Spinal Cord Disorders Neurology - Eva Peron UDH General The spinal cord is a cylindrical neural structure located

within the vertebral c anal. It extends from the cranial limit of the atlas to the lower border of L1, measuring 45 cm. The conus medullaris terminates at the lower limit of L1 and pr olonged the "filum terminale" which comes to the coccyx. Between the end of the cord and to the end of the dural sac is formed a space occupied by CSF and lumba r nerve roots, sacral and coccygeal called pony tail. " General clinical picture Pain: frequently where the injury settles. Sensory Motor Disorder Disorder: grea t value for the location. Lhermitte's sign: electrical sensation that runs cauda lly back when neck is flexed. Indicates involvement of posterior columns. Altere d vasomotor bowel disorders and sexual disorders sweating Vertebromedulares Syndromes Transverse cord syndrome Syndrome Brown - Sequard syndrome after intramedullary cordonal Syndrome Syndrome Syndrome radiculocordonal Tabet back or Epicon radicu lomedular medullary syndrome syndrome syndrome conus cauda equina syndrome of th e foramen magnum Transverse Medullary Syndrome Total loss of all sensory and motor activity below the injury. You can take an a cute or chronic. Causes: trauma, transverse myelitis, stroke, hematomas, tumors. Syndrome of acute spinal cord injury The bone goes through two phases: Spinal shock. Lasts four days and six weeks Clinically: flaccid paralysis with absent deep ten don reflexes below the injury, sensory level, sphincter incontinence, loss of er ection and ejaculation.

Spinal release phase. Characteristics of chronic spinal cord injury syndrome Chronic spinal cord injury syndrome The symptoms gradually settle spastic paralysis observed, the exaltation of tend on reflexes, Babinski + and commitment sphincter. Syndrome Brown - Sequard It is a syndrome of spinal cord hemisection. Clinically:

Commitment proprioception and ipsilateral spastic paresis or paraplegia. Commitm ent sensitivity contralateral pain sensation. Anesthesia band atrophy and fascic ulations at the level of the injury. Intramedullary Syndrome Also called dissociation syndrome Syringes Caused by the presence of an intramed ullary lesion involving central and paracentral structures. Clinically: anesthes

ia and pain sensation suspended and dissociated (with preservation of dorsal and lateral) Most common causes syringomyelia, intramedullary tumors, hematomyelia, trauma. Posterior cordonal Syndrome Clinically: loss of deep sensitivity and position below the injury. It is charac teristic of this table, ataxic gait, taconeante and Romberg + sign on exploratio n. When the posterior roots are affected with onset of pain, hypotonia and arefl exia syndrome constitutes Tabet (syphilis) Anterior horn syndrome The lesion clinically determine the presence of flaccid paralysis with segmental sclerosis and areflexic in the level of injury Epicon medullary syndrome Condition of segments: L5, S1, S2 Clinically: abnormal gait by difficulty in ext ending the hip, flex the foot, hypoesthesia in the back and side of the legs, an d Achilles areflexia, sphincter condition most common causes: tumors , trauma Conus syndrome Condition of segments S3, S4, S5. Clinically produces: saddle anesthesia, sphinc ter disorder without motor alteration and preservation of reflexes. Most common causes: cancer, trauma Syndrome of the cauda equina Plurirradicular injury. Clinically, pain, weakness, anesthesia, there is less di sorder than in the previous sphincter. Most common causes: cancer, trauma Foramen magnum syndrome Clinical features: headache that increases with coughing, sensation of lighthead edness, blurred vision, syncope, positional vertigo can be associated with Lherm itte's sign most common causes: Arnold Chiari malformation, tumors. Myelopathy: Classification Tumor Vascular Injuries Degenerative Inflammatory Congenital Syringomyelia Tumors Spinal cord injuries tumors represent 15% of tumors that affect the CNS, the vas t majority are benign. They have a reasonably good prognosis. Depending on their position are classified in:

Intramedullary: originating within the medulla and invade or destroy the gray ma tter and nerve tracts. Extramedullary: arising out of the spinal cord. They are classified into: Extradural Intradural Intramedullary tumors The most common are astrocytomas and ependinomas (60%). Chronic evolution may bl eed causing a sudden worsening. Most frequent: Ependinomas: filum terminale, conus medullaris astrocytoma: cervical or dorsal r egion MTS: exceptional Dx: MRI (diffuse enlargement of the ME) Differential Dx: stroke , myelitis, parasitosis Tto: surgical

Intramedullary Tumor Intramedullary neoplasia C3 to D5. Solid tumor with peripheral contrast sensor n ecrotic or cystic central area. Edema from medulla to D9 Extramedullary Tumors Extradural:

They are mostly metastases from systemic cancer (lung, breast, prostate, kidney, myeloma, lymphoma, melanoma, neuroblastoma, sarcoma) tumors primitive: osteosar coma, lipoma, chondrosarcoma. (Rare) Location most common: dorsal Dx: MRI, biopsy Tto: surgery, radiotherapy Extramedullary Tumors Intradural:

They are usually benign chronic course Meningiomas: more frequent in women, dors al location Schwannomas, neurofibromas Dx: MRI image showing sharp edges, can ha ve growth in an hourglass. Tto: surgical Extramedullary-intradural tumor Solid tumor, procurer of contrast from C2 to C7, 8 cm, cystic dilatation intradu ralextramedular caudal (ependyma). Clinical Manifestations Medullary sensory-motor impairment. Caused by compression of the spinal cord and not by invasion or tissue destruction noble.

progressive frame, motor home or sensitive, slowly evolving core part slow, musc ular hypertonia, hyperreflexia, Babinski sign and clonus Anesthesia with metamer ic level, often coupled in the classical types cordonal Syringes and Commitment Tabet back or general type sphincter retention Clinical Manifestations Commitment and root core. Here dominates the clinical radicular pain, the patien t reports from the early stages

Pain that increases with systematic efforts, well-defined and sensitive acute Co mmitment: Often linked to this pain, numbness or alterations are vague sensation , often accompanied by backache dissociated muscle contracture deformities and s ometimes the spines. Deficit progressive spinal motor and sensory disturbances b elow the injury sphincter disorders Clinical Manifestations Intramedullary Commitment. This occurs: Pyramidal motor deficit disorders progressive sensory dissociation sphincter pre servation rate Syringes with deep sensitivity and alteration of the surface (tac tile, thermal and algesic) Vascular Lesions Myocardial blood:

These lesions are ischemic, thrombotic or embolic Clinic: When the affected arte ry is the anterior spinal (which supplies two thirds of the bone), which usually presents with acute paraparesis, radicular pain, motor weakness, impaired infra lesional pain sensation with preservation of sensation deep and sphincter distur bance. The most vulnerable region is the upper chest, because of the poor collat eral circulation. If it affects the posterior spinal artery, much less common, t here is a variable deficit of strength and decrease of deep sensitivity. Venous infarction: Venous thrombosis secondary to surgical procedures in the absence of rare vascul ar malformations or hypercoagulable states. Vascular Lesions Hematomyelia: intramedullary blood collection "spontaneous" in the absence of trauma. It is ve ry rare, usually causes vascular malformations, or tumors that bleed, or in conn ection with hemorrhagic diathesis. Epidural or spinal subdural hematoma: Are rare, begin with sudden pain and signs of cord compression in thoracolumbar location. It usually occurs in patients with coagulopathy or anticoagulation aft er PL or vascular malformations. Vascular Malformations: Aneurysms, arteriovenous malformations, cavernous angiomas, venous angiomas and

capillary telangiectasias. Symptoms can be acute due to bleeding or progressive compression. Dx: MRI Vascular Lesions Magnetic resonance imaging T2 sequence showing a subdural hematoma cord from L1 to S1. Syringomyelia Definition: presence of a cavity within the spinal cord. Most frequent location: cervical region and can affect bulb (syringobulbia) can be:

Caller: cavity lined by epithelium and is caused by dilation of the ependyma, th ere is a change in CSF dynamics,€associated with Arnold-Chiari malformation (dec rease of cerebellar tonsils through the foramen magnum) not communicating: not o ften. It can grow in a fragment of bone secondary to a tumor or trauma. Clinical Center-medullary syndrome. Syringomyelia Dx: intramedullary syndrome, which was confirmed by MRI, this shows the presence and extent of the cavity, presence of ArnoldChiari anomaly. Syringomyelia Tto: early surgical treatment before they develop significant and irreversible n eurological deficits Technique: inserting a catheter shunt (shunt) into the cavi ty Syringes which drains the liquid retained for dispatch to the peritoneum, or the subarachnoid space. In the case of a Chiari malformation: Unzip the cranioce rvical area affected and expected to disappear syringomyelia to restore the free flow of CSF. Degenerative Disc disease and cervical narrow channel. (Less than 14mm) and narrow channel lu mbosacral disc disease Degenerative Cervicobraquialgias Are named for where they are painful clinical compromised cervical spine and upp er limb. Its origin is multiple, recognizes various etiologies: Disk: Predominantly of C5-6 and C6-7 and is due to the lateral protrusion of dis c material that irritates and compresses the Spinal emerging roots: Very common. Originating from biomechanical abnormalities of the cervical spine that induce the formation of osteophytes cervical osteoarthritis, syndesmophytes, disk dehyd ration, abnormal calcium deposits, etc. Clinically it is accompanied by cervical spine stiffness and muscular contraction regional Root: Narrowing of the holes reveal systematic combination of topography and aggravated root mobilization Der ivatives of brachial plexus injury brachial plexus trauma, tumor (Ca lung apex, neurinomas , etc.) vascular. Clinical Manifestations The roots most affected by cervical protrusions are those for C5-6 and C6-7 Pati ents usually manifest:

Cervicobraquialgias Limitation of neck movements Worsening of pain with movement , particularly hyperextension, and coughing and sneezing Paresthesias and areas of tenderness in the territories of different roots dedistribución motor upper l imb paresis with exceptional hiporeflexia medial protrusion a disc can give a ce rvical spinal cord compression syndrome. Diagnosis and treatment The helper methods for diagnosis include: Electromyography radiographic study with conduction velocity. NMR, which display s the herniated disc or roots and committed The initial medical treatment is based on the use of painkillers and muscle rela xants were continued cervical collar immobilization and physical therapy in refr actory cases and referral to specialists who can evaluate the surgical treatment Degenerative Sciatica. Is "back pain radiating along the path of the sciatic nerve." The sciatica is a picture of relative frequency. You can start sharply, which is the most common, or insidiously, with previous low back pain pictures pure. Eti ology: Produced by root compression, limits or prevents the sliding of the root. Causing pain by stretching nerve roots. Causes: spinal tumors, trauma, inflammatory phenomena. 90% is caused by herniate d nucleus pulposus compressing the result in the emergence of the bag, in the co urse of the foramen or departure. HNP usually occurs in young people suddenly or slowly and insidiously in older patients. Pathogenesis of intervertebral disc injury The onset of the hernia is caused by rupture of the fibrous lamellae ring disk i n your back to an excessive overload, following which the nucleus pulposus bulge s. The fibrous ring is weaker in the rear, since it is thin, less tissue present between the lamellae, it is associated with the fact that the posterior longitu dinal ligament becomes narrower at the level of L4-L5 and L5-S1 where it produce s 96% of hernias. In the form of insidious onset of disc herniation is a disorde r of collagen occurs with progressive degeneration of the nucleus and the ring, losing the ability to retain water due to the alteration of mucopolysaccharides. Pathogenesis of intervertebral disc injury When combined degenerative phenomena and overloads may occur protrusion of nucle us pulposus. Thus, the trauma or overload the trigger in the onset of the hernia . A clinical picture Pain is the symptom capital that characterizes this syndrome.€It begins in the l ower back and radiates to the buttocks, following the path of the sciatic, follo ws the posterior aspect of the buttock and thigh, on the external side and back of leg and foot to end in the fingertips. Increases with exertion, coughing, sne ezing, bowel movements, etc. Patients often relate that the pain subsides with r est, especially on her side.

Physicals The physical examination focuses on:

Stiffness antalgic scoliosis with severe lumbar muscle contracture Inability or difficulty walking on toes (S1 root compromise) decreased Achilles reflex Inabil ity to walk on his heels (when the affected root is L5) Lasègue maneuver: in med ical practice whenever there is commitment to L4 or L5 there is a positive sign Lasègue. Altered sensitivity: can present as paresthesia, dysesthesia, hypoesthe sia or anesthesia metameric area corresponding to each root. Diagnosis of lumbar HNP The diagnosis of nerve root compression is clearly based on clinical history in the distribution of pain in the spine and neurological examination and complemen tary studies

TAC for its accurate information on osteroarticular type items involved. But it shows the anatomy intrathecal MRI is very detailed, has a greater ability to dis criminate between the soft masses who occupy space inside and outside the dural space. but typically not required. Electromyography: Its greatest use is in help ing us know when one is old or new radiculopathy or to follow the evolution of a root is decompressed. Treatment With regard to the treatment of lumbar HNP with the vast majority give medical t reatment

We started with bedrest hard, in a fetal position long hand painkillers, muscle relaxants and nonsteroidal anti-inflammatory As pain subsides Gymnastics soft fo r strengthening the musculoaponeurotic belt, correct overweight, lifestyle chang es, etc. If there are repeated episodes of pain that seriously impair social or work life of the patient or neurological deficit appears, the indication is surg ical. Treatment Inflammatory They are classified into: Infectious Viral myelitis myelitis Myelitis bacterial parasite

No infectious Acute transverse myelitis Multiple Sclerosis Spinal Sarcoidosis Sjogren's Syndro me Infectious Viral myelitis HIV myelopathy Clinical rare complication: Table of paraparesis associated with sensory and sph incter disorders Dx by exclusion studies: NMR, PL

HTLV-1 myelopathy Higher incidence in northern Argentina bloodborne, sexual Clinical: progressive spastic paraparesis

Other: enterovirus, herpesvirus Echinococcosis Parasitic myelitis Infectious Bacterial myelitis Syphilis CNS disease occurs during late syphilis. Clinic: tabes dorsal spinal cord compre ssion caused by a rubber.

TBC Spinal cord injury following spinal commitment (Pott's disease) Clinic could res ult in a complete transection

S. Epidural Abscess aureus Bone marrow involvement of rapid evolution associated with fever and local pain at the affected vertebral segment occurs by hematogenous spread of distant focus or secondary focus of osteomyelitis Benign Acute transverse myelitis

Syndrome characterized by acute or subacute onset of motor, sensory and autonomo us secondary to inflammatory spinal cord injury was preceded by viral infection or vaccination days before the start of the clinical picture: pain on the affect ed spinal segment, ascending limb paresis, paraparesis or paraplegia and sphinct er disorders Table stabilizes between 10 days and 4 weeks Dx: clinical compatibl e, compression causes exclusion of MRI, spinal cord demonstrated by CSF inflamma tion, exclusion of other causes Tto: Symptomatic + high-dose glucocorticoids Benign Spinal Multiple Sclerosis

Neurological disorders and autoimmune disorders that affect young adults. Involv e different CNS regions at different times. It is characterized by demyelinating lesions of the cerebral white matter, spinal cord and optic nerve. Clinic: The most common initial symptoms are paresthesias and gait disturbance. After a numb er of relapses and remissions, often incomplete, the patient begins to be affect ed in a progressive manner. Myelopathy secondary Connective tissue diseases Rheumatoid arthritis, SLE, Sjögren Deficit hepatic vitamin B12 Nutritional deficiencies Metabolic Diseases Toxic Neoplasms Post-radiotherapy Thank you very much! Applause! Applause!