Acute onset hemiparesis is a common initial presentation of cerebral ischemic stroke. However, other possibilities should be considered as well before final diagnosis. Motor deficits resulting from spontaneous spinal epidural hematoma (SSEH) are usually paraparesis or quadriparesis, but a few cases of SSEH that presented hemiparesis have been documented and misdiagnosed as cerebral ischemic stroke. Herein, we present a rare case of SSEH with acute hemiparesis, which was initially misdiagnosed.

Background:Increasing literature data suggest that cranioplasty at early stage of skull defects may lead to better rehabilitation outcome. This study was conducted to explore the relationship between the timing of cranioplasty and neurological rehabilitation in patients with traumatic skull injury (

The aim of this paper is to present a 13-year-old patient with bilateral lower limb paralysis and bladder incontinence rapidly progressive within a week. Spine magnetic resonance imaging (MRI) showed a giant epidural mass extending from C6 to T6 and involving soft tissue paraspinally. A surgical procedure was performed, and postoperative histopathologic examinations proved that the mass was B-cell lymphoblastic lymphoma. Preoperative symptoms were not relieved because of some complications, which occurred postoperative. Decreased blood platelets caused a serious coagulation function disorder and discontinuity hyperpyrexia postoperatively. The patient had a poor prognosis and died 1 month postoperatively. When B-cell lymphoma has a serious neurological deficit with bone morrow involvement, surgical treatment should be considered cautiously.

Introduction: There are 3 ways for the treatment of patients for spondylolisthesis grade 1 in lumbosacral region associating with lumbar disk herniation or lumbar stenosis: pedicular screw fixation method alone; pedicular screw with insertion of trans lumbar interbody fusion (TLIF), or with posterior lumbar interbody fusion (PLIF). Interestingly, all methods have associated with satisfactory results. However, which method is superior for the treatment of such patients still has remained controversial. Materials and Methods: Patients with clinical signs and symptoms of disk herniation or lumbar canal stenosis and also spondylolysthesis grade 1 were selected, who had randomly undergone pedicle screw and posterior fusion surgery, pedicle screw and TLIF surgery, pedicle screw and PLIF surgery, or without instrumentation and fusion, in neurosurgery section in Mashhad, from 2009 to 2011. Afterwards, clinical symptoms, radiologic study results, amount of fusion in terms of Brantigan and Stefee indices, and functional improvement by Oswestry Disability Index were recorded after 6 and 12 months from surgery, respectively. Results: Of 120 patients who were analyzed in 4 treatment groups, age and sex distribution was matched. Also, L4-L5 involvement was more common in 3 groups with a normal distribution. Statistically, Oswestry Disability Index had a significant reduction after operation, and no significant differences were observed among the 3 study groups. These groups showed no significant variation in degree of fusion and Brantigan and Stefee index, but in the group which had been undergone surgery without instrumentation and fusion, the difference was significant. Conclusions: After a 12-month follow-up, the 3 procedures of TLIF, PLIF, and posterior fusion pedicle screw did not show any difference in functional improvement of the patients, degree of fusion, and complications significantly, whereas all of them had a significant preference rather than the fourth group, in which no instrumentation and fusion was applied.

The purpose of this study is to report a case of massive, spontaneous, subcutaneous hematoma in a neurofibromatosis type 1 (NF1) patient. NF is rarely associated with spontaneous hemorrhage. Massive, spontaneous, subcutaneous hemorrhage in the lower back is also rare. Patients with NF1 should understand the potential complications of their disease and surgeons and physicians should be prepared to promptly manage such complications in these patients.

Intramedullary spinal cord metastasis is the rarest type of central nervous system involvement from breast cancer. Only a few cases have been reported in the literature. Most commonly, it is a late manifestation of the disease and survival after the diagnosis of intramedullary metastasis is unfortunately not good. Herein, we present a case with no metastasis other than the neuroaxis, relatively newly diagnosed, an aggressive inflammatory infiltrative intraductal carcinoma, having multiple metastatic intramedullary masses and leptomeningeal involvement.

We report a unique case of recurrent asystolic episodes arising from carotid sinus hypersensitivity (CSH), during surgical intervention for cervical disk prolapse under general anesthesia. As the patient’s neck was positioned for optimal surgical exposure, an incidence of cardiac arrest lasting 5.8 seconds was detected that was restored to normal sinus rhythm by cessation of any manipulation in the neck and intravenous administration of atropine 0.5 mg. The incidence recurred twice and it was again elicited from light manipulations at the right side of the neck, where the surgical procedure was going to be performed. An extremely sensitive carotid sinus reflex was suspected, but as the surgical procedure could not be postponed owing to its urgent nature, a temporary pacing establishment was decided. Thereafter, having the temporary pacemaker in situ at demand function, surgical intervention was completed uneventfully. Recurrent episodes of bradycardia were recorded at several time-points throughout the surgical procedure, which was effectively managed by the ventricular pacing. The postoperative course was uneventful. Our case comes to highlight the importance of heightened awareness of CSH as this syndrome constitutes an unexpected but potentially lethal entity during positioning for cervical spine surgery. Considering that, the intraoperative period itself poses significant challenges, high clinical suspicion, early identification of the signs of possible CSH, close hemodynamic monitoring, and immediate availability of vagolytic drugs, b-1 stimulators, and intraoperative cardiac pacing are the key elements for an early diagnosis, timely management, and a favorable outcome.

There are some reports about the extreme lateral disk herniation mimicking a retroperitoneal neoplasm or a nerve sheath tumor. To date, however, few cases of anterior herniation of the disk have been reported and it is more frequently confused with a retroperitoneal neoplasm than the extreme lateral