Miyazaki syndrome: Cervical myelo/radiculopathy caused by overshunting. A systematic review

Várallyay, Péter; Nagy, Zoltán; Szücs, Anna; Czigléczki, Gábor; Markia, Balázs; Nagy, Gábor; Osztie, Éva; Vajda, J.; Vitanovics, Dusan

doi:10.1016/j.clineuro.2019.105531

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…The OSAM developed after long lapses following the VP shunt, with a mean of 12 years. [ 3 , 15 , 24 , 27 ] Thus, OSAM seems to be the ultimate stage of slowly progressing overdrainage. However, findings of dural sac shrinkage at the thoracic level were not mentioned in these reports.…”

Section: Discussionmentioning

confidence: 99%

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Dural sac shrinkage signs on spinal magnetic resonance imaging indicate overdrainage after lumboperitoneal shunt for idiopathic normal pressure hydrocephalus

Kawahara

Atsuchi

Arita

et al. 2022

Surgical Neurology International

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Background: We previously found the usefulness of dural sac shrinkage signs (DSSSs), which are the anterior shift of the spinal cord and dura mater behind the cord, detected by magnetic resonance imaging (MRI) at the thoracic level for the diagnosis of spontaneous intracranial hypotension (IH). This is a retrospective survey on the usefulness of DSSSs for the early detection of iatrogenic IH caused by overdrainage through a lumboperitoneal shunt (LPS) for patients with idiopathic normal pressure hydrocephalus (INPH). Methods: Forty-five INPH patients had an LPS using a pressure programmable valve equipped with an anti-siphon device. Results: Nine patients complained of orthostatic headache after the LPS, indicating IH due to overdrainage, which persisted for more than a week in three patients and 2–7days in six patients. The headache was transient/ nonorthostatic in ten patients and absent in 26 patients. The DSSSs and accompanying enlargement of the venous plexus were observed in all three patients with prolonged orthostatic headaches. Only the anterior shift of the dura mater was observed in 1 (4%) among 25 patients who had short-term orthostatic headache, transient/ nonorthostatic headache, or absent headache, and underwent spinal MRI. A patient with prolonged severe orthostatic headache with both DSSSs eventually developed intracranial subdural effusion and underwent tandem valve surgery, which provided a quick improvement of symptoms. The DSSSs on thoracic MRI also disappeared promptly. Conclusion: DSSSs may serve as objective signs for the diagnosis of IH due to overdrainage through an LPS for INPH.

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Section: Discussionmentioning

confidence: 99%

“…Meticulous observation of thoracic MRI scans in patients with OSAM may reveal DSSSs, which have been present in some figures of the past reports. [ 24 , 27 ] The assessment of the differences in DSSSs and enlargement of the epidural venous plexus between the LP and VP shunts may be a future research project.…”

Section: Discussionmentioning

confidence: 99%

Dural sac shrinkage signs on spinal magnetic resonance imaging indicate overdrainage after lumboperitoneal shunt for idiopathic normal pressure hydrocephalus

Kawahara

Atsuchi

Arita

et al. 2022

Surgical Neurology International

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“…It is not clear to the authors of this review why MAP was maintained above the AANS recommended range for acute SCI in this study. While CSF drainage was found to be safe in these trials, it is possible that excessive removal of CSF may cause the spinal cord and brain to lose the cushioning provided by the CSF and, in turn, contact surrounding bony structures, leading to temporary neurological deficits [ 85 , 86 , 87 ]. Other potential complications of the drainage procedure include leakage of CSF at the site of dural puncture, subdural hematoma, cerebral herniation, and infection [ 83 , 88 , 89 ].…”

Section: Managing Acute Pathophysiology After Traumatic Scimentioning

confidence: 99%

Clinical Trials Targeting Secondary Damage after Traumatic Spinal Cord Injury

Khaing

Chen

Safarians

et al. 2023

IJMS

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Spinal cord injury (SCI) often causes loss of sensory and motor function resulting in a significant reduction in quality of life for patients. Currently, no therapies are available that can repair spinal cord tissue. After the primary SCI, an acute inflammatory response induces further tissue damage in a process known as secondary injury. Targeting secondary injury to prevent additional tissue damage during the acute and subacute phases of SCI represents a promising strategy to improve patient outcomes. Here, we review clinical trials of neuroprotective therapeutics expected to mitigate secondary injury, focusing primarily on those in the last decade. The strategies discussed are broadly categorized as acute-phase procedural/surgical interventions, systemically delivered pharmacological agents, and cell-based therapies. In addition, we summarize the potential for combinatorial therapies and considerations.

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“…SIH fennállásának lehetősége esetén a koponyának gadolínium kontrasztanyaggal végzett, illetve a teljes gerincnek natív és kontrasztanyaggal végzett mágneses rezonanciás vizsgálata (MRI) javasolt, egyrészt a liquorhypotensio következményeinek (1. és 2. táblázat) [23][24][25][26][27][28][29][30][31], másrészt a liquorszivárgásnak és az azt okozó gerincpatológiának (például meningealis diverticulum) az azonosítására [32]. A SIH esetén gadolínium kontrasztanyagos koponya-MRI-vel látható, a liquorhypotensio következtében kialakult, jellemző eltéréseket saját, válogatott képanyaggal ábrázoljuk (1-4. ábra).…”

Section: Diagnosztikaunclassified

“…Gerinc-MRI során látott eltérések SIH esetén [24,[29][30][31] Extraarachnoidealis folyadékgyülemek [24] Az epiduralis vénás plexusok kitágulása, ami a canalis spinalist akár szűkítheti is (ritkán akár myelon-vagy gyöki kompressziót is okozhat kamrai söntös betegeken, mely a szakirodalomban Miyazaki-szindrómaként ismert) [29] Extraduralis folyadék-extravasatio [30,31] MRI = mágneses rezonanciás képalkotás; SIH = spontán intracranialis hypotensio ÖSSZEFOGLALÓ KÖZLEMÉNY látható kóros eltérés a gadolíniummal végzett koponya-MRI során [1]. Egy tanulmány a koponya-MRI szenzitivitását 83%-osnak, a gerinc-MRI szenzitivitását 94%-osnak értékelte [33].…”

Section: Táblázatunclassified

A spontán intracranialis hypotensio diagnosztikája mágneses rezonanciás képalkotással

Magyar

Nyilas

Bereczki

et al. 2021

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Összefoglaló. A klasszikus esetben ortosztatikus fejfájást okozó, spontán intracranialis hypotensiót az esetek túlnyomó többségében a gerinccsatornában, annak nyaki-háti átmenetében, illetve a háti szakaszán található liquorszivárgás okozza. Meglévő kötőszöveti betegség, degeneratív gerincbetegségek, illetve kisebb traumák szerepet játszhatnak a szivárgás kialakulásában. Az ortosztatikus fejfájás létrejöttében szerepet játszhat a meningealis szerkezetek, érzőidegek és hídvénák vongálódása. A klasszikus pozicionális, ortosztatikus fejfájásban szenvedő betegek körében gondolni kell a spontán intracranialis hypotensio lehetőségére, és az agykoponya, illetve a gerinc kontrasztanyaggal végzett mágneses rezonanciás vizsgálata (MRI) javasolt. A kontrasztanyaggal végzett koponya-MRI-vel klasszikus esetben diffúz, nem nodularis, intenzív, vaskos pachymeningealis kontrasztanyag-halmozás, kitágult vénássinus-rendszer, subduralis effusiók és az agytörzs caudalis diszlokációja („slumping”) látható. Fontos azonban szem előtt tartani, hogy az esetek 20%-ában ezen eltérések nem detektálhatók. Jó minőségű, randomizált, kontrollált vizsgálatok nem történtek, a kezelés hagyományokon alapul. Kezdetben általában konzervatív terápiát alkalmaznak (ágynyugalom, koffein- és folyadékbevitel), ennek hatástalansága esetén epiduralis sajátvér-injekció, epiduralis fibrinragasztó-injektálás, illetve sebészi terápia jöhet szóba. Orv Hetil. 2021; 162(7): 246–251. Summary. Spontaneous intracranial hypotension, the classic feature of which is orthostatic headache, is most commonly caused by a cerebrospinal fluid leakage at the level of the spinal canal, in most cases at the thoracic level or cervicothoracic junction. Underlying connective tissue disorders, minor trauma, degenerative spinal diseases may play a role in the development of cerebrospinal fluid leaks. Traction on pain-sensitive intracranial and meningeal structures, particularly sensory nerves and bridging veins, may play a role in the development of orthostatic headache. In the case of patients with classic orthostatic headache, the possibility of spontaneous intracranial hypotension should be considered, and if suspected, brain magnetic resonance imaging (MRI) with gadolinium and additional spine MRI are recommended. Diffuse, non-nodular, intense, thick dural enhancement, subdural effusions, engorgement of cerebral venous sinuses, sagging of the brain are typical features on brain MRI, which, however, remain normal in up to 20 percent of patients with spontaneous intracranial hypotension. Unfortunately, no randomized clinical trials have evaluated the effectiveness of the various treatment strategies and no definitive treatment protocols have been established. In clinical practice, the first-line treatment of spontaneous intracranial hypotension is conservative (bed rest, caffeine and fluid intake). If conservative therapy is not effective, epidural blood patch, epidural fibrin glue, or surgical repair should be considered. Orv Hetil. 2021; 162(7): 246–251.

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Miyazaki syndrome: Cervical myelo/radiculopathy caused by overshunting. A systematic review

Cited by 12 publications

References 26 publications

Dural sac shrinkage signs on spinal magnetic resonance imaging indicate overdrainage after lumboperitoneal shunt for idiopathic normal pressure hydrocephalus

Dural sac shrinkage signs on spinal magnetic resonance imaging indicate overdrainage after lumboperitoneal shunt for idiopathic normal pressure hydrocephalus

Clinical Trials Targeting Secondary Damage after Traumatic Spinal Cord Injury

A spontán intracranialis hypotensio diagnosztikája mágneses rezonanciás képalkotással

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