Spine Healing Therapy

Dorn Spinal Therapy

Dorn Spinal Therapy has been in uses in the past 40 years. The credit of this method goes to Dieter Dorn, who has made a significant impact in the medical field. DORN- Method has been used on various patients where results could get witnessed instants. Due to the impact, this method has brought in the country. It has been declared the standard practice in treating Pelvical Disorders, Spinal, and Back pain. Dieter Dorn first used this method on his family, which was a sign of confidence in a method, which later gained much attention from different people in the country and also globally. Every day Dorn was able to offer treatment to 15- 20 patients in a day. His services were purely free which attracted attention both in the local and also global. The primary treatment that DORN-Method which could be treated using this method include spine healing therapy, misalignments of the spine, resolving pelvis and joints, and also solving out significant problems which could get attributed to vertebrae.

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Finite Element Models of the Lumbar Spine

Vertebra Loading Finite Element

The human spine is a complex system that protects the delicate spinal cord while providing sufficient flexibility and stiffness to adequately perform various activities. With the support and control of muscles, the passive ligamentous column carries loads as low as those in upright standing postures and those under heavy lifting tasks. Due to the difficulty in analyzing the system as a whole, researchers often subdivide it into a number of regions and study them separately. Such attempts, in order to be successful, should realistically account for the boundary conditions between regions. Due to the absence of coupling between various regions, however, such isolated models cannot be expected to manifest all response characteristics present at the global system. In this chapter, finite element model studies of the lumbar functional units or motion segments (each functional unit consists of two adjacent vertebrae with connecting ligaments and intervertebral disc) and the entire...

Thoracic and Lumbar Spine

Apophyseal Joints The Lumbar Spine

Because of the larger size and widely spaced vertebrae in the lower spine, the small parts of the individual vertebrae are increasingly well delineated as one descends the spinal column toward the sacrum. For a baseline study, the Fig. 4.17A, B Posterior view of the lumbar spine. A Posterior pinhole scintigraph of the lumbar spine demonstrates increased tracer uptake in the apophyseal joints (aj), spinous processes (sp), and vertebral endplates (ep). The intervertebral disk spaces are photopenic. B Antero-posterior radiograph identifies the apophyseal joints (aj), spinous processes (sp), transverse process (tp) and vertebral endplates (ep). The disk spaces appear lucent Fig. 4.17A, B Posterior view of the lumbar spine. A Posterior pinhole scintigraph of the lumbar spine demonstrates increased tracer uptake in the apophyseal joints (aj), spinous processes (sp), and vertebral endplates (ep). The intervertebral disk spaces are photopenic. B Antero-posterior radiograph identifies the...

Kinetic Redundancy and Models of Spinal Loading

The kinetic redundancy present in the biomechanical models of complex joints, such as the spine, has presented an obstacle in estimating the joint reaction forces during simulation of the recreational or occupational physical activities. The lumbar spine is the most injury-prone region of the trunk during performance of manual material-handling tasks. Numerous biomechanical models for estimation of joint reaction forces in the spine have been developed. In the absence of any gold standard, one is unable to determine the accuracy and validity of these models. Earlier attempts to solve the problem simplified the role of muscles by grouping them into synergistic groups (i.e., flexor and extensor muscles) while carrying out the free-body analysis after passing an imaginary plane at a specificed level (i.e., L5 S1). This allowed the number of equations and unknowns to become identical so one could obtain the unique solution to the muscle forces and subsequently the net joint reaction...

Chorda Tissue Embryonic Spinal Column

The chorda dorsalis (notochord) consists of large star-shaped chorda cells, which form cell-to-cell contacts with each other. Chorda cells have a high water content, contain microfilaments and synthesize type II collagen. From the chorda dorsalis derives the nucleus pulposus of the intervertebral disks. The figure shows a detail section from the still mesenchymal spine of an embryo with a crown-rump length of 12 mm. The sagittal section is turned by 90 , ventral is up.

The spinal tract and nucleus pain and temperature sensation

This is so called because it extends down through the medulla into the cervical spinal cord. Caudally, it is in contact with the substantia gelatinosa of the dorsal horn of spinal grey matter which receives pain and temperature fibres of spinal nerves, and of which it can be considered a cranial extension. The spinal nucleus contains the cell bodies of secondary sensory pain and temperature neurons, the axons of which decussate and ascend in the trigeminal lemniscus to the contralateral thalamus, principally the ventromedial nuclear group. Thalamocortical neurons pass as explained in Section 4.1.

Flow of Cerebrospinal Fluid


The cerebrospinal fluid (CSF) is an ultra-filtrate of plasma actively secreted into the cerebral ventricles by the choroid plexus, a highly vascularized and perfused lining of the ventricles. Average blood flow through the cerebral circulation is about 0.5 ml min g of brain tissue, and flow to the choroid plexus is about ten times higher. The choroid plexus supplies at least 75 of the CSF, which is also derived from the interstitial fluid (ISF), which is produced by the endothelial cells of the blood-brain barrier in the choroid plexus. The transformed ISF is pumped into the subarachnoid space as CSF across the pial-glial membranes. CSF passes through the ventricles and into the subarachnoid space through the foramina of Magendie and Luschka(see also p. 16). A third source of water for CSF is provided by the complete oxidation of glucose by brain parenchymal cells. The subarachnoid space is a cavity between the arachnoid membrane and pia mater surrounding the brain and spinal cord....

Disorders of the Spinal Nerve Roots

E.g., brachialgia, girdle pain, sciatica. Pain is aggravated by cough (increased intraspinal pressure) movement of that part of the spine and stretching (e.g., straight leg raising L4, L5, SI femoral stretch test L2, L3, L4) Lower motor neuron type (e.g., weakness, tendon reflexes decreased or absent, flaccidity, fasciculations, and atrophy if existing for long enough) E.g., all modalities decreased or absent in dermatome dermatomes often overlap, so that sensory loss may be subtle. The disorders may affect the spinal roots in the spinal canal or intervertebral foramen Spinal stenosis

Spinal Intradural Cysts

Intraspinal neurenteric cysts form a spectrum that merges with intraspinal teratomas and intraspinal dermoids and epidermoids. More than 60 of the cases are diagnosed in the first 20 years of life 44 are located totally or partially in the cervical spinal canal, 37 are located in the thoracic spinal canal, and 19 in the lumbosacral spinal canal. The neurological signs and symptoms of a slowly progressing mass are associated by congenital anomalies, such as thickened or pigmented skin, a cutaneous dimple or dermal sinus, or a tuft of hair may occur in the midline of the back These account for 0.2 - 2 of primary spinal tumors in adults in children, however, these cysts represent 3-13 of such spinal tumors, and within the first year of life the incidence is even higher, at 17 . At least 62 of dermoid cysts and 63 of epidermoid cysts occur at or below the thoracolumbar junction. Among intraspinal dermoids, 30 are wholly or partially intramedullary in location, and 28 of intraspinal...

Multiple Lumbar Spine Surgery Failed Back Syndromes

A history of failed lumbar spine surgery represents a diagnostic and therapeutic challenge for the physician. The first step is to distinguish between patients whose back or leg pain originates from a systemic cause (e.g., pancreatitis, diabetes, abdominal aneurysm) and those with a mechanical problem a thorough medical evaluation should therefore be undertaken in this group at the same time as the neurosurgical evaluation is carried out.

Spinal Extradural Cysts

Congenital extradural spinal cysts Spontaneous spinal nerve root diverticula and cysts (Tarlov cysts) Spinal ganglion cysts and spinal synovial cysts Extradural spinal hy-datidosis These cysts arise as an evagination or herniation of the arachnoid that gradually enlarges. Its neck eventually closes, creating a cyst that no longer communicates with the CSF space. The cysts are located exclusively or primarily in the thoracic spine in 86 of cases, and less frequently in the cervical region (2.5 ) and lumbosacral region (11.5 ). Nearly 40 of patients with congenital extradural spinal cysts have Scheuermann's disease (kyphosis dorsalis juvenilis) or preoperative dorsal kyphosis without definite vertebral epiphysitis These cysts are extensions of the subarachnoid space along spinal nerve roots primarily located on the posterior spinal nerve roots and spinal ganglia, containing fluid that is either clear and colorless or faintly yellow. Occasionally, a perineural cyst can become large...

Osteomyelitis of the Spine

What Vertebral Endplate

Osteomyelitis of the spine (pyogenic spondyli-tis) typically affects adults. The main causative agents include S. aureus and streptococcus, and rarely gram-negative bacilli and salmonella. Pyogenic spondylitis may result from the direct implantation of organisms at the time of operation. However, in the vast majority the infection is blood-borne. The organisms are introduced through the arterial rather than venous pathway, and the early foci are located in the subchondral zone or the endplate of the vertebral body, the area richly supplied with nutrient endarteries (the equivalent of the long bone metaphysis). Clinically, the infection starts in the subchondral zone of one of the midlumbar vertebrae and rapidly spreads to the apposing vertebra above or below across the disk. In the course of the spreading the disk is inescapably involved, producing infective (pyogenic) diskitis. Pyogenic spondylitis Ordinary scintigraphy shows simple blocklike uptake in infective spondylitis, not...

Injury to the spinal cord

The first area of central nervous system trauma to be discussed will be injuries sustained to the spinal cord. The reasons for presenting this topic first are that the greatest levels of success with applications of motor pros-theses have been achieved with spinal cord injuries. Injuries of the spinal Figure 12.1 Overview of the human spinal cord and the motor biological function associated with each level. cord result in different types of disorders depending upon the level of the injury and the spinal cord tracts involved (Figure 12.1). Trauma to the spinal cord is usually the result of an automobile or diving accident, or a missile wound,1 often secondary to a fracture or dislocation of the vertebral column. This results in severance or compression of the cord by the fractured bone and edema (tissue swelling). As would be expected, the most mobile areas of the vertebral column are the most susceptible to injury. An injury to the lumbar or thoracic area results in paraplegia...

Cytology of Cerebrospinal Fluid

Cerebrospinal Fluid Analysis Imagines

The first step in all hemato-oncological and neurological diagnostic assessments of cerebrospinal fluid is the quantitative and qualitative analysis of the cell composition (Table 32). Undefinable cells with large nuclei suggest tumor cells in general, e.g., meningeal involvement in breast cancer or bronchial carcinoma, etc. The cell types are determined on the basis of knowledge of the primary tumor and or by marker analysis. Among primary brain tumors, the most likely cells to be found in cerebrospinal fluid are those from ependymoma, pinealoma, and medulloblastoma. The cytological analysis of the cerebrospinal fluid offers important clues to the character of meningeal inflammation, the presence of a malignancy, or hemorrhage. Viral, bacterial, and malignant meningitis can be distinguished by means of cerebrospinal fluid cytology Fig. 68 Cerebrospinal fluid cytology. a Cerebrospinal fluid cytology in bacterial meningitis granulocytes with phagocytosed diplococci (in this case,...

Spinal Cord

Colinear Hox gene expression is continuous from the hind-brain throughout the spinal cord, with genes located in more 3' regions of the chromosomes being expressed more rostrally, and those at more 5' regions in the clusters being expressed more caudally (Fig. 14). These transcription factors provide positional information within the neural tube and adjacent mesodermal somites that controls the development of cervical, thoracic, lumbar, and sacral development in the spine. Evidence in support of this comes from a comparison of the vertebrae of chick and mouse. These two species express similar Hox genes in their trunk, and the boundaries of expression of gene pairs match reproducibly with the division between cervical and thoracic (Hoxc5 and c6) and between lumbar and sacral (Hoxd9 and dlO) even though these two points occur in different locations in mouse and chick (Fig. 15). In addition, grafting experiments that moved either neural tissue or paraxial mesoderm (somite) to another AP...

Spinal Ganglion

Spinal ganglia are spindle-shaped nodes with a diameter of 5-8 mm. They are located in the posterior roots of the spinal nerves immediately before posterior and anterior roots merge. Each spinal ganglion is enveloped by a strong collagen fiber capsule ( constituent of the spinal dura mater). Distally, it continues in the perineurium of the spinal nerve. Each ganglion is traversed by a delicate vascularized connective tissue (endoneurium of the spinal nerve), which is continuous with the connective tissue of the capsule. Embedded in this loose connective tissue are pseudounipolar nerve cell bodies and their satellite cells ( peripheral glial cells) as well as the axons of these primary sensory neurons of the spinal nerves (cf. Figs. 256, 672-674). 2 Posterior root of the spinal nerve

Primary Nursing Diagnosis

The most important priority is the maintenance of an adequate airway, oxygen supply, breathing patterns, and circulatory status. Be prepared to assist with endotracheal intubation and mechanical ventilation by maintaining an intubation tray within immediate reach at all times. Maintain a working endotracheal suction at the bedside as well. If the patient is hemodynamically stable, position the patient for full lung expansion, usually in the semi-Fowler position with the arms elevated on pillows. If the cervical spine is at risk after an injury, maintain the body alignment and prevent flexion and extension by using a cervical collar or other strategy as dictated by trauma service protocol.

Genetic Considerations

The course of acromegaly is slow, with very gradual changes over 7 to 10 years. Reviewing a patient's old photographs may reveal the progressive changes in facial features. Determine if the patient has had a change in hat, glove, ring, or shoe size because of an overgrowth of the hands and feet. Ask the patient if he or she has had headaches or visual disturbances, which in acromegaly are caused by the growth of the adenoma, which exerts pressure on brain tissue and cranial nerves III, IV, and VI. Establish a history of altered sexual function, which may be an indicator of decreased gonadotropin production. Ask about the presence of pain in the hands, feet, and spine, which is probably caused by bone growths also ask about problems with chewing, swallowing, or talking, which may be caused by tongue, jaw, and teeth enlargement. Note the presence of a deepening of the voice, recurrent bronchitis, excessive sweating, heat intolerance, fatigue, and muscle weakness. Check for a...

Historical Conceptualizations

Although there is only a smattering of accounts of the psychological sequelae of natural and technological disasters during the late 19th century, it is known that civilian traumas were also attributed to organic causes. For example, Railway spine was considered to be the result of railroad accidents that produced theoretical, but usually unobservable, physical lesions or insults to the brain, spinal cord, or peripheral nervous system. This condition is representative of the tendency to attribute otherwise unexplainable physical disabilities to abnormal central nervous system mechanisms. Indeed, an English surgeon, John Erichsen (1882), cautioned against confusing (what he assumed to be) the organically caused symptoms of railway spine with hysteria, the prevailing diagnosis of the times (van der Kolk, Weisaeth, & van der Hart, 1996). When physical injuries could not be found in these patients, their symptoms were attributed to subtle forms of neurological damage and a general...

Immunological Procedures

A bacterial agglutination test is available for the detection of Streptococcus pneumoniae, S. agalactiae, Haemophilus influenzae type B, and Neisseria meningitidis. The assay uses latex particles coated with specific antibodies to structural antigens and can detect soluble antigens in urine, cerebrospinal fluid (CSF), and serum. The sensitivity and specificity of these tests in urine samples is extremely unreliable, and the tests should not be used on this specimen. For sterile body fluids, the tests are highly sensitive and specific for H. influenzae, but their sensitivity for other bacteria is much lower, particularly for N. meningitidis. It is important to note that the sensitivity of this assay was essentially identical to Gram stain smears prepared using a cytospin preparation of the fluid. Most laboratories have discontinued the use of this test. Those laboratories that still offer the latex particle agglutination tests will usually perform the procedure only on patients with...

Background Occupational Lower Back Disorders

Parnianpour et al. 13 , in their study of the fatiguing dynamic movement of the trunk against a set resistance, were the first to report on the combined analysis of triaxial motor output and movement patterns. They showed that during fatiguing trunk flexion and extension, there were significant reductions in the velocity, range of motion, and total angular excursion in the intended (sagittal) plane of motion, and a significant increase in the range of motion and total angular excursion in the accessory (coronal and transverse) planes. The presence of more unintended motion in the accessory planes indicates a loss of coordination and more injury-prone loading conditions for the spine. Numerous studies have demonstrated that soft tissues subjected to repetitive loading show creep and stress relaxation behavior because of their viscoelastic properties 14 . Since the internal stability of the spine is maintained by its passive and active structures, there is an even greater need for...

Malformations of the occipital bone

Basilar invagination - The term basilar invagination refers to the primary form of invagination of the margins of the foramen magnum upward into the skull. The radiographic diagnosis is based on pathological features seen on plain films, CT, and MRI. Basilar invagination is often associated with anomalies of the noto-chord of the cervical spine, such as atlanto-occipi-tal fusion, stenosis of the foramen magnum and Klippel-Feil syndrome and with maldevelopments of the epichordal neuraxis such as Chiari malformation, syringobulbia, and syringomyelia.

Biomarkers and Molecular Diagnostics

In contrast to targets, where a direct link to the disease model or the mechanism of action of the compound needs to be validated, the criteria for accepting a protein as a biomarker are less strict. In a sense, initially every difference in the proteome that is reproducibly detected in a given situation could be considered a marker for that situation. However, only a degree of specificity for a defined biological state turns a biomarker into a useful diagnostic tool. In contrast to markers, targets are not necessarily differentially expressed, as illustrated by the bengamide study discussed in the section on target discovery and validation, above. MetAp, the target of the compound, is inhibited, resulting in the differential expression of protein species such as the novel 14-3-3g isoform, which becomes a typical biomarker for bengamides it appears reproducibly after compound treatment, although there is no direct link to the phenotype (in this case cell death). Because they are...

Chemical Transmission

Ganglion, and their possible origin as collaterals from sensory nerve fibers, J. Physiol. 308 76. Bayliss, W. M., 1901, On the origin from the spinal cord of the vasodilator fibers of the hind limb, and on the Katz, B., and Miledi, R., 1963, A study of spontaneous miniature potentials in spinal motoneurones, J. Physiol. 168 389. Lembeck, F., 1953, Central transmission of afferent impulses. III. Incidence and significance of the substance P in the dorsal roots of the spinal cord, Naunyn Schmiedebergs Arch. Exp. Pathol. Pharmakol. 219 197. Otsuka, M., Konishi, S., and Takahashi, T., 1972, The presence of motoneuron-depolarizing peptide in bovine dorsal roots of spinal nerves, Proc. Jap. Acad. 48 342. Takahashi, T., and Otsuka, M., 1975, Regional distribution of substance P in the spinal cord and nerve roots of the cat and the effect of dorsal root section, Brain Res. 87 1.

Hox Gene Function In The Nervous System

The function of the Hox genes in controlling the regional identity of the vertebrate nervous system has been most clearly investigated in the hindbrain. The vertebrate hindbrain provides the innervation for the muscles of the head through a set of cranial nerves. Like the spinal nerves that innervate the rest of the body, some of the cranial nerves contain axons from motor neurons located in the hindbrain, as well as sensory axons from neurons in the dorsal root ganglia. However, we will primarily be concerned with the motor neurons for the time being. The cranial nerves of an embryo are shown in Figure 2.6. As noted above, during embryonic

Role of Combined Loading

In a linear system, the response under combined loads can be computed easily by superposition of that obtained under each of the applied loads separately. Alteration in magnitude of applied loads does not cause any inconvenience because a simple linear operation needs to be performed. This substantially facilitates the investigation as a repetition of analyses under various load levels and hence combinations are not needed. The lumbar spine, however, exhibits nonlinearity in response even under moderate load magnitudes observed in daily activities, thus requiring individual response analyses for each specific load magnitude and combination. In this section some results related to the lumbar behavior under single loads as compared with combined loads are presented in order to delineate this important feature of the system. Another example is presented for the model of the entire lumbar spine under right axial torque of 10 N-m applied on the L1 vertebra. The right axial rotation at...

Regulation Of Dendritic Morphology

Study of the Drosophila visual system has shown by mutations of Cdc42, a member of the Rho family of small GTPases, that Cdc42 affects not only dendritic length, girth and branching (Gao et al., 1999) but also dendritic spine density (Scott et al., 2003). The latter is particularly interesting because dendritic spines and their plasticity lie at the heart of the modulation of the responsiveness of many neurons (Segal, 2002). Kalirin, a Rho GDP-GTP exchange factor, causes spine formation when overexpressed and loss of hippocampal pyramidal spines and decreased dendritic complexity when underexpressed (Penzes et al., 2001 Ma et al., 2003). The Rho GTPases regulate actin dynamics and thereby the cytoskeleton of the developing dendrites. They are also important in activity-driven dendritic plasticity in Xenopus tadpoles light-induced visual activity promotes dendritic arborisation and this requires NMDA receptors, decreased RhoA activity and increased Rac and Cdc42 activity (Sin et al.,...

Basal cell nevus syndrome

Pitting of the palms or soles multiple basal cell carcinomas, often early in life jaw cysts cleft palate coarse facies with milia, frontal bossing, widened nasal bridge, and mandibular prognathia strabismus dys-trophic canthorum ocular hypertelorism calcification of the falx cerebri spine and rib abnormalities high arched eyebrows and palate kidney anomalies hypogonad-ism in males

Normal Pressure Hydrocephalus

Since its first descriptions in the early 1960s, normal pressure hydrocephalus (NPH) has been difficult to recognize, and conclusive diagnosis relied on response to cerebrospinal fluid shunting. The clinical manifestations classically consist of the triad of gait apraxia, urinary incontinence, and dementia.

Methods used in the analysis of biological samples 331 Introduction

Bioanalytical methods are defined here as chemical methods used to measure the levels of drugs and metabolites in biological fluids such as plasma, serum, urine and cerebrospinal fluid, etc. (see also Chapter 8). Measurements are usually taken to gain information on drug pharmacokinetics, product bioequivalence, drug in-vivo interactions and the effect of such parameters as disease state, age

Role of Bone Compliance

In biomechanical response studies of various joint systems, the bony structures are much stiffer than the remaining tissues and, hence, have occasionally been considered rigid bodies. This consideration suggests that the joint laxity is primarily due to connective soft tissues rather than the bony structures. The rigid simulation of bony elements is also motivated in part by the relative ease in modeling and the cost efficiency of the analysis, particularly in a nonlinear response study. A number of biomechanical studies have modeled bony structures as rigid bodies 45, 46, 70-74 . In the lumbar spine, loads are transmitted from one segment to the adjacent one via soft tissues and bony structures. The latter parts are, however, much stiffer than the former parts and, hence, are expected to play a smaller role in joint flexibility via their internal deformations. Our previous model studies have indicated the deformability of the bony elements and the need for their modeling as...

Role of Nucleus Fluid Content

The nucleus pulposus portion of intervertebral discs is generally recognized as playing an important role in the mechanics of the lumbar spine. Previous studies have demonstrated the role of disc fluid content on the segmental response by either removing the entire nucleus material (i.e., total nucleotomy) or altering its volume or pressure 28, 33, 53, 85-89 . The nearly hydrostatic pressure in normal or slightly degenerated nuclei 90, 91 increases the disc stiffness directly by resisting the applied compression force and indirectly by prestressing the surrounding annulus layers. The confined nucleus fluid may be lost into surrounding tissues as a result of disc prolapse, end-plate fracture, or diffusion. It could also be resolved by injection of nucleolytic enzymes utilized to treat disc herniation. Moreover, it may be removed during surgery (i.e., partial or total nucleotomy) or could mechanically alter with age and degeneration to become semisolid and dry. Such changes are expected...

Local Infiltration and Nerve Blocks

Spinal Anesthesia Spinal anesthesia is advantageous in patients requiring operations to the perineum and extremities in that it obviates the risk of aspiration and a difficult airway, allows for early identification of cardiac ischemic events and angina, and allows for detection of complications of urologic surgery such as bladder perforation and systemic absorption or irrigation solutions. Despite these advantages spinal anesthesia has not shown a uniform reduction in cardiac ischemic events during surgery. Contraindications to spinal anesthesia include major coagulopathy and unstable neurologic disease. Spinal anesthesia is produced by injecting anesthetics into the subarachnoid space at the L3-L4 level and the spinal level of anesthesia is determined by the dose of the drug administered. Other factors that can determine the level and number of spinal segments anesthetized include pregnancy, increased intra-abdominal pressure, positioning of the head of the patient, injection at...

Gender Ethnicracial And Life Span Considerations

Brain tumors may occur at any age and are fairly common in both children and adults, with about 100,000 symptomatic brain tumors, including metastatic brain tumors, diagnosed per year. They are common in children less than 1 year old, and then again between 2 and 13 years old. In children, primary tumors of the brain and spinal column are the second most common (after leukemias) type of childhood cancer that is, the most common solid tumor. However, most central nervous system (CNS) tumors occur in patients over 45, with the peak incidence found after 70. More than 50 of those are metastatic rather than primary. Gender considerations depend on tumor type. The 5-year survival rate decreases with age. For persons ages 15 to 44, it is 55 45 to 64 years of age, it is 16 and for those over 65 years of age, it is 5 . African Americans, especially African American women, have a slightly higher incidence of menin-giomas and pituitary adenomas.

Classification of motor components in cranial nerves

In spinal nerves, it is useful to distinguish between somatic and visceral motor fibres. This is based on the embryological origin of the muscle innervated. Somatic motor (voluntary) fibres innervate muscles which develop from somites striated muscle. Cell bodies are the ventral horn cells of the spinal cord grey matter. These muscles are under voluntary control.

Clinical Evaluation Of The Infant

The most difficult clinical diagnosis to make is that of HSV encephalitis, in large part because nearly 40 of infants with CNS infection do not have skin lesions at the time of clinical presentation (11,12). Clinical diagnosis under these conditions is based on a high index of suspicion. This is especially true if the patient's bacterial cultures are negative at 48-72 hours. Infection of the CNS should be suspected in the neonate who has evidence of acute neurological deterioration with the onset of seizures, especially when this occurs in the absence of intraventricular hemorrhage or metabolic imbalances. Serial increases in cerebrospinal fluid (CSF) cell counts and protein concentrations also suggest the possibility of HSV disease. An electroencephalogram, and to a lesser degree a computed tomographic scan of the head, may be of benefit in this situation (12).

Aicardigoutieres Syndrome

Aicardi-Goutieres syndrome was first described in 1984 in a series of eight patients. The clinical picture is of infants with familial progressive encephalopathy, basal ganglia calcification, and chronic cerebrospinal fluid pleocytosis (Table 1). It is a very rare syndrome, suspected to be familial with autosomal-recessive inheritance, and occurrence in siblings has been reported. A majority of reported cases have elevated serum levels of a-interferon, which is of unclear pathogenic significance.

Development of the Peripheral Nervous System

Neurons grow out from three principal embryonic tissues the neural crest, the neuroepithelium that lines the neural canal, and from ectodermal placodes, which are specialized areas of ectoderm in the neck and head. Dorsal root ganglia develop in register with the somites, and contain cells that relay sensory inputs to the brain. Chains of sympathetic ganglia develop bilaterally along the spinal cord, and parasympathetic ganglia develop in the walls of the visceral target organs innervated by the ANS. At the same time, motoneuron axons grow out from the basal columns of the cord. They form ventral roots at the level of each somite, and grow to innervate their striated target muscles. Motoneurons are the first axons that sprout from the spinal cord. They originate in the ventral gray columns of the cord, and first appear at about day 30 at the cervical level, and thereafter appear in a craniocaudal sequence. While the ganglia are developing, the sympathetic central neurons develop in...

Dual Head Planar Pinhole Scintigraphy

Pecten Pubis Bone

Fig. 2.1A-C Paired dual-head pinhole scans of a normal hip joint. A Anterior scan clearly showing the femoral head (fh), acetabular labrum (al), joint space (open arrow), acetabular socket, superior pubic ramus (spr), and pecten pubis (pp). B Posterior scan clearly delineating the ischial tuberosity (it), ischial spine (is), and arcuate line (arl). C Anteroposterior radiograph showing the femoral head (fh), ischium (i), pubis (p), ischial spine (arrow), and arcuate line (arrowheads) (from Bahk et al. 1998a, with permission) Fig. 2.1A-C Paired dual-head pinhole scans of a normal hip joint. A Anterior scan clearly showing the femoral head (fh), acetabular labrum (al), joint space (open arrow), acetabular socket, superior pubic ramus (spr), and pecten pubis (pp). B Posterior scan clearly delineating the ischial tuberosity (it), ischial spine (is), and arcuate line (arl). C Anteroposterior radiograph showing the femoral head (fh), ischium (i), pubis (p), ischial spine (arrow), and arcuate...

Rationale and Techniques of Pinhole Scintigraphy

Scan Normal Ankle

In general, pinhole scanning is efficiently performed with aperture-to-skin distance of 0-10 cm. For example, one vertebra or two with intervertebral disk, the hip or knee joint, fingers with small joints are imaged at no distance, while the whole cervical spine is imaged at a distance of about 10 cm. A total of 400-450 k-counts are accumulated over a period of 15-

Chiropractic Medicine

Part of the popularity of this therapy in the United States may be due to the fact that chiropractic medicine, unlike many other forms of CAM, was founded in this country. It was developed by Daniel D. Palmer, in Iowa, in the 1890s. Some form of spinal manipulation, as used in chiropractic medicine, also has been practiced in other cultures, including ancient Egypt and ancient Greece.

Clusterin mRNA Distribution in the Rodent and Human Brains

We, as well as two other groups, have reported on the distribution of clusterin mRNA in the CNS of young adult rats.26,32,38 Transcripts for clusterin were found to be distributed throughout the CNS, although regional differences in their prevalence were readily observed (Fig. 2.1). A strikingly high level of expression was observed in the ependymal lining of the ventricles and the choroid plexus (Figs. 2.1 and 2.2). In keeping with clusterin as a secretion product in other tissues, these results suggest that the protein is secreted locally into the cerebrospinal fluid (CSF), where the demand or turnover rate may be high. Several neuron-rich cell layers and nuclei contained high levels of clusterin mRNA. These included the pyramidal and granule cell layers of the hippocampal formation, the habenular complex, the hypothalamus, several brainstem nuclei, and some motor neurons in the ventral horns of the spinal cord (Figs. 2.1-2.3). Within most of these areas, much heterogeneity in the...

Studies in MS and Other Conditions

Musculoskeletal conditions that are seen in MS may respond favorably to chiropractic therapy. Most notably, multiple studies have evaluated the chiropractic treatment of low back pain, which may occur in people with MS. Of note, besides chiropractors, physical therapists and osteopaths also perform spinal manipulation. In addition, low back pain may resolve with no therapy at all and may respond to nonmanipulative forms of therapy given by primary care doctors, orthopedic physicians, neurologists, and physical therapists. The relative effectiveness and expense of these different approaches is debatable. In 1994, the Agency for Health care Policy and Research endorsed chiropractic therapy for low back pain that is recent and not longstanding. Chiropractic therapy has been investigated in other conditions. Among neurologic disorders, small or single-case studies note beneficial responses in people with headaches and spinal cord injury. These studies are too small to be conclusive....

The Neural Plate and Neural Tube

Ganglion White Matter

Development of the central nervous system commences on day 18, with the formation of the neural plate in the ectoderm anterior to the primitive pit. The neural plate seems to be chemically induced by so-called inducing substances that are secreted by the prechordal plate and the cranial end of the notochordal plate in the underlying mesoderm. The cells in this area of ectoderm begin to differentiate into a thick plate of pseudo-stratified columnar neuroepithelium, forming the neural groove and the neural folds. The neural plate first appears at the cranial end, and develops in a craniocaudal direction. The plate is broad at the cranial end, and narrows caudally. The cranial end will expand into the brain, and even at this primitive stage can be differentiated visually into the fore-, mid-, and hindbrain. The caudal end of the neural plate, which lies above the notochord, develops into the spinal cord. As the tube is closing, neural crest cells migrate from their origin at the lateral...

Cerebral Hemispheres Internal Structures

Internal Capsule Thalamus

Each hemisphere possesses a lateral ventricle, which is lined with a layer of ependyma and filled with cerebrospinal fluid (CSF). The ventricle has a body located in the parietal lobe, and horns, the anterior, posterior and inferior horns, which extend into the frontal, occipital and temporal lobes respectively. The body of the ventricle has a floor, roof, and a medial wall. The body of the caudate nucleus forms the floor of the ventricle, and the lateral margin of the thalamus and the inferior surface of the corpus callosum form the roof.

Stability and Response Analyses in Neutral Postures

The ligamentous lumbar spine, L1-S1, devoid of musculature has been reported to exhibit mechanical instability (i.e., hypermobility) under relatively small compression loads of less than 100 N 44, 137 . The question then arises as to how this structure may withstand much larger compression loads during daily activities. Using finite element models of the lumbosacral and thoracolumbar spines with and without muscles, we have identified a number of mechanisms that stabilize the passive system allowing it to carry large compression loads with minimal displacements 44, 47, 138, 139 . The neural controller

Additional Readings Books

Spinal manipulation a systematic review of sham-controlled, double-blind, randomized clinical trials. J Pain Symptom Management 2001 22 879-889. Hurwitz IL, Morganstern H, Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain 6-month follow-up outcomes from the UCLA back pain study. Spine 2002 27 2193-2204. Kaptchuk TJ, Eisenberg DM. Chiropractic origins, controversies, and contributions. Arch Intern Med 1998 158 2215-2224. Smith WS, Johnston SC, Skalabrin EJ, et al. Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurol 2003 60 1424-1428.

Tamoxifen and Breast Cancer Prevention

Tamoxifen also reduced the incidence of osteoporotic fractures of the hip, spine, and radius by 19 . However, the difference approached, but did not reach, statistical significance. This reduction was greatest in women aged 50 and older at study entry. No difference in the risk of myocardial infarction, angina, coronary artery bypass grafting, or angioplasty was noted between the groups.

Structural Injuries of the Heart

In 1971, Simson described the chin-sternum-heart syndrome.7 This syndrome is known to occur in parachutists wearing protective helmets when there is incomplete deployment or partial failure of a parachute. The pattern of cardiac injury, multiple atrial, endocardial and myocardial lacerations, is associated with sternal compression by the chin with laceration of the chin. One of the authors (DJD) has encountered a similar syndrome in individuals who have fallen down stairs, sustaining severe flexion injury to the neck. There is injury to the chin, compression or fracture of the sternum, cardiac injury, and cervical spine fracture with injury to the spinal cord. In some cases of blunt trauma to the chest, the ribs are fractured, with the fractured ends puncturing the heart.

Evaluation of the Axial Skeleton in Rodent Fetuses

Alterations in ossification, morphology, and number of the skeletal elements should be recorded for the entire, not just axial, skeleton. Focusing on the axial skeleton, however, we will address issues regarding examination of the sternum, ribs, and vertebrae. There is a wide variety of acceptable approaches for recording these findings. In most routine studies, elaborate notation systems may be unnecessary for adequate data recording. Recording the number of vertebrae in each subregion may also be dispensable however, recognizing important morphological features along the spinal column may be important in assessing fetal developmental.

Primary Sleep Disorders Dyssomnias

Move or speak when awaking from sleep), and hypnagogic hallucinations (visual or acoustic hallucinations while falling asleep). Polysomno-graphy reveals a short sleep latency and an early onset of REM sleep. The presence of HLA antigens (DR2, DQw1, DQB1*0602) is nonspecific, as is the absence of hypocretin-1 (orexin A) in the cerebrospinal fluid.

Primary sensory neuron receptor to sensory nucleus

This extends from peripheral receptor to CNS. The cell body is situated in a peripheral ganglion (dorsal root ganglion for spinal nerves) and the neuron is usually pseudounipolar, that is to say, it gives rise to a single axon which bifurcates into a peripheral process passing to the receptor, and a central process passing into the CNS. The cell body is thus both structurally and electrically out on a limb. The central process of the primary sensory neuron terminates by synapsing

Disease State Diagnosis

Biomarkers are also necessitated for improved diagnosis and medical management of AD. Ab, tau, and phosphorylated tau (ptau) proteins are potential biomarkers, and clinical studies over the course of the past decade have shown that monitoring the levels of Ab42 and ptau (pthr231, pthr181, pser199) in cerebrospinal fluid (CSF) can potentially serve to discriminate AD from normal aging and other neurological disorders and can predict conversion of patients from MCI to AD, with low Ab42 levels associated with both high total and ptau levels being a distinguishing feature.10 These biomarkers are not robust in being able to distinguish AD from other forms of dementias, and alternate biomarkers are being sought using quantitative proteomic analysis to identify a panel of proteins, a molecular fingerprint that can differentiate AD and be used diagnostically - a major challenge. The National Institute of Health's BIOCARD study (Biomarkers in Older Controls at Risk for Dementia) reported...

Strengths And Weaknesses Of Various Approaches

As noted above, the continuum methods are treated fully elsewhere in the book, so we restrict ourselves to a few comments. The main advantage of the continuum approach over the other choices is its greater efficiency. The effect of solvent on the electrostatic free energy of the solute, which is considerable, is calculated by a model theory rather than through explicit time averaging over the many degrees of freedom involved. The main disadvantage of continuum methods is that explicit atomic level interactions of interest between solute and solvent such as the ''spine of hydration'' of water molecules and or sodium ions in the minor groove of B-DNA 47 cannot be treated. For our purposes in this chapter, however, we are interested in the qualitative insights afforded by continuum methods, particularly with respect to long-range electrostatic effects.

Thyroid Hormone Transport

TTR, previously called thyroxine-binding prealbumin binds only about 15-20 of the circulating TH and has a lower affinity for the hormones thus dissociating from them more rapidly and thus responsible for much of the immediate delivery of T4 and T3. Transthyretin is the major thyroid hormone-binding protein in cerebrospinal fluid. It is synthesized in the liver and the choroids plexus and secreted into the blood and cerebrospinal fluid, respectively. Only 0.5 of the circulating TTR is occupied by T4 and it has a rapid turnover of 2 days in plasma. Hence, acute reduction of the rate of synthesis results in a rapid decrease of its serum concentration 2 . Acquired abnormalities in TTR include major illness, nephrotic syndrome, liver disease, cystic fibrosis, protein fasting and hyperthyroidism. However, changes in TTR concentrations have little effect on the serum concentrations of TH 15 .

Discharge And Home Healthcare Guidelines

Fetuses and infants are at particular risk because intrauterine CMV infection is the most common congenital infection it occurs in 0.5 to 3 of all live births. Infection of the fetus by CMV may not be recognized until birth or several years after birth because pregnant women with CMV infections may not have clinical symptoms. Infants who have been infected with CMV during gestation may have intrauterine growth retardation, microcephaly (small head size), or hydrocephaly (increased cerebrospinal fluid in the brain).

Central Nervous System Barriers

The neurons of the brain communicate with each other using chemical and electrical signals that depend on fine control of the local ionic microenvironment moreover such communication requires greater protection from circulating toxins than found in most other tissues of the body.1-3 Barriers at three interfaces separate the blood from the brain interstitial fluid (ISF, also called extracellular fluid, ECF) (Figure 1) the blood-brain barrier (BBB), formed by the endothelial cells lining the microvessels (Figure 2) the blood-CSF barrier, formed by the choroid plexus epithelium, which also secretes cerebrospinal fluid (CSF) and the arachnoid epithelium, which forms part of the meningeal covering.4 At each of these layers, tight junctions between cells form the 'physical' barrier, specific transport proteins transcytosis mechanisms mediate uptake and efflux ('transport' barrier), and enzymes add a 'metabolic' barrier. Together these mechanisms regulate molecular traffic between blood and...

Olfactory Bulb Anatomy

A simplified olfactory bulb circuit. Mitral cells (M) receive afferent input from olfactory receptor neurons (ORNs) at their primary dendrites in glomeruli (Glom) and make dendrodendritic synapses (circled) with periglomerular (PG) cells at primary dendrites and with granule cells (G) at secondary dendrites. PG cells also have axons that terminate on neighboring glomeruli. Enlarged (bottom right) is a reciprocal synapse between the shaft of a mitral cell secondary dendrite and a dendritic spine of a granule cell. Note that the M-to-G glutamatergic synapse (+) is directly adjacent to the G-to-M GABAergic synapse (-). Not shown are other cell-types in the bulb with less well-defined functions, including tufted cells and short-axon cells. Figure 1. A simplified olfactory bulb circuit. Mitral cells (M) receive afferent input from olfactory receptor neurons (ORNs) at their primary dendrites in glomeruli (Glom) and make dendrodendritic synapses (circled) with periglomerular (PG)...

Viral Diagnostic Assays And Their Interpretation

AFalse-positive and false-negative results can occur. Ig, immunoglobulin CSF, cerebrospinal fluid PCR, polymerase chain reaction RT-PCR, reverse transcriptase PCR PBMCs, peripheral blood mononuclear cells. In considering performance of these viral tests, one must remember the latent nature of these herpesviruses and understand that tests differ in their ability to distinguish nonreplicating, latent virus from replicating, active virus (Table 2). The presence of HHV-6 or HHV-7 DNA in PBMCs or other cellular material indicates viral infection but does not necessarily imply viral disease because these viruses persist latently following primary infection. Assays that detect active viral infection are necessary. In cellular specimens, active infection is typically indicated by the isolation of virus, the presence of specific viral ribonucleic acid, or the expression of viral proteins on cell membranes. In cell-free specimens (e.g., serum, plasma, or cerebrospinal fluid CSF ), viral...

Vertebral Artery Injury Laceration

The most common causes of vertebral artery trauma are blows to the neck, motor vehicle accidents, falls, and cervical spine manipulation. In most of Opeskin and Burke's cases, considerable force was involved.37 Chiropractic manipulation with resultant vertebral artery injury was the cause for two of their deaths. Injury of the vertebral artery should be suspected when an individual collapses and dies almost immediately after receiving a blow to In rupture of the artery due to blunt trauma, Opeskin and Burke noted bruising and abrasions below and behind the ear in 50 of 18 cases.36 Fractures of the cervical spines were present in 10 of 25 cases. Demonstration of the vertebral artery injury is easiest by injection of radio-opaque dye into the vertebral arteries with radiological demonstration of the injury. Only after such demonstration should there be dissection of the neck, because dissection is extremely difficult and, if not done correctly, may produce artifactual defects in the...

Simulations of Morphogenetic Processes

Computer simulations and other kinds of simulations play an important role in evaluating the mechanical validity of various theories about the forces that drive specific morphogenetic processes. Lewis (1947) constructed a physical model of the neural plate using brass plates hinged at their centers to a flexible spine, and tied to each of its neighbors by rubber bands. The lateral cell surfaces were represented by the plates, while the rubber bands acted as tension generators in the apical and basal ends. Different rubber band distributions produced different patterns of cell sheet folding. Practical considerations have limited the number of such physical simulation models. Fortunately, the rapid development of computers has made possible computer simulation models that are more accurate, realistic, and flexible than these early physical models.

Pharmacological Properties And Therapeutic Potential Of Coenzyme Q Analogs

The central nervous system (CNS), which is highly dependent on aerobic ATP production, is the tissue most sensitive to oxidative damage, for at least four different reasons.47 First, CNS accounts for less than 2 of body weight and yet it consumes up to 20 of total body oxygen, producing more superoxide radicals than other tissues. Second, neuronal membranes are very rich in easily peroxidable polyunsaturated fatty acids, and their antioxidant status is in some way lower than in other tissues. Third, the brain is extremely rich in iron and particularly prone to the deleterious consequences of LMW iron delocalization. As a matter of fact, the content of transferrin in cerebrospinal fluid is very low hence it cannot sequester LMW iron and prevent iron-catalyzed oxidative damage. Finally, neurons accumulate epinephrine, norepinephrine, 3,4-dihydroxypheny-lalanine, 6-hydroxydopamine, and melanins, all capable of reducing iron, which in turn reduces oxygen to O2 and H2O2. Considering that...

Steroids and Lipoproteins in the CNS

Likewise, the hippocampal CA1 also undergoes transient estrogen-induced synaptic remodeling.25 In the stratium radiatum of the CA1 both dendritic spine and synaptic density are increased on proestrus, and apoE mRNA levels also appear to be under estrogenic control in this region. On proestrus, when circulating estrogen levels are highest, apoE mRNA levels were found to be 30 to 70 higher than on other cycle days.26 In the same study, however, apoE mRNA levels were highest on diestrus in the CA3, when circulating estrogen levels are considerably lower. These results are not surprising as specialized subpopulations of astrocytes occur with different frequencies in the CA1 and CA3.27 This would suggest differential regulation of apoE mRNA levels in different astrocyte subpopulations different brain regions. These findings, however, do not constitute direct evidence that estrogen influences apoE mRNA in vivo, as levels of several other hormones also differ between cycle days (Fig. 3.1).28

Genesis of Hand Preference

Another theory suggests that the fetus in its mother's womb is more likely to be in a position where its left arm and hand are toward the mother's spine and thus have less freedom to move than does the right arm. This gives the right hand-left brain an advantage that increases as the child matures. The problem with this theory is that it cannot account for the observation that the position of the fetus in the womb is not random and again this theory will have little explanatory value for the relationship between hand preference and creativity. Deftness is defined as the ability to make fine, precise, and independent finger movements. Although the term dexterity is also used for these abilities, this word derives from the word dextral, which pertains to the right hand or right side, and many people are more deft with their left hand than with their right. Nonhuman primates, such as old world are very deft, and Lawrence and Kuypers (1968) found that in monkeys, injury to the...

Headache Related to Intrathecal Injections

Tali ET, Ercan N, Kaymaz M, Pasaoglu A, Jinkins JR. Intrathecal gadolinium (gadopentetate dimeglumine)-enhanced MR cisternography used to determine potential communication between the cerebrospinal fluid pathways and intracranial arachnoid cysts. Neuroradiology 2004 46 744-754.

Screening for osteoporosis and osteopenia

In dual x-ray absorptiometry (DXA), two photons are emitted from an x-ray tube. DXA is the most commonly used method for measuring bone density because it gives very precise measurements with minimal radiation. DXA measurements of the spine and hip are recommended.

Subarachnoid Space Metastases

Between 6 and 18 of central nervous system (CNS) metastases involve the arachnoid and subarachnoid space, or the pia, or both. The subarachnoid space can be diffusely or focally involved by spread from a primary CNS tumor, or by an extraneural malignancy. The typical locations for metastatic seeding are at the basal cisterns, the cerebellopontine angle cistern, the suprasellar cisterns, along the course of the cranial nerves, and over the convexities. Subtle leptomeningeal and subarachnoid space metastatic disease is identified in up to 45 of cases using contrast-enhanced magnetic resonance imaging (MRI) scans. Cerebrospinal fluid (CSF) cytology provides definitive diagnosis of leptomeningeal carcinomatosis, with abnormal CSF noted in up to 55 of cases after the first spinal tap and in up to 90 after the third. If lumbar puncture is contraindicated or the CSF cytology is equivocal, gadolinium-enhanced MRI is a useful diagnostic tool.

Verification of an outbreak and laboratory confirmation

Reports and alerts of outbreaks are frequent in emergency situations and must always be followed up. It is important to aware that in some languages one word may be used for more than one disease (e.g. in Serbo-Croat and its variants the same word is used for typhus and typhoid). Diagnosis must be confirmed either on a clinical basis by senior clinical workers (e.g. for measles) or by laboratory tests, in which case specimens (e.g. blood, serum, faeces or cerebrospinal fluid) must be sent to a laboratory for testing. Material required for an outbreak investigation is listed in Annex 6. Note Measles is diagnosed clinically and does not require laboratory confirmation. a CSF cerebrospinal fluid Note Measles is diagnosed clinically and does not require laboratory confirmation. a CSF cerebrospinal fluid

Evaluation Of The Neonate

Minimum laboratory evaluation should include a complete blood cell count and lumbar puncture, as well as bacterial cultures of blood, urine, and cerebrospinal fluid to rule out bacterial infection. Cerebrospinal fluid analysis, in both nonpoliovirus EV and poliovirus infections, may show a pleocytosis suggestive of viral meningitis (usually

Interpretation Of Diagnostic Evaluations

In general, positive cultures and PCR assays of mucosal sites such as throat or rectum may reflect asymptomatic infection or presence of virus that is causing symptoms. Positive culture and PCR tests of body fluids such as serum and cerebrospinal fluid more specifically suggest disease causation (35,91). Nevertheless, a positive culture or PCR from a mucosal site in the first month of life (even in the absence of positive testing of normally sterile body fluids) in the presence of an EV-compatible illness and in the absence of another viral (e.g., herpes simplex virus, cytomegalovirus, or adenovirus) or bacterial (e.g., group B Streptococcus or E. coli) pathogen or noninfectious condition (e.g., metabolic disorder or structural cardiac disease) that can produce the constellation of clinical findings likely signifies that an EV is the etiologic agent. Herpes simplex virus infection of the newborn can closely mimic findings of neonatal EV infection surface viral cultures and PCR testing...

Detection of Cytokine mRNA Expression by PCR

Assessment of cytokine expression during an immune response is a critical requirement for studies of basic immune mechanisms and the pathogenesis of disease. Although measurement of cytokine protein production is usually desirable, in many cases it is not experimentally feasible. This is particularly true when only small amounts of tissue (e.g., clinical biopsy specimens) or cells (e.g., blood, cerebrospinal fluid, bronchioalveolar lavage fluid, and joint fluid specimens) are available or when a small quantity of cells cannot be expanded in vitro because of slow growth or concern that their characteristics may change with expansion. As an alternative to measuring cytokine protein levels, analysis of cytokine mRNA may be appropriate, because production of many cytokines is primarily transcriptionally regulated. Therefore, the level of cytokine mRNA present in a sample may serve as a good estimate of the level of cytokine protein present.

Inner Ear Visible In

Hyperemic Tympanic Membrane

Figure 4.23 Left ear showing a pulsating air-fluid level in a patient operated 1 year previously to remove a lower cranial nerve neurinoma using a petro-occipital trans-sigmoid approach (POTS) (see preoperative MRI, Fig. 4.24 and postoperative CT scan, Fig. 4.25). The patient complained of a sensation of ear blockage and watery rhinorrhea on leaning forwards. The middle ear is full of cerebrospinal fluid (CSF) passing through open hypotympanic air cells that communicate with the subarachnoid space. The CSF rhinorrhea was treated by obliterating the eustachian tube and middle ear with the temporalis muscle and by closure of the external auditory canal as cul-de-sac. Figure 4.23 Left ear showing a pulsating air-fluid level in a patient operated 1 year previously to remove a lower cranial nerve neurinoma using a petro-occipital trans-sigmoid approach (POTS) (see preoperative MRI, Fig. 4.24 and postoperative CT scan, Fig. 4.25). The patient complained of a sensation of ear blockage and...

Subarachnoid Hemorrhage

Subarachnoid Hemorrhage

Subarachnoid and intraventricular hemorrhage due to arteriovenous malformation (intracellular met-hemoglobin). A 48-year-old female presented with acute onset of severe headache had a CT scan 24 hours after the onset of symptoms (a), which shows diffuse subarachnoid (arrowhead) and intraventricular hemorrhage (arrows). Forty-eight hours after the onset of symptoms (b-g) she had an MRI.On this examination the T2-weighted image (b) showed intraventricular hemorrhage (arrows), which is hypointense when compared with the cerebrospinal fluid.The diffuse subarachnoid hemorrhage cannot be visualized on the T2-weighted image.The T1-weighted image (c) shows the intraventricular hemorrhage (arrows) as hyperintense when compared with cerebrospinal fluid,but neither sequence can visualize the subarachnoid hemorrhage. The FLAIR image (d), however, shows both the subarachnoid (arrowheads) and intraventricular hemorrhage (arrows). The subarachnoid hemorrhage cannot be visualized on the DW image (e),...

Extreme implosive forces1820 Certain types of acoustic trauma may also cause PLFs We have confirmed reports of PLFs in

In 1971, Goodhill27 advanced the theory of implosive and explosive mechanisms for traumatic PLFs. According to Goodhill, an explosive PLF occurs when a sudden increase in the cerebrospinal fluid (CSF) pressure that ruptures the oval or round window due to increased intracranial pressure is transmitted to the perilymphatic fluid space. An implosive event occurs when sufficient external (ambient) pressures were applied to the tympanic membrane or entered the middle ear through the eustachian tube, driving the stapes into the inner ear and causing rupture of the oval or round window, or both.

Ventricular System of the Brain

Superior View Ventricles

The fourth ventricle is a roughly pyramid-shaped cavity that is bounded ven-trally by the medulla and pons and its floor is called the rhomboid fossa. The roof of the ventricle is incomplete and is formed from the anterior medullary velum and the posterior medullary velum (see also p. 17). The apex passes upward into the cerebellum at a point called the apex or fastigium. Cerebrospinal fluid (CSF) can flow from the fourth ventricle into the subarachnoid space through two apertures. The foramen of Luschka is an opening of the lateral recess into the sub-arachnoid space in the region of the cere-bellar flocculus. There is a more important aperture, the foramen of Magendie, which lies caudally in the ventricular roof. Most of the CSF outflow from the ventricle occurs via this aperture.

Vascular Syndromes Fig 16n

Anterior spinal artery The artery supplies the anterior funiculi, anterior syndrome horns, base of the dorsal horns, periependymal area, and anteromedial aspects of the lateral funiculi. Spinal cord infarction often occurs in boundary zones or watersheds, especially at the T1 -T4 segments and the L1 segment Caused by - After fracture dislocation of the spine Posterior spinal artery syndrome

Primary Isolation Of Hiv From Pbmc By Infection Of Allogeneic T Cell Blasts

As described in the first basic protocol, the most commonly used source for isolation and large-scale production of HIV is the PBMC of the patient under study. In addition, HIV has been successfully isolated from plasma in viremic patients (first basic protocol) as well as from other tissues and body fluids, including brain, pulmonary alveolar broncho-scopic lavage samples, and cerebrospinal fluid. Once isolated, HIV can be propagated by infecting freshly isolated CD4+ cells or cell lines, although the most commonly used target cells are allogeneic PHA-stimulated PBMC. The use of primary human monocyte-derived macrophages (MDM unit 7.6) has also been broadly used and has shown some complementarity to the T cell blast method in terms of efficiency of isolation, particularly in infected individuals in the asymptomatic stage of disease (unit 12.4).

Leptomeningeal Metastases

The clinical findings consist of early multifocal cranial or spinal nerve dysfunction, symptoms or signs of meningeal irritation, and even changes in the cerebrospinal fluid (CSF), such as mild pleocytosis and high protein. Differentiating between leptomeningeal metastases and other parenchymal or epidural metastases requires the following. - MRI with gadolinium enhancement of the brain and spine to reveal or exclude any mass lesions CSF cerebrospinal fluid MRI magnetic resonance imaging.

Progressive myelopathy

During the acute stage, MRI reveals spinal cord swelling, which may lead to a complete spinal block, and contrast enhancement of the area of damage. During the late stages, the spinal cord appears to be atrophic - Motor conduction velocity in the spinal cord pathways is reduced Spinal cord hemorrhage (8-30 years after radiotherapy, and only in a few - MRI reveals acute or subacute hemorrhage in the spinal cord, which may be atrophic, but no other lesions are found CSF cerebrospinal fluid MRI magnetic resonance imaging.

Stab Wounds from Weapons Other than Knives

The authors have seen fatal stab wounds inflicted with pens, pencils, broken pool cues, etc. In one case, an individual was stabbed on the left side of the neck with a ballpoint pen. The pen perforated skin, muscle, and ligaments penetrating into the spinal column at the atlanto-occipital junction, and perforating the spinal cord (Figure 7.10). Figure 7.10 Stab wound of neck from ballpoint pen with perforation of spinal cord at atlanto-occipital junction. Figure 7.10 Stab wound of neck from ballpoint pen with perforation of spinal cord at atlanto-occipital junction.

Vertical Nonlinear Models

In 1960, Coermann et al. 47 presented a 6-degree-of-freedom (DOF) model of a human (for standing and sitting postures) used to simulate human dynamic response to longitudinal vibration of very low frequencies. This model included masses for the head, the upper torso, the arm-shoulder, a simplified thorax-abdomen subsystem, the hips, and the legs. A nonlinear spring was connected between the upper torso and the hips in parallel with the thorax-abdomen subsystem to represent the elasticity of the spinal column. Model parameters for each element were estimated from measurements of the mechanical impedance. The performance of the whole-body model was not published and is therefore difficult to assess. The characteristics of the spine and the thorax-abdomen subsystem, however, were evaluated in detail. Each was modeled with 1 DOF in the whole-body model. Damping was not included in the spine and the performance of the thorax-abdomen subsystem did not match the experimental data...

Pudendal Nerve Terminal Motor Latency

Finger Electrodes

Pudendal nerve terminal motor latency (PNTML) is a measurement of time, or latency, from stimulation of the pudendal nerve at the level of the ischial spine to the muscle response in the external anal sphincter.5,23 A disposable electrode is placed on the examiner's gloved index finger (Fig. 11.4) and inserted into the anal canal (Fig. 11.5). The stimulation is transrectally performed with the electrode located at the ischial spine while the response is recorded at the base of the examiner's finger. Recordings are made from both sides of the pelvis, as pudendal nerve damage may be asymmetric in some Figure 11.5. The St. Mark's pudendal electrode is inserted into the anal canal and rectum. The stimulation is performed transrectally with the electrode located at the ischial spine (From Tetzschner T,Sorensen M,Johnson L, Lose G,Christiansen J.Delivery and pudendal nerve function. Acta Obstet Gynecol Scand 1997 76 324-331, with permission from Blackwell Publishing.) Figure 11.5. The St....

Routes Across the Blood Brain Barrier

Posterior Inferior Humeral Ligament

Blood-brain barrier (BBB), (2) the arachnoid epithelium forming the middle layer of the meninges, and (3) the choroid plexus epithelium which secretes cerebrospinal fluid (CSF). In each site, the physical barrier is caused by tight junctions that reduce the permeability of the paracellular (intercellular cleft) pathway. In circumventricular organs (CVO), containing neurons specialized for neurosecretion and or chemosensitivity, the endothelium is leaky. This allows tissue-blood exchange, but as these sites are separated from the rest of the brain by an external glial barrier, and from CSF by a barrier at the ependyma, CVOs do not form a leak across the BBB. (Reproduced with permission from Abbott, N. J. Drug Disc. Today Technol. 2004, 1, 407-416 (with permission from Elsevier), based on Figure 1.1 in Segal, M. B. Zlokomic, B. V. The Blood-Brain Barrier, Amino Acids and Peptides Kluwer Dordrecht, 1990, with kind permission of Springer Science and Business Media.)

Lacerations of the Brainstem

Violent hyperextension of the head and neck can cause laceration at the junction of the pons and medulla.18,53 These laceration may be either partial or complete, and are usually associated with fractures of the cervical spine, hinge fractures, or ring fractures.50,53 Occasionally, the injury will not be associated with either cervical or cranial fractures. The only evidence of injury to the brain, aside from the laceration, is generally subarachnoid hemorrhage around the brainstem. While death is almost always immediate, partial laceration is sometimes associated with survival of a few hours. While generally ascribed only to hyperextension, some individuals feel that these injuries can be a form of diffuse axonal injury due to angular acceleration of the head.53

Traumatic Brain Swelling and Edema

Transtentorial Herniation

Can produce tonsillar, transtentorial, or subfalcial herniation of the brain, with resultant necrosis, secondary infarction, and Duret hemorrhages (Figure 6.15). Herniation may be either symmetrical, due to brain swelling, or asymmetrical, due to a mass in one side of the brain or subdural space, e.g., a subdural hematoma or intracerebral hemorrhage. In the case of diffuse brain swelling, there is usually symmetrical herniation of the cerebellar tonsils without brain stem hemorrhage. The brain stem and cerebellar tonsils are forced into the foramen magnum, with resultant dysfunction or even infarction of the brain stem. The individual becomes unconscious and develops respiratory difficulty that proceeds to arrest and death. Severe herniation of the cerebellar tonsils can result in infarction. In some individuals with prolonged survival, the authors have seen the upper spinal cord encased in necrotic cerebellar tissues shed into the cerebrospinal fluid. In dealing with an asymmetrical...

Central Nervous System and Senses

The brain and spinal cord make up the central nervous system (CNS) A). The spinal cord is divided into similar segments, but is 30 shorter than the spinal column. The spinal nerves exit the spinal canal at the level of their respective vertebrae and contains the afferent somatic and visceral fibers of the dorsal root, which project to the spinal cord, and the efferent somatic (and partly autonomic) fibers of the anterior root, which project to the periphery. Thus, a nerve is a bundle of nerve fibers that has different functions and conducts impulses in different directions ( p. 42). Spinal cord ( A). Viewed in cross-section, the spinal cord has a dark, butterfly-shaped inner area (gray matter) surrounded by a lighter outer area (white matter). The four wings of the gray matter are called horns (cross-section) or columns (longitudinal section). The anterior horn contains motoneurons (projecting to the muscles), the posterior horn contains interneurons. The cell bodies of most afferent...

Diffuse Idiopathic Skeletal Hyperostosis

Diffuse Idiopathic

DISH, previously known as ankylosing hyperostosis of the spine and Forestier's disease, is characterized by bony proliferation at the site of tendon and ligament attachment to bone (entheses), calcification and ossification of the anterior longitudinal ligaments, and diskover-tebral osteophytosis. This is a common but not insignificant disease of the spine and extraspinal skeleton. The etiology has not been established, but some investigators consider that it may be associated with degenerative process. There are three radiographic features proposed by Resnick and Niwayama (1976) as important prerequisites for the diagnosis of DISH (Figs. 9.54A and 9.55A). They include (1) the presence of flowing type calcification and ossification along the anterolateral aspects of four Fig. 9.54A, B Diffuse idiopathic skeletal hyperostosis (DISH). A Anteroposterior radiograph of the thoracolumbar spine in a 45-year-old man with DISH shows flowing ossification along the lateral aspects of T8-L1...

Pain pathway to the CNS

Pain fibres enter the spinal cord in the medial portion of the dorsal roots of spinal nerves. They enter in the dorsilateral funiculus, just dorsal to dorsal grey horn. Descending collaterals travel for one to two cord segments in the dorsilateral funiculus as the tract of Lissauer. The main group of fibres ascend in the tract of Lissauer for two cord segments before entering the dorsal horn to synapse in cells in laminae II, III, IV and V on a group of neurons called the nucleus proprius. The Rexed laminae II and III correspond to the substantia gelatinosa. A delta fibres synapse in laminae IV and V, and C fibres in laminae I and II. The axons of the cells in the nucleus proprius travel across the midline of the cord in the ventral grey and white commissure just below the central canal of the spinal cord. They pass to the ventro-lateral portion of the contralateral lateral funiculus, where they form the ventral and lateral spinothalamic tracts. The lateral spinothalamic tract is...

David M Holtzman Mary Jo LaDu and Anne M Fagan

The intercellular transport of lipids through the aqueous circulatory system as well as within tissues and other body fluids requires the packaging of these hydrophobic molecules into water soluble carriers (lipoproteins) and their regulated targeting to appropriate tissues by receptor-mediated endocytic pathways as well as scavenger receptor-mediated pathways.1 Lipoproteins have been classified into several major groups on the basis of the density at which they float by ultracentrifugation. In the plasma, chylomicrons and very low density lipoproteins (VLDL) are large particles that have a high lipid to protein ratio and are the major carriers of triglycerides. Intermediate density lipoproteins (IDL) and low density lipoproteins (LDL) are intermediate sized particles that are high in cholesterol and cholesteryl esters in humans, LDL are the principal cholesterol transporting lipoproteins in the plasma. High density lipoproteins (HDL) are the smallest particles and contain the highest...

Seat Belts and Air Bags

Aircraft Airbags Lap Belts

While successful in reducing mortality and injury, on occasion, a lap belt can also cause injury. If the belt is worn too high (above the pelvis), the body can violently jackknife, producing compression fractures of the lumbar vertebrae transverse fractures of the vertebral bodies as well as fractures of the pedicles, transverse processes and lamina of the lumbar vertebrae.811 The vertebral injuries are caused by severe flexion combined with shearing forces. Soft tissue injuries produced by lap belts consist of contusions and lacerations of the duodenum, jejunum and ileum and lacerations of the spleen and pancreas. In intestinal injuries, the lacerations are on the anti-mesenteric side of the bowel. While all of the aforementioned injuries occur from wearing the lap belt too high, such injury can still take place if it is worn properly through a phenomenon called submarining, where, at impact, the pelvis sinks down into the seat and slides under the belt. Most abdominal and spinal...

Ossificationofthe Posterior Longitudinal Ligament

Opll Lateral Radiograph

Ossification of the posterior longitudinal ligament (OPLL) is an idiopathic disorder of the spine, in which calcification or ossification of various lengths occurs in the posterior longitudinal ligament. The middle cervical spine, T3 through T6, is most commonly affected. Pathologically, the condition is characterized by bony overgrowth of the ligament that is attached to the posterior surface of the vertebral body and intervertebral disk, compressing and flattening the spinal cord behind. The lesional bones are Fig. 9.56A-C Ossification of the posterior longitudinal ligament (OPLL). A Lateral radiograph of the cervical spine in a 46-year-old female shows vertical, plaque-like ossification attached to the posterior surface of the middle cervical vertebral bodies (arrows). B T2-weighted MRI reveals undulating low signal intensity of mineralized ligament posteriorly demarcated by bright signal of cerebrospinal fluid (arrows). C Posterior bone scan shows longitudinal tracer uptake in...

Autonomic Nervous System Sympathetic Division

Sympathetic Division

The sympathetic preganglionic neuron cell bodies are situated in the thoracic and upper two or three lumbar segments of the spinal cord. The cell bodies lie in the lateral horn of the spinal gray matter. The (usually) short preganglionic fibers leave the spinal cord in the ventral nerve root, and join the spinal nerve. These fibers synapse with the postganglionic fibers, either in one of the sympathetic ganglia, which lie in a bilateral longitudinal, paraverte-bral chain on either side of the spinal column, or in one of the plexuses, which surround the main branches of the abdominal aorta. These plexuses are the coeliac, superior mesenteric, and inferior mesenteric ganglia, and are unpaired. These ganglia are also termed prevertebral ganglia.

Increased Tracer Uptake In The C5 And C6 Vertebral Bodies

Contemporary Graphite Drawings Artists

Fig. 6.31A, B Tuberculous dactylitis with the spina ventosa (puffed spine) sign in an adult. A AP pinhole scan of the left first finger in a 33-year-old female patient with digital tuberculosis shows increased tracer uptake in the head of the proximal phalanx and the base of the distal phalanx with a photon defect in the interphalangeal joint (open arrow). B Lateral radiograph reveals swollen soft tissue with osteolysis and pathological fracture involving the proximal phalangeal head (arrow) Characteristic radiographic features include bone destruction with minimal bone proliferation (Fig. 6.32). Unlike in pyogenic infection, sequestration or significant periosteal reaction is uncommon. In dactylitis, however, sequestrum may occasionally be formed (Fig. 6.31). Abscess formation is a prominent feature of bone tuberculosis (Fig. 6.33). When the spine is involved, bone destruction typically starts in the anterior subchondral region of the vertebral body, gradually extending to the...

Receptor Clustering Signals In The

Clustering signal in the CNS has focused on three different pathways. First, a secreted pentraxin (i.e, a family of proteins sharing a discoid arrangement of five nonco-valently linked subunits), Narp, is concentrated at excitatory synapses in cultured spinal and hippocampal neurons, and ultrastructural studies from hippocampal neurons in vivo show that Narp is present on both the presynaptic surface and the dendritic shaft. To determine whether endogenous Narp participates in glutamate receptor clustering, the C terminus region that supports axon transport was disrupted such that axonal transport and secretion at the synapse could be prevented. When cultured spinal neurons were trans-fected with this mutant Narp, there was a dramatic reduction in the clustering of AMPA-type glutamate receptors at axon-dendrite contacts (O'Brien et al., 1999 2002). A second system that is able to cluster glutamate receptors is the EphrinB-EphB signaling pathway which plays such an important role in...

American Academy of Neurology Diagnostic Criteria for Chronic Inflammatory Demyelinating Polyneuropathy

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a diagnosis of pattern recognition based on clinical signs and symptoms, electrodiagnostic studies, cerebrospinal fluid examination, laboratory tests appropriate to the specific clinical situation, and, on occasions, results from nerve biopsy. Four features are used as the basis of diagnosis clinical, electrodiagnostic, pathological, and cerebrospinal fluid (CSF) studies. These are further divided into mandatory, supportive, and exclusion. Mandatory features are those required for diagnosis and should be present for all definite cases. Supportive features are helpful in clinical diagnosis, but by themselves, do not make a diagnosis and are not part of the diagnostic categories. Exclusion features strongly suggest alternative diagnoses.

The differential diagnosis of Lhermittes signs includes

Spinal metastasis Cervical spondylosis Cervical disk herniation Multiple sclerosis Posttraumatic syndrome Subacute combined degeneration Cisplatin chemotherapy Cervical radiation - MRI usually shows a normal spinal cord on T1-weighted images, but hyper-intensity can occasionally be identified on T2-weighted images contrast enhancement may be observed CSF cerebrospinal fluid MRI magnetic resonance imaging.

Diseases of Bone Epidemiology and Diagnosis

In the US, more than 1.3 million osteoporotic fractures occur each year. In 2001, the annual incidence of osteoporotic fractures in Australia was 64 500, which means that, every 8 min, one patient was being hospitalized for an osteoporotic fracture, resulting in a prevalence of 1.9 million (present population 20 million). Fifty percent of these fractures occur in the spine, while 25 are wrist and another 25 are hip fractures.23 Clearly, the latter are by far the most significant complications of the disease, with a 12-month mortality of 25-30 , and lasting morbidity requiring While most patients are oligo- or asymptomatic, a history of kidney stones is not uncommon and, together with osteopenia, nephrolithiasis is one of the more frequent manifestations of symptomatic pHPT. In long-standing pHPT, bone mass and density are typically reduced at predominantly cortical sites (e.g., distal radius), while at sites of cancellous bone (e.g., lumbar spine), bone density may be normal or only...

Osteoporosis and Fracture Risk

Incidence of fracture increases with age, and associated increased risk of trauma with falls, which is an independent contributor. The most common fractures occur in the spine, and their frequency increases progressively in women and men beginning in the sixth and seventh respective decades of life. The most serious fractures are of the hip. The incidence of these increases steadily, reaching a rate of about 5 per year in the ninth decade of life. Approximately 70-75 of all hip fractures occur in women, likely due to their earlier and more dramatic bone loss, gender-based differences in bone mass, and greater longevity. Men reach the fracture threshold about a decade later than women.

Clinical Use of Alendronate Fosamax

Interestingly, the increase in BMD at some skeletal sites with ALN (10 mg daily) treatment continues for up to 10 years with mean increases (versus baseline) in BMD of 13.7 at the lumbar spine, 10.3 at the trochanter, 5.4 at the femoral neck, and 6.7 at the total proximal femur.8 The ultimate goal for reducing bone turnover and increasing bone BMD is the reduction of fractures, and ALN has proven effective in cutting in half the risk of fractures of the spine, as well as nonvertebral fractures, including those of the hip.9-11'17'29'32'33

Scoliosis Introduction

Scoliosis is a lateral curvature of the spine with the thoracic area being the most commonly affected. It can be classified as functional or structural. Functional scoliosis is the result of another deformity and is corrected by treating the underlying problem. Structural scoliosis is most often idiopathic although it may be congenital or secondary to another disorder. There is a growing body of evidence that idiopathic scoliosis is probably genetic but the etiology is not completely understood. Structural scoliosis is more progressive and causes changes in supporting structures, such as the ribs. Management includes observation, bracing, and surgical fusion. Patients with idiopathic curves of less than 25 degrees are observed for progress until they have reached skeletal maturity. Bracing is recommended for adolescents with curves between 30 and 45 degrees, while curves greater than 45 degrees usually require surgery. The deformity may occur at any age, from infancy through...

Diagnostic Assays For Group B Streptococcus

Rapid antigen assays utilizing the group-specific GBS carbohydrate have been developed for rapid diagnosis of infection. These antigens can be found in the body fluids of infected persons, including the cerebrospinal fluid (CSF), serum, and urine. This antigen is detected by hyperimmune polyclonal antisera or monoclonal antibodies using a number of different test formats, including countercurrent immunoelectrophore-sis, enzyme immunoassay, and latex particle agglutination (6). The assays vary in sensitivity, and false-positive assays using both serum and CSF have been reported (6). Only CSF and serum are recommended fluids for testing in neonates and infants (28). Antigen assays should not be used as a substitute for bacterial cultures for diagnosis of GBS because of their limitations but may be useful in addition to cultures for diagnosis.