Dataset Information

Spinal cord compression secondary to intrathecal catheter-induced granuloma: a report of four cases.

ABSTRACT: OBJECTIVE: The management of nonmalignant pain by morphine pump implantation has become an effective and increasingly frequent strategy of care. We report a rare complication of intrathecal granuloma formation adjacent to the intrathecal catheter tip resulting in spinal cord compression in four patients undergoing intrathecal treatment for chronic pain. METHODS: Four patients presented with chronic back pain and lower extremity pain and weakness and were treated with morphine pump implantation (Fig 1). Each patient developed a mass at the level of the intrathecal catheter tip resulting in increased back pain and diminished neurological function. Following clinical examination and x-ray workup, the patients underwent surgical resection of the mass and removal of the intrathecal catheter. One patient received conservative saline therapy first, and another patient had granuloma resection first and removal of the intrathecal catheter at a later date. Pathological analysis showed granulation tissue with extensive necrosis and chronic inflammation, with negative culture results. No evidence of neoplasm was found. RESULTS: Patients showed varying degrees of improvement following removal of the intrathecal mass. Two patients had moderate pain reduction following resection of the granuloma; a third had minimal pain improvement; and a fourth had significant pain improvement but continued lower extremity weakness. CONCLUSIONS: The formation of granulomas caused by intrathecal catheter implantation is a rare but serious complication. Imaging studies including magnetic resonance imaging with contrast and computed tomography with myelogram should be used to follow up a neurological examination consistent with spinal cord compression. Timely surgical intervention may result in marked improvement of symptoms.

SUBMITTER: Arnold PM

PROVIDER: S-EPMC3427967 | biostudies-other | 2011 Feb

REPOSITORIES: biostudies-other

ACCESS DATA

Similar Datasets

Project description:BackgroundDegenerative cervical spinal cord compression is becoming increasingly prevalent, yet the MRI criteria that define compression are vague, and vary between studies. This contribution addresses the detection of compression by means of the Spinal Cord Toolbox (SCT) and assesses the variability of the morphometric parameters extracted with it.MethodsProspective cross-sectional study. Two types of MRI examination, 3 and 1.5 T, were performed on 66 healthy controls and 118 participants with cervical spinal cord compression. Morphometric parameters from 3T MRI obtained by Spinal Cord Toolbox (cross-sectional area, solidity, compressive ratio, torsion) were combined in multivariate logistic regression models with the outcome (binary dependent variable) being the presence of compression determined by two radiologists. Inter-trial (between 3 and 1.5 T) and inter-rater (three expert raters and SCT) variability of morphometric parameters were assessed in a subset of 35 controls and 30 participants with compression.ResultsThe logistic model combining compressive ratio, cross-sectional area, solidity, torsion and one binary indicator, whether or not the compression was set at level C6/7, demonstrated outstanding compression detection (area under curve =0.947). The single best cut-off for predicted probability calculated using a multiple regression equation was 0.451, with a sensitivity of 87.3% and a specificity of 90.2%. The inter-trial variability was better in Spinal Cord Toolbox (intraclass correlation coefficient was 0.858 for compressive ratio and 0.735 for cross-sectional area) compared to expert raters (mean coefficient for three expert raters was 0.722 for compressive ratio and 0.486 for cross-sectional area). The analysis of inter-rater variability demonstrated general agreement between SCT and three expert raters, as the correlations between SCT and raters were generally similar to those of the raters between one another.ConclusionsThis study demonstrates successful semi-automated compression detection based on four parameters. The inter-trial variability of parameters established through two MRI examinations was conclusively better for Spinal Cord Toolbox compared with that of three experts' manual ratings.

Project description:BackgroundSpontaneous spinal subarachnoid hemorrhage (SSH) is an infrequent yet critical condition, accounting for less than 1% of all spinal hemorrhages and presenting substantial diagnostic difficulties. It predominantly arises due to factors such as tumors, trauma, arteriovenous malformations (AVM), and certain medications including anticoagulants. The complexity of its presentation necessitates vigilance from healthcare providers to avert irreversible neurological impairments.Case descriptionThis study delineates the unusual case of an 82-year-old woman undergoing direct oral anticoagulant (DOAC) therapy who reported sudden, severe chest and back pain, rapidly escalating to lower limb motor and sensory deficits, coupled with urinary and fecal incontinence. An initial cranial computed tomography (CT) indicated a peri-mesencephalic subarachnoid hemorrhage (SAH). Subsequent spinal CT angiography (CTA) and magnetic resonance imaging (MRI) affirmed the diagnosis of a spontaneous SSH, displaying significant cord compression, particularly in the thoracic regions between the T6 and T9 vertebrae. Emergency laminectomy was done to evacuate the subarachnoid hematoma that was causing cord compression. Postoperatively, the patient recovered partial neurological function.ConclusionsSSH, though rare, embodies a significant diagnostic hurdle and potential for lasting neurological deficits if not identified and treated promptly. Particularly in patients on anticoagulant therapy presenting with acute onset back pain and neurological dysfunction, SSH ought to be a crucial consideration. It is imperative to integrate prompt and advanced neuroimaging techniques and consider spinal angiography as a golden standard for a comprehensive diagnosis. Treatment strategies depend largely on the presence of neurological deficits, emphasizing the necessity of quick identification and emergency intervention in severe cases. This study elucidates the critical role of timely intervention in optimizing recovery outcomes, highlighting the necessity of including anticoagulant-induced spinal hemorrhage in differential diagnoses for patients manifesting signs of acute spinal cord compression.

Dataset Information

Spinal cord compression secondary to intrathecal catheter-induced granuloma: a report of four cases.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets