High sensitivity of contact-heat evoked potentials in “snake-eye” appearance myelopathy

Ulrich, A; Min, Kan; Curt, Armin

doi:10.1016/j.clinph.2014.12.020

Cited by 12 publications

(4 citation statements)

References 48 publications

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“…The goal of establishing normative CHEPs values in cervical dermatomes was primary but not limited for clinical applications in traumatic spinal cord injury and cervical spondylotic myelopathy. While traumatic spinal cord injury is a relatively rare event, diagnosing level of injury and monitoring changes near the level of lesion (i.e., syringomyelia) is of paramount importance 6 8 26 52 . Diagnosing the level of impairment and monitoring deteriorating neurological function is equally important in the case of cervical spondylotic myelopathy, for which surgical intervention may be indicated.…”

Section: Discussionmentioning

confidence: 99%

Normative data for the segmental acquisition of contact heat evoked potentials in cervical dermatomes

Jutzeler

Rösner

Rinert

et al. 2016

Sci Rep

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Contact heat evoked potentials (CHEPs) represent a neurophysiological approach to assess conduction in the spinothalamic tract. The aim of this study was to establish normative values of CHEPs acquired from cervical dermatomes (C4, C6, C8) and examine the potential confounds of age, sex, and height. 101 (49 male) healthy subjects of three different age groups (18–40, 41–60, and 61–80 years) were recruited. Normal (NB, 35–52 °C) followed by increased (IB, 42–52 °C) baseline stimulation protocols were employed to record CHEPs. Multi-variate linear models were used to investigate the effect of age, sex, and height on the CHEPs parameters (i.e., N2 latency, N2P2 amplitude, rating of perceived intensity). Compared to NB, IB stimulation reduced latency jitter within subjects, yielding larger N2P2 amplitudes, and decreased inter-subject N2 latency variability. Age was associated with reduced N2P2 amplitude and prolonged N2 latency. After controlling for height, male subjects had significantly longer N2 latencies than females during IB stimulation. The study provides normative CHEPs data in a large cohort of healthy subjects from segmentally examined cervical dermatomes. Age and sex were identified as important factors contributing to N2 latency and N2P2 amplitude. The normative data will improve the diagnosis of spinal cord pathologies.

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Section: Discussionmentioning

confidence: 99%

Normative data for the segmental acquisition of contact heat evoked potentials in cervical dermatomes

Jutzeler

Rösner

Rinert

et al. 2016

Sci Rep

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“…Undoubtedly, chronic mechanical compression and vascular insufficiency can be among the main promoters of SEA [ 8 , 18 ]. However, the pathogenetic mechanism is not completely understood and research is still ongoing.…”

Section: Discussionmentioning

confidence: 99%

“…Within this volume there are some 100 muscle fibers. EMG amplitude is the sum of the electric potential differences within a muscle relating to all the active motor units in the vicinity of the electrodes on the skin [ 18 ]. Trans-cranial stimulation was performed to elicit MEPs recorded with sub-dermal needle electrodes placed bilaterally in the biceps brachii (BB), extensor radialis carpi (ERC), opponens pollicis (OPP), tibialis anterior (TA), and flexor digitorum brevis (FBD).…”

Section: Figures Scheme and Tablementioning

confidence: 99%

Snake-Eye Myelopathy and Surgical Prognosis: Case Series and Systematic Literature Review

Fontanella

Zanin

Bergomi

et al. 2020

JCM

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The prognostic value of “snake-eyes” sign in spinal cord magnetic resonance imaging (MRI) is unclear and the correlation with different pathological conditions has not been completely elucidated. In addition, its influence on surgical outcome has not been investigated in depth. A literature review according to PRISMA (Preferred reporting items for systematic review and meta-analysis protocols) guidelines on the prognostic significance of “snake-eyes” sign in operated patients was performed. Clinical, neuroradiological, and surgical data of three institutional patients, were also retrospectively collected. The three patients, with radiological evidence of “snake-eyes” myelopathy, underwent appropriate surgical treatment for their condition, with no new post-operative neurological deficits and good outcome at follow-up. The literature review, however, reported conflicting results: the presence of “snake-eyes” sign seems a poor prognostic factor in degenerative cervical myelopathy, even if some cases can improve after surgery. “Snake-eyes” myelopathy represents a rare form of myelopathy; pathophysiology is still unclear. The frequency of this myelopathy may be greater than previously thought and according to our literature review it is mostly a negative prognostic factor. However, from our experience, prognosis might not be so dire, especially when tailored surgical intervention is performed; therefore, surgery should always be considered and based on the complete clinical, neurophysiological, and radiological data.

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“…However, the definite pathological process of the SEA in chronic spinal cord compression remains ambiguous. Potential mechanisms, such as chronic mechanical compression, secondary changes in blood supply, and the high vulnerability of gray matter cells, may contribute to the process [14]. With advances in MRI techniques, increasing numbers of patients with chronic compressive myelopathy, such as cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament, are observed with the SEA on MRI reports.…”

Section: Discussionmentioning

confidence: 99%

Snake-Eyes Appearance on MRI Occurs during the Late Stage of Hirayama Disease and Indicates Poor Prognosis

Shao

Zhang

et al. 2019

BioMed Research International

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Purpose Because Hirayama disease is stereotyped as a self-limited disease in the absence of a definite pathology, we investigated the potential relationship between snake-eyes appearance (SEA) and Hirayama disease to bring a new perspective in the pathological process of Hirayama disease based on relevant radiological and clinical evidence. Methods A total of 30 cases observed SEA were selected from 293 patients with Hirayama disease to constitute the SEA group, and an equal number of cases were randomly selected from the remaining patients to form the non-SEA group. Cervical magnetic resonance imaging (MRI) was performed and subsequently used to measure the anteroposterior diameter and anterior shifting of the spinal cord. Additionally, clinical data, such as age, sex, duration of symptoms, symptoms, and signs, were collected and analyzed. Results Of 293 patients, 10.6% appeared with the SEA, which was mainly multisegmental (86.7%), particularly at the C5-6 segment (73.3%), and intense with a well-defined border (70.0%). The SEA group was an older population (p < 0.0001) with a longer duration (p < 0.0001) and a higher incidence of Hoffmann signs and knee hyperreflexia (p < 0.0001, p = 0.0038, respectively). The degree of spinal cord atrophy demonstrated a close association with the SEA, as it was significantly worse in the SEA group and SEA segment (p = 0.0008, p < 0.0001, respectively). The degree of spinal cord atrophy was positively related to both age and duration (p = 0.0095, p = 0.0176, respectively). Conclusions Confirmed as an irreversible lesion and an indication of poor prognosis, SEA appears during the late stage of Hirayama disease and is closely related to pyramidal signs and spinal cord atrophy.

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High sensitivity of contact-heat evoked potentials in “snake-eye” appearance myelopathy

Cited by 12 publications

References 48 publications

Normative data for the segmental acquisition of contact heat evoked potentials in cervical dermatomes

Normative data for the segmental acquisition of contact heat evoked potentials in cervical dermatomes

Snake-Eye Myelopathy and Surgical Prognosis: Case Series and Systematic Literature Review

Snake-Eyes Appearance on MRI Occurs during the Late Stage of Hirayama Disease and Indicates Poor Prognosis

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