Clinical features of spinal cord hemangioblastoma complicated by hematomyelia and subarachnoid hemorrhage: Description of a clinical case and review of literature

The paper describes subarachnoid hemorrhage (SAH) and hematomyelia resulting from bleeding from spinal hemangioblastoma. SAH is encountered in spinal pathology extremely rarely and results from bleeding from malformations in most cases. The described case demonstrates that the tumors may also cause spinal SAH even there is no clinical evidence of gradually progressive spinal cord compression in the history. Patients with hemangioblastoma are at the highest risk for clinically relevant massive bleeding in intramedullary tumors. In this case, of special attention is its clinical picture: SAH began with neck and arm pain, rather than headache, which indicates the primarily spinal level of bleeding. Head and arm pains were joined by SAH -typical headache, nausea, and vomiting in only a few minutes, which was associated with retrograde blood flow into the basal cisterns of the brain and the fourth ventricle. Primary MRI of the cervical spine was a more rational diagnostic scheme in this case

Spinal dural arteriovenous fistulas: Pathogenesis, clinical manifestations, diagnosis, treatment

The paper describes spinal dural arteriovenous fistulas (SDAVF), the most common type of spinal cord vascular anomalies. SDAVFs account for 60–80% of the spinal cord vascular anomalies. The causes of SDAVFs, the specific features of their hemodynamics, and their classification remain the subject matter of disputes.SDAVFs form in dura mater tissue, on the dorsal surface of radicular cuffs. The pathogenesis of neurological disorders in SDAVF has determined the name «venous hypertensive myelopathy», a spinal cord injury occurring in their presence. Pain and paresthesias, cacesthesia (more commonly in their distal parts), and motor disorders as flail legs are observed at the onset of SDAVF in typical cases. On average, 12 to 44 months elapse to establish its diagnosis. In addition of motor and sensory disorders, sphincter impairments and sexual dysfunction are detected in the patients at the time of diagnosis. By this time, most patients have already neurological disability.The paper presents the history of studying SDAVF, the existing classifications of arteriovenous malformations and fistulas, the clinical manifestations of venous hypertensive myelopathy in SDAVF, neuroimaging findings, and treatment options

Regression of lumbar disk herniation

Compression of the spinal nerve root, giving rise to pain and sensory and motor disorders in the area of its innervation is the most vivid manifestation of herniated intervertebral disk. Different treatment modalities, including neurosurgery, for evolving these conditions are discussed. There has been recent evidence that spontaneous regression of disk herniation can regress. The paper describes a female patient with large lateralized disc extrusion that has caused compression of the nerve root S1, leading to obvious myotonic and radicular syndrome. Magnetic resonance imaging has shown that the clinical manifestations of discogenic radiculopathy, as well myotonic syndrome and morphological changes completely regressed 8 months later. The likely mechanism is inflammation-induced resorption of a large herniated disk fragment, which agrees with the data available in the literature. A decision to perform neurosurgery for which the patient had indications was made during her first consultation. After regression of discogenic radiculopathy, there was only moderate pain caused by musculoskeletal diseases (facet syndrome, piriformis syndrome) that were successfully eliminated by minimally invasive techniques

Postoperative cognitive dysfunction: etiology, clinical features, diagnosis

Introduction. The present study analyzed the possibility of using neuropsychological tests to assess postoperative cognitive dysfunction. New data were obtained: in the postoperative period, hippocampal memory impairments predominate in patients, which makes it expedient to use methods for diagnosing primary modal-nonspecific memory disorders in patients who are to undergo neurosurgical intervention on the spinal cord.The aim of the study to evaluate the influence of surgery with anesthesia on the cognitive functions of middle-age patients.Materials and methods. The study included 20 middle-aged patients. All patients had to undergo spinal surgery. Patients received total intravenous anesthesia with propofol induction (4–12 mg/kg/hr). Cognitive functions before and after the operation were made with the use of the MoCA, TMT A and B, FCSRT, state-trait anxiety inventory test (STAI).Results. The development of POCD was noted in 15% of cases. The patients showed a decrease in the FCSRT prompt index (1st day = 87 ± 9.0; 2nd day = 83 ± 15; p = 0,0005), while the overall severity of cognitive impairments (total score of MoCA) did not change significantly (standard deviation according to MoCA: 24.25 ± 2.86 on day 1 and 24 ± 3.24 on the second day, p = 0.61). The RT level decreased by day 2: 44.65 ± 7.4 versus 41.1 ± 8.2 (p = 0.001). Correlation analysis did not show the relationship between the age of patients, education level, comorbidity and development of POCD; however, the duration of anesthesia was associated with a decrease in MoCA scores (Pearson’s correlation coefficient r = –0.44; p = 0.050).Conclusion. Thus, our study shows that the study of hippocampal memory impairments is important in patients with POCD. These data differ from the data of researchers presented earlier, where the most important clinical manifestations of POCD are considered to be a decrease in attention and speed of mental processes. Of course, the small sample size dictates the need for additional research

Carpal tunnel syndrome: issues of diagnosis and treatment

Objective: to analyze the typical medical practice management of patients with carpal tunnel syndrome (CTS), to evaluate the efficiency of surgical treatment, and to identify factors influencing the successful outcomes of surgical treatment.Patients and methods. The investigation enrolled 85 patients (14 men and 71 women; mean age, 62±10.8 years). Previous diagnosis and treatment of patients were assessed in other healthcare facilities. All patients underwent median nerve decompression. The efficiency of surgical treatment was assessed according to the Boston Carpal Tunnel Questionnaire (BCTQ) and a visual analogue scale for pain before and 1, 3, 6, and 12 months after surgery.Results and discussion. Informative diagnostic tests are rarely performed in patients with CTS, but cervical spine neurovisualization is often unreasonably prescribed. Erroneous diagnoses (predominantly those of cervical spine osteochondrosis (46%), and diabetic neuropathy (6%)) are made frequently (60%) in patients with CTS; the latter receive ineffective treatment for a long time. Surgical treatment in reducing pain and improving hand functionality is noted to be highly effective. The mean BCTQ score decreased from 2.81±0.68 to 1.62±0.55 and 1.24±0.41 at 1 and 12 months, respectively (p<0.05), the mean functional state score dropped from 2.92±0.78 to 2.4±0.72 and 1.46±0.57, respectively (p<0.05). Permanent numbness, subjective weakness, thenar muscle atrophy, Stage III CTS, and diabetes mellitus are predictors for less pronounced improvement in BCTQ scores after surgery (p<0.05).Conclusion. Physicians are noted to be unaware of the manifestations of CTS and effective methods for its diagnosis and treatment. Decompression surgery is shown to be a highly effective procedure in patients with CTS following 1 and 12 months

Median nerve decompression in carpal tunnel syndrome: short- and long-term results

Objective: to investigate the short- and long-term results of surgical median nerve decompression via classical and minimally invasive approaches in patients with carpal tunnel syndrome (CTS), as well as factors that influence surgical outcomes. Patients and methods. The investigation enrolled 70 patients (13 men and 57 women) aged 36 to 84 years (mean age, 62±10.8 years) who had undergone median nerve decompression. Surgery was performed in the classical way in 35 patients (Group 1) and via a minimally invasive access in the remaining 35 patients (Group 2). The efficiency of treatment was evaluated using the Boston Carpal Tunnel Questionnaire (BCTQ) and a visual analog scale for pain before and 1, 3, 6, and 12 months after surgery, as well as from patient satisfaction with surgical outcomes. Results. No complications of surgical treatment were detected. There was a marked reduction in pain and other neuropathic disorders just 1 month after surgery and a substantial hand functional improvement following 6 months. After 12 months, in Group 1, the mean BCTQ Symptom Severity Scale and Functional Deficit Scale scores decreased from 2.76 to 1.15 (p≤0.01) and from 2.72 to 1.24 (p≤0.01), respectively; in Group 2, these dropped from 2.86 to 1.14 (p≤0.01) and from 2.95 to 1.24 (p≤0.01), respectively. Complete recovery from sensory problems occurred in 24 (69%) patients in Group 1 and in 25 (71%) patients in Group 2; their partial recovery was observed in 11 (31%) and 10 (29%) patients in these groups, respectively. One 1 month following decompression, the patients in Group 1 had more severe pain syndrome than those in Group 2; these differences became statistically insignificant after 6 months. The patients were found to be highly satisfied with surgical treatment. Permanent numbness, subjective weakness, thenar muscle atrophy, stage III CTS, and diabetes mellitus (DM) were predictors for less pronounced improvement in BCTQ scores after surgical treatment (p<0.05). The paper describes a clinical case that achieved full postoperative occupational and home rehabilitation. Conclusion. The patients with CTS were observed to have a marked reduction in pain and other neuropathic disorders just one month after surgical decompression and a substantial hand functional improvement following 6 months. The benefit from a minimally invasive access is less severe pain syndrome at 1 month after surgery. The predictors of less successful results of surgery are age (the older the patient is, the greater likelihood of having a worse result), permanent numbness, subjective hand weakness, thenar muscle atrophy, DM, and stage III CTS