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PubMed1991

Imaging of the spine and spinal cord.

Recent technologic advances in MR imaging of the spine and spinal cord have been aimed at shortening examination time and suppressing artifacts. Gradient-recalled fast T2-weighted imaging is advocated for evaluating cervical radiculopathy. Better signal-to-noise ratios are achieved with three-dimensional Fourier transform gradient-recalled T2-weighted imaging and with decreased bandwidth acquisition. Obtaining high-contrast images of the spine is often complicated by the appearance of truncation artifacts. In outpatient radiculography, both iopamidol and iohexol appear safe, but iohexol seems better tolerated. In trauma, MR imaging is definitive, and signal abnormalities can help in evaluating neurologic recovery. Intraoperative spinal sonography may be helpful in evaluating acute injury. Enhancement with gadolinium diethylenetriamine penta-acetic acid is useful in the evaluation of disk space infections, osteomyelitis, and epidural abscess and in the study of spinal cord sarcoidosis. In patients with the acquired immunodeficiency syndrome, MR imaging may show hyperintense spine on T2-weighted images. MR imaging with gadolinium diethylenetriamine penta-acetic acid or gadolinium tetra-azacyclododecane tetra-acetic acid enhancement can be useful in evaluating intramedullary and intradural extramedullary tumors and for determining the extent of spinal leptomeningeal metastases. MR imaging can also be used to differentiate benign from pathologic fractures.

Humans↗

PubMed1989

Septic arthritis of a lumbar facet joint: detection with bone SPECT imaging.

We present a rare case of septic arthritis of a lumbar facet joint with an associated epidural abscess resulting from Staphylococcus aureus. The infection was initially detected with planar bone scintigraphy and precisely localized with single photon emission computed tomography bone scintigraphy, despite an initially negative radiologic evaluation that included radiographs of the lumbar spine, lumbar myelography, and a postmyelography x-ray computed tomography scan. In the appropriate clinical setting, a bone scan demonstrating unilateral increased activity within the spine should raise the suspicion of inflammatory involvement of the posterior elements.

Aged↗

PubMed1986

[Diagnosis and differential diagnosis of back pain from the neurological point of view].

Affections of the vertebral body, the intervertebral disc, the epidural and subdural space, the nerve root, and the spinal cord may have back pain as the main symptom. Initially a topical diagnosis is established in the light of the neurologic symptoms and signs (segmental "beltlike" pain, radicular motor and sensory signs, central mono-, para-, and tetraparesis, as well as sensory signs and bladder dysfunction). Degenerative changes and herniated discs are the most frequent causes of cervical and lumbar spinal disease with neurologic signs, followed by extramedullary tumors. In the extradural space metastases, plasmocytoma, lymphomas and primary bone tumors are the most common, and neurinomas and meningiomas in the intradural space. In the spinal cord ependymomas and astrocytomas are found, as well as benign cavities (syringomyelia). Conditions which are rare, but very important because treatable at an early stage, are spinal epidural hematomas with anticoagulation and spinal epidural abscesses. Vertebral osteomyelitis must also be considered in differential diagnosis. Inflammatory nerve root lesions seldom cause pain, except for subacute demyelinating polyneuropathy responding to corticosteroid treatment, and radiculitis caused by borrelia and herpes zoster.

Adult↗

PubMed1986

Three different pathogenic mechanisms for paraparesis in association with bacterial infections.

Three different pathogenic mechanisms are apparent for paraparesis in association with a bacterial infection: a spinal cord compression caused by either an epidural abscess or a vertebral collapse due to spondylitis, an ischaemic spinal cord lesion as a result of septic thromboembolus in abdominal aorta, and a nonspecific, probably immunological, cause in association with reactive polyarthritis. An example of each of these mechanisms is described by means of case histories.

Adult↗

PubMedDate not supplied

Cervical myelopathy: a comparison of magnetic resonance and myelography.

Fifty-seven patients with a strong clinical suspicion of cervical myelopathy were studied with body coil magnetic resonance (MR) and conventional myelography or CT myelography. Eight patients were believed to have normal studies with both modalities. There were six patients with syringomyelia; four with an intramedullary tumor; one with an arteriovenous malformation; 19 with cervical spondylosis at multiple levels; eight with cervical spondylosis at a single level; four with extensive rheumatoid arthritis; four with extradural neoplasm; two with trauma; and one patient with an epidural abscess. In this study, body coil MR was the superior examination for the evaluation of an intramedullary process. It was as diagnostic as myelography in one case of an extramedullary intradural lesion. In patients with extradural disease, body coil MR was the superior study in 45%, equivalent to myelography in 37%, and, although still diagnostic, inferior to myelography in 17%. In 8% of the cases, body coil MR was at best equivocal, whereas myelography was diagnostic. It appears that in technically adequate studies, MR is at least equivalent to myelography in its ability to delineate disease. A superior MR study provides a better appraisal of the size and character of the spinal cord as well as the degree of both anterior and posterior defects on the subarachnoid space and neural structures. In addition, MR is as good as conventional myelography for the identification of extrinsic cervical cord lesions producing cervical myelopathy. Finally, an additional small group of 30 patients were studied with a prototype surface coil to determine its advantages relative to body coil imaging. Each patient had correlative myelography. As with body coil MR, imaging with the surface coil was believed to be more informative than conventional myelography in four patients with intramedullary lesions. The remaining 26 patients suffered from cervical spondylosis. Surface coil MR was believed to be more informative than myelography in six cases (23%), equivalent to myelography in 19 (73%), and less diagnostic than myelography in one (4%). The improved spatial resolution with the use of the surface coil was believed to increase the accuracy of MR.

Adolescent↗

PubMed1985

[Squamous cell carcinoma of the frontal sinus caused osteomyelitis of the frontal bone].

A case of the squamous cell carcinoma of the frontal sinus complicated with osteomyelitis of the frontal bone was reported. A 47-year-old male was admitted to Asahikawa Medical College Hospital because of a bulging of forehead and remittent fever of a six-month history and general convulsive seizures on the day before admission. On physical examination, a bulging of forehead with redness, tenderness and fluctuation was noted. Sense of smell diminished bilaterally. Oto-laryngological examination disclosed paranasal sinusitis. Skull X-P and CT scan suggested osteomyelitis of the frontal bone secondary to frontal sinusitis. However, a frontal sinus tumor with osteomyelitis was also possible. Operation was performed and a granulomatous mass attached to the dura with thick epidural abscess was noted. The mass and affected bone edge were removed. Pathological examination of the specimens disclosed findings of squamous cell carcinoma and osteomyelitis. Recurrence of the tumor rapidly occurred and reoperation was performed a month after the first operation. Postoperative irradiation and chemotherapy with pepleomycin were done but failed to control the growth and recurrence occurred immediately. The tumor penetrated the skin of the forehead and the patient died of cachexy 7 months after the first surgery. Osteomyelitis usually occurred in the metaphysis of long tubular bone and rarely in short bone or flat bone such as a skull. This is attributed to the difference of distribution of the bone marrow vessels. Embolization and subsequent growth of bacteria in the blood flow is less liable to occur in short bone and flat bone.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗

PubMed1979

[Contribution to the knowledge of the "periostitis ossificans interna" of the cranial vault (author's transl)].

An unusual observation of hyperostosis of the frontal bone exhibiting five alternating layers of compact and cancellous bone on cross section is demonstrated. The peculiar, hitherto not described hyperostosis occurred in an 18 year old female suffering from recurrent chronical pachy- and lepto-meningitis since birth. A second similar observation was made in a 15 year old male, trepanated because of an epidural abscess. Similar accessory layers of cancellous bone on the internal surface of temporal bone suggested that also the first observation had to be interpreted as an unusually extensive form of periostitis ossificans, only involving the frontal bone, due to the recurring inflammation processes of the meninges.

Adolescent↗

PubMed1994

Neurologic manifestations of Staphylococcus aureus infections. Analysis of 43 patients.

We present an analysis of the neurologic manifestations of Staphylococcus aureus infections in 43 patients. Half of the infections whose source could be identified were nosocomial. The spectrum of neurological sequelae included meningitis, solitary and multiple intracerebral and epidural abscesses, cerebral ischemia and hemorrhage, acute encephalopathies, subdural empyemas, spinal abscesses, and radicular compression syndromes. In the majority of patients the course was severe and protracted and relapses were frequent. Mortality was high (28%), even with early diagnosis and treatment; diabetes mellitus, alcohol abuse, and chronic renal failure were unfavorable prognostic factors. In patients with abscess formation early surgical drainage improved the outcome. However, often treatment was complicated by sequestration at inaccessible foci and secondary dissemination. Combined antibiotic therapy with flucloxacillin and chloramphenicol may be the most successful antibiotic regimen.

Adolescent↗

PubMed1995

Inflammatory and infectious processes of the cervical spine.

This article discusses infectious and inflammatory processes of the cervical spine. Major emphasis is placed on infectious discitis/osteomyelitis and epidural abscess, particularly the epidemiologic, bacteriologic, pathophysiologic, and clinical aspects, as well as the major role played by magnetic resonance imaging and other imaging modalities used in the detection and diagnosis of these processes.

Arthritis, Rheumatoid↗

PubMed1995

MR imaging and CT of central nervous system tuberculosis in the patient with AIDS.

CNS TB represents a disease that complicates AIDS with an increasing incidence in endemic areas as well as in developed countries in those patients who have some risk factors such as intravenous drug abuse. Although TB infection of the CNS in AIDS patients may follow a rapidly progressive course, the imaging findings otherwise are similar to those of the nonimmunosuppressed population. Meningeal enhancement, hydrocephalus, parenchymal granulomata, and infarcts are seen frequently and are often observed in combination with one another. Nevertheless, the differential diagnosis in AIDS patients must include other opportunistic infections and primary or metastatic lymphoma of the CNS. Spinal TB usually is seen in the form of epidural abscess secondary to tuberculous spondylitis, although it may be seen in isolation of spinal column involvement. The differential diagnosis includes spinal lymphoma or pyogenic abscess formation. Radiculomyelitis or isolated spinal cord tuberculomata are much less frequently observed and can be suspected on imaging only if there is concomitant evidence of the classic findings of intracranial TB.

AIDS-Related Opportunistic Infections↗

PubMed1995

[Thrombosis of the sigmoid sinus and transverse sinus with an unusual course].

A case of intracranial complication in patient with cephalgia and short period of the temperature without signs of sharpening chronic otitis is reported. At the time of the operation epidural abscess of fossa cranial posterior, perisinusal abscess and thrombus of sigmoid sinus, abscess in transverse sinus were found.

Adult↗

PubMed1995

Acute sinusitis.

Acute sinusitis is one of the most commonly observed entities in clinical practice. Despite the frequency of the disease, diagnosis and therapy often remain empiric. Most cases are secondary to sinus ostia obstruction associated with the common cold or allergies. Maxillary sinusitis is most common. Because of the proximity of vital anatomic structures and venous drainage systems, serious complications frequently arise from sphenoid, frontal, and ethmoid sinusitis. Clinical signs and symptoms most helpful in the diagnosis of maxillary sinusitis are the presence of a maxillary toothache, lack of improvement with decongestants, a purulent nasal discharge, cough, purulent secretions observed on nasal examination, abnormal transillumination, and sinus tenderness. Plain film radiographs are helpful, but do not adequately visualize the anterior ethmoid sinuses. Computed tomography provides superior visualization, but cost remains prohibitive for routine cases. Most maxillary sinusitis in adults is secondary to Streptococcus pneumoniae or Hemophilus influenzae. Moroxella catarrhalis is common in children. Staphylococcus aureus is observed more frequently in frontal or sphenoid disease. Most patients with acute sinusitis are treated without microbiological diagnosis and respond well to commonly used oral antimicrobials with activity against the usual pathogens. Complications of sinusitis include meningitis, periorbital infections, subdural empyema, epidural abscess, brains abscess, cavernous sinus thrombosis, and osteomyelitis.

Acute Disease↗

PubMed1995

Management of anesthetic complications and emergencies in the obstetric patient.

The importance of cooperation and understanding between the obstetrician and anesthesiologist in the management of obstetric emergencies cannot be overemphasized. Indications for cesarean section and choice of anesthetic are significant considerations. Algorithms for the management of special treatment problems such as malignant hyperthermia, postdural headache, and epidural abscess and hematoma are presented. Posting of protocols for the management of particular crises in both delivery and postanesthesia care units is strongly recommended.

Anesthesia, Conduction↗

PubMed1994

MRI of the spine.

In many instances, magnetic resonance imaging (MRI) has become the initial imaging modality in the evaluation of the spine. The authors present a broad review of the MRI features of the major disease processes which can involve the spine. Disk disease, failed back syndrome, infectious spondylitis, epidural abscess, and neoplastic disease are all discussed.

Humans↗

PubMed1993

[Spondylodiscitis with spinal and radicular involvement. Limits of conservative treatment].

During 1988 to 1992 18 patients with spondylodiscitis and neurological deficits were treated in our clinic. Tuberculous spondylodiscitis was diagnosed in 4 patients and 14 suffered from non specific spondylodiscitis. The mean age was 59 years (range 25-77). 16 (89%) of the patients had risk factors like diabetes mellitus, genitourinary tract infection, respiratory tract infection, rheumatism, intervertebral disc operation and old spine fracture. MR-tomography revealed the most valuable diagnostic method. 14 patients with progressive spinal cord compression, and root lesions because of gross vertebral damage and epidural abscess underwent operative removal of the focus with intercorporal spondylodesis. Postoperative neurological examination revealed improvement in 7 and no changes in the other 7 patients. In 4 patients with non specific spondylodicitis and radicular deficits conservative treatment was performed and spontaneous interbody fusion without persisting neurological complaints occurred.

Abscess↗

PubMed1996

Pediatric spinal infections.

A high index of suspicion for spinal infection and an appropriate and prompt diagnosis are essential for the treatment of pediatric spinal infections. A 3-week course of antibiotics and supportive therapy is effective in the majority of cases of discitis, the most common pediatric spinal infection. Patients who are not toxic may be treated with bracing, or with casting alone in many cases. Neurologic deficit or a failure to respond to early treatment requires more aggressive measures, including biopsy or surgical debridement. It is essential to diagnose rare but serious conditions such as epidural abscess, tuberculosis, or opportunistic infections in patients at risk. The authors stress that clinical evaluation and appropriate diagnosis are critical for prevention of permanent neurologic damage or late bony deformity.

AIDS-Related Opportunistic Infections↗

PubMed1996

Microbiology and antimicrobial therapy of spinal infections.

Hematogenous vertebral osteomyelitis is almost always a monomicrobial infection affecting predominantly the older population. S. aureus is the most common micro-organism isolated. Gram-negative bacilli, however, are seen primarily in elderly males with the urinary tract as the source of infection, as well as in IVDA. In the latter group, P. aeruginosa, as well as S. aureus, are the dominant microorganisms. The offending organisms are generally isolated by needle biopsy, using a cutting needle, or by open surgical biopsy when necessary. Spinal epidural abscesses have very similar microbiology. Antimicrobial therapy is generally given parenterally in high doses, together with surgical evacuation of abscesses and debridement of necrotic tissue, when necessary. Therapy may be guided by the ESR. In VO, when the patient is doing clinically well and the ESR decreases to at least half of the pretherapy value, therapy may be stopped, but continued elevation of the ESR and the presence of abscesses may necessitate more prolonged therapy. The role of oral antimicrobial therapy is currently unclear.

Abscess↗

PubMed1996

[Back pain in children: symptoms which should be taken seriously].

Back pain in children is a rare but serious problem. The varied etiologies and the necessary diagnostic workup are illustrated in 8 children. Infectious processes were found in 3 children, spondylodiscitis twice and epidural abscess once. Tumours (one eosinophilic granuloma and one spinal ependymoma) were present in 2 boys. One girl had a herniated lumbar disc. Malformations (spondylolysis and diastematomyelia) were the cause of symptoms in 2 children. Leading symptom in all 8 children was back pain lasting from 3 days to 2 years. Careful clinical neurological examination, parameters of inflammation in the blood and conventional radiography of the spine were helpful in guiding further investigations. Scintigraphy was useful for localization of infectious and tumorous diseases. MRI was superior to CT in evaluating tumours and malformations of the spinal cord. In most cases CT was sufficient in workup of infectious and osseous processes.

Adolescent↗