A 61-year-old woman with an abrupt onset of paralysis of the legs and impairment of the bladder and bowel function

Article Abstract:

The case history is presented of a 61-year-old woman who suddenly developed paraplegia (paralysis of the legs and lower body). This followed a four-month-long bout of lower back pain when standing, and an acute episode of pain, pins and needles sensations in the buttocks and rectal region, and numbness. The symptoms worsened and, after hospitalization, the patient lost control of bowel and bladder. Magnetic resonance imaging (a noninvasive method of diagnostic imaging) showed abnormalities of the lower thoracic and upper lumbar spinal cord. The possible causes of this lesion are discussed. It is important to determine where a spinal cord lesion is located: at what height in the cord, and at what depth. These results have implications for the lesion's cause and its treatment. The clinical diagnosis was a tumor of the conus medullaris (the lowest portion of the spinal cord), with a probable hemorrhage. The neurosurgeon's report of removing the softened, dead tissue from the spinal cord, which contained no signs of a tumor, is presented. The anatomical diagnosis was of acute spinal-cord infarction (tissue death) resulting from the presence of small arterial or venous clots (emboli) formed of fibrocartilage from the disks that lie between the vertebrae. Similar cases in the medical literature involve females more often than males, and often a history of minor head or neck injury. The way the fibrocartilage enters the vascular system is not known. The neurological impairment in such cases, as in the one discussed, is usually irreversible. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Causes of, Central nervous system diseases, Infarction

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A 67-year-old man with aphasia and memory loss, followed by progressive dementia

Article Abstract:

A 67-year-old man was referred to the hospital with memory loss and progressive loss of speech. His father and a brother had been diagnosed with Alzheimer's disease, and both subsequently died. He scored relatively high on a scale that measures dementia. CT and MRI scans showed moderate cerebral atrophy. Over the next few years, his mental condition continued to deteriorate. He died approximately four years after his initial symptoms began. An autopsy of his brain revealed atrophy of the frontal and temporal lobes and enlarged ventricles. His condition was ascribed to Pick's disease, a degenerative brain disease similar to Alzheimer's disease.

Presenile dementia

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Thrombolysis - not a panacea for ischemic stroke

Article Abstract:

Thrombolytic drugs should not be used in all stroke patients but may benefit certain patients. These drugs break up blood clots in the brain, which are the primary cause of most strokes. The drugs can thus prevent the death of brain tissue from lack of blood, but they can also increase the risk of bleeding. This could cause a fatal brain hemorrhage. There are other causes of stroke and some conditions that mimic a stroke. Thrombolytic drugs would be of no benefit in these patients. Several non-invasive imaging techniques such as MRI and ultrasound could be used to determine which patients would benefit most from thrombolytic therapy.

Health aspects, Drug therapy, Stroke (Disease), Stroke, Tissue plasminogen activator, Fibrinolytic agents, Thrombolytic drugs

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