Immunoglobulin G4 (IgG4)-related sclerosing disease is a systemic disease, characterized by mass forming inflammatory lesions which respond well to steroid therapy. Pancreas is the most common site of involvement, and other organ involvements are also common. However, there are only a few reports about central nervous system involvement. We report a case of IgG4-related sclerosing disease which involves spinal cord causing paraplegia. A middle-aged female presented with sudden lower limb weakness. Magnetic resonance imaging showed a soft tissue mass which was diffusely compressing spinal cord along the C7 to T5 levels. Intravenous steroid pulse therapy and emergent operation was performed. The immunopathologic findings revealed IgG4-related sclerosing pachymeningitis postoperatively. There was no evidence of other organ involvement. Her neurologic deficit remained unchanged after two months of comprehensive rehabilitation therapy.
Citations
The postoperative infectious spondylitis has been reported to occur among every 1% to 12%. It is difficult to early diagnose in some cases. If the diagnosis is delayed, it can be a life-threatening condition. We report a 32-year-old male patient with postoperative infectious spondylitis. He had surgical treatments for traumatic intervertebral disc herniations in L3-4 and L4-5. Three weeks after surgery, he complained for fever and paraplegia. Cervicothoracic magnetic resonance imaging showed the collapsed T2 and T3 vertebral body with changes of bone marrow signal intensity. Moreover, it showed anterior and posterior epidural masses causing spinal cord compressions which suggested infectious spondylitis. After the use of antibiotics and surgical decompressions T2-T3, his general conditions were improved and muscle power of lower extremities began to be gradually restored. However, we could not identify the exact organisms that may be the cause of infectious spondylitis. It could be important that the infectious spondylitis, which is presented away from the primary operative level, should be observed in patients with fevers of unknown origin and paraplegia.
Citations
The children with Down's syndrome are predisposed to atlantoaxial instability due to ligamentous laxity of the atlantoaxial joint. That can lead to cervical spinal cord compression. A careful neurologic examination and periodic screening for atlantoaxial instability would be very important for early detection and prompt management. We report a child with Down's syndrome who was diagnosed as atlantoaxial dislocation, long times after he showed progressive symptoms of cervical cord compression including respiratory distress.
Aspergillosis of the spine has been reported infrequently. It has usually been attributed to hematogenous infection, spread from an adjacent pulmonary infection. Acute paraplegia developed in a 68 year old man with aspergillus infection. Histopathologic findings showed aspergillus hyphae and magnetic resonance imaging study revealed mid thoracic cord compression. Direct extension of aspergillus infection caused an epidural abscess, vertebral destruction, thoracic spinal cord compression, and paraplegia.
First
Prev
