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Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
The C1–C5 spinal root fibers emerge from the upper cervical cord laterally between the anterior and posterior spinal nerve roots to form a separate nerve trunk, which ascends into the skull through the foramen magnum.
Epidural Anesthesia
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The precise mode of action of epidural anesthesia remains controversial. Probably, it is not a simple matter of spinal root and nerve blockade, but the result of complex interactions at the following sites (see Figure 3.22): Periphery of the spinal cord via the subarachnoid space and cerebrospinal fluidSpinal roots within their dural sleevesSpinal gangliaSpinal nerves after the passage of the anesthetic solution into the paravertebral and perineural spaces via intervertebral foramina
Clinical Neuroanatomy
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The spinal root arises from ventral horn cells in the cord between C1 and C5. These fibres emerge from the cord laterally between the anterior and posterior spinal nerve roots to form a separate nerve trunk, ascending into the skull through the foramen magnum. This then exits from the skull via the jugular foramen in the same dural sheath as the vagus. It runs posteriorly as soon as it emerges to supply the sternocleidomastoid and the upper part of the trapezius and receives a major contribution from branches of the anterior roots of C3 and C4, to form the neural plexus, which supplies the cervical musculature. Evidence from surgical procedures suggests that these additional root components make important contributions, as upper cervical root section is required to denervate completely the sternocleidomastoid and trapezius. The peripheral portion of the nerve is easily damaged in lymph node biopsy and other operations in the posterior triangle of the neck.28
Therapeutic issues in Guillain–Barré syndrome
Published in Expert Review of Neurotherapeutics, 2023
Conversely, the appropriate time frame to start any immunotherapy in GBS is not anymore a matter of debate. Considering the mechanisms of nerve injury in this disorder and the potential long-term disability in affected people, the ‘time is nerve’ formula should be widely applied, at least in people who have a significant disability during the ascending phase of the disease. This necessitates careful monitoring of the clinical status of patients affected with GBS in the first hours and days after admission, so as not to miss the time window for treatment to be effective. Moreover, spinal root edema is a very early event in GBS, usually reflected by subtle electrodiagnostic abnormalities, such as F wave prolongation. In this respect, pulses of methylprednisolone in severely impaired patients in the early course of the disease might be worth prescribing, although controlled trials lack to confirm their efficacy.
Clinico-radiological correlation and surgical outcome of idiopathic spinal cord herniation: A single centre retrospective case series
Published in The Journal of Spinal Cord Medicine, 2021
Deepak Menon, Sruthi S. Nair, Bejoy Thomas, K. Krishna Kumar, Muralidharan Nair
The presentation of ISCH as cervical radiculopathy was hitherto unreported. This was observed in our patient who had a cord herniation at T1segment with radicular symptoms localising to C7 root. Since patient had no apparent imaging evidence of a spinal root compression, it could be that the ventral herniation of cord could have resulted in a functional traction of the spinal roots manifesting the symptom. The imaging studies also revealed a few novel findings. In our series, two of the patients had evidence for syrinx; one at the level of herniation and the other one segment above it. The mechanism could be due to change in CSF flow due to the adhesion and herniation obstructing the normal flow dynamics as demonstrated by experimental studies. The transmission, reflection and Venturi effects of CSF pressures at the site of obstruction leads to the development of syrinx.7 Incidentally there was electrophysiological evidence for anterior horn cell damage at the same segment of syrinx (case 3).
Trans-sacral epiduroscopic laser decompression versus the microscopic open interlaminar approach for L5-S1 disc herniation
Published in The Journal of Spinal Cord Medicine, 2020
Seung-Kook Kim, Su-Chan Lee, Seung-Woo Park
SELD was performed with the patient in the prone position. The skin entry point was generally the middle point of the sacral hiatus. After the entry point was locally infiltrated with anesthetic, a 20-gauge needle was introduced under fluoroscopic guidance. The final target point of the endoscopic catheter was the posterior vertebral line in the anteroposterior (Fig. 2A) and lateral views (Fig. 2B). Next, epidurography was performed using contrast media to confirm the location of the spinal root (traversing and exiting) and LDH. The following steps were then performed: a small insertion point was made in the skin at the entry point, a tapered cannula was inserted through the sacral hiatus, and a laser and camera equipped for epiduroscopy (Meta Biomed Co., Ltd.; I Dolphin) were inserted below the disc along the cannula. An elevated pathological nucleus and ruptured fragment helped with disc discrimination.