Progressive late post-traumatic syringomyelia.
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Biomedical subjects
Publications and source records attributed to D Foo.
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Thirteen patients with motor complete but sensory incomplete lesions following vertebral and spinal cord injuries are described. Sensory dissociation was present with more impairment of pain than touch or proprioception. The loss of pain sensation was complete in seven patients, but was incomplete in the other six subjects four of whom showed major motor recovery. The major point of interest of this study is to show that patients who retain not only touch but also pain sensation have a definitely better prognosis for neurological recovery.
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Complete motor tetraplegia with incomplete sensory loss was caused by spontaneous epidural bleeding from an arteriovenous malformation in the cervical region. There was a family and personal history of cutaneous hemangioma.
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Radionuclide cerebral blood flow (CBF) examinations of 48 patients with atherosclerosis, 18 with occlusion and 30 with stenosis of the internal carotid artery (ICA) were correlated with their respective cerebral angiograms. The following results were obtained. Flow was visually unilaterally diminished in 29 (60%) of 48 patients, including 14 (78%) with occlusion and 15 (50%) with stenosis. Sixty-two percent of the subjects with severe stenoses and 46% of the patients with mild stenoses had a positive flow study. Diminished flow was evident in the neck in 80% of the patients, intracranially in 20%. Positive radionuclide angiograms always pointed to the side with occlusion or the greater degree of stenosis even though bilateral interanl carotid disease was frequently found (54%). The data leading to the differentiation between major and minor ICA stenosis are not sufficient to justify any conclusion.
Posttraumatic syringomyelia was studied in 15 patients. Gas myelography in 12 patients showed a definite spinal cord swelling in 10 and a probable cord enlargement in two. Plain spinal computed tomography (CT) in four patients demonstrated intramedullary radiolucent zones in three. After intrathecal injection of metrizamide in 10 patients, cysts were opacified in eight. Postoperative CT in two patients demonstrated collapse of the cyst in one. Gas myelography shows the extent and site of maximal dilatation of the cyst where a shunt can be placed. CT is less invasive and provides a definitive diagnosis.