Paraplegia
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Magnetic resonance (MR) images of 87 patients who had sustained spinal cord injuries during the past 2 years, were analyzed and compared with the corresponding clinical, surgical, and in some cases pathological findings. In addition to the standard MR imaging techniques applied in the spinal cord injuries, we also introduced some recent MRI technical achievements which are anticipated to improve diagnostic accuracy and broaden clinical application of this modality with regard to the spinal cord trauma. ⋯ The reviewed post traumatic changes disclosed in these MR images were classified in 4 categories: acute, subacute, chronic, and the injury's sequelae. The essential properties of the 4 new imaging advancements are considered in relationship to the gain in diagnostic improvement of MRI of the 4 phases of patients with spinal cord trauma.
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Neural prostheses: clinical applications of functional electrical stimulation in spinal cord injury.
Function lost in spinal cord injury can be partially restored in some patients by electrical stimulation of remaining neurons. Neural prostheses designed for this purpose have been under development for several decades and are now in increasing clinical use. Applications are outlined for restoration of respiration, bladder, bowel and sexual function, exercise, hand grasp and standing and walking.
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Case Reports
Post-operative paraplegia with spinal myoclonus possibly caused by epidural anaesthesia: case report.
We report a patient who developed paraplegia following percutaneous nephrolithotresis of the left kidney under epidural anaesthesia. The cause of the paraplegia was unknown, but occlusion of the anterior spinal artery or central arteries and arachnoiditis, possibly due to the epidural anaesthesia, may have taken part in the onset and progression of the paralysis. The patient had spinal myoclonus corresponding to the spinal levels where myelomalacia was found by magnetic resonance (MR) imaging.
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Two groups of patients who developed orthostatic hypotension (OH) after spinal cord injury (SCI) were studied. In the first group all patients (4 females and 6 males) were asymptomatic, whereas in the second group (1 female and 9 males) all had clinical manifestations of hypotension. All but 3 patients were tetraplegic, and these patients were paraplegic above the T6 level. ⋯ CBF in the symptomatic group during the hypotensive reaction at 80 degrees was 32.5 +/- 5 cm/sec, while at the same body position in the asymptomatic group it was 40.9 +/- 8 cm/sec (significant at the p less than 0.02). In addition, CBF decreased in the symptomatic group at 80 degrees to 55.5 +/- 9.6% of baseline, while in the asymptomatic group the fall was 69.3 +/- 7.2% (p less than 0.001). Our data suggest that autoregulation of CBF rather than systemic BP plays a dominant role in the adaptation to OH in patients with SCI.
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Clinical Trial Controlled Clinical Trial
Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury.
The effects of intrathecal baclofen infusion were studied in 9 spinal cord injury patients whose spasticity had been refractory to oral medications. In a two stage, placebo controlled trial, baclofen was administered into the lumbar intrathecal space and subsequent clinical and neurophysiologic changes were assessed. In stage 1, 9 patients underwent a 5 day percutaneous infusion of baclofen and placebo via an external pump. ⋯ There was no clinical evidence of any significant baclofen neurotoxicity either in Stage 1 or 2. The only ambulatory patient developed marked lower extremity weakness during Stage 1 intrathecal baclofen infusion and was temporarily unable to walk. We conclude that continuous administration of intrathecal baclofen is an effective and safe modality for spasticity control in patients who are refractory to oral medications.