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Neurology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Spinal cord disease – commonly produces a sensory ‘level’, may: affect all modalities (whole cord)affect vibration/proprioception only (posterior cord)affect pain/temperature only (anterior cord)produce dissociated loss, i.e. vibration/proprioception one limb and pain/temperature in the opposite limb (half cord, i.e. Brown-Séquard syndrome)
Systemic Illnesses (Diabetes Mellitus, Sarcoidosis, Alcoholism, and Porphyrias)
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
The prevalence of neurosarcoidosis is registered in 5% of patients with sarcoidosis.19 Peripheral nervous system involvement ranges between 25% and 67%.20 The central nervous system can also be affected; in the brain, patients can have leptomeningeal and intraparenchymal granulomatous infiltrates, but these lesions can be found anywhere along the spinal cord.21 In a review of neurosarcoidosis literature, cranial neuropathy was the most common manifestation, with micturition abnormalities reported in 23/206 (11%) patients. Spinal cord disease and peripheral neuropathies were identified in a larger portion of patients (185); however, it is not clear how many patients were evaluated for urinary tract symptoms.
The nervous system and the eye
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
James A.R. Nicoll, William Stewart, Fiona Roberts
The spinal cord extends from the base of the skull to the first lumbar vertebra. The major ascending tracts carry sensation to the cerebellum or thalamus and then on to the cerebral cortex. Sensory fibres enter the spinal cord via the dorsal roots, with some fibres terminating in the dorsal horn before crossing over to form the lateral and anterior spinothalamic tracts, which carry the sensations of pain, temperature and light touch. Other dorsal root fibres pass into the dorsal horns and then ascend in the posterior columns to end in the gracile and cuneate nuclei. These pathways carry the sensations of vibration, weight, proprioception and pressure. The major descending pathways are the corticospinal tracts, which arise from the primary motor cortices and pass via the internal capsules and cerebral peduncles to reach the midbrain, and, from there, the base of the pons. These tracts then descend via the pyramidal decussation to join the lateral corticospinal tracts in the spinal cord before terminating on ventral horn cells. Spinal cord disease tends to result in a combination of motor, sensory and autonomic dysfunction.
Myelopathy associated with SARS-COV-2 infection. A systematic review
Published in Neurological Research, 2021
Artemios Artemiadis, Andreas Liampas, Loizos Hadjigeorgiou, Panagiotis Zis
These definitions correspond to the presumed pathogenesis of spinal cord disease as determined by clinical and laboratory biomarkers. Infectious myelopathy assumes a direct invasion of the virus into the neurons causing cytopathology [3]. In the absence of confirmatory biopsy, the term possible infectious myelopathy was considered provided that the virus was detected in the CSF. On the other hand, the term parainfectious denotes a bystander tissue damage due to systemic inflammation caused by the current viral infection [3,8]. The virus should be present in the human body, and if not detected in the CSF, a systemic inflammation (cytokine storm) should be documented to explain a possible parainfectious damage [3,8,9]. As such, myelopathies associated with systemic inflammation (for this study fulfilling systemic inflammatory response syndrome or SIRS criteria [10], or elevated cytokines in the CSF and/or serum) and presence of viral DNA during nasopharyngeal swab tests (or IgM positive antibodies in the serum) were considered to be possibly parainfectious. In the absence of the above findings, the term post-infectious was used, implying a failure of the adaptive immune response to tolerate self-antigens following a previous infection, as previously described in influenza infections [9]. The presence of COVID-19 symptoms was not included in the above definitions since many patients remained asymptomatic despite the positive PCR tests.
Outcome factors in surgically treated patients for cervical spondylotic myelopathy
Published in The Journal of Spinal Cord Medicine, 2020
Jiolanda Zika, George A. Alexiou, Sotirios Giannopoulos, Ioannis Kastanioudakis, Athanasios P. Kyritsis, Spyridon Voulgaris
In this prospective study, we found no correlation between the grade of myelopathy on MR and patients’ outcome. In a prospective study of 112 CSM patients that quantitative assessed SI changes preoperatively and postoperatively, the SI ratio on T2 was the main significant prognostic factor of surgical outcome. The grading system that was used based on T2WI, which is close to the one used in our study, provided predictive information for patient’s outcome.15 The fact that in our study myelopathy grade on MRI did not reach statistical significance might be explained by the limited number of patients included. Uchida et al. found that low SI on preoperative T1 but not on T2 correlated with poor outcome. Additional, on postoperative MRI the presence of decreased SI on T1 and increased SI on T2 were associated with poor neurologic outcomes.16 The use of several different grading systems of SI changes on MRI have been used to assess prognosis.17,18 Furthermore, it is of great interest the implementation of latest MR techniques such as Diffusion Tensor Imaging (DTI) for CSM prognostication and diagnosis of cervical spinal cord disease.1,17–22
Pelvic floor dysfunction in midlife women
Published in Climacteric, 2019
An overall assessment should include evaluations of general fitness, balance and mobility, and cognitive status. Body mass index is important, as obesity is a major risk factor for UI alone and for PFD65. If a neurologic condition is suspected based on symptoms or preexisting spinal cord disease, a basic neurologic examination should be performed, focusing on the sacral dermatomes and lower extremities. The S2–S4 dermatomes are evaluated with light touch sensation on the perineum. Muscle strength and symmetry can be assessed with plantar flexion (S1–S2) and hip flexion (S2–S3). The integrity of the sacral cord reflexes is easily assessed by observing a bulbocavernosus contraction with light clitoral touch, although the reflex is absent in upward of 10% of normal patients66.