This document summarizes a case study of a 61-year-old female undergoing thoracic spinal reconstruction surgery. Prior to surgery, long-latency motor evoked potentials (LLMEPs) were observed in addition to standard motor evoked potentials (MEPs) when the recording window was expanded beyond 200ms. During surgery, the LLMEPs disappeared before standard MEPs as the spinal stenosis was decompressed, suggesting LLMEPs may be a sensitive indicator of spinal cord function. Post-surgery, LLMEPs did not fully return even as standard MEPs persisted, demonstrating the potential utility of LLMEPs in monitoring spinal surgeries. The author encourages expanding MEP recording windows and further study of LLME
Leiomyoma is a benign tumor that originates from smooth
muscle cell. The most common sites are the uterus, gastrointestinal tract & skin. Leiomyoma is a relatively uncommon smooth muscle tumor rarely found in the head and neck. Enzinger and Weiss (1995), analyzed a total of 7748 leiomyomas, 95% of the tumors occurred in the female genitalia (uterus), 3% in the skin, 0.9% in the gastrointestinal tract and the remainder at various sites including skull base.
Leiomyoma is a benign tumor that originates from smooth
muscle cell. The most common sites are the uterus, gastrointestinal tract & skin. Leiomyoma is a relatively uncommon smooth muscle tumor rarely found in the head and neck. Enzinger and Weiss (1995), analyzed a total of 7748 leiomyomas, 95% of the tumors occurred in the female genitalia (uterus), 3% in the skin, 0.9% in the gastrointestinal tract and the remainder at various sites including skull base.
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8% of all bone tumors present in spine
25-30% of bone tumors are benign
Peak age: 2-3rd decade
Posterior element involved: osteoid osteoma, osteoblastoma, aneurysmal bone cyst
Anterior element involved: giant cell tumor, hemangioma, eosinophilic granuloma
Vertebral Column Tumors
Primary tumors: These tumors occur in the vertebral column, and grow either from the bone or disc elements of the spine. They typically occur in younger adults. Osteogenic sarcoma (osteosarcoma) is the most common malignant bone tumor. Most primary spinal tumors are quite rare and usually grow slowly.
Metastatic tumors: Most often, spinal tumors metastasize (spread) from cancer in another area of the body , These tumors usually produce pain that does not get better with rest, may be worse at night, and is often accompanied by other signs of serious illness (such as weight loss, fever/chills/shakes, nausea or vomiting).
This was an invited talk at the Royal Sutani Hospital, Muscat , Oman in 2007 delivered by:
Dr Ahmed Elwatidy, MD, FRCS
Senior consultant cardiac Surgeon
Associate clinical professor of cardiac surgery
Epilepsy getting the most out of neuroimaging 2019Felice D'Arco
Lecture presented at the Great Ormond Street Hospital Paediatric Neuroradiology Masterclass 2019 on how to optimize MR imaging in epilepsy with most common epilepsy cases and differential diagnoses and use of multidisciplinary approach in lesion detection.
8% of all bone tumors present in spine
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This was an invited talk at the Royal Sutani Hospital, Muscat , Oman in 2007 delivered by:
Dr Ahmed Elwatidy, MD, FRCS
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Associate clinical professor of cardiac surgery
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Metastasizing benign leiomyoma is an extrauterine smooth muscle tumour. Leiomyoma in spine is extremely rare. We report a case of a 47-year-old female with benign leiomyoma metastasizing to the spine. To our knowledge no case of benign leiomyoma metastasizing to the spine has been reported before. Magnetic Resonance Imaging (MRI) revealed C6, C7 vertebral involvement, T2, T4, T7, T8, T11, L2, L3, L4, L5 moderate spinal canal stenosis and cord impingement and cord compression at T12 level. She also presented with growth over her right elbow and psoas muscle.
Melanotic schwannoma of adrenal gland - A rare entity/ diagnostic dilemmaApollo Hospitals
Melanotic schwannoma of adrenal gland is very rare entity with
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Long-Latency Motor Evoked Potential Changes During Spinal Reconstruction
1. Title: Long-Latency Motor Evoked Potentials (LLMEPs): Changes Observed During Thoracic Spinal Reconstruction
Author: David Barnkow, Au.D., D.ABNM, CCC-A, Medsurant Health, Denver, Colorado, March 28, 2019
The Case Presentation: A 61 year-old female with a history of mid-thoracic spinal cord infarct and C8 incomplete quadriplegia as a complication of spinal cord
stimulator placement. The chief complaints were increasing hand numbness and weakness, low back and lower extremity spasticity, and loss of range of
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graft, and T4- S1 revision posterior spine fusion and instrumentation.Table 1. Motor Strength Assessment
Figure 1. Sensory Assessment – Pin Prick
Figure 2. Left TceMEPs prior to incision. Identification of possible repetitive myogenic
activity beyond 200 ms prompts Neurophysiologist to expand recording window to 300
ms. Normal latency MEPs in red. LLMEP extending beyond 200 ms in orange. LLMEPs
greater than 200 ms in blue.
Figure 3. Left TceMEPs during thoracic decompressive laminectomies. LLMEPs (orange)
emerge before TceMEPs. Conventional TceMEPs (red) persist after LLMEP disappear.
Discussion: Ulnar SSEPs remained identifiable and posterior tibial SSEPs
remained absent throughout the surgery. Right side TceMEPs
demonstrated data similar to left side TceMEPs throughout the surgery.
This case study demonstrates that expanding the recording window of
current standard TceMEP protocols beyond 200 ms can reveal another
category of motor evoked potentials, the LLMEP. The disappearance of
the LLMEPs during a surgical period presumed to improve
neurophysiologic function is interesting. While the underlying
mechanisms and clinical utility of LLMEPs have not been described, this
author encourages all clinicians to consider expanding their recording
window to collect possible LLMEPs, and to publish and share their
LLMEP findings for a greater meta-analysis of this interesting, yet
essentially undescribed, phenomenon.
Figure 4. Left TceMEPs during instrumentation, deformity correction, and closing.
Note the persistence of the conventional TceMEPs (red). Also note the absence of
LLMEPs in VM and AbH montages, and pronounced intermittency of LLMEPs (orange)
in TA montage.
Figure 2. Sensory Assessment - Light Touch