Dr. Pooja discusses various types of spinal dysraphism seen on imaging. She describes open spinal dysraphisms like myelomeningocele and myelocele which involve defects in closure of the neural tube. Closed spinal dysraphisms include lipomas, meningoceles, myelocystoceles, tight filum terminale, and dermal sinuses. Complex dysraphic states arise from disorders of midline notochordal development and include dorsal enteric fistulas, neurenteric cysts, and diastematomyelia where the spinal cord is split. Imaging plays a key role in characterizing these lesions preoperatively.
This PPT is about interpretation of bone marrow signal changes in MRI. It is recommende to be studied for interpretation of BM abnormalities in the MRI of vertebral column.
This PPT is about interpretation of bone marrow signal changes in MRI. It is recommende to be studied for interpretation of BM abnormalities in the MRI of vertebral column.
Its important to recognise the myelination pattern in neonates and infants. This presentation talks about the myelination pattern and imaging of white matter diseases in children.
Radiology Spotters collection by Dr Pradeep. Nice collection Radiology spotters mixed collection ppt made by or collected by Dr. Pradeep, this is a collection of confusing spotter and very important spotter commonly asked in exams, our references is radiopaedia, learning radiology and Aunt Minnie.. Thanks
Its important to recognise the myelination pattern in neonates and infants. This presentation talks about the myelination pattern and imaging of white matter diseases in children.
Radiology Spotters collection by Dr Pradeep. Nice collection Radiology spotters mixed collection ppt made by or collected by Dr. Pradeep, this is a collection of confusing spotter and very important spotter commonly asked in exams, our references is radiopaedia, learning radiology and Aunt Minnie.. Thanks
Tips, Pearls and Pitfalls of Spinal Cord MRIWafik Bahnasy
- Many neurological disorders simultaneously or consecutively affect the brain and spinal cord, however most neurologist find their comfort zone in attending the diagnosis via the brain access.
- This concept resulted in lagging of spinal cord imaging researches compared to brain ones and consecutive underestimation of the opportunity of an important tool sometimes essential to reach a definite diagnosis.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
2. Congenital malformations of the spine and spinal cord are
generally referred to as spinal dysraphisms
*Neural tube defects
* Spina bifida
In the spine, the most common congenital lesions
diverse forms of spinal dysraphism
diverse forms of caudal spinal anomalies
4. Spinal CordDevelopment
Summarized in three basic embryologic stages
The first stage : Gastrulation (the 2or 3week)
a bilaminar embryonic disk to a trilaminar disk.
The secondstage:primaryneurulation(weeks3–4)
the notochord and overlying ectoderm interact neural plate.
bends and folds neural tube,
which then closes bidirectional in a zipperlike manner
The final stage :secondary neurulation (weeks 5–6),
a secondary neural tube is formed by the caudal cell mass.
cavitation, the tip of the conus medullaris and filum terminale
retrogressive differentiation.
8. Disjunction.
Upon completion of disjunction,
the cutaneous ectoderm fuses in
the midline, dorsal to the closed
neural tube.
Failure leads to Myelomeningocele.
12. OPEN SPINAL DYSRAPHISM (OSD)
There is a defect in the overlying skin, and the neural tissue is
exposed to the environment.
MYELOCELEAND MYELOMENINGOCELE
Embryological defect : Complete nondisjunction of cutaneous ectoderm from
neural ectoderm.
Neural folds do not fuse in the midline to form neural tube.
Remain in continuity with the cutaneous ectoderm.
This exposed part of the spinal cord is NEURAL PLACODE.
MC location : Lumbosacral region >thoraco- lumbar region
Imaging usually not done(clinically obvious)
13. The main differentiating feature between a myelomeningocele and
myelocele is the position of the neural placode relative to the skin surface
The neural placode protrudes above the skin surface with a myelomeningocele
and is flush with the skin surface with a myelocele
MYELOMENINGOCELE MYELOCELE
14. Myelomeningocele. Axial
schematic of myelomeningocele
shows neural placode (star)
protruding above skin surface
due to expansion of underlying
subarachnoid space (arrow).
Myelomeningocele.
Axial T2- weighted
MR image
Myelomeningocele.
Sagittal T2- weighted MR
image).
15. Myelocele.Axial schematic of
myeloceleshows neural placode
(arrow) flush with skin surface.
Myelocele. Axial T2-weighted MR
image in 1-day-old girl shows
exposed neural placode (arrow) that
is flush with skin surface, consistent
with myelocele. There is no
expansion of underlying
subarachnoid space
16. HEMIMYELOMENINGOCELE AND HEMIMYELOCELE
Hemimyelomeningoceles and hemimyeloceles can also occur
but are extremely rare .
These conditions occur when a myelomeningocele or myelocele
is associated with diastematomyelia (cord splitting) and one
hemicord fails to neurulate.
17. • Placode ulceration and infection are leading causes of mortality in
the untreated newborn, affected patients are operated on soon after
birth.
• MRI investigation should be performed whenever possible to
obtain:
(a)anatomic characterization of the various components of the
malformation, especially regarding the relationships
between the placode and nerve roots.
(b)presurgical evaluation of the entity and morphology of the
malformation sequence (hydromyelia, Chiari-II
malformation,and associated hydrocephalus)
(c)identification of rare caseswith associated cord splitting
(hemimyelomeningoceles andhemimyeloceles)
18. • All patients with OSDsalso harbor a Chiari-II
malformation,which is an element, rather than an associated
feature, of the diseasecommonly called
“myelomeningocele,” aswell asof the other forms of OSDs
21. 1.Lipomas with a duraldefect
• lipomyeloceles and lipomyelomeningoceles.
• defect in primary neurulation whereby mesenchymal tissue
enters the neural tube and forms lipomatous tissue
• Characterized clinically by the presence of a
subcutaneous fatty mass above the intergluteal crease.
• Diff both based on lipoma – placode interface
• Lipomyelocele : interface within spinal canal
• Lipomyelomenigocele: Outside the spinal canal due to sub-
arachnoid space expansion.
22. Fig. 4—Lipomyelocele. A, Axial schematic of lipomyelocele shows
placode–lipoma interface (arrow) lies within spinal canal. B, Axial T2-
weighted MR image in 3-year-old girl shows placode–lipoma interface
(arrow) within spinal canal, characteristic for lipomyelocele. C, Sagittal
T1-weighted MR image in 3-year-old girl with lipomyelocele shows
subcutaneous fatty mass (black arrow) and placode–lipoma interface
(white arrow) within spinal canal.
23. Fig. 5—Lipomyelomeningocele. A, Axial schematic of
lipomyelomeningocele shows placode–lipoma interface (arrow) lies
outside of spinal canal due to expansion of subarachnoid space. B, Axial
T1-weighted MR image in 18-month-old boy shows
lipomyelomeningocele (arrow) that is differentiated from lipomyelocele
by location of placode–lipoma interface outside of spinal canal due to
expansion of subarachnoid space.
26. 2. MENINGOCELE :herniation of CSF filled sac lined by dura and arachnoid matter .
Spinal cord not located within a meningocele but may be tethered to the neck of the sac
Posterior meningocele : posterior spina bifida Lumbar/sacral
Anterior : Pre-sacral mostly
27. Fig. 6—Posterior meningocele. A, Sagittal T1-weighted MR image in in 12-month-old
girl shows posterior herniation of CSF-filled sac (arrow) in occipital region, consistent
with posterior meningocele. B, Sagittal T2-weighted MR image in 5-year-old boy
shows large posterior meningocele (arrow) in cervical region. C, Sagittal T2-weighted
MR image in 30-month-old girl shows small posterior meningocele (arrow) in lumbar
region.
29. 3.Myelocystocele
• Myelocystoceles are rare malformations
composed of a herniation of the spinal cord,
containing ahydromyelic cavity, within a
meningocele.
• Myelocystoceles are classified into terminal
and nonterminal, depending on whether the
malformation involves the apex of the conus
medullaris or an intermediate segment ofthe
spinal cord.
30. TERMINAL
MYELOCYSTOCELE
MYELOCYSTOCELE
(NON TERMINAL)
Herniation of large
terminal syrinx
(syringocele) into a
posterior meningocele
through a posterior spinal
defect is referred to as a
terminal .
The terminal syrinx and
meningocele components
do not usually
communicate with each
other
Dilated central canal
herniates through a
posterior spina bifida
defect.
covered with skin
MC -cervical or
cervicothoracic regions
31. Fig. 8—Terminal myelocystocele. A, Sagittal schematic of terminal
myelocystocele shows terminal syrinx (star) herniating into large posterior
meningocele (arrows). B and C, Sagittal (B) and axial (C) T2-weighted MR
images in 1-month-old girl show terminal syrinx (white arrows) protruding
through large posterior spina bifida defect and herniating into posterior
meningocele component (black arrows). Sagittal image shows turbulent flow in
more anterior meningocele component (star, B).
33. ClosedSpinalDysraphisms Without a
SubcutaneousMass
COMPLEX DYSRAPHIC STATES
A)Disorders of midline notochordal
integration
Dorsal neurentericfistula,
Neurenteric cyst
Diastematomyelia,
B)Disorders of notochordal formation,
Caudal agenesis
Segmental spinal dysgenesis.
SIMPLEDYSRAPHIC STATES
Intradural lipoma,
Filar lipoma,
Tight filum terminale
Persistent terminalventricle
Dermal sinus.
34. 1. LIPOMA
2Types :Intradural lipoma and Filar lipoma
Embryological defect :focal premature disjunction of epidermalfrom
neural ectoderm.
1.INTRADURALLIPOMA
Lipoma within the duralsac
MC :Lumbosacralspine
a/w tethered-cord syndrome
2.FILAR LIPOMA
Fibrolipomatous thickening of the filum terminale is referred to asa
filar lipoma.
MR :T1hyperintense signal +thickened filum terminale
35. Intradural lipoma
Filarlipoma
, Sagittal (A) and axial (B) T1-weighted MR
images I with filar lipoma (arrows),
which has characteristic T1 hyperintensity and
marked thickening of filum terminale
.Sagittal T1-weighted (A) and sagittal T2- weighted fat-saturated (B) MR images show
large intradural lipoma (arrows), which is
hyperintense on T1-weighted image and hypointense on
T2-weighted fat-saturated image. Lipoma is attached to
conus medullaris, which is low lying.
36. 3. TIGHT FILUM TERMINALE
hypertrophy and shortening of the filum terminale
EMBRYOLOGY:incomplete involution of
the distal spinalcord during embryogenesis.
This condition causes tethering of the spinal cord
and impaired ascent of the conus medullaris.
The conus medullaris is low lying relative to its
normal position, which is usually above the L2–
L3disc level
Sagittal T2-weighted MR image in 12-month-old boy shows tight filum terminale, characterized
by thickening and shortening of filum terminale (black arrow) with low-lying conus medullaris.
Incidental cross-fused renal ectopia (white arrow) is also present.
37. Persistence of a small,
ependymal lined cavity within
the conus medullaris.
It is the widest part of the
central canal at the levelof
conus
point of union between the
portion of the central canal
made by neurulation and the
portion made by canalization
of the caudal cell mass
Imaging :Location –above the
filum terminale and lack of
contrast enhancment Persistent terminal ventricle.
A and B, Sagittal T2-weighted (A) and sagittal
T1-weighted contrast-enhanced (B) MR
images show persistent terminal ventricle as
cystic structure (arrows) at inferior aspect of
conus medullaris, which does not enhance
4.PERSISTENTTERMINAL VENTRICLE
38. Epithelial lined fistula that
connects neural tissue or
meninges to the skinsurface.
If the superficial ectoderm
fails to separate from the
neural ectoderm at onepoint.
MC :Lumbo sacralregion
C/F :midline dimple , hairy
naevus , hyperpigmented
patch /capillary hemangioma
Infectious complication if not
surgically treated
5.DERMAL SINUS
39. Fig. 14—Dermal sinus. A and B, Sagittal schematic (A) and sagittal T2-weighted
MR image (B) in 9-year-old girl show intradural dermoid (stars) with tract
extending from central canal to skin surface (black arrows). Note tenting of dural
sac at origin of dermal sinus (white arrows). C, Axial T2-weighted MR image from
same patient as in B shows posterior location of hyperintense dermoid (arrow).
40. COMPLEX DYSRAPHIC STATES
DISORDERS OF MIDLINE
NOTOCHORDAL
INTEGRATION
1. Dorsal enteric fistula,
2. Neurenteric cyst
3. Diastematomyelia,
DISORDERS OF NOTOCHORDAL
FORMATION
1. Caudal agenesis
2. Segmental spinal dysgenesis.
{Gastrulation is characterized by the development of the notochord, apotent
inductor that is involved in the formation of not only the spine and spinal cord, but
also of several other organs and structures in the human body; therefore, spinal
dysraphisms originating during this period will characteristically show a complex
picture in which not only the spinal cord, but also other organs are impaired.
Hence disorders of gastrulation are also called complex dysraphic states}
41. DISORDERS OF MIDLINE
NOTOCHORDAL INTEGRATION
1. DORSAL ENTERIC FISTULA
Abnormal connection between the skin surface and bowel.
2.NEURENTERIC CYSTS
Localized form of dorsal enteric fistula
~ Mucin-secreting epithelium (~GItract )lined cyst
MC :cervico-thoracic spine anterior to spinal cord
42. Fig. 15—Neurenteric cyst in 3-year-old girl. A and B, Sagittal T2-weighted (A) and
axial T1-weighted (B) MR images show bilobed neurenteric cyst (arrows)
extending from central canal into posterior mediastinum. C, Three-dimensional
CT reconstruction image shows osseous opening (arrow) through which
neurenteric cyst passes. This opening is called the Kovalevsky canal.
43. 3.DIASTEMATOMYELIA
Separation of the spinal cord into two hemicords
The two hemicords are usually symmetric, although thelength of
separation is variable.
Type 1: Dual Dural-Arachnoid Tubes (Pang Type I) :
the two hemicords are located within individual dural sacs
separated by an osseous or cartilaginousseptum
In Type 2 : Single Dural-Arachnoid Tube (Pang Type II) :
Single dural tube containing two hemicords, sometimes with an
intervening fibrous septum
C/F:Hairy tuft , scoliosis , tethered cordsyndrome.
44. Fig. 16—Type 1 diastematomyelia. A–C, Sagittal T2-weighted MR (A), axial T2-
weighted MR (B), and axial CT with bone algorithm (C) images in 6-year-old boy
show two dural tubes separated by osseous bridge (arrows), which is characteristic
for type 1 diastematomyelia.
45. Fig. 17—Type 2 diastematomyelia. A–C, Sagittal T1-weighted (A), coronal T1-
weighted (B), and axial T2-weighted (C) MR images in 9-year-old girl show
splitting of distal cord into two hemicords (white arrows, B and C) within single
dural tube, which is characteristic for type 2 diastematomyelia. Incidental filum
lipoma (black arrows, A and B) is present as well.
46. II.DISORDERS OFNOTOCHORDAL FORMATION
1. CAUDALAGENESIS
Total or partial agenesis of the spinalcolumn
A/w anal imperforation, genital anomalies, renal dysplasia or aplasia,
pulmonary hypoplasia, or limb abnormalities.
2Types
Type 1: high positionof conus +abrupt termination of conus
medullaris(D11/12)+ sig neuro deficit
Type II:low position(L1) +tethering of conus medullaris
47. CAUDALAGENESIS
,
Fig. 18A —Caudal agenesis.
Sagittal T2-weighted (A) and
sagittal T1-weighted (B) MR
images in 6-month-old girl show
agenesis of sacrum.
Conus medullaris is high in
position and wedge shaped (arrow)
due to abrupt termination.
These findings are characteristic of
type 1 caudal agenesis.
Distal cord syrinx (arrowhead) is
present as well.
48. CAUDALREGRESSION SYNDROME
• Partial agenesis of the thoracolumbosacral spine
• Imperforate anus
• Malformed genitalia
• Bilateral renal dysplasia or aplasia
• Pulmonary hypoplasia
• Extreme external rotation and fusion of the lower
extremities (sirenomelia)
• Sacral agenesis arises early in gestation, probably
before the 10th week of gestation
• a/w diabetes mellitus,
49. CLASSIFICATION OF LUMBOSACRALAGENESIS
1. Type I :Total sacral agenesis +somelumbar vertebrae missing
2. Type II:Total SA +lumbar vertebrae not involved, severely shortening
transverse pelvic diameter
3. Type III: Subtotal SA +at least S-1 ispresent.
4. Type IV:Hemisacrum
1. IVA Total hemisacrum; all sacral segments present on one side, but entire
opposite side ismissing
2. IVB Subtotal hemisacrum, unilateral; all sacral segments present on one side,
only part of opposite sideis missing
3. IVC Subtotal hemisacrum, bilateral; part of each side is missing but to different
extents
5. Type V: Coccygeal agenesis
6. VATotal
7. VB Subtotal
50. 2.SEGMENTALSPINAL DYSGENESIS
Segmental agenesis or dysgenesis of
the thoracic or lumbar spine
+ segmental abnormality of the spinal
cord / nerve roots
+ congenital paraparesis / paraplegia,
+ congenital lower limb deformities.
Three-dimensional CT reconstruction image
(A) in 4-year-old girl and schematic illustration
(B) show multiple segmentation anomalies in
lumbar spine (superior to inferior
beginning at level of arrow):
partial sagittal partition,
butterfly vertebra,
hemivertebra,
tripedicular vertebra
widely separated butterfly
vertebra