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Neurogenic Stunned Myocardium Associated with Acute Spinal Cord Infarction: A Case Report  [PDF]
Gillian A. Beauchamp,Jason T. McMullan,Jordan B. Bonomo
Case Reports in Critical Care , 2012, DOI: 10.1155/2012/439528
Abstract: Introduction. Neurogenic stunned myocardium (NSM) is a reversible cardiomyopathy resulting in transient left ventricular apical ballooning presumed to result from catecholamine surge occurring under physiologic stress. Acute spinal cord ischemia is a rare ischemic vascular lesion. We report a case of neurogenic stunned myocardium occurring in the setting of acute spinal cord infarction. Methods. Singe case report was used. Results. We present the case of a 63-year-old female with a history of prior lacunar stroke, hypertension, chronic back pain, and hypothyroidism who presented with a brief episode of diffuse abdominal and bilateral lower extremity pain which progressed within minutes to bilateral lower extremity flaccid paralysis. MRI of the spinal cord revealed central signal hyperintensity of T2-weighted imaging from conus to T8 region, concerning for acute spinal cord ischemia. Transthoracic echocardiogram was performed to determine if a cardiac embolic phenomenon may have precipitated this ischemic event and showed left ventricular apical hypokinesis and ballooning concerning for NSM. Conclusion. Neurogenic stunned myocardium is a reversible cardiomyopathy which has been described in patients with physiologic stress resulting in ventricular apical ballooning. Our case suggests that it is possible for neurogenic stunned myocardium to occur in the setting of acute spinal cord ischemia. 1. Introduction Neurogenic stunned myocardium (NSM) is a reversible cardiomyopathy resulting in transient left ventricular apical ballooning which has been described to occur in the setting of catecholamine release [1, 2] during situations of physiologic stress such as subarachnoid hemorrhage [3–5], reversible posterior leukoencephalopathy [6], atrial fibrillation [7], hemorrhagic cerebral contusion [8], status epilepticus [9], ischemic cerebrovascular accident [10], limbic encephalitis [11], and severe emotional stress [12]. NSM has also been referred to as “broken heart syndrome” [12], “takotsubo cardiomyopathy,” “apical ballooning syndrome,” “neurogenic stress cardiomyopathy,” [13] and “transient left ventricular dysfunction syndrome.” [14] This condition typically presents with mildly elevated cardiac biomarkers [14] and reversible regional-wall motion abnormalities on echocardiogram [15]. Care for NSM involves treatment of the underlying cause and supportive care. Acute spinal cord ischemia is a rare ischemic vascular lesion with high morbidity and mortality [16]. To the best of our knowledge, this is the first case report of the occurrence of neurogenic stunned
Effects of Erythropoietin on The Volume of Infarction After Spinal Cord Ischemia Model  [PDF]
Figen BOYACI,Necati GOKMEN,Serhat ERBAYRAKTAR,Osman YILMAZ
Journal of Neurological Sciences , 2012,
Abstract: Background: In this study we aimed to investigate the effects of intravenous erythropoietin on motor neuron cells and volume of infarction in a rabbit model of spinal cord ischemia of 40 minutes.Methods: Seventeen New Zealand Rabbits were used. Abdominal aorta was occluded for 40 minutes to induce spinal cord ischemia. Subjects were randomly divided into 2 groups. In the control group (n=7) we infused physiological saline solution while 1000 U/kg of erythropoietin in the group erythropoietin (n=7). Motor functions were evaluated with criteria of Drummond and Moore at times 1., 24., 48., and 72th hours. At the third postoperative day subjects were infused with high dose of thiopental and their spinal cords were removed. The number of viable motor neurons and the volume of infarction were obtained in the ischemic regions. Comparisons regarding motor functions and infarct volumes revealed significant differences.Results: Erythropoietin treated animals not only neurological functions were improved, but also number of motor neurons as well as the volume of infarction were decreased clearly in ischemic regions (1,48 ± 0,69 % vs 2,00 ± 1,28 % ).Conclusion: Since erythropoietin seemed to protect the rabbits against neurological deterioration even after 40 minutes of spinal cord ischemia, transferring these findings to clinical studies designed for spinal cord ischemia may improve the outcome expectations.
Delayed post-traumatic spinal cord infarction in an adult after minor head and neck trauma: a case report  [cached]
Bartanusz Viktor,Ziu Mateo,Wood Leisha E,Caron Jean-Louis
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-314
Abstract: Introduction Delayed post-traumatic spinal cord infarction is a devastating complication described in children. In adults, spinal cord ischemia after cardiovascular interventions, scoliosis correction, or profound hypotension has been reported in the literature. However, delayed spinal cord infarction after minor head trauma has not been described yet. Case presentation We report the case of a 45-year-old Hispanic man who had a minor head trauma. He was admitted to our hospital because of paresthesias in his hands and neck pain. A radiological workup showed cervical spinal canal stenosis and chronic cervical spondylotic myelopathy. Twelve hours after admission, our patient became unresponsive and, despite full resuscitation efforts, died. The autopsy revealed spinal cord necrosis involving the entire cervical spinal cord and upper thoracic region. Conclusions This case illustrates the extreme fragility of spinal cord hemodynamics in patients with chronic cervical spinal canal stenosis, in which any further perturbations, such as cervical hyperflexion related to a minor head injury, can have catastrophic consequences. Furthermore, the delayed onset of spinal cord infarction in this case shows that meticulous maintenance of blood pressure in the acute post-traumatic period is of paramount importance, even in patients with minimal post-traumatic symptoms.
Clinical Evaluation of Patients with Spinal Cord Infarction in Mashhad, Iran
Kavian Ghandehari,Mohammad Reza Gerami Sarabi,Parham Maarufi
Stroke Research and Treatment , 2010, DOI: 10.4061/2010/942417
Abstract: Background. Spinal Cord Infarction (SCI) is a rare and disabling disease. This hospital-based study was conducted for clinical evaluation of SCI patients in east of Iran. Methods. Consecutive SCI patients admitted in Ghaem hospital,Mashhad during 2006–2010 were enrolled in a prospective clinical study. Diagnosis of SCI was made by neurologists and radiologists. Demographic features, clinical syndrome, and Magnetic Resonance Imaging (MRI) findings were recorded. All of the patients underwent a standard battery of diagnostic investigations. All of the patients suspected to SCI had MRI of spinal cord at the symptomatic level of cord with a 0.5 Tesla generation, Philips NT Intra , Netherland equipment. An equal number of patients with Brain Infarction (BI) were randomly selected from our stroke registry data bank. Etiology and degree of disability were compared between these groups of patients. Results. Fourteen SCI patients (9 females, 5 males) with mean age 38.8±SD: 19.9 years were evaluated. Miscellaneous causes consisted 50% of etiologies in patients with SCI. Uncertain etiology, atherosclerosis, and cardioembolisms consisted 35.7%, 7.1%, and 7.1% of SCI causes, respectively. Distribution of etiologies was significantly different between SCI and BI patients, 2=12.94, =3, =.003. Difference in mean disability score at acute phase of stroke was not significant between two studied groups, =1.54, =.057. Difference in mean changes of disability score at 90 days postevent was significant in two groups of patients, =2.65, =.019. Conclusion. SCI is a rare disease with poor recovery. Distribution of etiologies of SCI patients is quite different than of BI patients.
Cerebral Venous Thrombosis in a Patient with Clinically Isolated Spinal Cord Syndrome  [PDF]
Jasem Yousef Al-Hashel,Samar Farouk Ahmed,K. J. Alexander,Walaa Ahmed
Case Reports in Neurological Medicine , 2013, DOI: 10.1155/2013/364869
Abstract: Background. The association between cerebral venous thrombosis (CVT) and multiple sclerosis (MS) has already been reported in patients with clinically definite MS in relation to intravenous methylprednisolone (IVMP) or previously performed lumbar puncture (LP). Case Summery. We report a 29-year-old Indian female who presented with a clinically isolated spinal cord syndrome according to the revised 2010 McDonald Criteria. She developed CVT after a lumbar puncture and two days of finishing the course of IVMP. Conclusion. We conclude that the sequence of doing lumbar puncture followed by high-dose IVMP may increase the risk of CVT. A prophylactic anticoagulation may be indicated in this setting. 1. Introduction Cerebral venous thrombosis (CVT) may occur at any age and may be idiopathic or secondary to various causes. Several cases of CVT have been described in patients with multiple sclerosis (MS) [1]. In the majority of these cases, lumbar puncture followed by IVMP was suspected as the cause of CVT [2]. MS may present with a wide range of central and even peripheral nervous system symptoms and signs, so the coincidence of other neurological disorders in MS patients may remain undetected. Therefore, more clinical evaluations and investigations should be considered in any MS patient who presents with new atypical symptoms [1]. We report a case with multifocal clinically isolated syndrome (CIS). This patient developed CVT following lumbar puncture and 2 days after IVMP pulse therapy. 2. Case Presentation A 29-year-old Indian female, who was two months postpartum, presented to our hospital with history of numbness of her lower limbs that ascended up to her chest. The numbness began about ten months back and remained stationary during the pregnancy. She did not seek any medical advice at that time. Two months postpartum, the numbness became more severe and annoying. She did not have any other neurological symptoms. There was no history of any oro-genital ulcers, redness of eyes, or abortions. She denied any previous similar attacks. She had skin lesions over the elbow and knee joints suggestive of psoriasis, which was treated with topical corticosteroid. On examination she was fully conscious, alert, oriented, and with normal cranial nerve functions. Motor system examination revealed normal muscle bulk, tone, power, and deep tendon reflexes in the upper limbs. Lower limb examination showed normal muscle bulk with hypertonicity and distal weakness of Medical Research Council Power Scale grade 4/5 bilaterally. The deep tendon reflexes were exaggerated in the
Neurogenic Stunned Myocardium Associated with Acute Spinal Cord Infarction: A Case Report
Gillian A. Beauchamp,Jason T. McMullan,Jordan B. Bonomo
Case Reports in Critical Care , 2012, DOI: 10.1155/2012/439528
Abstract: Introduction. Neurogenic stunned myocardium (NSM) is a reversible cardiomyopathy resulting in transient left ventricular apical ballooning presumed to result from catecholamine surge occurring under physiologic stress. Acute spinal cord ischemia is a rare ischemic vascular lesion. We report a case of neurogenic stunned myocardium occurring in the setting of acute spinal cord infarction. Methods. Singe case report was used. Results. We present the case of a 63-year-old female with a history of prior lacunar stroke, hypertension, chronic back pain, and hypothyroidism who presented with a brief episode of diffuse abdominal and bilateral lower extremity pain which progressed within minutes to bilateral lower extremity flaccid paralysis. MRI of the spinal cord revealed central signal hyperintensity of T2-weighted imaging from conus to T8 region, concerning for acute spinal cord ischemia. Transthoracic echocardiogram was performed to determine if a cardiac embolic phenomenon may have precipitated this ischemic event and showed left ventricular apical hypokinesis and ballooning concerning for NSM. Conclusion. Neurogenic stunned myocardium is a reversible cardiomyopathy which has been described in patients with physiologic stress resulting in ventricular apical ballooning. Our case suggests that it is possible for neurogenic stunned myocardium to occur in the setting of acute spinal cord ischemia.
Successful management of aortic thrombi resulting in spinal cord infarction in a patient with antiphospholipid antibody syndrome and acute cholecystitis
Izumi M, Teraoka S, Yamashita K, Matsumoto K, Muronoi T, Izawa Y, Yonekawa C, Ano M, Suzukawa M
International Medical Case Reports Journal , 2011, DOI: http://dx.doi.org/10.2147/IMCRJ.S26618
Abstract: ccessful management of aortic thrombi resulting in spinal cord infarction in a patient with antiphospholipid antibody syndrome and acute cholecystitis Case report (1911) Total Article Views Authors: Izumi M, Teraoka S, Yamashita K, Matsumoto K, Muronoi T, Izawa Y, Yonekawa C, Ano M, Suzukawa M Published Date December 2011 Volume 2011:4 Pages 93 - 96 DOI: http://dx.doi.org/10.2147/IMCRJ.S26618 Manabu Izumi, Shoko Teraoka, Keisuke Yamashita, Kenji Matsumoto, Tomohiro Muronoi, Yoshimitsu Izawa, Chikara Yonekawa, Masaki Ano, Masayuki Suzukawa Department of Emergency and Critical Care Medicine, Jichi Medical University, Tochigi, Japan Abstract: A 74-year-old man with coronary artery disease was suffering from acute nonobstructive cholecystitis and was admitted to a nearby hospital. Dual antiplatelet (aspirin and ticlopidine) therapy was discontinued before preparation for surgical resection of the gall bladder. During his time in hospital he was aware of lumbar pain and weakness in both legs. He was transferred to our hospital for further evaluation and therapy. Diffuse intra-aortic thrombi were revealed by computed tomography with contrast media, and magnetic resonance imaging showed spinal cord infarction. However, computed tomography scans of the descending aorta obtained 4 months before admission exhibited no signs of atherosclerotic plaques or intra-aortic thrombi. Laboratory data suggest that antiphospholipid antibody syndrome might have caused these acute multiple intra-arterial thrombi. By restarting dual antiplatelet therapy and increasing the dose of heparin (from 10,000 IU/day to 15,000 IU/day) we successfully managed the patient's clinical condition and symptoms. It is important to understand that stopping antiplatelet therapy may rapidly grow thrombi in patients with a hypercoagulative state.
Successful management of aortic thrombi resulting in spinal cord infarction in a patient with antiphospholipid antibody syndrome and acute cholecystitis  [cached]
Izumi M,Teraoka S,Yamashita K,Matsumoto K
International Medical Case Reports Journal , 2011,
Abstract: Manabu Izumi, Shoko Teraoka, Keisuke Yamashita, Kenji Matsumoto, Tomohiro Muronoi, Yoshimitsu Izawa, Chikara Yonekawa, Masaki Ano, Masayuki SuzukawaDepartment of Emergency and Critical Care Medicine, Jichi Medical University, Tochigi, JapanAbstract: A 74-year-old man with coronary artery disease was suffering from acute nonobstructive cholecystitis and was admitted to a nearby hospital. Dual antiplatelet (aspirin and ticlopidine) therapy was discontinued before preparation for surgical resection of the gall bladder. During his time in hospital he was aware of lumbar pain and weakness in both legs. He was transferred to our hospital for further evaluation and therapy. Diffuse intra-aortic thrombi were revealed by computed tomography with contrast media, and magnetic resonance imaging showed spinal cord infarction. However, computed tomography scans of the descending aorta obtained 4 months before admission exhibited no signs of atherosclerotic plaques or intra-aortic thrombi. Laboratory data suggest that antiphospholipid antibody syndrome might have caused these acute multiple intra-arterial thrombi. By restarting dual antiplatelet therapy and increasing the dose of heparin (from 10,000 IU/day to 15,000 IU/day) we successfully managed the patient's clinical condition and symptoms. It is important to understand that stopping antiplatelet therapy may rapidly grow thrombi in patients with a hypercoagulative state.Keywords: intra-aortic thrombus, antiphospholipid antibody syndrome, spinal cord infarction
Neurovascular Coupling of the Posterior Cerebral Artery in Spinal Cord Injury: A Pilot Study  [PDF]
Aaron A. Phillips,Andrei V. Krassioukov,Mei Mu Zi Zheng,Darren E. R. Warburton
Brain Sciences , 2013, DOI: 10.3390/brainsci3020781
Abstract: Purpose: To compare neurovascular coupling in the posterior cerebral artery (PCA) between those with spinal cord injury (SCI) and able bodied (AB) individuals. Methods: A total of seven SCI and seven AB were matched for age and sex. Measures included PCA velocity (PCAv), beat-by-beat blood pressure and end-tidal carbon dioxide. Posterior cerebral cortex activation was achieved by 10 cycles of (1) 30 s eyes closed (pre-stimulation), (2) 30 s reading (stimulation). Results: Blood pressure was significantly reduced in those with SCI (SBP: 100 ± 13 mmHg; DBP: 58 ± 13 mmHg) vs. AB (SBP: 121 ± 12 mmHg; DBP: 74 ± 9 mmHg) during both pre-stimulation and stimulation, but the relative increase was similar during the stimulation period. Changes in PCAv during stimulation were mitigated in the SCI group (6% ± 6%) vs. AB (29% ± 12%, P < 0.001). Heart rate and end-tidal carbon dioxide responded similarly between groups. Conclusions: Clearly, NVC is impaired in those with SCI. This study may provide a link between poor perfusion of the posterior cerebral region (containing the medullary autonomic centres) and autonomic dysfunction after SCI.
Cerebral blood flow increase in cancer patients by applying cervical spinal cord stimulation
Clavo,B.; Robaina,F.; Catalá,L.; Lloret,M.; Pinar,B.; Caramés,M.A.; Ruiz,A.; Cabezón,A.; González,G.; Lara,P.; Ruiz-Egea,E.; Hernández,M.A.;
Neurocirugía , 2007, DOI: 10.4321/S1130-14732007000100003
Abstract: introduction. generally, high-grade gliomas and head and neck tumors have decreased loco-regional blood flow resulting in reduced delivery of chemotherapy and oxygen, as well as an increases in radiation resistance to radiotherapy. the aim of this study was to analyze the effect of cervical spinal cord electrical stimulation (cscs) on cerebral blood flow in patients with those tumors. patients and methods. we have evaluated 27 cancer patients with 12 with high grade gliomas and 15 with advanced head and neck tumors, who had cscs devices placed after tumor diagnoses and before the commencementinitiating of radio-chemotherapy. they were 12 high grade gliomas and 15 advanced head and neck tumors. before and after cscs, cerebral blood flow was assessed bilaterally by transcranial doppler. results. during cscs there was a significant (p<0.001) increase in systolic (mean >22%) and diastolic (>29%) blood-flow velocities in both, healthy and tumor middle cerebral arteries. the analyses by subgroup of tumors showed similarly significant outcomesfindings. conclusions. the results suggest that neuro-stimulationspinal cord electrical stimulation can increase cerebral blood flow in cancer patients. the implication is that this technique could be useful in modifying loco-regional ischemia in brain tumors thus improveing the outcomes of after radio-chemotherapy. further research is in progress to confirm the advantages of the technique.
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