We performed a revisionary open reduction and internal fixation for treating nonunion of the mid-shaft of the left clavicle with an autogenous cancellous bone graft. On postoperative day 4, the patient presented with neurologic deficits in the left upper extremity. We removed the implant and made a superior angulation to decompress the brachial plexus. At 6 months postoperatively, callus bridging and consolidation were visible and all hand and elbow functions were fully recovered. Our case suggests that brachial plexus neuropathy may be caused by stretching and compression after reduction and straightening of the nonunion site around adhesions or scar tissue. Therefore, care should be taken whether there are the risk factors that can cause brachial plexus neuropathy when revision surgery is performed for treating nonunion of a clavicle shaft fracture.
Bony Callus ; Brachial Plexus Neuropathies ; Brachial Plexus ; Cicatrix ; Clavicle ; Elbow ; Hand ; Humans ; Neurologic Manifestations ; Risk Factors ; Transplants ; Upper Extremity

Infantile hemangioma (IH) usually presents solely as a cutaneous manifestation, and rarely accompanies diverse anomalies such as spinal dysraphism. A 2-month-old girl presented with IH on her lumbar skin as a coin-sized red plaque with adjacent depressed skin and a child-palm-sized red plaque on her left ankle since birth. Considering the coexistence of IH and depressed skin on the midline in her lumbosacral area, magnetic resonance imaging of her spine was performed, which showed intraspinal/dermal vascular tumors with spina bifida occulta at the 12th thoracic vertebrae level. Furthermore, no neurologic deficits were observed. She has been taking oral propranolol with topical timolol to prevent neural complications and the lesions clinically improved. However, additional surgery for the intraspinal lesions was considered due to urination/defecation abnormalities since she was 13 months of age. In cases of midline IH, particularly with additional skin lesions, appropriate imaging studies to identify accompanying anomalies should be performed, and referrals to neurosurgical specialists should be considered.
Ankle ; Female ; Hemangioma ; Humans ; Infant ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Parturition ; Propranolol ; Referral and Consultation ; Skin ; Specialization ; Spina Bifida Occulta ; Spinal Dysraphism ; Spine ; Thoracic Vertebrae ; Timolol

Subarachnoid hemorrhage (SAH) usually occurs due to aneurysmal rupture of intracranial arteries and its typical computed tomography (CT) findings are increased attenuation of cisterns and subarachnoid spaces. However, several CT findings mimicking SAH are feasible in diverse conditions. They are so-called as pseudo-SAH, and this report is a case of pseudo-SAH which is misdiagnosed as aneurysm rupture accompanied by bilateral chronic subdural hematoma (cSDH). A 42-year-old male with severe headache visited our institute. Non-contrast brain CT images showed increased attenuation on basal cistern, and cSDH on both fronto-temporo-parietal convexity with midline shifting. Trans-femoral cerebral angiography was done and we confirmed small aneurysm at right M1 portion of middle cerebral artery. Under diagnosis of SAH, we planned an operation in order to clip aneurysmal neck and remove cSDH. cSDH was removed as planned, however, there was no SAH and we also couldn't find the rupture point of aneurysm. Serial follow-up CT showed mild cumulative cSDH recurrence, but the patient was tolerant and had no neurologic deficit during hospitalization. We have checked the patient via out-patient department for 6 months, there are no significant changes in volume and density of cSDH and the patient also have no neurologic complications.
Adult ; Aneurysm ; Arteries ; Brain ; Brain Edema ; Cerebral Angiography ; Diagnosis ; Follow-Up Studies ; Headache ; Hematoma, Subdural, Chronic ; Hemorrhage ; Hospitalization ; Humans ; Intracranial Hypertension ; Male ; Middle Cerebral Artery ; Neck ; Neurologic Manifestations ; Outpatients ; Recurrence ; Rupture ; Subarachnoid Hemorrhage ; Subarachnoid Space

Brown-Séquard syndrome (BSS) is an incomplete spinal cord injury caused by damage to one-half of the spinal cord. Most cases of BSS result from penetrating trauma or tumors, and acute cervical disc herniation is a relatively rare cause of BSS. In this case, a 34-year-old man with a sudden onset posterior neck pain and left side motor weakness was admitted to the local spine hospital. Pain and temperature sensation of pain was decreased below the right C4 dermatome. The left arm and leg motor grade was 0. Magnetic resonance imaging (MRI) showed a huge trans-ligamentous herniated disc rupture from the center to the left at the level of C3–4, and anterior cervical discectomy and fusion were performed. After emergency surgery, left arm and leg motor grade recovered to 2, and normal voiding function returned. MRI verified complete removal of the cervical herniated disc. This case describes the approach to rapid diagnosis in a patient with characteristic clinical symptoms of BSS and radiological findings of a herniated cervical disc. Rapid and accurate diagnosis and immediate decompressive surgery increased the possibility of a good surgical outcome, even if the neurologic deficits are grave at the time of admission.
Adult ; Arm ; Brown-Sequard Syndrome ; Diagnosis ; Diskectomy ; Emergencies ; Humans ; Intervertebral Disc Displacement ; Leg ; Magnetic Resonance Imaging ; Neck Pain ; Neurologic Manifestations ; Rupture ; Sensation ; Spinal Cord ; Spinal Cord Injuries ; Spine

Decompressive craniectomy (DC) is commonly performed in patients with intracranial hypertension or brain edema due to traumatic brain injury. Infrequently, neurologic deteriorations accompanied by sunken scalp may occur after DC. We report two patients with traumatic subdural hemorrhage who had neurologic deteriorations accompanied by sunken scalp after DC. Neurologic function improved dramatically in both patients after cranioplasty. Monitoring for neurologic deterioration after craniectomy is advised. For patients showing neurologic deficit with a sunken scalp, early cranioplasty should be considered.
Brain Edema ; Brain Injuries ; Decompressive Craniectomy ; Hematoma, Subdural ; Humans ; Intracranial Hypertension ; Neurologic Manifestations ; Scalp ; Skin

OBJECTIVE: There is a lack of knowledge regarding whether decompression is necessary in treating patients with epidural spinal cord compression (ESCC) grade 2. The purpose of this study was to compare the outcomes of minimally invasive surgery (MIS) without decompression and conventional open surgery (palliative laminectomy) for patients with hepatocellular carcinoma (HCC) spinal metastasis of ESCC grade 2.METHODS: Patients with HCC spinal metastasis requiring surgery were retrospectively reviewed. Patients with ESCC grade 2, medically intractable mechanical back pain, a Nurick grade better than 3, 3–6 months of life expectancy, Tomita score ≥5, and Spinal Instability Neoplastic Score ≥7 were included. Patients with neurological deficits, other systemic illnesses and less than 1 month of life expectancy were excluded. Thirty patients were included in the study, including 17 in the open surgery group (until 2008) and 13 in the MIS group (since 2009).RESULTS: The MIS group had a significantly shorter operative time (94.2±48.2 minutes vs. 162.9±52.3 minutes, p=0.001), less blood loss (140.0±182.9 mL vs. 1534.4±1484.2 mL, p=0.002), and less post-operative intensive care unit transfer (one patient vs. eight patients, p=0.042) than the open surgery group. The visual analogue scale for back pain at 3 months post-operation was significantly improved in the MIS group than in the open surgery group (3.0±1.2 vs. 4.3±1.2, p=0.042). The MIS group had longer ambulation time (183±33 days vs. 166±36 days) and survival time (216±38 days vs. 204±43 days) than the open surgery group without significant difference (p=0.814 and 0.959, respectively).CONCLUSION: MIS without decompression would be a good choice for patients with HCC spinal metastasis of ESCC grade 2, especially those with limited prognosis, mechanical instability and no neurologic deficit.
Back Pain ; Carcinoma, Hepatocellular ; Decompression ; Decompression, Surgical ; Humans ; Intensive Care Units ; Life Expectancy ; Minimally Invasive Surgical Procedures ; Neoplasm Metastasis ; Neurologic Manifestations ; Operative Time ; Prognosis ; Retrospective Studies ; Spinal Cord Compression ; Spinal Cord ; Spine ; Walking

BACKGROUND: Although kidney transplantation outcomes have improved dramatically after using calcineurin inhibitors (CNIs), CNI toxicity continues to be reported and the mechanism remains uncertain. Here, we investigated the neurotoxicity of CNIs by focusing on the viability of glioma cells.METHODS: Glioma cells were treated with several concentrations of CNIs for 24 hours at 37℃ and their cell viability was evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay.RESULTS: Exposure to 0, 0.25, 0.5, 2.5, 5.0, and 10.0 mM concentrations respectively showed 100%, 64.3%, 61.3%, 68.1%, 62.4%, and 68.6% cell viability for cyclosporine and 100%, 38.6%, 40.8%, 43.7%, 37.8%, and 43.0% for tacrolimus. The direct toxic effect of tacrolimus on glioma cell viability was stronger than that of cyclosporine at the same concentration.CONCLUSION: CNIs can cause neurological side effects by directly exerting cytotoxic effects on brain cells. Therefore, we should carefully monitor the neurologic symptoms and level of CNIs in kidney transplant patients.
Animals ; Brain ; Calcineurin Inhibitors ; Calcineurin ; Cell Survival ; Cyclosporine ; Glioma ; Humans ; Kidney ; Kidney Transplantation ; Neurologic Manifestations ; Rats ; Tacrolimus

Lying on the side while falling asleep deeply after drinking or taking a sleeping pill can cause compressive neuropathy. We report a 70-year-old male patient of medial cord of left brachial plexus injury (BPI) after deep sleep. The mechanism of the injury might be compression and stretching of brachial plexus. The electrodiagnostic study was performed and the medial cord lesion of BPI was suggested. The ultrasonography image of compression site revealed the nerve swelling of medial cord of brachial plexus and median nerve at the mid-arm level. Pharmacologic treatment including oral prednisolone and exercise training were prescribed. On 6 months after initial visit, neurologic symptom and pain were improved but mild sequelae was remained.
Accidental Falls ; Aged ; Brachial Plexus ; Deception ; Drinking ; Electrodiagnosis ; Humans ; Male ; Median Nerve ; Neurologic Manifestations ; Prednisolone ; Ultrasonography

Torticollis is an abnormal, asymmetric head or neck position which usually caused by imbalance of paracervical muscles. The traumatic torticollis can be caused by following events; atlantoaxial rotatory subluxation, atlantoaxial dislocation, cervical vertebral fractures, and injury to the cervical musculature. Especially, acute traumatic atlantoaxial rotatory subluxation usually presents limitation of cervical range of motion without pain or neurologic deficit. We report a case of a 58 year-old man who developed the acute atlantoaxial rotatory subluxation right after the chiropractic therapy, which induced the limitation of cervical range of motion to 52.5% of normal range. The magnetic resonance image revealed the facture of the odontoid process and the partial injury in transverse ligaments of the atlas. He underwent intramuscular botulinum toxin injection and 10 days of continuous cervical traction 15 hours a day using a 5 kg weight. The range of the cervical motion restored up to 90.2% of normal range.
Atlanto-Axial Joint ; Botulinum Toxins ; Chiropractic ; Dislocations ; Head ; Ligaments ; Muscles ; Neck ; Neurologic Manifestations ; Odontoid Process ; Range of Motion, Articular ; Reference Values ; Torticollis ; Traction

Herein, we report a case of lung transplantation in a patient with profound preoperative hypercapnia, focusing on the cardiopulmonary bypass strategy used for brain perfusion during the operation. We applied the pH-stat method for acid-base regulation, and thereby achieved the desired outcome without any neurologic deficit.
Brain ; Cardiopulmonary Bypass ; Cerebrovascular Circulation ; Humans ; Hypercapnia ; Lung Transplantation ; Lung ; Methods ; Neurologic Manifestations ; Perfusion