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. Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion.(1) As a result of the injury, the functions performed by the spinal cord are interrupted at the distal level of the injury. SCI causes serious disability among patients.(2) The treatment and rehabilitation period is long, expensive and exhausting in SCI. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI.(3) Material and method. Having the patient’s consent and The Teaching Emergency Hospital “Bagdasar-Arseni” Ethics Committee’s approval, a 48 years old patient, complete tetraplegic with intense and refractory spasticity and frequency of spasm with presacral pressure sores (successfully operated) post traumatic spinal cord injury. The patient was functionally assessed using the following scales: : Glasgow Outcome Scale Extended, Modified Rankin Scale, Modified Ashworth, Penn Spasm Frequency Scale Functional Independence Measure, FAC International Scale, Quality of Life Assessment. Conclusions. Spasticity is a common secondary impairment after SCI characterized by hypertonus, increased intermittent or sustained involuntary somatic reflexes (hyperreflexia), clonus and painful muscle spasms. Severe spasticity may contribute to increased functional impairment, contractures, ulcers, posture disorders and pain. Treatment should start as soon as possible to prevent such negative effects. Keywords: tetraplegia, spinal cord injury, spasticity, pressure sores, traumatism, 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
The subject matter of the present scientific paper is the report of a sustained, sequential, stage-adjusted and persistent therapeutic rehabilitation team-run program over a relatively short period of time in the case of a polytraumatized patient with severe TBI (GCS=4), multiple pelvic fractures, right clavicle fracture, incomplete fracture of the left transverse apophysis L5 -unoperated, perivesical hematoma, thoracoabdominal contusion, neurogenic bladder and antero-retrograde amnesia related to trauma that led to a favorable progression despite the contraindication of sitting positioning and the mental state of the patient during hospitalization.
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