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Acute Transverse Myelitis •occurs over days to weeks(Myelopathy) •ascending parasthesia, back pain, weakness or urinary retention •no gender or age predilection •poor prognosisToxic Myelopathy •occurs as a result of injection of chemotherapeutic agents into subarachnoid space to treat malignancyIschemic Myelopathy •loss of blood for less than 30 minutes •occlusion of segmental spinal arteries •sudden onset of paraplegia •accompanying chest or abdominal pain as a “sharp, tearing” sensationVascular Malformations •uncommon •most common spinal vascular abnormality •paresis, sensory changes, bowel and bladder dysfunctionAnterior Spinal Cord •sudden onset of flaccid para- or quadraparesisInfarction •preservation of discriminative touch (dorsal column spared)Central Spinal Cord •”cape-like” anesthesiaSyndrome •destruction of pain fibers as they cross in the ant. white commissure •”Man in a Barrel” sign -greater weakness in upper extremity vs. lower extremity •common cause is a whiplash injuryPosterior Cord Syndrome •occurs with Vit B12 deficiency •affects dorsal columsn and corticospinal tracts •general weakness, “pins and needles” parasthesias of hands and feetMultiple Sclerosis •disease onset between 15-50 yrs (rare after 40) •female predominance •autoimmune disease against CNS myelin •extremity weakness, numbness, Babinsky sign, Lhermitte’s PhenomenonBrown-Sequard Syndrome •hemisection lesion of the spinal cord •ipsilateral spastic weakness below lesion level •ipsilateral loss of dorsal column below level •contralateral loss of spinothalamic tract •lesions at C8-T1 affect ciliospinal center of Budge – result in Horner’s SyndromeConus Medullaris Syndrome •involves lower sacral-coccygeal cord segments •caused by tumor metastase or hemorrhagic infarcts •destruction of parasympathetics causes paralytic bladder and fecal incontinence •”saddle anesthesia” with absence of motor deficits in lower extremities
Cauda Equina Syndrome •involves spinal roots of lower lumber-coccygeal region •deficits similar to conus medullaris syndromeSyringomyelia •central cavitation of the spinal cord •damages decussating spinothalamic fibers •a CSF dissection thru the ependymal lining to form a paracentral cavity •”cape-like” loss of pain and temp over shoulders •muscular atrophy and weakness with decreased myotatic reflexes in UEHydromyelia •an ependymal line distension of the central canal of the cord •same symptoms as syringomyeliaSpondylosis •osteophytic bony spurs and disc bulges •stiffness, pain, radicular signsNeoplasms •epidural location most common •often metastatic in origin: prostate, breast, lung, etc. •common occurrence in thoracic cord •pain worse at night and in a recumbent position that increase with cough or a Valsalva maneuverEpidural Abcess •hematogenous spread of bacteria to reside above dura •fever, spine pain with focal tenderness to palpationFoster-Kennedy Syndrome •ipsilateral anosmia, optic atrophy and contralateral papilledema •result of a mass lesion like a meningioma -compresses the olfactory tract and optic nerveWilbrand’s Knee •lesion at the junction of the optic nerve and the chiasm on one side •loss of ipsilateral temporal and nasal retinal fibers and contralateral loss of inferonasal retinal fivers •results in ipsilateral blindness and contralateral upper visual field loss •JUNCTIONAL SCOTOMAAdies Syndrome •tonically dilated pupil •secondary to damage to ciliary ganglion or short ciliary nerves •predominantly young femalesHolmes-Adies Syndrome •all symptoms of Adies syndrome •absent DTR’sArgyle-Robertson Pupil •small, irregularly shaped pupil •lack of constriction to direct light •will constrict upon accommodation-convergence reaction •associated with syphilis
Marcus-Gunn Pupil •afferent papillary defect •pupil on affected side will paradoxically dilate upon direct light •”swinging flashlight test” •common in demyelinating diseasesMedial Longitudinal •damage to one or more MLF between abducens and oculomotor nucleiFasciculus •medial rectus palsy on side of lesionSyndrome •effort horizontal nystagmus on contralateral eyeOne and a Half Syndrome of •frozen globe on the lesion sideFisher •effort nystagmus of the opposite eye •abducens nucleus lesion with ipsilateral MLF lesionTranstentorial Herniation •increased supratentorial pressure due to a mass lesion •oculomotor nerve crushed •parasympathetic innervation lost •dilated pupilBielchowsky Sign •4th nerve palsy •patient presents with head tilted to opposite side of lesion - superior oblique lost therefore loss of intorsionTrigeminal Neuralgia •recurrent sharp, stabbing facial pain(Tic douloureuz) •one or more divisions of trigeminal nerveHerpes Zoster Opthalmicus •viral infection affecting the V1 distributionRaeder’s Paratrigeminal •secondary to lesion of trigeminal ganglionSyndrome •loss of sympathetic fibers •Horner’s like symptomsNumb Chin Syndrome •V3 distribution of numbness •associated with metastatic cancerMobius Syndrome •congenital absence of both facial nuclei •also absence of abducens nuclei •crossed eyes •upper and lower facial palsyCentral Facial Palsey •upper motor neuron lesion •contralateral paresis of lower portion of facePeripheral Facial Palsey •lower motor neuron lesion •Bell’s Palsy •paresis of upper and lower ipsilateral face
Hyperacusis •increased, painful acuity to sounds •due to stapedius muscle weaknessCrocodile Tears Syndrome •destruction of facial nerve proximal to geniculate ganglion •preganglionic salivatory fibers regenerate •misdirected fibers to pterygopalatine ganglion •lacrimation while eatingConduction Hearing Loss •caused by interruption of the passage of sound waves thru the external or middle ear •due to: ear wax, otosclerosis, or otitis mediaSensori-neural Hearing Loss •secondary to disease of the cochlea, nerve, or central auditory connections •may be from ototoxic drugsAcoustic Neuroma •a schwannoma associated with: •vertigo, nausea, hearing loss, tinnitus, nystagmusRamsey Hun Syndrome •herpes zoster oticusGlossopharyngeal Neuralgia •extreme pain in pharynx •swallowing difficult