Traumatic spinal cord injury: current concepts and treatment update

Spinal cord injury (SCI) affects 1.3 million North Americans, with more than half occurring after trauma. In Brazil, few studies have evaluated the epidemiology of SCI with an estimated incidence of 16 to 26 per million per year. The final extent of the spinal cord damage results from primary and secondary mechanisms that start at the moment of the injury and go on for days, and even weeks, after the event. There is convincing evidence that hypotension contributes to secondary injury after acute SCI. Surgical decompression aims at relieving mechanical pressure on the microvascular circulation, therefore reducing hypoxia and ischemia. The role of methylprednisolone as a therapeutic option is still a matter of debate, however most guidelines do not recommend its regular use. Neuroprotective therapies aiming to reduce further injury have been studied and many others are underway. Neuroregenerative therapies are being extensively investigated, with cell based therapy being very promising.Univ Fed Sao Paulo, Dept Neurol & Neurocirurgia, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Neurol & Neurocirurgia, Sao Paulo, SP, BrazilWeb of Scienc

Traumatic spinal cord injury: current concepts and treatment update

ABSTRACT Spinal cord injury (SCI) affects 1.3 million North Americans, with more than half occurring after trauma. In Brazil, few studies have evaluated the epidemiology of SCI with an estimated incidence of 16 to 26 per million per year. The final extent of the spinal cord damage results from primary and secondary mechanisms that start at the moment of the injury and go on for days, and even weeks, after the event. There is convincing evidence that hypotension contributes to secondary injury after acute SCI. Surgical decompression aims at relieving mechanical pressure on the microvascular circulation, therefore reducing hypoxia and ischemia. The role of methylprednisolone as a therapeutic option is still a matter of debate, however most guidelines do not recommend its regular use. Neuroprotective therapies aiming to reduce further injury have been studied and many others are underway. Neuroregenerative therapies are being extensively investigated, with cell based therapy being very promising

' Man in the Barrel '' Syndrome with Anterior Spinal Artery Infarct due to Vertebral Artery Dissection

Background: Man in the barrel syndrome (MBS) is a condition of brachial diplegia initially described after a bilateral watershed cerebral infarct between the anterior and the middle cerebral artery territories. Objective: To report a case of MBS as a consequence of anterior spinal artery infarct due to vertebral artery dissection. Discussion: More recently, nonischemic lesions in brain and brain stem have also been described as etiologies of MBS. There are few reports describing spinal cord infarction leading to MBS. The anterior spinal artery syndrome with only brachial diplegia also represents a rare and atypical pattern. Conclusion: The conventional neurological consideration that MBS provides a precise anatomical localization is now challenged. The finding of a brachial diplegia leads to the need to investigate the brain, the spinal cord, and the peripheral nervous system. Key Words: Man in the barrel syndrome-anterior spinal artery infarct-intracranial vertebral artery dissection-brachial diplegia-incomplete spinal cord infarct. (C) 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.Univ Fed Sao Paulo, Dept Neurol & Neurosurg, Rua Pedro Toledo,650 Vila Clementino, BR-04039002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Neurol & Neurosurg, Rua Pedro Toledo,650 Vila Clementino, BR-04039002 Sao Paulo, SP, BrazilWeb of Scienc