World Neurosurg
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Case Reports
Early-diagnosed Hirayama disease with unusual symptoms improved by steroid pulse therapy: A case report.
Hirayama disease (HD), or monomelic amyotrophy, is a benign neurologic disorder mostly affecting young Asian men. It usually presents with unilateral or bilateral muscular atrophy and weakening of the upper limbs. We treated a patient with HD with bilateral hand paresthesia and weakness in 1 hand and both legs. To our knowledge, this is the first HD case including lower extremity weakness and sensory abnormalities. We improved the patient's symptoms by administering steroids in parallel with conservative treatment. ⋯ HD occurs at a young age and therefore can damage quality of life. Although the patient had unusual symptoms, the condition was diagnosed quickly, and his symptoms improved with steroid therapy. If HD is suspected, additional tests such as MRI with neck flexion should be performed and early steroid treatment might be considered.
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As of May 4, 2020, the coronavirus disease 2019 (COVID-19) pandemic has affected >3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems worldwide, leading to the cancellation of elective surgical cases and discussions regarding health care resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak and may recur with future pandemics, creating a need for a means of triaging patients for emergent and elective spine surgery. ⋯ We present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, although not all encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.
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Reports on neurologic manifestations of coronavirus disease 2019 (COVID-19) have attracted broad attention. We present an unusual case of COVID-19-associated encephalitis mimicking a glial tumor. ⋯ Our case raises awareness of neurologic manifestations of the disease and their potential to mimic glial tumors. For prompt diagnosis and prevention of transmission, clinicians should consider COVID-19 in patients with similar presentation.
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Locally aggressive vertebral body tumors of the axis must be treated with wide local excision for best outcome. Reconstruction of the load-bearing vertebra needs to be done after tumor resection in such a manner so as to give stable, long-term fusion in this young population. ⋯ Iliac crest autograft is inexpensive and easy to harvest and can be considered as a C2 prosthesis, especially in a resource-constrained setting. Modified iliac crest graft can be used for load transmission from C1 lateral mass to C3 body, and the mesh cage can be modified according to need as a plate with good results in an emergency.
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Post-traumatic diploic leptomeningeal cyst with bilateral posterior cranial fossa epidural hygroma is a rare complication after calvarial fracture. Very few cases have been reported to date; hence, there are no specific guidelines for the management of these cases. ⋯ Post-traumatic leptomeningeal cyst is commonly associated with occipital injury. The causes are as follows: the dura is very loosely attached to the intracranial lamina in young children, injury to the skull results in potential epidural space, and any tear or breach in the meninges leads to accumulation of cerebrospinal fluid in these spaces giving rise to cystic swelling. Watertight duroplasty with trials of duro-periosteal hitching has been described in the management of these cases.