- MeSH
- 2. světová válka MeSH
- bomby MeSH
- chirurgie operační * metody MeSH
- dějiny lékařství MeSH
- drenáž MeSH
- lidé MeSH
- pitva MeSH
- pooperační komplikace * etiologie MeSH
- poranění tlakovou vlnou * terapie MeSH
- poranění zad * etiologie komplikace terapie MeSH
- příčina smrti MeSH
- vražda * dějiny MeSH
- výsledek terapie MeSH
- významné osobnosti MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- biografie MeSH
- O autorovi
- Heydrich, Reinhard, 1904-1942, Autorita
- Dick, Walter, 1899-1990 Autorita
- Hohlbaum, Josef, 1884-1945 Autorita
- Gebhardt, Karl, 1897-1948 Autorita
- Honěk, Alois, 1911-2002 Autorita
- Stumpfegger, Ludwig, 1910-1945 Autorita
- Puhalla, Arpád Gejza, 1912- Autorita
- Rössel, Josef Alexander, 1911- Autorita
- Branstätter, Erich, 1903- Autorita
- Hamperl, Herwig, 1899-1976 Autorita
- Weyrich, Günther, 1898-1998 Autorita
- Sachs, Hans, 1912-2000 Autorita
PURPOSE OF THE STUDY Spinal cord concussion is characterised as fully reversible, temporary inhibition of conductive function due to trauma, without signs of structural changes. Although neurological deficit is usually related to the severity of spinal injury, this is different in spinal cord concussion. The aim of this retrospective study was to evaluate a group of 24 patients with spinal cord concussion, to design a diagnostic algorithm and propose an effective therapy with a good prognosis for the patients. MATERIAL We reviewed clinical records of 9 768 patients hospitalised at the Department of Spinal Surgery, University Hospital in Motol, from September 2002 till December 2010, and of 457 patients treated at other departments of the Hospital between January 2008 and December 2010; this was a total of 10 225 patients. The data were retrospectively analysed and only the patients with a clear history of trauma and subsequent conservative therapy were selected to comprise a group characterised by the generally known criteria of spinal cord concussion: (1) spinal injury with immediate neurological deficit of varying degree; (2) neurological deficit corresponding to the level of spinal injury; (3) recovery of neurological function within 72 hours of injury; (4) no morphological evidence of injury to the spinal structures obtained by imaging methods. This group comprised 24 patients. METHODS The patients were followed up from 6 to 95 months, with a mean of 46 months and a median of 48 months, at intervals of 6 and 12 weeks and 6 and 12 months after injury, and then every following year. The recorded information included the patient's age at the time of injury, their gender, the mechanism of injury, reports on alcohol consumption, the first detected neurological deficit, its development immediately after injury, during the hospital stay and at follow-ups in the out-patient department, methylprednisolone administration according to the National Acute Spinal Cord Injury Study (NASCIS) 2, and findings of imaging methods, particularly MRI. RESULTS Our group consisted of 22 men (91.7%) and two women (8.3%), with an average age of 29 years; the average age was 30 years in men and 18.5 years in women. Seven patients (29.2%) were younger than 18 years, with an average of 16.14 years; the remaining 17 patients (70.8%) were older than 18 years, with an average of 34.35 years. The major mechanisms of injury included falls from a height in 10 patients (41.7%) and injury due to alcohol consumption in five patients (20.1%). Clinical findings involved lesions of the medullary cone in 12 (50.0%), cervical spinal cord in seven (29.2%) and thoracic spinal cord in five (20.8%) patients. Motor function deficit was present in all patients, of whom 10 (41.2%) showed a complete loss of motor function. Impaired sensory function was found in 21 (87.5%) patients. One patient had perianal and genital sensory deficit and one (4.2%) had urinary retention. Neither radiograms nor CT scans showed traumatic changes in any of the patients; MRI findings free of any traumatic spinal changes were recorded in 21 patients (87.5%). One patient had oedema of the T5 and T8 vertebral bodies. No complications were recorded. All patients experienced rapid resolution of neurological deficit, which occurred within 6 hours of injury in two (8.4%), within 12 hours in two (8.4%), within 24 hours in 12 (50.0%) and within 48 hours in six (25.0%) patients, and later than 48 hours after injury in two patients (8.4%). However, recovery always occurred within 72 hours of injury. DISCUSSION A good prognosis for patients with this injury is supported by our findings, because all patients experienced rapid resolution of neurological deficit within 72 hours of injury. This result is in agreement with the relevant international studies reporting no serious complications associated with spinal trauma. There are no clear recommendations for administration of high doses of methylprednisolone according to the NASCIS system. CONCLUSIONS Spinal cord concussion is not a frequent injury; in our study, it accounted for 3.54% of the patients with trauma histories out of the total number of 678 patients, or for 2.40% out of 997 injured spinal levels. The first steps should be the same as in any other injury to the spinal cord. An early examination of the patient with imaging methods including MRI is of primary importance. At present administration of methylprednisolone according to the NASCIS system is disputable. The patient diagnosed with spinal cord concussion has a good prognosis, with rehabilitation as the main therapeutic approach.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie využití MeSH
- methylprednisolon terapeutické užití MeSH
- neurologické manifestace MeSH
- poranění míchy etiologie radiografie terapie MeSH
- poranění zad etiologie radiografie terapie MeSH
- prognóza MeSH
- protetické prostředky využití MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- 2. světová válka MeSH
- automobily dějiny MeSH
- bomby MeSH
- dějiny 20. století MeSH
- dějiny lékařství MeSH
- poranění zad etiologie komplikace MeSH
- záchranná práce metody MeSH
- zbraně klasifikace MeSH
- Check Tag
- dějiny 20. století MeSH
- Publikační typ
- biografie MeSH
- historické články MeSH
- O autorovi
- Heydrich, Reinhard, 1904-1942 Autorita
Neuropatická bolest je stav, jehož incidence v běžné populaci se pohybuje okolo 1 % veškerých bolestivých stavů, přičemž je zřejmý její nárůst úměrně zvyšujícímu se věku. Jelikož neuropatická bolest může mít mnoho příčin, liší se i výskyt bolesti konkrétního typu – např. bolest u periferní diabetické neuropatie postihuje ročně 15/100 000 obyvatel, postherpetická neuralgie 11–40/100 000 a neuralgie trigeminu 5–27/100 000 obyvatel. Pouze připomeňme, že neuropatická bolest vzniká jako důsledek postižení nervového systému. Jako taková se tak liší od bolesti nociceptivní, ať již ve smyslu patogeneze, tak i v kontextu následné léčby. Základ terapie představují antidepresiva (I. generace či SSRI a SNRI) a antikonvulziva (karbamazepin, kyselina valproová, gabapentin, pregabalin aj.).
- Klíčová slova
- Lyrica,
- MeSH
- bolest etiologie farmakoterapie MeSH
- bolesti zad etiologie farmakoterapie MeSH
- diabetické neuropatie farmakoterapie MeSH
- GABA aplikace a dávkování farmakologie terapeutické užití MeSH
- lidé MeSH
- nemoci nervového systému komplikace MeSH
- nežádoucí účinky léčiv MeSH
- poranění zad etiologie komplikace MeSH
- postherpetická neuralgie farmakoterapie komplikace MeSH
- Check Tag
- lidé MeSH
- MeSH
- bolesti zad komplikace prevence a kontrola MeSH
- Evropská unie MeSH
- kongresy jako téma normy zákonodárství a právo MeSH
- muskuloskeletální systém patofyziologie zranění MeSH
- nemoci z povolání prevence a kontrola MeSH
- poranění páteře etiologie prevence a kontrola MeSH
- poranění z opakovaného přetěžování patofyziologie prevence a kontrola MeSH
- poranění zad etiologie patofyziologie prevence a kontrola MeSH
- MeSH
- elektromyografie využití MeSH
- financování organizované MeSH
- lidé MeSH
- magnetická rezonanční tomografie využití MeSH
- míšní kořeny fyziologie patofyziologie MeSH
- nemoci páteře diagnóza chirurgie patofyziologie MeSH
- počítačová rentgenová tomografie využití MeSH
- poranění páteře diagnóza etiologie patofyziologie MeSH
- poranění zad diagnóza etiologie patofyziologie MeSH
- studie případů a kontrol MeSH
- termografie metody přístrojové vybavení využití MeSH
- Check Tag
- lidé MeSH