Copyrighted Material
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Intramedullary Cystic Lesions Ofthe Conus Medullaris
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.31.2.106 on 1 April 1968. Downloaded from J. Neurol. Neurosurg. Psychiat., 1968, 31, 106-109 Intramedullary cystic lesions of the conus medullaris SAMI I. NASSAR, JAMES W. CORRELL, AND EDGAR M. HOUSEPIAN From the Department of Neurosurgery, College ofPhysicians and Surgeons, Columbia University, and the Neurological Institute of the Columbia-Presbyterian Medical Center, New York, U.S.A. Intramedullary cystic lesions of the conus medullaris of the aetiology, these cysts may simulate the clinical are rare. Although an extensive literature describes picture of syringomyelia. syringomyelia as being a frequent basis for cystic The cases of cysts of the conus medullaris re- cervico-thoracic lesions it is apparent that this ported here simulated the clinical picture of does not occur frequently in the lumbosacral region syringomyelia, tumour, or lumbar disc disease. (Kirgis and Echols, 1949; Netsky, 1953; Rand and The radiographic findings in each case were inter- Rand, 1960; Love and Olafson, 1966). Poser (1956), preted as indicating the presence ofan intramedullary in a review of 234 cases of syringomyelia, found tumour. The correct diagnosis was made in each that the cavity extended into the lumbosacral region case only at operation. in only 12-6% and in only five cases were the Protected by copyright. cavities restricted to the lumbosacral segments. Some authors (Thevenard, 1942; Andre, 1951) CASE REPORTS question the occurrence of syringomyelia in the lower spinal cord. Nevertheless a high incidence CASE 1 (F.T., NO. 179 16 92) A 22-year-old negro male of constitutional defects has been noted among was admitted complaining of weakness and pain in the syringomyelia patients and members of their legs for three years. -
Split Spinal Cord Malformations in Children
Split spinal cord malformations in children Yusuf Ersahin, M.D., Saffet Mutluer, M.D., Sevgül Kocaman, R.N., and Eren Demirtas, M.D. Division of Pediatric Neurosurgery, Department of Neurosurgery, and Department of Pathology, Ege University Faculty of Medicine, Izmir, Turkey The authors reviewed and analyzed information on 74 patients with split spinal cord malformations (SSCMs) treated between January 1, 1980 and December 31, 1996 at their institution with the aim of defining and classifying the malformations according to the method of Pang, et al. Computerized tomography myelography was superior to other radiological tools in defining the type of SSCM. There were 46 girls (62%) and 28 boys (38%) ranging in age from less than 1 day to 12 years (mean 33.08 months). The mean age (43.2 months) of the patients who exhibited neurological deficits and orthopedic deformities was significantly older than those (8.2 months) without deficits (p = 0.003). Fifty-two patients had a single Type I and 18 patients a single Type II SSCM; four patients had composite SSCMs. Sixty-two patients had at least one associated spinal lesion that could lead to spinal cord tethering. After surgery, the majority of the patients remained stable and clinical improvement was observed in 18 patients. The classification of SSCMs proposed by Pang, et al., will eliminate the current chaos in terminology. In all SSCMs, either a rigid or a fibrous septum was found to transfix the spinal cord. There was at least one unrelated lesion that caused tethering of the spinal cord in 85% of the patients. -
Cerebellar Ataxia
CEREBELLAR ATAXIA Dr. Waqar Saeed Ziauddin Medical University, Karachi, Pakistan What is Ataxia? ■ Derived from a Greek word, ‘A’ : not, ‘Taxis’ : orderly Ataxia is defined as an inability to maintain normal posture and smoothness of movement. Types of Ataxia ■ Cerebellar Ataxia ■ Sensory Ataxia ■ Vestibular Ataxia Cerebellar Ataxia Cerebrocerebellum Spinocerebellum Vestibulocerebellum Vermis Planning and Equilibrium balance Posture, limb and initiating and posture eye movements movements Limb position, touch and pressure sensation Limb ataxia, Eye movement dysdiadochokinesia, disorders, Truncal and gait Dysmetria dysarthria nystagmus, VOR, ataxia hypotonia postural and gait. Gait ataxia Types of Cerebellar Ataxia • Vascular Acute Ataxia • Medications and toxins • Infectious etiologies • Atypical Infectious agents • Autoimmune disorders • Primary or metastatic tumors Subacute Ataxia • Paraneoplastic cerebellar degeneration • Alcohol abuse and Vitamin deficiencies • Systemic disorders • Autosomal Dominant Chronic • Autosomal recessive Progressive • X linked ataxias • Mitochondrial • Sporadic neurodegenerative diseases Vascular Ataxia ▪ Benedikt Syndrome It is a rare form of posterior circulation stroke of the brain. A lesion within the tegmentum of the midbrain can produce Benedikt Syndrome. Disease is characterized by ipsilateral third nerve palsy with contralateral hemitremor. Superior cerebellar peduncle and/or red nucleus damage in Benedikt Syndrome can further lead in to contralateral cerebellar hemiataxia. ▪ Wallenberg Syndrome In -
Brainstem: Midbrainmidbrain
Brainstem:Brainstem: MidbrainMidbrain 1.1. MidbrainMidbrain –– grossgross externalexternal anatomyanatomy 2.2. InternalInternal structurestructure ofof thethe midbrain:midbrain: cerebral peduncles tegmentum tectum (guadrigeminal plate) Midbrain MidbrainMidbrain –– generalgeneral featuresfeatures location – between forebrain and hindbrain the smallest region of the brainstem – 6-7g the shortest brainstem segment ~ 2 cm long least differentiated brainstem division human midbrain is archipallian – shared general architecture with the most ancient of vertebrates embryonic origin – mesencephalon main functions:functions a sort of relay station for sound and visual information serves as a nerve pathway of the cerebral hemispheres controls the eye movement involved in control of body movement Prof. Dr. Nikolai Lazarov 2 Midbrain MidbrainMidbrain –– grossgross anatomyanatomy dorsal part – tectum (quadrigeminal plate): superior colliculi inferior colliculi cerebral aqueduct ventral part – cerebral peduncles:peduncles dorsal – tegmentum (central part) ventral – cerebral crus substantia nigra Prof. Dr. Nikolai Lazarov 3 Midbrain CerebralCerebral cruscrus –– internalinternal structurestructure CerebralCerebral peduncle:peduncle: crus cerebri tegmentum mesencephali substantia nigra two thick semilunar white matter bundles composition – somatotopically arranged motor tracts: corticospinal } pyramidal tracts – medial ⅔ corticobulbar corticopontine fibers: frontopontine tracts – medially temporopontine tracts – laterally -
The Brain Stem Medulla Oblongata
Chapter 14 The Brain Stem Medulla Oblongata Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Central sulcus Parietal lobe • embryonic myelencephalon becomes Cingulate gyrus leaves medulla oblongata Corpus callosum Parieto–occipital sulcus Frontal lobe Occipital lobe • begins at foramen magnum of the skull Thalamus Habenula Anterior Epithalamus commissure Pineal gland • extends for about 3 cm rostrally and ends Hypothalamus Posterior commissure at a groove between the medulla and Optic chiasm Mammillary body pons Cerebral aqueduct Pituitary gland Fourth ventricle Temporal lobe • slightly wider than spinal cord Cerebellum Midbrain • pyramids – pair of external ridges on Pons Medulla anterior surface oblongata – resembles side-by-side baseball bats (a) • olive – a prominent bulge lateral to each pyramid • posteriorly, gracile and cuneate fasciculi of the spinal cord continue as two pair of ridges on the medulla • all nerve fibers connecting the brain to the spinal cord pass through the medulla • four pairs of cranial nerves begin or end in medulla - IX, X, XI, XII Medulla Oblongata Associated Functions • cardiac center – adjusts rate and force of heart • vasomotor center – adjusts blood vessel diameter • respiratory centers – control rate and depth of breathing • reflex centers – for coughing, sneezing, gagging, swallowing, vomiting, salivation, sweating, movements of tongue and head Medulla Oblongata Nucleus of hypoglossal nerve Fourth ventricle Gracile nucleus Nucleus of Cuneate nucleus vagus -
The Spinal Cord Is a Nerve Column That Passes Downward from Brain Into the Vertebral Canal
The spinal cord is a nerve column that passes downward from brain into the vertebral canal. Recall that it is part of the CNS. Spinal nerves extend to/from the spinal cord and are part of the PNS. Length = about 17 inches Start = foramen magnum End = tapers to point (conus medullaris) st nd and terminates 1 –2 lumbar (L1-L2) vertebra Contains 31 segments à gives rise to 31 pairs of spinal nerves Note cervical and lumbar enlargements. cauda equina (“horse’s tail”) –collection of spinal nerves at inferior end of vertebral column (nerves coming off end of spinal cord) Meninges- cushion and protected by same 3 layers as brain. Extend past end of cord into vertebral canal à spinal tap because no cord A cross-section of the spinal cord resembles a butterfly with its wings outspread (gray matter) surrounded by white matter. GRAY MATTER or “butterfly” = bundles of cell bodies Posterior (dorsal) horns=association or interneurons (incoming somatosensory information) Lateral horns=autonomic neurons Anterior (ventral) horns=cell bodies of motor neurons Central canal-found within gray matter and filled with CSF White Matter: 3 Regions: Posterior (dorsal) white column or funiculi – contains only ASCENDING tracts à sensory only Lateral white column or funiculi – both ascending and descending tracts à sensory and motor Anterior (ventral) white column or funiculi – both ascending and descending tracts à sensory and motor All nerve tracts made of mylinated axons with same destination and function Associated Structures: Dorsal Roots = made -
Spinal Cord Organization
Lecture 4 Spinal Cord Organization The spinal cord . Afferent tract • connects with spinal nerves, through afferent BRAIN neuron & efferent axons in spinal roots; reflex receptor interneuron • communicates with the brain, by means of cell ascending and descending pathways that body form tracts in spinal white matter; and white matter muscle • gives rise to spinal reflexes, pre-determined gray matter Efferent neuron by interneuronal circuits. Spinal Cord Section Gross anatomy of the spinal cord: The spinal cord is a cylinder of CNS. The spinal cord exhibits subtle cervical and lumbar (lumbosacral) enlargements produced by extra neurons in segments that innervate limbs. The region of spinal cord caudal to the lumbar enlargement is conus medullaris. Caudal to this, a terminal filament of (nonfunctional) glial tissue extends into the tail. terminal filament lumbar enlargement conus medullaris cervical enlargement A spinal cord segment = a portion of spinal cord that spinal ganglion gives rise to a pair (right & left) of spinal nerves. Each spinal dorsal nerve is attached to the spinal cord by means of dorsal and spinal ventral roots composed of rootlets. Spinal segments, spinal root (rootlets) nerve roots, and spinal nerves are all identified numerically by th region, e.g., 6 cervical (C6) spinal segment. ventral Sacral and caudal spinal roots (surrounding the conus root medullaris and terminal filament and streaming caudally to (rootlets) reach corresponding intervertebral foramina) collectively constitute the cauda equina. Both the spinal cord (CNS) and spinal roots (PNS) are enveloped by meninges within the vertebral canal. Spinal nerves (which are formed in intervertebral foramina) are covered by connective tissue (epineurium, perineurium, & endoneurium) rather than meninges. -
The Conus Medullaris: a Comprehensive Review
THE SPINE SCHOLAR VOLUME 1, NUMBER 2, 2017 SEATTLE SCIENCE FOUNDATION REVIEW The Conus Medullaris: A Comprehensive Review Garrett Ng1, Anthony V. D’Antoni1, R. Shane Tubbs2 1 The CUNY School of Medicine, New York, NY 10031, USA 2 Department of Anatomical Sciences, St. George’s University, Grenada http:thespinescholar.com https:doi.org/10.26632/ss.10.2017.1.2 Key Words: anatomy, embryology, spinal cord, spine ABSTRACT The position of the conus medullaris within the vertebral canal varies. Given its role in sensory and motor function, a comprehensive understanding of the conus medullaris is necessary. PubMed and Google Scholar were used to review the literature on the conus medullaris. Pathological states and traumatic injury relating to the conus medullaris should be studied further. Spine Scholar 1:93-96, 2017 INTRODUCTION The conus medullaris (Fig. 1), also known as the medullary cone, is the distal end of the spinal cord. Its location varies, and in adults it tapers at approximately the first or second lumbar vertebra, ranging from T11 and L3 (Neel, 2016). Derived from the neural tube, the structure ascends in the vertebral canal because the growth rates of the spinal cord and the vertebral column differ during development (Salbacak et al., 2000). Figure 1: Schematic drawing of the conus medullaris and distal nerve roots in relation to the sacrum. The conus contains the sacral and coccygeal segments of the spinal cord (Taylor and Coolican, 1988). Criteria for recognizing the conus on computed tomography (CT) scans have been published by Grogan et al. (1984). The radiological properties of the structure have been studied through magnetic resonance imaging (MRI) (Saifuddin et al., 1997). -
227 INTRODUCTION: Diastematomyelia (Also Known As a Split Cord Malformation) Is a Rare Dysraphic Lesion of the Spinal Cord in W
Role of rehabilitation a case of diastematomyelia Stanescu Ioana¹, Kallo Rita¹, Bulboaca Adriana³, Dogaru Gabriela ² 1.Rehabilitation Hospital Cluj, Neurology Department 2.Rehabilitation Hospital Cluj, Physical Medicine and Rehabilitation Department 3.University of Medecine and Pharmacy Cluj - Physiopathology Department Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2017.156 Vol.8, No.4, December 2017 p: 227 – 230 Corresponding author: Gabriela Dogaru, E-mail address: [email protected] Abstract Diastematomyelia (split cord malformation) is a rare dysraphic lesion in which a part of the spinal cord is split in the sagittal plane into two hemicords, a bony, cartilagenous or fibrous spur projecting through the dura mater is visible in 33% of cases. Vertebral anomalies (spina bifida) are common. It occurs usually between D9 and S1. Classificatin includes two types: type 1 with a duplicated dural sac, with common midline spur, usually symptomatic, and type 2 with a single dural sac and usually less symptomatic. The majority of patients are presenting with tethered cord syndrome (neurologic deficits in the lower limbs and perineum). MRI is the modality of choice for diagnosis. In symptomatic cases, surgical release of the cord and resection of spur with repair of dura are performed, with good results. We present a case of a pauci-symptomatic type 1 dyastematomyelia, manifested by intermittent and resistant lumbar pain, in which physiotherapy during rehabilitation program have shown to improve pain intensity. Key words: spinal cord malformation, dyastematomyelia, lumbar spine, INTRODUCTION: Diastematomyelia (also Intramedullary tumours associated with known as a split cord malformation) is a rare diastematomyelia have been rarely described and dysraphic lesion of the spinal cord in which a part associated conditions like a tethered cord, inclusion of the spinal cord is split in the sagittal plane into dermoid, lipoma, syringo-hydromyelia and Chiari two hemicords. -
Topical Diagnosis in Neurology
V Preface In 2005 we publishedacomplete revision of Duus’ Although the book will be useful to advanced textbook of topical diagnosis in neurology,the first students, also physicians or neurobiologists inter- newedition since the death of its original author, estedinenriching their knowledge of neu- Professor PeterDuus, in 1994.Feedbackfromread- roanatomywith basic information in neurology,oR ers wasextremelypositive and the book wastrans- for revision of the basics of neuroanatomywill lated intonumerous languages, proving that the benefit even morefromit. conceptofthis book wasasuccessful one: combin- This book does notpretend to be atextbook of ing an integrated presentation of basic neu- clinical neurology.That would go beyond the scope roanatomywith the subject of neurological syn- of the book and also contradict the basic concept dromes, including modern imaging techniques. In described above.Firstand foremostwewant to de- this regard we thank our neuroradiology col- monstratehow,onthe basis of theoretical ana- leagues, and especiallyDr. Kueker,for providing us tomical knowledge and agood neurological exami- with images of very high quality. nation, it is possible to localize alesion in the In this fifthedition of “Duus,” we have preserved nervous system and come to adecision on further the remarkablyeffective didactic conceptofthe diagnostic steps. The cause of alesion is initially book,whichparticularly meets the needs of medi- irrelevant for the primarytopical diagnosis, and cal students. Modern medical curricula requirein- elucidation of the etiology takes place in asecond tegrative knowledge,and medical studentsshould stage. Our book contains acursoryoverviewofthe be taught howtoapplytheoretical knowledge in a major neurologicaldisorders, and it is notintended clinical settingand, on the other hand, to recognize to replace the systematic and comprehensive clinical symptoms by delving intotheir basic coverage offeredbystandardneurological text- knowledge of neuroanatomyand neurophysiology. -
THE SYNDROMES of the ARTERIES of the BRAIN and SPINAL CORD Part 1 by LESLIE G
65 Postgrad Med J: first published as 10.1136/pgmj.29.328.65 on 1 February 1953. Downloaded from THE SYNDROMES OF THE ARTERIES OF THE BRAIN AND SPINAL CORD Part 1 By LESLIE G. KILOH, M.D., M.R.C.P., D.P.M. First Assistant in the Joint Department of Psychological Medicine, Royal Victoria Infirmary and University of Durham Introduction general circulatory efficiency at the time of the Little interest is shown at present in the syn- catastrophe is of the greatest importance. An dromes of the arteries of the brain and spinal cord, occlusion, producing little effect in the presence of and this perhaps is related to the tendency to a normal blood pressure, may cause widespread minimize the importance of cerebral localization. pathological changes if hypotension co-exists. Yet these syndromes are far from being fully A marked discrepancy has been noted between elucidated and understood. It must be admitted the effects of ligation and of spontaneous throm- that in many cases precise localization is often of bosis of an artery. The former seldom produces little more than academic interest and ill effects whilst the latter frequently determines provides Protected by copyright. nothing but a measure of personal satisfaction to infarction. This is probably due to the tendency the physician. But it is worth recalling that the of a spontaneous thrombus to extend along the detailed study of the distribution of the bronchi affected vessel, sealing its branches and blocking and of the pathological anatomy of congenital its collateral circulation, and to the fact that the abnormalities of the heart, was similarly neglected arterial disease is so often generalized. -
Crossed Brainstem Syndrome Revealing
Beucler et al. BMC Neurology (2021) 21:204 https://doi.org/10.1186/s12883-021-02223-7 CASE REPORT Open Access Crossed brainstem syndrome revealing bleeding brainstem cavernous malformation: an illustrative case Nathan Beucler1,2* , Sébastien Boissonneau1,3, Aurélia Ruf4, Stéphane Fuentes1, Romain Carron3,5 and Henry Dufour1,6 Abstract Background: Since the nineteenth century, a great variety of crossed brainstem syndromes (CBS) have been described in the medical literature. A CBS typically combines ipsilateral cranial nerves deficits to contralateral long tracts involvement such as hemiparesis or hemianesthesia. Classical CBS seem in fact not to be so clear-cut entities with up to 20% of patients showing different or unnamed combinations of crossed symptoms. In terms of etiologies, acute brainstem infarction predominates but CBS secondary to hemorrhage, neoplasm, abscess, and demyelination have been described. The aim of this study was to assess the proportion of CBS caused by a bleeding episode arising from a brainstem cavernous malformation (BCM) reported in the literature. Case presentation: We present the case of a typical Foville syndrome in a 65-year-old man that was caused by a pontine BCM with extralesional bleeding. Following the first bleeding episode, a conservative management was decided but the patient had eventually to be operated on soon after the second bleeding event. Discussion: A literature review was conducted focusing on the five most common CBS (Benedikt, Weber, Foville, Millard-Gubler, Wallenberg) on Medline database from inception to 2020. According to the literature, hemorrhagic BCM account for approximately 7 % of CBS. Microsurgical excision may be indicated after the second bleeding episode but needs to be carefully weighted up against the risks of the surgical procedure and openly discussed with the patient.