Background Degenerative cervical myelopathy (DCM) is characterized by progressive deterioration in spinal cord function. Its evaluation requires subjective clinical examination with wide inter-observer variability. Objective quantification of spinal cord function remains imprecise, even though validated myelopathy-grading scales have emerged and are now widely used. We created a Smartphone App with the aim of quantifying accurately and reliably spinal cord dysfunction using a 5-minute Test. Methods A patient suffering from DCM was clinically evaluated before surgery, at 3 and 6 months follow-up after surgical decompression of the cervical spinal cord. Standard scores (Nurick grade, mJOA score) were documented at these time points. A 5-minute motor and proprioceptive performance test aided by a smartphone with the N-outcome app was also performed. Results Motor performance in rapid alternating movements and finger tapping improved in correlation with improvements in standard grading scale scores. Clinical improvements were seen in maximum reflex acceleration and in Romberg testing which showed less closed/open eyes variation, suggesting pyramidal and proprioceptive function recovery. Conclusions We demonstrate that using a smartphone app as an adjunct to clinical evaluation of compressive myelopathy is feasible and potentially useful. The results correlate with the results of clinical assessment obtained by standard validated myelopathy scores.
Sinusitis refers to inflammation in the sinuses. Complications of sinusitis are rare and most often affect the orbit. However, in rare cases, these complications may be intracranial. One of these intracranial complications is subdural empyema, which is a loculated suppuration between the dura mater and the arachnoid. Despite its rarity, it has a high mortality rate and is often underestimated by physicians. We report here a rare case of a 5-year-old girl with a subdural empyema secondary to contralateral sinusitis. She was admitted to a local hospital complaining of fever, nasal congestion and headache for 6 days. Antibiotic therapy was initiated on admission. After six days, the patient maintained the previous symptoms and developed a decreased level of consciousness, a right hemiparesis and had a witnessed tonic-clonic seizure. This prompt her transfer to a tertiary hospital for brain computed tomography (CT) scan, which revealed a left subdural collection and a right maxillo-sphenoid sinusitis. She was referred to neurosurgical care and underwent surgical drainage of the empyema. There were another two complications of sinusitis: periorbital cellulitis and frontal osteomyelitis (both on the right). The patient was discharged from the tertiary hospital on day 39 without neurological sequelae. This case shows a rare complication of sinusitis and its clinical, surgical and radiological features and reinforces to physicians the importance of being aware of the possible complications of sinusitis. The peculiarity of the case is attributable to the way in which bacterial spread from sinusitis to a contralateral subdural empyema occurred.
Case presentation: A 4-year-old and 5-month-old child with a history of sudden onset of clonic seizures that started in the left hallux and progressed to the ipsilateral hemibody and face, lasting up to five minutes. After that, she presented walking and learning difficulty and was unable to perform everyday activities (drawing, writing), which evolved in five months. Electroencephalogram (EEG): diffuse slowing predominating in the right hemisphere; very frequent, almost continuous bilateral interictal epileptiform activity in frontocentroparietal regions mainly on the right. Brain magnetic resonance imaging showed right hemispheric atrophy, with predominantly frontoparietal cortical thinning and reduced brainstem volume on the right, in addition to a nonspecific signal alteration in the left thalamic-mesencephalic area, with possible inflammatory or demyelinating origin. She received CBZ and LEV without seizure control. Cerebrospinal fluid analysis was unremarkable including autoantibodies. At age 5-year-old and 2-month-old she developed progressive left hemiparesis. She received two cycles of pulse therapy (methylprednisolone 30 mg/kg for three days), without significant improvement, with continuous clonic seizures in left hallux. Video-EEG revealed right sided epileptiform activity with midline involvement. At age 6-year-old and 8-month-old the child underwent right hemispherotomy and has been seizure free since then, presenting left hemiparesis and taking clobazam, LEV, ESM and CBZ. Histopathology revealed signs of Rasmussen’s encephalitis (RE), with frequent microglial nodules and perivascular lymphocytic infiltrate, and some lymphocytes surrounding neurons. Discussion: Bilateral brain disease in RE is debated, but it is probably very rare. Only two out of 200 published cases had evidence of bilateral disease. Conclusion: Although rare, the possibility of bilateral involvement in RE should be considered to stress early surgical treatment and to improve outcome.
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