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Spinal Cord Pathology: Introduction

by Carlo Raj, MD
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    00:01 We will talk about spinal cord pathologies.

    00:06 Begin by looking at some etiologies.

    00:08 Trauma itself taking place resulting in spinal cord injury.

    00:14 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.

    00:26 Abscesses or hemorrhage even.

    00:29 Extraspinal mass is therefore causing spinal cord injury.

    00:32 Or intraspinal masses such as a hematoma or maybe perhaps even a tumor itself, intraspinal.

    00:43 Other causes.

    00:44 Inflammation referred to as being transverse myelitis, and of course, you’re quite familiar with the term myelo-.

    00:54 Nutritional deficiencies such as B12 deficiency.

    00:56 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 spinocerebellar issues.

    01:10 I close my eyes and have positive Romberg sign because I have damage to the dorsal column, so on and so forth.

    01:17 Infection, such as tertiary syphilis may result in once again, damage to the dorsal column.

    01:23 We call this tabes dorsalis.

    01:25 Vascular, strokes, possibility, and AVM malformations.

    01:34 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.

    01:44 What does that mean to you? Spastic paralysis and increased of reflexes, upper motor neuron below the level of the transection.

    01:54 Complete sensory loss below the level because you can’t make it up, right? So therefore, you have sensory loss below the level.

    02:02 Pay attention to the section and where it’s taking place.

    02:07 Bowel and bladder dysfunction.

    02:08 Look for incontinence.

    02:11 You may see lower motor neuron signs at the level of the lesion.

    02:15 Is that clear? So, at the level of the lesion, lower motor neuron, what does that mean? Flaccid paralysis.

    02:22 Spastic paralysis below the level of the lesion.

    02:27 In particular, hemisection of the cord is called Brown-Sequard syndrome.

    02:32 Let’s take a look at the cause, such as trauma would be the most common cause.

    02:37 Rarely, cord compression or partial transverse myelitis, referring to inflammation.

    02:44 Most common cause, trauma.

    02:47 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.

    02:57 Ipsilateral.

    02:58 So think about the spinal cord where one half of it has been lesioned, ipsilateral weakness, joint position, and sensory loss.

    03:07 You’ve talked about some of these with the neuroanatomy.

    03:11 I just want to make sure that we’re reinforcing it here.

    03:15 Contralateral, pain, and temperature loss.

    03:18 Think about the spinothalamic tract and as to how it crosses over.

    03:23 The center region of the spinal cord and makes its way up on the contralateral side.

    03:29 So therefore, if there was a hemisection, you can expect there to be contralateral loss of pain and temperature.

    03:35 And here once again, bowel and bladder dysfunction would be rare.

    03:41 It could occur, but rare.

    03:45 Our topic quickly here is central cord syndrome.

    03:48 Where are we? In the central portion of spinal cord.

    03:51 Picture that for me.

    03:54 Tumor.

    03:54 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.

    04:06 There is something called syringomyelia.

    04:08 Where is my lesion right now? My topic is spinal cord pathology, specifically central cord syndrome.

    04:14 With syringomyelia, what can you expect? Fluid-filled cavity within the spinal cord.

    04:20 Where? Right smack dab in the middle.

    04:23 Most commonly occurs in the cervical cord.

    04:25 Think about where you are now, okay, because this is important.

    04:29 Now, we’re going to eventually get into our signs and symptoms, and you’ve heard of cape-like issues.

    04:35 What does cape-like mean? Think of Superman and he wears a cape or batman, whatever, but a cape.

    04:41 And where does the cape then drape you? Oh yes, over the shoulders, right? The cervical region.

    04:47 And we’ll talk about cape-like lesions in a second, but understand as to what that means.

    04:51 Don’t just memorize cape.

    04:53 That makes no sense.

    04:54 That will tell you where lesion is taking place.

    04:58 It can occur after trauma.

    05:00 It can occur in conjunction with Chiari malformation.

    05:06 Chiari, what does that mean? Arnold-Chiari.

    05:08 Not Budd.

    05:10 Are we okay here? Budd-Chiari, uh-uh, has nothing to do with the spinal cord, huh? It has nothing to do with CNS pathology.

    05:20 Budd-Chiari was hepatic vein thrombosis.

    05:23 Keep that separate.

    05:24 Another topic for another day.

    05:26 Here, it’s Arnold-Chiari.

    05:28 Arnold-Chiari means small posterior fossa.

    05:31 You have type I and type II Arnold-Chiaris.

    05:35 And with Arnold-Chiari Type I, you could have syringomyelia.

    05:40 Signs and symptoms.

    05:41 So where are we? Good. Central portion of spinal cord.

    05:46 I told you about cape, what does that mean? We’ll see in a second now.

    05:49 Loss of pain and temperature in cape-like distribution.

    05:52 Does that make sense to you? So, where are you? Over the shoulders and you’re draping down.

    05:57 Next, lower motor neuron signs in the arms.

    06:02 Upper motor neuron in the lower extremities.

    06:04 Is that understood? Your neuroanatomy has to be strong so that I can walk you quickly through the signs and symptoms in neuropathology.

    06:12 Generally spares the dorsal column.

    06:13 Why? Because this is the central portion of your canal, of your spinal cord.

    06:18 Clear? Your dorsal column is usually spared.

    06:22 Where do we see damage to this earlier? Subacute combined degeneration.

    06:26 B12 deficiency, number one.

    06:27 Number two, maybe something like your tabes dorsalis, secondary to tertiary syphilis.


    About the Lecture

    The lecture Spinal Cord Pathology: Introduction by Carlo Raj, MD is from the course Spinal Cord Pathology. It contains the following chapters:

    • Spinal Cord Pathologies
    • Spinal Cord Transection: Symptoms
    • Brown-Sequard Syndrome
    • Central Cord Syndrome

    Included Quiz Questions

    1. Dorsal column dysfunction
    2. Red nucleus dysfunction
    3. Ventral column dysfunction
    4. Olivary nucleus dysfunction
    5. Transverse column dysfunction
    1. Flaccid paralysis and decreased reflexes
    2. Upper motor neuron signs below the level of the lesion
    3. Complete sensory less below the level of the lesion
    4. Bowel and bladder dysfunction
    5. Lower motor neuron signs at the level of the lesion
    1. Syringomelia
    2. Brown - Sequard syndrome
    3. Anterior spinal artery syndrome
    4. Spinal cord transection
    5. Tabes dorsalis
    1. Left side loss of pain
    2. Right side loss of pain
    3. Right side loss of temperature
    4. Left side joint sensation loss
    5. Bowel and bladder dysfunction is common
    1. Arnold Chiari malformations
    2. Budd-Chiari syndrome
    3. Polycystic adult kidney disease
    4. Brown - Sequard syndrome
    5. Anterior spinal cord syndrome
    1. Since the dorsal columns are not involved.
    2. Since the corticospinal tracts are not involved.
    3. Since the dorsal root and horn are not involved.
    4. Since the central canal is not involved.
    5. Since the lateral columns are not involved.

    Author of lecture Spinal Cord Pathology: Introduction

     Carlo Raj, MD

    Carlo Raj, MD


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