Presentation
An uncommon presentation is acute headache due to subarachnoid hemorrhage 8. In children, progressive scoliosis may be seen. Motor regression and frequent falls may be the presenting features in young children 7. [radiopaedia.org]
In the present series 60.2% of lesions were radically excised. [neurologyindia.com]
Contrast enhancement is generally present and is usually heterogeneous. [appliedradiology.com]
The emergency department (ED) workup for patients who present with persistent back pain or subacute or chronic neurological deficits should include an interview and a careful examination and timely referral if findings are present. [emedicine.medscape.com]
Presenting an inter-disciplinary perspective, the book includes up-to-date information on therapy [including neurosurgical], new information on developmental disorders of the spine, and a definitive chapter on trauma, including information on biomechanics [books.google.com]
Entire Body System
- Localized Pain
Indications – Diagnosis or treatment of a contrast-enhancing intradural lesion in a symptomatic patient • Sensory or motor deficits and sphincter dysfunction • Localized pain, especially nonmechanical pain exacerbated by recumbency • Not indicated for [neupsykey.com]
Extramedullary and extradural spinal cord tumors can cause severe local pain and tenderness. Intramedullary tumors can cause pain, but this is usually less severe. Radicular pain runs through the distribution of the nerve root that is affected. [neurospinewi.com]
Back pain often associated with radiating radicular pain, which intensified by coughing, sneezing or straining. Often back pain and local pain on palpation precede in weeks other symptoms of spinal cord epidural (extradural) compression. [minclinic.ru]
Local pain is generally a deep, aching pain resulting from soft tissue and vertebral body irritation. Leg pain (radicular pain) is generally a sharp, stabbing pain resulting from compression of the nerve roots. [emedicinehealth.com]
PERTINENT ASSOCIATED COMPLAINTS AND FINDINGS Generally, central herniation produces local neck pain while lateral herniation produces upper extremity pain. [chiro.org]
Gastrointestinal
- Fecal Incontinence
Fecal incontinence Hypotonic anal sphincter Abnormal bulbocavernosus and anal wink reflexes Transverse myelopathy Lesions affecting all or most tracts of the spinal cord at ≥ 1 segmental levels Deficits in all functions mediated by the spinal cord (because [msdmanuals.com]
Both conus medullaris and cauda equina lesions are associated with urinary retention and incontinence and fecal incontinence or constipation. [emedicine.medscape.com]
incontinence, sudden or stress incontinence, new-onset enuresis, urinary frequency, and nocturia, often together with fecal soiling, are the most common modes of presentation. [pediatrics.aappublications.org]
Cardiovascular
- Hypertension
contributes to the development of lacunar infarction and hypertensive hemorrhage flaccidity severe form of hypotonicity flexor plantar response flexion (curling down) of all toes (“downgoing toe”) in response to application of a stimulus to the skin [strokecenter.org]
[…] entry for bacteria and producing meningitis, subdural empyema, or brain abscess; (2) causing aseptic meningitis through the desquamation of epithelial debris from the tract and/or associated dermoid or epidermoid cysts; and (3) causing intracranial hypertension [pediatrics.aappublications.org]
Skin
- Flushing
The steroids are generally very well tolerated, however, some patients may experience side effects, including a ‘steroid flush’ (flushing of the face and chest that can last several days and can be accompanied by a feeling of warmth or even a low grade [spine.org]
Neuritis is considered to occur from mechanical irritation to the vertebral artery anywhere along its course, producing symptoms of a vasomotor nature; eg, headache, vertigo, tinnitus, nasal disturbances, facial pain, facial flushing, and pharyngeal paresthesias [chiro.org]
Eyes
- Blurred Vision
Vague autonomic symptoms may be exhibited such as dizziness, blurred vision, and hearing difficulties. These can usually be attributed to involvement of the plexus around the vertebral artery or intermittent disruption of the blood flow. [chiro.org]
- Visual Impairment
impairment ; due to a lesion of the occipital lobe extending from primary visual cortex into visual association cortex aphasia syndrome of disordered expression or comprehension of spoken and/or written language caused by brain injury; see also non-fluent [strokecenter.org]
Musculoskeletal
- Back Pain
When to see a doctor There are many causes of back pain, and most back pain isn't caused by a tumor. [mayoclinic.org]
View/Print Figure Low Back Pain FIGURE 1. Suggested approach to the initial assessment of the patient with acute low back pain. (CT = computed tomographic; MRI = magnetic resonance imaging) Adapted from Bigos SJ, et al. [aafp.org]
Low back pain is very common. It affects millions of people. In most cases, you don't need surgery for low back pain. [webmd.com]
Back pain often associated with radiating radicular pain, which intensified by coughing, sneezing or straining. Often back pain and local pain on palpation precede in weeks other symptoms of spinal cord epidural (extradural) compression. [minclinic.ru]
Not all people with back pain and/or leg pain and changes in bowel or bladder function have cauda equina syndrome. [emedicinehealth.com]
- Low Back Pain
Low back pain is very common. It affects millions of people. In most cases, you don't need surgery for low back pain. [webmd.com]
View/Print Figure Low Back Pain FIGURE 1. Suggested approach to the initial assessment of the patient with acute low back pain. (CT = computed tomographic; MRI = magnetic resonance imaging) Adapted from Bigos SJ, et al. [aafp.org]
Symptoms of cauda equina syndrome include low back pain, numbness and/or tingling in the buttocks and lower extremities ( sciatica ), weakness in the legs, and incontinence of bladder and/or bowels. [medicinenet.com]
Symptoms of cauda equina syndrome include the following: Low back pain Pain in one leg (unilateral) or both legs (bilateral) that starts in the buttocks and travels down the back of the thighs and legs ( sciatica ) Numbness in the groin or area of contact [emedicinehealth.com]
He landed on his back and buttocks. He immediately experienced low back pain and leg pain. He ignored it for the rest of the day. [en.wikibooks.org]
- Muscular Atrophy
Other spinal cord problems include Tumors Infections such as meningitis and polio Inflammatory diseases Autoimmune diseases Degenerative diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy Symptoms vary but might include pain, numbness [medlineplus.gov]
This may or may not correlate with the diagnosis of spinal stenosis which is based on clinical findings of radiculopathy, neurogenic claudication, weakness, bowel and bladder dysfunction, spasticity, motor weakness, hyperreflexia and muscular atrophy. [en.wikibooks.org]
Neurologic
- Paresthesia
Neurologic deficits may not improve, and a risk of worsening exists, including pain, paralysis, paresthesia, bowel or bladder problems, and sexual dysfunction. [emedicine.medscape.com]
Grieve points out that some clinicians are far too anxious to blame upper limb paresthesiae on the presence of a cervical rib just because it is there. [chiro.org]
Then develop a syndrome of transverse myelopathy with paresthesias, alternating with loss of sensitivity. Motor paresis starts in the toes and feet and rises to the spinal cord compression level. [minclinic.ru]
[…] following: Low back pain Pain in one leg (unilateral) or both legs (bilateral) that starts in the buttocks and travels down the back of the thighs and legs ( sciatica ) Numbness in the groin or area of contact if sitting on a saddle (perineal or saddle paresthesia [emedicinehealth.com]
- Ataxia
I would describe Hurcules as having “ambulatory tetraparesis with an upper-motor neuron, general proprioceptive ataxia. The thoracic limbs are worse than the pelvic limbs and the left side is more affected than the right.” [sevneurology.com]
Affected individuals may also develop pain and stiffness (spasticity) in the legs and uncoordinated movements (ataxia), eventually affecting the ability to walk. In severe cases, paralysis of the arms or legs can occur. [rarediseases.org]
[…] links [ edit ] 06-093c. at Merck Manual of Diagnosis and Therapy Home Edition Cauda_equina_syndrome at the Duke University Health System 's Orthopedics program v t e Lesions of spinal cord and brain Spinal cord / vascular myelopathy sensory: Sensory ataxia [en.wikipedia.org]
[…] injury characterized by an increase in the number and size of astrocytes (primary reaction) and cytoplasmic changes including increased glial filaments and glassy eosinophilic cytoplasm followed by formation of a dense gliotic scar (secondary reaction) ataxia [strokecenter.org]
Tumors projecting into the posterior fossa produce symptoms of intracranial pressure such as nystagmus, papilledema, vertigo, ataxia, past pointing, and asteriognosis. [chiro.org]
- Sciatica
Symptoms of cauda equina syndrome include low back pain, numbness and/or tingling in the buttocks and lower extremities ( sciatica ), weakness in the legs, and incontinence of bladder and/or bowels. [medicinenet.com]
People with pain in both legs (bilateral sciatica ) have less chance or full recovery than persons with single leg pain (unilateral sciatica). [emedicinehealth.com]
Ankylosing spondylitis (Bechterew's disease) Back pain in pregnancy Coccydynia (sore tailbone) Compression fracture of the spine Degenerative and hereditary myelopathy Epiduritis and spinal abscess Low back pain, pain in leg, Sherman Mau diseases Lumbago, sciatica [minclinic.ru]
Sciatica -type pain on one side or both sides, although pain may be wholly absent Weakness of the muscles of the lower legs (often paraplegia ) Achilles (ankle) reflex absent on both sides. [6] : 216 Sexual dysfunction Absent anal reflex and bulbocavernosus [en.wikipedia.org]
Quite often, it manifests as sciatica or radiculopathy. [emedicine.medscape.com]
- Hyporeflexia
Acute, severe lesions (eg, infarction, traumatic lesions) cause spinal shock with flaccid paresis (decreased muscle tone, hyporeflexia, and no extensor plantar responses). [msdmanuals.com]
The neurologic examination usually reveals symmetric weakness with either flaccidity and hyporeflexia (if the diagnosis is made early) or spasticity and hyperreflexia (if the diagnosis is made later). 13 The sudden onset of myelopathy secondary to spinal [aafp.org]
[…] acute inflammatory demyelinating polyneuropathy) acute, ascending, and progressive neuropathy believed to result from an autoimmune response triggered by an antecedent illness or various medical conditions and characterized by weakness, paresthesias, hyporeflexia [strokecenter.org]
These reflexes should be compared bilaterally to judge whether the hyporeflexia is unilateral. Unilateral hyperreflexia is pathognomonic of an upper motor neuron lesion. [chiro.org]
- Dysesthesia
Patients typically present with pain (local, radicular), sensory deficits (dysesthesias, numbness, proprioceptive loss), and/or weakness (focal weakness, clumsiness/falls). [journals.lww.com]
Cold dysesthesia: a symptom of extramedullary tumors of the spinal cord. J Neurosurg 1970; 33:75–78. PubMed Google Scholar 27. Endtz LJ, Frenay JJ. Studies on asterognosis and amyotrophy of the hand in brainstem syndromes. [link.springer.com]
Patients may present with the following: Weakness Ataxia Clumsiness Atrophy Twitching and fasciculation Gait disturbance Other disturbances Patients may present with the following nonpainful sensory disturbances: Paresthesia Dysesthesia Dissociative syndrome [emedicine.medscape.com]
[…] to pronounce or articulate words due to disorders of the vocal apparatus (e.g., lips, tongue, larynx) dysdiadochokinesia impaired ability to perform rapid alternating movements (e.g., pronation/supination of hands); indicates cerebellar dysfunction dysesthesia [strokecenter.org]
Urogenital
- Urinary Retention
However, it mimics conus medullaris syndrome, causing distal leg paresis and sensory loss in and around the perineum and anus (saddle anesthesia), as well as bladder, bowel, and pudendal dysfunction (eg, urinary retention, urinary frequency, urinary or [msdmanuals.com]
retention, incontinence and constipation, as well as back pain. [pacificneuroscienceinstitute.org]
Detrusor weaknesses causing urinary retention and post-void residual incontinence as assessed by bladder scanning the patient after the patient has urinated. [en.wikipedia.org]
Post-operative course The patient experienced transient urinary retention after surgery. The patient was kept in the hospital for 3 weeks of intravenous (IV) antibiotics. His urinary retention and constipation had resolved at the time of discharge. [pediatricneurosciences.com]
Both conus medullaris and cauda equina lesions are associated with urinary retention and incontinence and fecal incontinence or constipation. [emedicine.medscape.com]
- Urinary Incontinence
Urinary incontinence is often associated with a syrinx when the lesion causes disruption of the sacral pathways. Sexual dysfunction may also occur in association with loss of sphincter control. [neurospinewi.com]
Difficulties with bowel and bladder function may become evident with urinary and fecal urgency and/or incontinence, urinary tract infections, dribbling urinary stream, incomplete emptying, or inability to void. [pediatrics.aappublications.org]
[…] unique to, Alzheimer's disease neurogenic bladder bladder dysfunction associated with a lesion in the brain, spinal cord, or peripheral nerves and characterized by underactivity (failure to empty) or overactivity (failure to store); symptoms include urinary [strokecenter.org]
- Overflow Incontinence
When the tumor causes pressure on the second or third sacral nerve roots, micturition is affected and there is paralysis of bladder contractions, bladder distention, and retention of urine with overflow incontinence. [neurospinewi.com]
Workup
Autoimmune and degenerative disorders These disorders include the following: Transverse myelitis Multiple sclerosis Viral infection or its sequela Amyotrophic lateral sclerosis Workup Overview The diagnostic workup overlaps, in part, with the workup presented [emedicine.medscape.com]
Treatment After diagnostic workup, spinal cord edema (swelling) should be managed preoperatively with oral or IV steroids. Edema is most commonly managed with a corticosteroid such as Decadron (dexamethasone). [neurospinewi.com]
Clinical Testing and Workup A specialized imaging technique called magnetic resonance imaging (MRI) is used to diagnose syringomyelia. [rarediseases.org]
Isolated coccygeal dimples do not require further workup or treatment. FIGURE 9 Benign coccygeal dimple within the gluteal cleft and overlying the tip of the coccyx. [pediatrics.aappublications.org]
Treatment
Standard Therapies Treatment The treatment of syringomyelia is directed toward the specific symptoms that are apparent in each individual. Treatment may require the coordinated efforts of a team of specialists. [rarediseases.org]
You don't have permission to access /cancer/brain-cancer/tc/childhood-astrocytomas-treatment-pdq-treatment---health-professional-information-nci-general-information-about-childhood-astrocytomas.html on this server. [qufiy.com]
What Is the Treatment for Cauda Equina Syndrome? Medical treatment options are useful in certain persons, depending on the underlying cause of the cauda equina syndrome. [emedicinehealth.com]
Childs Nerv Syst 1999;15:17-28 Treatment Recommendations for Pediatric Spinal Cord Ependymoma Dodul Mondal 34. [slideshare.net]
Prognosis
Prognosis of Meningioma of the Spinal Cord Benign meningiomas are associated with a very good survival prognosis with approximately 100% 5 year survival. [myvmc.com]
Overall, prognosis is dictated by the pathology and location of the individual tumor. Keywords: ependymoma ; schwannoma ; spinal cord tumor Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved [journals.lww.com]
Prognosis [ edit ] The prognosis for complete recovery is dependent upon many factors. The most important of these is the severity and duration of compression upon the damaged nerve(s). [en.wikipedia.org]
Prognosis In general, the earlier the detection of the tumor and the more minor the neurological deficit, the better the prognosis for treatment and recovery. Advanced age and severe neurologic deficit are associated with a poor prognosis. [emedicine.medscape.com]
What is the outlook (prognosis) for cauda equina syndrome? Ultimately, the outlook for patients affected by cauda equina syndrome is determined by the extent of damage to involved nerve tissue. [medicinenet.com]
Etiology
ETIOLOGIC PICTURE See Table 5.11. Table 5.11. [chiro.org]
and it is important to distinguish between etiologies due to the range of treatments and prognoses between the separate entities. [appliedradiology.com]
With regard to studies of the urinary tract, back pain with positive urinalysis results may suggest a genitourinary (GU) etiology. Renal ultrasonography or a GU CT scan can be diagnostic. [emedicine.medscape.com]
Intramedullary abscess of the spinal cord in the antibiotic era: Clinical features, microbial etiologies, trends in pathogenesis, and outcomes. Clin Infect Dis 1998;27:619-26. 5. Simon JK, Lazareff JA, Diament MJ, Kennedy WA. [pediatricneurosciences.com]
Etiology and Pathophysiology: Spinal cord tumors can be primary or metastatic. [neurospinewi.com]
Epidemiology
This single hospital-based epidemiological study, in the absence of any such or community-based epidemiological study in the region, will hopefully serve the purpose of spinal tumor predictability in a given population and the approaches of management [ruralneuropractice.com]
Primary spinal cord glioma: a Surveillance, Epidemiology, and end results database study. J Neurooncol2010;98(1):83–92 Dodul Mondal 18. [slideshare.net]
CES-I with its more favourable prognosis may become CES-R at a later stage. [22] Epidemiology [ edit ] The nerve roots extending from the lumbar spine are susceptible to compression, leading to CES. [en.wikipedia.org]
Epidemiology Tumors of the spinal cord are rare and reported to represent approximately 10-15% of all central nervous system tumors. Overall, they represent an estimated incidence of 0.5-2.5 cases per 100,000 population. [emedicine.medscape.com]
Pathophysiology
Etiology and Pathophysiology: Spinal cord tumors can be primary or metastatic. [neurospinewi.com]
Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurgical Focus. 2007;23(2):1-10. DOI: 10.3171/FOC-07/08/E6 ↑ Filippidis A, Kalani M, Theodore N, Rekate H. [physio-pedia.com]
Normal Embryology and the Pathophysiology of Spinal Cord Tethering Dysraphic CNS malformations arise during the second, third, and fourth weeks of human embryogenesis, generally referred to as the period of neurulation. [pediatrics.aappublications.org]
Pathophysiology The distal or terminal region of the spinal cord, the conus medullaris and cauda equina, is a complex region of spinal anatomy and transition from the central to peripheral nervous system. [emedicine.medscape.com]
[…] waves and some physiological functions normal pressure hydrocephalus (NPH) clinical symptom complex characterized by abnormal gait, urinary incontinence, and dementia in the setting of hydrocephalus with normal cerebrospinal fluid pressure; proposed pathophysiology [strokecenter.org]
Prevention
Drink plenty of fluids and use good personal hygiene to prevent urinary tract infections. Check for waste and clear the bowels with gloved hands. If needed, use glycerin suppositories or enemas. Wear protective pads and pants to prevent leaks. [webmd.com]
• Immaculate hemostasis and placement of moist Cottonoids (Saramall, Tandil, Argentina) in the epidural space will prevent the accumulation of blood in the operative cavity. – Midline durotomy is performed just rostral to the tumor and extended caudal [neupsykey.com]
SLIDESHOW Sciatica Symptoms, Causes, Treatments See Slideshow Can cauda equina syndrome be prevented? Cauda equina syndrome occurs as a result of conditions which are not predictable and is therefore not a preventable syndrome. [medicinenet.com]
Página 310 - A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. [books.google.es]
This thickening prevents the ascension of the conus medullaris, resulting in an abnormally elongated spinal cord. [physio-pedia.com]