Most spinal schwannomas derived from Schwann cells
Most spinal schwannomas derived from Schwann g to mol calculator along the dorsal sensory roots involve radicular pain as the most common initial symptom. However, symptoms may be subtle and progress slowly over time, owing to the slow-growing nature of these tumors. In our case, it\'s more difficult to think about a spinal tumor in a schizophrenic patient with persecutory delusion history who complains that “something in his back was giving him electric shock”. Moreover, the back pain complaint was relatively nonspecific and could be multifactorial. A thorough and detailed neurological examination is required to evaluate patients presenting with back pain for any signs of myeloradiculopathy or abnormal reflexes.
We highlighted this case for another purpose, namely to remind every clinician about the possibility of organic disease in patients with psychotic delusions. A wide variety of organic diseases masquerade as psychiatric disorders. Clinicians may be distracted easily by a patient\'s chief presentation of psychotic delusions, hallucinations, or anxiety, and ignore the possibility of organic disease. This case reminds us of the danger of misdiagnosis, and should encourage every clinician to remain alert to etiological clues when obtaining medical histories and during examination, especially when treating patients who have a history of psychotic disorder.
The treatment of choice for spinal canal schwannoma is complete microsurgical resection. Solitary schwannomas are rarely found, and infrequently manifest malignant degeneration. The prognosis of spinal schwannoma is good when complete tumor resection is achieved. They rarely recur after gross total resection, except in cases of schwannomatosis.
The major goals of spinal schwannoma surgery are to perform neural decompression and total tumor resection without damaging adjacent neural tissue. Radical tumor removal sometimes requires that the nerve root origin involved in the schwannoma be sacrificed. However, several studies have reported the risk of neurological deficits following resection of the nerve roots involved in schwannomas. Kim et al reported that 7 of 31 patients (22.5%) developed partial loss of motor strength or sensation postoperatively. Ohnishi et al reported that 3 of 15 patients developed neurological deficits. Two of 6 patients (33.3%) with ventral nerve root origin tumors had minor postoperative motor weakness. Only 1 of 9 patients (11.1%) with dorsal nerve root origin tumors had postoperative segmental sensory numbness. In our case, there was no resulting neurologic deficit from dorsal root sacrifice. Similarly, Schirmer et al even demonstrated that resection of dorsal nerve root tumors resulted in almost no detectable loss of skin sensation. Dermatomes overlapping from adjacent nerve roots could be one possible explanation.
Intraoperative electrophysiological monitoring including neurostimulation is a useful tool to establish the function of nerve root before sacrifice. Free-running electromyography (EMG) and electrical stimulation with compound muscle action potential (CMAP) recordings, also called triggered EMG, could be used to monitor and identify root function. A monopolar stimulation electrode is used to elicit evoked EMG responses from the affected root, or any suspicious tissues that may contain neural structures before resection. Additionally, somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (MEP) could prove efficacious in monitoring the integrity of the spinal cord. SSEPs monitor the dorsal column-medial lemniscus pathway, while MEPs monitor the corticospinal tracts. The combined use of SSEPs, MEPs, and both spontaneous and triggered EMG provide optimal monitoring of spinal cord function and minimize intraoperative neurological injury.
Introduction The eosinophilias encompass a broad range of nonhematologic (secondary or reactive) and hematologic (primary, clonal) disorders with potential for end-organ damage. Hypereosinophilic syndrome (HES) has generally been defined as a peripheral blood eosinophil count greater than 1500/mm3 and may be associated with tissue damage. Overall, HES is a rare disease with an incidence of approximately 0.036 per 100,000.