Introduction. Cranio-cerebral trauma (CCT) can be defined as a brain damage caused by an external factor. It may or may not penetrate the skull. Examples of CCT causing sources can be: car accidents, falls (from height or same level), blows with blunt objects, shooting, etc. The diagnosis is generally easy to establish through anamnesis with the patient or witnesses, then by tomography. Having the patient's consent and The Teaching Emergency Hospital "Bagdasar-Arseni" Ethic committee's approval, N.O. 17464 per 14.06.2019, this article presents the evolution of a 32-year-old male, tetraparetic with predominance of paraparesis, bradylalia and cerebrastenia (with significant improvement) and disgraphy, following a severe CCT -bifronto-basal and bitemporal contusion. Operated temporo-parieto-occipital fracture (right parietal decompression flap) -all by falling off the horse (affirmative). Joint stiffness in the knees (by Pellegrin-Shida heterotopic periosteal calcifications). Total post-traumatic optic atrophy RE and partial optic atrophy LE. Multiple bedsores. Neurogenic bladder (carrier of indwelling urinary catheter). UTI with Proteus Mirabiris (etiologically treated) was admitted in the Neurorehabilitation Clinic of the Teaching Emergency Hospital"Bagdasar Arseni" (TEHBA) for tetraparesis motor deficit, retention sphincter disorders, locomotor and severe auto-care dysfunctions, specialized recovery and nursing treatment with favorable development. Discussion: The peculiarity of this case is the good evolution of a patient with severe CCT and multiple associated complications. Last but not least, we can highlight how the CCT was produced, namely by falling off the horse. This tells a lot about the importance of the precautions and equipment needed during a sport, in our case wearing a helmet.
Introduction Paraplegia or paralysis of lower extremities is caused mainly by disorders of the spinal cord and cauda equina. They are classified as traumatic and non traumatic. Non traumatic paraplegia has multiple causes such as cancer, infection, intervertebral disc disease, vertebral injury and spinal cord vascular disease. The current case report presents the case of a male patients with paraplegia related to the thoracic spondylodiscitis in a patient on haemodialysis. Material and method. Having the patient's consent and The Teaching Emergency Hospital "Bagdasar-Arseni" Ethics Committee's approval, N.O. 17464/14.06.2019, a 72 years old patient, which known with operated bladder neoplasm (2015-neobladder), Chronic kidney failure in haemodialysis program and spondylodiscitis T10-T11 operated in 29.12.2018. Results and discussions. The patient improved on most of the assessment scales/scores implemented in our clinic's Division Motor FIM ( Functional İndependence Measure) from 43/91 to 54/91,AIS (American Spinal Injury Association Impairment Scale) from 85/100 motor to 92/100. Conclusions. İnfectious diseases are important causes of non-traumatic paraplegia. The risk of infection on haemodialysis patient is further increased because of frequent routine skin penetration for venipuncture and operative procedures such as placement of venous catheters and vascular grafts.
Introduction. Disc herniation occurs most commonly in the lumbar region (95% of the cases). The current trend is to have surgery on patients with disc herniation if the kinetic treatment was not beneficial. The data from the literature suggest that early active recovery after lumbar disc herniation is more beneficial than a traditional, less active training program. Material and method. Having the patient's consent and the approval of the Ethics Committee of “Bagdasar-Arseni” Clinical Emergency Hospital, N.O. 17464 / 14.06.2019, the paper presents the case of a 75-year-old patient with paraparesis after multilevel lumbar disc herniation, spinal canal stenosis and spondylolisthesis iteratively operated, in pluripathological context (hyperplastic type II obesity, hypertension, prostate adenocarcinoma operated in 2015, Clostridium enterocolitis). The patient was clinically and functionally evaluated, according to the standardized protocols implemented in our clinic, through the assessment scales (ASIA, FIM, FAC, QoL, Ashworth and Penn) and also paraclinically, in order to evaluate his biological reserve and his bearing availability of the recovery program. Results and discussions. The patient presented a slowly favorable evolution (slowed down not only by his multiple above-mentioned comorbidities) from a dysfunctional point of view. Conclusions. Early active recovery after lumbar disc herniation surgery is more beneficial than a traditional, less active training program for operated herniated discs. Keywords: Schizophrenia, spinal cord injury, multidisciplinary, suicide attempt, rehabilitation,
Introduction. Schizophrenia is a surprisingly common chronic psychiatric illness in the general population affecting 1 in 100 people worldwide. Although the symptoms widely differ from one case to another, schizophrenia is quite difficult to recognize because the patient can behave normally and appropriately in different social situations. Studies in the literature highlight that the majority of the patients with SCI and pre-existing schizophrenia have suffered accidents as a result of voluntary height adjustments. Also, 37.5% of the suicide attempts with SCI are caused by schizophrenia and depression. The main difficulties encountered in the recovery of these patients are the psychiatric manifestations. At the same time, the risk of suicide in patients with schizophrenia after suffering from SCI is higher than those with SCI without schizophrenia. Therefore, the recovery of the patients with SCI and schizophrenia is a complex process which requires the control of the psychiatric symptoms. A multidisciplinary team is required for such a purpose. Material and method. Having the patient's consent and approval of the Ethics Committee of “Bagdasar-Arseni” Clinical Emergency Hospital, N.O. 3159/30.01.2020, the paper presents the case of a 23-year-old female patient with AIS/ Frankel B flaccid paraplegia after TVML after falling from height (affirmative through window-suicide attempt) operated on, in a polytraumatic context. The patient is known with schizophrenia and she was being monitored by a psychiatrist at the time of the accident, but she voluntarily discontinued treatment during that period. The patient was clinically and functionally evaluated, according to the standardized protocols implemented in our clinic, through the assessment scales (ASIA, FIM, FAC, QoL, Ashworth and Penn) and also paraclinically, in order to evaluate her biological reserve and her bearing availability of the recovery program. Results and discussions. The patient presented a slowly favorable evolution (slowed down by her severe motor deficit, but also by her psychiatric symptoms such as affective ability with depressive, negative behavior, depersonalization). Conclusions. The main difficulties encountered in the recovery of these patients are the psychiatric manifestations. Therefore, the recovery of patients with SCI and schizophrenia is a complex process that first requires the control of psychiatric symptoms. A multidisciplinary team is required for such a purpose. Keywords: Schizophrenia, spinal cord injury, multidisciplinary, suicide attempt, rehabilitation,
Introduction. Millard-Gubler syndrome (MGS), also known as the ventral pontine syndrome or hemiplegic syndrome, is one of the classical crossed syndromes characterized by a unilateral lesion of the basal portion of the caudal part of the pons. MGS manifests as ipsilateral palsy of CN VI and VII with contralateral hemiplegia. Wallenberg syndrome or lateral medullary syndrome, is characterized by the triad of Horner's syndrome, ipsilateral ataxia and contralateral hypoalgesia. Other clinical symptoms may include difficult swallowing, slurred speech, vertigo, nausea, vomiting, dyspnea, tachycardia, headaches and muscular hypertonia. Materials and Methods Having the patient’s consent and The Teaching Emergency Hospital “Bagdasar-Arseni” Ethics Committee N.O 20270 from the 26th of June 2019, the current case report presents a 67-year-old male patient from rural area with left hemiplegia (complete brachial and crural motor deficit), right eye abduction paresis, dysphagia, dysphonia, central facial palsy - all post acute ischemic stroke. The patient was also diagnosed with ischemic cardiomyopathy, atherosclerosis, alcoholism, type 2 diabetes with Insulin therapy and oral antidiabetic agent. The patient was admitted in the Neurorehabilitation Clinic of the Teaching Emergency Hospital „Bagdasar-Arseni” (TEHBA) Bucharest, Romania, associating severe alteration in self-care abilities, locomotor dysfunction, memory disorders, slurred speech, for specialized rehabilitation treatment and nursing. Results. A case of rare pathology for which, unfortunately, there is a discrepancy between functional improvement and the poor motor control in the in the lower limbs (muscle force was 0-1 out of 5 on the Medicale Research Council scale), within an overall favorable evolution, including elements of the clinical status afferent to the two above mentioned syndromes. Conclusions. Approaching such a clinical case has been a complex and extensive challenge for the entire neuromuscular recovery team and remains similar for any other squad. This pathology remains an issue that demands our earnest attention. Key words: Millard-Gubler syndrome (MGS), Wallenberg syndrome, crossed syndromes, hemiplegia, neurorehabilitation, stroke
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