MyMedR

Fulltext Langerhans cell histiocytosis with extensive spinal and thyroid gland involvement presenting with quadriparesis: an unusual case in an adult patient

Mohd Ariff S, Joehaimey J, Ahmad Sabri O, Zulmi W

Malays Orthop J, 2011 Nov;5(3):28-31.

PMID: 25279033 MyJurnal DOI: 10.5704/MOJ.1111.004

Langerhans cell histiocytosis of the spine frequently presents as a solitary lesion and rarely results in neurological deficit. Involvement of thyroid tissue is also rare, even in multifocal disease presentations. We present an unusual variant of Langerhans cell histiocytosis in a 37-year-old man presenting with profound quadriparesis and incidental thyroid involvement. MR imaging and skeletal radiographs revealed widespread involvement of the spine. The patient underwent surgical resection of the tumour and stabilization of the spine. Diagnosis was confirmed by histological and immunohistochemistry analysis. Langerhans cell histiocytosis should be included in the differential diagnosis of radiolucent lesions of the spine in adults.

Matched MeSH terms: Quadriplegia*

Rapidly progressing tetraparesis in a young male patient with pyrexia

Fadilah SA, Cheong SK, Raymond AA

Postgrad Med J, 2000 Mar;76(893):170-3.

PMID: 10684332

Matched MeSH terms: Quadriplegia/etiology*

Pearls & Oy-sters: Upbeat Nystagmus and Quadriplegia in a Young Girl with Bilateral Medial Medullary Syndrome

Md Isa IA, Halim SA, Chuan CY

Neurology, 2021 04 06;96(14):e1921-e1924.

PMID: 33441459 DOI: 10.1212/WNL.0000000000011493

Matched MeSH terms: Quadriplegia/etiology*

Fulltext Botulinum toxin type A for rehabilitation after a spinal cord injury: a case report

Naicker AS, Roohi SA, Chan JL

J Orthop Surg (Hong Kong), 2009 Apr;17(1):96-9.

PMID: 19398803 DOI: 10.1177/230949900901700121

A 56-year-old man became quadriplegic, bed bound, and carer-dependent secondary to cervical osteomyelitis. Three years later, he presented with generalised spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his hips and knees prevented ischial sitting. Injections of botulinum toxin type A to both hamstrings and gastrosoleuii controlled the flexor spasticity of his lower limbs and facilitated rehabilitation and wound healing through proper positioning, wound care, stretching, and weight-bearing exercises. A few weeks later, the patient could better position himself in bed (prone lying) and on his wheelchair (ischial sitting). His spasm-related pain lessened and his mobility and activities of daily living improved. The sacral pressure sore healed completely a few months later. The patient could sleep better, feed with set-up and adaptive aids, groom, dress, and transfer himself with minimal assistance. The effects of botulinum toxin extended beyond just spasticity reduction. His upper extremity function, mobility, and social well-being were all improved through better positioning.

Matched MeSH terms: Quadriplegia/drug therapy*; Quadriplegia/etiology; Quadriplegia/rehabilitation*

Fulltext Transtubular Transoral Surgery for Excision of a Dystrophic Os Odontoideum: A Case Report

Ariffin MH, Ashfaq MM, Kang E

Malays Orthop J, 2016 Mar;10(1):50-52.

PMID: 28435547 MyJurnal DOI: 10.5704/MOJ.1603.009

Transoral approach to the cervico-medullary junction is a well-established procedure. However oropharyngeal complications in the form of soft tissue morbidity postoperatively do occur. We report a case of a teenage boy with traumatic quadriparesis secondary to compression of the cervico-medullary junction by an os odontoideum. Decompression was done via transoral approach through a tubular retractor system, hence obviating the need for the splitting or separate retraction of the soft palate and minimised the damage and violation of surrounding soft tissues. His neurological status improved and he was able to ambulate with support on fourth post-operative day with no soft tissue morbidity in the oral cavity. To our knowledge this is the first case reported using this technique. We conclude that adoption of this method would improve the traditional transoral approach and reduce the oropharyngeal complications.

Matched MeSH terms: Quadriplegia

Fulltext Spinal cord compression following traditional confinement massage

Sahathevan R, Tan HJ, Abdullah S, Shahizon AM, Hamidon BB, Raymond AA

Med J Malaysia, 2011 Dec;66(5):495-6.

PMID: 22390109 MyJurnal

We describe a case of tetraparesis in a 33-year-old woman following neck manipulation performed by a traditional confinement mid-wife. An MRI of the cervical spine revealed a fracture of the second cervical vertebra with atlanto-axial subluxation that resulted in cord compression.

Matched MeSH terms: Quadriplegia/diagnosis; Quadriplegia/etiology*

Fulltext Delayed decompression of chronic C1C2 subluxation in a pediatric patient with tetraplegia--is recovery possible?

Razif M, Lim HH

Med J Malaysia, 2001 Jun;56 Suppl C:76-9.

PMID: 11814256

A 2 year-old Malay girl was admitted to our institution with a chesty cough and breathlessness but later found to have a chronic C1/C2 subluxation for one and half year with tetraplegia. Her cervical cord was decompressed and occipito-cervical fusion performed. Her neurological status improved significantly post-operatively and is able to care for her personal hygiene. The authors believe that the ability of the cervical cord to recover in the paediatric age group is remarkable that surgical option should be considered even when all seen lost. We believe that this is the first report in the literature to support this potential.

Matched MeSH terms: Quadriplegia/radiography; Quadriplegia/surgery*

Benefit of triple-strap abdominal binder on voluntary cough in patients with spinal cord injury

Julia PE, Sa'ari MY, Hasnan N

Spinal Cord, 2011 Nov;49(11):1138-42.

PMID: 21577218 DOI: 10.1038/sc.2011.53

STUDY DESIGN: A cross-sectional experimental study.
OBJECTIVE: The purpose of this study is to examine the benefit of elastic abdominal binders on voluntary cough in persons with spinal cord injury.
SETTING: Spinal rehabilitation unit in a teaching hospital.
METHODS: We measured voluntary cough peak expiratory flow rate (in 21 subjects with spinal cord injury, (18 tetraplegia, 3 paraplegia) under three conditions: without abdominal binder as the baseline, with single-strap abdominal binder and triple-strap abdominal binder.
RESULTS: The results showed that the mean cough peak expiratory flow rate in all subjects without abdominal binder was 277.1 l per min. There was a significant increase in flow rate with the use of abdominal binders: 325.7 l per min with single-strap abdominal binder and 345.2 l per min with triple-strap abdominal binder (P<0.05, paired t-test). The mean cough peak expiratory flow rate in tetraplegic subjects using triple-strap abdominal binders was significantly higher compared with those using single-strap abdomina
l binders (322.1 l per min and 299.4 l per min, respectively).
CONCLUSION: Abdominal binders can be used as an effective method to improve cough ability in spinal cord injured patients, with triple-strap abdominal binder achieving greater cough peak expiratory flows.

Comment in: Frisbie JH. Question of stamina for the diaphragm. Spinal Cord. 2012 Jun;50(6):480. doi: 10.1038/sc.2011.164. Epub 2012 Jan 17. PubMed PMID: 22249332.

Matched MeSH terms: Quadriplegia/physiopathology; Quadriplegia/rehabilitation

Rare morbidity of permanent quadriplegia caused by neurenteric cyst of the cervical cord

Tan Chor Lip H, Jih Huei T, Chong Abdullah A, Rahman NABA

Avicenna J Med, 2019 5 31;9(2):78-81.

PMID: 31143701 DOI: 10.4103/ajm.AJM_153_18

The incidence of neurenteric cyst (NC) is rare, accounting for 0.3%-1.3% of all spine tumors. The occurrence of quadriplegia caused by NC is even scarcer. Herein we report on a young girl with a rare NC over the C2-C5 spinal cord, which led to the morbidity of permanent quadriplegia despite early surgical intervention. This case highlights the rare morbidity of cervical cord NC presenting with permanent quadriplegia that failed to respond despite early surgical excision.

Matched MeSH terms: Quadriplegia

Fulltext Pulmonary rehabilitation using mechanical insufflation-exsufflation therapy for spinal cord injury – two case studies in the University Malaya Medical Centre

Tan, J.H., Aishah A. Fauzi, Hasnan, N.

JUMMEC, 2017;20(2):31-33.

MyJurnal

There is a high incidence of 36% to 83% of respiratory dysfunction in patients with acute cervical spinal cord
injury. Complications arising from respiratory dysfunction remain one of the most common causes of morbidity
and mortality in the spinal cord injured population. Specialized pulmonary care and therapy can help individuals
with tetraplegia to maintain a stable respiratory status allowing active participation in active rehabilitation.
This would allow them to achieve rehabilitation goals of independent function and community reintegration.
Mechanical insufflation-exsufflation (MIE) therapy is an option for secretion management in individuals with
acute spinal cord injury. In this paper, we present our experience using MIE as an adjunct to management of
secretions in the spinal cord injured population at the University of Malaya Medical Centre.

Matched MeSH terms: Quadriplegia

Is neck massage safe? A rare case of tetraplegia and spinal shock after neck manipulation

Ling TH, Zakaria AF, Abdullah AT

J Orthop Surg (Hong Kong), 2017 01;25(1):2309499017690459.

PMID: 28228050 DOI: 10.1177/2309499017690459

Neck manipulation is associated with spinal cord injury. However, occurrence of such cases is infrequent. This article presents a 33-year-old gentleman who sustained acute tetraplegia after neck manipulation. The aim of this case report is to create awareness that vigorous neck manipulation could cause injury to the spinal cord.

Matched MeSH terms: Quadriplegia/etiology*

Compressive radial neuropathy induced by 'hooking' manoeuvre in a tetraplegic person

Julia PE, Mazlina M, Nazirah H

Spinal Cord, 2011 Oct;49(10):1082-3.

PMID: 20877330 DOI: 10.1038/sc.2010.137

Case report.

Matched MeSH terms: Quadriplegia/complications*; Quadriplegia/rehabilitation

Fulltext White cord syndrome: A devastating complication of spinal decompression surgery

Vinodh VP, Rajapathy SK, Sellamuthu P, Kandasamy R

Surg Neurol Int, 2018;9:136.

PMID: 30090668 DOI: 10.4103/sni.sni_96_18

Background: Reperfusion injury of the spinal cord or "white cord syndrome" refers to the sudden onset of neurological deterioration after spinal decompressive surgery. Associated magnetic resonance (MR) findings only include focal hyperintensity on T2-weighted images without any other pathological changes.

Case Description: A patient with cervical stenosis secondary to metastatic tumor in the intradural and extradural compartments presented with lower limb paraparesis. She underwent an uneventful tumor excision accompanied by posterior cervical decompression and fusion. Postoperatively, she was quadriplegic and required ventilator support. The emergent postoperative MR scan revealed focal hyperintensity on the T2-weighted image consistent with spinal cord edema extending into the lower brain stem.

Conclusion: Very few cases of reperfusion injury of the cervical spinal cord or "white cord syndrome" are described in the literature. Here we present a patient who, following cervical laminectomy and fusion for excision of metastatic tumor, developed quadriplegia. Notably, postoperative MR showed only findings of upper cervical cord and lower brain stem edema consistent with a "white cord syndrome" without other compressive pathology.

Matched MeSH terms: Quadriplegia

Fulltext Cervical spine fracture in a patient with ankylosing spondylitis causing a C2-T9 spinal epidural hematoma- Treatment resulted in a rapid and complete recovery from tetraplegia: Case report and literature review

Wong AS, Yu DH

Asian J Neurosurg, 2015 3 15;10(1):53.

PMID: 25767586 DOI: 10.4103/1793-5482.151519

Full recovery from tetraplegia is uncommon in cervical spine injury. This has not being reported for cervical spine fracture in a patient with ankylosing spondylitis causing spinal epidural hematoma. We report on a case of cervical spine fracture in a patient with ankylosing spondylitis who came with tetraplegia. He underwent a two stage fixation and fusion. He had a complete recovery. Two hours after the operation he regained full strength in all the limbs while in the Intensive Care Unit. He went back to full employment. There are only two other reports in the literature where patients with ankylosing spondylitis and extradural hematoma who underwent treatment within 12 h and recovered completely from tetraparesis and paraplegia respectively. Patient with ankylosing spondylitis has a higher incidence of spinal fracture and extradural hematoma. Good outcome can be achieved by early diagnosis and treatment. This can ensure not only a stable spine, but also a rapid and complete recovery in a tetraplegic patient.

Matched MeSH terms: Quadriplegia

A Rare but Disabling Stroke

Lau KF, Tan KS, Goh KJ, Ramli N, Tai SM

Ann Acad Med Singap, 2019 Mar;48(3):109-111.

PMID: 30997481

Matched MeSH terms: Quadriplegia/etiology

Fulltext Posterior reversible encephalopathy syndrome: Malaysian haemato-oncological paediatric case series

Choong, Yi Fong, Chaw, Su Hlaing, Aye, Aye Mya Min, Chee, Geap Tay, Lai, Choo Ong, Hany Ariffin

Neurology Asia, 2015;20(3):275-281.

MyJurnal

Background & Objective: Posterior reversible encephalopathy syndrome (PRES) is associated with
immunosuppressive agents used in children with haemato-oncological diseases. There are no reports
to date from the South Asia and South East Asia region. We report a Malaysian tertiary centre case
series of children with haemato-oncological disease who developed PRES. Methods: Retrospective
study of children seen with haemato-oncology diseases seen at the University Malaya Medical Centre
Kuala Lumpur who developed PRES from 2011 – 2013. Clinical details were obtained from medical
records and brain neuroimaging was reviewed. Results: Five patients met the inclusion criteria. All
5 patients had significant hypertension acutely or subacutely prior to neurology presentation. Four
presented with acute seizures and the remainder 1 presented with encephalopathy.Three patients
were on chemotherapy, 1 had renal impairment and 1 had prior immunosupression for bone marrow
transplantation. A full recovery was seen in 4 patients and 1 patient had mild residual quadriplegia.
Conclusion: Our case series expands the clinico-radiological spectrum of PRES in children with
underlying haemato-oncological disorders. It is the first to show that prior cyclosporin intake as long
as 2 months is a potential risk factor for PRES. Clinicians need to be vigilant for development of
PRES and closely monitor the blood pressure in these children who are receiving or recently had
immunosuppressive drugs and present with acute neurological symptoms.

Matched MeSH terms: Quadriplegia

Epidemiology of spinal cord injury in Hospital Kuala Lumpur

Ibrahim A, Lee KY, Kanoo LL, Tan CH, Hamid MA, Hamedon NM, et al.

Spine (Phila Pa 1976), 2013 Mar 1;38(5):419-24.

PMID: 22914700 DOI: 10.1097/BRS.0b013e31826ef594

Cross-sectional study.

Matched MeSH terms: Quadriplegia/epidemiology

Characteristics of persons with spinal cord injury who drive in Malaysia and its barriers: a cross sectional study

Lee RCH, Hasnan N, Engkasan JP

Spinal Cord, 2018 04;56(4):341-346.

PMID: 29288252 DOI: 10.1038/s41393-017-0034-2

STUDY DESIGN: Cross sectional study.

OBJECTIVES: To determine the prevalence, characteristics of and barriers to driving among persons with a spinal cord injury (SCI).

SETTING: SCI Rehabilitation Clinic, University Malaya Medical Centre (UMMC).

METHODS: This is a questionnaire-based study on persons with SCI who attended the UMMC SCI Rehabilitation Clinic between June 2015 and November 2016. The questionnaire comprised demographic data, clinical characteristics, driving variables, Spinal Cord Independence Measure III, WHOQOL-BREF, and Craig Handicap Assessment and Reporting Technique Short Form. Malaysians aged greater than 18 years old with any etiology and levels of SCI, had no other physical disabilities and not suffering from progressive illness were recruited. A single investigator administered the questionnaire via face-to-face interviews.

RESULTS: A total of 160 participants were included in this study. Overall, 37% of persons with SCI drove and owned a modified vehicle. Almost half of persons with paraplegia (47%) drove, but only 12% of tetraplegia did. A majority (93%) of those who drove aged below 60 years, and had higher level of independence in activity of daily living. More drivers (81%) compared to non-drivers (24%) were employed; drivers also reported better community reintegration and quality of life. Three commonest barriers to driving included medical reasons (38%), fear and lack of confidence (17%), and inability to afford vehicle modifications (13%).

CONCLUSIONS: The percentage of persons with SCI driving post injury is low. Based on the findings of this study, more efforts are needed to motivate and facilitate persons with SCI to drive.

Study site: SCI Rehabilitation Clinic, University Malaya Medical Centre (UMMC)

Matched MeSH terms: Quadriplegia

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