Disorders of Circulation of the Cerebrospinal Fluid
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Syringomyelia of cervical spinal cord needs to be distinguished from other diseases that affect the cervical spinal cord: Sarcoidosis.Multiple sclerosis.Amyotrophic lateral sclerosis.Spinal cord compression by meningioma or neurofibroma.Spinal cord compression by metastatic tumors.Intrinsic tumors of the spinal cord such as ependymoma or astrocytoma.Cervical spondylosis with spinal cord compression and neurosyphilis.
C1–C2 Transarticular Screw Technique
Alexander R. Vaccaro, Christopher M. Bono in Minimally Invasive Spine Surgery, 2007
A thorough history and physical exam is performed. Patients may present with symptoms ranging from mechanical complaints such as axial neck pain, neck spasm, torticollis, and headaches to myelopathy from spinal cord compression. Symptoms are usually worsened with neck flexion. The neurologic exam can range from normal to transient quadriparesis. Complete spinal cord injuries are rare as they are usually fatal at this level. Neurologic complaints may present late. In cases of severe atlantoaxial instability, patients may present with brain stem symptoms such as vertigo, syncope, respiratory distress, and stroke secondary to vertebrobasilar insufficiency from vertebral artery occlusion. Body habitus is important to assess when planning a C1–2 posterior arthrodesis. Excessive thoracic kyphosis or obesity may preclude correct screw trajectory for the C1–2 transarticular approach.
Motor Areas in the Frontal Lobe: The Anatomical Substrate for the Central Control of Movement
Alexa Riehle, Eilon Vaadia in Motor Cortex in Voluntary Movements, 2004
in the intermediate zone (laminae V-VIII) of the cervical spinal cord. Terminations here were concentrated at three locations: (1) the dorsolateral portion of laminae V-VII; (2) the dorsomedial portion of lamina VI at the base of the dorsal columns; and (3) the ventromedial portion of lamina VII and adjacent lamina VIII. The cingulate motor areas (CMAr, CMAd, CMAv) also terminated most densely within the intermediate zone.128 142 However, the density of their terminations was noticeably lower than those from the SMA. In addition, terminations from the CMAr and CMAd were concentrated in the dorsolateral portions of the intermediate zone whereas CMAv terminations were most dense in the dorsomedial portions.128 142 This differential pattern of terminations suggests that the CMAr, CMAd, and CMAv innervate specific sets of spinal interneurons and thereby influence different spinal mechanisms for controlling forelimb movements.
Acute quadriplegia and death following a routine MRI for undiagnosed degenerative cervical myelopathy
Published in British Journal of Neurosurgery, 2023
Cylene Yang, Oliver D. Mowforth, Amir Rafati Fard, Benjamin M. Davies, Rodney J. C. Laing
Firstly, an acute spinal cord injury is rare in DCM, but can occur following mild trauma (e.g. a fall from standing), and result in a central cord syndrome with greater weakness affecting the arms than the legs.2,11 Acute, non-traumatic cervical spinal cord injuries are normally attributed to inflammatory disease, infection, neoplasia and rarely ischaemic events or spontaneous disc prolapse. Spinal cord infarct is extremely rare in the cervical spinal cord, and/or in an individual without pre-existing cardiovascular disease. Moreover, spontaneous acute disc prolapse typically occurs in isolation and in younger individuals. Whilst the T2 signal intensity of the disc at C5/C6 was increased compared to the adjacent discs, a feature sometimes associated with acute herniation, this seems related to the nucleus pulposus not the prolapse, and at surgery the disc complex appeared chronic.
Neuromyelitis optica spectrum disorder: pathophysiological approach
Published in International Journal of Neuroscience, 2022
Mario A. Mireles-Ramírez, Fermín P. Pacheco-Moises, Héctor A. González-Usigli, Nayeli A. Sánchez-Rosales, Martha R. Hernández-Preciado, Daniela L. C. Delgado-Lara, José J. Hernández-Cruz, Genaro Gabriel Ortiz
The analysis of CNS lesions supports an immunological and pathophysiological mechanism, due to complement activation, eosinophil infiltration and vascular fibrosis, a marked decrease in AQP4 expression and loss of astrocytes in lesions of the spinal cord and optic nerves. Brain magnetic resonance (MRI) is usually normal early in the disease; in a more advanced stage, only 10% of patients present lesions comparable to MS [6]. The contribution of magnetic resonance imaging, the analysis of the immunological profiles of the cerebrospinal fluid (CSF), the pathological data as well as the very specific antibody actions allow to better delineate the limits of this affection [7]. For instance, using functional magnetic resonance imaging, inflammation will be observed as hyperintensity on T2 and hypointensity on T1 in the acute event [8]. Additionally, patients tend to have longer-segment less prominent involvement of the optic nerves, more often involving the chiasm and optic tracts [9]. The most commonly affected regions of the spinal cord are the cervical and upper thoracic. It is not uncommon to find lesions that continue from the bulbar portion. Distinctively, the myelopathy is longitudinally extensive, with involvement of at least three contiguous vertebral segments and with a preference for the central area of the spinal cord. In the follow-up, the lesions can be seen shorter and chronically atrophy of the spinal cord appears in the compromised segments [6]. Using optical coherence tomography a severe thinning of the retinal nerve fiber layer and internal plexiform/ganglion cell layer was detected [3].
Evaluation of the prognostic value of extra-parenchymal changes in traumatic spinal cord injury, assessed by magnetic resonance imaging
Published in The Journal of Spinal Cord Medicine, 2022
Rubén Mora-Boga, Olalla Vázquez-Muíños, Sonia Pértega-Díaz, Sebastián Salvador-de la Barrera, María Elena Ferreiro-Velasco, Antonio Rodríguez-Sotillo, Rosa María Meijide-Failde, Antonio Montoto-Marqués
After the abovementioned articles, Martínez-Pérez et al. proposed a relationship between soft tissue damage and TSCI prognosis. Currently, and to the best of our knowledge, Martínez-Pérez has published only three articles that exclusively analyze this point. All the works were carried out in patient populations with cervical spinal cord injuries. In the first study, lesion length with regard to the damage to ligament structures was examined.30 The authors showed a relationship and extrapolated it to other publications that associated the length of the injury with the prognosis for recovery. The authors argue that the great advantage of the study on soft tissue damage is that LI is not a dynamic process and is not as influenced by possible delays in getting the necessary tests as occurs in cases of changes in spinal cord signals, which commonly show important variations during the most acute phase of TSCI.
Related Knowledge Centers
- Animal
- Brainstem
- Cerebrospinal Fluid
- Meninges
- Nervous Tissue
- Vertebra
- Medulla Oblongata
- Vertebral Column
- Lumbar
- Central Canal