A male patient, aged 55 years, presented to the emergency room with complaints of bilateral upper extremity weakness. His past medical history was significant for paraplegia and neurogenic bladder from a spinal cord injury, complicated with decubitus ulcers and end-stage renal disease secondary to type II diabetes mellitus. His past surgical history was significant for posterior spine fusion with Harrington rod instrumentation at the level of T10. He developed subacute onset of bilateral upper extremity weakness and paresthesias on the day of presentation. He reported a 2-day history of neck and back pain that he initially contributed to his bedridden state. The patient denied fever, recent infections, or trauma. His vital signs were unremarkable. Physical examination revealed quadriparesis, absence of deep tendon reflexes, hypoesthesia, and decubitus ulcers (figure 1). He had a normal leukocyte count and elevated C-reactive protein. Blood cultures and cultures from the ulcers were obtained. With the concern of spinal cord compression based on presentation, intravenous corticosteroids and broad spectrum antibiotics were initiated. A magnetic resonance imaging (MRI) scan of the spine (figure 2) revealed large elongated epidural collection posteriorly within the cervical spine, extending into the thoracic spine and inferiorly. Spinal cord compression was prominent in the narrowed areas of disc-osteophyte complexes at the levels of C3-4 and C5-6, where the spinal cord was compressed between these disc-osteophyte complexes and the posterior epidural collection, with some mildly increased signal intensity within the cord. The lumbosacral spine was not well imaged due to artifacts of spinal hardware. Emergent drainage of the collection was indicated, but the patient declined. Per the patient's wishes, palliative care was initiated on the day Spinal subdural abscess (SSA) is an uncommon entity. The exact incidence is unknown, with very few cases reported in the literature. This condition may result in spinal cord compression, thus constituting a medical and neurosurgical emergency. The pathogenesis of SSA is not welldescribed, and the available knowledge is based on case observations only. There is only one case report that describes direct seeding from decubitus ulcers as a possible mechanism for development of SSA. We report a case of subacute onset of quadriplegia in a male patient, age 55 years, due to spinal cord compression from SSA and superimposed spinal subdural hematoma. The direct seeding from decubitus ulcers is thought to be the cause of infection in our patient. We present this case of SSA to elucidate and review the predisposing factors, pathogenesis, clinical presentation, diagnostic modalities, and treatment regarding management of this rare disorder.

Unprovoked deep venous thrombosis (DVT) in young adults is an unusual phenomenon, but it is associated with significant morbidity. Developmental anomalies of the inferior vena cava (IVC) should be considered as a possible aetiological factor, and appropriate investigations should be performed to determine the conclusive diagnosis and necessary treatment plan. We report a case of spontaneous thrombosis of the IVC and bilateral iliac venous system in a young man, associated with membranous obstruction of the IVC. He was diagnosed using several different investigational techniques, and successfully treated with mechanical thrombectomy, thrombolysis therapy and anticoagulation.

Background. Rehabilitation of patients with chronic disorders of consciousness is extremely important due to severity of the condition and increasing number of such patients. Disorders of consciousness have led to inability of self-care, need for constant care and complete dependence on outside assistance. Applying noninvasive brain stimulation and rhythmic transcranial magnetic stimulation seems to be perspective methods of rehabilitation. Aim. to evaluate the efficiency of rhythmic transcranial magnetic stimulation of left dorsolateral prefrontal cortex using local navigation in patients with chronic disorders of consciousness. Methods. This prospective study was carried out in patients with chronic disorders of consciousness after severe brain injury. All patients received 10-day treatment with active high-frequency rhythmic transcranial magnetic stimulations of the left dorsolateral prefrontal cortex. Revised coma recovery scale (JFK Coma Recovery Scale-Revised, CRS-R) was used to evaluate the effectiveness of the procedure. Results. After the treatment with rhythmic transcranial magnetic stimulations according to CRS-R 8 out of 12 patients improved their score. The best response was observed in patients in minimally conscious state. There were no cases of adverse events during the treatment. Conclusion. High-frequency rhythmic transcranial magnetic stimulations provide an opportunity to improve level of consciousness in patients after severe brain injury. Using navigation system allows to rule out an inaccuracy in determining the dorsolateral prefrontal cortex. As a result this study proposed the effective and safe protocol for rehabilitation of patients with chronic disorders of consciousness.

The article outlines the current knowledge of the etiology, pathogenesis, clinical features and diagnostic criteria of one of the forms of mitochondrial encephalomyopathy – the Kearns–Sayre syndrome. The observation of a patient with an incomplete case of the Kearns–Sayre syndrome is presented. The complexity of diagnosis and the range of differential diagnostic search as well as approaches to treatment with the use of neurotrophic factors are widely discussed in the research.