A Case of Persistent Back Pain and Constipation in a 5-Year-Old Boy
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Abstract:
Pediatric intramedullary spinal cord tumors are rare and account for 3% to 6% of all central nervous system tumors. Astrocytomas are infiltrating neoplasms, and they predominate in the pediatric population. We report a case of an intramedullary spinal cord astrocytoma in a 5-year-old boy with nonspecific mid-back pain for 3 months. Physical examination revealed clonus, thoracolumbar tenderness, and pain with sitting straight leg raises. An urgent magnetic resonance imaging showed an intramedullary tumor in the mid-thoracic cord, confirmed by surgical excision. The physician should maintain a high index of suspicion when evaluating the pediatric patient who presents with unexplained and persistent back pain. Associated findings, including nocturnal pain and neurological symptoms may indicate a more serious underlying pathology such as a tumor. Early detection, prompt treatment, and proper post surgical management will often lead to improved outcomes in patients.Keywords:
Conus medullaris
Clonus
Conus medullaris
Cauda equina
Spinal cord tumor
Neurological examination
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Intramedullary dermoid cyst is a type of rare congenital intraspinal lesions especially those located in the conus medullaris and not associated with spinal dysraphism. The Management of DC is especially difficult in eloquent areas such as the conus medullaris, with tendency to recurrence and poorly respond to oncologic treatment.
Conus medullaris
Dermoid cyst
Conus
Ependymoma
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Objective To investigate the variation in the position of conus medullaris in Chinese adult population in order to avoid hitting conus during spinal puncture. Methods Eight hundred patients suffering from back pain, aged 18-91 yr, were enrolled in this study. The position of conus medullaris was determined using Siemens 1.5 T magnetic resonance imaging system. According to the method described by Reimann, the vertebral body was used as mark of reference to the level of the end of conus. Results There were 190 patients in whom the position of the end of conus medullaris was lower than L1,2 . The incidence of the position of the end of conus medullaris lower than L1,2 was higher in patients 30-60 or older than in those under 30, and in those over the age of 60 than in those 30-60 (P ＜ 0.05). Conclusion Spinal puncture should be performed cautiously at L2,3. CT or MRI is recommended before operation for the patients to locate the position of conus medullaris and avoid injury to the spinal cord.
Key words:
Spinal cord; Anatomy; Intraoperative complications
Conus medullaris
Conus
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Objective To explore the methods on locating conus medullaris in neonates with ultrasound.Methods The normal location of conus medullaris in 150 full-term neonates were expressed in two ways: The length of internal filum terminal and the distance between conus medullaris and sacral hiatus.Results The length of internal filum terminal was from 3.62 cm to 5.54 cm,and the distance between conus medullaris and sacral hiatus was from 5.92 cm to 9.72 cm.The length of internal filum terminal and the distance between conus medullaris and sacral hiatus were correlated with newborn' height and weight.There was correlation between the length of internal filum terminal and the distance between conus medullaris.Conclusion The length of internal filum terminal,the distance between conus medullaris and sacral hiatus can express exactly the position of conus medullaris in neonates.
Conus medullaris
Filum terminale
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The conus medullaris typically terminates at the L1 level; however, variations in its level and the factors associated with the conus medullaris level are unclear. We investigated the level of conus medullaris on magnetic resonance imaging in healthy volunteers. In total, 629 healthy adult volunteers (≥50 individuals of each sex and in each decade of age from 20 to 70) were enrolled. The level of the conus medullaris was assessed based on the T2-weighted sagittal magnetic resonance images, and factors affecting its level were investigated employing multivariate regression analysis including the participants’ background and radiographical parameters. L1 was the most common conus medullaris level. Participant height was significantly shorter in the caudally placed conus medullaris (p = 0.013). With respect to the radiographical parameters, pelvic incidence (p = 0.003), and pelvic tilt (p = 0.03) were significantly smaller in participants with a caudally placed conus medullaris. Multiple regression analysis showed that the pelvic incidence (p < 0.0001) and height (p < 0.0001) were significant factors affecting the conus medullaris level. These results indicated that the length of the spinal cord varies little among individuals and that skeletal differences affect the level of the conus medullaris.
Conus medullaris
Conus
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Pereira (Revue Neurol., 1925, t. II, 4) gives the results of his studies of foot clonus, produced by the use of graphic recording of leg movements and recording of electromyograms with a galvanometer. The author comes to the conclusion that there is no difference between the "pyramidal" clonus of the foot and the physiological clonus - muscle contractions are the same in both.
Clonus
Foot (prosody)
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Objective To observe the self-locking intramedullary nail’s advantage in femoral shaft fracture treatment. Methods 22 cases of femoral shaft fractures were treated with self-locking intramedullary nail, and 18 cases were treated with interlocking intramedullary nail. Measure the bleeding and time consuming in operation. Results In bleeding and time consuming, the group using self-locking intramedullary nail are better than using interlocking intramedullary nail. Conclusion The self-locking intramedullary nail is a good internal fixation method to treat femoral shaft fractures. It’s a minimally invasive intramedullary nail.
Femoral shaft
Interlocking
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Clinical evaluation of clonus in spastic muscles was performed by comparing reflex path length with clonus frequency for different muscles in the same patient. It was found that clonus frequency varied inversely with reflex path length (r = 0.84, p less than 0.001). The findings confirm that clonus is generated by a peripheral mechanism of self re-excitation rather than a central spinal pacemaker.
Clonus
Stretch reflex
Tonic (physiology)
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Pentylenetetrazol (PTZ) is often used in experimental models of epilepsy. The relationship of the PTZ-induced seizure sequence of myoclonus, clonus and hindlimb extension (TE) to brain PTZ levels has not been reported. This study examined this relationship and determined how different routes of PTZ administration affected brain PTZ uptake and seizure development. The critical brain PTZ level for onset of clonus ranged from 20 to 50 microg/g. Brain PTZ uptake was rapid after I.P. injection of PTZ convulsant dose (CD55) for clonus/and clonus onset occured at 4.0+/- 1.6 min. uptake was slower after S.C. administration; clonus onset occurred at 9.9 +/- 3.7 min. at a CD for TE (CD40), clonus onset occured at 5.1 +/- 3.0 and 2.4 +/- 2.4 min for S.C. and I.P. routes of administration, respectively. TE onset did not appear to depend solely on brain PTZ levels were falling . Factors that could modulate the appearance of TE are discussed.
Clonus
Pentylenetetrazol
Convulsants
Seizure threshold
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[Objective] To comparatively analyze the effect of expandable intramedullary nail and interlocking intramedullary nail fixation in the treatment of the tibial shaft fractures.[Methods]Totally 40 cases of the tibial shaft fractures underwent surgical treatment with different fixation including expandable intramedullary nails in 19 cases and interlocking intramedullary nails in 21 cases.The operative difficulties,outcomes and complications were analyzed and compared retrospectively.[Results]The operation with expandable intramedullary nails was much easier than interlocking intramedullary nails.According to average 18 months postoperative follow-up,the average duration of bone union was 14 weeks and the complication rate was 0 in the cases fixed with expandable intramedullary nails,19 weeks and 38.1% in the cases fixed with interlocking intramedullary nails respectively.[Conclusion]The application of expandable intramedullary nails in the treatment of tibial shaft fractures has advantages of less trauma,more simple operation,and less complications.It's a new method of the treatment of the tibial shaft fractures better than interlocking intramedullary nails,and It's worthy of recommending.
Interlocking
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