Pics Of Spinal Sclerosis

The clinical differential diagnosis of myelopathies is based on the level of the spinal cord lesion, the particular structures affected, and the temporal course of the disorder (p. 48, Table 39, p. 381).

Acute Myelopathies

Symptoms and signs develop within minutes, hours, or days.

■ Spinal Cord Trauma

Viral myelitis (p. 234 ff). Enteroviruses (poliovirus, coxsackievirus, echovirus), herpes zoster virus, varicella zoster virus, FSME, rabies, HTLV-1, HIV, Epstein-Barr virus, cytome-galovirus, herpes simplex virus, postvaccinial myelitis.

Nonviral myelitis (p. 222 ff). Mycoplasma, neu-roborreliosis, abscess (epidural, intramedul-lary), tuberculosis, parasites (echinococcosis, cysticercosis, schistosomiasis), fungi, neurosyphilis, sarcoidosis, postinfectious myelitis, multiple sclerosis/neuromyelitis optica (Devic syndrome), acute necrotizing myelitis, connective tissue disease (vasculitis), paraneoplastic myelitis, subacute myelo-optic neuropathy (SMON), arachnoiditis (after surgical procedures, myelo-graphy, or intrathecal drug administration).

Anterior spinal artery syndrome. Segmental paresthesia and pain radiating in a bandlike distribution may precede the development of motor signs by minutes to hours. A flaccid paraparesis or quadriparesis (corticospinal tract, anterior horn) then ensues, along with a dissociated sensory loss from the level of the lesion downward (spinothalamic tract ^ impaired pain and temperature sensation, with intact perception of vibration and position) and urinary and fecal incontinence. Often only some of these signs are present.

Posterior spinal artery syndrome is rare and difficult to diagnose. It is characterized by pain in the spine, paresthesiae in the legs, a loss of position and vibration sense below the level of the lesion, and global anesthesia with segmental loss of deep tendon reflexes at the level of the lesion. Larger lesions cause paresis and sphincter dysfunction.

Sulcocommissural artery syndrome. Segmental pain at the level of the lesion, followed by flaccid paresis of ipsilateral arm/leg; loss of proprioception, position sense, and touch perception with contralateral dissociated sensory loss (Brown-Sequard syndrome). Sphincter dysfunction is rare.

Complete spinal infarction. Acute spinal cord transection syndrome with flaccid paraplegia or quadriplegia, sphincter dysfunction, and total sensory loss below the level of the lesion. Au-tonomic dysfunction may also occur (e. g., vasodilatation, pulmonary edema, intestinal atony, disordered thermoregulation). The cause is often an acute occlusion of the great radicular artery (of Adamkiewicz). Central spinal infarction. Acute paraplegia, sensory loss, and sphincter paralysis. Claudication of spinal cord. Physical exercise (running, long walks) induces paresthesiae or paraparesis that resolves with rest and does not occur when the patient is lying down. Cause: Exercise-related ischemia of the spinal cord due to a dural arteriovenous fistula or highgrade aortic stenosis (see also p. 284).

Dural/perimedullary arteriovenous (AV) fistula is an abnormal communication (shunt) between an artery and vein between the two layers of the dural mater. An arterial branch of a spinal artery feeds directly into a superficial spinal vein, which therefore contains arterial rather than venous blood, flowing in the opposite direction to normal. Paroxysmal stabbing pain and/or episodes of slowly progressing paraparesis and sensory loss separated by periods of remission occur in the early stage of the disorder, which usually affects men between the ages of 40 and 60. If the suspected diagnosis cannot be confirmed by MRI scans (because of low shunt volume), myelography may be helpful (^ dilated veins in the subarachnoid space). Spinal hemorrhage can occur in epidural, sub-dural, subarachnoid, and intramedullary locations (intramedullary hemorrhage = hematomy-elia). Possible causes: intradural/intramedullary AV malformation, cavernoma, tumor, aneurysm, trauma, lumbar puncture, and coagulopathy.

Fractured vertebral arch and dislocated vertebral body

Destruction of vertebral body

Intraspinal (epidural) spread of infection

Intraspinal (epidural) spread of infection

Intraspinal Stimulator

Infarct (anterior spinal a.)

Anterior spinal a.

Infarct (left sulco-commissural a.)

Thoracic dural AV fistula

(T2-weighted MRI scan, lateral view of thoracic spine)

Mri Images Multiple Sclerosis

Infarct (anterior spinal a.)

Anterior spinal a.

Infarct (left sulco-commissural a.)

Spondylitis

(thoracic vertebra)

Vascular spinal cord lesion Engorged dorsal medullary veins hil

Thoracic dural AV fistula

(T2-weighted MRI scan, lateral view of thoracic spine)

Subacute and Chronic Myelopathies

Spinal cord syndromes (p. 282) may be subacute or chronic depending on their cause. The

■ Mass Lesions complete clinical picture may develop over days to weeks (subacute) or months to years (chronic). For myelopathies due to developmental disorders, see p. 288 ff.

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Responses

  • Eleleta
    Does spinal infarction cause ms?
    5 years ago

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