Paraplegia
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In a patient wounded by a gunshot in the abdomen, the bullet was radiologically located intradurally at S1 level. Although she had no neurological deficit at admission, she developed pain and motor weakness a few days later. At operation the bullet was found at L4 level and its removal resulted in complete neurological recovery.
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This is a retrospective study conducted in all of the hospitals of Istanbul to survey new patients with a traumatic spinal cord injury (SCI) in 1992. In that year 152 new traumatic SCI were identified. The estimated annual incidence was 21 per million population. ⋯ The commonest associated injury was head trauma, followed by fractures of an extremity (or extremities). Severe head trauma, as a major cause of death, may obscure the actual incidence of SCI in this study. Accidental falls (exceeding road accidents) were mostly due to falls from buildings and accidents on work premises.
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Clinical Trial
Peripheral neuropathies in the upper extremities of paraplegic wheelchair marathon racers.
In order to know if peripheral neoropathies in the upper extremities of paraplegic individuals are induced by participating in wheelchair marathon races, we performed nerve conduction studies bilaterally on the median, ulnar, and radial nerves of 10 male wheelchair marathon racers, and on 10 male sedentary paraplegic individuals. In five of 10 paraplegic racers, and in nine of 10 sedentary paraplegics there was a decrease of motor nerve conduction velocities and/or prolongation of motor or sensory nerve distal latencies. ⋯ Although paraplegic racers had fewer peripheral neuropathies in the upper extremities than did sedentary paraplegics, ulnar lesions due to involvement of the deep motor branch and at the elbow were a characteristic feature of nerve injuries, presumably caused by wheelchair marathon racing. It is suggested that although a wheelchair marathon is generally a safe sport, wearing gloves and handling a wheelchair in the correct way during the race are necessary to prevent nerve injuries.
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This survey of traumatic spinal cord injuries in Japan from January 1990 to December 1992 was carried out by a statistical method of the nationwide epidemiological study. The number of the registered patients during these 3 years was 9752 and the mean response rate of every of the 47 prefectures was 51.4%. ⋯ The age distribution and the causes of spinal cord injuries are presented in detail. From the results of this study, the prevention campaign should be focused mainly on the following topics: sports and motorcycle accidents involving young people; traffic accidents involving adults; falling accidents involving aged people.
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We present the case of a 60 year old C6 complete tetraplegic patient who developed profound hypotension following initiation of the angiotensin-converting enzyme inhibitor lisinopril to control blood pressure. Other causes of hypotension, such as myocardial infarction and sepsis was ruled out. ⋯ This case demonstrates the critical importance of the renin-angiotensin-aldosterone axis in the maintenance of blood pressure in tetraplegic patients, who may lack input from the brain to sympathetic neurons, and therefore have increased reliance on the renin-angiotensin-aldosterone axis for the maintenance of blood pressure. Angiotensin-converting enzyme inhibitors should be avoided in tetraplegic patients, unless other treatment modalities are ineffective.