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Traumatic central cord syndrome

M A Akulov, S E Khat'kova, O A Mokienko, O R Orlova, D Yu Usachev, V O Zakharov, A S Orlova, A A Tomsky
Spasticity is a type of muscle hyperactivity that occurs in patients after focal lesions of the Central nervous system due to various diseases: stroke, traumatic brain injury or spinal cord injury, neurosurgical intervention, as well as multiple sclerosis and other diseases of the Central nervous system and is the most disability manifestation of the syndrome of upper motor neuron (UMNS). Focal spasticity of the upper limb requires a complex treatment. Botulinum toxin therapy is an effective treatment for focal/multifocal spasticity in reducing muscle tone and improving function with the highest level of evidence according to the latest American and European guidelines for treatment of spasticity...
2016: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
Marcel A Kopp, Thomas Liebscher, Ralf Watzlawick, Peter Martus, Stefan Laufer, Christian Blex, Ralf Schindler, Gerhard J Jungehulsing, Sven Knüppel, Martin Kreutzträger, Axel Ekkernkamp, Ulrich Dirnagl, Stephen M Strittmatter, Andreas Niedeggen, Jan M Schwab
INTRODUCTION: The approved analgesic and anti-inflammatory drugs ibuprofen and indometacin block the small GTPase RhoA, a key enzyme that impedes axonal sprouting after axonal damage. Inhibition of the Rho pathway in a central nervous system-effective manner requires higher dosages compared with orthodox cyclooxygenase-blocking effects. Preclinical studies on spinal cord injury (SCI) imply improved motor recovery after ibuprofen/indometacin-mediated Rho inhibition. This has been reassessed by a meta-analysis of the underlying experimental evidence, which indicates an overall effect size of 20...
2016: BMJ Open
Jefferson R Wilson, Lindsay Tetreault BSc, Bizhan Aarabi, Paul A Anderson, Paul M Arnold, Darrel S Brodke, Anthony Burns, Robert Chen, Kazuhiro Chiba, Joseph Dettori, Julio C Furlan, James S Harrop, Langston T Holly, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar N Kurpad, Brian K Kwon, Ralph Marino, Allen R Martin, Eric M Massicotte, Geno Merli, James Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Mohammed F Shamji, Anoushka Singh, Andrea Skelly, Albert Yee, Michael Fehlings
INTRODUCTION: The objective of this study is to develop guidelines that outline the optimal timing of decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. METHODS: A systematic review of the literature was conducted to address the following key questions: (1) What is the efficacy of early decompression (=24 hours) compared with late decompression (>24 hours) based on clinically important change in neurological status? (2) Does timing of decompression influence functional or administrative outcomes? (3) What is the safety profile of early decompression compared with late decompression? (4) What is the evidence that early decompression has differential efficacy or safety in subpopulations? (5) What is the comparative cost-effectiveness of early vs late decompression? A multidisciplinary guideline development group used this information, in combination with their clinical expertise, to develop recommendations for the optimal timing of SCI...
August 2016: Neurosurgery
Sunil Kukreja, Jan Schwab, Francis Farhadi
INTRODUCTION: The influence of initial clinical and imaging parameters on long-term outcomes following spinal cord injury (SCI) has been examined in previous studies, often with inconsistent or contradictory findings. In this study, we evaluated a comprehensive set of admission parameters and analyzed their relationships with long-term neurological recovery. METHODS: Institutional databases were used to retrospectively identify consecutive patients with cervical SCI admitted between 2008 and 2015...
August 2016: Neurosurgery
C M Stevenson, D P Dargan, J Warnock, S Sloan, R Espey, S Maguire, N Eames
STUDY DESIGN: Retrospective cohort analysis with prospective follow-up. OBJECTIVES: To evaluate neurological and functional recovery following central cord syndrome. SETTING: Northern Ireland, population 1.8 million. METHODS: Twenty-seven cords were identified in 1 year. Five managed conservatively and 22 with surgery. American Spinal Injury Association (ASIA) motor scores (AMS) were calculated to assess neurological recovery...
March 29, 2016: Spinal Cord
Ian Burkovskiy, Juan Zhou, Christian Lehmann
OBJECTIVE: Severe CNS injury, such as stroke, traumatic brain injury, or spinal cord injury, is known to increase susceptibility to infections. The increased susceptibility to infection is due to an impaired immune response and is referred to as CIDS. The CB2 receptor on immune cells presents a potential therapeutic target in CIDS as activation of this receptor has been shown to be involved in immunosuppression. The main purpose of this study was to determine the impact of CB2 receptor inhibition on leukocyte activation within the microcirculation following endotoxin challenge in an experimental stroke model...
May 2016: Microcirculation: the Official Journal of the Microcirculatory Society, Inc
Anil A Panackal, Peter R Williamson
PURPOSE OF REVIEW: This article summarizes current knowledge on the epidemiology, clinical presentations, diagnosis, and management of selected fungal infections of the central nervous system (CNS). Key syndromes, differential diagnoses, and therapeutic interventions according to host immune status and exposure are reviewed. RECENT FINDINGS: Advancements in imaging of the brain and spinal cord, and molecular DNA and antigen-based laboratory diagnostics afford improved sensitivity for CNS mycoses...
December 2015: Continuum: Lifelong Learning in Neurology
Karen K Anderson, Lindsay Tetreault, Mohammed F Shamji, Anoushka Singh, Rachel R Vukas, James S Harrop, Michael G Fehlings, Alexander R Vaccaro, Alan S Hilibrand, Paul M Arnold
BACKGROUND: Traumatic central cord syndrome (TCCS) is an incomplete spinal cord injury defined by greater weakness in upper versus lower extremities, variable sensory loss, and variable bladder, bowel, and sexual dysfunction. The optimal timing of surgery for TCCS remains controversial. OBJECTIVE: To determine whether timing of surgery for TCCS predicts neurological outcomes, length of stay, and complications. METHODS: Five databases were searched through March 2015...
October 2015: Neurosurgery
William J Readdy, William D Whetstone, Adam R Ferguson, Jason F Talbott, Tomoo Inoue, Rajiv Saigal, Jacqueline C Bresnahan, Michael S Beattie, Jonathan Z Pan, Geoffrey T Manley, Sanjay S Dhall
OBJECT The optimal mean arterial pressure (MAP) for spinal cord perfusion after trauma remains unclear. Although there are published data on MAP goals after spinal cord injury (SCI), the specific blood pressure management for acute traumatic central cord syndrome (ATCCS) and the implications of these interventions have yet to be elucidated. Additionally, the complications of specific vasopressors have not been fully explored in this injury condition. METHODS The present study is a retrospective cohort analysis of 34 patients with ATCCS who received any vasopressor to maintain blood pressure above predetermined MAP goals at a single Level 1 trauma center...
July 31, 2015: Journal of Neurosurgery. Spine
Kyle L Martin, Rodney W Hicks
Acute traumatic central cord syndrome (ATCCS) occurs in more than 11,000 individuals annually. A common cause in older adult is a low-velocity hypertension neck injury. This article reviews ATCCS from the perspective of an older adult who, after a fall at his primary residence, sustained a facial laceration. Just prior to discharge, neurological deficits were noted, which required further investigation with magnetic resonance imaging. Subsequently, the findings required emergent surgical intervention. Emergency nurses should be familiar with muscle assessment, deep tendon reflex assessment, and nervous system dermatomes...
July 2015: Advanced Emergency Nursing Journal
Christopher K Kepler, Christopher Kong, Gregory D Schroeder, Nikolaus Hjelm, Amir Sayadipour, Alexander R Vaccaro, D Greg Anderson
OBJECT: The purpose of this study was to characterize changes in American Spinal Injury Association motor score (AMS) in the 1st week after traumatic central cord syndrome (CCS) to identify predictors of improved early outcome in patients treated with early versus delayed surgical intervention. METHODS: All patients presenting to a regional spinal cord injury center between January 2004 and June 2009 were queried for those with a diagnosis of CCS. Patients treated conservatively were excluded...
October 2015: Journal of Neurosurgery. Spine
Domenico Intiso, Mario Basciani, Andrea Santamato, Marta Intiso, Filomena Di Rienzo
Pain is a natural protective mechanism and has a warning function signaling imminent or actual tissue damage. Neuropathic pain (NP) results from a dysfunction and derangement in the transmission and signal processing along the nervous system and it is a recognized disease in itself. The prevalence of NP is estimated to be between 6.9% and 10% in the general population. This condition can complicate the recovery from stroke, multiple sclerosis, spinal cord lesions, and several neuropathies promoting persistent disability and poor quality of life...
July 2015: Toxins
Charles N Munyon, David J Hart
Vascular insults to the spinal cord are substantially less common than their corresponding events in the brain; it has been estimated, for example, that spinal cord infarcts make up ≤ 1% of ischemic events in the central nervous system. Although the public health burden of spinal cord injury remains severe, the majority of this burden stems from traumatic rather than vascular events. Still, vascular injuries in the spine are common enough and their consequences devastating enough that a familiarity with the pathophysiology, diagnosis, and treatment of the more common etiologies is essential to any practitioner of the clinical neurosciences...
May 2015: Neurologist
Andre M Samuel, Ryan A Grant, Daniel D Bohl, Bryce A Basques, Matthew L Webb, Adam M Lukasiewicz, Pablo J Diaz-Collado, Jonathan N Grauer
STUDY DESIGN: A retrospective study of surgically treated patients with acute traumatic central cord syndrome (ATCCS) from the National Trauma Data Bank Research Data Set. OBJECTIVE: To determine the association of time to surgery, pre-existing comorbidities, and injury severity on mortality and adverse events in surgically treated patients with ATCCS. SUMMARY OF BACKGROUND DATA: Although earlier surgery has been shown to be beneficial for other spinal cord injuries, the literature is mixed regarding the appropriate timing of surgery after ATCCS...
March 1, 2015: Spine
Alain Goriely, Marc G D Geers, Gerhard A Holzapfel, Jayaratnam Jayamohan, Antoine Jérusalem, Sivabal Sivaloganathan, Waney Squier, Johannes A W van Dommelen, Sarah Waters, Ellen Kuhl
The human brain is the continuous subject of extensive investigation aimed at understanding its behavior and function. Despite a clear evidence that mechanical factors play an important role in regulating brain activity, current research efforts focus mainly on the biochemical or electrophysiological activity of the brain. Here, we show that classical mechanical concepts including deformations, stretch, strain, strain rate, pressure, and stress play a crucial role in modulating both brain form and brain function...
October 2015: Biomechanics and Modeling in Mechanobiology
Courtney Takahashi, Holly E Hinson, Ian J Baguley
The central autonomic nervous system (CAN) is a multifaceted, richly connected neural network incorporating the hypothalamus, its descending tracts through the brainstem, the insular cortex and down into the spinal cord. All levels of the CAN are susceptible to injury following traumatic brain injury (TBI), whether from focal or diffuse injury. Focal injuries would be expected to produce localized damage to CAN control centers, whereas the effects of diffuse injuries are presumed to be more diverse and/or widely distributed...
2015: Handbook of Clinical Neurology
Andrzej Szczudlik, Jan Dobrogowski, Jerzy Wordliczek, Adam Stępień, Małgorzata Krajnik, Wojciech Leppert, Jarosław Woroń, Anna Przeklasa-Muszyńska, Magdalena Kocot-Kępska, Renata Zajączkowska, Marcin Janecki, Anna Adamczyk, Małgorzata Malec-Milewska
Neuropathic pain may be caused by a variety of lesions or diseases of both the peripheral and central nervous system. The most common and best known syndromes of peripheral neuropathic pain are painful diabetic neuropathy, trigeminal and post-herpetic neuralgia, persistent post-operative and post-traumatic pain, complex regional pain syndrome, cancer-related neuropathic pain, HIV-related neuropathic pain and pain after amputation. The less common central pain comprises primarily central post-stroke pain, pain after spinal cord injury, central pain in Parkinson disease or in other neurodegenerative diseases, pain in syringomyelia and in multiple sclerosis...
2014: Neurologia i Neurochirurgia Polska
Neslihan Yücel, Cem Ertan, Mustafa S Pepele, Ahmet Sigirci
BACKGROUND: Traumatic central cord syndrome (TCCS) is the most frequently encountered incomplete spinal cord injury, and it is a relatively rare situation in children younger than 15 years, but may have serious consequences. METHODS: We report the case of a 2-year-old female child with upper extremity weakness following a simple fall. All vitals and systemic examination findings were normal, except for 2/5 muscular strength in the upper extremities. While radiographic imaging showed no pathologic findings, MRI exposed spinal injury...
2014: World Journal of Emergency Medicine
Andrei F Joaquim, Alpesh A Patel, Alexander R Vaccaro
INTRODUCTION: The Subaxial Injury Classification (SLIC) system and severity score has been developed to help surgeons in the decision-making process of treatment of subaxial cervical spine injuries. A detailed description of all potential scored injures of the SLIC is lacking. MATERIALS AND METHODS: We performed a systematic review in the PubMed database from 2007 to 2014 to describe the relationship between the scored injuries in the SLIC and their eventual treatment according to the system score...
April 2014: Journal of Craniovertebral Junction and Spine
Sang Ku Jung, Hyung Jin Shin, Hui Dong Kang, Se Hyun Oh
Acute traumatic central cord syndrome is commonly associated with major trauma such as falling and motor vehicle crash, but minor or nontraumatic causes are very rare in children. As a consequence, most physicians frequently overlook children presenting with complaints of arm weakness when history of any definite major trauma does not exist, especially in the emergency department. We present the case of a 7-year-old boy who was experiencing weakness in both arms after a standing high jump with tilting his head back in school...
September 2014: Pediatric Emergency Care
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