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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]
  • 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]
  • 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]
  • ’s behavioral presentation on examination under normal and lesioned conditions.Overview Menu Main Menu Exit 5.[slideshare.net]
  • Mistakes in diagnosis can be avoided by proper appreciation of these characteristics and by examining the patient for motor, reflex and sensory disturbances which, although usually not marked, are frequently present.[link.springer.com]
Fecal Incontinence
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]
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]
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
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]

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]

Treatment

  • She received appropriate treatment for her hypercalcemia.[casesjournal.biomedcentral.com]
  • Early detection and treatment based on neurological status, age and estimated survival are crucial with all treatment modalities.[patient.info]
  • Strategies, which combine a number of the aforementioned treatments, are most likely to have a beneficial effect in the future.[knowyourback.org]
  • Historically, non-surgical treatment has been the mainstay of treatment. Surgical treatment is controversial but a definite indication for surgery is progressive neurological deficit.[orthobullets.com]

Prognosis

  • Diagnosis and prognosis of acute cervical spine cord injury . Original Text by Clifford R. Wheeless, III, MD.[wheelessonline.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]
  • Prognosis of anterior cord syndrome is worst among all other spinal cord injury syndromes.[radiopaedia.org]
  • Prognosis The spinal cord has very limited powers of regeneration. Prognosis for neurological deficit depends on the magnitude of the spinal cord damage present at the onset.[patient.info]

Etiology

  • 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]
  • 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]
  • Spinal cord injury may be Etiology Spinal cord injury During a typical year, there are about 12,000 spinal cord injuries in the US or 40 cases per million persons per year.[merckmanuals.com]
  • Etiology Since 2005, the most common causes of spinal cord injury (SCI) remain: (1) motor vehicle accidents (40.4%); (2) falls (27.9%), most common in those aged 45 y or older.[emedicine.medscape.com]

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]
  • Clinical Epidemiology . 6 : 309–31. doi : 10.2147/CLEP.S68889 . PMC 4179833 . PMID 25278785 . DeVivo, M.J. (2012). "Epidemiology of traumatic spinal cord injury: Trends and future implications".[en.wikipedia.org]
  • […] spinal cord injury Spinal cord compression, spinal cord trauma Neurology Traumatic damage to the spinal cord resulting in a significant or complete loss of voluntary control of extremities or autonomic nervous system at and below the level of injury Epidemiology[medical-dictionary.thefreedictionary.com]
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]
  • A complex cascade of pathophysiologic events related to free radicals, vasogenic edema, and altered blood flow accounts for this clinical deterioration.[emedicine.medscape.com]

Prevention

  • 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]
  • Prevention Risk of spinal cord injury can be reduced through prevention of the accidents that lead to it.[medical-dictionary.thefreedictionary.com]
  • Other emergency treatment involves maintaining breathing ability, preventing shock, keeping the neck immobilized, and preventing complications such as blood clots.[livescience.com]
  • Preventing pressure injuries You or your caregiver can help prevent pressure injuries. These steps can help keep skin healthy: Prevent constant pressure on any part of the body.[northshore.org]
  • Rapid diagnosis and management are essential to have the highest chances of preventing permanent loss of function.[patient.info]

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