Endemic skeletal fluorosis is widely prevalent in India and is a major public health problem. The first ever report of endemic skeletal fluorosis and neurological manifestation was from Prakasam district in Andhra Pradesh in the year 1937. Epidemiological and experimental studies in the endemic areas suggest the role of temperate climate, hard physical labor, nutritional status, presence of abnormal concentrations of trace elements like strontium, uranium, silica in water supplies, high fluoride levels in foods and presence of kidney disease in the development of skeletal fluorosis. Neurological complications of endemic skeletal fluorosis, namely radiculopathy, myelopathy or both are mechanical in nature and till date the evidence for direct neurotoxicity of fluoride is lacking. Prevention of the disease should be the aim, knowing the pathogenesis of fluorosis. Surgery has a limited role in alleviating the neurological disability and should be tailored to the individual based on the imaging findings.
Two cases of cervico-dorsal neurenteric cysts are presented, one located dorsal and the other ventral to the spinal cord, with associated Klippel-Feil anomaly, meningocele, spinal dysraphism and possibly spinal cord malformation. One patient was operated on as a neonate for a cervico-thoracic meningocele and presented during adolescence with spastic quadriparesis. Imaging revealed spina bifida, a dorsally located neurenteric cyst and a tendency towards split cord malformation. The other child presented with cervico-thoracic kyphoscoliosis and paraparesis. Imaging demonstrated persistence of a cervico-thoracic remnant of the primitive neurenteric canal through the upper thoracic spine.
The clinical presentation and pathological characteristics of 18 histologically verified meningiomas in the paediatric age group are reviewed. There was a 1:1 sex ratio. Two children presented with seizures. The majority were supratentorial in location and large in size. In 4 patients, the meningiomas showed sarcomatous changes, while in 6 patients they were cystic.
Alkaptonuria is a rare genetic disorder caused by de®ciency of the enzyme homogentisic acid oxidase, resulting in accumulation of homogentisic acid in various body tissues; it produces a multisystemic disorder with a characteristic bluish-black discolouration of the skin and cartilage, termed ochranosis. Ochranosis primarily involves the large joints of the body including the spine. Spinal involvement produces loss of¯exibility and ankylosis of the thoracic and lumbar segments. 1 The clinical presentation with spondylosis and canal stenosis is common after the third and fourth decades, 2 but intervertebral disc prolapse is unusual in ochranosis.Keywords: alkaptonuria; ochranosis; disc prolapse; spine Case reportA 22 year old male presented with backache and left sided sciatica of 6 weeks duration. Conservative treatment from his general practitioner failed to relieve the pain and he developed paraesthesiae in left lower limb. There was marked restriction of straight leg raising on the left side; weakness of the left ankle dorsi¯exors and of the extensor hallucis longus; and decreased sensation over the medical aspect of left foot.A clinical diagnosis of prolapsed intervertebral disc at L4/L5 on the left side was made, and he was investigated. Plain radiographs of the lumbar spine were unremarkable; magnetic resonance image tomography revealed a prolapse of the L4/5 intervertebral disc (Figure 1). At operation, there was marked hypertrophy of the facet joints with encroachment onto the canal, and there was severe pressure on the L5 left nerve root due to the underlying bulging disc.
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