-
Journal of the American Board of Family... 2020Cervical spondylotic myelopathy (CSM) is a neurologic condition that develops insidiously over time as degenerative changes of the spine result in compression of the... (Review)
Review
Cervical spondylotic myelopathy (CSM) is a neurologic condition that develops insidiously over time as degenerative changes of the spine result in compression of the cord and nearby structures. It is the most common form of spinal cord injury in adults; yet, its diagnosis is often delayed. The purpose of this article is to review the pathophysiology, natural history, diagnosis, and management of CSM with a focus on the recommended timeline for physicians suspecting CSM to refer patients to a spine surgeon. Various processes underlie spondylotic changes of the canal and are separated into static and dynamic factors. Not all patients with evidence of cord compression will present with symptoms, and the progression of disease varies by patient. The hallmark symptoms of CSM include decreased hand dexterity and gait instability as well as sensory and motor dysfunction. magnetic resonance imaging is the imaging modality of choice in patients with suspected CSM, but computed tomography myelography may be used in patients with contraindications. Patients with mild CSM may be treated surgically or nonoperatively, whereas those with moderate-severe disease are treated operatively. Due to the long-term disability that may result from a delay in diagnosis and management, prompt referral to a spine surgeon is recommended for any patient suspected of having CSM. This review provides information and guidelines for practitioners to develop an actionable awareness of CSM.
Topics: Adult; Cervical Vertebrae; Humans; Magnetic Resonance Imaging; Spinal Cord Compression; Spinal Cord Diseases; Spondylosis
PubMed: 32179614
DOI: 10.3122/jabfm.2020.02.190195 -
BMJ (Clinical Research Ed.) Feb 2018
Review
Topics: Cervical Vertebrae; Diagnosis, Differential; Disease Progression; Humans; Magnetic Resonance Imaging; Neurologic Examination; Referral and Consultation; Spinal Cord Diseases
PubMed: 29472200
DOI: 10.1136/bmj.k186 -
Seminars in Neurology Dec 2022Misdiagnosis of myelopathies is common and can lead to irreversible disability when diagnosis- and disease-specific treatments are delayed. Therefore, quickly... (Review)
Review
Misdiagnosis of myelopathies is common and can lead to irreversible disability when diagnosis- and disease-specific treatments are delayed. Therefore, quickly determining the etiology of myelopathy is crucial. Clinical evaluation and MRI spine are paramount in establishing the correct diagnosis and subsequently an appropriate treatment plan. Herein, we review an approach to myelopathy diagnosis focused on the time course of neurologic symptom progression and neuroimaging pearls, and apply them to a variety of inflammatory, structural, and vascular myelopathy cases.
Topics: Humans; Spinal Cord Diseases; Neuroimaging; Magnetic Resonance Imaging; Diagnosis, Differential
PubMed: 36417994
DOI: 10.1055/a-1985-0124 -
Revista Medica de Chile Mar 2022Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Its prevalence is increasing as a result of population aging. The... (Review)
Review
Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Its prevalence is increasing as a result of population aging. The diagnosis of DCM is often delayed or overlooked, resulting in secondary neurologic morbidity. The natural course of DCM typically presents as a gradual neurological deterioration, with symptoms ranging from muscle weakness to complete paralysis, with variable degrees of sensory deficits and sphincter dysfunction. Magnetic resonance imaging (MRI) and electrophysiological studies allow the assessment of spinal cord function and its structural damage to determine treatment and clinical outcomes. All patients with signs and symptoms consistent with DCM should be referred to a spine surgeon for assessment and tailored treatment. Those patients with mild DCM can be managed non-operatively but require close monitoring and education about potentially alarming signs and symptoms. Surgery is not currently recommended for asymptomatic patients with evidence of spinal cord compression or cervical spinal stenosis on MRI, but they require a structured follow-up. Patients with moderate or severe DCM require surgical decompression to avoid further progression. The objective of this review is to raise awareness of degenerative cervical myelopathy and its increasing prevalence as well as to aid non-surgical healthcare workers for a timely diagnosis and management of this disabling condition.
Topics: Adult; Cervical Vertebrae; Disease Progression; Humans; Magnetic Resonance Imaging; Spinal Cord Compression; Spinal Cord Diseases
PubMed: 36156719
DOI: 10.4067/S0034-98872022000300339 -
Brain Pathology (Zurich, Switzerland) Jan 1997Schistosomiasis is an infection caused by digenetic trematode platyhelminths of the genus Schistosoma. These blood flukes use man and other mammals as definitive hosts... (Review)
Review
Schistosomiasis is an infection caused by digenetic trematode platyhelminths of the genus Schistosoma. These blood flukes use man and other mammals as definitive hosts and aquatic and amphibious snails as intermediate hosts. Of the schistosomal species, S. mansoni, S haematobium and S. japonicum are the most important to man and the most widely distributed. The infection affects about 200 million individuals in 74 countries of Latin America, Africa and Asia. Far less commonly, schistosomes reach the central nervous system (CNS). This may occur at any time from the moment the worms have matured and the eggs have been laid. For this reason, CNS involvement may be observed with any of the clinical forms of schistosomal infection. The presence of eggs in the CNS induces a cell-mediated periovular granulomatous reaction. When eggs reach the CNS during the early stages of the infection or during evolution of the disease to its chronic forms, large necrotic-exudative granulomas are found. In-situ egg deposition following the anomalous migration of adult worms appears to be the main, if not the only, mechanism by which Schistosoma may reach the CNS in these stages. The mass effect produced by the heavy concentration of eggs and the presence of large granulomas in circumscribed areas of the brain and spinal cord explains, respectively, 1) the signs and symptoms of increased intracranial pressure and focal neurological signs; and 2) the signs and symptoms of rapidly progressing transverse myelitis, usually affecting the lumbosacral segments of the spinal cord. Most of the cases of CNS involvement associated with the hepatosplenic and cardiopulmonary chronic forms, or with severe urinary schistosomiasis, though more frequent, are asymptomatic. In the patients with these clinical forms, the random and sparse distribution of eggs in the CNS indicates that the embolization of eggs from the portal mesenteric system to the brain and spinal cord constitutes the main route of CNS invasion by Schistosoma. The discrete inflammatory reaction elicited by the sparsely distributed eggs in the CNS explains the lack of neurological symptoms that could be produced by egg deposition.
Topics: Animals; Brain Diseases; Host-Parasite Interactions; Humans; Schistosoma; Schistosomiasis; Spinal Cord Diseases
PubMed: 9034571
DOI: 10.1111/j.1750-3639.1997.tb01080.x -
Journal of Veterinary Internal Medicine Sep 2020Sidewinder gait in horses is poorly understood and characterized by walking with the trunk and pelvic limbs drifting to 1 side.
BACKGROUND
Sidewinder gait in horses is poorly understood and characterized by walking with the trunk and pelvic limbs drifting to 1 side.
HYPOTHESIS/OBJECTIVES
To report causes, clinical and diagnostic features.
ANIMALS
Horses examined at 2 institutions.
MATERIALS AND METHODS
Retrospective study (2000-2019). Cases with sidewinder gait, neurological and orthopedic examination, and diagnostic work up or postmortem evaluation were included. Descriptive statistics were performed.
RESULTS
Twenty-four horses (mean age 18.9 years) of various breeds and both sexes were included. Onset was acute (N = 10), subacute (N = 6), and insidious (N = 8). Electromyography and muscle biopsy supported neurologic disease and further aided in localizing site of lesion (N = 9/9). Neurologic causes included dynamic thoracolumbar spinal cord compression (N = 5), equine protozoal myeloencephalitis (N = 4, confirmed and presumed [2 each]), thoracic myelopathy of unknown etiology (N = 4), gliosis (N = 2), and thrombosis of thoracic spinal cord segments (N = 1). Non-neurologic causes included osteoarthritis of the coxofemoral joint (N = 4), multiple displaced pelvic fractures (N = 2), bilateral rupture of the ligamentum capitis ossis femoris (N = 1), and severe myonecrosis of multiple pelvic limb muscles (N = 1). Case fatality was 79%.
CONCLUSION AND CLINICAL IMPORTANCE
Sidewinder gait is usually observed in older horses and can have neurologic or musculoskeletal etiologies. Electromyography can be used as a diagnostic aid to determine neurologic versus non-neurologic disease and further localize those of neurologic origin. The condition often has a poor prognosis for function and life.
Topics: Animals; Female; Gait; Horse Diseases; Horses; Male; Retrospective Studies; Spinal Cord Compression; Spinal Cord Diseases
PubMed: 32820825
DOI: 10.1111/jvim.15870 -
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 -
Antiviral Research Jan 2017Even though an estimated 10-20 million people worldwide are infected with the oncogenic retrovirus, human T-lymphotropic virus type 1 (HTLV-1), its epidemiology is... (Review)
Review
Even though an estimated 10-20 million people worldwide are infected with the oncogenic retrovirus, human T-lymphotropic virus type 1 (HTLV-1), its epidemiology is poorly understood, and little effort has been made to reduce its prevalence. In response to this situation, the Global Virus Network launched a taskforce in 2014 to develop new methods of prevention and treatment of HTLV-1 infection and promote basic research. HTLV-1 is the etiological agent of two life-threatening diseases, adult T-cell leukemia and HTLV-associated myelopathy/tropical spastic paraparesis, for which no effective therapy is currently available. Although the modes of transmission of HTLV-1 resemble those of the more familiar HIV-1, routine diagnostic methods are generally unavailable to support the prevention of new infections. In the present article, the Taskforce proposes a series of actions to expand epidemiological studies; increase research on mechanisms of HTLV-1 persistence, replication and pathogenesis; discover effective treatments; and develop prophylactic and therapeutic vaccines.
Topics: Advisory Committees; Biomedical Research; Cost of Illness; Global Health; HIV Infections; HTLV-I Infections; Human T-lymphotropic virus 1; Humans; Leukemia-Lymphoma, Adult T-Cell; Paraparesis, Tropical Spastic; Spinal Cord Diseases
PubMed: 27840202
DOI: 10.1016/j.antiviral.2016.10.015 -
Journal of Neurology, Neurosurgery, and... Sep 2023Nitrous oxide (NO) is the second most common recreational drug used by 16- to 24-year-olds in the UK. Neurological symptoms can occur in some people that use NO...
BACKGROUND
Nitrous oxide (NO) is the second most common recreational drug used by 16- to 24-year-olds in the UK. Neurological symptoms can occur in some people that use NO recreationally, but most information comes from small case series.
METHODS
We describe 119 patients with NO-myeloneuropathy seen at NHS teaching hospitals in three of the UK's largest cities: London, Birmingham and Manchester. This work summarises the clinical and investigative findings in the largest case series to date.
RESULTS
Paraesthesia was the presenting complaint in 85% of cases, with the lower limbs more commonly affected than the upper limbs. Gait ataxia was common, and bladder and bowel disturbance were frequent additional symptoms. The mid-cervical region of the spinal cord (C3-C5) was most often affected on MRI T2-weighted imaging. The number of NO canisters consumed per week correlated with methylmalonic acid levels in the blood as a measure of functional B deficiency (rho (ρ)=0.44, p=0.04).
CONCLUSIONS
Preventable neurological harm from NO abuse is increasingly seen worldwide. Ease of access to canisters and larger cylinders of NO has led to an apparent rise in cases of NO-myeloneuropathy in several areas of the UK. Our results highlight the range of clinical manifestations in a large group of patients to improve awareness of risk, aid early recognition, and promote timely treatment.
Topics: Humans; Nitrous Oxide; Substance-Related Disorders; Spinal Cord Diseases; Paresthesia
PubMed: 37253616
DOI: 10.1136/jnnp-2023-331131 -
The Veterinary Clinics of North... Sep 2010The objective of this article is to review the recent literature that reports on the most common diseases affecting the spinal cord of cats, and to draw some general... (Review)
Review
The objective of this article is to review the recent literature that reports on the most common diseases affecting the spinal cord of cats, and to draw some general conclusions that will be useful to formulate diagnosis and prognosis for feline spinal patients. The most common types of feline spinal cord diseases documented were inflammatory/infectious diseases, and feline infectious peritonitis was the most common disease, representing approximately 50% of all feline myelitis. Neoplasms were documented in approximately 25% of cases; lymphosarcoma was the most common tumor affecting the spinal cord of cats, with reported prevalence between 28% and 40%. Cats diagnosed with spinal lymphosarcoma were significantly younger (median age 4 years) than cats with other spinal cord tumors (median age 10 years). Cats with clinical signs of intervertebral disc disease had a median age of 8 years, and 67% had Hansen type I disc protrusions. The most commonly affected intervertebral disc was at the L4 to L5 intervertebral disc space. Fibrocartilaginous embolism-affected older cats (median age 10 years), seemed to predominate in the cervicothoracic intumescence, and clinical signs were markedly lateralized, especially when the cervical region was affected.
Topics: Animals; Cat Diseases; Cats; Diagnosis, Differential; Female; Male; Myelitis; Prognosis; Spinal Cord Diseases; Spinal Cord Neoplasms
PubMed: 20732602
DOI: 10.1016/j.cvsm.2010.05.005