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Spinal Cord Transection


Presentation

  • One child presented with a CSF leak. Two children (22%) required revision of their ventriculoperitoneal shunts.[ncbi.nlm.nih.gov]
  • Herein we present a case in which a paraplegic spina bifida patient presenting with symptomatic spinal retethering experienced autonomic dysreflexia following an elective spinal cord transection.[ncbi.nlm.nih.gov]
  • The clinical presentation, imaging findings, and recommended evaluation modalities are discussed. An overview of pediatric spinal column and vascular injuries secondary to physical abuse is given.[ncbi.nlm.nih.gov]
  • OBJECTIVES AND RESULT: We present the case of a 20-year-old male, who sustained an AOD with a complete medulla/spinal cord transection in a motorcycle accident to discuss the possibility of long-term survival with this condition.[ncbi.nlm.nih.gov]
  • Cord injury usually follows breech presentation, the lesion is in the lower cervical or upper thoracic segments, and results from excessive traction.[adc.bmj.com]
Unable to Stand
  • Review Questions: Case 3Following surgical repair of a knife wound the patient is unable to stand or walk becausehe is unable to move or bear weight on his right leg.[slideshare.net]
Congestive Heart Failure
  • heart failure, asthma, immune system dysfunction, and more.Features a new, more user-friendly design and organization to expedite quick access to the answers you need.[books.google.de]
Back Pain
  • Symptoms Patients with associated spine fractures typically have significant, localized neck or back pain. Patients with incomplete spinal cord injuries may complain of pain in other areas and not notice the severity of neck of back pain.[uscspine.com]
  • However, less than 0.1% of people with back pain who visit their general practitioner have spinal metastases [ 3 ].[patient.info]
Muscle Spasticity
  • Musculoskeletal management Patients with SCIs typically experience muscle spasticity as spinal shock recedes and reflexes return. Spasticity may take a flexor or extensor pattern or a combination.[americannursetoday.com]
Suggestibility
  • These data suggest that dopaminergic regulation of adrenal zona glomerulosa corticosteroid and renal renin secretion is absent in patients with high spinal cord transections, suggesting that intact neural pathways from the central nervous system are necessary[ncbi.nlm.nih.gov]
  • These findings suggest a possible role for increased iNOS expression in the pathogenesis of OH in persons with SCI.[ncbi.nlm.nih.gov]
  • This single case suggest that successful stimulation of the sacral neural outflow may not require intrathecal placement of stimulating electrodes, sensory rhizotomy, or pudendal neurotomy.[ncbi.nlm.nih.gov]
  • This article describes the location of the testis in 32 spina bifida patients and the effect of spinal cord transection in neonatal rats: both studies suggest that the spinal cord influences testicular descent.[ncbi.nlm.nih.gov]
  • These observations suggest that PLGA nerve conduits combined with exogenous NT3 may serve as an alternative therapeutic approach for spinal cord injury repair. Copyright 2011 Wiley Periodicals, Inc.[ncbi.nlm.nih.gov]
Distractibility
  • Abstract Distraction injury of the spine with spinal cord transection and adjacent vascular injury is rarely described in the setting of child physical abuse. We report a 5-week-old infant boy who sustained these injuries after an abusive event.[ncbi.nlm.nih.gov]
  • Mechanism of injury There are four main mechanisms of injury in SCI – distraction, compression, torsion, and penetration.[openanesthesia.org]
Hyperreflexia
  • It presents with spastic paresis, hyperreflexia, and continued sensory loss. Acute stabilization, a thorough neurological examination, and imaging is required for adequate diagnosis.[amboss.com]
  • When the stage of spinal shock passes, the typical UMN picture within hyperreflexia and spastic paralysis below the level of the injury supervenes. Clinical symptoms and signs of spinal cord transection depend on the level injured.[casemed.case.edu]
  • Ipsilaterally, paralysis, loss of vibration and position sense below the level of the lesion, hyperreflexia, and an extensor toe sign are present. In addition, ipsilateral segmental anesthesia occurs at the level of the lesion.[emedicine.medscape.com]
  • After days or weeks, upper motor neuron dysfunction evolves into spastic paresis (increased muscle tone, hyperreflexia, and clonus). Extensor plantar responses and autonomic dysfunction are present.[merckmanuals.com]
Spastic Paralysis
  • Characteristically there is: lower motor neuron paralysis at the level of injury upper motor neuron (or spastic) paralysis below the level of injury The degree of neurological compromise corresponds with the degree of cord transection.[radiopaedia.org]
  • A change in symptoms occurs after a period of 6–8 weeks and includes spastic paralysis, recurrence of proprioceptive reflexes as hyperreflexia, and the presence of pathological reflexes (e.g., plantar reflex )! References: [1] [2] [3] [4][amboss.com]
  • When the stage of spinal shock passes, the typical UMN picture within hyperreflexia and spastic paralysis below the level of the injury supervenes. Clinical symptoms and signs of spinal cord transection depend on the level injured.[casemed.case.edu]
Flaccid Paralysis
  • paralysis and a complete absence of reflexes occur below the injury.[amboss.com]
  • During this period, there is complete absence of reflex and autonomic activity below the level of the injury with flaccid paralysis.[casemed.case.edu]
Spastic Paraplegia
  • : 7347432 Clinical observations on patients with spastic paraplegia have indicated that a training regime including weight load on the lower limbs may reduce the muscular hypertonus.[easystand.com]
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[merckmanuals.com]
  • During the initial stage of spinal shock after cord transection at any level, reflex emptying of the bladder may be lost, resulting in urinary retention and bladder distention.[casemed.case.edu]
  • Acute SCI must be suspected whenever someone presents with a combination of autonomic (ie, urinary retention, constipation, ileus, hypothermia, hypotension, bradycardia), motor (ie, hemiplegia and/or hemiparesis sparing the face, paraplegia and/or paraparesis[emedicine.medscape.com]
  • The latter can lead to neurogenic shock, paralytic ileus, aspiration, urinary retention, priapism and loss of thermoregulation. Clinical features depend upon the extent and rate of development of cord compression.[patient.info]
  • Genitourinary management A patient in neurogenic shock experiences abrupt loss of voluntary muscle control and reflexes, resulting in acute urinary retention.[americannursetoday.com]
Urinary Incontinence
  • 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]
Cryptorchidism
  • Abstract In spina bifida there is a high incidence of cryptorchidism, particularly where the lesion is at or above L2.[ncbi.nlm.nih.gov]

Workup

Hypocapnia
  • It is concluded that the responses of the cerebral circulation to change of blood pressure and to hypocapnia are normal in patients with high spinal cord transection.[ncbi.nlm.nih.gov]
Hypercapnia
  • CO2 responsiveness was tested by induced hypercapnia in 11 patients with CCT and 2 patients with TCT. Autoregulation was tested in 10 patients with CCT and 4 patients with TCT by decreasing cerebral perfusion pressure during postural tilting.[ncbi.nlm.nih.gov]

Treatment

  • Adult Sprague-Dawley rats (n 56) transected at T8-9 had one of five treatments beginning 7 days after transection: Tx (transection only), Tx Ex, Tx DOPA, Tx Ex DOPA, and control (Ctl, no treatment) groups.[ncbi.nlm.nih.gov]
  • Based on their experience, treatment can be effective in carefully selected patients who undergo spinal cord transection, and the rate of repetitive tethered spinal cord can be decreased.[ncbi.nlm.nih.gov]
  • It should be a focus of treatment strategies.[books.google.de]
  • There are currently no effective therapies for the treatment of traumatic SCI in humans. Various animal models have been developed to mimic human SCI.[ncbi.nlm.nih.gov]
  • BACKGROUND: Spinal cord transection is a radical but effective treatment for highly selective cases of symptomatic spinal retethering in paraplegic spina bifida patients.[ncbi.nlm.nih.gov]

Prognosis

  • Treatment and prognosis The role of acute MRI is usually to assess for the presence of treatable acute pathologies such as an epidural hematoma or cord compression, which can be targeted by surgical decompression.[radiopaedia.org]
  • Glasis Post 1 Unfortunately at this time spinal cord injuries mean a pretty gloomy prognosis. An injury to the spinal cord generally results in some sort of permanent impairment regardless of the treatment.[wisegeekhealth.com]
  • According to the National Institutes of Health (NIH), the prognosis of spinal cord damage will depend on if the injury was complete or incomplete.[birthinjuryguide.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]
  • […] incomplete) Exclude associated injuries Imaging Complete spinal imaging (cervical, thoracic, lumbar): plain x-rays or CT, if available MRI : can provide further information on extent of ligamentous/disc injuries, spinal cord pathology, or epidural hematoma Prognosis[amboss.com]

Etiology

  • References: [1] [2] [3] Complete spinal cord injury Etiology Incomplete spinal cord syndromes may develop into complete spinal cord lesions Trauma (complete transection) Spinal tumors, multiple sclerosis, or myelitis Extradural pathologies (e.g., spinal[amboss.com]
  • The most common etiologies include trauma ; compression from tumor, hematoma, or abscess ; or transverse myelitis (viral, post-viral, or demyelinative), among other causes.[casemed.case.edu]

Epidemiology

  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 2001;26S:2. Tator CH, Duncan EG, Edmonds VE, et al. Changes in epidemiology of acute spinal cord injury from 1947 to 1981. Surg Neurol 1993;40:207.[uscspine.com]
Sex distribution
Age distribution

Pathophysiology

  • Organized by disease, the new edition of this popular guide has been completely revised and updated to reflect the latest information on definition, current pathophysiology, significant pre-, intra-, and postoperative factors of the disease process, anesthetic[books.google.de]
  • Pathophysiology and pharmacologic treatment of acute spinal cord injury. Spine J 2004;4:451. Rizzolo SJ, Vacarro AR, Cotler JM: Cervical spine trauma. Spine 1994;19:2288. Sekhon LH, Fehlings MG.[uscspine.com]

Prevention

  • The authors describe the case of an 11-year-old girl with lumbar myelomeningocele and worsening thoracolumbar scoliosis who underwent a T11-L5 fusion and spinal transection to prevent tethering.[ncbi.nlm.nih.gov]
  • AIMS: In patients with myelomeningocele (MMC) and coexistent scoliosis, a spinal cord transection (SC-transection) is sometimes performed before scoliosis correction to prevent traction on the myelum after stretching the spinal column.[ncbi.nlm.nih.gov]
  • The spinous process and transverse process would prevent a knife blade from crossing the midline before entering the ligamentum flavum.[onlinejets.org]
  • The outlook for someone with complete spinal cord transection is limited because the cord does not regenerate, so treatment is focused on providing support and preventing complications.[wisegeekhealth.com]
  • This may help prevent diarrhea. Drink several glasses of water each day. This can prevent constipation. Medications.[webmd.com]

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