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Spinal cord ischemia is a rare but ominous clinical situation with high levels of disability. There are emerging reports on COVID-19 and spinal cord ischemic events. To investigate the cardinal manifestations of SARS-CoV-2 associated spinal cord ischemia, review treatment paradigms, and follow outcomes. A systematic review. The current study was conducted under Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The authors searched PubMed, Scopus, Web of Science, and Google Scholar for studies published up to February 12, 2023, on spinal cord ischemia and SARS-CoV-2 infection. Data on patient demographics, study methods, medical records, interventions, and outcomes were extracted from eligible articles. For each data set, the authors performed pooled estimates examining 3 factors of interest, which were (1) predisposing factors (2) treatment regimens, and (3) neurological rehabilitation outcomes. Neurological status was reported as the American Spinal Injury Association (ASIA) impairment scale reported by data sets. Six data sets were identified. The mean age of the study population was 50 years old, with 66.6% male predominance. Sixty-six percent of the patients had severe COVID-19. Five data sets reported preexisting coagulopathy. ASIA A and B were the most prevalent primary neurological status (80%). The mean interval between COVID-19 and the first neurological deficit was 13 days. Anterior spinal artery lesions were the most prevalent ischemic pattern. The most common treatment regimens were heparin and steroid therapy. Physical rehabilitation showed poor functional outcomes. SARS-CoV-2 is associated with spinal cord ischemia through multiple neuropathological mechanisms. Proper coagulation profile control and aggressive rehabilitation may play a promising role in the prevention and recovery of spinal cord infarction in SARS-CoV-2 patients. [ABSTRACT FROM AUTHOR]

Spinal cord injury is a condition affecting the central nervous system, causing different levels of dysfunction below the point of nerve damage. A 50-year-old woman suffered a neck injury as a result of a car accident. After undergoing posterior cervical C3-C6 internal fixation with titanium plates on one side and C7 lamina decompression, the patient, who had been diagnosed with C3-C7 cervical disk herniation and spinal stenosis causing persistent compression of the spinal cord, was transferred to the rehabilitation department. After implementing the combined therapy of Virtual Reality-based arm and leg cycling along with transcutaneous electrical stimulation of the spinal cord, the patients experienced a notable enhancement in both sensory and motor abilities as per the ASIA scores. The patient's anxiety and depression were reduced as measured by the Hamilton Anxiety and Hamilton Depression Tests. As evaluated by the SCIM-III, the patient's self-reliance and capacity to carry out everyday tasks showed ongoing enhancement, leading to the restoration of their functionality. Hence, the use of Virtual Reality-based arm and leg cycling along with transcutaneous electrical spinal cord stimulation has potential to positively impact function in patients with spinal cord injury. However, as this is a case report, the small number of patients and the fact that the intervention was initiated early after the injury, we were unable to separate the recovery due to the intervention from the natural recovery that is known to occur in the initial weeks and months after SCI. Therefore, further randomized controlled trials with a large sample size is necessary. [ABSTRACT FROM AUTHOR]

The bulbocavernosus reflex (BCR) has been used during the initial evaluation of a spinal cord injury patient as a metric to determine prognosis and whether the patient is in "spinal shock." This reflex has been less utilized over the last decade, and therefore a review was performed to assess the value of BCR in patient prognosis. The North American Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of tertiary medical centers that includes a prospective SCI registry. The NACTN registry data was analyzed to evaluate the prognostic implication of the BCR during the initial evaluation of a spinal cord injury patient. SCI patients were divided into those with an intact or absent BCR during their initial evaluation. Associations of participants' descriptors and neurological status on follow-up were performed, followed by associations with the presence of a BCR. A total of 769 registry patients with recorded BCRs were included in the study. The median age was 49 years (32-61 years), and the majority were male (n = 566, 77%) and white (n = 519, 73%). Among included patients, high blood pressure was the most common comorbidity (n = 230, 31%). Cervical spinal cord injury was the most common (n = 470, 76%) with fall (n = 320, 43%) being the most frequent mechanism of injury. BCR was present in 311 patients (40.4%), while 458 (59.6%) had a negative BCR within 7 days of injury or before surgery. At 6 months post-injury, 230 patients (29.9%) followed up, of which 145 had a positive BCR, while 85 had a negative BCR. The presence/absence of BCR was significantly different in patients with cervical (p = 0.0015) or thoracic SCI (p = 0.0089), or conus medullaris syndrome (p = 0.0035), and in those who were American Spinal Injury Association Impairment Scale grade A (p = 0.0313). No significant relationship was observed between BCR results and demographics, AIS grade conversion, motor score changes (p = 0.1669), and changes in pin prick (p = 0.3795) and light touch scores (p = 0.8178). In addition, cohorts were not different in surgery decision (p = 0.7762) and injury to surgery time (p = 0.0681). In our review of the NACTN spinal cord registry, the BCR did not provide prognostic utility in the acute evaluation of spinal cord injury patients. Therefore, it should not be used as a reliable marker for predicting neurological outcomes post-injury. [ABSTRACT FROM AUTHOR]

Background: Thoracic disc herniation accounts for only 0.15 to 1.8% of all spinal herniated discs. Usually present between the third and sixth decades with a female predilection. Objectives: To describe the surgical outcome and prognostic factors of post-decompression without fixation in CTDs. Patient and methods: from October 2016 to July 2019, a series of 9 patients with a CTD with demographic data, presentation, imaging findings, operative details, degree of spinal stenosis, duration of symptoms 'and outcomes using ASIA scale or mFAC. Results: All patients presented with at least one sign of myelopathy. Simple laminectomy was performed, and followup was in 1st week and 6th month. In 1st week, according to ASIA grade improved in 4 (44, 4%), stationary in 3 (33.3%), deteriorated in 2 (22.2%) patients. According to ambulation, non-ambulatory in 3 (33.3%) and independent in 5 (66.6%) patients. In 6th month, according to ASIA grade improved in 5 (62.5%), stationary in 2 (25%), deteriorated in1 (12.5%) patient. According to ambulation, non-ambulatory in 1 (12.5%), independent in 3 (37.5%) and walker in 4 (50%) patients, one patient is missed in the 6th-month follow-up. Prognostic factors affected the surgical outcome, including the degree of spinal canal stenosis and duration of symptoms. Conclusions: Posterior decompression without instrumentation allowed us to decompress the compromised spinal cord. Results overall are good with the majority of patients improving at least 1 ASIA scale or mFAC. Better outcomes were affected with less degree of spinal stenosis and less duration of symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Spinal cord injury causes permanent neurological deficits, which have devastating physical, social, and vocational consequences for patients and their families. Traditional Chinese medicine uses acupuncture to treat neuropathic pain and improve nerve conduction velocity. This treatment can also reduce peripheral nerve injury joint contracture and muscle atrophy in affected patients. And it's got a remarkable restoration when electrical stimulation therapy on impaired peripheral nerves in animal models and clinical trials. Case description: A 48-year-old woman was hit by a heavy object that injured her lower back. The patient had a T12-L1 vertebral flexion and stretch fracture with traumatic spinal stenosis. The patient was transferred to the rehabilitation department after posterior T12-L2-segment pedicle screw system distraction and reduction, internal fixation, decompression, and bone graft fusion. Ultrasound-guided electroacupuncture was used to stimulate the sacral nerve, the spinal nerve, and the head of the patient, accompanied by spinal joint loosening training, respiratory training, lumbar comprehensive sports training, paraplegic limbs comprehensive training, and other manipulative treatment. Outcomes: After the intervention, the patient showed significant improvements in sensory and motor scores, resulting in functional recovery according to ASIA and FIM. The patient gradually showed reasonable functional remission. Discussion: The sacral nerve, the spinal cord, and the head were electrically stimulated by ultrasound-guided electroacupuncture in terms of intervention, and various functions of the patient were alleviated to a certain extent. The efficacy of ultrasound-guided electroacupuncture stimulation in treating neurologic symptoms should be validated in future clinical trials. [ABSTRACT FROM AUTHOR]

Aims: Our team tested spinal cord fusion (SCF) using the neuroprotective agent polyethylene glycol (PEG) in different animal (mice, rats, and beagles) models with complete spinal cord transection. To further explore the application of SCF for the treatment of paraplegic patients, we developed a new clinical procedure for SCF called vascular pedicle hemisected spinal cord transplantation (vSCT) and tested this procedure in eight paraplegic participants. Methods: Eight paraplegic participants (American Spinal Injury Association, ASIA: A) were enrolled and treated with vSCT (PEG was applied to the sites of spinal cord transplantation). Pre‐ and postoperative pain intensities, neurologic assessments, electrophysiologic monitoring, and neuroimaging examinations were recorded. Results: Of the eight paraplegic participants who completed vSCT, objective improvements occurred in motor function for one participant, in electrophysiologic motor‐evoked potentials for another participant, in re‐establishment of white matter continuity in three participants, in autonomic nerve function in seven participants, and in symptoms of cord central pain for seven participants. Conclusions: The postoperative recovery of paraplegic participants demonstrated the clinical feasibility and efficacy of vSCT in re‐establishing the continuity of spinal nerve fibers. vSCT could provide the anatomic, morphologic, and histologic foundations to potentially restore the motor, sensory, and autonomic nervous functions in paraplegic patients. More future clinical trials are warranted. [ABSTRACT FROM AUTHOR]

Introduction: We report a case and a literature review of delayed postoperative cervical spinal cord injury after thoraco-lumbar spine surgery. Case report: A 13-year-old Prader-Willi Syndrome female was treated by a T3-L5 posterior spine fusion for progressive scoliosis. Intraoperative neuromonitoring and immediate postoperative neurological examination were normal. Sixty hours after surgery, she developed a tetraplegia. The immediate MRI and CT scan of the spine were negative. Two days after, a new MRI revealed an ischemic cervical lesion at the level C5-C6. After 1 week, she gradually improved breathing and motility/sensibility at the extremities. After 4 months of intensive neurologic rehabilitation, the patient improved to ASIA grade D and was discharged. At 1-year follow, the neurologic recovery was nearly completed. Methods: We performed a systematic review of the literature through PubMed and Embase database focused on delayed postoperative cervical spinal cord lesion after a thoraco-lumbar fusion for spinal deformity. Results: Only 14 cases of neurological injuries at levels above the site of surgery have been previously reported and never in Prader Willy Syndrome. All patients were adolescent and 86,7% were females but no specific risk factors were found. Conclusions: Delayed postoperative neurological deficit far from the surgical site can be considered a specific subgroup of these rare complication that can occur several hours after spine surgery, regardless of intraoperative complication. Despite the rarity of this complication, clinicians should be aware of it. Perioperative optimization of spinal cord perfusion and close neurological examination in first postoperative days may be helpful to quickly recognize and treat this complication. [ABSTRACT FROM AUTHOR]

Hirayama disease (HD) is characterized by the juvenile onset of unilateral or asymmetric weakness and amyotrophy of the hand and ulnar forearm and is most common in males in Asia. A perception of compliance with previous standards of diagnosis and treatment appears to be challenged, so the review is to update on HD. First, based on existing theory, the factors related to HD includes, (1) cervical cord compression during cervical flexion, (2) immunological factors, and (3) other musculoskeletal dynamic factors. Then, we review the clinical manifestations: typically, (1) distal weakness and wasting in one or both upper extremities, (2) insidious onset and initial progression for 3–5 years, (3) coarse tremors in the fingers, (4) cold paralysis, and (5) absence of objective sensory loss; and atypically, (1) positive pyramidal signs, (2) atrophy of the muscles of the proximal upper extremity, (3) long progression, and (4) sensory deficits. Next, updated manifestations of imaging are reviewed, (1) asymmetric spinal cord flattening, and localized lower cervical spinal cord atrophy, (2) loss of attachment between the posterior dural sac and the subjacent lamina, (3) forward displacement of the posterior wall of the cervical dural sac, (4) intramedullary high signal intensity in the anterior horn cells on T2-weighted imaging, and (5) straight alignment or kyphosis of cervical spine. Thus, the main manifestations of eletrophysiological examinations in HD include segmental neurogenic damages of anterior horn cells or anterior roots of the spinal nerve located in the lower cervical spinal cord, without disorder of the sensory nerves. In addition, definite HD needs three-dimensional diagnostic framework above, while probable HD needs to exclude other diseases via "clinical manifestations" and "electrophysiological examinations". Finally, the main purpose of treatment is to avoid neck flexion. Cervical collar is the first-line treatment for HD, while several surgical methods are available and have achieved satisfactory results. This review aimed to improve the awareness of HD in clinicians to enable early diagnosis and treatment, which will enable patients to achieve a better prognosis. [ABSTRACT FROM AUTHOR]

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system predominantly targeting optic nerves and the spinal cord. The prevalence of the disease is much higher in Asia than in other parts of the world. Pain can be detected in more than 80% of NMOSD patients, with evoked pain mostly being caused by painful tonic muscle spasms and neuropathic pain as the most characteristic types. Depression is often comorbid with pain, and their comorbidity can severely influence quality of life. In recent years, studies have found considerable overlaps between the mechanisms of pain and depression; however, their association remains unclear. This article reviews the epidemiology, mechanism, evaluation and treatment of pain-depression comorbidity in NMOSD patients. [ABSTRACT FROM AUTHOR]

Training of impaired motor functions forms activity-dependent plasticity aimed to compensate the functional deficiency. In individuals with chronic motor-complete spinal cord injury (SCI), the existence of potential for neuroplasticity and the possibility to mobilize it are debatable. The study aimed at assessing the existence, frequency, and magnitude of positive changes in locomotor ability and sensory and motor characteristics of patients with motor-complete SCI during repeated courses of complex neurorehabilitation. For analysis we selected 37 patients (16 men, 19 women, aged 18–55) with thoracic or lumbar cord injuries with a post-injury period of more than 1 year (1–32 years) and the severity of AIS A (20) and B (15) according to the American Spinal Injury Association (ASIA) impairment scale. All participants completed 3 inpatient courses of complex rehabilitation with exoskeleton-induced walk training (two 22-day courses and one 14‑day course, with one-month intervals). Each course included exoskeleton-induced walk training (40 min/day), training of vertical posture with electrical stimulation of muscles, pneumatic stimulation of the supporting areas of the sole, classical manual and lymphatic drainage massage, and exercise therapy (3–4 h a day in total). The third course additionally included transcutaneous spinal cord electrical stimulation (SCES) performed in static mode and in phasic mode during exoskeleton-induced walking. The dynamics of tactile (AISLT) and pain (AISPP) sensitivity, as well as leg muscle strength (AISMOTOR) were evaluated before and after each course. Locomotor capabilities of participants were tested by forward and backward tetrapedal tests with control of the time spent and need for external assistance. The excitability of motor neurons of the lumbar enlargement was also evaluated. Over the observation period, an increase of AISLT was detected in 28 patients (76%) on average for 9.4 AIS points and of AISPP in 22 patients (60%) for 8.0 AIS points, and of AISMOTOR – in 15 patients (40.5%) for 3.9 AIS points. Neurological improvements (AIS) could begin during the first, second, or third courses, positive changes occurred during the course and between courses with comparable frequency and were cumulative. In some cases, a post-interval return to the initial level was observed but no cases of significant deterioration. Changes in sensitivity prevailed during the first and second courses, motor progress was observed in the third course that included SCES. Progress in locomotor capabilities, sensitivity, and muscle control, as well as changes in the excitability of lumbar enlargement motor neurons in patients with motor-complete SCI during intensive exoskeleton-induced walk training are estimated as a result of sensorimotor adjustments revealing of activity-dependent plasticity. The obtained data substantiate the possibility to mobilize the potential for neuroplasticity in adults with a chronic motor-complete SCI: powered exoskeleton-induced walk training with intense afferent stimulation shows high impact on locomotor and sensory functions, whereas the SCES improves motor ability. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective observational cohort study.Objective: We explored the relationship between diffusion tensor imaging (DTI) parameters and prognosis in patients with acute traumatic cervical spinal cord injury (ATCSCI).Summary Of Background Data: DTI has been used to diagnose spinal cord injury; nevertheless, its role remains controversial.Methods: We analyzed retrospectively 24 patients with ATCSCI who were examined using conventional T2-weighted imaging and DTI. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were recorded at the injured site. Diffusion tensor tractography (DTT) was used to measure the spinal cord white matter fiber volume (MWFV). American Spinal Injury Association (ASIA) grades were recorded. Correlations between DTI parameters and ASIA scores were evaluated using Spearman correlation coefficients.Results: FA values at injured sites were significantly lower than those of the control group, whereas ADC values in injured and control groups were not significantly different. DTT revealed that ATCSCI could be divided into four types: Type A1-complete rupture of spinal cord white matter fiber (MWF); Type A2-partial rupture of MWF; Type B-most MWF retained with severe compression or abnormal fiber conduction direction; and Type C-MWF basically complete with slight compression. Preoperative physical examinations revealed complete injury (ASIA A) in patients with A1 (n = 4) and A2 (n = 4). The ASIA grades or scores of A2 were improved to varying degrees, whereas there was no significant improvement in A1. FA values and MWFV of ASIA B, C, and D were significantly higher than those of ASIA A. FA and MWFV were correlated with ASIA motor score preoperatively and at final follow-up.Conclusion: We propose a classification for the severity of ATCSCI based on DTI and DTT that may explain why some patients with ASIA A recover, whereas others do not.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Hirayama disease is a rare neurological entity that is characterized by initial progressive muscular wasting and weakness of the distal upper limb in young men, followed by a spontaneous arrest within several years. The disease is believed to be a result of forward displacement of the cervical dural sac and spinal cord induced by neck flexion. It is commonly seen in Asia and rarely encountered in the Middle East countries. We report a rare case of a 20-year-old Kuwaiti patient presenting with a 10-month duration of gradual left upper limb weakness and wasting. We describe his electrophysiological and radiological findings that confirmed the diagnosis, and conducted a literature review. Hirayama disease is rarely encountered in clinical settings and should be suspected in male patients presenting with unilateral or asymmetrical bilateral lower motor weakness of hands and forearms. It is a benign entity, and cervical collar is usually the only treatment needed in most cases. [ABSTRACT FROM AUTHOR]

To review the experience of managing central cord syndrome (CCS) surgically, we retrospectively reviewed 71 patients from October 2015 to April 2017. Deteriorating neurologic status with evidence of radiologic compression and spinal instability were absolute indications for surgery. The American Spinal and Injury Association (ASIA) motor scores (AMS) were recorded at the time of admission (aAMS), 3 days postoperatively (3dAMS), 1 month postoperatively(1mAMS), and at final follow-up (fAMS). Analysis of variance was performed to compare 3dAMS, 1mAMS, and fAMS. Surgery was successful in all 71 patients without re-injury of the spinal cord, infection, or other perioperative complications. The postoperative AMS at 3 days, 1 month, and at the final follow-up significantly improved over preoperative scores. ASIA sensory scores at fAMS were significantly better than 3dAMS and1mAMS scores. The ASIA motor and sensory scores at 1mAMS showed no significant improvements compared with the 3dAMS. Therefore, for patients diagnosed with CCS, combined with evidence of radiologic compression and spinal instability, surgery was beneficial in terms of gains in neurologic recovery. [ABSTRACT FROM AUTHOR]

To investigate the changes in the sagittal parameters of the cervical spine and the clinical efficacy of C2∼3 anterior cervical discectomy and fusion (ACDF) combined with internal fixation for unstable hangman's fractures. The clinical data of 46 patients with unstable hangman's fractures treated with both C2∼3 ACDF combined with internal fixation between May 2012 and May 2017 were analyzed retrospectively. The upper cervical angle (C0∼2), the forward translation of the C2 vertebral body (C2-T), C2∼3 local kyphosis angle (C2∼3 LK), C2∼7 cervical curvature (C2∼7 CC), C2 sagittal vertical axis (C2-SVA), and T1 slope angle (T1S) were compared preoperatively, postoperatively, and at the last follow-up to evaluate the clinical therapeutic effects. A total of 46 patients were followed-up for an average of 16 months. No aggravation of the spinal cord, nerve injury, cerebrospinal fluid leakage, or other complications occurred. Six patients had American Spinal Injury Association (ASIA) grade C preoperatively; 4 improved to grade E, and 2 improved to grade D postoperatively. Twelve patients with ASIA grade D preoperatively improved to grade E postoperatively. C0∼2, C2-T, C2∼3 LK, C2∼7 CC, and C2-SVA measurements were significantly improved postoperatively and at the last follow-up, but there was no significant change in T1S between preoperative and postoperative values. For patients with unstable hangman's fractures, C2∼3 ACDF combined with internal fixation can achieve immediate stability of the upper cervical vertebrae, effectively correct the forward displacement and angulation of C2, and restore the sagittal balance of the cervical spine. The rate of osseous intervertebral fusion is high, and there are few complications. This method can effectively promote the recovery of spinal nerve function and preserve the motor function of the cervical vertebrae. [ABSTRACT FROM AUTHOR]

Purpose: In patients with spinal instability, cord compression, or neurologic deficits, the standard of care is surgery followed by radiation therapy (RT). Recurrence rates after conventional RT remain high. The purpose of this study is to prospectively examine the efficacy of postoperative stereotactic body RT (SBRT) in patients who have undergone surgical intervention for spine metastases. We hypothesize that postoperative SBRT to the spine would be associated with higher local control than historical rates after conventional RT.Methods and Materials: Thirty-five adult patients with a Karnofsky Performance Status score ≥40 and spine metastases from solid tumors with no prior overlapping RT and target volumes ≤3 consecutive vertebral levels were enrolled. Thirty-three patients were treated. Two patients underwent treatment to 2 target volumes for a total of 35 target volumes. All patients received SBRT 30 Gy in 5 fractions. Patients were followed with neurological examinations and computed tomography and/or magnetic resonance imaging every 3 months. Neurologic function was assessed at the same time points using the American Spinal Injury Association (ASIA) impairment score. Pain was rated according to the 10-point visual analogue scale and MD Anderson Cancer Center brief pain index. Toxicity was recorded according to National Cancer Institute Common Toxicity Criteria for Adverse Events Version 4. The primary objective was the rate of radiographic local recurrence at 12 months after completion of SBRT.Results: Patient characteristics were as follows: 34.3% had radioresistant primaries; 71.4% were ASIA E and the remainder ASIA D; and the median baseline Karnofsky Performance Status score was 70 (range, 50-100). Radiographic and symptomatic local control at 1 year were 90% (95% confidence interval, 76%-98%). The median time to recurrence in these 3 patients was 3.5 months (range, 3.4-5.8 months), all had radiosensitive tumors, and all recurrences were epidural. No patients experienced wound dehiscence, hardware failure, or spinal cord myelopathy. The median time to return to systemic therapy was 0.5 months (range, 0-9.4 months).Conclusions: This prospective study of postoperative spine SBRT demonstrates excellent local control with low toxicity. These data suggest superior rates of local control compared with conventional RT; however, a formal comparative study is warranted. [ABSTRACT FROM AUTHOR]

Importance: CIS to MS conversion rates vary depending on population cohorts, initial manifestations, and durations of follow-up. Objective: To investigate conversion rate of patients from CIS to MS and the prognostic significance of demographic and clinical variables in Taiwanese population. Design: Nationwide, prospective, multi-centric, observational study from November 2008 to November 2014 with 4 years follow-up. Setting: Multi-centre setting at 5 institutions in Taiwan. Participants: 152 patients having single clinical event potentially suggestive of MS in last 2 years were enrolled as consecutive sample. 33 patients were lost to follow-up and 16 patients did not complete the study.103 patients completed the study. Intervention(s) (for clinical trials) or exposure(s) (for observational studies): Natural progression from first episode of CIS to MS or NMO was observed. Main outcome(s) and measure(s): Variables analysed were ‘proportion of patients converting to MS or NMO after first episode of CIS’, ‘duration between first episode of neurological event and diagnosis of MS’, ‘status of anti-AQP4 IgG’ and ‘length of longest contiguous spinal cord lesion in MS patients’. Association between baseline characteristics and progression to MS from CIS was analyzed using multiple logistic regression. Multivariate time dependent effect of baseline characteristics on progression to MS was plotted. Results: 14.5% patients with CIS converted to MS after 1.1 ± 1.0 years with greater predisposition (18.8%) in those having syndromes referable to the cerebral hemispheres. Conversion rate from ON to MS was 9.7%. 90.9% patients had mild disease course. 46.7% patients had abnormal MRIs at baseline, with 0.6±0.5 contrast enhanced lesions. ‘Below normal BMI’ and ‘MRI lesion load (≥ 4 lesions)’ were identified as risk indicators for the development of MS. Amongst the patients who developed NMO as diagnosed by modern criteria, 80% were positive for anti-AQP4 IgG antibody. Conclusions and relevance: ‘Below normal BMI’ and ‘number of demyelinating lesions (≥4)’ are significant predictors of conversion from CIS to MS. A low conversion rate to MS in Taiwanese CIS patients and majority of them having a mild course and minimal disability suggest the roles of geographic, genetic and ethnic factors. Trial registration: Non-trial observational study. [ABSTRACT FROM AUTHOR]

Traumatic spinal cord injury (SCI) can lead to debilitating motor weakness with long term impacts on quality of life. Following the initial trauma, secondary injury mechanisms, including edema, ischemia and inflammation can lead to considerable extension of the injury, providing a window of opportunity for interventions to preserve function. Early surgical decompression and optimization of spinal cord perfusion have emerged as potential targets. Expansile duraplasty could provide benefit by extending surgical decompression to the intrathecal space and increasing spinal cord perfusion; however, there remains a paucity of data on whether this provides a measurable benefit. Assess whether expansile duraplasty is associated with greater motor recovery in patients with acute traumatic SCI compared with bony decompression alone. Retrospective review of medical records. Patients who underwent surgical spinal decompression and stabilization for traumatic spinal cord injury from February 2017 to June 2021 at an academic, Level 1 trauma center. Patients were excluded from analysis if they did not attend inpatient rehabilitation after their acute hospital stay. Change in American Spinal Injury Association (ASIA) motor scores between preoperative evaluation, acute hospital discharge, and discharge from inpatient rehabilitation. Patients were divided between those who had expansile duraplasty performed at the time of surgical stabilizationand those who did not. Data collected included patient demographics, injury type, surgery performed, and ASIA motor scores (International Standards for Neurological Classification of SCI, range 0-100) preoperatively and at the time of hospital and inpatient rehabilitation discharge. A total of 101 patients were included: 12 treated with expansile duraplasty and 89 treated without duraplasty. Patients were 76% male with a mean age of 50.9 years. The mean preoperative motor score for all patients was 48.7+/-29.3 (mean +/- std.dev.), 50.5+/-19.7 for the control group and 35.7+/-23.0 for the expansile duraplasty group (p=0.06). From preoperative exam to hospital discharge, the mean improvement in motor score for the control group was 3.7+/-11.3, compared to 9.3+/-11.4 in the expansile duraplasty group (p=0.12). Mean change in motor score from preoperative exam to rehabilitation discharge was 10.9+/-13.4 for controls and 19.9+/-11.0 for expansile duraplasty patients (p=0.02). In this contemporaneous, single-center, retrospective study, SCI patients undergoing expansile duraplasty had significantly greater improvement in ASIA motor scores at rehabilitation discharge compared to non-duraplasty controls. These data present an independent and the first US validation of preliminary data from international centers in favor of expansile duraplasty. Further prospective studies are warranted to assess whether this adjunctive surgical technique is efficacious in treating acute traumatic SCI. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

OBJECTIVES Syringobulbia is a very rare condition defined as a fluid-filled cavity in the medulla oblongata. Although there have been reported several conditions that cause syringobulbia, such as spinal cord trauma, it can also be isolated. MATERIALS AND METHODS We present a patient that seven years before admission in our department suffered a traumatic spinal cold injury that resulted in sublesional complete deficit in the lower limbs (ASIA A). RESULTS In the current admission the MRI exam revealed syringobulbia that communicated with the fourth ventricle and syringomyelia at C2- D10 level. We performed a suboccipital craniectomy and partial resection of the posterior C1 arch for posterior fossa decompression and membrane arachnolysis of the bulbar cyst. CONCLUSIONS Patients with spinal cord injury can develop posttraumatic syringomyelia followed by syringobulbia. The signs and symptoms can vary, but most often are bulbar signs that reflect the rostral evolution of the syringomyelia. Even minor neurological deterioration can reveal evolution of this pathology. [ABSTRACT FROM AUTHOR]

Simple Summary: Aluminum-hydroxide is an effective vaccine adjuvant used in most commercial sheep vaccines. It facilitates the establishment of a robust immune response against the vaccine antigen. During the first decade of the 21st century, repetitive injections with vaccines containing aluminum-based adjuvants were proposed to be linked to a progressive wasting syndrome in sheep. The aim of this work was to analyze several clinicopathological parameters, including growth performance, clinical data, and histopathological observations in lambs intensively injected with aluminum-containing vaccines, aluminum-hydroxide only, or a saline solution as control. Although aluminum-hydroxide was linked to chronic inflammatory reactions at the injection site and the development of behavioral changes in sheep, the results presented here indicate that injected aluminum-hydroxide, either alone or in combination with vaccine antigens, is not enough to induce relevant changes in the parameters studied. Other factors such as sex, breed, age, production system, diet or climate conditions could play a role in the development of the previously described wasting syndrome. Aluminum (Al) hydroxide is an effective adjuvant used in sheep vaccines. However, Al-adjuvants have been implicated as potential contributors to a severe wasting syndrome in sheep—the so-called ovine autoimmune-inflammatory syndrome induced by adjuvants (ASIA syndrome). This work aimed to characterize the effects of the repetitive injection of Al-hydroxide containing products in lambs. Four flocks (Flocks 1–4; n = 21 each) kept under different conditions were studied. Three groups of seven lambs (Vaccine, Adjuvant-only, and Control) were established in each flock. Mild differences in average daily gain and fattening index were observed, indicating a reduced growth performance in Vaccine groups, likely related to short-term episodes of pyrexia and decreased daily intake. Clinical and hematological parameters remained within normal limits. Histology showed no significant differences between groups, although there was a tendency to present a higher frequency of hyperchromatic, shrunken neurons in the lumbar spinal cord in the Adjuvant-only group. Although Al-hydroxide was linked to granulomas at the injection site and behavioral changes in sheep, the results of the present experimental work indicate that injected Al-hydroxide is not enough to fully reproduce the wasting presentation of the ASIA syndrome. Other factors such as sex, breed, age, production system, diet or climate conditions could play a role. [ABSTRACT FROM AUTHOR]

Objective: Traumatic spinal injury (TSI) is a global health issue contributing to morbidity and mortality, especially in low- and middle-income countries. The aim of this study is to compare the epidemiological estimates of TSI with the corresponding amount of published papers for different regions., Methods: A bibliometric analysis was performed by collecting the number of publications concerning TSI from the PubMed database. Results were sorted according to the different geographical World Health Organization regions. A "publication-to-volume ratio" was obtained by comparing the average number of documents per year with the number of TSI cases across each region., Results: A total of 2304 articles were detected from 2008 to 2018. The major publishing regions were North America (AMR-US/Can: 843 articles, 36.6%) and Europe (EUR: 833, 36.2%), then Western Pacific (WPR: 410, 17.8%), Eastern Mediterranean (EMR: 73, 3.2%), South-East Asia (SEAR: 71, 3.1%), Latin America (AMR-L: 55, 2.4%), Africa (AFR: 19, 0.8%). The United States is the most publishing country in AMR-US/Can (86.0%), and Germany in EUR (22.4%). In 2018, EUR published 36.6% of papers versus AMR-US/Can 26.5% and WPR 25.7%, thanks to an increase in Chinese publications. The highest publication ratios of 4.63 and 2.68 were found for AMR-US/Can and EUR, respectively. The other were EMR (0.22), WPR (0.18), AMR-L (0.07), SEAR (0.03), and AFR (0.01)., Conclusions: A marked divide is currently found between countries with a high burden of TSI and those where there is most research interest, estimated as amount of publications. Data demonstrate the need for increased inclusiveness in guidelines generation from high-income countries including collection and analysis from low- and middle-income countries., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background AC or Rat Lungworm meningitis usually presents as a self-limited illness with headache and sensory changes, rarely progressing to coma, death, or permanent brain damage. It is usually diagnosed by eosinophils in the CSF. Once limited to Asia and the tropical Pacific AC transmission via slugs and snails documented on US mainland in 2018. We describe 2 unusual, severe examples of AC infection in infants presenting with ascending paralysis and initial CSF without eosinophilia suggesting Guillain–Barre syndrome (GBS). Methods Conventional lab testing of serum and CSF, brain and spine MRI, AC PCR by Hawaii Department of Health, and mcfDNA next-generation sequencing (NGS) of plasma (Karius). Results Two infants, aged 8 and 11 months, presented with fever, lower extremity weakness, and ascending paralysis. An initial evaluation in both included normal brain/spine imaging and CSF with modest lymphocytic pleocytosis without eosinophils. Paralysis progressed despite IVIG. Case 1: 11-month male: Admitted on fever day 5. Paralysis progressed to respiratory failure requiring ventilation for 20 days. Illness day 16: MRI showed spinal cord swelling C3-C7, Brain normal. CSF#3: WBC 269 28% eos, ↑ protein. Visible 8 mm long young adult worms, PCR positive for AC. Rx high-dose corticosteroids, albendazole for >4 weeks. Day 29 illness MRI: Cerebral infarct L frontal lobe, worm tracks medulla, inflammation cauda equina. Slow improvement over 5 months. Case 2: 8-month-old female: Admitted fever day 8. Weakness progressed to arms and trunk. Day 10 illness: CSF #2: Visible worms present, WBC 84, 26% eos. PCR positive for AC. Rx: High-dose steroids and albendazole x4 weeks. MRI spine illness day 30: inflammation cauda equina. Weakness improved by illness day 37. McfDNA sequencing of plasma detected AC in acute stage peaks of 123 and 12 molecules/microliter in cases 1 and 2. Serial mcfDNA testing showed a decline in the AC DNA level in plasma which correlated with treatment and clinical response. Conclusion AC infection may mimic GBS or transverse myelitis. AC diagnosis may require repeat CSF testing. NGS detection of AC in plasma holds promise as rapid, noninvasive diagnosis and assessment of response to therapy. High-dose steroids with albendazole may be effective even in severe AC. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]