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Spinal Cord Lesion


Presentation

  • The patient’s age at presentation varies without sex predilection. Clinically, spinal cord lesions often present nonspecifically; symptomology can vary from a sudden onset to a slowly progressive course.[appliedradiology.com]
  • Although this was a presumed diagnosis based on other lesions, our case is the first in which both intramedullary and epidural masses are present.[ncbi.nlm.nih.gov]
  • Our purpose is to illustrate and review the differential diagnosis for intramedullary spinal cord lesions and masses and to discuss their distinguishing MR imaging features and clinical presentations.[ingentaconnect.com]
  • With a long follow up of 8 yr, the modification presented by our group proved to be highly successful, reliable, safe, and even cost-effective. Therefore, it seems to be a valuable tool for the treatment of this group of patients.[ncbi.nlm.nih.gov]
  • Case presentation A 51-year-old Iranian woman presented with 2-month history of progressive unremitting back pain, exacerbated at night, superimposed on a creeping paraparesis.[casesjournal.biomedcentral.com]
Fecal Incontinence
Back Pain
  • Progressive lower back pain, paraplegia, and urinary incontinence subsequently developed. Magnetic resonance imaging (MRI) revealed a lesion of the thoracic spinal cord and thecal sac; a biopsy specimen was obtained ( Figure 1 ).[nejm.org]
  • Back pain is a serious presentation in children and should be appropriately worked up.[appliedradiology.com]
  • Case presentation A 51-year-old Iranian woman presented with 2-month history of progressive unremitting back pain, exacerbated at night, superimposed on a creeping paraparesis.[casesjournal.biomedcentral.com]
  • There are three common types of spinal tumors that can cause back pain: vertebral column tumors, intradural-extramedullary tumors, and intramedullary tumors. 1.[spine-health.com]
  • Some of the anatomic and physiologic considerations pertinent to an understanding of disorders of the cord and of the spine can be found in Chaps. 3 , 9 ( Figs. 9-5 and 9-7 ), and Chap. 11 , on motor paralysis, somatic sensation, and back pain, respectively[accessmedicine.mhmedical.com]
Muscle Spasticity
  • Symptoms may include: Muscle weakness or paralysis in the trunk, arms or legs Loss of feeling in the trunk, arms, or legs Muscle spasticity Breathing problems Problems with heart rate and blood pressure Digestive problems Loss of bowel and bladder function[hopkinsmedicine.org]
  • Some people with spinal cord injuries experience one of two types of muscle tone problems: uncontrolled tightening or motion in the muscles (spasticity) or soft and limp muscles lacking muscle tone (flaccidity). Fitness and wellness.[mayoclinic.org]
  • You may also learn how to handle problems such as pressure injuries , urinary tract infections , and muscle spasticity . Do daily tasks, such as cook, brush your teeth, and move from a wheelchair to a bed or chair.[northshore.org]
Low Back Pain
  • Red flags See also separate Neck Pain (Cervicalgia) and Torticollis and Low Back Pain and Sciatica articles. Red flags that suggest spinal compression include: Insidious progression.[patient.info]
  • It can cause low back pain, weakness or paralysis in the lower limbs, loss of sensation, bowel and bladder dysfunction, and loss of reflexes. Unlike in conus medullaris syndrome, symptoms often occur on only one side of the body.[en.wikipedia.org]
Muscle Twitch
  • This means that when the muscle receptors are briefly stretched by the tap, the nerve impulses in the afferent pathway travel directly to the motor neurons and excite them reflexly to cause the normally visible muscle twitch.[encyclopedia.com]
Hyperreflexia
  • […] extermities is due to nerve root return and must not be mistaken for evidence of return of spinal function; - spinal shock (spinal cord concussion): - usually invovles 24-72 hour period of paralysis, hypotonia, & areflexia, and at its conclusion there may be hyperreflexia[wheelessonline.com]
  • Hyperreflexia From my perspective, I have no bladder or bowl problems but I do have leg and arm pain (was told I have fibromyalgia 2 years ago) and have Hashimoto's (thyroid) which is an autoimmune.[thisisms.com]
  • Autonomic hyperreflexia occurs because nerve messages that were once able to go up the spinal cord to the brain are blocked.[uiortho.com]
Clonus
  • […] must not be mistaken for evidence of return of spinal function; - spinal shock (spinal cord concussion): - usually invovles 24-72 hour period of paralysis, hypotonia, & areflexia, and at its conclusion there may be hyperreflexia, hypertonicity, and clonus[wheelessonline.com]
  • Upper motor neurone signs in the lower limbs (Babinski's sign: up-going plantar reflex, hyperreflexia, clonus, spasticity). Lower motor neurone signs in the upper limbs (atrophy, hyporeflexia).[patient.info]
Unable to Walk
  • Spinal pain is often present for three months and neurological symptoms for two months before paraplegia, but almost 50% of patients are unable to walk by the time of diagnosis. Of these, almost 70% remain immobile.[patient.info]
  • The levels go from 0 (client unable to walk) to 20 (client walking without braces and/or devices and without physical assistance for at least 10 m).[nature.com]
  • Motor wise, he showed marked truncal and gait ataxia ; he was unable to walk because of ataxia. Muscle atrophy and marked weakness was noted in both upper extremities more on the left side.[en.wikibooks.org]
Radiculomyelopathy
Urinary Incontinence
  • To evaluate the clinical usefulness of transobturator sub-urethral tapes for the treatment of stress urinary incontinence in women with spinal cord injury.[ncbi.nlm.nih.gov]
  • The artificial sphincter is the method of choice in patients with stress urinary incontinence due to neurogenic bladder dysfunction. However, long-term studies reveal a high revision rate.[ncbi.nlm.nih.gov]
  • Two females in each group underwent tension-free vaginal tape for stress urinary incontinence (SUI), reducing episodes per week of SUI by 90% after 5 years.[ncbi.nlm.nih.gov]
  • Progressive lower back pain, paraplegia, and urinary incontinence subsequently developed. Magnetic resonance imaging (MRI) revealed a lesion of the thoracic spinal cord and thecal sac; a biopsy specimen was obtained ( Figure 1 ).[nejm.org]
  • Male Stress Urinary Incontinence surgery Female Stress Urinary Incontinence PHARMACEUTICAL TREATMENT Your doctor may prescribe medications to improve bladder function, such as reduce bladder contractions, lower urinary frequency, improve loss of bladder[nafc.org]
Overflow Incontinence
  • There may be overflow incontinence when the bladder cannot physically hold any more urine.[neuroanatomy.wisc.edu]

Workup

  • […] fracture; can be used when plain radiography is inadequate or fails to visualize segments of the axial skeleton Magnetic resonance imaging (MRI) - Used for suspected spinal cord lesions, ligamentous injuries, and other soft-tissue injuries or pathology See Workup[emedicine.medscape.com]
Lymphocytic Infiltrate
  • At autopsy, the spinal cord and brain exhibited characteristic histopathological features of both NBD and ALS, including chronic destruction of the ventral thoracic white and gray matter, perivascular lymphocytic infiltration, binucleated neurons, lower[ncbi.nlm.nih.gov]

Treatment

  • Solifenacin treatment significantly improved bladder capacity, detrusor compliance, reflex volume and maximum detrusor pressure. Solifenacin treatment seems to be an effective oral treatment of NDO after SCI.[ncbi.nlm.nih.gov]
  • Five of the six patients without treatment success underwent second-line treatment (artificial sphincter or urinary diversion).[ncbi.nlm.nih.gov]
  • Treatment is key for spinal tumours, as any damage it causes can be made more severe or indeed, permanent, if treatment is not sought soon enough.[spinalcord.com]
  • She received appropriate treatment for her hypercalcemia.[casesjournal.biomedcentral.com]
  • This treatment resulted in accelerated migration of reactive astrocytes to sequester inflammatory cells that spared myelinated fibres and significantly promoted functional recovery.[ncbi.nlm.nih.gov]

Prognosis

  • Diagnosis and prognosis of acute cervical spine cord injury . Original Text by Clifford R. Wheeless, III, MD.[wheelessonline.com]
  • Treatment and prognosis As a ‘spinal lesion’ can cover so many kinds of diagnosis, there are varying forms of treatment and different prognoses an individual can have. A lesion is categorized dependent upon its size and location.[spinalcord.com]
  • The prognosis of a patient who has an intramedullary cord lesion is grave, the treatment is mostly undertaken to relieve pain and to preserve or stabilize neurologic function.[casesjournal.biomedcentral.com]
  • Functional prognosis in the elderly spinal cord injured . Arch Phys Med Rehabil 1982; 63 : 513–514. 7. Cifu DX , Huang ME , Kolakowsky-Hayner SA , Seel RT .[nature.com]

Etiology

  • To compare a walking reeducation program using Lokomat with conventional overground training among individuals with incomplete SCI of both traumatic and nontraumatic etiology.[ncbi.nlm.nih.gov]
  • If there is no focal cord expansion or considerable mass effect, non-neoplastic etiologies should be considered first. Cysts can be tumoral or nontumoral.[appliedradiology.com]
  • Spinal cord infarction: etiology and outcome. Neurology. 1996;47 (2): 321-30. Pubmed citation 4. Beck K. Das Syndrom des Verschlusses der vorderen Spinalarterie. Deutsche Zeitschrift f. Nervenheilkunde. 1952;167 (3): 164-186. doi:10.1007/BF00242756[radiopaedia.org]
  • Spinal cord infarction: etiology and outcome. Neurology. 1996;47 (2): 321-30. Pubmed citation 4. Beck K. Das Syndrom des Verschlusses der vorderen Spinalarterie. Deutsche Zeitschrift f.[radiopaedia.org]
  • Etiology: Since 2005, motor vehicle crashes account for 42.1% of reported SCI cases. The next most common cause of SCI is falls, followed by acts of violence (primarily gunshot wounds), and recreational sporting activities.[fscip.org]

Epidemiology

  • Epidemiology The characteristics of the two groups are shown in Tables 1 and 2 .[nature.com]
  • Epidemiology of traumatic spinal cord injury. Kirshblum S, Campagnolo DI, DeLisa JA, eds. Spinal Cord Medicine . Baltimore, Md: Lippincott Williams & Wilkins; 2002. 69-81. Go BK, DeVivo MJ, Richards JS. The epidemiology of spinal cord injury.[emedicine.medscape.com]
  • "Epidemiology, demographics, and pathophysiology of acute spinal cord injury". Spine . 26 (24 Suppl): S2–12. doi : 10.1097/00007632-200112151-00002 . PMID 11805601 .[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology 1. The spinal cord and nerve roots may be injured by: a. Compression from bone, ligaments, extruded disc material and tumors. b. Disruption or overstretching of neural tissues c. Edema following compression or concussion d.[kobiljak.msu.edu]
  • A review of the pathophysiology of cervical spondylotic myelopathy with insights for potential novel mechanisms drawn from traumatic spinal cord injury. Spine . 1998;23:2730–7. 3. Wilkinson M.[aafp.org]
  • Epidemiology, demographics and pathophysiology of acute spinal cord injury . Spine 2001; 24S : S2–S12. 20. McKinley WO , Seel RT , Hardman JT . Nontraumatic spinal cord injury: incidence, epidemiology and functional outcome .[nature.com]

Prevention

  • […] of cryptogenic myelopathy, especially in patients with a long spinal cord lesion, as treatment with chenodeoxycholic acid and/or competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase reverse the metabolic derangement and prevent[ncbi.nlm.nih.gov]
  • The majority of spinal cord injuries are due to preventable causes such as road traffic crashes, falls or violence.[who.int]
  • Spinal shock cannot be prevented and must resolve on its own. The muscles (diaphragm, intercostal, and abdominal) needed for breathing and coughing may become weak after a spinal cord injury.[uiortho.com]
  • Other emergency treatment involves maintaining breathing ability, preventing shock, keeping the neck immobilized, and preventing complications such as blood clots.[livescience.com]

References

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