Neuromuscular

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MYELOPATHY

Anatomical syndromes
  Anterior cord
  Cauda equina
  Central cord
  Hemicord (Brown-Séquard)
  Inferior cord (Conus medullaris)
  Posterior cord
Systemic disorders
Traumatic myelopathy
Vascular myelopathy

From: M Al-Lozi


PARTIAL CORD INJURY SYNDROMES

MYELOPATHY: SPINAL & SYSTEMIC CAUSES

Intrinsic 
Skeletal 

Cervical spinal stenosis
  


Skeletal & Extramedullary lesions Spinal Cord: Intrinsic lesions


TRAUMATIC SPINAL CORD INJURY

Clinical features
Epidemiology
Late complications
Partial cord injury syndromes
  Anterior cord
  Brown-Séquard
  Cauda Equina
  Conus medullaris
  Hemicord
  Posterior cord
Treatment

Epidemiology Clinical features
VASCULAR DISEASE OF SPINAL CORD

Blood supply to spinal cord Anatomy of lesions Types of vascular disease Prognosis of vascular disease

SPINAL ARTERIOVENOUS MALFORMATIONS

Dural:Type I; Extramedullary 5
  • Anatomy & Physiology
    • Location
      • Thoracic (Lower) & Lumbar: 90%
      • Sacral: 4%
      • Cervical 3%
      • Left > Right: 2:1
    • Feeding vessels
      • Location: Often lumbar
      • Number: Usually 1; Occasionally 2 or 3
    • Fistula in dorsolateral root sleeve
    • High venous pressure in spinal cord
    • Reduced spinal cord perfusion
  • Epidemiology
    • Male:Female = 4:1
    • Age of onset: Mean 58 years; Range 21 to 78
    • 75% of all AVMs
  • Clinical
    • General
      • Lumbar or sacral signs most common
      • Poor correlation between lesion & level of symptoms
      • Similar syndrome: Associated with remote pelvic AVM
    • Initial symptom
      • Gait disorder
      • Sensory symptoms: Numbness or Paresthesias
      • Pain (low back, or radicular)
      • Leg weakness: Often asymmetric
      • No change with Valsalva
      • Hemorrhage: 5% to 25%
    • Sensory
      • Loss: Sacral 1st; Spinal level in 20%
      • Paresthesias
      • Pain: Back or Legs; 25% to 50%
    • Motor
      • Weakness
        • Legs: Mild paraparesis most frequent
        • May be asymmetric
        • Progression to flaccid
        • Lower motor neuron only in 35%
      • Wasting: Proximal - buttocks & thighs
      • Gait disorder
        • Early in course: Exacerbated by exercise
        • Later in course: Fixed
    • Reflexes
      • Tendon: Reduced or increased
      • Plantar: Upgoing
      • Anal & cremasteric: Reduced
    • Bladder dysfunction
      • Frequency: 80%
      • More severe with conus AVM
    • Vascular
      • Bruit: Rare
      • Cutaneous angioma
        • More prominent with Valsalva
        • ? Related to dural or intradural AVM
    • Progression
      • Gradual over months to years
      • Short term exacerbations: Related to exercise
      • Stepwise exacerbations: 20%; Related to ischemia or hemorrhage
      • Full symptom complex (motor, sensory, bladder) after 1 year in 2/3
      • Severe gait disorder: 90% by 3 years
    • Treatment 6
      • Endovascular
      • Surgery
        • Cut intradural venous connection to parenchyma
        • Improvement in 60% to 80%
        • Symptom recurrence may be 2° to new collaterals to AVM
      • Benefit
        • Motor & gait improvement most likely: Rarely reverts to normal
        • Pain often reduced
        • More improvement with lower thoracic AVMs
  • Diagnosis
    • Myelography: 90% positive
      • Supine and prone films
    • MRI 7
      • Use small field of view
      • Eliminate motion artifact
      • T2 signal or flow voids: Present in most
      • Perform T1 sequence after gadolinium: Detects enhancement
      • 86% positive
      • Detects other lesions
    • Spinal angiography7
      • Localizes fistula
      • May be only positive diagnostic test (30% to 50%)

From M Al-Lozi

Arteriogram:
Tortuous vessels


MRI T2:
Flow voids on dorsal cord surface


MRI T1:
High signal in cord

Intramedullary AVMs Perimedullary Fistula: Intradural; Type I & IV

Spinal Hemangioblastoma Spinal Cavernous Malformation
External link: LSUMC



Destructive spondyloarthropathy with chronic renal failure

Decompression Sickness




NEOPLASMS



Spinal epidural metastasis

Epidural lipomatosis Cruikshank

Intravascular B-cell Lymphoma



CSF Cytology


Ischemic myelopathy 2° surgery or traumatic laceration of aorta


Recurrent optic neuromyelitis with endocrinopathies (Vernant's disease)1


Transverse Myelitis



Transverse Myelitis


Myelitis in ADEM


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References
1. Curr Opin Neurol 1998;11:539-544
2. Brain 1999;122:2183-2194
3. Neurology 2003;60:517
4. Neurol India 2002;50:386-397
5. J Neurol Neurosurg Psychiatry 2003;74:1438–1440
6. Neurosurgery 2004;55:815-823
7. Neurology 200628;66:928-931
8. Acta Paediatr 2006;95:1500-1504
9. European Journal of Neurology 2006;13:112–124
10. J Neurosurg Spine 2014 Jun 13:1-6
11. Ann Neurol 2014 May 16

9/15/2015