The aim of this study is to evaluate the sensory, motor and functional improvement in patients with a Spinal Cord Lesion (SCL) by recording at admission, discharge and at 12 months after discharge. Fifty-®ve patients (29 with paraplegia and 26 with tetraplegia) admitted to our departments of Physical Medicine and Rehabilitation between December 1992 ± 1995. Three patients were excluded as they did not give their consent. Each patient was evaluated at admission, before discharge and at 12 months after discharge. Motor status was evaluated by the motor score (MS), sensory status by the light touch score (LTS), and functional status by the Functional Independence Measure (FIM) score. Each patient was asked to complete a patient questionnaire which was developed according to the standards of the American Spinal Injury Association (ASIA) scale. Twelve patients (10 with paraplegia and two with tetraplegia) were evaluated at 12 months after discharge. Paired samples t-test was used for statistical analysis. The mean age of the patients group was 36.42+17.70 years, the mean duration of inpatient rehabilitation was 93.87+44.95 days. The SCL was due to trauma in 45 patients, 86.50% of the cases and was complete in nine patients (17.30%) and incomplete in 19 (36.53%) with paraplegia. Six tetraplegic patients (11.53%) had complete and 18 had (34.61%) incomplete lesions. The evaluation of MS, LTS and FIM scores at admission and discharge showed signi®cant improvement in the MS and LTS in all of the patients with incomplete lesions (P50.001). FIM scores showed signi®cant improvement only in those with complete or incomplete paraplegia (P50.05). At 12 months follow-up there was no signi®cant change in the MS and the LTS whereas a signi®cant change was noted in the FIM scores (P50.05) in 10 paraplegic patients. In summary, the results of this study indicate that rehabilitation was e ective in our SCL series although the signi®cant gain may also be attributed to the fact that 71.1% of the study group had incomplete neurological lesions.

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Epidural fibrosis is a challenging topic in spinal surgery. Numerous clinical and experimental studies have been focused on this issue to clarify problems faced in spinal procedures for the patient as well as the surgeon and find out new methodologies. Dense cytokines and growth factors which are released from inflammatory cells have been suggested to play a major role in the inception and progression of fibrosis. One of the most investigated and important actor in epidural fibrosis is assumed to be the transforming growth factor-1β (TGF-1β) formation. Studies showed that Dexmedetomidine (DEX) downregulates TGF-β pathway with its anti-inflammatory and antioxidant effects. From this point of view, for the first time in the literature we try to observe if there will be an effect of topical DEX administration over epidural fibrosis in a rat model. We hypothesized that DEX might have preventive effects on epidural fibrosis via anti-inflammatory and antioxidant effects. Twenty-four adult male Wistar albino rats were randomly assigned to three groups (Topical DEX, Spongostan, Laminectomy). A total laminectomy was performed at the L3-L5 level and then the ligamentum flavum and epidural fat tissue were cleared away from the surgical site. Histopathological assessment was performed postoperatively after 4 weeks. Our study revealed that topical DEX administration may have effects on reducing epidural fibrosis. Topical DEX administration may be helpful in preventing epidural fibrosis after laminectomy in rats through multiple anti-inflammatory and antioxidant mechanisms as well as through TGF -1β pathway.

Kernohan-Woltman notch phenomenon (KWNP) is an ipsilateral motor weakness due to compression of the contralateral cerebral peduncle. Most of the KWNP cases reported have been due to subdural hematomas, intracranial space-occupying lesions, and spontaneous bleeding of vascular malformations. In this study, we present the first pediatric case of KWNP caused by a traumatic epidural hematoma. Although subdural hematomas are the most frequent reason for KWNP, epidural hematomas may cause paradoxical ipsilateral signs not only in adults but also in pediatric patients.

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An epidural hematoma (EDH) following posterior fossa surgery is extremely rarely reported. We report the case of a 49-yearold woman diagnosed with cerebellar lesions and hydrocephalus. The patient underwent left paramedian suboccipital craniotomy, and total resection of the lesion was performed. After the surgery, the patient was transferred to the intensive care unit with a Glasgow coma score of 15. Because the patient was neurologically stable, computed tomography (CT) was performed on the first postoperative day. A right, frontal, large EDH was seen on the CT image without any complaint and neurological deterioration. EDH evacuation was performed by right frontal craniotomy, and the patient was discharged with full recovery. This case reinforces the importance of a close follow-up and the early imaging of posterior fossa tumors, particularly with hydrocephalus, for not overlooking this rare, but serious, complication, even if a patient is clinically silent.

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