Search Results (172)

Atlantoaxial dislocation (AAD) or subluxation (AAS) is a potentially life-threatening disorder caused by instability between the atlas and axis. Typical symptoms include neck pain, torticollis, and neurological deficits, but dizziness has rarely been reported in association with AAD/AAS. We describe an adolescent girl who presented with non-spinning dizziness, neck pain, and torticollis after prolonged head flexion and extension. Neurological examination showed rightward torticollis without nystagmus. Cervical spine imaging revealed atlantoaxial rotatory dislocation and fixation, while CT angiography confirmed patency of both vertebral arteries. Conservative management with cervical traction was ineffective, and surgical reduction with C1–C2 fixation and fusion was performed. The patient experienced complete resolution of dizziness and torticollis postoperatively without complications. This image-based report describes a rare case of AAD in which dizziness was the main presenting symptom. This case highlights that cervical instability should be considered in the differential diagnosis of dizziness. Full article

Hydronephrosis caused by malignant ureteral obstruction or radiotherapy-induced ureteral stenosis is a frequent complication in patients with cervical cancer. Effective management requires continuous urinary drainage, which can be achieved either internally through ureteral stent placement or externally via percutaneous nephrostomy. Among available devices, the Allium^TM fully covered nitinol mesh ureteral stent is designed to treat ureteral or urethral strictures while allowing safe and easy removal. However, serious complications have been reported, including uretero-enteric, uretero-arterial, and uretero-vaginal fistulas, pseudoaneurysm, ureteral perforation and sepsis. We report the case of a 44-year-old woman diagnosed in 2020 with stage IIIC1 cervical cancer (FIGO classification) who underwent surgery followed by adjuvant radiotherapy. In 2021, a right metallic ureteral stent was placed to treat ureteral obstruction. Two years later, she presented with right lumbar pain, and abdominal ultrasonography revealed grade III right hydronephrosis. CT scan demonstrated migration of the metallic ureteral stent into the rectal wall. Endoscopic extraction of the migrated stent was successfully performed via colonoscopy. Retrograde pyelography and CT imaging confirmed the presence of a recto-ureteral fistula. A 6 Ch/26 cm double-J ureteral stent was subsequently placed with good positioning and drainage. At the six-month follow-up, replacement of the double-J stent was performed. Imaging studies showed only minor residual hydronephrosis. Although metallic ureteral stents are effective for managing malignant ureteral obstruction, particularly in complex oncologic cases, they are not free of severe complications. The risk appears increased in patients who have undergone radiotherapy, emphasizing the need for careful monitoring and long term follow-up. Full article

Background and Objectives: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex disorder characterized by persistent or relapsing fatigue lasting at least six months, not alleviated by rest and not previously present. It is accompanied by post-exertional symptom exacerbation and non-restorative sleep. Fatigue is often disabling and reduces daily activity by more than 50%. This study aimed to evaluate the long-term frequency of somatic and psychiatric disorders in women previously diagnosed with ME/CFS and to describe the long-term clinical course, laboratory findings, and fatigue-related changes during a 16-year follow-up period. Materials and Methods: Sixteen years ago, 40 women diagnosed with ME/CFS according to then-current CDC criteria were enrolled at the Clinic for Infectious Diseases and the Center for Laboratory Medicine, University Clinical Center of Vojvodina. All participants provided informed consent. After 16 years, 20 women agreed to follow-up evaluation. At both time points, participants underwent structured questionnaires, clinical examination, psychological assessment, and comprehensive laboratory testing, including hematological, biochemical, endocrinological, and virological analyses. Fatigue severity was assessed using the FibroFatigue Scale (FFS) and the Multidimensional Assessment of Fatigue (MAF) scale. Results: During follow-up, 15% of participants were diagnosed with rheumatoid arthritis, 10% with cervical or breast cancer, 5% experienced premature myocardial infarction, 5% developed bronchial asthma, and 20% were diagnosed with clinical depression. Progression of ME/CFS was observed in 15%, while 5% reported infertility. Additionally, 15% developed arterial hypertension. Only 15% of participants did not report symptom worsening or new diagnoses. Conclusions: Over the 16-year follow-up, 85% of women with ME/CFS developed significant somatic or psychiatric conditions. These findings suggest that women diagnosed with ME/CFS may experience substantial long-term somatic and psychiatric disease burden, supporting the need for continued clinical monitoring and individualized follow-up. Full article

Background: Fractures of the upper cervical spine are challenging to treat due to their proximity to critical neurovascular structures and the need for immediate, stable fixation. Open posterior fixation remains the standard but is associated with soft-tissue disruption and morbidity. Minimally invasive, navigation-assisted pedicle screw fixation represents a viable alternative for older populations, significantly reducing surgical morbidity and tissue trauma. The present study evaluates the accuracy, safety, and perioperative outcomes of minimally invasive navigated posterolateral C1–C2 fixation. Methods: We conducted a retrospective consecutive case review of 51 patients who underwent minimally invasive C1–C2 screw fixation between 2019 and 2024. All procedures were performed using intraoperative O-arm imaging and StealthStation S8 navigation. Screw placement accuracy was assessed using the Bredow modification of the Gertzbein–Robbins and Heary classifications. Perioperative data, including operative time, screw dimensions, radiation dose, complications, and hospital stay, were recorded. Results: Fifty-one patients were included in the study. A total of 212 screws were placed. According to Gertzbein–Robbins grading, 92.4% were Grade A, 6.6% were Grade B, and 1% were Grade C. According to Heary grading, 95% were Grade I and 5% were Grade III. No vertebral artery injuries, new neurological deficits, or intraoperative hardware failures occurred. The mean screw lengths were 33.2 mm (SD = 3.38 mm) (C1) and 32 mm (SD = 4.30 mm) (C2). The mean operative time was 128 min (SD = 52.95 min). The mean radiation dose was 629.16 mGy·cm² (SD = 372.2 mGy·cm²). One superficial wound infection occurred. The median postoperative NRS was 4 (IQR: 4–5). The mean hospital stay was 4.21 (SD = 3.77) days. Conclusions: Our findings demonstrate that the presented approach for C1–C2 fixation is a highly accurate and safe alternative to open posterior fixation for upper cervical fractures. Full article

Background/Objectives: Occipital defects with dural exposure represent a complex reconstructive challenge requiring reliable vascularized coverage to prevent severe complications. This study aims to describe a salvage reconstructive approach using a transverse cervical artery (TCA)-based inferior trapezius flap and to highlight a technical modification intended to increase flap reach. Methods: We report the case of a 61-year-old male presenting with a chronic occipital defect associated with infection following cerebellar abscess evacuation. After failure of primary closure, skin grafting, and local flap reconstruction, a regional pedicled inferior trapezius musculocutaneous flap was performed. Intraoperatively, the dorsal scapular artery (DSA) was selectively sacrificed after confirmation of dominant TCA perfusion to increase the arc of rotation. Flap perfusion was assessed clinically. Results: The flap provided adequate coverage of the defect with stable perfusion. The postoperative course was favorable, with resolution of a minor donor-site seroma. At 1- and 3-month follow-up, stable coverage, preserved cervical mobility, and satisfactory aesthetic outcomes were observed. These results were maintained at 1-year follow-up, with no functional limitation or late complications. Conclusions: This single case report suggests that a TCA-based inferior trapezius flap may represent a feasible salvage option in selected occipital defects. The intentional sacrifice of the DSA appeared to increase flap reach in this case; however, its safety and reproducibility remain uncertain. Further studies are required before this approach can be routinely recommended. Full article

Background: Cervical radiculopathy due to vertebral artery loop formation (VALF) is rare. This case demonstrates endoscopic posterior foraminotomy after failed conservative treatment. Methods: We report a case of VALF treated by means of uniportal full-endoscopic posterior foraminotomy. A focused narrative literature review identified prior surgical cases of VALF-related cervical radiculopathy. Case description: A 69-year-old woman had a 4-month right C5 radiculopathy (neck pain, arm radiation, Spurling-positive) due to VALF at C4-5, confirmed via MRI and CT angiography. After failed conservative treatment, full-endoscopic posterior foraminotomy was performed; the symptoms resolved at 3 months. Conclusions: Clinicians should be aware that vertebral artery loop formation, although rare, is an important potential cause of cervical radiculopathy. In suspected cases, the vertebral artery should be carefully evaluated with MR or CT angiography to confirm the presence of a loop formation. Full-endoscopic posterior foraminotomy may be technically feasible for carefully selected patients with VALF-related cervical radiculopathy, demonstrating short-term symptom improvement in this case. Full article

Background/Objectives: The seventh cervical vertebra (C7), the terminal segment of the cervical spine, demonstrates transitional characteristics between the cervical and thoracic regions. The transverse foramen (TF), a defining feature of all cervical vertebrae, is consistently present in C1 to C6 but shows marked variability at C7, appearing rudimentary or atypical. This study aimed to analyze the prevalence and morphology of TF of the C7 vertebra in the South African skeletal collection. The objectives of the study were to document the absence of the C7 TF, describe its morphological characteristics, and investigate associations between the C7 TF morphology and demographic factors. Methods: An exploratory osteological anatomical study appraised dry macerated C7 vertebrae. A total of six hundred and eighty-nine (n = 689) C7 vertebrae were analyzed. Frequency and descriptive statistics were used, as well as cross tabulations, to determine relationships between demographic factors and the presence or absence of a TF at C7. Results: Bilateral TF were present in 98.5% (n = 679) of vertebrae; 1.5% (n = 10) exhibited unilateral absence (4 left, 6 right). No bilateral absence was observed. The oval-oblique (toward midline) configuration was the most frequent shape bilaterally (left: 36.3%; right: 43.4%). Accessory double foramina occurred in 5.6% (left) and 8.3% (right); triple accessory foramina were rare (0.3%, right side only). Significant associations were found between TF shape and population affinity (p = 0.000, both sides) and age (p = 0.025 left, p = 0.037 right). A weak association was found between sex and right TF shape (p = 0.025). Conclusions: The findings support clinical and surgical implications for anatomical understanding of the vertebral artery, vein, and sympathetic nerve fibre pathways. The enclosed TF variation predominated, and triple accessory foramina were rare but notable. Full article

Background/Objectives: Acute carotid tandem lesions (TLs), defined by concurrent cervical internal carotid artery (ICA) stenosis or occlusion and intracranial large vessel occlusion, occur in 10–20% of patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Optimal periprocedural antiplatelet management during emergent carotid artery stenting (eCAS) remains uncertain, particularly regarding the balance between preventing stent thrombosis and avoiding hemorrhagic complications. Methods: A narrative review was conducted using PubMed and Scopus (until 6 March 2026) to identify English-language studies evaluating antiplatelet therapies during eCAS for TLs. We included seven real-world studies and registry analyses. Data on study design, patient characteristics, procedural strategies, angiographic results, functional outcomes, and safety metrics were extracted. Results: No randomized controlled trials (RCTs) were identified. The available evidence is derived exclusively from observational studies. Across these cohorts, glycoprotein IIb/IIIa inhibitors (GPIs), particularly tirofiban, were generally associated with lower rates of in-stent thrombosis and higher reperfusion success, with symptomatic intracranial hemorrhage (sICH) rates that appeared comparable to or lower than those reported with acetylsalicylic acid (ASA). Cangrelor, an intravenous (IV) P2Y₁₂ inhibitor, was associated with improved stent patency and increased likelihood of complete reperfusion, although reported effects on clinical outcomes were inconsistent when compared with GPIs or ASA. Aside from abciximab, potent IV antiplatelet agents did not consistently show an increased sICH signal. Oral dual antiplatelet therapy was also associated with improved technical outcomes without a clear excess in bleeding complications. Conclusions: Current real-world observational data suggest that rapid-acting IV antiplatelet agents—particularly GPIs and, increasingly, cangrelor—may represent feasible periprocedural options during eCAS for TLs, with potential benefits for technical success and no consistent evidence of increased hemorrhagic risk. However, interpretation is limited by study heterogeneity and non-randomized designs. The absence of RCTs highlights the need for prospective comparative studies and standardized periprocedural antiplatelet protocols. Full article

The vitamin D receptor (VDR) acts as both a nuclear transcription factor and a non-genomic mediator that regulates a broad spectrum of physiological processes beyond calcium and phosphate homeostasis. VDR plays an important role in the modulation of ion channels across multiple tissues, including osteoblasts, renal and intestinal epithelial cells, neurons, and vascular smooth muscle. These regulatory mechanisms encompass genomic actions through vitamin D response elements in target genes—such as TRPV5, TRPV6, KCNK3, and KCNH1—as well as rapid, non-genomic actions at the plasma membrane involving protein disulfide isomerase A3 and associated signaling cascades. VDR-mediated transcriptional control of calcium, potassium, and chloride channels contributes to the fine-tuning of cellular excitability, calcium transport, and mitochondrial function. Evidence also implicates VDR–ion channel crosstalk in various pathological contexts, including renal cell carcinoma, breast and cervical cancers, pulmonary arterial hypertension, and osteoporosis. Understanding the molecular interplay between VDR and ion channels provides new perspectives on the pleiotropic effects of vitamin D and offers promising therapeutic opportunities in oncology, cardiovascular disease, and skeletal disorders. This review synthesizes previous and current evidence on the genomic and non-genomic mechanisms underlying VDR–ion channel regulation and highlights novel frontiers in vitamin D signaling relevant to human health and disease. Full article

Heart failure is one of the most prevalent conditions worldwide, exerting a substantial impact on both prognosis and quality of life. It affects both psychological and physical domains, leading to multiple limitations in patients’ daily lives. Background/Objectives: The primary objective of this study was to identify clear factors related to disease severity, living conditions, and associated comorbidities that may negatively influence the quality of life of patients with heart failure. Methods: This study had a cross-sectional observational design and was conducted between 2024 and 2025 in the Department of Internal Medicine of the CF University Hospital in Cluj-Napoca, Romania. A total of 122 patients (mean age 67.9 ± 9.69 years, 62% women) diagnosed with heart failure, regardless of ejection fraction, and hospitalized in the Internal Medicine department during the study period were included. All participants self-administered the Minnesota Living with Heart Failure Questionnaire. Results: The analysis identified several factors associated with better quality of life, including female sex, atrial fibrillation with electrostimulated heart rhythm, type 2 diabetes mellitus, arterial hypertension, hepatitis, and chronic gastritis. Conversely, several factors were found to have a negative association with quality of life, such as advanced age, obesity, higher New York Heart Association (NYHA) functional class, reduced ejection fraction, valvular heart disease, obstructive sleep apnea syndrome, cervical–thoracic–lumbar polydiscopathy, hyperthyroidism, and hepatic steatosis. Conclusions: These results highlight the importance of key factors associated with quality of life in patients with heart failure. Full article

Background/Objectives: Recent meta-analyses have established that factors such as sarcopenia, male sex, and low serum albumin significantly correlate with increased postoperative complications in head and neck surgery, with routine neck computed tomography (CT) at the third cervical vertebra (C3) serving as a practical tool for muscle mass assessment. This study aimed to confirm the prognostic value of C3-based sarcopenia and specific clinical comorbidities in predicting early postoperative complications in patients with oral squamous cell carcinoma (OSCC). Methods: A retrospective cohort study was conducted on 167 patients undergoing primary surgery for OSCC. Sarcopenia was assessed using the C3-vertebra skeletal muscle index (SMI) derived from routine preoperative neck CT scans. Clinical and surgical variables, including preoperative serum albumin levels, comorbidities, and flap reconstruction types, were evaluated. A priori multivariate logistic regression models were utilized to identify independent predictors of surgical site and pulmonary and total complications (Clavien–Dindo classification) within 30 days. Results: The overall complication rate was 51%. Multivariate analysis revealed that sarcopenia (aOR: 3.26; 95% CI: 1.11–9.56), male sex (aOR: 3.48; 95% CI: 1.11–10.85), coronary artery disease (CAD) (aOR: 4.30; 95% CI: 1.21–15.36), and free-flap reconstruction (aOR: 15.06; 95% CI: 2.47–92.01) were robust independent predictors of total complications. Male sex (aOR: 4.17; 95% CI: 1.51–11.58) and preoperative hypoalbuminemia (<3.5 g/dL) (aOR: 3.43; 95% CI: 1.20–9.82) were independent predictors of surgical site complications, while regional flap reconstruction was independently associated with pulmonary complications (aOR: 5.97; 95% CI: 1.38–25.97). Conclusions: Sarcopenia, male sex, CAD, and flap reconstruction type are strong independent predictors of postoperative morbidity in OSCC. These findings advocate for “opportunistic screening” of muscle mass via routine preoperative neck CT, alongside rigorous cardiovascular profiling, to identify high-risk phenotypes for targeted perioperative optimization. Full article

Carbon-Fiber-Reinforced Polyetheretherketone (CFR-PEEK) instrumentation is increasingly preferred in spinal oncology for its physical properties, minimizing imaging artifacts and facilitating precise postoperative radiotherapy planning and tumor surveillance. However, a significant technical limitation exists: the current unavailability of dedicated CFR-PEEK pedicle screws for the cervical spine. The smallest available implants are designed for thoracic use (minimum diameter 4.5 mm, minimum length 25 mm), posing substantial risks of neurovascular injury when applied to smaller cervical pedicles. We present a technical note/feasibility report illustrated by a single case of robot-assisted placement of thoracic CFR-PEEK screws in the cervical spine for the treatment of a C7 Giant Cell Tumor. Following neoadjuvant therapy with Denosumab, a single-stage, two-step circumferential resection and reconstruction was performed. The anterior step was complicated by an iatrogenic injury to the highly adherent left vertebral artery (VA), which was successfully repaired. Consequently, the posterior step required maximal precision to preserve the sole remaining intact VA on the right side. Given the anatomical mismatch between the 4.5 mm thoracic screws and the narrow cervical pedicles (measuring as narrow as 3.2 mm on the critical right side), robotic navigation (ExcelsiusGPS^®) was utilized to plan and execute safe trajectories. Specifically, on the side of the intact VA, a small, controlled medial cortical violation was planned to avoid lateral vascular compromise. The procedure resulted in rigid, artifact-free stabilization with no immediate neurological sequelae. This single-case experience suggests that robotic guidance may facilitate adaptation of thoracic CFR-PEEK instrumentation to the cervical spine in selected oncologic scenarios; reproducibility, costs, and long-term outcomes remain uncertain. Full article

Background/Objectives: The aim of this study was to investigate the effects of cranio-cervical artery stenosis (CAS) and cerebral infarction (CI) on the function of the glymphatic system (GS). Methods: Hospitalised patients with CI and/or CAS were enrolled, along with a control group. A total of 111 participants (62.68 ± 9.85 years; 37% female) were enrolled in this study. GS function was assessed using the diffusion tensor imaging analysis along with the perivascular space (DTI-ALPS) method. The influencing factors and the individual and combined effects of CI and CAS on the DTI-ALPS index were analysed. Results: Age (p = 0.024), CI (p < 0.001), and CAS (p = 0.001) were independent predictors of a lower DTI-ALPS index. There were statistically significant differences in the DTI-ALPS index among the four groups (CI, CAS, CI + CAS, control) (F(3, 107) = 91.4, p < 0.0001). The DTI-ALPS index was lower in the CI, CAS, and CI + CAS groups compared with the control group (p < 0.0001); in the CI group compared with the CAS group (p < 0.0001); and in the CI + CAS group compared with the CI group (p < 0.05). CI and CAS were found to have a significant interaction effect on the DTI-ALPS index (F(1, 107) = 6.43, p = 0.013). Conclusions: Aging, CAS, and CI independently impair GS function, with CI having a stronger effect. All three are independent predictors of GS dysfunction. Patients with CAS experience more significant GS dysfunction after suffering CI than patients without CAS. CI and CAS have a synergistic effect on GS impairment. Full article

The mechanisms underlying meningeal lymphatic vessel (mLV)-mediated immune cell clearance after stroke remain unclear. Using a mouse middle cerebral artery occlusion model, we performed single-cell RNA sequencing to analyze post-ischemic meningeal macrophages. In vitro co-culture and CCR2 inhibition (RS504393) validated the CCL2-CCR2 axis between lymphatic endothelial cells and macrophages. Macrophage trafficking to mLVs and cervical lymph nodes was assessed by Evans Blue tracing and F4/80 immunofluorescence. We utilized VEGF-C to enhance meningeal lymphatic vessel function and concomitantly evaluated neurological deficits, brain edema, and neuroinflammation. Ischemia expanded meningeal macrophages, whose crosstalk with lymphatic endothelial cells relied on CCL2-CCR2 axis. CCR2 inhibition impaired macrophage trafficking to mLVs and cervical lymph nodes, worsening edema, motor deficits, and inflammation, whereas VEGF-C enhanced mLV drainage and improved outcomes. We identify a novel mechanism where in mLVs recruit macrophages via CCL2 for perivascular clearance post-ischemia. Combining VEGF-C with modulation of the CCL2-CCR2 axis presents a promising synergistic therapeutic strategy for stroke. Full article

Background/Objective: It remains unknown whether patients with the more common forms of hypermobility carry an elevated risk for the development of intracranial/cervical artery abnormalities. The objective of this study was to determine the prevalence of unruptured intracranial aneurysms, spontaneous cervical artery dissections, and fibromuscular dysplasia in patients with hypermobile Ehlers–Danlos Syndrome (hEDS) and hypermobility spectrum disorders (HSD) who presented to an academic headache clinic. Methods: This is a retrospective cohort study. We used an electronic medical record to look for all patients seen at the Mayo Clinic Florida Headache Center and EDS Clinic between 2019 and 2025 with a diagnosis of hEDS or HSD and neuroimaging of both the intracranial and cervical arteries. Results: There were 103 patients who met the inclusion criteria. There was no statistically significant difference between hEDS and HSD patients in developing cerebral/cervical arterial anomalies. Of the sample, 95% of the hypermobile patients with abnormal neuroimaging also had migraine. A total of eleven (10.7%) patients (hEDS + HSD) were diagnosed with unruptured intracranial aneurysms. Trends included age less than 50 years, small aneurysms in the anterior circulation, and having migraine with aura. Five (4.8%) patients were diagnosed with spontaneous cervical artery dissection with trends for HSD, over the age of 50 years, vertebral artery involvement and a history of migraine without aura. Six (5.8%) patients were diagnosed with fibromuscular dysplasia with trends for HSD, over the age of 50 years, carotid artery involvement and a history of migraine with aura. Conclusions: This is the first study to identify that patients with the more common type of EDS, HSD and hEDS, and a possible concomitant history of migraine have a heightened risk for the development of unruptured intracranial aneurysms, spontaneous cervical artery dissections, and fibromuscular dysplasia. Our findings suggest the need for targeted screening with intracranial and extracranial arterial imaging for this unique patient population. Full article