The scientific literature reports that about 180,000 cases of spinal-cord injuries (SCI) occur yearly in the world. Recent publications show neurological benefit in selected quadriplegics undergoing intra-lesion transplantation of autologous cultured bone-marrow mesenchymal stem cells. Objectives: This case-study reports level–III objective evidence and partial neurological clinical recovery in a 32year old-male with chronic complete quadriplegia that underwent somatic nuclear cell transfer (SCNT) and embryonic cell therapy for traumatic spinal-cord injury (SCI) sustained 6-years previously. The research question was: “Can autologous SCNT cell-therapy improve extremity motor and sensory impairment in chronic quadriplegia?” The hypothesis tested: “SCNT cell-therapy is unable to improve severe motor and sensory impairment in selected persons with chronic complete quadriplegia and unable to improve functional outcome or independence”. Material and methods: Cell-transplantation was by neuro-surgical implantation into the damaged cervical cord 6-years after SCI that rendered the patient a complete quadriplegic confirmed on neurological examination and magnetic resonance imaging (MRI). Neurologic assessment, restoration of dermatomes and myotomes were evaluated post-procedurally for 12-months together with MRI, and American Spinal Injury Association grading (ASIA). Results: Neurological improvement was asymmetrically improved in the shoulder girdle, upper extremity bilaterally and trunk without dramatic change in legfunction at 12-months. ASIA-scales increased from 29/112 to 64/112 at 6-months after treatment and at least one ASIAlevel was gained. Conclusion: Compared to baseline findings, measured neurological improvement was documented in the shoulder-girdle and upper-extremities, 6-12 months after intra-lesion autologous SCNT cell transplantation in a chronic
Liebenberg, W. Adriaan M.B., Ch.B., M.Med., F.C.S. Neurosurg. (SA); Demetriades, Andreas K. B.Sc., M.B., Ch.B., M.Phil.; Hankins, Matthew B.Sc.; Hardwidge, Carl B.M., F.R.C.S.; Hartzenberg, Bennie H. M.Med.
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ABSTRACT OBJECTIVE: Several factors have led to our unique approach of delayed definitive débridement. We wanted to evaluate the effectiveness of our management and compare it with the existing data in the literature. METHODS: We retrospectively reviewed the records of 194 patients presenting between January 1996 and October 2003 with penetrating craniocerebral gunshot wounds. After exclusion criteria, 125 patients qualified. RESULTS: Of the patients, 88.8% were male. The mean age was 24.9 ± 10.9 years. In 70.4% of patients, the presenting Glasgow Coma Scale (GCS) score was 3 to 8. Only 38 (30.4%) of the 125 patients survived, with poor outcome in 2 and good outcome in 36. Bilaterally fixed and dilated pupils and bihemispheric tract on computed tomographic scan were significantly related to poor outcome. There were 49 surgical procedures performed on 27 of the patients, with a mortality rate of 7.4%. Of the 38 survivors, 13 underwent no surgery. Average time to surgery was 11.04 days. Total rate of infection was 8%, and it did not influence outcome. No patient presenting with a GCS score of 3 or 4 survived. Seventeen patients attended follow-up, for a total of 3609 days (average, 212 d) and very few late complications. CONCLUSION: Our supportive care of patients is not optimal. We should have saved more of our patients who presented with GCS scores of 14 and 15 who subsequently died. We have been able to report unconventionally late surgical management of two-thirds of survivors, with no surgery in one-third of survivors. Despite a high rate of infectious complications, infection did not lead to death or disability. Our protocol rarely leads to patients surviving in a permanently vegetative state. In the future, we would perform early surgery for patients who present awake and continue our current management for poor-grade patients. In this way, we will improve the number of good outcomes without increasing the population of severely damaged and dependent survivors.
Abstract Background The natural history of untreated aneurysmal subarachnoid haemorrhage carries a dismal prognosis. Case fatalities range between 32% and 67%. Treatment with either surgical clipping or endovascular coiling is highly successful at preventing re-bleeding and yet the diagnosis is still missed. Methods Based on the national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage and a review of other available literature this study has compiled guidance in making the diagnosis. Conclusion In patients presenting with a suspected non-traumatic subarachnoid haemorrhage, computed tomography within 12 hours will reliably show 98% of subarachnoid haemorrhage. In patients who present after 12 hours with a negative computed tomogram, formal cerebrospinal fluid spectophotometry will detect subarachnoid haemorrhage for the next two weeks with a reliability of 96%. Between the early diagnosis with the aid of computed tomography and the later diagnosis with the added benefit of spectophotometry in the period where computed tomograms become less reliable, it should be possible to diagnose most cases of subarachnoid haemorrhage correctly.
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