RESUMO
TITLE: Neurolinfomatosis primaria de cola de caballo como manifestacion inicial del virus de la inmunodeficiencia humana.
Assuntos
Cauda Equina/patologia , Linfoma Relacionado a AIDS/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Neurolinfomatose/etiologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Renais , Cauda Equina/diagnóstico por imagem , Citarabina/administração & dosagem , Transtornos Neurológicos da Marcha/etiologia , Humanos , Neoplasias Renais , Linfoma Relacionado a AIDS/líquido cefalorraquidiano , Linfoma Relacionado a AIDS/diagnóstico por imagem , Linfoma Relacionado a AIDS/tratamento farmacológico , Linfoma Difuso de Grandes Células B/líquido cefalorraquidiano , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/etiologia , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/diagnóstico por imagem , Segunda Neoplasia Primária/tratamento farmacológico , Segunda Neoplasia Primária/etiologia , Neurolinfomatose/líquido cefalorraquidiano , Neurolinfomatose/diagnóstico por imagem , Neurolinfomatose/tratamento farmacológico , Rituximab/administração & dosagemRESUMO
Background: Spinal neoplasms are classified into extradural, intradural/extramedullary or intramedullary. Intradural/extramedullary tumors include meningiomas and nerve sheath tumors, which arise from meninges or peripheral nerves around the spinal cord. Clinical signs are related to dysfunction of the involved nerve and include pain, nerve root signature and atrophy. Osteochondromas are benign tumors located within the bone, on its surface or in extra-osseous regions, when they are classified as soft tissue osteochondoma. The aim of this study is to describe a case of an osteochondroma in a nervous root of the cauda equina in a dog, whose surgical resection allowed the resolution of the clinical signs.Case: A 12-year-old, male, Labrador Retriever dog, was presented with a 40-day history of progressive, painful, pelvic limb paresis, with no improvement when treated with analgesics and acupuncture. Neurological abnormalities included paraparesis, sometimes worse in the left pelvic limb, that was carried flexed at the level of the stifle, hindlimb atrophy, decreased interdigital reflexes and pain in the lumbar spinal region, mainly over L6 vertebra. Results of blood count and serum biochemical analysis were unremarkable. Computed tomography (CT) of the lumbosacral area was performed and the evaluation of images in transverse and reconstructed dorsal and sagittal planes allowed the visualization of a hyperattenuating and calcified round structure with 8 mm x 6 mm, in the left side of vertebral canal, at the level of caudal epiphysis of L6. Lumbosacral (L7-S1) CT abnormalities, as subchondral sclerosis, mild disc margin bulging, spondylosis deformans and foraminal proliferation were also observed but were considered clinically insignificant.[...](AU)
Assuntos
Animais , Masculino , Cães , Osteocondroma/diagnóstico por imagem , Osteocondroma/cirurgia , Osteocondroma/veterinária , Cauda Equina/patologia , Cauda Equina/cirurgia , Neoplasias do Sistema Nervoso Periférico/veterináriaRESUMO
Background: Spinal neoplasms are classified into extradural, intradural/extramedullary or intramedullary. Intradural/extramedullary tumors include meningiomas and nerve sheath tumors, which arise from meninges or peripheral nerves around the spinal cord. Clinical signs are related to dysfunction of the involved nerve and include pain, nerve root signature and atrophy. Osteochondromas are benign tumors located within the bone, on its surface or in extra-osseous regions, when they are classified as soft tissue osteochondoma. The aim of this study is to describe a case of an osteochondroma in a nervous root of the cauda equina in a dog, whose surgical resection allowed the resolution of the clinical signs.Case: A 12-year-old, male, Labrador Retriever dog, was presented with a 40-day history of progressive, painful, pelvic limb paresis, with no improvement when treated with analgesics and acupuncture. Neurological abnormalities included paraparesis, sometimes worse in the left pelvic limb, that was carried flexed at the level of the stifle, hindlimb atrophy, decreased interdigital reflexes and pain in the lumbar spinal region, mainly over L6 vertebra. Results of blood count and serum biochemical analysis were unremarkable. Computed tomography (CT) of the lumbosacral area was performed and the evaluation of images in transverse and reconstructed dorsal and sagittal planes allowed the visualization of a hyperattenuating and calcified round structure with 8 mm x 6 mm, in the left side of vertebral canal, at the level of caudal epiphysis of L6. Lumbosacral (L7-S1) CT abnormalities, as subchondral sclerosis, mild disc margin bulging, spondylosis deformans and foraminal proliferation were also observed but were considered clinically insignificant.[...]
Assuntos
Masculino , Animais , Cães , Cauda Equina/cirurgia , Cauda Equina/patologia , Neoplasias do Sistema Nervoso Periférico/veterinária , Osteocondroma/cirurgia , Osteocondroma/diagnóstico por imagem , Osteocondroma/veterináriaRESUMO
BACKGROUND: Giant cell ependymoma of the filum terminale is a rare variant, generally manifested as a well-circunscribed intradural mass with an indolent biological behavior. CASE PRESENTATION: We describe the case of a 48-year-old Mexican female who non-relevant past medical history, that developed a GCE of the filum terminale. Magnetic resonance imaging and computed tomography revealed the presence of an intra-axial tumor extending from L3 to L5 with extra-medullary invasion. Therefore the tumor was considered unresectable and only incisional biopsy was obtained, establishing the tentative diagnosis of a poorly differentiated neoplasia. A second evaluation of the case revealed the presence of numerous non-cohesive pleomorphic giant cells with intranuclear inclusions and broad eosinophilic cytoplasm, alternating with intermediate size cells with round, hyperchromatic nuclei and forming a perivascular pseudo-rosettes pattern. The ependymal phenotype was supported by light microscopy and corroborated by immunohistochemistry analysis. The patient was subsequently treated with radiotherapy 54Gy. She is alive after a 27-month follow-up, with residual disease, difficulty ambulating and pain. CONCLUSIONS: GCE of filum terminale may have an atypical clinical and radiological presentation, albeit with invasive characteristics and anaplasia on histologic analysis. However, its biological behavior is indolent and associated to longer survival. Due to the presence of giant cells, the differential diagnosis of other primary neoplasias at that site were considered, including paraganglioma, malignant peripheral nerve sheath tumors as well as metastatic malignant melanoma, adrenal carcinoma, thyroid gland carcinoma and urothelial carcinoma, that may all harbor giant cells.
Assuntos
Cauda Equina/patologia , Ependimoma/patologia , Tumores de Células Gigantes/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-IdadeRESUMO
UNLABELLED: To evaluate the association of redundant nerve roots of cauda equina (RNRCE) with the degree of lumbar spinal stenosis (LSS) and with spondylolisthesis. METHOD: After Institutional Board approval, 171 consecutive patients were retrospectively enrolled, 105 LSS patients and 66 patients without stenosis. The dural sac cross-sectional area (CSA) was measured on T2w axial MRI at the level of L2-3, L3-4 and L4-5 intervertebral discs. Two blinded radiologists classified cases as exhibiting or not RNRCE in MRI. Intra- and inter-observer reproducibility was assessed. RESULTS: RNRCE were associated with LSS. RRNCE was more frequent when maximum stenosis<55 mm2. Substantial intra- observer agreement and moderate inter-observer agreement were obtained in the classification of RNRCE. Spondylolisthesis was identified in 27 patients and represented increased risk for RRNCE. CONCLUSION: LSS is a risk factor for RNRCE, especially for dural sac CSA<55 mm2. LSS and spondylolisthesis are independent risk factors for RNRCE.
Assuntos
Cauda Equina/patologia , Raízes Nervosas Espinhais/patologia , Estenose Espinal/patologia , Espondilolistese/patologia , Estudos de Casos e Controles , Humanos , Imageamento por Ressonância Magnética , Variações Dependentes do Observador , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
To evaluate the association of redundant nerve roots of cauda equina (RNRCE) with the degree of lumbar spinal stenosis (LSS) and with spondylolisthesis. Method After Institutional Board approval, 171 consecutive patients were retrospectively enrolled, 105 LSS patients and 66 patients without stenosis. The dural sac cross-sectional area (CSA) was measured on T2w axial MRI at the level of L2-3, L3-4 and L4-5 intervertebral discs. Two blinded radiologists classified cases as exhibiting or not RNRCE in MRI. Intra- and inter-observer reproducibility was assessed. Results RNRCE were associated with LSS. RRNCE was more frequent when maximum stenosis<55 mm2. Substantial intra- observer agreement and moderate inter-observer agreement were obtained in the classification of RNRCE. Spondylolisthesis was identified in 27 patients and represented increased risk for RRNCE. Conclusion LSS is a risk factor for RNRCE, especially for dural sac CSA<55 mm2. LSS and spondylolisthesis are independent risk factors for RNRCE. .
Avaliar associação entre raízes nervosas redundantes da cauda eqüina (RNRCE) com grau de estenose do canal lombar (ECL) e espondilolistese. Método Após aprovação do Comitê de Ética, 171 pacientes foram selecionados retrospectivamente, 105 com ECL e 66 sem estenose. Foram realizadas mensurações da área seccional do saco dural em imagens axiais de RM ponderadas em T2 em L2/L3, L3/L4 e L4/L5. Presença ou não de RRNCE foi classificada de forma independente por dois radiologistas, às cegas. Concordância intra e inter-observador foi analisada. Resultados RNRCE foi associada à ECL e foi mais freqüente quando a máxima estenose encontrada foi <55mm2. Houve grande concordância intra-observador e moderada inter-observador na classificação das RRNCE. Espondilolistese foi identificada em 27 pacientes e representou maior risco para desenvolvimento de RNRCE. Conclusão ECL é fator de risco para RNRCE, especialmente com áreas seccionais <55mm2. ECL e espondilolistese representam fatores de risco independentes para desenvolvimento de RNRCE. .
Assuntos
Humanos , Cauda Equina/patologia , Raízes Nervosas Espinhais/patologia , Estenose Espinal/patologia , Espondilolistese/patologia , Estudos de Casos e Controles , Imageamento por Ressonância Magnética , Variações Dependentes do Observador , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
Cauda equina syndrome (CES) is characterized by varying patterns of low back pain, sciatica, lower extremity sensorimotor loss, and bowel and bladder dysfunction. The prognosis for complete recovery of CES is dependent on not only the time before surgical intervention with decompression but also the severity of the nerve damage. Delayed or severe nerve compression impairs the capability of nerve regeneration. Transplantation of neural stem cells (NSCs) may facilitate axon regeneration and functional recovery in a spectrum of neurological disorders. Our study shows that the NSCs derived from early postnatal dorsal root ganglion (DRG) are able to proliferate to form neurospheres and differentiate into O4(+) oligodendrocytes but not glial fibrillary acidic protein (GFAP(+)) astrocytes or ßIII-tubulin(+) neurons in vitro. After intrathecal transplantation into the lumbar spinal canal stenosis animal model, most of the GFP-expressing NSCs were induced to differentiate into oligodendrocytes in vivo. Although the recovery of sensorimotor function was not significantly improved in rats with transplantation therapy, our results implied that subarachnoid microinjection of NSCs may promote axon regeneration of DRG neurons in the cauda equina model after nerve injury.
Assuntos
Diferenciação Celular , Gânglios Espinais/patologia , Células-Tronco Neurais/fisiologia , Oligodendroglia/metabolismo , Polirradiculopatia/terapia , Animais , Cauda Equina/patologia , Cauda Equina/fisiopatologia , Células Cultivadas , Masculino , Regeneração Nervosa , Células-Tronco Neurais/transplante , Nociceptividade , Polirradiculopatia/fisiopatologia , Ratos , Ratos Sprague-Dawley , Recuperação de Função Fisiológica , Esferoides Celulares/metabolismoRESUMO
PLANTEAMIENTO DEL PROBLEMA: Los tumores primarios de médula espinal representa 2 por ciento al 4 por ciento de todas las neoplasias del SNC, los tumores son generalmente los neurinomas y los meningiomas, en ellos la resección completa puede lograr frecuentemente la curación, la problemática sin embargo es la falta de estudios clínicos en general para los tumores del SNC y en particular para los tumores de la médula espinal. El objetivo de nuestro estudio es conocer la incidencia actual de tumores primarios de la médula espinal y cauda equina en adultos del servicio de columna vertebral y nervios periféricos del HNERM. Metodología: El presente estudio es de tipo retrospectivo, transversal y descriptivo, de los pacientes con el diagnóstico anátomo patológico de tumor primario de médula espinal y cauda equina, atendidos en el servicio de columna vertebral y nervios periféricos del HNERM, desde el 1 de Enero 2007 al 31 de Diciembre del 2011. Resultados: La incidencia de tumores primarios de médula espinal y cauda equina fue de 1.99 por ciento de los tumores del sistema nervioso central, el más frecuentemente fue neurinoma con el 41.46 por ciento, seguidos de los meningioma con el 34.15 por ciento, juntos representan más del 75 por ciento, seguidos de los astrocitomas con el 12.19 por ciento, predomina en el sexo femenino con el 65.85 por ciento, siendo el grupo etario más afectado entre 35-50 años, promedio 48.9 años, el tiempo de enfermedad al ingreso fue principalmente más de 9 meses 48.78 por ciento, se localizan más en el segmento torácico 51.23 por ciento, presentando al momento de ingreso dolor axial o radicular y debilidad de extremidades, con hipoestesia debajo del nivel de compresión y paraparesia, el procedimiento quirúrgico más frecuente fue laminectomía y resección microquirúrgica completa del tumor 78.05 por ciento, logrando función motora aceptable en el 70 por ciento, para neurinomas y meningiomas, a los 6 a 12 meses post quirúrgicos. Discusión: La...
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Cauda Equina/patologia , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/epidemiologia , Estudos Retrospectivos , Estudos TransversaisRESUMO
Filum terminale ependymomas are slow growing tumors of the cauda equina with a high incidence in young adults. Although a complete microsurgical resection can lead to a cure, recurrence is not uncommon. Sixteen cases of filum terminale ependymomas treated at the Instituto de Neurologia de Curitiba were analyzed. Eleven patients were females and 5 males, their age ranging from 7 to 84 years. Symptoms and signs included lumbar pain (31.25%), radicular pain (56.25%) and neurological deficits (12.5%). In three cases, patients had previously undergone surgery in other hospitals. All were tested through MRI and were operated on. Two underwent a laminoplasty and 14 a laminectomy. The last 8 patients of this series had neuro-physiological monitoring during surgery. In all patients a total microsurgical resection was achieved. Histologically, 2 cases were cellular ependymomas and 14 cases myxopapillary ependymomas. There was no recurrence during a 2 to 84 month follow-up period.