Spinal Cord Normal & Pathology Flashcards by Varsha Kumar

At which cervical segment does the spinal cord fill 75% of the canal, thereby making it vulnerable to pathologic entities?

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A measurement less than how many mm indicates stenosis in the lumbar spine?

12mm

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What % of disc herniations occur in the thoracic spine?

1% (lower segments)

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At what segment does the cord terminate in a child?

L3 disc level

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What connects the pia mater with the dura mater?

Denticulate ligament

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What is the innermost meningeal membranes that encases the spinal cord?

Pia mater

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Which areas are supplied by the anterior spinal artery?

Anterior and central spinal cord (67%).

Mostly C/S!

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Which areas are supplied by the posterior spinal artery?

Posterior column

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Which artery supplies the lower thoracic cord, the lumbar cord and cous medullaris?

Artery of Adamkiewicz

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What supplies the cord in the middle (not extraspinal part)?

ASA & PSA penetrating arteries that anastomose.

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What is the M/C/C for debilitation cord compression?

vertebral fx/dislocation

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Where is the M/C level for a cord contusion?

C5 (than C4 & C6)

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What is the CT imaging difference between contusion and hematoma?

Contusion = hypodense
Hematoma = hyperdense

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What are the causes for intraspinous hemorrhage?

a) Spontaneous (33%)
b) Therapeutic anti-coagulation
c) Instrumentation
d) Vascular malformation

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What is the difference btwn hydromyelia and syringomyelia?

Hydromyelia = cystic central canal dilation

Syringomyelia = cystic spinal cord cavity not contiguous with central spinal canal

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How does CSF get into the cord?

Through the perivascular spaces

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What is the clinical features of a syrinx?

“cloak-like” pain
temperature sensory loss
preservation of position sense, proprioception and light touch

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What are some causes of arachnoiditis?

a) infection
b) non-traumatic hemorrhage
c) trauma
d) spinal surgery
e) injection of substance into subarachnoid space

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Acute meningitis is almost always caused by which type of infection?

Bacterial (same organisms as those for the brain according to age).

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Subacute meningitis is mostly caused by which type of infection?

Viral

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The M/C organisms involved in chronic meningitis are:

a. TB
b. Syphilis
c. Fungal (eg. coccidiodomycosis, cryptococcus, aspergillosis)

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Where is the M/C location for an abscess in the spine?

Epidural space (anterior) – abscess extends beneath the PLL.

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What is the difference between an abscess and a phlegmon?

Phlegmons = active inflammation containing pus that can spread (in the spine, it is often associated with spondylodiscitis)
Enhance homogeneously

Abscess = inflammation that is walled off and can contain necrotic material
Enhance peripherally

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Where is the M/C spinal location for a subdural abscess?

Thoracolumbar region

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What are the 2 M/C organisms seen with granulomatous osteomyelitis of the spine and which locations do they M/C involve?

i) Tuberculosis -- mid-thoracic spine | ii) Brucellosis -- lower lumbar spine/sacroiliac joints

Why does TB of the spine spare the IVD initially?

B/c of lack of proteolytic enzymes

An acute inflammatory insult to the spinal cord d/t direct viral infection or post-viral immunologic attack will result in what condition to the spinal cord?

Transverse myelitis

Which location and age group is typical for transverse myelitis?

Mid-thoracic and young individuals

Which organism is the M/C/C for transverse myelitis?

Enteroviruses (eg. coxsackie, echovirus, hepatitis, rubella, measles, mumps)

Within the cervical spinal cord, what area is M/C involved in MS (eg. anterior, posterior etc.)

Lateral columns

What sensory information does the anterior spinothalamic tract carry?

Crude touch/firm pressure

What sensory information does the lateral spinothalamic tract carry?

Pain & temperature

What information does the spinocerebellar tract convey?

Joint & limb position (proprioception)

What sensory information does the dorsal column (fasciculus gracilis and cuneatus) provide?

Proprioception, deep touch, vibration and visceral pain Gracilis (medial) = T7 and lower Cuneatus (lateral) = T6 and higher

What information does the reticulospinal tract carry?

Locomotion & postural control

What information does the corticospinal tract carry?

Voluntary movement

What information does the rubrospinal tract carry?

Voluntary movement

What information does the tectospinal tract carry?

Head & eye movements

What is Brown-Sequard syndrome?

Damage to one half of spinal cord --> - ipsilateral hemiparaplegia - ipsilateral loss of proprioception - contralateral loss of pain & temperature

Where is the M/C location in the spine for epidural lymphoma?

Thoracic > lumbar > cervical

Where is the M/C location in the spine for intradural lymphoma?

Cervical > thoracic > lumbar

Where are the common locations within the spinal cord for lymphoma? (eg. dural related)

Extradural > Intradural > Intramedullary

What is the M/C malignancy of the epidural space?

Lymphoma

What % of patients who present with spinal MS lesions also have brain lesions?

90%

What is Devic's syndrome?

aka. neuromyelitis optica (NMO) | CNS demyelinating syndrome characterized by optic neuritis & myelitis.

What condition can Devic's syndrome present identical to in the spine?

MS (consider NMO if brain lesions of MS are absent)

What is Guillain-Barre syndrome?

Ascending paralysis. Immune-mediated attack on myelin sheath of schwann cells of motor peripheral nerves. Starts bilateral, symmetric in lower extremities first.

What are the imaging findings associated with Guillain-Barre?

- enlargement & enhancement of spinal nerve roots of cauda equina - NORMAL spinal cord

What part of the spinal cord is M/C involved in sarcoidosis (not looking for region eg. T/S, L/S)?

Leptomeningeal or dural involvement is prominent.

Which is M/C: extradural or intradural CNS tumors?

Extradural (80%)

Where is the M/C location for an angiolipoma?

Extradural -- mid-thoracic

List as many intradural-extramedullary spinal tumors.

- Meningioma - Neurofibroma - Schwanoma - Hemangioblastoma - CSF disseminated mets - Hemangiopericytoma - Ependymoma - Lymphoma - Arachnoid cyst - Dermoid cyst

What are the 1st & 2nd M/C intradural/extramedullary tumor?

``` 1st = schwannoma 2nd = meningioma ```

True or false: neurofibromas occur exclusively in NF-1.

False. Only 50-60%.

List as many intramedullary spinal lesions.

- Ependymoma - Astrocytoma - Hemangioblastoma - Lipoma - Mets - Schwannoma - Paraganglioma - AVM - Syringohydromyelia - Cord ischemia/infarct - Viral myelitis

What is the M/C primary spinal cord tumor in adults?

Ependymoma (60%)

What is the M/C primary spinal cord tumor in children? What is the 2nd M/C?

``` 1st = Astrocytoma (60%) 2nd = Ependymoma (30%) ```

Which subtype of ependymoma M/C occurs at the conus/filum terminale?

Myxopapillary ependymoma

What % of spinal hemangioblastoma is associated with VHL?

25%

What is the M/C primary tumor to metastasis to the spinal cord? What is the 2nd?

``` 1st = lung 2nd = breast ```

Where is the M/C location for a paraganglioma in the spine?

Cauda equina/filum terminale

Where is the M/C location for a paraganglioma overall in the body?

Adrenal medulla (eg. pheochromocytoma)

Where is the M/C location for an extra-adrenal paraganglioma?

Carotid body (80-90%) --> glomus tumor

Spinal cord cellular ependymomas is M/C seen where?

Cervical spine > cervicothoracic spine = thoracic spine

What is an aka for Tarlov's cyst?

Perineural (root sleeve) cyst

A primary arachnoid cyst is thought to form how?

Congenital diverticulum of the arachnoid/dural mater w/ a ball-valve mechanism.

What is the classical clinical sx associated with a cervical syrinx?

"Cloak-like" pain. Temperature sensory loss; preservation of position sense/proprioception.

What is the difference btwn diplomyelia and diastematomyelia?

``` Diplomyelia = duplicated spinal cord Diastematomyelia = spinal cord splits ```

What is the difference btwn type 1 and type 2 diastematomyelia?

Type 1: - duplicated dural sac - midline spur (osseous/fibrous) often present - often associated with vertebral anomalies - tethered cord common - hairy patch & skin pigmentation - more symptomatic Type 2: - single dural sac - no spur - few vertebral anomalies - less symptomatic

A tethered spinal cord may or may not present with what other finding at the conus medullaris?

- fibrolipoma | - lipoma

Enhancing gray matter pattern in the spinal cord is seen in which conditions?

Ischemic encephalitis (stroke) & viral encephalitis

What is the M/C/C of spinal pachymeningitis?

What are some extradural spinal lesions?

Degenerative: - herniated disc - rheumatoid pannus - osteophytes - synovial cysts Nondegenerative: - metastasis - abscess - hematoma - epidural lipomatosis

What are 2 ddx to consider when nodular densities are seen along the spinal cord?

Drop mets & fungal infections

What is a ddx for enhancing nerves?

- Guillain-Barre - CMV radiculopathy - Arachnoiditis - Meningitis

Spinal Cord Normal & Pathology Flashcards

(75 cards)