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Open Veterinary Journal 2022Extended, continuous hemilaminectomy has only been reported in small to medium-sized dogs so far. It remains unclear whether excessive continuous hemilaminectomy can...
Continuous hemilaminectomy of nine vertebrae can be performed safely in large breed dogs: A case report of a German Shepherd Dog with intervertebral disc extrusion and extensive extradural hemorrhage.
BACKGROUND
Extended, continuous hemilaminectomy has only been reported in small to medium-sized dogs so far. It remains unclear whether excessive continuous hemilaminectomy can also be performed safely in large breed dogs.
CASE DESCRIPTION
We describe the surgical treatment and clinical outcome of a 5-year-old German Shepherd Dog that presented with paraplegia and deep pain perception following a short episode of bilateral hind-limb lameness, secondary to jumping off of a car. Computed tomography-myelography revealed that the paraplegia originated from extensive extradural spinal cord compression (Th6-L1), due to intervertebral disc extrusion and associated epidural hemorrhage. The dog was treated with a continuous hemilaminectomy involving nine vertebrae (Th6-L1) and recovered completely with no remaining neurological deficits, within 6 months.
CONCLUSION
The rapid, uncomplicated, and complete functional recovery in the presented case emphasizes the practicability of extensive, continuous hemilaminectomies, also in large breed dogs.
Topics: Animals; Dog Diseases; Dogs; Hemorrhage; Intervertebral Disc; Intervertebral Disc Displacement; Laminectomy; Paraplegia
PubMed: 36118714
DOI: 10.5455/OVJ.2022.v12.i4.4 -
BMJ Neurology Open 2022To assess the knowledge, attitudes and practices of healthcare professionals regarding the diagnosis and management of spontaneous intracranial hypotension (SIH).
OBJECTIVE
To assess the knowledge, attitudes and practices of healthcare professionals regarding the diagnosis and management of spontaneous intracranial hypotension (SIH).
METHODS
We performed a cross-sectional, web-based survey of multiple healthcare professional groups in the UK from June to August 2021. There were 227 respondents to the survey, including 62 general practitioners, 39 emergency medicine physicians, 38 neurologists, 35 radiologists, 20 neurosurgeons, 18 anaesthetists and 15 headache nurse specialists. The majority of the respondents were at the consultant level and all worked in the UK National Health Service.
RESULTS
Few general practitioners or emergency medicine physicians had ever been involved in the care of a patient with SIH or received teaching about SIH. Only 3 of 62 (4.8%) general practitioners and 1 of 39 (2.5%) emergency medicine physicians were confident in recognising the symptoms of SIH. Most neurologists were confident in recognising SIH and performed MRI of the brain as a first-line investigation, although there was variability in the urgency of the request, whether contrast was given or MRI of the spine organised at the same time. Most said they never or rarely performed lumbar puncture for diagnosis of SIH. Most neuroradiologists, but few general radiologists, were confident in interpreting imaging of patients with suspected SIH. Lack of access to epidural blood patching, personnel able to perform myelography, and established management pathways were identified by many respondents as barriers to the treatment of SIH.
CONCLUSIONS
We have identified a lack of awareness of SIH among non-specialists, several barriers to optimal treatment of SIH and a variation in current management pathways. The results highlight the need for education of healthcare professionals about SIH and the development of clinical practice guidelines to enable delivery of optimal and equitable care for patients with SIH.
PubMed: 36110926
DOI: 10.1136/bmjno-2022-000347 -
Clinical Neuroradiology Mar 2023
Topics: Humans; Myelography; Cerebrospinal Fluid Leak; Intracranial Hypotension; Upper Extremity
PubMed: 36063168
DOI: 10.1007/s00062-022-01210-w -
Journal of Neurosurgery. Case Lessons Dec 2021Spinal subdural hygroma (SSH) is a rare pathological entity occurring as a complication of spinal surgery. It is different from spinal subdural hematoma due to blunt...
BACKGROUND
Spinal subdural hygroma (SSH) is a rare pathological entity occurring as a complication of spinal surgery. It is different from spinal subdural hematoma due to blunt trauma, anticoagulation therapy, spinal puncture, and rupture of vascular malformations.
OBSERVATIONS
The authors presented five patients with SSH who received decompression for lumbar stenosis. None had incidental durotomy. All presented postoperatively with unexpectedly severe symptoms, including back and leg pain and weakness. Postoperative magnetic resonance imaging (MRI) revealed SSH with a characteristic imaging finding termed the "flying bat" sign. Four patients underwent evacuation of SSH, with immediate and complete resolution of symptoms in three patients and improvement in one patient. One patient improved without additional surgery. At surgery, subdural collections were found to be xanthochromic fluid in three patients and plain cerebrospinal fluid (CSF) in one patient.
LESSONS
Unexpectedly severe back and leg pain and weakness after lumbar or thoracic spine surgery should raise suspicion of SSH. MRI and/or computed tomography myelography shows the characteristic findings termed the flying bat sign. Surgical evacuation is successful although spontaneous resolution can also occur. The authors hypothesized that SSH is due to CSF entering the subdural space from the subarachnoid space via a one-way valve effect.
PubMed: 36061085
DOI: 10.3171/CASE21291 -
Journal of Neurosurgery. Case Lessons Dec 2021Spontaneous intracranial hypotension (SIH) is a well-documented condition that typically follows a defined clinical course. Previously published studies describing the...
BACKGROUND
Spontaneous intracranial hypotension (SIH) is a well-documented condition that typically follows a defined clinical course. Previously published studies describing the pathophysiology of SIH have demonstrated extensive evidence of low intracranial pressure (ICP) driving the clinical features of the condition. Through lumbar puncture and use of intracranial monitoring devices, however, both low and normal cerebrospinal fluid (CSF) pressures have been documented. This report outlined and discussed the unique finding of elevated ICP associated with clinical features of SIH.
OBSERVATIONS
Here, the authors presented a case of a patient with spontaneous spinal CSF leak who developed tonsillar herniation, cerebral edema, and subsequent episodes of elevated ICP. Although more diverse presentations of SIH are being reported, the authors believed the case to be unique because SIH was accompanied by elevated ICP.
LESSONS
This case adds to the growing body of literature surrounding SIH by demonstrating that patients can develop elevated CSF pressures associated with acute encephalopathy.
PubMed: 36061084
DOI: 10.3171/CASE21118 -
Chinese Neurosurgical Journal Aug 2022Spinal extradural meningeal cysts (SEMCs) are rare lesions of the spinal canal. Although closure of the dural defect can achieve satisfactory therapeutic effects,... (Review)
Review
Spinal extradural meningeal cysts (SEMCs) are rare lesions of the spinal canal. Although closure of the dural defect can achieve satisfactory therapeutic effects, locating the fistula is difficult. This review summarizes the methods for locating the fistula of SEMCs and the distribution and features of fistula sites.This was a non-systematic literature review of studies on SEMCs. We searched PubMed for English-language articles to summarize the methods of locating the defect. The search words were "epidural arachnoid cyst," "dural cyst," "epidural cyst," and "epidural meningeal cyst." For the defect location component of the study, case reports, studies with a sample size less than four, controversial ventral dural dissection(s), and undocumented fistula location reports were excluded.Our review showed that radiography and computed tomography (CT) may show changes in the bony structure of the spine, with the largest segment of change indicating the fistula site. Occasionally, magnetic resonance imaging (MRI) can show a cerebrospinal fluid (CSF) flow void at the fistula site. The middle segment of the cyst on sagittal MRI, the largest cyst area, and cyst laterality in the axial view indicate the fistula location. Myelography can show the fistula location in the area of the enhanced cyst and subarachnoid stenosis. Digital subtraction or delayed CT can be used to observe the location of the initial cyst filling. Cine MRI and time-spatial labeling inversion pulse techniques can be used to observe CSF flow. Steady-state image construction interference sequence MRI has a high spatial resolution. Neuroendoscopy, MRI myelography, and ultrasound fistula detection can be performed intraoperatively. Moreover, the fistula was located most often in the T12-L1 segment.Identifying the fistula location is difficult and requires a combination of multiple examinations and experience for comprehensive judgment.
PubMed: 36045421
DOI: 10.1186/s41016-022-00291-3 -
Biomedicines Aug 2022Cerebrospinal fluid (CSF) hypovolemia is the core of spontaneous intracranial hypotension (SIH). More than 1000 magnetic resonance myelography (MRM) images are required...
Cerebrospinal fluid (CSF) hypovolemia is the core of spontaneous intracranial hypotension (SIH). More than 1000 magnetic resonance myelography (MRM) images are required to evaluate each subject. An effective spinal CSF quantification method is needed. In this study, we proposed a cascade artificial intelligence (AI) model to automatically segment spinal CSF. From January 2014 to December 2019, patients with SIH and 12 healthy volunteers (HVs) were recruited. We evaluated the performance of AI models which combined object detection (YOLO v3) and semantic segmentation (U-net or U-net++). The network of performance was evaluated using intersection over union (IoU). The best AI model was used to quantify spinal CSF in patients. We obtained 25,603 slices of MRM images from 13 patients and 12 HVs. We divided the images into training, validation, and test datasets with a ratio of 4:1:5. The IoU of Cascade YOLO v3 plus U-net++ (0.9374) was the highest. Applying YOLO v3 plus U-net++ to another 13 SIH patients showed a significant decrease in the volume of spinal CSF measured (59.32 ± 10.94 mL) at disease onset compared to during their recovery stage (70.61 ± 15.31 mL). The cascade AI model provided a satisfactory performance with regard to the fully automatic segmentation of spinal CSF from MRM images. The spinal CSF volume obtained through its measurements could reflect a patient's clinical status.
PubMed: 36009595
DOI: 10.3390/biomedicines10082049 -
Radiology Case Reports Oct 2022Spontaneous intracranial hypotension (SIH) is a rare condition where the CSF pressure is lower than expected. In this report, we introduce a case of SIH in a 32-year-old...
Spontaneous intracranial hypotension (SIH) is a rare condition where the CSF pressure is lower than expected. In this report, we introduce a case of SIH in a 32-year-old pregnant woman who came to our emergency department at 32 weeks' gestation with a postural and bilateral headache. After MRI confirmation, conservative treatment was started for her, and a cesarean section was scheduled. After the operation, CT-myelography and CT-cisternography were performed for the patient to find the source of the CSF leak, which was located in the C3-C5 level. Still, due to the dangerous nature of the operation, the patient continued supportive treatment and had a significant improvement in his next MRI without any invasive procedure.
PubMed: 35965921
DOI: 10.1016/j.radcr.2022.06.103 -
The Journal of Veterinary Medical... Sep 2022Cervical vertebral stenotic myelopathy (CVSM), a common cause of cervical spinal cord compression, is a neurological disease characterized by general proprioceptive...
Cervical vertebral stenotic myelopathy (CVSM), a common cause of cervical spinal cord compression, is a neurological disease characterized by general proprioceptive ataxia and weakness of hindlimbs that tends to develop in young adult Thoroughbred horses. Although male horses seem to be at increased risk for CVSM, the mechanism for the occurrence of sex differences in the prevalence of CVSM is still poorly understood. Hence, we hypothesized that sex differences in the development of cervical spinal cord and spinal canal would affect the development of CVSM. This study aimed to evaluate sex differences in the development of cervical spinal cord and spinal canal in Thoroughbred horses. A total of 29 Thoroughbred horses underwent computed tomographic myelography. Thereafter, the volumes of cervical spinal cord and spinal canal were calculated. Accordingly, male horses had significantly lager cervical spinal cord volume and cervical spinal cord-to-spinal canal volume ratio than those of female horses (P<0.05). Sex differences in the cervical spinal cord-to-spinal canal volume ratio gradually decreased until around 1,400 days of age. Younger male horses have narrower interspace between the cervical spinal cord and spinal canal than younger female horses, suggesting that an imbalanced cervical spinal cord and spinal canal growth is one of the causes of CVSM.
Topics: Animals; Cervical Cord; Female; Horse Diseases; Horses; Male; Sex Characteristics; Spinal Canal; Spinal Cord Compression; Spinal Cord Diseases; Spinal Stenosis
PubMed: 35944983
DOI: 10.1292/jvms.22-0234 -
Pathogens (Basel, Switzerland) Jul 2022is a neglected and re-emerging metastrongyloid angio-neurotropic nematode causing severe chronic meningomyelitis in domestic cats () as well as in free-ranging small... (Review)
Review
is a neglected and re-emerging metastrongyloid angio-neurotropic nematode causing severe chronic meningomyelitis in domestic cats () as well as in free-ranging small wild felids such as kodkods (), margays () and the northern tiger cat () in South America. Within these definitive hosts (DH), adult males and females of parasitize the leptomeningeal veins of the subarachnoid space and/or the meningeal veins of spinal cord parenchyma, inducing vascular alterations. Feline gurltiosis has been associated with progressive thrombophlebitis of the meningeal veins, resulting in ambulatory paraparesis, paraplegia, ataxia, hindlimb proprioceptive deficit, uni- or bilateral hyperactive patellar reflexes, faecal and urinary incontinence, and tail paralysis. The complete life cycle of has not been elucidated yet, but most probably involves gastropods as obligate intermediate hosts (IH). In terms of epidemiology, infections in domestic and wild felids are scattered around various South American countries, with hyperendemic areas in southern parts of Chile. Etiological diagnosis of still represents a challenge for clinicians due to a lack of evidence of the excretion of either eggs or larvae in faeces or in other body fluids. Diagnosis is based on clinical neurological signs, imaging findings through computed tomography (CT), myelography, magnetic resonance imaging (MRI), and post mortem examination. Nonetheless, novel diagnostic tools have been developed, including semi-nested PCR for detecting circulating DNA in the cerebrospinal fluid, serum and blood samples as well as in serological diagnostic kits detecting parasite-derived antigens, but these need validation for routine usage. The hypothetical life cycle of is addressed in this article, including the exogenous stages (i.e., eggs, and first- (L1), second- (L2) and third-stage (L3) larvae) and obligate gastropod IH and/or paratenic hosts (PH), and we propose possible anatomical migration routes of infective L3 that reach the leptomeningeal veins in vivo. Finally, the pro-inflammatory endothelium- and leukocyte-derived innate immune reactions of the host against , which most likely result in thrombophlebitis and meningomyelitis, are briefly touched on.
PubMed: 35890036
DOI: 10.3390/pathogens11070792