We report a case of V ventricular cystic dilatation, presenting with specific neurological symptoms including low back pain, bilateral sciatica, weakness of dorsiflexion, and urinary retention. MRI showed a large cystic dilatation of the ventriculus terminalis. Surgical fenestration of the cyst allowed complete relief from symptoms and remission of the neurological deficit.
Thirteen patients with post-stroke spastic hemiparesis underwent a percutaneous test trial of spinal cord stimulation (SCS) in order to modify their motor disturbances. Clinical evaluation based on Albert's motor scale and neurophysiological evaluation consisting of surface EMG during voluntary, involuntary, and reflex motor activity were performed before and during SCS. At the end of the test period, eight patients showed a significant improvement in their motor performance. The EMG analysis confirmed the clinical data. SCS was followed by a reduction or disappearance of synergic coactivation with better agonist-antagonist coordination, a decrease of clonus both in duration and spreading, and better endurance. The effect on motor control did not increase with time after the first month of SCS, but was long lasting (mean follow-up: 2 years). There was a correlation between sensory deficit and motor outcome suggesting that the enhancement of sensory input put into play by SCS and the consequent development of new sensory-motor integration might be responsible for the improvement in motor performance.
Spinal cord function was monitored during surgery in 2 cases of syringomyelia. The intraoperative recording of spinal segmental and conduction potentials evoked at cervical levels by the stimulation of median and tibial nerves were essential in the definition of the extent of the lesion and was consistent with postoperative neurological outcome.
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