We will talk about
spinal cord pathologies.
Begin by looking at
Trauma itself taking place
resulting in spinal cord injury.
What about extraspinal mass?
What if there was a metastasis
that was taking place to the bone?
Maybe from the breast to the vertebrae,
maybe from the prostate to the vertebrae,
and therefore, causing
injury to the spinal cord.
Abscesses or hemorrhage even.
Extraspinal mass is therefore
causing spinal cord injury.
Or intraspinal masses such as a hematoma
or maybe perhaps even a
tumor itself, intraspinal.
Inflammation referred to as
being transverse myelitis,
and of course, you’re quite
familiar with the term myelo-.
such as B12 deficiency.
We’ll look at this with
the megaloblastic anemia,
resulting in what kind of issue?
The neurologic deficit called subacute
combined degeneration, right?
And have ataxia due to
I close my eyes and have
positive Romberg sign
because I have damage to the
dorsal column, so on and so forth.
such as tertiary syphilis may result in
once again, damage to the dorsal column.
We call this tabes dorsalis.
and AVM malformations.
What if there was a
spinal cord transection?
What are the signs and
symptoms that you can expect?
Upper motor neuron signs
below the level of lesion.
What does that mean to you?
Spastic paralysis and
increased of reflexes,
upper motor neuron below the
level of the transection.
Complete sensory loss below the level
because you can’t make it up, right?
So therefore, you have sensory
loss below the level.
Pay attention to the section
and where it’s taking place.
Bowel and bladder dysfunction.
Look for incontinence.
You may see lower motor neuron
signs at the level of the lesion.
Is that clear?
So, at the level of the lesion, lower
motor neuron, what does that mean?
Spastic paralysis below
the level of the lesion.
In particular, hemisection of the cord
is called Brown-Sequard syndrome.
Let’s take a look at the cause, such as
trauma would be the most common cause.
Rarely, cord compression or
partial transverse myelitis,
referring to inflammation.
Most common cause, trauma.
So with the hemisection that’s
taking place at the cord,
what are my signs and symptoms?
I’m going to walk you through this
carefully and very, very deliberately.
So think about the spinal cord where
one half of it has been lesioned,
ipsilateral weakness, joint
position, and sensory loss.
You’ve talked about some of
these with the neuroanatomy.
I just want to make sure that
we’re reinforcing it here.
and temperature loss.
Think about the spinothalamic tract
and as to how it crosses over.
The center region of the spinal cord and
makes its way up on the contralateral side.
So therefore, if there was a hemisection,
you can expect there to be contralateral
loss of pain and temperature.
And here once again, bowel and
bladder dysfunction would be rare.
It could occur, but rare.
Our topic quickly here is
central cord syndrome.
Where are we?
In the central portion
of spinal cord.
Picture that for me.
It would be a good idea at this point
to make sure that you have a full understanding
of the anatomy of the spinal cord
so that we can walk
through this together.
There is something
Where is my lesion right now?
My topic is spinal cord pathology,
specifically central cord syndrome.
what can you expect?
within the spinal cord.
Right smack dab in the middle.
Most commonly occurs
in the cervical cord.
Think about where you are now,
okay, because this is important.
Now, we’re going to eventually
get into our signs and symptoms,
and you’ve heard of
What does cape-like mean?
Think of Superman and he wears a cape
or batman, whatever, but a cape.
And where does the
cape then drape you?
Oh yes, over the shoulders, right?
The cervical region.
And we’ll talk about cape-like
lesions in a second,
but understand as
to what that means.
Don’t just memorize cape.
That makes no sense.
That will tell you where
lesion is taking place.
It can occur after trauma.
It can occur in conjunction
with Chiari malformation.
Chiari, what does that mean?
Are we okay here?
uh-uh, has nothing to do
with the spinal cord, huh?
It has nothing to do
with CNS pathology.
Budd-Chiari was hepatic
Keep that separate.
Syringomyelia can occur in conjunction with a Chiari malformation.
It generally spares the dorsal columns, but these can be affected by B12 deficiency or tertiary syphilis.
A Chiari malformation is a congenital condition causing abnormalities of the brain at the junction of the skull with the spine.
Chiari one malformation means low-lying cerebellar tonsils without other congenital brain malformations,
downwardly-displaced in the foramen magnum.
Some patients are asymptomatic, but some have syringomyelia symptoms.
These are lower motor neuron signs in the upper extremities,
causing loss of pain and temperature sensation of the upper torso and arms
in a cape-like distribution, loss of muscle strength in the hands and arms, aswell as hypotonia can also be expected.
In the legs, there may be upper motor neuron signs including spasticity, positive Babinski sign, and loss of function or reflexes.
Chiari two malformation is also named “Arnold-Chiari” where the cerebellar tonsils and medulla go through the foramen magnum into the upper cervical canal,
and occurs almost exclusively in patients with myelomeningocele.
These patients may have symptoms of syringomyelia as well as other symptoms.