different ae of spinal cord diseases

1. Spinal cord disorders
Dr. Mohammed E. Mahdy, MSC

7. Spine & spinal cord imaging
methodology
 Plain x-ray of spine
 Computed tomography – CT - traditional
(„normal” CT) - reconstructions - myelo-CT
 Magnetic resonance – MR - standard techniques
 Angiography

8. Aetiological classification
• VITAMIN D
 Vascular
 Arteriovenous malformation
 Antiphospholipid syndrome and other hypercoagulable states
 Inflammatory
 Transverse myelitis (idiopathic)
 Sarcoidosis
Traumatic
Toxic
Tumors
Autoimmune
Vasculitis

9.  Metabolic
 Infectious/Postinfectious
 Viral: VZV, HSV-1 & -2, CMV, HIV, HTLV-I
 Bacterial and mycobacterial: Borrelia, Listeria, syphilis,
Mycoplasma pneumoniae
 Parasitic: schistosomiasis, toxoplasmosis
 Nutritional
 Vitamin B12 deficiency (subacute combined
degeneration)
Demyelinating
Multiple sclerosis
Neuromyelitis optica (Devic’s Disease)
• Degenerative
• Developemental

10. Vascular causes
Arterial
Venous

11. Vascular Diseases of the Spinal Cord
• Infarcts
– Anterior spinal artery infarct
• from atherosclerosis, during surgery in which the
aorta is clamped, dissecting aortic aneurysm
– less often, chronic meningitis or following trauma
• posterior columns preserved (JPS, vib)
• weakness (CST) and pain/temperature loss
(spinothalamic tracts)
– Artery of Adamkiewicz at T10-11
– Watershed area
• upper thoracic

12. • Arteriovenous malformation (AVM) and venous
angiomas
• Both occur in primarily the thoracic cord
• May present either acutely, subacutely or chronically
(act as a compressive lesion)
• Can cause recurrent symptoms
• If they bleed
• Associated with pain and bloody CSF
• Notoriously difficult to diagnose
• Hematoma - trauma, occasionally tumor

13. Incomplete injuries
i) Central Cord Syndrome
ii) Anterior Cord Syndrome
iii) Posterior Cord Syndrome
iv) Brown – Sequard Syndrome
v) Cauda Equina Syndrome

14. Traumatic Spinal Cord Disease
• 10,000 new spinal cord injuries per year
• MVA, sports injuries the most common
• Victims under 30 yrs old, male>>females
• Fx/dislocation of vertabrae most likely to occur at:
• C5,6
• T12, L1
• C1,2

15. Compressive fracture of vertebral body – one
of the most frequent?

16. water jump

17. pathologic fracture of vertebral body (meta) - compression
of spinal cord conus

18. Tumors
• Metastatic or primary
• Extramedullary
– Extradural - most common
• Bony - breast, prostate
– Intradural - very rare
• Meninges - meningioma
• Nerve root - schwannoma
– Intramedullary - very rare
• Metastatic
• Primary - astrocytoma or ependymoma

19. Spinal canal tumors extra-meningeal
  benign: neurinoma, osteoma, fibroma, lipoma
  malignant: osteo - & chondrosarcoma, chordoma,
lymphoma
  metastases
• Fibrolipoma

20. Spinal canal tumors extra-meningeal
neurinoma (schwannoma

21. Spinal canal tumors intra-meningeal / extra-medullary
naurinoma, neurofibroma
meningioma
lipoma, teratoma (seldom)

22. Intra-medullary tumors
astrocytoma (most frequent)
ependymoma, hemangioma
metastases

23. Intra-medullary tumors (intra-axial

24. Intra-medullary ependymoma

25. Vertebral spine and spinal canal
metastases

26. Spinal cord hemangioma intra-medullary focal lesion
„nidus” pathologic vessels in spinal canal (intra-meningeal)

27. Nutritional : B12 Deficiency
• Subacute combined degeneration of the cord
• B12 deficiency
• malabsorption of B12 secondary to pernicious anemia
or surgery
• insufficient dietary intake - vegan
• Posterior columns and CST involvement with a
superimposed peripheral neuropathy

28. Inflammation of the spinal cord
transverse myelitis
• Post-infectious
• Post-vaccinial
• Multiple sclerosis
• Pain at level of lesion may preceed onset of
weakness/sensory change/sphincteric disturbance
• Spinal tap may help with diagnosis

29. MS

30. MS Vs NMO
MS NMO
SPINAL Less than 2 segments
Posterior
Commonly cervical
More than 3 segments
Central
Dorsal or cervical
optic Less severe
unilateral
More severe
Unilateral or bilateral
Simultaneous or
sequential
Brain Typical sites
Dawson
Atypical sites
Lower medulla
Hypothalamic
linear
Csf OCB OCB
NMO IgG

34. Confusing focal lesions

35. Infections Involving the Spinal Cord
• T.B
• Polio
• only the anterior horn cells are infected
• Tabes dorsalis
• dorsal root ganglia and dorsal columns are involved
• tertiary syphillis
• sensory ataxia, “lightening pains”
• HIV myelopathy
• mimics B12 deficiency
• HTLV-1 myelopathy -
• tropical spastic paraparesis

36. inflamed process in vertebral bodies border
laminas spondylodiscitis

37. Developmental anomalies
Congenital spine & spinal cord defects
• heterogenic group of disorders

38. cervical vertebral bodies
in block

40. Hydromyelia

41. Syringomyelia

42. Captured (tethered ) spinal cord combined
anomaly

43. ”spina bifida

44. Degenarative spinal disease
  discopathy
  bone degeneration

45. Intervertebral disc prolapsus with spinal
nerve compression

46. L-S discopathy L4-L5 & L5-S1 levels massive left-side
disc protrusion L5-S1 spinal nerve compression

48. Intervertebral disc protrusion - MR from I to
IV degree

49. non-stability L5 vertebral body slide down