochondroma is usually treated by en bloc resection through posterior approach. Conclusion Osteochondroma of the cervical spine in the elderly is rare. However, this diagnosis could be considered as a possible cause of radiculopathy in this age group aside from other degenerative causes.

Herpes zoster (HZ) affects approximately 1 in 3 persons in their lifetime, and the risk of HZ increases with increasing age. The most common, debilitating complication of HZ is the chronic neuropathic pain of postherpetic neuralgia (PHN). Two herpes zoster vaccines, a live-attenuated varicella-zoster virus (VZV) vaccine (zoster vaccine live [ZVL]; ZOSTAVAX [Merck]) and an adjuvanted VZV glycoprotein E (gE) subunit vaccine (recombinant zoster vaccine [RZV]; SHINGRIX [GlaxoSmithKline]) are licensed for the prevention of HZ and PHN in healthy older adults. The safety and efficacy of both vaccines has been demonstrated in clinical trials in immunocompetent adults and in selected immunocompromised persons and persons with immune-mediated diseases. Numerous real-world effectiveness studies have confirmed the safety and effectiveness of both ZVL and RZV. Recombinant zoster vaccine (RZV) is more effective for prevention of HZ than ZVL. Recombinant zoster vaccine is nonreplicating and is thus safe in immunocompromised persons. Additional zoster vaccines are in different stages of development. Wider distribution of safe and effective zoster vaccines will improve the health and well being of the rapidly growing population of older adults around the world.

Background and Aims Etiologic evaluation of postoperative neurologic lesions after regional techniques can be challenging. We present a case of a neurologic lesion after a gynecologic procedure under combined epidural and general anesthesia. Methods Forty-one-year-old female, ASA I, scheduled for abdominal hysterectomy. Epidural catheter was placed before surgery at L3-L4: linear and atraumatic technique, without pain/paresthesia and a negative 0.375% ropivacaine test dose. The surgery lasted 2h in supine position. Gosset retractors were used. In postoperative care unit, a 0.2% ropivacaine bolus (10 ml) was performed and 0.16% ropivacaine epidural perfusion (5.2 ml/h) was connected. Motor block at discharge: Bromage II. Results Twenty-four-hours after surgery epidural perfusion was stopped due to proximal right inferior limb paresthesia and hemiparesis. These complaints persisted and a formal neurological evaluation was performed, documenting decrease segmental strength and allodynia at L3-L4 distribution and hypoesthesia at L5 dermatome. Radiologic evaluation (head/lumbar spine CT and MRI) excluded acute complications. Electromyography revealed decreased motor response on right femoral nerve territory: absent motor activity on vastus-medialis and rectus-femoris muscles; mild signs of active denervation. Physical rehabilitation resulted in progressive improvement of motor deficit. Two months after, hypoesthesia of L2-L4 territory persisted. Conclusions Radiculopathy is a complication of 2.19/10000 epidurals. It can be a consequence of mechanical lesions or neurotoxicity. With a linear epidural technique and normal imaging, the first seems unlikely, but neurotoxicity cannot be excluded. On the other hand, the use of static retractors can cause mechanical or ischemic femoral nerve lesions. Regardless of the etiology, early recognition and implementation of motor rehabilitation programs are crucial.

Herpes zoster (HZ) is a painful rash caused by the reactivation of the varicella-zoster virus (VZV) permanently latent within the cranial or dorsal root ganglia. Usually the rash presents in only one side of the body, in a single dermatome or restricted to a part of it. In immunocompromised patients, more than one contiguous unilateral dermatome, called multidermatomal HZ, has been described, usually in cervical dermatomes. Bilateral rash is rare. Besides immunosuppression, the major risk factors for virus reactivation are older age and female gender. This is a case of a bilateral lumbar multidermatomal HZ in an elderly woman with chronic renal failure.

Background The scalp, an excellent donor site for thin skin grafts, presents a limited surface but is rich in stem cells. The purpose of this study was to test a double harvesting procedure from the scalp and to evaluate the capacity of the dermal layer. Methods Two layers corresponding to a split-thickness skin graft (SSG) and a split-thickness dermal graft (SDG) were harvested from the scalp using a Zimmer dermatome during the same procedure. Healing of the scalp donor site, reason for recipient site grafting, and the percentage of graft loss were evaluated. Results Fourteen patients, comprising six men and eight women with a mean age of 34.2 years, were treated according to our protocol. The most common reason for a recipient site graft was a postburn scar deformity (10/14 patients). The mean area of scalp SSGs was 151.8 cm2. The mean area of scalp SDGs was 88.2 cm2. The mean healing time of scalp donors was 9.9 days. The only donor complication was a tufted scar deformity. Conclusions Skin defects in the scalp of donors healed faster and led to less scarring than defects at other donor sites. Scalp SDGs needed 10 days for adequate epithelization. The scalp was the best donor site for SSGs and SDGs for burn reconstructive patients.

Segmental nevus depigmentosus and segmental vitiligo can be difficult to differentiate from each other. Differential diagnosis of these two diseases is important because they have significantly different prognoses and psychological effects. The purpose of this study is to identify clinical clues that may be helpful in differentiating these two diseases. We enrolled 63 patients with segmental nevus depigmentosus and 149 patients with segmental vitiligo. Sex, age of onset, sites involved, dermatomal distribution, margin of lesion and presence of poliosis were evaluated in both groups. The age of onset was less than 10 years in 96.8% of segmental nevus depigmentosus and 28.9% of segmental vitiligo cases. Trunk (36.5%) and cervical (38.1%) dermatomes were the most commonly involved in segmental nevus depigmentosus and face (67.1%) and trigeminal (64.4%) dermatomes in segmental vitiligo. The average number of dermatomes involved in truncal lesions was different in segmental nevus depigmentosus and segmental vitiligo (2.71 vs 1.62, P = 0.001). Segmental vitiligo on the face, neck and trunk appeared closer to the axis than segmental nevus depigmentosus (P < 0.001). Segmental nevus depigmentosus and segmental vitiligo showed significantly different margins (90.5% and 41.6% serrated, respectively; P < 0.001). We observed clinical differences between patients with segmental nevus depigmentosus and those with segmental vitiligo. Distribution (site, distance to axis, dermatome), vertical width, margin of lesion and presence of poliosis can be helpful in differentiating segmental nevus depigmentosus and segmental vitiligo.

The aim of this case report is to demonstrate the robot-assisted laparoscopic decompression approach to treat the aberrant vessels entrapping the sacral nerves causing pelvic pain. A 34-year-old female patient had been complaining about pelvic pain on the left perineal region which was radiating to the sacral 1-2 nerves dermatome for 3 years. Decompression of sacral nerve roots and sciatic nerve was performed via robot-assisted and a four-arm Da Vinci Si Surgical System laparoscopic approach. This case report is the first presentation of robot-assisted laparoscopic management of a vascular entrapment of the sacral nerve roots. The robotic technique offers, three-dimensional vision, improved maneuverability and enhanced ergonomics in the deepest area in the pelvis and could be a valid alternative to laparoscopy in the treatment of intrapelvic neurovascular entrapments.

Transplantation of human xenografts onto immunocompromised mice is a powerful research tool for studying wound healing. However, differences in healing between humans and mice and their small size limit this model. We determined whether human cadaver skin xenografts transplanted onto pigs with severe combined immune deficiency (SCID) would survive and not be rejected. Meshed (1:1.5), cryopreserved human cadaver skin was transplanted onto 10 partial thickness dermatome wounds in each of two normal domestic pigs and two SCID pigs. Autografts (n = 2/animal) from the four animals were used as controls. In normal pigs, all autografts were engrafted and healed with a minimal, if any, inflammation and scarring. All human xenografts were rejected by the normal pigs within 5-11 days and associated with an intense T-cell inflammatory response. In contrast, both autografts and xenografts were engrafted and survived the 28-day study in the SCID pigs with a minimal inflammation and no gross scarring.

Objective To review pediatric idiopathic intervertebral disc calcification (PIIVDC) within a single center and within the literature to outline the disease course, management, and outcome. Study design A retrospective chart review was performed spanning the period between January 2001 and February 2016 for diagnoses of PIIVDC. Patient age, sex, symptoms, and history and physical and neurologic findings were reviewed. Laboratory and imaging findings, management, follow-up, and outcome also were studied. Results Nine cases of PIIVDC were identified; they included 6 male and 3 female patients, with an age range of 23 months to 12 years. Two patients were asymptomatic, and PIIVDC was discovered incidentally. Of the remaining 7 patients, 5 presented with neck and/or back pain, 1 with painless torticollis, and 1 with painful torticollis. One patient reported neurologic symptoms of pain radiating along 1 dermatome. Disc spaces affected were 5 cervical, 4 thoracic, and 2 lumbar, with 2 patients having more than 1 space affected. All patients were managed conservatively. In 1 case, symptoms and lesions persisted after 5 years, but the remainder had complete symptom resolution, generally within 6 months. Conclusions The etiology of PIIVDC remains unknown but appears to occur spontaneously, without preceding trauma or underlying medical condition. A conservative approach to patients without severe neurologic deficit with outpatient follow-up is supported.

Background Tuberculosis (TB) of the posterior spinal element is an uncommon condition. In a developed country its diagnosis is becoming difficult due to low incidence. Case Description A 60-year-old lady presented with low back pain and right leg pain for 6 months. On examination there was tenderness over L4 and L5, a positive straight leg raise test at 70 degrees on the right side and free on the left, and sensory involvement on the right L5 dermatome. Initial magnetic resonance imaging (MRI) showed an L4-5 ligamentum flavum cyst, high signal intensity in the right pedicle and facet joint. It was considered to be a degenerative spinal disorder. Later MRI showed increased size of the cyst, and computed tomography revealed erosion of the right pedicle of the L5 vertebrae, which raised the suspicion of the tubercular pathology. Initially the patient was managed for a degenerative spinal disorder. Later, when tubercular pathology was suspected, she underwent full endoscopic uniportal stenosis decompression and excision biopsy of the cyst. The histology of the cyst revealed chronic granulomatous inflammation with central necrosis. The diagnosis of a TB cyst was confirmed, and antitubercular therapy was started. Conclusion TB of the posterior elements of the spine is a diagnostic challenge in developed parts of the world. We describe the first likely case of tubercular ligamentum flavum cyst, which was managed by a full endoscopic uniportal approach.

Highlights • The spinal subdural hematoma is a rare situation which should be evoked in any patient treated by vitamin K antagonists with signs of spinal cord compression. • Magnetic resonance imaging is the imaging exam of choice to establish the diagnosis. • Rapid correction of bleeding disorders is required. • Sometimes, emergent surgical evacuation of the hematoma is the only therapeutic option to ensure optimal neurological prognosis. • The procedures for resuming anticoagulation should be subject to a multidisciplinary consultation., Background The spinal subdural hematoma (SSH) is an extremely rare entity which represents only 4.1% of all spinal hematomas. It needs accurate diagnosis and rapid intervention because of the major neurological risk induced by spinal compression. Several etiologies have been reported: anticoagulant treatments, haematological disorders, arterio-venous malformation, repeated attempts at lumbar punctures and tumors. We report the case of an 82-year-old patient under acenocoumarol for atrial fibrillation who presented with paraplegia secondary to SSH. Case report An 82-year-old patient with a history of ischemic heart disease and atrial fibrillation under acenocoumarol was admitted to emergency department with sudden onset of paraplegia and intense back pain associated with urinary incontinence and anal sphincter disorder. On examination his lower limb power was MRC grade 0 out of 5 in all ranges of movement bilaterally and a complete bilateral anesthesia reaching the T12 dermatome was noted. Biological test results showed an International Normalized Ratio at 10. Magnetic resonance imaging revealed a posteriorly located spinal hematoma at T12 level, measuring 36 mm with spinal cord compression. After correction of hemostasis disorders the patient was admitted to the operating room for a T11-L1 laminectomy with evacuation of the subdural hematoma. Muscle power showed a gradual improvement in the lower limbs estimated at 3/5 with regression of sphincter disorders but unfortunately a sequellar sensory impairment persisted. Conclusion SSH is a rare situation of acenocoumarol bleeding incident, it should be evoked in any patient treated by this molecule with signs of spinal cord compression.

Background Brown-Séquard syndrome often occurs in spinal cord injury, and few myelitis patients present with Brown-Séquard syndrome. Case presentation A 33-year-old Han man was admitted with neck pain plus numbness in the right limbs for 2 days and weakness in the left limbs for 1 day. Examination was significant for left limbs with grade 4 muscle power, positive left Babinski sign, diminished vibration sensation in the left limbs and decreased pain below the right clavicle dermatome. The cerebrospinal fluid (CSF) cell count was 24 × 106/L, and the protein count was 185 mg/L. Cervical magnetic resonance imaging (MRI) indicated abnormal swelling signals in the medulla-cervical cord long segment and enhanced signals in the C2-3 region. In the second case, a 47-year-old Han woman was admitted with weakness in the right lower limb and numbness in the left lower limb for more than 20 days. Examination was significant for the right lower limb with grade 4 muscle power, left knee hyperreflexia, positive left Babinski sign, diminished vibration sensation in the right lower limb and decreased pain below the right T2 dermatome. Cervical MRI indicated hyperintense and enhanced signals in the C7-T2 region. In these two cases, CSF culture, oligoclonal band (OB) and aquaporin 4 (AQP4) antibody were negative. Brain MRI was normal. Their symptoms and MRI results improved after treatment with methylprednisolone. Conclusions Myelitis can present as Brown-Séquard syndrome, providing an extended reference in terms of the differential diagnosis for clinical physicians.

Background: To report 2 different presentations of thoracic myelopathy with ossification of ligamantum flavum (OLF) due to fluorosis. Methods: Two females presented with thoracic myelopathy secondary to spinal stenosis with OLF due to fluorosis. On examination, the first patient had a grade 4 power in both lower limbs with altered sensation below L1 dermatome. She had segmental OLF on magnetic resonance imaging and computed tomography and was treated with posterior thoracic laminectomy and recovered well. The second patient had a history of a prior thoracic laminectomy at another institution and presented with paraplegia with bladder involvement. Radiological investigations revealed a 3-column injury at the level of D8/D9. This patient was treated with decompression and stabilization. Results: The first patient recovered neurologically and regained independent ambulation while the second patient had a reduction in spasticity but no recovery of power or bladder function. Conclusion: Different presentations and causes of myelopathy due to OLF should be recognized and treated. An unstable injury is very rare and should not be missed.

Acute non-traumatic paraparesis is usually caused by vascular, inflammatory or neoplastic myelopathies; however, it is sometimes caused by non-myelopathic pathologies, including polyradiculoneuropathies, myopathies, psychogenic aetiologies or parasagittal cortical pathologies. A 73-year-old woman reported weakness of the bilateral lower limbs and urinary incontinence. Together with the sensory level at the left T6 dermatome, we initially considered thoracic myelopathy as the most likely diagnosis. However, MRI of the cervicothoracic cord was negative and subsequent cranial CT revealed a bilateral subdural haematoma. A parasagittal cortical pathology should not be excluded from differential diagnoses as a rare cause of paraparesis until its possibility is carefully ruled out.

Objectives The study aimed to investigate if patients with lumbar radicular pain only and those with combined lumbar radicular pain + radiculopathy differ in their somatosensory profiles and pain experiences. Methods Quantitative sensory testing (QST) was performed in 26 patients (mean age 47 ± 10 years, 10 females) with unilateral leg pain in the L5 or S1 distribution in their main pain area (MPA) and contralateral mirror side, in the relevant foot dermatome on the symptomatic side and in the hand dorsum. Pain experience was captured on the painDETECT. Results Eight patients presented with lumbar radicular pain only and 18 patients with combined radicular pain + radiculopathy. Patients with radicular pain only demonstrated widespread loss of function (mechanical detection) bilaterally in the MPA (p Conclusions Distinct differences in somatosensory profiles and pain experiences were demonstrated for each patient group, suggesting differing underlying pain mechanisms.

Background: Musculoskeletal pain disorders are among the leading causes of years lived with disability worldwide representing a significant burden to society. Studies investigating a “nociceptive-fusimotor” relationship using experimentally-induced pain/noxious stimuli and muscle spindle afferent (MSA) response have been published over several decades. The purpose of this scoping review was to systematically identify and summarize research findings related to the impact of experimentally-induced pain or noxious stimulation on direct MSA discharge/response.Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane and Embase were searched from database inception to August 2020. Eligible studies were: (a) published in English; (b) clinical or pre-clinical studies; (c) original data studies; (d) included the investigation of MSA response to experimentally-induced pain or noxious stimulation; (e) included quantification of at least one direct physiological measure associated with MSA activity/response. Two-phase screening procedures were conducted by a pair of independent reviewers and data extracted from eligible studies.Results: The literature search resulted in 195 articles of which 23 met inclusion criteria. Six studies (26%) were classified as clinical and 17 (74%) as pre-clinical. Two clinical studies investigated the effects of sacral dermatome pin-pricking on MSA response, while the remaining 4 studies investigated the effects of tonic muscle and/or skin pain induced by injection/infusion of hypertonic saline into the tibialis anterior muscle or subdermal tissues. In pre-clinical studies, muscle pain was induced by injection of noxious substances or the surgical removal of the meniscus at the knee joint.Conclusion: Clinical studies in awake humans reported that experimentally-induced pain did not affect, or else slightly decreased MSA spontaneous discharge and/or response during weak dorsiflexor muscle contraction, thus failing to support an excitatory nociceptive-fusimotor relationship. However, a majority of pre-clinical studies indicated that ipsilateral and contralateral muscle injection of noxious substances altered MSA resting discharge and/or response to stretch predominately through static fusimotor reflex mechanisms. Methodological differences (use of anesthesia, stretch methodology, etc.) may ultimately be responsible for the discrepancies between clinical and pre-clinical findings. Additional investigative efforts are needed to reconcile these discrepancies and to clearly establish or refute the existence of nociceptive-fusimotor relationship in muscular pain.

Complex Regional Pain Syndrome (CRPS) is a regional pain disorder where pain is the presenting feature. The pain is not restricted to a joint or dermatome but rather affects the distal extremity. Upper limbs are affected more than the lower limbs, and the involvement is typically unilateral. CRPS is generally preceded by injury, but the pain continues after the original injury has healed. Pain is commonly accompanied by sensory symptoms, motor weakness, vasomotor or sudomotor symptoms, and trophic changes. Blood investigations are unremarkable in CRPS. A three-phase bone scan is the imaging modality of choice in early CRPS. Single-phase bone scans where images are obtained 2–6 h after injection are not recommended in CRPS. A normal three-phase bone scan does not rule out CRPS. Nonsteroidal anti-inflammatory drugs, corticosteroids, amitriptyline, pregabalin, gabapentin, and bisphosphonates are used to treat CRPS. Physical therapy and occupational therapy are complementary to these treatments.

Study Objective To demonstrate the application of surgical neuroanatomic principles for the diagnosis and treatment of deep infiltrating endometriosis involving the lateral femoral cutaneous nerve. Design Video demonstration of laparoscopic lateral femoral cutaneous endometriosis resection with nerve transplant. Setting Endometriosis infiltrating somatic nerves is a poorly known condition, which can cause severe neuropathic symptoms [1] and is often unrecognized with a subsequent treatment delay [1] . Intimate knowledge of pelvic neuroanatomy and expertise in minimally invasive surgery are essential to manage this challenging surgical scenario 2 , 3 , 4 . Interventions Thirty-six years old patient with primary infertility and chronic pelvic pain associated with dysmenorrhea, dyspareunia, dysuria, and dyschezia. Preoperative magnetic resonance imaging detected a 3-cm parauterine and a 2-cm retrocervical endometriosis nodule. Magnetic resonance imaging did not demonstrate pelvic nerve involvement. Preoperative neuropelveologic assessment demonstrated a significant hypoesthesia of the corresponding lateral femoral cutaneous nerve dermatome, representing the primary complaint. A swab test showed spotting areas of allodynia. These findings prompted us to investigate for a right lateral femoral cutaneous entrapment. Laparoscopy showed an endometriosis nodule infiltrating the right lateral femoral cutaneous nerve. A resection of the nerve was necessary, and a subsequent reconstruction with a collagen bovine neuro-guide was carried out. The operative time was 300 minutes, and the estimated blood loss was 150 mL. Hospital stay was 3 days. After 3 months, the patient showed a clinical improvement in the pain and hypoesthesia on the reconstructed nerve dermatome. Conclusion Neuropelvic anatomic assessment should be considered during the preoperative evaluation for patients with endometriosis who have pelvic pain and neuropathy as part of the diagnostic process [5] . This unique case demonstrates that nerve resection and transplantation can be used in specific situations for neuropathy related to deep infiltrative endometriosis of pelvic nerves.

A comprehensive physical examination is essential in the evaluation of the child or adolescent with back pain. The physical examination should begin with an extensive but focused history of the present illness. Inspection, palpation, and range of motion should be performed as well as a detailed screening neurologic examination. Special testing can help lead the physician to the appropriate differential diagnosis.

Background. Herpes zoster is a skin disease caused by reactivation of varicella zoster virus after its primary infection and characterized by the onset of a skin rash with a dermatomal distribution and accompanied by severe pain. The cases of herpes zoster have tended with increasing age. Objectives. This study was aimed to obtain the dermatome pattern of herpes zoster in the Dermatovenerology Polyclinic of Dr. M. Djamil Hospital Padang period 2015-2017. Method. This study was a descriptive study that was conducted in May 2018-August 2018. Simple size was 18 patients suited by inclusion criteria. Data were obtained from medical records of herpes zoster patients and presented in the frequency distribution tables. Results. The results showed that thoracic dermatome and trigeminal nerve area were most commonly involved (44.4%), within the age range of 45-64 years old (33.3%). There is no differences in events between men and women (50%). Pain is the most common major subjective complaint (88.2%) and classical grouped vesicles is the most major objective complaint (92.9%). Most patients have complications (72.2%), common complication is the neurological (38%). Conclusion. The location of dermatomes for herpes zoster patients in the the Dermatovenerology Polyclinic of Dr. M. Djamil Hospital Padang was a thoracic region of 8 patients (44.4%) and a trigeminal nerve area of ​​8 patients (44.4%). Keywords: : dermatome, herpes zoster

Background: Piriformis syndrome is an uncommon disease result from compression of the sciatic nerve by the piriformis muscle. Symptoms may include pain and numbness in the buttocks and down the leg. This study analyzes the laparoscopic surgical treatments of pelvic piriformis syndrome. Presentation: We report two cases of pelvic piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back and sciatalgia on her right side. The severity of the pain was 10/10 on the visual analog scale(VAS). Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The laparoscopic decompression surgery was performed to release the right sciatic nerve from the aberrant piriformis muscle. Postoperative 3 and 6 months follow-up, her VAS decreased to 0/10. The second case was a 30 years old woman with a 2-year history of sciatalgia on her left side. Her VAS was 9/10. The laparoscopic decompression surgery was performed to release the left sciatic nerve and left sacral nerve S2 dermatome from the aberrant piriformis muscle. Postoperative 3 and 6 months follow-up, her VAS decreased to 1/10. Conclusion: Due to the very few cases in the literature, pelvic piriformis syndrome is thought to be an exclusively clinical diagnosis. If the sciatica is refractory despite appropriate conservative treatments; laparoscopic exploration of the pelvic nerves and piriformis muscle and decompression surgery can be a good option. Keywords: Laparoscopy, pain, piriformis muscle syndrome, sacral nerve root, the sciatic nerve.

We present the case of a 77-year-old man who developed shingles over the cervical C8 dermatome followed by post-herpetic medial cord brachial plexopathy, with hand weakness and difficulty performing the pinch " O " sign. This is the very first case, to our knowledge, of a detailed presentation of a medial cord plexopathy following shingles. We review the literature of post-herpetic brachial plexopathies and discuss the magnetic resonance imaging (MRI) findings of the brachial plexus in this group of patients. We also speculate on the intriguing finding that despite frequent abnormalities on MRI such as T2 signal hyperintensity and nerve hypertrophy, contrast enhancement of nerves is exceedingly rare. Furthermore, we adumbrate on the localization of brachial plexus lesions by proposing a user-friendly diagram and table, which simplifies the diagnostic algorithm.

Background:. Scars developing after wrist cutting (a deliberate action of self-harm) have various patterns and are difficult to treat. In addition, they can occur at anatomically prominent sites and are easily recognized as caused by self-harm; thus, scars can cause lifelong regrets. However, there are no standard treatment guidelines for wounds inflicted through self-harm. This study aimed to evaluate the effectiveness of our novel technique using 90-degree rotated skin grafts, which were thinly collected at a thickness of 250 μm from a wound site, together with minced-skin grafts. Methods:. Five regions on the forearm of 5 Japanese women (age, 19–29 years) were treated from July 2011 to April 2012. The skin at the scar site was cut with an electric dermatome at a thickness of 250 μm. The scar contained therein was excised, and the skin was rotated 90 degree and transplanted. The scar remaining in the dermis of the wound was resected and resurfaced. At the site where the skin graft was insufficient, the skin was processed into a minced shape and then transplanted (minced-skin graft). Results:. In all cases, skin grafting was performed. The scar was successfully camouflaged and transformed into a socially acceptable appearance. At the wound site, the skin texture was reproduced. Following skin grafting, nodules, pigmentation, and redness around the graft transiently occurred, which then disappeared over time. No scar contractures were observed. Conclusion:. A combination of thin-skin graft rotated 90 degrees and minced-skin graft is useful in camouflaging a wide variety of deliberate self-harm scars.

Study design An experimental study. Objectives To investigate the changes in somatosensory functions using the combined application of quantitative sensory testing (QST), contact heat-evoked potentials (CHEPs) and laser-evoked potentials (LEPs) studies in individuals with spinal cord injury (SCI) in relation to neuropathic pain (NeP). Setting Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland. Methods Individuals with SCI were compared: 12 with NeP (SCI NeP) and 12 without NeP (SCI no NeP). Tools used were QST, CHEPs, LEPs and self-reported questionnaires. Tests were applied to the control (hand) and test (dermatome of altered sensation) sites, and compared to the able-bodied group. Results QST, LEPs and CHEPs assessments showed abnormalities both on the test and control sites, which did not differ between the groups with SCI. QST showed higher prevalence of allodynia in SCI NeP. CHEPs and LEPs demonstrated diminished amplitudes in both groups with SCI in comparison to able-bodied individuals. Only reaction time (RT) analysis revealed the difference of SCI NeP from the other two groups, expressed in partially preserved responses to the laser C-fibre stimulations. Conclusions Combination of assessments in our study allowed to examine spinothalamic and dorsal column functions in individuals with SCI. Changes in QST, CHEPs and LEPs were detected below the level of injury independent of NeP and at the control site indicating modifications in sensory processing rostral to the spinal lesion. Analysis of RT during laser stimulation could be an essential component when evaluating the somatosensory functions related to NeP in persons with SCI.

INTRODUCTION: While autonomic dysreflexia caused by severe spinal cord lesions can be life-threatening, relevant reports on non-traumatic spinal lesions are rare. Furthermore, modes of innervation of the supraspinal inhibitory pathways at each spinal sympathetic segment remain unknown. Herein, I report the case of a patient with autonomic dysreflexia and radiation myelopathy. The laterality of autonomic dysreflexia was investigated with special reference to the sudomotor function. CASE PRESENTATION: A 51-year-old man with a history of epipharynx carcinoma, radiotherapy, and cisplatin chemotherapy was referred for the evaluation of autonomic function. He was ambulant but displayed spastic tetraparesis, areflexia of the extremities, sensory disturbance below C4 dermatome, dysuria, and impotence. Spinal magnetic resonance imaging demonstrated a cervical lesion involving the lateral portion of C2–C5, bilaterally. The thermal sweating test showed that sweating was lower on the left side of the face and neck, left shoulder, and arm than the corresponding parts on the right side. The rest of the body was anhidrotic. Sweating due to autonomic dysreflexia was symmetric, but more abundant on the left side of the face. Acetylcholine-induced sweating was markedly reduced on the left leg. DISCUSSION: This might be the first documentation of autonomic dysreflexia observed in a patient with radiation myelopathy. The present observations suggested that the supraspinal inhibitory pathway to spinal preganglionic neurons may descend on the same side as thermal sudomotor facilitatory pathways at the cervical level. Furthermore, autonomic dysreflexia was more prominent in the standing position suggesting that the pressure stimulus might enhance autonomic dysreflexia.

Intradural disc herniation is a rare presentation of a common pathology, comprising around 0.28-0.3% of all disc herniations. It occurs when disc material related to an intervertebral disc penetrates the spinal dura and lies in an intradural extramedullary location. A 60 years old male patient presented with complaints of low back pain and right lower limb radiculopathy of 2 weeks duration. Neurological examination revealed the weakness of extensor hallucis longus and ankle dorsiflexion with diminished sensation corresponding to fourth and fifth lumbar (L4-L5) dermatome on the right side. Magnetic resonance imaging showed a large sequestered fragment with intradural extensions and posterior longitudinal ligament tear. Intradural nerve root showed significant displacement with severe central canal and right lateral recess stenosis. Discectomy was performed along with the removal of the intradural extension. The postoperative course was uneventful.

We reported a patient who presented with analgesia and thermanaesthesia from the face to T4 dermatome on the contralateral side to the lesion due to infarction of the dorsal tegmentum of the caudal pons, which was inconsistent with classical dorsolateral pontine infarction. We speculated that the lesion affected the trigeminothalamic tract deriving from the second-order neurons on the contralateral side and partial lateral spinothalamic tracts carrying pain and temperature sensation above T4 dermatome, while the spinal trigeminal tract and its nucleus on the ipsilateral side and other parts of lateral spinothalamic tracts were spared. This case showed the atypical presentations of dorsolateral pontine infarction and may provide clinicians with new diagnostic ideas., Neuroscience; Neurology; Public health; Nervous system; Clinical research; Pontine infarction; Uncrossed sensory symptomatology; Segmental sensory disturbance.

Background: Soft tissue preservation using a hydroxyapatite-coated abutment in bone conduction hearing implant surgery may lead to improved clinical outcomes over the short (1 year) and long term (3 years).Methods: In this open multi-center, randomized (1:1), controlled clinical trial, subjects with conductive, mixed hearing loss or single-sided sensorineural deafness were randomly assigned to receive the conventional intervention, a titanium abutment with soft tissue reduction surgery (control), or a new intervention, a hydroxyapatite-coated abutment with soft tissue preservation surgery (test). The primary efficacy outcome was the combined endpoint of numbness, pain, peri-abutment dermatitis, and soft tissue thickening/overgrowth after 1 and 3 years.Results: The Intention-to-treat (ITT) population consisted of 52 control subjects and 51 test subjects. The difference between the groups after 1 year of follow-up as measured by the primary efficacy outcome was not statistically significant (p = 0.12) in the ITT population (n = 103), but did reach statistical significance (p = 0.03) in the per-protocol (PP) population (n = 96). It showed an advantage for the test group, with over twice as many subjects (29%) without these medical events during the first year compared to the control group (13%). After 3 years, the difference between the two groups had declined and did not reach statistical significance (24 vs. 10%, ITT p = 0.45). Secondary outcome measures which showed a statistical significant difference during the first year, such as surgical time (15 vs. 25 minutes, p Conclusions: Soft tissue preservation with a hydroxyapatite-coated abutment leads to a reduction in the combined occurrence of complications over the first year which is not statistically significant in the ITT population but is in the PP population. This effect decreased for the long-term study follow up of 3 years and did also not reach statistical significance.

Rationale: We present a rare case of a traumatic intradural ruptured disc associated with a mild vertebral body compression fracture along with a review of the relevant medical literature. An intradural ruptured disc often occurs due to chronic degenerative diseases and is rarely due to trauma. It can cause irreversible neurological complications if the appropriate treatment is not planned. Patient concerns: A 32-year-old male presented with motor paraparesis (grade 3/5), right ankle dorsiflexion, and great toe dorsiflexion (grade 1/5), along with radiating pain at his right L4 and L5 sensory dermatome following a fall. Diagnoses: Computed tomography revealed a compression fracture of the L2 body. Lumbar magnetic resonance imaging showed an intradural mass-like lesion on the ventral side of his spinal cord and an epidural mass-like lesion on the dorsal side of his spinal cord, indicating a hematoma. Interventions: An emergency L2 laminectomy was performed to remove the space-occupying lesions and to decompress the cauda equina and nerve root. The mass-like lesion was removed. No other lesions were found in the spinal canal. Outcomes: Pathologic examination of the intradural mass lesion revealed fibrocartilage similar to that found in disc material. The patient still continued to experience motor weakness at the 1-year follow-up examination. Lessons: We report a rare case of a traumatic lumbar disc rupture into the dural sac associated with a mild vertebral body compression fracture. Early diagnosis and prompt surgical intervention are essential, as is performing a magnetic resonance imaging or computed tomography myelogram promptly to evaluate the spinal canal when there are unexplained neurologic symptoms. An intraspinal canal evaluation should be completed before the postural reduction of the vertebral body fracture to prevent any neurological complications.

Tyrimo pagrindimas. Pasireiškus Th4 sindromui, sutrinka vegetacinės nervų sistemos (VNS) funkcija (Karas, Pannone, 2017). Tai būklė, kuri gali atsirasti, kai kaklinės ir krūtininės stuburo dalies slanksteliai yra hipomobilūs, ir tai gali sukelti rankų parestezijas, tirpimą, šalimą arba prakaitavimą. Esant Th4 sindromui, gali sutrikti rankų judesių valdymas, atsirasti sunkumas, patinimas. Rankų skausmai gali būti susiję su sąstingiu ir galvos skausmu. Skausmas ir sąstingis pasireiškia menčių srityje, priekinėje arba nugarinėje krūtinės dalyje (Fernández-de-las-Peñas et al., 2015; Conroy, Schneiders, Tyrimo tikslas – įvertinti krūtininės stuburo dalies mobilizacijos ir savimobilizacijos poveikį rankų ir kaklo skausmui, funkcijai bei gyvenimo kokybei esant Th4 sindromo Metodai. Buvo tiriama 20 asmenų, kurie skundėsi galvos, rankų, pečių srities skausmu bei tirpimu. Buvo įvertinti pokyčiai miotomose ir dermatomose, rankų refleksai ir judesių amplitudės, rankų raumenų jėga, skausmas, Rezultatai. Tyrimo rezultatai parodė, kad MOB grupės kaklo srities ir rankų skausmas po mobilizacijos sumažėjo nuo 4,8 ± 1,55 iki 3,3 ± 0,71 (p < 0,05) ir nuo 4,5 ± 0,71 iki 2,8 ± 1,34 (p < 0,05). SAVIMOB grupės kaklo ir rankų skausmas po savimobilizacijos sumažėjo nuo 3,6 ± 0,84 iki 2,3 ± 1,7 (p > 0,05) ir nuo 4 ± 1,56 iki 3 ± 2,49 (p > 0,05). Po mobilizacijos nustatyta, kad iš visų gyvenimo kokybės rodiklių labiausiai pagerėjo socialinis funkcionavimas, fizinė būklė, sumažėjo kūno skausmai ir veiklos apribojimas dėl emocinių ir fizinių Išvados. Kineziterapija, kurios metu taikoma mobilizacija, veiksmingiau mažina kaklo ir rankos skausmą, turi tendenciją labiau pagerinti stuburo paslankumą ir gyvenimo kokybę nei kineziterapija, kai atliekama savimobilizacija.Raktažodžiai: Th4 sindromas, krūtininės stuburo dalies mobilizacija, savimobilizacija.

Caution is necessary when using symptom or physical examination findings to localize the osteoporotic vertebral fractures (VFs) attributable to the discrepant colocalized relationship. Whether the location of symptoms or physical examination findings delineates the appropriate spinal range for imaging has not been thoroughly investigated for VFs. The present study aims to analyze the consistency between the fractural vertebrae location and the location suggested by patient-reported pain or physical examination findings. This observational study, following a prospective design, enrolled 358 patients with VFs. The locations of two symptoms (patient-reported back pain [P-RBP], radiating pain [RP]) and findings from two physical examinations (spinal palpation tenderness [SPT], axial spinal percussion pain [ASPP]) were used to locate the VF segments identified using whole-spine magnetic resonance imaging (MRI). The percentage of agreements and kappa coefficient were calculated. In 20.7% (74/358), the P-RBP site and VF segments were in the same location (kappa = 0.153); 21.2% (76/358) presented with concomitant RP in 93.4% (71/76) of whom the RP dermatome was colocalized with the VF segments (kappa = 0.924); 55.0% (197/358) and 23.2% (83/358) of patients presented with positive SPT and ASPP, respectively; and in 49.2% (97/197) and 96.4% (80/83) of patients with positive SPT (kappa = 0.435) and ASPP (kappa = 0.963), the positive finding and the VF segments were consistently colocalized. The positive finding of RP or ASPP is useful in determining the spinal range for imaging tests, while an MRI scan covering the whole thoracic and lumbar spine is necessary in VF-suspected patients with P-RBP or positive SPT, indicating that caution is necessary when using symptoms or physical examination findings to localize VFs.

Background: Prostate cancer is a common cancer found in men worldwide. Brachytherapy is an established modality used for the treatment of these patients. Although anesthetic management of such patients is challenging but the ideal anesthetic technique has not yet been established. Our study aims to identify the most efficacious anesthetic technique for perioperative management of prostate cancer patients undergoing brachytherapy. Methods: Retrospective analysis of ten patients who underwent 16 brachytherapy sessions under combined spinal epidural (CSE) anesthesia between April 2016 and December 2016 was done. The data were collected, tabulated using MS Excel, and statistically analyzed with EPI Info 6 and SPSS-16 statistical software (SPSS Inc. Chicago, USA) to draw relative conclusions. Results: The median peak sensory dermatome level achieved was T6 and the median maximum motor block achieved was grade 2. The mean (± standard deviation (SD)) time to sensory regression to T10 (range T5-T8) dermatome was found to be 118.00 ± 47.110 (range = 0-238) minutes. Despite the presence of co-morbidities, minor intraoperative complications were observed only in two patients. The postoperative numerical rating scale (NRS) was less than 4 in all patients during the first 24 hours. None of our patients complained of nausea, vomiting, pruritus and respiratory depression. The mean (± SD) patient satisfaction score was 44.40 ± 0.871 (range : 1-5) at the end of 24 hours. Conclusions: CSE anesthesia is a safe and effective technique for anesthetic management of patients undergoing prostate brachytherapy.

Trigeminal trophic syndrome is an uncommon condition characterized by paresthesia, itch, and self-inflicted wounds following the trigeminal dermatome(s). Similar processes adhering to cervical nerve distributions have been reported, calling into question the specificity of trigeminal trophic syndrome for the trigeminal network. Herein, we report patient with trigeminal trophic syndrome adhering to the C2 dermatome, a previously unreported distribution.

Introduction: Knee pain is among the commonest complaints in the outpatient orthopedic department. However the cause does not always originate from knee itself. and knee pain is used by the patient more as an umbrella term. In fact very few patients give the complete list of accompanying symptoms. They have more often than not to be coaxed out of the patient. To make matters more complex, Referred pain from the Spinal nerves, Hip and Ankle joints join the many structures around the knee to make knee pain an umbrella term for this Pandora’s Box. Misdiagnosis or partial diagnosis leads to inadequate or wrong treatment and continued suffering for patient and treating doctorsMaterials & Methods: 78 patients with knee pain attended the OPD of Walawalkar hospital, Dervan. On x-ray, 28 were found to have different grades of osteoarthritis. Of these 25 agreed to be part of this pilot study. They underwent standing x rays & MRI of the lumbosacral spine.Results: This study found an unusually high rate of coexistent knee and spine pathologies. All patients had some degree of disc disease accompanying medial or tricompartmental osteoarthritis. It undermines the need for investigating this important contributor to the umbrella term of knee pain.The commonest affected disc segment was L4-5 i.e 92% with two patients having L5- S1 prolapse 8%. The purpose of this pilot study is only to alert the surgical and rehabilitation colleagues of the frequent coexistence of the spine and knee conditions for Counseling, consent, surgery & rehabilitation and thus improve patient satisfaction.

Мета роботи – виявити й охарактеризувати ознаки алкоголь-асоційованого обтяження викликаних скорочень скелетних м’язів при хронічній алкогольній міопатії на підставі аналізу показників силової продуктивності м’язової системи. Результати дослідження показали, що алкоголізація щурів призводить, як мінімум, до 2-х функціональних змін показників скорочувальних процесів: необхідності збільшення часу релаксації для можливості адекватної м’язової відповіді на стимуляційні пули та збільшення часу дотетанічних періодів силової відповіді м’язів при застосуванні модульованої стимуляції. Отже, алкогольна міопатія насамперед проявлятиметься при виконанні точних позиціонованих рухів і корекції точної цілеспрямованої зміни в суглобових кутах. Результати дослід- ження можна застосовувати в клінічних умовах для характеристики локомоторної дисфункції в постраждалих із хронічною алкогольною міопатією. The research goal was to identify and characterize the traits of alcohol-associated suppression caused by contractions of skeletal muscles under chronic alcoholic myopathy by analysing muscle force performance in muscular system.The registration of dynamic contraction performances was done by conducting an acute experiment using nonanion anesthesia, dermatome, fasciotomy and denervation methods. The isolated muscle force and contraction productivity were studied by using a strain-gauge method to determine the stress-strain state of an isolated muscular preparation on the basis of an electric strain gage. Experimental chronic alcohol myopathy in laboratory rats was conducted the method of enterogastral injection with a catheter for 30 days. The study showed that chronic30 day alcohol intoxicated rats results in at least 2 functional changes of contraction performances.The first is the need to increase the relaxation time for the possibility of an adequate muscular response to stimulating pulls. The second is the increase of the time of pre-tetanic periods of muscle force response under condition of modulated stimulation. This functional feature of myopathic muscles will be important for the adequate and correct realization of the central motor commands in a muscular system. This result illustrates that alcoholic myopathy will be primarily developed when performing accurate positioning movements and correcting precise, targeted changes in articular angles. In addition, the insufficient length of relaxation period may be increased by fluctuational disorders of muscle dynamics meaning, the muscles inability to accurately fix the stationary sites of contraction. On the background of an increase in the pre-tetanic phase of contraction that will lead to systematic errors in precise positioning. The research results can be used in clinical condition to characterize the locomotor dysfunction in patients with chronic alcoholic myopathy.

Parkinson's disease, a neurodegenerative disorder, presents with resting tremor, muscle rigidity and bradykinesia. Affecting multiple organ-systems, it's an important cause of peri-operative morbidity. General anaesthesia may deteriorate cardio-pulmonary and neuro-cognitive functions; moreover, medications used may interact with anti-parkinsonian agents. Spinal anaesthesia is usually avoided in Parkinson's disease. However, it offers neurologic monitoring and less surgical stress response and avoids complications of general anaesthesia. This case report aims to demonstrate application of spinal anaesthesia for laparoscopic cholecystectomy in a Parkinson's elderly with pulmonary dysfunction and anticipated difficult airway management. Sensory blockade of third thoracic dermatome was achieved. Bupivacaine was instilled intra-peritoneally. Surgery was smooth at low intra-abdominal pressure. Regular Paracetamol provided satisfactory post-operative analgesia. Single episode of post-operative vomiting was effectively managed. Without deterioration, patient was discharged from hospital on third day. Spinal anaesthesia is a valid technique for laparoscopic cholecystectomy in needy patients with multiple peri-operative risks. Keywords: Laparoscopic cholecystectomy; Parkinson's disease; spinal anaesthesia.

Background: Prevalence of aging patients appearing for laparoscopic cholecystectomy to treat cholelithiasis is ever on the rise. Associated co-morbidities make the elderly prone to peri-operative complications during laparoscopic cholecystectomy performed under general anaesthesia.Objectives: This study aims to assess the safety and applicability of spinal anaesthesia for the elderly undergoing laparoscopic cholecystectomy.Methodology: In this cross-sectional study, fifty-four patients of age 65 years or more undergoing laparoscopic cholecystectomy were studied. Hyperbaric Bupivacaine 15 milligrams was used in spinal anaesthesia to obtain sensory block to fifth thoracic dermatome. Local anaesthetics were instilled intra-peritoneally before surgical dissection. Surgery was performed through three ports with carbon dioxide pneumoperitoneum at eight mmHg intra-abdominal pressure. Data included demography, co-morbidities, need for analgesics or general anaesthesia, operative and post-operative complications and hospital stay. Univariate analysis for peri-operative events and bivariate analysis for outcome and explanatory variables were done.Results: The mean age was 71.4 years with co-morbidity in 40 patients. Conversion to open cholecystectomy occurred in three patients necessitating general anaesthesia. Surgery was completed laparoscopically under spinal anaesthesia in remaining 51 patients. Increment in intra-abdominal pressure was required in five patients. Six patients needed analgesics for shoulder pain. Intra-operative hypotension and shivering occurred in 15 and four patients respectively. Post-operatively, urinary retention and nausea occurred in four and three patients respectively. Mean hospital stay was 3.2 days.Conclusion: There is no undue risk in spinal anaesthesia for conducting laparoscopic cholecystectomy in the elderly and it is efficient for uncomplicated cholelithiasis with minimal modifications in surgical technique.

Introduction Plantar hyperkeratosis, such as corns and calluses, is common in older people and associated with pain, mobility impairment, and functional limitations. It usually develops on the palms, knees, or soles of feet, especially under the heels or balls. There are several treatment methods for plantar hyperkeratosis, such as salicylic acid plaster and scalpel debridement, and conservative modalities, such as using a shoe insert and properly fitting shoes. Methods We present an effective method of reconstructing the wound after corn excision using a split-thickness sole skin graft (STSSG). We harvested the skin graft from the arch of the sole using the dermatome with a skin thickness of 14/1000th inches. Results Because the split-thickness skin graft, harvested from the sole arch near the distal sole, is much thicker than the split-thickness skin graft from the thigh, it is more resistant to weight and friction. The healed wound with STSSG coverage over the distal sole was intact, and the donor site over the sole arch had healed without complication during the outpatient follow-up, 3 months after surgery. Conclusions The recovery time of STSSG for corn excision is shorter than that with traditional treatment. Therefore, STSSG can be a reliable alternative treatment for recurrent palmoplantar hyperkeratosis.

Rationale: Herpes zoster frequently causes dermatomal vesicular rash accompanied by severe neuralgia, and reaching a differential diagnosis may be challenging before the appearance of the vesicular rash. Patient concerns: A 40-year-old male patient visited the emergency department with a complaint of sudden onset motor weakness and ipsilateral radiating neuralgia to the Lt. thigh. He had suffered from chickenpox during childhood. Diagnoses: No skin lesion was present at the initial visit. The reverse Straight Leg Raise test was negative. Magnetic resonance imaging showed asymmetrically swollen dorsal root ganglion with Gadolinium enhancement. The vesicular rash that appeared on the sixth day after the symptom onset led to the diagnosis of herpes zoster. Interventions: Antiviral agent of valacyclovir (1000 mg t.i.d.) was administered for 7 days. Outcomes: The patient recovered from motor weaknesses by 2 weeks from the onset of the symptom. Mild degree post-herpetic neuralgia recovered by 2 months. Lessons: A high index of suspicion is necessary to differentiate early herpes zoster radiculitis before the appearance of vesicular rash from compressive radiculopathy. In L2–3 ipsilateral radiating pain along the dermatome or myotome, the absence of reverse Straight Leg Raise sign may be a possible factor in differentiating herpes zoster radiculitis from compressive radiculopathy.