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2018 ; 2018
(ä): 5129513
Nephropedia Template TP
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English Wikipedia
Retained Glass Fragment in the Cervical Spinal Canal in a Patient with Acute
Transverse Myelitis: A Case Report and Literature Review
#MMPMID30009065
Jesmanas S
; Norvainyt? K
; Gleiznien? R
; Ma?ionis A
Case Rep Neurol Med
2018[]; 2018
(ä): 5129513
PMID30009065
show ga
A 50-year-old male presented with a one-day history of right leg weakness,
numbness, and urinary retention. Weakness was present for two weeks but worsened
significantly during the last 24 hours. On the right there was sensory loss in
the leg and below the Th8 dermatome. On the left there was sensory loss below the
Th10 dermatome and distal loss of temperature sensation. Past medical history
revealed a cervical trauma 30 years ago when a glass chip lodged into the left
side of the neck. The patient did not seek medical attention after removing it
himself. No neurological symptoms followed the incident. No cervical manipulation
or other physical trauma occurred before current symptom onset. Magnetic
resonance (MR) imaging showed features consistent with myelitis at the level of
C4-Th3. At the level of C6-C7, a T1 and T2 hypointense lesion was noted. On
computed tomography, this lesion was hyperdense and occupied the spinal canal and
the left intervertebral foramen. It was deemed to be a glass fragment. Surgical
removal was withheld because the fragment was clinically silent for 30 years, the
risk of surgical removal would outweigh the benefits and the patient did not
prefer surgical treatment. Acute demyelinating transverse myelitis was diagnosed
and treated with methylprednisolone. 10 months later MR features of myelitis
resolved and the patient's neurological condition improved. Our case shows that
foreign bodies in the cervical spinal canal can remain asymptomatic for up to 30
years. In the case of a long asymptomatic retention period the need for surgical
removal of a foreign body must be carefully evaluated, taking into account the
probability that a foreign body is the cause of current symptoms, risk of a
foreign body causing damage in the future, risk of damage to the spinal cord
during removal, and probability of therapeutic success.