Background:Spontaneous spinal epidural hematomas (SEHs) due to the utilization of factor Xa inhibitors are rare.Case Description:A 66-year-old female presented with a Brown-Sequard syndrome attributed to a cervical epidural hematoma secondary to the utilization of rivaroxaban, one of the factor Xa inhibitors. Following a cervical laminectomy for the evacuation of the hematoma, the patient completely recovered.Conclusion:A spinal hemorrhagic event should be suspected in patients receiving factor Xa inhibitor drugs. Here, we had an elderly female on rivaroxaban experienced the acute onset of neck/back pain associated with a Brown-Sequard syndrome. A literature review showed that this is the seventh example of SEH occurring as a result of the use of anticoagulation drugs (OACDs; e.g., including Xa inhibitors).
Atlantoaxial rotatory fixation (AARF) is a rare condition in adults and is almost always due to an accompanying trauma. The first example of traumatic AARF in adults was reported by Corner in 1907 and since then only 55 adult cases with this rare traumatic scenario have been published so far. Approximately 80% of adults with traumatic AARF are diagnosed soon after the traumatic events. However, in the remaining casualties, the condition might be missed with some delay from the diagnosis to treatment. If this pathology is diagnosed early enough, the conservative attempts for a closed reduction are usually effective. After closed reduction, external immobilization is required to prevent recurrence of the dislocation. However, with delayed diagnosis, the condition may remain refractory to traction on manipulation and require an open reduction instead. In the literature, such irreducible chronic AARFs are rarely reported, being confined to only 14 adult examples, in whom surgical intervention for correction of the deformity will be required. In such cases, release of the atlantoaxial facet joints is the first surgical step. In the subsequent step, reduction of the dislocated facet joints can be done via one of the already described maneuvers. As the final step, C1-C2 fixation will be necessary for prevention of re-dislocation. Herein, 2 adult patients with chronic rotatory atlantoaxial dislocation of traumatic origin are presented. In both cases, cranial traction and manipulations were ineffective and therefore an open reduction procedure was proposed and accomplished via the posterior midline corridor. The transverse rod technique was implemented subsequent to the atlantoaxial facet release. After correction of the deformity, a C1-C2 fixation was accomplished followed by arthrodesis. In addition to the outlined procedure, an historical review of the literature on this subject from the beginning of 20th century is demonstrated.
Upper cervical spine injuries are the most common form of spinal cord trauma that occur in preschool children. Among such injuries, odontoid synchondrosis fractures are the most frequently observed, though relatively few cases have been reported in the medical literature. The most appropriate approach to describe such cases is physeal injuries of the basilar synchondrosis plate between the odontoid process and the body of the axis. Acute odontoid synchondrosis fractures are further classified into 3 subtypes based on the amount of dense displacement and the degree of fracture angulation. Type Ic, the most severe subtype, will require a posterior atlantoaxial fixation for an associated atlantoaxial subluxation. The majority of Type Ia and type Ib odontoid synchondrosis fractures that display only mild to moderate dense displacement and angulation, can be adequately addressed through proper fusion. Complete fusion may be achieved through external immobilization after careful alignment is reached by either Minerva Orthosis or the use of a Halo-vest. Regardless of the technique applied, prior to immobilization, acute synchondrosis fractures should be brought together through either neck hyperextension or by using the skull traction procedure. While Minerva orthosis has been effective in the treatment for two case series and a few case reports, the use of Halo-vesting in young children presents challenges due to decreased skull thickness and the presence of a certain amount of soft osseous tissue. For these reasons, a certain level of controversy exists in the medical literature as to whether the use of such a device is warranted. According to the opponents of this practice, Halo-vesting is often a frustrating and anxiety-provoking experience for young patients. They likewise draw attention to the concerns and hospitality anticipated from the caregivers of such children who have been vested. Furthermore, these authors document that Halo orthosis is associated with a higher percentage of complications such as pin site infections, pin loosening or dislodgement, the breakdown of skin, dysphagia, dural tears and even brain abscesses. Conversely, proponents believe that Halo-vesting is a well-tolerated procedure in a majority of children as well as in toddlers. In accordance with this belief, existing evidence demonstrates that with a modification in the pin number, pin design, location of insertion, and insertion torque, the incidence of pin dislodgement and pin loosening may be reduced. Moreover, pin-site infections can be prevented through periodic medical supervision of the child patient as well as educating caregivers on how to properly clean and monitor pin sites. Overall, the number of the children with odontoid synchondrosis fractures, who have been treated with Halo-vesting accounts for roughly 40 cases with a mean percentage of complication rate recorded at 40%. Herein, 3 young children with acute odontoid synchondrosis fractures are reported in whom solid fusion at the synchondrosis plate was achieved t...
Background: Myxopapillary ependymoma (MPE) with anaplastic features is extremely rare. There are very few such case reports in the medical literature. Case Description: A 23-year-old female presented with lower back pain, and both urinary and fecal dysfunction. The patient underwent gross total surgical excision of the MR documented expansile intrasacral tumor. The histology was compatible with a MPE containing anaplastic features. Conclusion: The medical literature contains a few comparable cases of subcutaneous sacrococcygeal MPE with anaplastic components. Here, however, we have a young female with an anaplastic intrasacral MPE treated with gross total surgical excision.
Background: In a small percentage of children born with congenital hydrocephalus, enlargement of the head and the presence of ventriculomegaly may halt and ultimately stabilize the condition designated as arrested hydrocephalus. Arrested hydrocephalus in children is typically due to congenital aqueduct stenosis, which can be described appropriately as a stasis existing within the channel between the third and fourth ventricles. Os odontoideum (OO) is an uncommonly occurring pathology at the craniovertebral junction. Although the clinical and radiologic features of its existence and the therapeutic options for its pathology have been widely discussed within the medical literature, its true etiology has been a source of divisive debate, proposing both a traumatic as well as a congenital mechanism. The etiology of OO has been heartily debated in the literature for several years as well. Most authors have come to support a posttraumatic causality. However, strong evidence exists to support a congenital origin to this rarely observed malformation. Methods: Within this case study we present a 24-year-old woman with atlantoaxial subluxation that exists secondary to an orthotropic OO. The patient had a history of arrested hydrocephalus due to congenital aqueductal stenosis beginning in early childhood. She presented with normal intelligence and was neurologically without deficits before the occurrence of an atlantoaxial dislocation. Unfortunately, the pathology was initially misdiagnosed as a decompensation state of the arrested hydrocephalus, and after 8 months the patient became wheelchair bound. Following this unfortunate event the correct diagnosis was ultimately uncovered. Subsequently a C2-1 instrumentation procedure resulted in excellent alignment and fusion. Conclusions: To the best of our knowledge, this is the first example of an aqueduct stenosis in the setting of an existing OO, a combination that might be another clue in favor of a congenital etiology.
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