Spinal cord diseases are usually caused by disturbances outside the spinal cord (extrinsic) such as the following:
Diseases of the spinal cord can cause permanent severe neurological disability. In some patients, such interference can be avoided or minimized if evaluation and treatment occur rapidly. Diseases of the spinal cord due to disturbances outside the spinal cord (extrinsic) such as the following to be: compression by spinal stenosis herniated tumor abscess hematoma Less interference often lie within the spinal cord (intrinsic). Among the intrinsic disorders include RückenmarksInfarzierung, bleeding, transverse myelitis, HIV infection, poliovirus infection, West Nile infection, syphilis (which can cause locomotor ataxia, trauma, vitamin B12 deficiency (leading to Funikulärer myelosis), decompression sickness, injury by lightning (may lead to keraunoparalysis), radiation therapy (may cause myelopathy), Syrinx and spinal cord tumor. Arteriovenous malformations may be extrinsically or intrinsically. copper deficiency can have a myelopathy result, similar to that caused by vitamin B12 deficiency. spinal nerve roots outside the spinal cord may also be damaged (diseases of the nerve roots). Anatomy the spinal cord extends caudally of the medulla oblongata in the area of ??the foramen magnum to the uppermost lumbar vertebrae, generally between L1 and L2, where the medulla Conus ris forms. In the lumbosacral nerve roots rise coming from the lower spinal cord segments from within the spinal space in a horse tail-like bundle, and form the cauda equina. The white matter at the periphery of the spinal cord contains ascending and descending paths of myelinated sensory and motor nerve fibers. The central, H-shaped gray matter consists of nerve cell bodies and fibers nichtmyelinisierten (spinal nerve). The front horns (ventral portions) of the “H” contain the lower motor neurons; these refer impulses from the motor cortex on the descending corticospinal tracts and, on the respective height of neurons and afferent fibers from the Museklspindlen. The axons of the lower motor neurons are the efferent fibers of the spinal nerves. The posterior horn (dorsal shares) contain sensitive fibers that originate from cell bodies in the dorsal root ganglia. The gray matter also contains many neurons, the motor, sensory or reflex pulses from the dorsal to the ventral nerve roots, from one side of the spinal cord to pass to the other or from one segment to another. The spinothalamic tract transmits the pain and temperature sensation of the contralateral side of the body in the spinal cord; most of the other paths transmitted information from the ipsilateral side of the body. The spinal cord is divided (heights) in functional segments correspond approximately to the 31 pairs of spinal nerve roots. Spinal nerve symptoms and complaints A neurological disorder by a disease of the spinal cord is manifested in the betroffenden spinal segment (see table: Effects of spinal cord dysfunction after segment height) and in all segments below. The exception is the central cord syndrome (see Table: Spinal Cord Syndrome), can omit the deeper segments. Effects of spinal cord dysfunction after segment height location of the lesion * Possible effects on or above C5 respiratory paralysis quadriplegia between C5 and C6 paralysis of the legs, wrists and hands weakness in shoulder abduction and elbow flexion failure of the biceps tendon reflex loss of brachioradialis reflex between C6 and C7 paralysis legs, wrists and hands, but moving the shoulder and elbow flexion usually possible Between C7 and C8 failure of the triceps tendon reflex paralysis of the legs and the hands on C8 to T1 Horner syndrome (constricted pupil, ptosis, facial anhidrosis) paralysis of the legs between T1 and Conus medullaris paralysis of the legs * The abbreviations refer to the Whirl; the spinal cord is shorter than the spine, so that the height of the spinal segments and of the vertebral body deviates from each caudal increasingly. In all spinal cord injury, the tendon reflexes are below the lesion changed (initially weakened, later increased), below the injury bowel and bladder control are disturbed and also the sensitivity. Diseases of the spinal cord cause various symptoms constellations depending on which nerves are damaged in the spinal cord or outside the spinal cord which spinal roots. Disorders, but pull the spinal nerves, not exactly the marrow affected, cause sensory and / or motor deficits only in the supplied by the affected spinal nerve areas. Spinal cord dysfunction caused autonomic dysfunction (e.g., intestine, bladder and erectile dysfunction, loss of sweat.) Paresis loss of sensation reflex changes his The impairment may partially (incomplete). Autonomous disorders and reflex abnormalities are usually the most objective signs of dysfunction of the spinal cord; Sensory disturbances are the least objective. Spinal cord Syndrome Syndrome cause symptoms and complaints Spinalis anterior syndrome lesions which impair the front spinal cord disproportionately, often due to an infarct (z. B. caused by occlusion of the anterior spinal artery) malfunctions of all tracks except for the posterior columns and thus recess of position and vibration sensation Brown Sequard syndrome (rare) Unilateral lesions of the spinal cord, typically due to a penetrating trauma Ipsilateral Parase ipsilateral loss of touch, position and vibration sensation contralateral loss of pain and temperature sensation * Zentromedulläres syndrome, which affects the cervical spinal cord lesions in the center of the cervical spinal cord, v. a. the central gray matter (incl. crossing spinothalamic tract), often due to trauma, Syrinx or tumors in the central spinal cord The paralysis are rather more pronounced than in the lower extremities and in the sacral region tendency to failure of pain and temperature sensation in the upper extremities with a cape similar distribution pattern over the upper neck, shoulders and upper body, with the perception of light touch, as well as the position and vibration sensation are relatively obtained (dissociated sensory loss) Conus medullaris syndrome lesions by L1 Distal leg paralysis perianal and perineal failure of the sensor system (saddle anesthesia) Erectile dysfunction urinary retention, urge incontinence or Inko ntinenz fecal incontinence Hypotonic anal sphincter Abnormal Bulbocavernosus- and anal reflex Querschnittsmyelopathie lesions affecting all or most tracts of the spinal cord at ? 1 segment height deficits in all functions mediated by the spinal cord (as all cars are to some degree affected) * Occasionally, malfunctions in only part of one side of the spinal cord (partial Brown-Sequard syndrome). Lesions of the corticospinal rail system cause disturbances to the upper motoneurons. Acute severe lesions (z. B. infarction, traumatic lesions) cause a spinal shock with flaccid paralysis (reduced muscle tone, and hyporeflexia no positive Babinski sign). After days or weeks, the dysfunction of the upper motor neurons to a spastic paralysis (increased muscle tone, hyperreflexia and clonus) developed. Then have a positive Babinski sign and autonomic dysfunction. Flaccid paralysis that lasts more than a few weeks, has a dysfunction of the lower motor neurons out (eg. As a result of Guillain-Barre syndrome). Specific Cord syndromes (see table: Spinal Cord Syndrome): Transverse sensorimotor myelopathy Brown Sequard syndrome has central cord syndrome Spinalis anterior syndrome Conus medullaris syndrome The cauda equina syndrome, the damage to the nerve roots at the caudal end of the spinal cord is not a spinal cord syndrome. However, it is very similar to a Conus medullaris syndrome, as it distal leg paralysis and sensory deficits in and around the perineum and anus (saddle anesthesia) and bladder, bowel and Pudendusfunktionsstörungen causes (eg. As urinary retention, urge incontinence, urinary – or fecal incontinence, erectile dysfunction, loss of rectal tone, impaired Bulbocavernosus- and anal reflex). During cauda equina syndrome are (unlike a spinal cord injury) of muscle tone and deep tendon reflexes reduced in the legs. Diagnosis MRI neurological deficits on a segmental level suggest a disease of the spinal cord. Similar deficits, v. a. if they are one-sided, can be caused by a nerve root or peripheral nerve disease; but this can usually be differentiated clinically. Amount and pattern of spinal cord dysfunction help determine the presence and location of a spinal cord, but not always on the nature of the lesion. MRI is the most accurate imaging examination in diseases of the spinal cord: it shows the Rückenmarkparenchym, soft tissue lesions (e.g., abscess, hematoma, tumors, abnormalities of the discs.) And bone lesions (e.g., erosion, severe hypertrophic changes, sinterings, fracture. and subluxation, tumors). Myelography with contrast medium followed by CT is used less frequently. It is less accurate than MRI and invasive, but can sometimes be more readily available. Native-ray images can help detect bone lesions.