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A 61-year-old man whose arms and legs became temporarily paralyzed was diagnosed with a lymphoblastic lymphoma in the membranes surrounding the spinal cord in his neck. He was treated with corticosteroids and radiotherapy.

Rehydration in children with varying blood sodium levels may lead to a rare demyelination of the central nervous system. A four-year-old boy was hospitalized after three days of watery diarrhea, and was diagnosed with rotavirus gastroenteritis. He was rehydrated with normal saline, which caused his blood sodium levels to fluctuate. He experienced a seizure and required mechanical ventilation, and was transferred to an academic medical center. Magnetic resonance imaging showed demyelination of the central pons and other areas of the brain. The boy gradually regained neurologic function, but still experienced deficits five months after hospitalization., ABBREVIATIONS. CPM, central pontine myelinolysis; MRI, magnetic resonance imaging; NS, normal saline; CSF, cerebrospinal fluid; ADEM, acute disseminated encephalomyelitis. Acute gastroenteritis is one of the most common childhood illnesses encountered [...]

Damage to the spinal cord in athletes, while rare, is devastating. Before such injuries can be prevented, it is essential to understand just how they occur, and documentation of injuries associated with several sports is ample. The National Football Head and Neck Injury Registry was established in 1975 in response to a high number (eight) of cervical spine injuries that year that led to permanent paralysis of all four extremities (quadriplegia). Comparisons between data gathered for the years 1971 to 1975 and data for 1959 to 1963 showed a 66 percent reduction in intracranial hemorrhages (bleeding within the head) and a 42 percent decrease in the number of deaths from such accidents. However, the Registry found a 204 percent increase for cervical spine fractures and injuries and a 116 percent increase for cervical quadriplegia. The conclusions were drawn that improved helmet design had reduced head injuries, while changes in playing technique to compensate for head protection placed the cervical spine (the uppermost levels of the spine) at greater risk, since the top of the head could now be used as the initial point of contact. When these findings were presented at a meeting of the NCAA football rules committee in early 1976, new rules were instituted. These prohibited spearing (deliberate use of the helmet to strike a runner) and using the top of the head to ram an opponent. Such actions put the cervical spine at risk, since force is transmitted along the spine's vertical axis. The most dangerous position is one where the neck is slightly flexed and the spine converted into a straight column from its normally slightly extended position. On impact, the spine is crushed between the suddenly immobile head and the still-moving trunk (axial compression). Data from the Registry from 1971 to the present time were analyzed to determine the number of cervical spine or head injuries that either: required hospitalization for more than 72 hours or surgical intervention; involved a fracture, subluxation (partial dislocation), or a dislocation; or led to permanent paralysis or death. Information was obtained from several sources, including school and trainer associations and newspaper reports. Results showed definite trends over time. Hemorrhages within the skull increased between 1976 (the year the new rules were enacted) and 1982, then levelled off. Mortality from this cause remained constant throughout the study. It is suggested that the observed increase in hemorrhages was due to improvement in diagnosis as a result of computerized axial tomography, or CAT-scanning, a method of viewing the tissues inside the skull. Fractures, subluxations, and dislocations of the cervical spine decreased between 1976

Byline: Ahmet N. Kok (1), Omer S. Yildirim (2), Mehmet Kizilkaya (3), Ali F. Isik (4), Nasuhi E. Aydin (5), Talat Yurtman (6) Keywords: Solitary plasmacytoma; Neck pain; Trivial injury; Quadriplegia Abstract: Abstract After complaining of neck pain for 3 weeks, a 36-year-old man suddenly become quadriplegic during a massage session in a traditional Turkish bath. He was immediately transferred to hospital, where the initial examination consisting in plain radiography and magnetic resonance imaging revealed a compression fracture of the fourth cervical vertebra. The patient was immediately treated by anterior vertebral decompression and bone grafting from the iliac crest. Unfortunately, the patient did not respond to surgical intervention and died. Solitary plasmacytoma of the fourth cervical vertebrae was detected at autopsy during forensic examination. Pain and spinal cord compression resulted from solitary plasmacytoma of the vertebral column. However, paralysis, especially quadriplegia, occurs seldom. In this case report, solitary plasmacytoma of the vertebral column associated with neck pain is presented with the relevant pathological and clinical aspects. Author Affiliation: (1) Department of Forensic Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey (2) Surgery Orthopaedic, Faculty of Medicine, Ataturk University, Erzurum, Turkey (3) Department of Anesthesia and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey (4) Department of Forensic Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey (5) Department of Pathology, Faculty of Medicine, Inonu University, Malatya, Turkey (6) Council of Forensic Medicine, Ankara, Turkey Article History: Registration Date: 01/01/2004 Received Date: 08/10/2003 Accepted Date: 01/03/2004

Byline: D. D. Kennedy (1), S. N. Fletcher (1), I. R. Ghosh (2), J. H. Coakley (1), J. P. Monson (3), C. J. Hinds (1) Keywords: Key words Critical illness; Diabetes; Sepsis; Neuromuscular disease; Neuropathies; Motor and sensory; Electromyography Abstract: Critical illness polyneuromypathy has not previously been reported as a complication of diabetic coma. We describe a patient with hyperosmolar non-ketotic coma (HONK) complicating gram-negative sepsis in whom persistent coma and profound tetraplegia caused considerable concern. Although, initially, it was feared that the patient had suffered a central neurological complication such as stroke or cerebral oedema, a diagnosis of critical illness motor syndrome (CIMS) was subsequently confirmed neurophysiologically. Profound limb weakness associated with HONK is not necessarily due to a catastrophic cerebral event, rather it may be a result of CIMS, which has an excellent prognosis for full neurological recovery. Author Affiliation: (1) Department of Intensive Care, St. Bartholomew's Hospital, Smithfield, London EC1A 7BE, UK Tel.: + 44-1 71-6 01 75 26 Fax: + 44-1 71-6 01 75 26, GB (2) Department of Neurophysiology, St. Bartholomew's Hospital, Smithfield, London EC1A 7BE, UK, GB (3) Division of Metabolism, St. Bartholomew's Hospital, Smithfield, London EC1A 7BE, UK, GB Article note: Received: 4 June 1999 Accepted: 22 September 1999