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Anterior spinal cord syndrome as a rare complication of acute bacterial meningitis in an adult

Ng KS, Abdul Halim S

BMJ Case Rep, 2018 Oct 24;2018.
PMID: 30361450 DOI: 10.1136/bcr-2018-226082

Acute bacterial meningitis is not an uncommon central nervous system infection. In severe cases, it can be associated with various neurological or systemic complications. However, acute spinal cord dysfunction rarely occurs. We report a case of bacterial meningitis complicated with spinal cord infarction despite adequate treatment with antibiotics and corticosteroid therapy. He had residual paraplegia and was fully dependent in the activity of daily living.

Matched MeSH terms: Paraplegia/microbiology
Fulltext Clinical profile of acute flaccid paralysis

Rasul CH, Das PL, Alam S, Ahmed S, Ahmed M

Med J Malaysia, 2002 Mar;57(1):61-5.
PMID: 14569719

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.

Matched MeSH terms: Paraplegia/etiology*; Paraplegia/physiopathology*; Paraplegia/therapy
Fulltext Intercostal nerve neurotization of the femoral nerve in patients with paraplegia--an anatomical feasibility study

Lim HH, Baskaran

Med J Malaysia, 2001 Jun;56 Suppl C:61-5.
PMID: 11814252

Neurotization of the brachial plexus is an established procedure in the upper limb. However, neurotization of the lower limb remains experimental. Brunelli reported the use of the ulnar nerve to neurotize the lower limb. Zhao et al reported the use of intercostals nerve to neurotize the lower limb in rats. The aim of the study was to determine the feasibility of using intercostals nerve to neurotize the femoral nerve in human cadavers and to ascertain the ideal intercostals nerve that has the anatomical course that suit this role. Six fresh cadaveric dissection were performed through an extensile midline incision in the postmortem room and the lower six (T7-T12) were identified and traced from their origin. Their length and course identified and charted. T9 and T10 intercostal nerve was thought to be the most suitable nerve as the donor nerve, and the T11 and T12 intercostal nerve could not be free from its intra-muscular course sufficiently to be use as donor.

Matched MeSH terms: Paraplegia/pathology*; Paraplegia/surgery*
Paroxysmal, exercise-induced, diurnally fluctuating dystonia: Expanding the phenotype of SPG8

Mulroy E, Magrinelli F, Mohd Fauzi NA, Kutty SK, Latorre A, Bhatia KP

Parkinsonism Relat Disord, 2021 04;85:26-28.
PMID: 33662919 DOI: 10.1016/j.parkreldis.2021.02.011
Matched MeSH terms: Paraplegia/complications; Paraplegia/diagnosis; Paraplegia/genetics; Paraplegia/physiopathology*; Spastic Paraplegia, Hereditary/complications; Spastic Paraplegia, Hereditary/diagnosis; Spastic Paraplegia, Hereditary/genetics; Spastic Paraplegia, Hereditary/physiopathology*
Design and development of a wheelchair seating pressure relief reminder system for pressure ulcer prevention among paraplegics

Md Nadzri N, Hamzaid NA, Chung TY

J Med Eng Technol, 2021 Oct;45(7):574-581.
PMID: 34184592 DOI: 10.1080/03091902.2021.1936238

Individuals with paraplegia spend their time on the wheelchair for life. Adapting to prolonged wheelchair seating for almost all activities of daily living is challenging. The loss of abilities to sense any pain or excessive seating pressure cause them to remain seated on the wheelchair without any pressure relief activities. This situation leads to secondary complications including pressure ulcer which further degrades the individual's health. To overcome this, a wheelchair seating pressure relief training system (WSETs) was developed. Optimal placement of the force sensitive resistors (FSR) as seating pressure sensors on the cushion were determined, and their responses were investigated with 5 paraplegics. Two different FSR orientations, A and B, were compared. Each paraplegic sat in resting position and then performed pressure relief activities (PRA) which included whole body push-up, left and right lean and forward lean, before returning to resting position. Orientation B, with more forward positioned FSRs, showed higher sensitivity, implying better capture of high-risk area of pressure ulcer development. The FSR sensor readings were significantly different among pressure relief activities in all subjects (p

Matched MeSH terms: Paraplegia
Development of a control system for artificially rehabilitated limbs: a review

Bhuiyan MS, Choudhury IA, Dahari M

Biol Cybern, 2015 Apr;109(2):141-62.
PMID: 25491411 DOI: 10.1007/s00422-014-0635-1

Development of an advanced control system for prostheses (artificial limbs) is necessary to provide functionality, effectiveness, and preferably the feeling of a sound living limb. The development of the control system has introduced varieties of control strategies depending on the application. This paper reviews some control systems used for prosthetics, orthotics, and exoskeletons. The advantages and limitations of different control systems for particular applications have been discussed and presented in a comparative manner to help in deciding the appropriate method for pertinent application.

Matched MeSH terms: Paraplegia/rehabilitation
Fulltext The impact of personal and environmental factors on the rehabilitation of persons with neglected spinal cord injury in Malaysia

Hanapi NHM, Zainin ES, Aziz MHA, Darus D

Spinal Cord Ser Cases, 2019;5:10.
PMID: 30701087 DOI: 10.1038/s41394-019-0154-3

Introduction: Managing neglected spinal cord injury (SCI) patients in a rural setting can be challenging due to a lack of resources and the unique personal and environmental contextual factors that may hinder rehabilitation. This article aims to identify the contextual factors and their impact on successful rehabilitation.
Case presentation: A middle-aged man from a rural area had suffered a neglected traumatic SCI and was first seen by the rehabilitation team 17 years post injury. He had a T7 AIS A paraplegia and was bedridden with multiple secondary complications. He was admitted with goals of optimizing his health, initiating basic spinal rehabilitation and improving his functional status. By 1 month, the patient made gradual improvement of his mobility and ADL but requested discharge despite not having achieved his rehab goals. We identified the factors that contributed to his poor motivation to be more functionally independent. Personal factors include poor educational level, his background personality and erratic health-seeking behaviour. Environmental factors included poor family and financial support, physical barriers, lack of work opportunities and facilities for people with disability, poor community support and acceptance and poor healthcare facilities and expertise.
Discussion: The patient's personal and environmental factors affected the delivery of SCI management, spinal rehabilitation and management of secondary comorbidities. Awareness of early spinal rehabilitation among the rural community and healthcare authorities is crucial to promote better implementation of policies, services or programs to support people with SCI.

Matched MeSH terms: Paraplegia/complications; Paraplegia/rehabilitation*
An unique case of thoracic endovascular aortic repair (TEVAR) graft infection with Streptococcus viridans

Zubaidah NH, Azim MI, Osama MH, Harunarashid H, Das S

Clin Ter, 2012;163(1):27-9.
PMID: 22362230

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.

Matched MeSH terms: Paraplegia/etiology
Fulltext Asymptomatic tachycardia and acute pulmonary embolism in a case of tuberculosis spondylodiscitis

Ahmedy F, Ahmad Fauzi A, Engkasan JP

Spinal Cord Ser Cases, 2018;4:43.
PMID: 29844926 DOI: 10.1038/s41394-018-0074-7

Introduction: Tachycardia, or elevated heart rate is one of the important clinical parameters considered when diagnosing pulmonary embolism (PE) based on Wells' criteria. However, tachycardia is not highly specific and commonly presents in many other conditions.
Case presentation: A 29-year-old female with incomplete paraplegia secondary to tuberculosis (TB) spondylodiscitis presented with asymptomatic sinus tachycardia. The related medical conditions, including anaemia, acute coronary syndrome, hyperthyroidism and other infective causes had been ruled out. Deep venous thrombosis was not on the list of differentials as she showed improvements in neurological and mobility functions with no clinical signs of calf pain or swelling. She had moderate risk of acute PE based on Wells' criteria with positive D-dimer testing and computed tomography pulmonary angiography (CTPA) showing thrombus formation in the left-ascending pulmonary artery.
Discussion: Acute PE may present solely with asymptomatic sinus tachycardia in TB spondylodiscitis. This caveat should provide a high index of suspicion to prevent delay in diagnosis and prevention of more sinister complications. Early stratification based on Wells' criteria for a possible diagnosis of acute PE is proven to be a useful approach in conjunction with clinical features.

Matched MeSH terms: Paraplegia
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: Paraplegia
Unusual cause of neuropathy: extensive dural spread of primary cervical osteosarcoma

Ponnampalam SN, Tan WY, Wazir NN, George J

Acta Radiol Short Rep, 2012;1(1):1-3.
PMID: 23986826 DOI: 10.1258/arsr.2012.110028

We report a very rare case of a high grade osteosarcoma of the cervical spine in a 62-year-old woman. She presented with a relatively short history of a swelling in the posterior neck and cervical lymphadenopathy. This was associated with hoarseness of the voice, significant weight loss, and right upper arm radicular symptoms initially, progressing to paraplegia. Based on MR and CT imaging of the neck and an excision biopsy of an enlarged right supraclavicular lymph node, the histology revealed a high grade primary osteosarcoma of the cervical spine.

Matched MeSH terms: Paraplegia
Fulltext Complete Recovery of Thoracic Myelopathy after Eleven Months of Paraplegia: A Case Report

Manmohan S, Nor Azlin ZA, Fazir M, Dzulkarnain A, Goh JH

Malays Orthop J, 2015 Mar;9(1):32-34.
PMID: 28435594 MyJurnal DOI: 10.5704/MOJ.1503.004

Instances of neurological recovery after early decompression of the spine in non-traumatic spinal cord compression are well documented. We present a patient with paraplegia of 11 months' duration due to atypical spinal tuberculosis who showed complete neurological recovery in three months.

Matched MeSH terms: Paraplegia
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: Paraplegia/epidemiology
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: Paraplegia/physiopathology; Paraplegia/rehabilitation
Fulltext Post-thoracotomy paraplegia after oxidized cellulose spinal compression

Than DJ, Perumall VV, Johan S, Lee XL, Karim KA, Hayati F

Einstein (Sao Paulo), 2023;21:eRC0078.
PMID: 37436267 DOI: 10.31744/einstein_journal/2023RC0078

Post-thoracotomy paraplegia after non-aortic surgery is an extremely uncommon complication. A 56-year-old woman presented with a 1-year history of progressive shortness of breath. Computed tomography revealed a locally advanced posterior mediastinal mass involving the ribs and the left neural foramina. Tumor excision with a left pneumonectomy was performed. Post-resection, bleeding was noted in the vicinity of the T4-T5 vertebral body, and the bleeding point was packed with oxidized cellulose gauze (Surgicel®). Postoperatively, the patient complained of bilateral leg numbness extending up to the T5 level, with bilateral paraplegia. An urgent laminectomy was performed, and we noted that the spinal cord was compressed by two masses of Surgicel® with blood clots measuring 1.5 × 1.5cm at T4 and T5 levels. The paraplegia did not improve despite the removal of the mass, sufficient decompression, and aggressive postoperative physiotherapy. Surgeons operating in fields close to the intervertebral foramen should be aware of the possible threat to the adjacent spinal canal as helpful hemostatic agents can become a preventable threat.

Matched MeSH terms: Paraplegia/complications; Paraplegia/surgery
Diagenesis dan Asal Mula Dolomit dan Kuarza di dalam Batu Kapur Kodiang, Kedah (Diagenetic and Origin of Dolomite and Quartz in Kodiang Limestone, Kedah)

Che Aziz Ali, Kamal Roslan Mohamed

Sains Malaysiana, 1996;25(4):47-68.

The Kodiang Formation which outcrops in Kodiang and Alor Setar areas has been well studied and documented. Various geological aspects of the limestone formation have been reported in detail including its stratigraphy, sequence startigraphy, sedimentology and paleontology. Diagenetic aspect of this rock formation, however, had not been specifically discussed before. The Kodiang limestone has undergone a complicated diagenetic history which started immediately after the sediments were laid down on the sea bed. Various diagenetic products have been identified including, early marine cement, meteoric cement, and deeper subsurface cement. The diagenetic features identified are as follows; Fibrous calcite cement, sparry and poikilotopic calcites, calcite overgrowth, dolomite, silica cements and evaporites. Close examination at outcrops shows that dolomite occurs at several levels in the sequence. Their systematic occurrences can be correlated across the area. Petrographic studies show that dolomite occurs in several modes as stratified dolomite and as non-stratified dolomite. The two dolomite groups are attributed to two phases of dolomitizations. The stratified dolomites are interpreted to have been formed early in the limestone diagenetic history. The non-stratified dolomite type is, however, attributed to dolomitization during deep burial under the control of deeper subsurface physico-chemical conditions.
Batu Kapur Kodiang yang tersingkap di Kodiang dan Alor Setar telah banyak dikaji dan didokumentasikan. Berbagai aspek geologi formasi batu kapur ini telah dilaporkan termasuk stratigrafi, startigrafi jujukan, sedimentologi dan paleontologi. Walau bagaimanapun aspek diagenesis formasi batuan ini tidak pernah dibincangkan secara khusus. Batu kapur Kodiang ini telah melalui sejarah diagenesis yang rumit yang bermula sebaik saja sedimen dimendapkan di atas permukaan dasar laut. Berbagai hasil diagenesis telah dikenal pasti termasuk penyimenan samudera awal, penyimenan meterorik dan penyimenan di bawah permukaan yang lebih dalam. Secara asas fitur-fitur yang dikenalpasti adalah seperti berikut; simen kalsit berserat, kalsit spar dan poikilotopik, tumbuhlampau kalsit, dolomit, simen silika dan evaporit. Pemeriksaan rapi pada singkapan menunjukkan dolomit hadir pada beberapa aras di dalam jujukan. Kehadirannya secara bersistematik boleh dikorelasikan pada setiap singkapan. Kajian petrografi menunjukkan dolomit wujud dalam berbagai mod yang boleh diklaskan sebagai dolomit berstrata dan dolomit tidak berstrata. Dua klas ini boleh dikaitkan dengan dua fasa pendolomitan. Dolomit berstrata ditafsirkan telah terbentuk awal di dalam sejarah diagenesis batu kapur. Dolomit tidak berstrata pula dikaitkan dengan pendolomitan semasa timbusan dalam di bawah keadaan fiziko-kimia bawah permukaan.

Matched MeSH terms: Paraplegia
Fulltext Predictive factors in the evolution of neural deficit in tuberculosis of the spine

Tan SC, Harwant S, Selvakumar K, Kareem BA

Med J Malaysia, 2001 Jun;56 Suppl C:46-51.
PMID: 11814249 MyJurnal

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.

Matched MeSH terms: Paraplegia/etiology*
Primary plasma cell leukemia presented as progressive paraplegia: a case report

Hasmoni MH, Wahid FA, Keng CS

South. Med. J., 2009 Jan;102(1):101-3.
PMID: 19077786 DOI: 10.1097/SMJ.0b013e31818018c1

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.

Matched MeSH terms: Paraplegia/etiology*; Paraplegia/pathology
Fulltext Acute flaccid paralysis surveillance: looking beyond the global poliomyelitis eradication initiative

Saraswathy TS, Zahrin HN, Apandi MY, Kurup D, Rohani J, Zainah S, et al.

Southeast Asian J. Trop. Med. Public Health, 2008 Nov;39(6):1033-9.
PMID: 19062691

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.

Matched MeSH terms: Paraplegia/etiology; Paraplegia/epidemiology*; Paraplegia/virology*
Fulltext Traumatic posterior rotatory fracture-dislocation of lumbo-sacral spine

Mukundala VV, Lim HH

Singapore Med J, 2001 Feb;42(2):82-4.
PMID: 11358198

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.

Matched MeSH terms: Paraplegia/etiology

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