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Spinal Cord Injury Without Radiologic Abnormality (SCIWORA) accounts for up to 19% of spinal cord related lesions in pediatric population, mostly comprising the cervical spine. A 2-year-old patient is presented, who suffered a motor-vehicle accident. After being admitted, neither X-Ray nor spinal TC scan showed any structural abnormalities. Neurological examination showed complete sensory and motor loss under T7 as well as bladder and bowel dysfunction. Magnetic resonance imaging (MRI) showed spinal cord lesion extending from T7 to T10. The patient was treated with external immobilization and physical therapy. Thoracic SCIWORA is an uncommon diagnosis that should be considered in pediatric patients who suffer spinal trauma. Spinal cord MRI has proven to be the most accurate modality for diagnosis.

Zadesne povrede kičmene moždine (k.m.) oštećuju u različitom obimu i dužini provodne puteve bele mase, centripetalne senzorne i centrifugalne motorne što uzrokuje kliničku sliku paraplegije i tetraplegije. Oštećenje motorne kontrole dovodi do paraliza i pojave spasticiteta koji predstavlja čestu komplikaciju lezije kičmene moždine. U sadašnjim okolnostima ne postoji terapijska opcija koja uspešno kontroliše spasticitetom kod svih pacijenata. Traga se i dalje za novim metodama i tehnikama. Stimulisanje vestibulospinalnih puteva delovanjem galvanskog električnog impulsa transmastoidnim putem dovodi do smanjenja tonusa muskulature iste strane tela na strani anode, a do povećanja tonusa na strani katode. Iz tog razloga novija ispitivanja se bave proučavanjem mogućnosti stimulisanja vestibularnog trakta radi smanjenja spasticiteta kod bolesnika sa povredom k.m. pošto su dokazali da galvanska stimulacija vestibularisa može da izazove EMG odgovore kao i modulaciju soleusnog H-refleksa. Cilj: Našim istraživanjem proučavali smo očuvanost descedentnih vestibulospinalnih puteva ispod nivoa lezije kod pacijenata sa različitim oštećenjima k.m. da bismo utvrdimo uticaje galvanske stimulacije vestibularisa na jačinu spasticiteta muskulature donjih ekstremiteta. Takođe, želeli smo da utvrdimo povezanosti dve metode (modifikovane Ashworth-ove skale i Watenbergovog Pendulum testa) za preciznu kvantifikaciju spazma u donjim ekstremitetima. Metodologija: Ispitivanje predstavlja kohortni tip studije. Merenja su sprovedena na Klinici za rehabilitaciju “Dr Miroslav Zotović” u Beogradu u periodu od 01.06.2016 do 15.11.2017 godine. Studija je obuhvatala 50 pacijenata sa lezijom kičmene moždine. Jedan pacijent, koji je prijavio da je preležao oboljenje čula za ravnotežu i koji je naveo da ima smetnje sa sluhom, isključen je iz daljeg ispitivanja. Istraživanje je obavljeno na preostalih 49 (100%) ispitanika (77,6 % muškarci i 22,4 % žene), prosečne starosti 41,6 (SD±14,6) godina. Uključujući kriterijum bili su: stabilna lezija cervikalne ili torakalne kičme iznad Th12 nivoa sa stabilnim neurološkim i medicinskim statusom bez kognitivnih oštećenja. Svi ispitanici su bili svrstani prema AISA standardima za procenu lezije k.m.... Injuries on the right side of the spinal cord damage conductive pathways of the white matter, centripetal sensory and centrifugal motor pathways in different scope and length thus causing a clinical picture of para- and tetraplegia. Damage to the motor control leads to paralysis and the emergence of spasticity which represents a frequent complication of the spinal cord lesion. At present, there is no therapeutic option which could successfully control spasticity in these patients. Stimulation of the vestibulospinal pathways by galvanic electrical impulse on transmastoid process leads to a decrease in myotonia of the body side where anode is, and to an increase on the side with cathode. Therefore, new investigations deal with the possibility of stimulating the vestibulospinal tract in order to reduce spasticity in patients with the spinal cord injury since it has been proven that galvanic stimulation can evoke both EMG responses and the modulation of the soleus H- reflex. Objective: We investigated the preservation of the descending vestibulospinal pathways below the lesion level in patients with different spinal cord damages with the aim to establish the effect of galvanic stimulation of the vestibularis nerve on the spasticity of the lower extremities muscles. We also wanted to determine the correlation between the two methods (modified Ashworth scale and Wartenberg’s Pendulum test) regarding precise quantification of the spasm in the lower extremities. Method: Measurements for our cohort study were conducted at the Clinic for Rehabilitation “Dr Miroslav Zotović” in Belgrade from 01.06.2016 till 15.11.2017. The study included 50 patients with the spinal cord lesion. One patient who reported to have had balance disorder and problem with his sense of hearing was excluded from the study. The investigation included the remaining 49 (100 %) participants (77.6 % male and 22.4 % female), average age 41.6 (SD±14,6). The inclusion criteria were a stable lesion of the cervical or thoracic spine above Th12 level with stable neurological and medical status with no cognitive impairment. All participants were measured according to the ASIA standards for the estimation of the spinal cord lesion...

The recovery of walking function following spinal cord injury (SCI) is of major importance to patients and clinicians. In experimental SCI studies, a rat model is widely used to assess walking function, following thoracic spinal cord lesion. In an effort to provide a resource which investigators can refer to when seeking the most appropriate functional assay, the authors have compiled and categorized the behavioral assessments used to measure the deficits and recovery of the gait in thoracic SCI rats. These categories include kinematic and kinetic measurements. Within this categorization, we discuss the advantages and disadvantages of each type of measurement. The present review includes the type of outcome data that they produce, the technical difficulty and the time required to potentially train the animals to perform them, and the need for expensive or highly specialized equipment. The use of multiple kinematic and kinetic parameters is recommended to identify subtle deficits and processes involved in the compensatory mechanisms of walking function after experimental thoracic SCI in rats.

Objective:To determine whether cognitive-motor interference using ability of dual-task obstacle crossing could predict a risk of fall in 90 ambulatory individuals with spinal cord injury.Design:Six-month prospective study.Setting:A rehabilitation center and community hospitals.Subjects:Independent ambulatory individuals with spinal cord injury.Main outcome measures:Subjects were interviewed and evaluated for personal characteristics, dual-task obstacle crossing ability, and functional ability using the 10 Meter Walk Test, Timed Up and Go Test, and Five Times Sit-to-Stand Test. Then they were prospectively monitored for fall data every month for six months in total.Results:A total of 90 chronic ambulatory individuals with spinal cord injury with an average age of 52.51 ± 13.43 years, who mostly had mild lesion severity ( n = 71, 79%) and walked with a walking device ( n = 54, 60%) completed in the study. More than one-third of the subjects ( n = 32, 36%) failed in dual-task obstacle crossing. The failures were obviously associated with the fall (unadjusted odds ratio = 7.07, P Conclusion:Cognitive-motor interference is important for ambulatory individuals with spinal cord injury, as it could detect those with low functional ability and risk of future falls.

Background Several enteroviruses (EVs), including EV-A71 and EV-D68, have been associated with acute flaccid myelitis (AFM). Clinical features distinguishing AFM presentations associated with specific EV types are not well described. Methods EV-associated AFM was defined as any child presenting to Children’s Hospital Colorado in 2013–2018 who met the Council of State and Territorial Epidemiologists definition for confirmed AFM (flaccid limb weakness with longitudinal gray-matter-predominant spinal cord lesion on MRI) and had EV-A71 or EV-D68 identified in any biologic specimen (cerebrospinal fluid [CSF], nasopharyngeal [NP], oropharyngeal [OP], rectal) by VP1-specific RT-PCR and sequencing. Summative limb strength scores (SLSS) were calculated by adding Medical Research Council strength scores (1–5) for all limbs. Results Ten cases of EV-A71-associated AFM were identified, all from 2018; 8 cases of EV-D68-associated AFM were identified from 2013 (1), 2014 (4), 2016 (1), and 2018 (2) [Table 1]. Viral detection rates were higher in rectal and OP swabs in EV-A71 cases and NP specimens in EV-D68 cases. Virus was not detected in CSF of EV-D68 cases and in 1 EV-A71 case. EV-A71 cases were younger (median 19 vs. 100 months) and had neurologic onset earlier after prodromal symptom onset (median 1 vs. 5.5 days) than EV-D68 cases. Hand, foot, and/or mouth lesions distinguished EV-A71 cases, whereas respiratory symptoms were uniformly noted in EV-D68 cases. Associated neurologic findings more commonly associated with EV-A71 cases than EV-D68 cases included irritability, myoclonus, and ataxia. Weakness was more generalized with EV-A71 and more asymmetric with EV-D68, though patterns of brainstem and spinal cord involvement on MRI were similar. Compared with EV-D68, EV-A71 cases had milder weakness at onset and improved strength at 1- to 2-month follow-up (Figure 1), shorter length of stay (median 5.5 vs. 32 days) and a greater rate of full neurologic recovery (90% vs. 13%). Conclusion EV-D68 and EV-A71 are both associated with AFM with similar MRI findings, but cases can be distinguished by associated prodromal symptoms, neurologic findings, and outcomes. Timely collection and testing of nonsterile site specimens, particularly NP for EV-D68 and OP and rectal for EV-A71, are key to case identification. Disclosures All Authors: No reported Disclosures.

Both sensorimotor and autonomic dysfunctions often occur after spinal cord injury (SCI). Particularly, a high thoracic or cervical SCI interrupts supraspinal vasomotor pathways and results in disordered hemodynamics due to deregulated sympathetic outflow. As a result of the reduced sympathetic activity, patients with SCI may experience hypotension, cardiac dysrhythmias, and hypothermia post-injury. In the chronic phase, changes within the CNS and blood vessels lead to orthostatic hypotension and life-threatening autonomic dysreflexia (AD). AD is characterized by an episodic, massive sympathetic discharge that causes severe hypertension associated with bradycardia. The syndrome is often triggered by unpleasant visceral or sensory stimuli below the injury level. Currently the only treatments are palliative - once a stimulus elicits AD, pharmacological vasodilators are administered to help reduce the spike in arterial blood pressure. However, a more effective means would be to mitigate AD development by attenuating contributing mechanisms, such as the reorganization of intraspinal circuits below the level of injury. A better understanding of the neuropathophysiology underlying cardiovascular dysfunction after SCI is essential to better develop novel therapeutic approaches to restore hemodynamic performance.

Cranial nerve thickening as an initial isolated presentation of CNS lymphoma is rare. Once an extremely rare neoplasm, primary lymphoma of the central nervous system (CNS) now ranks only next to meningiomas and low-grade astrocytomas in prevalence. Multiple cranial nerve thickening can be a feature of primary CNS lymphoma. Here we report a case of a 45-year-old immunocompetent female who presented with relapsing remitting multiple cranial nerve thickening as an initial feature of primary CNS lymphoma without any other brain or spinal cord lesions.

Innovation in training equipment is important for increasing training effectiveness, performance and changes in body composition, especially in wheelchair users with paraplegia. The main objective of a workout session is to induce an adaptation stimulus, which requires overload of involved muscles by voluntary effort, yet this overload may be highly influenced by the size of the spinal cord lesion. Krancykl construction is designed to allow exercise on any wheelchair and with adjustable height or width of crank handles, where even the grip handle may be altered. The aim of this study was to determine the differences in body composition, performance and the rate of perceived exertion (RPE) in paraplegics with a different level of paralyses after a 12 week training programme of a unilateral regime on Krankcycle equipment (a crank machine). The study sample included four men and one women at a different spine lesion level. The 12 weeks programme was successfully completed by four participants, while one subject got injured during the intervention process. Three participants were paraplegics and one was quadriplegic with innervation of the biceps humeri, triceps humeri and deltoideus. The Krankcycle 30 min programme was followed by four other exercises, which were performed after themselves rather than in a circuit training manner as the latter would result in much longer rest periods between exercises, because paraplegics have to be fixed by straps during exercise on hydraulic machines. The RPE after the workout decreased following the twelve week adaptation period.

Alginate was studied as a degradable nerve guidance scaffold material in vitro and in vivo. In vitro degradation rates were determined using rheology to measure the change in shear modulus vs time. The shear modulus decreased from 155 kPa to 5 kPa within 2 days; however, alginate samples maintained their superficial geometry for over 28 days. The degradation behavior was supported by materials characterization data showing alginate consisted of high internal surface area (400 m2 /g), which likely facilitated the release of cross-linking cations resulting in the rapid decrease in shear modulus. To assess the degradation rate in vivo, multilumen scaffolds were fabricated using a fiber templating technique. The scaffolds were implanted in a 2-mm-long T3 full transection rodent spinal cord lesion model for 14 days. Although there was some evidence of axon guidance, in general, alginate scaffolds degraded before axons could grow over the 2-mm-long lesion. Enabling alginate-based scaffolds for nerve repair will likely require approaches to slow its degradation. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 611-619, 2016.

Fur Patienten mit einer Querschnittlahmung (QSL) ist die Therapie der neurogenen Blasenfunktionsstorung extrem wichtig zum Schutz der Nierenfunktion und zum bestmoglichen Erhalt der Lebensqualitat. Besonders Harnwegsinfektionen (HWI) haben stark negative Einflusse auf das Befinden der Betroffenen. Die heutigen Prophylaxen bei HWI sind nur eingeschrankt wirksam. Zudem sind perioperative Komplikationen bei Patienten mit QSL haufiger. Von einer Kooperation zwischen Homoopathie und Neurourologie konnen Patienten mit QSL nicht nur bei chronischen Storungen wie HWI, sondern auch bei akuten postoperativen Problemen effektiv und nebenwirkungsarm profitieren.

Objective Evaluate the correlation between spinal cord lesion length and pyramidal function system score in a cohort of patients with NMO. Methodology Retrospective retrieval of all exams performed in our center from January 2004 to December 2012 for patients with NMO. The exams were evaluated for lesion length, contrast enhancement and T1 hypointensity; these variables were correlated with the functional system score from the EDSS, performed no more than three months from the scan. Results 41 patients were included. Although patients with lesion extension ≥ 2 vertebral segments did not present worse pyramidal scores in a direct comparison, the influence of lesion length was not so strong when patients were separated in 3 groups (≥ 2, ≥ 3 or ≥ 4 vertebral segments) and evaluated with a receiving operating characteristics (ROC) curves. Gadolinium enhancement also contributed to more severe pyramidal system scores, but T1 hypointensity did not. Conclusion Although patients with spinal cord lesion extending ≥ 3 vertebral segments had more pyramidal disability, its difference was not so strong when compared to patients with ≥ 2 or ≥ 4 vertebral segments. This suggests that lesion extension might not be the most important factor in favoring a worse prognosis in spinal cord lesions in NMO.

Introduction Changes in spinal reflexes can result from alterations in the spinal cord and descending pathways. We studied whether H-reflex excitability and its recovery depend on the level and/or severity of spinal cord injury (SCI). Methods The soleus Hmax and Mmax responses and the H-reflex recovery curve (HRC) at interstimulus intervals (ISIs) ranging from 50 to 1,000 ms were recorded in 38 SCI individuals and 18 healthy subjects. Results Amplitude of Mmax correlated with level and severity of lesion (smaller amplitude correlated with more severe SCI or with more caudal lesion). Hmax/Mmax correlated only with age in the SCI group. HRC was increased significantly in complete SCI at ISIs 200 ms with respect to healthy subjects. Conclusions The changes in spinal reflexes as measured by the H-reflex and its recovery curve after SCI depend on the severity, but not on the level of the lesion. Muscle Nerve 52: 616–622, 2015

Spinal cord biopsy is a difficult procedure fraught with the risk of false-negative results or even misdiagnosis in up to 30% of cases. Differential diagnoses of spinal cord lesions include a wide range of inflammatory, infectious and neoplastic diseases. Given the importance of correctly managing these pathologies, it is crucial to avoid delays in making the correct diagnosis in order to improve the patient's outcome. We present here the case of a 21-year-old male with rapidly progressing sphincter and lower limb motor dysfunctions up to complete paraplegia with evidence of thoracic spinal cord lesion on magnetic resonance imaging. None of the blood and cerebrospinal fluid tests pointed to a diagnosis, while a first spinal cord biopsy revealed an inflammatory necrotic process. After several weeks of empirical treatments and clinical stability, the patient started having focal structural seizures that became generalized with local progression of the lesion and diffuse leptomeningeal spread on magnetic resonance imaging. A second spinal cord biopsy found a grade IV glioblastoma with H3 K27M histone mutation. Unfortunately the patient passed away before any treatment could be initiated. In this report, the authors analyze the difficulty of making the rapid, correct diagnosis of a highly malignant intrinsic spinal cord lesion, discussing also possible strategies to avoid diagnostic delays and to improve the outcome of these difficult patients.

Title: Conductive training in individuals after spinal lesions Objectives: The aim of the bachelor thesis is the positive influence of fitness training plan for people with sleep lesions to improve their physical condition. The secondary aim is to examine the subjective attitudes of probands to the conditional program, according to Feldenkreis's satisfaction questionnaire supplemented with a written probanda assessment. Methods: In the framework of a quantitative and qualitative research, 4 probands were monitored in the form of case studies after a spinal lesion participating in a reconditioning stay at the Paraple Center. The average proband age was 45 years. In probands an initial examination was performed and a monthly training session with an instructor was carried out. To evaluate the effect, the following methods were used: observation, bodystat assessment by Bodystat and assessment of physical fitness on a rowing and cross-country trainer. Results: All proband monitors achieved a slight improvement in bodystat scores evaluated by the Bodystat instrument: decreasing body fat in percent and increasing the proportion of active body mass. These results confirmed physical fitness improvements with measured times on trainers. Conclusion: Monthly fitness training for 4 individuals with spinal...

Spinal cord injury is a disabling disorder, worldwide spread, with important consequences on functioning and health conditions and impacts on physical, psychological, and social well-being. The consequences are related to the lesion itself and to other complications related to the lesion. In the last decades, there have been an increasing of the mean ages of onset and also an increase in life expectancy after the lesion. So, differently from the past, people with spinal cord injury can age after the lesion. Taking into account the need to share data and information about specific disabling conditions and their relationship with ageing, this paper aims to discuss some issues from recent literature on the relationship between aging and disability in the spinal cord injury, according to a narrative review approach. A narrative review of the literature on ageing and spinal cord injury was undertaken. Search was based on the following electronic databases: PubMed/Medline and Ovid/PsychINFO. A combination of the following keywords was used: (1) “ageing” or “aging” and (2) “spinal cord injury” or “spinal cord lesion” and (3) disability. Data on consequences of the lesion in the life of aging people, secondary health conditions, life expectancy, participation, and quality of life are discussed. Then, a brief discussion of clinical issues and the role of interventions aimed to promote wellbeing, health, quality of life, and participation of people with spinal cord injury is proposed.

The impact on health, mental state and quality of life in people after spinal cord injury is enormous. Significant impairment occurs not only of sensorimotor functions. The autonomic nervous system is also disturbed to some extent, which is very closely related to the management of cardiovascular functions (and heart rate). The aim of this study is to evaluate the effect of different physical activities on heart rate in people after spinal cord injury. The study included 30 people in the chronic stage after spinal cord injury, which were divided into 3 groups according to the neurological level of the spinal cord lesion in tetraplegics (lesion C1-C8), paraplegics with high thoracic lesion (T1-T6), and paraplegics with lesion from T6 below. Each proband completed 4 exercise tests on sports simulators (rowing, kayaking and cross-country trainer and Rotren) and peak heart rate values (SFpeak) were measured after reaching the subjective maximum load (according to the Borg RPE scale). The values of SFpeak were then statistically processed, evaluated and compared - within groups between sports simulators and between groups. The results of the statistical processing show that the sports simulators are not different in terms of reaching the top SFpeak. Although differences between peak heart rate values...

International audience; This article is a contribution to a special issue aiming at collecting data and documenting the different specificities of the teams which participated into Cybathlon 2016 FES-bike discipline. Our team prepared one paraplegic pilot over one year and developed a FES-cycling device based on existing commercial products. Our pilot (47 y.o, spinal cord lesion T3 AIS A since year 1995) was qualified for the final race and finished in 6th position over 12 participants in the discipline, covering a total distance of 750m at an average speed of 5.71km/h, propelled by his own quadriceps and hamstrings muscles.

This study investigated the relationship between functional disability and perceived barriers to physical activity and exercise in persons with Spinal Cord Injury (SCI). Participants were 144 individuals with SCI (mean age was 44 years old; 61% were male participants; 41.3% had spinal cord lesion at the cervical level, 43.7% at the thoracic level, and 14.3% at the lumbar level) from the National Spinal Cord Injury Association in the United States. Data on physical activity and exercise participation were collected using a cross-sectional online survey and analysed using multivariate analysis of variance and hierarchical regression analysis. The primary research findings indicate that level of functional disability was a predictor of perceived barriers to physical activity and exercise. Moreover, health barriers were found to be a partial mediator for functional disability and physical health-related quality of life, suggesting perceived barriers may help to explain the association between functional disability and physical health-related quality of life.

A 7-year-old intact male mixed dog was presented with a history of acute and progressive paraparesis. Abnormal clinical signs consisted of non-ambulatory paraparesis, hind limbs hypertonia and severe thoracolumbar pain. Magnetic resonance imaging demonstrated an isointense in T1 and T2 WI epidural lesion, with good contrast enhancement, extending from T-10 to T-13. Laminectomy was carried out to remove the epidural mass. Histological examination revealed a pyogranulomatous lesion characterized by numerous macrophages containing yeast-like Grocott and PAS-positive bodies. Immunohistochemistry and PCR performed on formalin-fixed paraffin-embedded tissue confirmed Histoplasma capsulatum as the causative agent. H. capsulatum has a worldwide distribution in temperate and subtropical climates but its presence as an autochthonous fungus in Europe is now recognized. To the authors' knowledge this is the first report of canine histoplasmosis in Italy with lesion confined to the central nervous system.

Cross-sectional validation study.To adapt the Spinal Cord Lesion-related Coping Strategies Questionnaire into the Spanish language (SCL CSQ-S) and to examine the relationship between coping strategies, global quality of life and psychological adaptation.Data were collected through individuals with spinal cord injury (SCI) now living in the community who completed their routine follow-up assessment at the Institute Guttmann in Barcelona, Spain.Forward and backward translation into Spanish of the English version of the questionnaire. Questionnaires of global Quality of Life, Community Integration, Coping, Depression, Anxiety and Functional Independence were administered to 349 adults with paraplegia and 162 adults with tetraplegia. Statistical analysis included confirmatory factor analysis and regression analysis.The factorial structure of the questionnaire was partly verified. The original correlated, three-factor model sufficiently fit the data obtained in this study: χ(2)(48)=109.46; P0.001; Comparative Fit Index=0.96; Tucker-Lewis Index=0.96; Root Mean Square Error of Approximation=0.050 (0.038-0.062); Akaike information criterion=13.46. Items were found to be good indicators of their respective latent factors, showing adequate factorial charge ranges (between 0.41 and 0.75). The reliability coefficient (Cronbach's α) for the Acceptance subscale was 0.74, for Social reliance 0.76 and for Fighting spirit 0.69. Coping strategies as measured by SCL-CSQ-S contributed to the prediction of outcomes related to adaptation to disability.The results of the study show some evidence for the robustness of the structure of SCL CSQ-S and show that the Spanish version of the questionnaire largely replicate previous results. Coping strategies, especially Acceptance, are related to adaptation to injury.

The purpose of this review is to describe the diagnostic criteria for spinal cord arteriovenous shunts (SCAVSs) when using magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), and to discuss the extent to which the different MRI and MRA sequences and technical parameters provide the information that is required to diagnose these lesions properly. SCAVSs are divided into four groups according to location (paraspinal, epidural, dural, or intradural) and type (fistula or nidus); each type of lesion is described. SCAVSs are responsible for neurological symptoms due to spinal cord or nerve root involvement. MRI is usually the first examination performed when a spinal cord lesion is suspected. Recognition of the image characteristics of vascular lesions is mandatory if useful sequences are to be performed-especially MRA sequences. Because the treatment of SCAVSs relies mainly on endovascular therapies, MRI and MRA help with the planning of the angiographic procedure. We explain the choice of MRA sequences and parameters, the advantages and pitfalls to be aware of in order to obtain the best visualization, and the analysis of each lesion.

CaseWe present a 64 year old gentleman with previous non-metastatic melanoma and newly diagnosed myeloma, for which he had received steroids but not chemotherapy. He developed fever followed by an ascending acute flaccid paralysis with brainstem involvement, requiring ventilatory support within hours of onset. MRI demonstrated an extensive enhancing longitudinal spinal cord lesion with signal change in thalami, temporal lobes and pons. CSF protein was >6 g, WCC 150 (90% neutrophils), no organisms and negative virology. Neurophysiology demonstrated a selective motor neuropathy/neuronopathy.H1N1-influenza A (‘swine flu’) RNA was detected on nasopharyngeal aspirate. He was treated with Zanamavir, antimicrobials, steroids, and plasma exchange. His clinical improvement remains slow, and he will require long-term care.DiscussionThis patient developed a rare, catastrophic neurological complication of pandemic FluA, in the context of untreated multiple myeloma. Whilst not a pure acute flaccid myelitis, this case highlights the need to be aware of uncommon neurological complications of viral infections.There has been a peak in 2018 of cases of acute flaccid myelitis across the UK, Europe, and America. Public Health England has declared a national incident in response to this. The cause remains unproven, and neurologists should report suspected cases to PHE.

Neuromyelitis optica typically presents at a median age of 40-50 years. The myelitis is usually of acute onset, long (>3 vertebral segments) and causes severe sensorimotor and bladder and bowel disturbances. We describe a 73-year-old Caucasian woman with aquaporin-4 antibody-positive neuromyelitis optica whose index event was intermittent paroxysmal tonic spasms (and no other myelitis features) that recurred for 6 months and was associated with a short spinal cord lesion on MRI. This case reiterates recent observations that neuromyelitis optica can occur in older persons, and its myelitis can be 'short' and clinically mild.

Spinal Cord Lesion-Related Coping Strategies Questionnaire (SCL CSQ) is a specific test that is developed for evaluating the coping strategies of the persons with spinal cord injury (SCI). The aim of this study was to evaluate the reliability and validity of the Turkish version of SCL CSQ (SCL CSQ-T) in persons with SCI.One hundred persons with SCI were included in the study. All participants were evaluated with SCL CSQ-T and Brief Coping Styles Inventory (BCSI) at the baseline. SCL CSQ-T was repeated twice in 15 days. American Spinal Injury Association Impairment Scale and Functional Independence Measurement were used for the evaluation of the neurological loss severity and functional status. Emotional status was assessed by Hospital Anxiety and Depression Scale (HADS). Internal consistency reliability, test-retest reliability and construct validity of SCL CSQ-T were evaluated.Intraclass correlation coefficients of the SCL CSQ-T were between 0.51-0.86. Cronbach's alpha values and test-retest reliability of the acceptance, fighting spirit and social reliance subscales were good. Three factors were found in exploratory factor analysis. There was a positive correlation between the subscales of SCL CSQ-T. There was a statistically significant positive correlation between acceptance strategy of SCL CSQ-T and self-confidence and optimism of BCSI. The fighting spirit strategy positively correlated with self-confidence and optimistic strategies. The social reliance strategy positively correlated with helplessness and seeking social support. Coping strategies did not correlate with HADS.The results of this study revealed good internal consistency reliability, test-retest reliability and concurrent validity of the SCL CSQ-T factors acceptance and fighting spirit in relation to general coping strategies. The coping strategy social reliance needs revisions.

We report the clinical and autopsy features of a 65-year-old Japanese man who clinically exhibited overlap of both neuro-Behcet's disease (NBD) and amyotrophic lateral sclerosis (ALS). The patient had a HLA-B51 serotype, a recent history of uveitis and had suffered paraparesis, sensory and autonomic disturbance, frontal signs and tremor. A brain and spine MRI study revealed a longitudinally extensive thoracic cord (Th) lesion, but no apparent intracranial abnormalities. The lesion extended ventrally from Th4 to Th9, exhibiting low intensity on T1-weighted images, high intensity on T2-weighted and fluid-attenuated inversion recovery images and gadolinium enhancement. The patient's upper and lower motor neuron signs and sensory disturbance worsened and he died 16 months after admission. At autopsy, the spinal cord and brain exhibited characteristic histopathological features of both NBD and ALS, including chronic destruction of the ventral thoracic white and gray matter, perivascular lymphocytic infiltration, binucleated neurons, lower and upper motor neuron degeneration, Bunina bodies and skein-like inclusions. Although incidental coexistence of these rare disorders could occur in an individual, this case raises the possibility of a pathomechanistic association between NBD and ALS.

OBJETIVOS: Avaliar os efeitos de monossialogangliosídeos (GM1) administrados com laser por via transdérmica na recuperação da lesão da medula espinal de ratos. MÉTODOS: Quarenta ratos Wistar machos foram submetidos a contusão da medula espinal usando NYU Impactor. No Grupo 1, os ratos receberam 0,2 ml de solução salina diária por via intraperitoneal; no Grupo 2, GM1 foi administrada intraperitonealmente em concentração de 30 mg/kg por dia; no Grupo 3, os ratos foram tratados diariamente com o laser a baixa temperatura sobre a pele, e no Grupo 4, a sessão de laser diária também continha GM1. Todos os grupos foram tratados durante 42 dias. Os animais foram avaliados pela escala funcional de Basso, Baettie e Bresnahan (BBB) nos dias 7, 14, 21, 28, 35 e 42 após a lesão, e por histopatologia e potencial motor evocado 42 dias depois da lesão. RESULTADOS: Os animais do Grupo 4 apresentaram escores BBB mais elevados em comparação com os outros grupos. Não houve diferenças entre os grupos ou nas comparações ao longo do tempo. A avaliação histológica não mostrou diferenças, e tampouco foram encontradas diferenças significativas no potencial evocado. CONCLUSÃO: A GM1 associada ao uso de laser a baixa temperatura não mostra resultados superiores no tratamento de lesões da medula espinal de ratos. Nível de Evidência I, Experimental, Estudo Controlado de Animais. OBJECTIVES: to evaluate the effects of monosialoganglioside (gm1) administered transdermally with laser in the recovery of spinal cord injury in rats. METHODS: forty male wistar rats underwent spinal cord contusion using the nyu impactor. in group 1, the rats received 0,2 ml of saline intraperitoneally daily; in group 2, gm1 was administered intraperitoneally at a concentration of 30 mg/kg per day; in group 3, rats were treated daily with laser at low temperature on the skin, and in group 4, the daily laser session also contained gm1. all the groups were treated for 42 days. the animals were evaluated by the Basso, Baettie and Bresnahan (BBB) functional scale on days 7, 14, 21, 28, 35 and 42 after the injury, and by histopathology and motor evoked potential after 42 days of injury. RESULTS: the animals in group 4 had higher BBB scores compared with the other groups. there were no differences between the groups, or in the comparisons over time. Histological evaluation showed no differences, and no differences were found in the motor evoked potential tests either. CONCLUSION: gm1 associated with the use of low-temperature laser shows no superior functional, neurological or histological results in the treatment of spinal cord lesions in rats. Evidence Level I, Experimental, Controlled, Animal Study.