This study was done to determine the clinical course, cause and outcome of Acute Flaccid Paralysis (AFP) in children. All AFP cases (< 15 years) in the children's ward of Khulna Medical College Hospital (Bangladesh) were recorded, investigated and followed up to sixty days as a part of passive surveillance. Main outcome variables were vulnerable age group, vaccine status, predominant limb involvement, clinical variants, virus isolation and residual paralysis. Thirty-four children with AFP were admitted in hospital in the last three years with the highest number (14) in 1998. The majority of children belonged to the age group 5-9 years with a male female ratio of 1.3:1. Nearly one third of the cases were either partially vaccinated or not vaccinated at all. The lower limbs bore the brunt of paralysis excepting a few (14.7%). Clinically, Guillain Barre Syndrome was the commonest (47.1%) followed by encephalomyelitis. No poliovirus was isolated from these cases. Residual paralysis was observed in four out of ten cases who returned for follow up. AFP will continue to occur even after eradication of poliomyelitis and Guillain Barre Syndrome is the most important clinical entity for this.
Plasma cell leukemia (PCL) is a rare plasma cell disorder. It is the leukemic variant of multiple myeloma. A 52-year-old man with an atypical presentation of primary plasma cell leukemia is reported. The patient presented with paraparesis which progressively worsened to paraplegia. MRI of the spine showed an extradural mass causing cord compression and multiple bony erosions from soft tissue masses. Peripheral blood film examination and bone marrow aspiration showed numerous plasmablasts. Atypical cells expressed surface and cytoplasmic lambda light chain on immunochemical studies, surface CD45 and CD38. To our knowledge, primary PCL presenting with progressive paraplegia has not been reported in the literature.
This study was conducted to determine the factors involved in predicting the onset of paraplegia in tuberculosis of the spine. A cross-sectional, case control review of 85 cases of spinal tuberculosis was conducted at the National Tuberculosis Centre in Kuala Lumpur. Sixty-nine of these cases were normal neurologically, whilst 16 cases experienced neural deficit. The data was analysed using backward logistic regression and Fishers exact probability test. The factors studied included symptoms and signs of spinal tuberculosis, common investigations for tuberculosis, and physical factors of the disease. Only the erythrocyte sedimentation rate (ESR) showed a significant difference between the neural deficit and neurologically normal groups. This suggests that the ESR may be a factor in predicting evolution of paraplegia in spinal tuberculosis. In addition, it was noted that a low proportion of patients had positive sputum smear results and bacterial culture growth for mycobacterium tuberculosis suggesting these tests are of limited value for tuberculosis of the spine.
Spinal vascular malformation is an uncommon but potentially treatable cause of myelopathy. We describe two cases of angiographically proven spinal vascular malformation in Malaysia. The first case is a 47-year-old man who had a progressive myelopathy and the second a 60-year-old man with intermittent attacks of transient paraparesis leading to paraplegia. As the clinical presentation of spinal vascular malformation is variable, it should be considered as a cause of patients with myelopathy.
In 1992 surveillance of acute flaccid paralysis (AFP) cases was introduced in Malaysia along with the establishment of a national referral laboratory at the Institute for Medical Research. The objective of this study was to determine the incidence, viral etiology and clinical picture of AFP cases below 15 years of age, reported from 2002 to 2007. Six hundred seventy-eight of 688 reported cases were confirmed as AFP by expert review. The clinical presentation of acute flaccid paralysis in these cases was diverse, the most commonly reported being Guillian-Barre syndrome (32.3%). Sixty-nine viruses were isolated in this study. They were Sabin poliovirus (25), Echovirus (22), Cocksackie B (11), EV71 (5), Cocksackie A (1), and untypable (5). Malaysia has been confirmed as free from wild polio since the surveillance was established.
A prospective study of patients with acute aortic occlusion (AAO) admitted to the Vascular Unit, Hospital Kuala Lumpur was carried out over a 12 month period. There were a total of 11 patients admitted with a clinical diagnosis of AAO. There was a male preponderance with 10 patients. The median age was 58 years (40-70 years). Hypertension was the commonest underlying medical illness (n = 7). All patients had painful lower limb paraparesis or paraplegia with bilateral absent limb pulses from the groin downwards on admission to the vascular unit. The majority of patients (10 patients) were referred from other hospitals, of which 6 patients came from outside the Klang Valley. Only eight (8) patients underwent an operative procedure with seven (7) having an initial bilateral balloon catheter thromboembolectomy. There was one (1) aorta-bifemoral bypass after failed embolectomy. An aneurysectomy with inlay-graft was done as the initial procedure in one (1) patient. Mortality was 82% (9/11). The two survivors were in the group that had vascular reconstructive surgery. Acute aortic occlusion is an uncommon but catastrophic event with a high mortality. Clinicians must have a high index of suspicion in patients who present with painful paresis or paraplegia. Clinical examination of peripheral pulses in these patients is mandatory. Early diagnosis and treatment is important to improve the outcome of this disease.
Fracture-dislocation of the lumbo-sacral spine was an unusual injury and was divided into anterior, posterior and lateral types depending on the displacement of the cephalad portion of the spine over the caudal portion. According to the authors' knowledge, only 31 cases of traumatic fracture-dislocation of the lumbo-sacral spine were reported in the English literature. Only 3 previous reports referred to this injury with a posterior displacement, which was an even rarer injury. This was the fourth report of this type of injury.
One hundred and forty-one patients with non-traumatic paraplegia were reviewed. The common causative factors and the problems arising were evaluated. Management of the clinical problems were described. The need for prevention and early treatment has been stressed.
Tuberculous paraplegia in pregnancy is reported to be rare. Paraplegia due to tuberculosis has a good prognosis if surgical decompression and stabilisation are done early together with chemotherapy. Vaginal delivery is not contraindicated in pregnancy complicated by paraplegia, but is associated with problems related to the initiation and progression of labour. Performing spinal nursing on an unstable spine with a rapidly enlarging gravid uterus in the third trimester of pregnancy poses a significant challenge. We report successful simultaneous Caesarean section and surgical treatment of a paraplegic spine due to tuberculosis.
The incidence of infection following TEVAR is low. To the best of our knowledge, this is the first case report of post thoracic endovascular aortic repair (TEVAR) with Streptococcus viridans graft infection. A 54-year-old male underwent TEVAR for dissecting thoracic aneurysm with spinal ischaemia. He had an eventful recovery with prolonged period of stay in intensive care unit. Three months later, he presented with persistent chest discomfort and fever. Computed tomography (CT) of the thorax revealed evidence of graft infection and the blood culture grew Streptococcus viridans. The rarity of TEVAR graft infection due to Streptococcus viridans and its management are being discussed.