Spinal Cord Lesion


Presentation

urogenital
Urinary Incontinence
  • The presenting symptoms of ISCM vary from pain, sensory loss, weakness, urinary incontinence to pseudo Brown-Sequard and/or Brown-Sequard syndrome [ 5 ]. The duration of symptoms before diagnosis of ISCM ranges from days to a few months [ 5 , 6 ].[casesjournal.biomedcentral.com]
  • 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]
  • ., urinary urgency or hesitancy, partial retention of urine, mild urinary incontinence), bowel dysfunction (e.g., constipation or urgency), and sexual dysfunction (e.g., erectile dysfunction or impotence in men, genital anesthesia or numbness in women[healthcentral.com]
  • Twenty-one patients had pain, 35 had demonstrable sensory loss, 37 had weakness, and 25 had urinary incontinence at presentation. Nine patients had true Brown-Séquard syndrome and nine others had pseudo-Brown-Séquard syndrome.[en.wikibooks.org]
  • It is common to experience sexual dysfunction after injury , as well as dysfunction of the bowel and bladder, including fecal and urinary incontinence . [7] It is also possible for the bladder to fail to empty, leading to a potentially harmful buildup[en.wikipedia.org]
Overflow Incontinence
  • There may be overflow incontinence when the bladder cannot physically hold any more urine.[neuroanatomy.wisc.edu]
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  • musculoskeletal
    Back Pain
    • 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]
    • Symptoms Patients with injuries to the sacral nerve roots may experience: Lack of control of bowels or bladder Lower back pain Leg pain, which may radiate down the back of the leg(s) Sensory issues in the groin and buttocks area Causes The most common[spinalcord.com]
    • However, less than 0.1% of people with back pain who visit their general practitioner have spinal metastases [ 3 ] .[patient.info]
    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 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]
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  • neurologic
    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]
    • A characteristic physical finding of CSM is hyperreflexia. The biceps and supinator reflexes (C5 and C6) may be absent, with a brisk triceps reflex (C7).[aafp.org]
    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]
    • These signs include increased deep tendon reflexes and muscle tone, a plantar extensor response (upgoing toe), clonus (most commonly found at the ankle by rapidly flexing the foot upward), and a Hoffman reflex (a positive response is flexion of the terminal[merckmanuals.com]
    • This pattern is almost pathognomonic of cord compression because of cervical spondylosis at the C5-C6 interspace. 12 Ankle clonus and Babinski's sign (pathologic extension of the great toe elicited by stroking the foot) in the feet may also be revealed[aafp.org]
    Unable to Walk
    • 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]
    • 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]
    • 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
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  • Entire body system
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  • Workup

    Laboratory

    Serum
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  • Treatment

    Prognosis

    Complications

    Erectile Dysfunction
    • ., erectile dysfunction or impotence in men, genital anesthesia or numbness in women, pain with intercourse for either sex). Complete loss of bladder and bowel control may be lost in more advanced cases of MS.[healthcentral.com]
    • Erectile dysfunction is common in men with spinal cord MS. Orgasmic and fertility problems can strike both sexes with cord lesions. Spasticity is another major problem for those with spinal cord problems of all types.[my-ms.org]
    • This is called erectile dysfunction (ED). There are many medical treatments available to help with this. The ability to ejaculate may also change. Therefore, men may have difficulty with fertility (the ability to have children).[uiortho.com]
    • Men may have erectile dysfunction , and women diminished sexual response. Anal sphincter tone is lax, and bulbocavernosus and anal wink reflexes are abnormal. These findings may be similar to those of conus medullaris syndrome.[merckmanuals.com]
    • Erection may be enhanced through the same means used to treat erectile dysfunction in the general population. Prognosis The prognosis of SCI depends on the location and extent of injury.[medical-dictionary.thefreedictionary.com]
    Paraplegia
    • Paraplegia, paralysis below the waist, or quadriplegia, loss of sensation and paralysis below the neck, may also affect people with spinal cord lesions.[livestrong.com]
    • Paraplegia 1992; 30 : 520–525. 14. Burns SP et al . Recovery of ambulation in motor-incomplete tetraplegia . Arch Phys Med Rehabil 1997; 78 : 1169–1172. 15. Maynard FM et al .[nature.com]
    • Quadriplegia, incomplete 31.2% - Paraplegia, complete 28.2% - Paraplegia, incomplete 23.1% - Quadriplegia, complete 17.5% The figures above represent the resultant permanent disability suffered by a survey of people breaking their backs and necks.[spinal-injury.net]
    • Funding and Disclosures * From the Paraplegia Service, Veterans Administration Medical Teaching Group, Kennedy Hospital.[nejm.org]
    • The most frequent neurologic category at discharge of persons reported to the database is incomplete tetraplegia (30.1%), followed by complete paraplegia (25.6%), complete tetraplegia (20.4%), and incomplete paraplegia (18.5%).[fscip.org]
    Radiculomyelopathy
    Syringomyelia
    • Syringomyelia refers to an eccentric CSF-filled cavity that may reflect a prior insult to the cord parenchyma.[appliedradiology.com]
    • MRI is important for the postoperative follow-up of patients with syringomyelia, including tracking the cyst and detecting complications. [47] Syringomyelia causes progressive myelopathy.[en.wikibooks.org]
    • Central Cord SyndromeClick to animate C5-C6 DRG R L DRG Lateral Spinothalamic TractCommon causesinclude posttraumatic Impaired pain and temperaturecontusion and sensation, C5-C6 dermatomes,syringomyelia, and bilaterallyintrinsic spinal cordtumors.Main[slideshare.net]
    • […] myelopathy Radiation-induced myelopathy Type 1 Excludes myelopathy NOS ( G95.9 ) Disease, diseased - see also Syndrome spinal (cord) G95.9 Lesion (s) (nontraumatic) spinal cord G95.9 Myelopathy (spinal cord) G95.9 ICD-10-CM Codes Adjacent To G95.9 G95.0 Syringomyelia[icd10data.com]
    • […] than 55 MRI findings Spondylosis Spondylosis Fasciculations Absent Present Atrophy of arms Present Present Atrophy of legs Absent Present Denervation Absent Present Other conditions that can mimic CSM on presentation are primary spinal cord tumors, syringomyelia[aafp.org]
    Hematomyelia
    • Hemorrhage in the spinal cord resulting from trauma (hematomyelia) is usually confined to the cervical central gray matter, resulting in signs of lower motor neuron damage (muscle weakness and wasting, fasciculations, and diminished tendon reflexes in[merckmanuals.com]
    • Findings on MRI such as intervertebral disk rupture, spinal epidural hematoma, cord contusion, and hematomyelia have all been recognized as causing primary or secondary spinal cord injury.[emedicine.medscape.com]
    Brown-Sequard Syndrome
    • sequard syndrome - anterior cord syndrome - posterior cord syndrome - isolated nerve root injury - cauda equina syndrome (w/ or w/o root escape) - conus medullaris injury (w/ or w/o root escape) - functional & quantitative criteria: - naming of cord[wheelessonline.com]
    • The presenting symptoms of ISCM vary from pain, sensory loss, weakness, urinary incontinence to pseudo Brown-Sequard and/or Brown-Sequard syndrome [ 5 ]. The duration of symptoms before diagnosis of ISCM ranges from days to a few months [ 5 , 6 ].[casesjournal.biomedcentral.com]
    • In this case, the deficit fit the pattern of a partial Brown-Sequard syndrome. See infra for another report of cerebral-spinal germinoma causing a Brown Sequard syndrome.[en.wikibooks.org]
    • Brown-Sequard syndrome is defined as a unilateral cord injury with ipsilateral motor deficit and loss of contralateral pain and temperature recognition.[orthobullets.com]
    Spondylolisthesis
    • Herniated or slipped disks, spinal stenosis (narrowing of the canal through which the spinal cord travels), scoliosis and kyphotic deformities (abnormal curvature or bending of the spine) and spondylolisthesis (slipping of the bones of the spine) are[uwmedicine.org]
    Spondylitis
    • These include TB arachnoiditis, intramedullary spinal cord tuberculoma, TB spondylitis of the odontoid peg, and one child with tuberculous extradural abscess.[en.wikibooks.org]

    Etiology

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

    Prevention

    Summary

    Patient Information

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    Spinal Cord Neoplasm

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    References

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    2. Recovery in 12 patients after high cervical spinal cord injury. A retrospective review of the diaphragm status of 107 patients ventilated after acute spinal cord injury. - T Oo, JW Watt, BM Soni, PK Sett - Spinal cord, 1999 - ukpmc.ac.uk
    3. Bone disturbances in injuries to the spinal cord and cauda equina (paraplegia) their prevention by ambulation - AS Abramson - The Journal of Bone & Joint Surgery, 1948 - jbjs.org
    4. Catheterization and oxybutynin bladder instillation on urinary continence status and quality of life in a selected group of spinal cord injury patients with neuropathic - S Vaidyananthan, BM Soni, E Brown, P Sett - Spinal cord, 1998 - cat.inist.fr
    5. Antegrade continence enema for the treatment of neurogenic constipation and fecal incontinence after spinal cord injury - CC Yang, SA Stiens - Archives of physical medicine and rehabilitation, 2000 - Elsevier
    6. Centrally acting skeletal muscle relaxants and associated drugs - HJ Waldman - Journal of pain and symptom management, 1994 - Elsevier
    7. 4‐Aminopyridine Improves Pulmonary Function in Quadriplegic Humans with Longstanding Spinal Cord Injury - JL Segal, SR Brunnemann - Pharmacotherapy: The Journal of , 1997 - Wiley Online Library
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    9. Cavernous angiomas of the spinal cord - GR Cosgrove, G Bertrand, S Fontaine - Journal of , 1988 - thejns.org
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    11. Brown-Sequard syndrome after management of vertebral hemangioma with intralesional alcohol: a case report - T Niemeyer, J McClellan, J Webb, T Jaspan, N Ramli - Spine, 1999 - journals.lww.com
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    14. Central dysesthesia pain after traumatic spinal cord injury is dependent on N-methyl-D-aspartate receptor activation - PK Eide, A Stubhaug, AE Stenehjem - Neurosurgery, 1995 - journals.lww.com
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    16. -like movements in humans with complete spinal cord injury induced by epidural stimulation of the lumbar cord: electromyographic study of compound muscle action - K Minassian, B Jilge, F Rattay, MM Pinter, H Binder - Spinal Cord, 2004 - nature.com
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    18. A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury - F Fregni, PS Boggio, MC Lima, MJL Ferreira, T Wagner - Pain, 2006 - Elsevier
    19. Of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury - EC Field-Fote - Archives of physical medicine and rehabilitation, 2001 - j-workout.com
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