18 research outputs found

    Brachial plexus injury mimicking a spinal-cord injury.

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    Objective High-energy impact to the head, neck, and shoulder can result in cervical spine as well as brachial plexus injuries. Because cervical spine injuries are more common, this tends to be the initial focus for management. We present a case in which the initial magnetic resonance imaging (MRI) was somewhat misleading and a detailed neurological exam lead to the correct diagnosis.Clinical presentation A 19-year-old man presented to the hospital following a shoulder injury during football practice. The patient immediately complained of significant pain in his neck, shoulder, and right arm and the inability to move his right arm. He was stabilized in the field for a presumed cervical-spine injury and transported to the emergency department.Intervention Initial radiographic assessment (C-spine CT, right shoulder x-ray) showed no bony abnormality. MRI of the cervical-spine showed T2 signal change and cord swelling thought to be consistent with a cord contusion. With adequate pain control, a detailed neurological examination was possible and was consistent with an upper brachial plexus avulsion injury that was confirmed by CT myelogram. The patient failed to make significant neurological recovery and he underwent spinal accessory nerve grafting to the suprascapular nerve to restore shoulder abduction and external rotation, while the phrenic nerve was grafted to the musculocutaneous nerve to restore elbow flexion.Conclusion Cervical spinal-cord injuries and brachial plexus injuries can occur by the same high energy mechanisms and can occur simultaneously. As in this case, MRI findings can be misleading and a detailed physical examination is the key to diagnosis. However, this can be difficult in polytrauma patients with upper extremity injuries, head injuries or concomitant spinal-cord injury. Finally, prompt diagnosis and early surgical renerveration have been associated with better long-term recovery with certain types of injury

    Intraspinal pathology

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    The term "spinal dysraphism" covers two types of spinal congenital malformations, traditionally grouped as "open" and "closed" forms. These two groups have almost no features in common, including their embryological origin, presentation, natural history, and treatment algorithm. Open spinal dysraphism or myelomeningocele is primarily a neural tube closure defect, resulting with a more or less very stereotypic lesion and clinical presentation. The aim of treatment is to preserve the neurological and clinical status of the newborn. Closed spinal dysraphism is far more complicated and is represented by various forms of different combinations of mesodermal structures. While the neurological impairment in myelomeningocele is straightforward related to the incomplete differentiation of the neural tissue, the mechanisms of neurological impairment in closed dysraphisms are far more complex and controversial. This complexity, in turn, generates an ongoing controversy in establishing universal algorithms for treatment
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