Shistosomal myelitis and its diagnostic complexity: report of two cases in Alagoas

Context: In Brazil, schistosomal myelitis is the third most common cause of myelopathy. The diagnosis of neuroschistosomiasis is not easy to make. In a study published in 2001, the author proposed a classification for the diagnosis of schistosomal myelorradiculopathy: Proven Diagnosis; Probable Diagnosis and Possible Diagnosis. Case Reports: Case 1, admitted in 2021 with 40 days of paraparesis and ascending paraesthesia, urinary retention and severe low back pain. He had proximal and distal grade 1 paraparesis, eosinophilia at blood count, CSF with hyperproteinorrhachia, normal cellularity and indirect immunofluorescence (IFI) for reactive schistosomiasis, as well as stool parasitology (EPF) and spine MRI with hypersignal in the spinal cord. Case 2, admitted in 2020 with 20 days of constipation and urinary retention followed by paraparesis and ascending paresthesia and sexual impotence. He presented proximal and distal grade 3 paraparesis and CSF with protein-cytological dissociation. Both had abolished deep reflexes and hypoaesthesia with levels in L2 and T10, respectively. As a result of the other exams and MRI with hypersignal of D6 to medullary cone with contrast impregnation and cauda equina roots, despite case 2 having EPF and IFI for schistosomiasis in the CSF negative, for presenting positive epidemiology for schistosomiasis, both were treated with solumedrol for 5 days, praziquantel and oral prednisone, with improvement afterwards. Conclusion: The outcome of schistosomal myelitis is directly related to early diagnosis and treatment. It is necessary to value all clinical, laboratory and epidemiological findings in patients living in an endemic area.

DYNAMICS OF TEMPERATURE-PAIN SENSITIVITY IN DERMATOMES OF THE CAUDA EQUINA ROOTS IN THE DISTANT PERIOD AFTER SURGICAL TREATMENT OF SPONDYLOLISTHESIS IN ADULTS

Проведено исследование динамики температурно-болевой чувствительности в дерматомах корешков конского хвоста у взрослых больных со спондилолистезом I и II степенях смещения в отдаленные сроки после хирургического лечения. Показано, что в отдаленный период наблюдения уменьшилась доля больных с гипестезией тепла и боли, термоанестезией, увеличилось количество больных с нормальными порогами. Наиболее уязвимым является Lдерматом, где регистрируется наименьший процент больных с нормальными порогами болевой чувствительности. The dynamics of temperature and pain sensitivity in the dermatomes of cauda equina roots in adult patients with spondylolisthesis of I and II degrees of displacement in the long term after surgical treatment was conducted in the paper. It is shown that in the long-term follow-up period, the proportion of patients with heat and pain hypesthesia and thermoanesthesia decreased, and the number of patients with normal thresholds increased. The most vulnerable is L5 dermatome, where the lowest percentage of patients with normal thresholds of pain sensitivity is registered.

Ganglioglioma of Conus Medullaris—A Rare Case

Gangliogliomas favor the temporal lobe. They are rarely reported in the spinal cord. Ganglioglioma of the conus medullaris is very rare. An 11-year-old boy presented with progressive weakness of bilateral lower limbs. Clinical examination and radiologic investigations revealed a lesion in the conus medullaris with an exophytic component involving the cauda equina roots. The lesion was excised near totally. Its histopathologic examination revealed it to be a ganglioglioma. Gangliogliomas of the conus medullaris are rare lesions. Subtotal or near-total excision with preservation of the function should be the aim of the surgical intervention. Because preoperative function largely dictates the postoperative course, it is advisable to intervene early at the first hint of neurologic compromise.

PERIARTICULAR CYSTS OF FACET JOINTS: ETIOPATHOGENESIS, DIAGNOSIS, METHODS OF SURGICAL TREATMENT. A CLINICAL EXAMPLE

Background. Periarticular cysts (PC) of facet joints is a rare pathology in neurosurgical practice. The concept of PC is applicable for all cysts that are located either pararticularly in the region of facet joints, or start from them.Material and methods. A systematic search was performed in medical databases: Medline, RINC, EMedicine, UMKB, Pubmed on the relevant topic in Russian and English. The search query includes words: arcuate joint, periarticular cyst, clinic, diagnosis, surgical treatment. One of the significant factors of PC development is the instability of the vertebralmotor segment of both degenerative and post-traumatic character.Results. The result of the literature review was the writing of a clinical lecture, the current state of the issue of etiopathogenesis, diagnosis and management of patients with periarticular cysts of facet joints was studied. The article gives a clinical example of surgical treatment of a patient with a periarticular cyst at the level of LIV-LV on the right.Conclusion. Periarticular cysts of facet joints are one of the factors of compression of cauda equina roots, with surgical treatment being a radical and effective way of treatment. A detailed study of this pathology is a promising direction in spinal neurosurgery. Further research is required on comparative analysis of clinical and instrumental efficacy of various methods of surgical treatment of periarticular cysts of facet joints.

THERAPY FOR COMPLICATED DEGENERATIVE STENOSIS OF THE LUMBOSACRAL SPINE SEGMENT IN ELDERLY PATIENTS

The paper present a retrospective analysis of surgical treatment of 22 elderly patients aged 60 to 80 years who had complicated degenerative stenosis of lower thoracic and lumbar spine segments associated with neurological deficits ranging from mild peripheral manifestations to severe unilateral and bilateral paresis. The severity of degenerative spine lesions and compressive stenosis of spinal channel contents correlated with patients’ age and culminated in the maximal degenerative stenotic alterations, up to 5,5±0,9 cm, at the L3 to L5 level at the age of 76,5±1,4 years. Surgery performed to decompress the spinal channel and cauda equina roots and to stabilize the spine with Stryker and Fixpain transpedicular inner fixation and correction devices resulted in the regress of neurological deficits and restoration of lower limbs motor functions up to the capability of unassisted locomotion in old age.