Chapter 57-F. Spinal Cord Vascular Disease

Question 1

Question 57F-1: A 70-year-old man presents with two epjsodes of leg weakness associated with activity. The episodes improve within 15 minutes. Spinal claudication is considered, but there is no significant cord compression on MRI of the thoracic and lumbar spine. Which is the most likely cause? A. Cord compression which was missed on theMRl. B. Femoral arterial insufficiency C. lntermittent cord ischemia from aortic atherosclerosis D. Transverse myelitis

Answer 1

Answer S7F-l: C. Atherosclerotic disease can produce impaired perfusion of the cord With activity. the ischemia becomes symptomatic. This can result in transient myelopathic findings, essentially a spinal TIA (p1316)

Question 2

Question 57F-2: How does the clinical presentation of spinal venous infarction differ from arterial infarction? A. Arterial infarctions produce more one-sided deficits whereas venous infarctions produce bilateral deficits B. Arterial infarctions produce secondary hemorrhagic changes in the cord, whereas venous infarctions only rarely do C. There is no substantial difference in presentation

Answer 2

I Answer 57F-2: C. There is DO substantial difference in presentation between arterial and venous infarctions of the spinal cord. Venous infaretion can be associated with hemorrhage. (p1317)

Question 3

Question 57F-3: Which is the best method for imaging spinal cord ischemia? A. CT B. MRI C. PET D. Myelography

Answer 3

answer 57F-3: B. MRI is the best method for imaging spinRI cord ischemia. The other imaging modalities arc of virtually no use. (p1315)

Question 4

Question 57F-4: A 57-year-old man presents with quadriparesis with the legs being more affected than the arms. He carries the diagnosis ofMS, and has been wheelchair bound for 5 years. He has had stepwise worsening of myelopathy. MRI of the brain shows some punctate areas of increased signal intensity on T2-weighted imaging. MR1 of the cervical spine is shown in the image. What is the most likely diagnosis? A. Multiple sclerosis B. Spinal aneurysm C. Spinal AVM D. Transverse myelitis

Answer 4

Answer 57F-4: C. The left image shows multiple flow voids in the region of the upper cervical cord The right image shows an intramedullary nidus communicating with superficial vessels. This is a typical clinical presentation of spinal A VM. frequently misdiagnosed as TM or MS. The brain MRI fmdings are probably nonspecific TI-signal abnormalities which are not uncommon at this age. (p 1319)