Timothy C. Kriss

SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) in Infants and Children

We review the biomechanics of the pediatric cervical spine and the clinical findings that pertain to SCIWORA (spinal cord injury without radiographic abnormality) in order to provide a more thorough understanding of this pediatric phenomenon of closed spinal trauma with significant neurologic sequelae but without bony injury. The unique hypermobility and ligamentous laxity of the pediatric bony cervical and thoracic spine predispose to a SCIWORA-type injury. In SCIWORA, the unusually elastic biomechanics of the pediatric bony spine allow deformation of the musculoskeletal structures beyond physiologic extremes, permitting direct cord trauma followed by spontaneous reduction of the bony spine. Potential mechanisms of the SCIWORA include hyperextension/ flexion, longitudinal distraction, and ischemic injury of the spinal cord.

Equine-related neurosurgical trauma: a prospective series of 30 patients.

Thirty million Americans ride horses; 50,000 of these riders are treated in emergency rooms annually. Equestrian activities are uniquely dangerous because the participant is unrestrained, often helmetless, and riding large, unpredictable animals capable of 40-mph speeds and kicking with up to 1 ton of force. Neurologic injuries in equestrians constitute the majority of severe injuries and fatalities. We prospectively studied all patients admitted to the University of Kentucky Medical Center with equine-related neurosurgical trauma from July 1992 to January 1996. Eighteen of 30 patients were male. Age ranged from 3 to 64 years. Five patients died (17%), and two suffered permanent paralysis. There were 24 head injuries (80%) and 9 spinal injuries (30%). The majority of injuries (60%) were caused by ejection or fall from the horse. Twelve patients (40%) were kicked by a horse, and four patients sustained crush injuries. Six patients underwent craniotomy, three had operative spinal stabilization, and five required ventriculostomy. Eleven patients (37%) were professional riders. Twenty-four patients (80%) were not wearing helmets, including all fatalities and craniotomy patients. Our data show that equine-related neurosurgical injuries can be severe and fatal because of the significant size, force, and unpredictability of these animals as well as the lack of proper headgear. We recommend that helmets be worn at all times around horses because a significant number of our patients (33%) were injured as bystanders. Risk of serious injury appears to be a function of cumulative exposure to horses, not level of expertise. Experience is not protective; helmets are.

Symptomatic spinal intradural arachnoid cyst development after lumbar myelography. Case report and review of the literature.

Study Design. This case report describes the unique occurrence of acquired intradural spinal arachnoid cyst after lumbar puncture, which was proven radiographically and surgically. Objectives. To review and explore complications of lumbar puncture in the context of subsequent cyst development and to review the incidence, presentation, pathogenesis, and management of spinal intradural arachnoid cysts. Summary of Background Data. The etiology of the spinal intradural arachnoid cyst remains obscure; some such cysts are ascribed anecdotally to previous trauma or arachnoiditis, whereas the majority are idiopathic and assumed by many authors to be congenital. Methods. A 20‐year‐old woman with back and leg pain underwent lumbar myelography that yielded normal results with no evidence of arachnoid cyst at that time. Within 5 months, clinical symptoms of cauda equina compression and an S1 radiculopathy developed. Subsequent myelography and magnetic resonance imaging revealed a lumbar spinal arachnoid cyst. There was no history of intervening trauma or arachnoiditis. The lumbar puncture was thought to be the cause of the arachnoid cyst. Results. A laminectomy was performed with complete excision of the arachnoid cyst. The patient had an unremarkable postoperative course with excellent relief of her symptoms. Conclusions. This case provides supporting evidence for the traumatic etiology of spinal intradural arachnoid cyst. The development of an intradural spinal arachnoid cyst should be included as a possible complication of lumbar puncture.

Cavernous Sinus Thrombophlebitis: Case Report

OBJECTIVE AND IMPORTANCE Cavernous sinus thrombophlebitis is a rare, dangerous, and historically difficult condition to diagnose and treat. Knowledge of the imaging findings and the importance of early diagnosis and treatment are emphasized. CLINICAL PRESENTATION We present a case of cavernous sinus thrombo-phlebitis caused by sphenoid sinusitis. Previously undescribed magnetic resonance imaging findings of cavernous sinus thrombophlebitis include enlargement of the cavernous sinus, abnormal enhancement and increased T2 signal of the petrous apex and clivus, and marked narrowing of the cavernous portion of the internal carotid artery. Resolution of cavernous sinus thrombophlebitis is also documented by magnetic resonance imaging. INTERVENTION The anatomy of the cavernous sinus dictates the natural history and diagnosis of cavernous sinus thrombophlebitis. We review the literature regarding the clinical diagnosis, differential diagnosis, and treatment of cavernous sinus thrombophlebitis. CONCLUSION We emphasize the importance of a high index of suspicion, the potentially rapid and fatal course of the disease process, and the subsequent need for antibiotic therapy and selective surgery.

Occult Spinal Dysraphism in the Infant Clinical and Sonographic Review

The progressive neurologic dysfunction caused by occult spinal dysraphism can be prevented with early clinical recognition, radiographic diagnosis, and neurosurgical treatment. However, detection of occult spinal dysraphism in the infant is difficult because neurologic symptoms often are not apparent until the child becomes ambulatory. Occult spinal dysraphism, however, can be suspected in the asymptomatic neonate when cutaneous stigmata, such as hemangiomas, hairy patches, deep and/or eccentric dimples, or subcutaneous masses are seen over the lumbosacral spine. Because of the serious, often irreversible, sequelae of a delayed diagnosis, spinal sonography of high-risk infants with midline, lumbosacral, cutaneous stigmata should be considered as an effective, noninvasive screening method.

Cervical paraspinous desmoid tumor in a child: case report.

Desmoid tumors are uncommon fibroblastic proliferative lesions usually occurring in the abdominal wall of adults. We report an unusual case of such a tumor presenting as a rapidly growing cervical paraspinous mass in a 19-month-old girl. After surgical resection without adjuvant therapy, the child is recurrence free after 17 months. The primary treatment of these lesions is surgical resection. We found magnetic resonance imaging to be the best imaging method for evaluation, because it was able to distinguish the tumor from the surrounding muscle. Careful postoperative surveillance is warranted, because these tumors have a high rate of recurrence. Although rare, desmoid tumor should be considered in the differential diagnosis of a paraspinous soft tissue tumor in a pediatric patient.

Cervical Paraspinous Desmoid Tumor in a Child

ABSTRACTDESMOID TUMORS ARE uncommon fibroblastic proliferative lesions usually occurring in the abdominal wall of adults. We report an unusual case of such a tumor presenting as a rapidly growing cervical paraspinous mass in a 19-month-old girl. After surgical resection without adjuvant therapy, the