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  • 1
    Electronic Resource
    Electronic Resource
    Symptomatic spinal cord deformity secondary to a redundant intramedullary shunt catheter (1985)
    Springer
    Neuroradiology 27 (1985), S. 176-180 
    Details
    ISSN: 1432-1920
    Keywords: Quadraplegia ; intraoperative spinal sonography ; spinal cord cysts ; shunt malfunction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Right arm pain, motor and senory loss in the right arm and right facial numbness recurred in a 27 year old quadraplegic shortly after a posttraumatic spinal cord cyst (PTSCC) was shunted via a catheter into the adjacent subarachnoid space. Although shunt malfunction was clinically suspected, metrizamide computed tomography (MCT) suggested that redundancy of the catheter had caused deformity of the spinal cord. This hypothesis was confirmed at surgery when intraoperative spinal sonography (IOSS) showed that the spinal cord deformity at C1−C2 disappeared when the catheter was withdrawn. This case shows that new or recurrent spinal cord symptoms may be due to a mechanical deformity of the cord rather than shunt malfunction, that restricting the length of the shunt catheter which is used to decompress PTSCCs is important, and that IOSS is an indispensible tool for visualizing the changes in spinal cord morphology during shunting procedures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00343792
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Acute traumatic central cord syndrome: MRI-pathological correlations (1992)
    Springer
    Neuroradiology 34 (1992), S. 85-94 
    Details
    ISSN: 1432-1920
    Keywords: Acute traumatic central cord syndrome ; Magnetic resonance imaging ; Pathology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The acute traumatic central cord syndrome (ATCCS) is commonly stated to result from an injury which affects primarily the center of the spinal cord and is frequently hemorrhagic. To test the validity of this widely disseminated hypothesis, the magnetic resonance images [MRI] of 11 consecutive cases of ATCCS caused by closed injury to the spine were analyzed and correlated with the gross pathological and histological features of 3 cervical spinal cords obtained at post mortem from patients with ATCCS, including 2 of patients studied by MRI. The MRI studies were performed acutely (18 h to 2 days after injury) in 7 patients and subacutely (3–10 days after injury) in 4. Ten of the 11 patients had pre-existing spondylosis and/or canal stenosis. The 11th suffered a cervical fracture. All patients exhibited hyperintense signal within the parenchyma of the cervical spinal cord on gradient echo MRI. None showed MRI features characteristic of hemorrhage on T1-weighted spin echo or T2*-weighed gradient echo studies. Gross and histological examination of the necropsy specimens showed no evidence of blood or blood products within the cord parenchyma: the primary finding was diffuse disruption of axons, especially within the lateral columns of the cervical cord in the region occupied by the corticospinal tracts. The central gray matter was intact. In patients with ATCCS, the predominant loss of motor function in thedistal muscles of the upper limbs may reflect the importance of the corticospinal tract for hand and finger function in the primate. In this study, the MRI and pathological observations indicate that ATCCS is predominantly a white matter injury and that intramedullary hemorrhage is not a necessary feature of the syndrome; indeed, it is probably an uncommon event in ATCCS. We suggest that the most common mechanism of injury in ATCCS may be direct compression of the cervical spinal cord by buckling of the ligamenta flava into an already narrowed cervical spinal canal; this would explain the predominance of axonal injury in the white matter of the lateral columns.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00588148
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Follow-up computerized tomography (CT) scans in moderate and severe head injuries: Correlation with Glasgow coma scores (GCS), and complication rate (1997)
    Springer
    Acta neurochirurgica 139 (1997), S. 1042-1048 
    Details
    ISSN: 0942-0940
    Keywords: Computerized tomography (CT) ; glasgow coma score (GCS) ; blunt head trauma ; complication ; intracranial pressure ; cerebral perfusion pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Background: The wide availability of computerized tomography (CT) scan has popularized its use in initial and follow-up evaluations of head trauma patients. Follow-up CT scans of clinically stable patients, however, may not provide additional information, but could potentially subject the patients to secondary injuries. The authors investigated the correlation between CT scans and Glasgow coma score (GCS), and complication rate during follow-up CT scans in an attempt to dissuade clinicians from obtaining unnecessary follow-up CT scans. Methods: The medical records of 180 patients with blunt head trauma were retrospectively reviewed. Only patients (117) with moderate and severe head injuries were included in the study. A total of 319 follow-up brain CT's for 94 patients were obtained. Results: The change in CT scans was compared to the GCS the day of the scan. These two variables were found to be positively correlated by Chi-square analysis (χ2=81.2; α 〈 0.001). CPP trend was found also be correlated with CT scan evolution by the Chisquare analysis (α 〈 0.001). When patients had unchanged or improved GCS, 73.1% had improved or the same CT appearance. When patients had a worse GCS, the CT was worse in 77.9%. A 16.9% (54/319) complication rate was documented during the follow-up scans (hemodynamic instability, increased intracranial pressure, desaturation, and agitation). This rate was higher in severe head trauma (GCS 3–8) patients than in moderate head injury (GCS 9–12) patients. Hemodynamic instability was the most common complication, which comprises 42.6% (23/54) of all complications. Conclusion: Because of the correlation between the CT scan appearance and the clinical status, as well as the detrimental effect of mobilizing critically ill patients, the authors urge the use of follow-up CT scans only in patients with clinical deterioration unexplained by ICP changes alone.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01411558
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    Paper (German National Licenses)
    Fulltext
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