Neuro spine CORE - Sheet1 Flashcards
one of the main arteries that supplies that anterior spinal artery
Artery of Adamkiewicz
where does the Artery of Adamkiewicz arise in 75% of people
comes off the left side of the aorta between T8 and T1 - supplies the lower 2/3 of the cord
posterior spinal artery usually arises from one of these two
vertebral arteries or posterior inferior cerebellar
conus medullaris usually terminates at
around L1 (below L2-3 is abnormal)
Torg-Pavlov ratio for congential stenosis
vertebral body width to cervical canal diameter <0.85
definition: focal herniation
herniated disc comprising less than 90 degrees of disc circumference
definition: broadbased herniation
herniated disc comprising 90-180 degrees of disc circumference
definition: protrusion
distance between the edge of the disc herniation is < the distance between the edges of the base
definition: extrusion
edges of the disc are greater than the distance of the base
Scheuermann’s
> 3 levels of Schmorl’s nodes in the spine of a teenager resulting in kyphotic deformity
limbus vertebra
fracture mimic - herniated disc material between the non-fused apophysis and adjacent vertbral body
Modic 1 signal
“edema” - T1 dark, T2 bright
Modic 2 signal
“fat” - T1 bright, T2 bright
Modic 3 signal
“scar” - T1 dark, T2 dark
how long to stop coumadin before LP
4-5 days
how long to stop plavix before LP
7 days
how long to hold LMW heparin before LP
12 hours
how long to hold heparin before LP
2-4 hours - document normal PTT
how long to hold NSAIDs/Aspirin before LP
no need
early sign of failed back surgery syndrome
epidural abscess
late signs (3) of failed back surgery syndrome
- epidural fibrosis/scar (enhances) 2. recurrent disc herniation 3. arachnoiditis
how long is nerve root enhancement normal after back surgery?
6 weeks - after that it’s arachnoiditis (infectious or inflammatory)
conjoined nerve roots?
s/p spine surgery - 2 adjacent nerve roots share an enlarged common sleeve
definition/mechanism: Jefferson
burst fracture of C1/axial loading
definition/mechanism: Hangman
bilateral pedicle/pars fx of C2 - hyperextension
definition/mechanism: Teardrop
anterior/inferior teardrop shaped fx fragment - can be flexion or extension
definition/mechanism: Clay-Shoveler’s
avulsion of spinous process at C7 or T1 - hyperflexion
definition/mechanism: Chance
horizonal fracture through the thoracolumbar spine
odontoid fracture: type 1
upper part of odontoid - maybe stable
odontoid fracture: type 2
fracture at base of odontoid - unstable
odontoid fracture: type 3
fracture through dens into the body of C2 - unstable, but better prognosis for healing
os odontoideum is associated with what funny named syndrome?
Morquio’s
clinical scenario for hangman’s fracture
“direct blow to face” - chin hits dashboard in MVA
clinical scenario for flexion teardrop
“ran into wall”
clinical history for extension teardrop
“hit from behind”
anterior cord function
motor, pain, temperature
dorsal cord function
proprioception and vibration
cord syndrome associated with flexion teardrop
anterior cord syndome - loss of motor, pain + temp (immediate paralysis)
mechanism of bilateral facet dislocation
severe hyperflexion - disruption of posterior ligament complex
syndromes associated with atlantoaxial instability
Down + juvenile RA
most important factor for outcome in spinal cord trauma
prescence of hemorrhage (low T2)
brown sequard
one half motor/other half sensory - seen in rotation or penetrating trauma
central cord syndrome
upper extremity deficit worse than lower
who gets central cord syndrome
old lady with spondylosis or younger person with bad extension injury
what is a terminal ventricle?
development variant - stupid looking cyst at the end of your cord
spina bifida aperta
open neural defect with tissue exposed through a defect in bone and skin
spina bifida occulta
closed neural defect - covered with skin
lipomyelomeningocele is 100% associated with
tethered cord (myelomeningocele may or may not)
terminal myelocystocele
herniation of the terminal syrinx into a posterior meningocele via a posterior spinal defect
fibrolipoma of the filum terminale
linear T1 bright structure in the filum terminale - incidental
diastematomyelia
sagital split in the cord
most common spinal vascular disorder
Type 1 (85%) - dural AVF
Spinal AVM/F: type 1
dural AVF with a single coiled vessel
Spinal AVM/F: type 2
intramedullary nidus - from ant or post spinal artery
Spinal AVM/F: type 3
juvenile, very rare/complex/terrible
Spinal AVM/F: type 4
intradural perimedullary - occur near conus
Foix alajouanine syndrome
myelopathy associated with dural AVF - “45 yo with LE weakness and sensory deficits”
2 ways of showing Pagets in the spine
- enlarged “ivory” verebrae (ddx mets) 2. picture frame vertebrae (sclerotic border)
if H-shaped vertebrae aren’t from sickle cell
Gauchers
most common bacterial discitis/osteo
Staph A
“calcified psoas abscess”
TB
“Gibbus deformity”
TB - desctructive focal kyphosis
TB tends to ….. the disc space
spare
what unusual infection favorst the lower L-spine and SI joints
brucellosis
MS lesions are usually
short segment, in the C-spine (white matter)
transverse myelitis lesions are usually
long segment, involving both sides of cord, expanded/swollen cord
ADEM lesions are usually
seen after viral illness in a kid, CN enhancement
NMO/Devics lesions are usually
long segment, involving full transverse diameter of the cord, involve optic nerves (duh)
Subacute combined degeneration
bilateral symmetrically increased T2 signal in the dorsal columns - “inverted V”
deficiency in subacute combined degeneration
B12
HIV vacuolar myelopathy
spinal cord atrophy, high T2 posterior columns
“owl eye appearance” of anterior spinal cord
anterior spinal artery ischemia - usually long segment/restricts diffusion
“empty thecal sac sign”
arachnoiditis - nerves roots adhere peripherally, giving appearance of empty sac
what causes Guillain Barre
campylobacter (or s/p surgery, lymphoma, SLE)
enhancing “onion bulb” nerve roots
CIDP - chronic form of guillain barre
3 intramedullary tumors
- astrocytoma 2. ependymoma 3. hemangioblastoma
4 extramedullary/intradural tumors
- schwannoma 2. meningioma 3. neurofibroma 3. drop mets
4 extradural “tumors”
- disc disease (most common) 2. bone tumors 3. mets 4. lymphoma
astrocytoma vs. ependymoma: location
astrocytoma - c-cord, eccentric; ependymoma - lower cord, central, hemorrhagic
most common intramedullary mass in adults
ependymoma
ependymoma in the conus
myxopapillary form
most common extramedullary/intradural tumor
schwannoma
2 syndromes with multiple schwannomas
NF-2 and Carney complex
most common primary tumor to drop mets
medulloblastoma
most common systemic tumor to drop mets
breast ca (followed by lung and melanoma)
“lytic expansile lesion in the sacrum with no rim of sclerosis”
giant cell tumor
