scholarly journals Immediate Response to Chemotherapy in an Adult Neuroblastoma Patient Presenting with Cord Compression

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Nedal Bukhari ◽  
Bachar Harfouch ◽  
Majid Shallal Alotaibi ◽  
Hulayel Al-Harbi ◽  
Omar Chamdine
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Response To Chemotherapy ◽  
History Of ◽  
Bilateral Lower Limb ◽  
The Right ◽  
Neuroblastoma Patient

We report a case of a 31-year-old female patient with high-risk neuroblastoma (NBL) who presented with a history of static back pain and bilateral lower limb weakness for almost a month. Her primary tumor was located in the right paraspinal region, causing spinal cord compression (SCC). Chemotherapy was administered with an immediate clinical improvement noted after 24 hours of starting treatment. We herein report the efficacy of chemotherapy in an adult neuroblastoma (aNBL) patient presenting with spinal cord compression.

A Case of Metastatic Small Cell Neuroendocrine Carcinoma Presenting as Intractable Back Pain

2020 ◽  
Author(s):  
Tony El Murr
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Lymph Nodes ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Small Cell ◽  
Lower Limbs ◽  
History Of ◽  
Neuroendocrine Small Cell Carcinoma ◽  
The Right

A 59 year old male with a past medical history of cholecystectomy and essential hypertension, presented to the emergency department with severe back pain, abdominal discomfort, poor appetite, generalized fatigue and progressive weight loss of 10 kgs over a three-month period. He has never been a smoker and drinks alcohol occasionally. He has no known allergies and no familial history of cancer. His current home medication includes beta blocker; angiotensin receptor blocker and low dose acetylsalicylic acid. His back pain started two months prior to presentation; it is not well localized to specific vertebra, not irradiating to lower limbs and sometimes related to weight lifting and cough. It is rarely exacerbated at night. His orthopedic surgeon attributed it to osteoarthritis since the patient used to practice hard manual work and weights lifting at his shop. He has been treated since that time with NSAIDs, muscle relaxant and opioids without complete analgesic response. At presentation, he had no fever, chills or night sweats. He had no urinary or sexual complaints that would suggest prostatic disease and was otherwise asymptomatic. The physical examination showed diffuse pain on lumbar vertebral percussion and abdominal tenderness in the right upper quadrant. He has no skin lesions and no palpable peripheral lymph nodes. His neurologic examination was also normal. On admission, significant laboratory findings showed hemoglobin 11.8 g/dl, platelets of 97,000 k/ul, white blood count 4,400 k/ul, ESR=40, creatinine 0.4 mg/dl,CRP 7.5 mg/L, lactate dehydrogenase 2256 U/L, alanine aminotransferase (ALAT) 70 U/L, gamma-glutamyl transferase (GGT) 1500 U/L, total bilirubin 2.32 mg/dl, and a creatine kinase (CK) 167 U/L. Prostatic specific antigen (PSA) was normal and equal to 1.17 ng/ml. Peripheral smear displayed normal pattern and thyroid tests were all within normal ranges. He was negative for salmonellosis, brucellosis and HIV. Tuberculin PPD test was negative as well. His chest X-ray was normal and abdominopelvic ultrasound showed only multiple liver nodules and mild prostate hypertrophy without ascites or significant abdominal lymph nodes. Lumbar MRI done one week before his admission revealed multiple vertebral lytic lesions without spinal cord compression. PET/CT done on the third day at hospital revealed a significant uptake of radiotracer by multiple small nodules in the right lung, in the liver and by multiple lymph nodes within the abdominal cavity. Moreover there were many lytic lesions in the dorsal and lumbar vertebrae. Surprisingly, the scan also showed focal, intense uptake of the prostate with a SUVmax of 8, 28 with evidence of seminal vesicles invasion. Both gastroscopy and colonoscopy was normal as well as his brain MRI. Ultrasound-guided liver nodules biopsies performed on the fifth day after stopping the acetylsalicylic acid revealed neuroendocrine small cell carcinoma as it showed immunohistochemical (IHC) positivity for synaptophysin and CD56. IHC was negative for TTF1 and PSA. Ultrasound-guided biopsy of the prostate was not performed for medical reasons as on his hospital day 7, the patient started feeling numbness and muscle weakness in his lower limbs more severe on the left side associated with urinary incontinence and revealing a spinal cord compression by secondary bone lesions. Regarding this rapidly progressive disease, high dose dexamethasone subcutaneous therapy and ten sessions of focused proton beam radiotherapy has been conducted on daily basis to release the spinal cord compression without significant improvement. Meanwhile, and based on liver biopsy findings, treatment by octreotide 100mg S/C twice daily was started, followed by chemotherapy with Carboplatin, Etoposide, and Atezolizumab (TECENTRIQ) 1200mg. Few days after, the patient developed severe prolonged pancytopenia requiring blood and platelets transfusions and treatment with double dose of granulocyte stimulating growth factor. His prolonged neutropenia was complicated by CMV colitis with unretractable diarrhea, bilateral pneumonia and pseudomonas aeroginosa septicemia. After one month of large spectrum antibiotics, antiviral and antifungal treatment, and while he was still neutropenic, bone marrow biopsy revealed severe infiltration by neuroendocrine small cell carcinoma. The patient was still deteriorating clinically and showing further weight and appetite loss, total muscle weakness and asthenia. At this point, he was no longer a candidate for chemotherapy but only symptomatic treatment was maintained. He died 45 days after his admission.

Segmental neurofibromatosis—induced spinal cord compression

2001 ◽  
Vol 95 (2) ◽  
pp. 236-238
Author(s):  
Natarajan Muthukumar
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Peripheral Nerves ◽  
Cord Compression ◽  
Lower Extremity Weakness ◽  
Content Type ◽  
Neuralgic Pain ◽  
History Of ◽  
Intercostal Neuralgia ◽  
The Right

✓ Spinal segmental neurofibromatosis (NF) is a rare entity. To date, patients in reported cases of segmental NF (or NF5) have harbored neurofibromas involving the peripheral nerves only. The author reports a rare case of segmental NF that caused spinal cord compression in a 40-year-old woman who presented with a 6-month history of intercostal neuralgia. Examination revealed mild lower-extremity weakness and dysesthesia in the right-sided T-9 dermatome. Magnetic resonance imaging revealed three neurofibromas involving the T-9 region, which were excised, and the patient's neuralgic pain was resolved postoperatively. Traditionally, it has been believed that segmental NF involved only the peripheral nerves. The present case illustrates that although rare, spinal cord compression can also occur in patients with segmental NF.

scholarly journals Wide-Open Eyes to the “Snake-Eye Sign”

2018 ◽  
Vol 26 (3) ◽  
pp. 242-243
Author(s):  
Paulo Sergio Faro Santos ◽  
Jerônimo Buzetti Milano ◽  
Hélio Afonso Ghizoni Teive ◽  
Pedro André Kowacs
Keyword(s):  
Spinal Cord ◽  
Magnetic Resonance ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Pain Sensation ◽  
Limb Weakness ◽  
The Right ◽  
Spastic Tetraparesis ◽  
Spastic Gait ◽  
Tendon Reflexes

Patient with progressive four-limb weakness, unsteadiness and falls. Examination revealed paretic-spastic gait, spastic tetraparesis, brisk tendon reflexes, reduced pain sensation at the right side and bilateral Hoffman and Babinski signs. Cervical magnetic resonance (MRI) revealed the “snake-eye sign” and spinal cord compression by protruded discs during cervical extension.

Extradural Thoracic Arteriovenous Malformation in a Patient with Klippel-Trenaunay-Weber Syndrome: Case Report

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1275-1279 ◽  
Author(s):  
Michael J. Alexander ◽  
Peter M. Grossi ◽  
Robert F. Spetzler ◽  
Cameron G. McDougall
Keyword(s):  
Spinal Cord ◽  
Cord Compression ◽  
Magnetic Resonance Imaging Scan ◽  
Lower Extremity Weakness ◽  
Thyrocervical Trunk ◽  
Weber Syndrome ◽  
History Of ◽  
Cutaneous Hemangioma ◽  
The Right ◽  
Upper Thoracic

Abstract OBJECTIVE AND IMPORTANCE Spinal cord involvement in Klippel-Trenaunay-Weber (KTW) syndrome is rare. Cases of intradural spinal cord arteriovenous malformations (AVMs) have been associated with this syndrome. Likewise, cases of epidural hemangioma and angiomyolipoma have been reported to occur at the same segmental level as cutaneous hemangioma in KTW syndrome. This report details a rare case of an extradural thoracic AVM in a patient with KTW syndrome. CLINICAL PRESENTATION A 30-year-old man presented with a 10-month history of progressive myelopathy, bilateral lower-extremity weakness, and numbness, with the right side affected more than the left. His symptoms had progressed to the point that he was unable to walk. The patient had the characteristic manifestations of KTW syndrome, including numerous cutaneous angiomas and cavernomas, limb hypertrophy and syndactyly, and limb venous malformations. A magnetic resonance imaging scan and subsequent angiogram demonstrated a large extradural AVM causing cord compression at the T3–T4 levels. INTERVENTION The patient underwent two separate endovascular procedures, including embolization of upper thoracic and thyrocervical trunk feeders. Subsequently, he underwent T1–T4 laminectomy and microsurgical excision of the AVM. Clinically, the patient improved such that he could walk without assistance. CONCLUSION KTW syndrome represents a spectrum of clinical presentations. Although involvement of the spinal cord is uncommon, the manifestations of this syndrome may include both intradural and extradural AVMs in addition to various tumors.

scholarly journals Initial presentation of Hodgkin’s Lymphoma as Extradural Spinal Cord Compression: A case report

2020 ◽  
Vol 11 (2) ◽  
pp. 101-103
Author(s):  
Rishav Mukherjee ◽  
Sampurna Chowdhury
Keyword(s):  
Spinal Cord ◽  
Hodgkin Lymphoma ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Acute Onset ◽  
Initial Presentation ◽  
Classical Hodgkin Lymphoma ◽  
Night Sweats ◽  
History Of ◽  
Mediastinal Widening

A 23 year old female presented with acute onset paraparesis. She denied any history of fever, weight loss or drenching night sweats. Neither did she have any obvious lymphadenopathy on general examination. Chest Xray was however suggestive of mediastinal widening and her MRI spine showed metastases with superior mediastinal SOL. Biopsy of this SOL ultimately revealed classical Hodgkin lymphoma. Thus this was a very unusual initial presentation of Hodgkin lymphoma presenting as Epidural Spinal Cord Compression. Hasenclever IPS score was 2. Patient was treated with radiotherapy followed by ABVD chemotherapy and achieved remission in 3months.

Impact of Myelography on the Radiotherapeutic Management of Malignant Spinal Cord Compression

Neurosurgery ◽  
1986 ◽  
Vol 19 (4) ◽  
pp. 614-616 ◽  
Author(s):  
Alison R. Calkins ◽  
Margaret A. Olson ◽  
James H. Ellis
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Additional Information ◽  
Compression Syndrome ◽  
Plain Films ◽  
Port Design ◽  
Bony Lesions ◽  
History Of ◽  
Spinal Cord Compression Syndrome

Abstract From December 1981 through August 1984, 24 patients with spinal cord compression syndrome due to epidural neoplasms were evaluated for radiotherapy with clinical examination, radiographs of the spine, and myelography. All plain films were reviewed, and mock radiotherapy fields designed using specific criteria for margins. The same patients were reviewed a second time considering the additional information provided by myelography. The initial treatment fields were found to be inadequate in 69% of the patients. Even in patients with discrete bony lesions, the results of myelography affected the treatment 45% of the time. A history of previous spinal irradiation significantly influenced port design in only 1 of the 7 patients who had received previous radiotherapy. Although invasive, myelography is essential in planning the treatment of spinal cord compression.

scholarly journals Metastatic epidural spinal cord compression

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Preci Hamilton ◽  
Peyton Lawrence ◽  
Christian Valentin Eisenring
Keyword(s):  
Spinal Cord ◽  
Stereotactic Radiosurgery ◽  
Spinal Cord Compression ◽  
Scoring Systems ◽  
Cord Compression ◽  
Tumor Burden ◽  
Pedicle Screw Fixation ◽  
Limb Weakness ◽  
Neoplastic Lesion ◽  
Spinal Sagittal Alignment

Abstract Up-to-date management for metastatic epidural spinal cord compression is based on appropriate scoring systems. In this case, separation surgery and stereotactic radiosurgery achieved an optimized outcome. A 75-year-old man had thoracic band-like pain, left lower limb weakness and difficulty ambulating for 6 weeks. Spinal images showed a T4 metastatic epidural spinal cord compression with a pathological fracture of T4 and T10 and L3 lytic lesions. There was no other neoplastic lesion. The metastasized T4 was decompressed by a posterolateral right costotransversectomy, vertebrectomy and insertion of an expandable titanium cage. The spinal sagittal alignment was restored with T1–T7 pedicle screw fixation. Post-operatively the pain and motor power improved significantly so that the patient was discharged home. Separation surgery and adjuvant stereotactic radiosurgery of the spine successfully improved tumor burden, pain control and overall prognosis.

scholarly journals Rosuvastatin-related rhabdomyolysis causing severe proximal paraparesis and acute kidney injury

2019 ◽  
Vol 12 (10) ◽  
pp. e229244 ◽  
Author(s):  
Kosar Hussain ◽  
Anil Xavier
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
High Dose ◽  
Normal Range ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
History Of ◽  
Complicated Course ◽  
Bilateral Lower Limb ◽  
Initial Blood

We describe the case of a 76-year-old man who presented with bilateral lower limb weakness associated with decreased urine output. His initial blood results showed acute kidney injury (AKI) stage 3 with substantially raised serum creatine kinase concentration of 37 950 IU/L (normal range <171 U/L). He had been on high-dose rosuvastatin for 4 years with a recent brand change occurring 1 week prior to onset of symptoms. There was no history of pre-existing neuromuscular disease. Statin-related rhabdomyolysis was suspected and rosuvastatin was withheld. His muscle strength gradually improved. He required haemodialysis for 10 weeks. He was discharged home after a complicated course of hospitalisation. His renal function improved and he became dialysis-independent; however, he was left with residual chronic kidney disease.

Epidural Venous Angioma Presenting with Spinal Cord Compression in a 42-Year-Old Woman with Previous History of Ovarian Malignancy

2016 ◽  
Vol 93 ◽  
pp. 488.e5-488.e7
Author(s):  
Atef Ben Nsir ◽  
Rym Hadhri ◽  
Mohamed Kilani ◽  
Mohamed Chabaane ◽  
Mehdi Darmoul ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Previous History ◽  
Cord Compression ◽  
Ovarian Malignancy ◽  
Venous Angioma ◽  
History Of
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