Special Conditions Affecting the Spinal Cord Flashcards
Which of the following is included in the“American/English/French Connection” classification systems of spinal AVMs?
● A. Type 1: Dural AVM (AV fistula) is the most common type of SVM (80%) in adults. This is fed by a radicular artery which forms an AV shunt at the dural root sleeve and drains into an engorged vein. It is further divided into type 1A (single arterial feeder) and type 1B with two or more arterial feeders
● B. Type 2: Also known as spinal glomus AVM it is intramedullary and constitutes 15 to 20% of all AVMs. It is fed by medullary arteries and has worse prognosis than dural AVM
● C. Type 3: Also known as juvenile spinal AVM it occupies the entire cross section of the cord and invades the vertebral body which may cause scoliosis
● D. Type 4: It is intradural perimedullary AVM which is further divided into three types
● E. All of the above
E. All of the above
Which of the following is incorrect regarding Merland’s subclassification of type 4 (perimedullary) AV fistulas?
● A. Subtype 1 with single arterial feeder, single AVF, and slow ascending perimedullary venous system
● B. Subtype 2 with multiple arterial supply, multiple AVF, and slow ascending perimedullary venous system
● C. Subtype 3 with multiple arterial feeders, single giant AVF, and giant venous ectasia with rapid venous drainage
● D. Subtype 4 with multiple arterial feeders, multiple AVF, and multiple fast draining veins
● E. All of the above
E. All of the above
Which of the following statements is correct regarding treatment of dural AVF?
● A. Type 1 is mostly treated with surgery
● B. Type 2B is preferably treated with surgery while type 2A is more comfortably treated by neuroradiologic procedures like embolization
● C. Type 3 is treated conservatively
● D. Type 4: Subtype 1 on filum terminale can be treated surgically but on conus medullaris it is difficult to treat surgically. While embolization is difficult for subtype 4. Subtype 3 is treated with embolization
● E. All of the above
D. Type 4: Subtype 1 on filum terminale can be treated surgically but on conus medullaris it is difficult to treat surgically. While embolization is difficult for subtype 4. Subtype 3 is treated with embolization
Following are correct regarding spinal meningeal cyst types and their treatment except?
● A. Type 1 is extradural meningeal cysts without spinal nerve root fibers which can be extradural meningeal/arachnoid cysts (type 1A) or sacral meningocele (type 1B) and it is treated by closing the ostium between the cyst and subarachnoid space
● B. Type 2 is extradural meningeal cysts with spinal nerve root fibers (Tarlov perineural cyst, spinal nerve root diverticulum) which is treated by partially resecting cyst wall and oversewing the cyst wall or excising the cyst and involved nerve root
● C. Type 3 is spinal intradural meningeal cyst (intradural arachnoid cyst) which is excised completely unless dense fibrous adhesion prevents this in which case the cyst is marsupialized
● D. Type 4 is both intradural and extradural, which is managed conservatively
● E. None of the above
D. Type 4 is both intradural and extradural, which is managed conservatively
A 40-year-old male patient presents with thoracic pain followed by lower extremity symptoms and then myelopathy. This patient also has upper extremity numbness and paresthesias. MRI of thoracic spine of this patient shows indentation or
displacement of the spinal cord which is “scalpel sign.” This patient has syringomyelia as well. What is the most likely diagnosis in this case?
● A. Spinal arachnoid cyst
● B. Spinal arachnoid web
● C. Spinal meningeal cyst
● D. Syringomyelia
● E. Myelomalacia
B. Spinal arachnoid web
A patient presents with progressive neurologic deterioration over months to years with upper limbs being affected more than the lower limbs. Syringomyelia is also known as syrinx which is cystic cavitation of the spinal cord. What is the most common cause of syrinx formation?
● A. Chari type 1 malformation
● B. Post inflammatory including TB or fungal meningitides or
postoperative meningitis
● C. Postoperative syringomyelia
● D. Basilar impression with constriction at the foramen magnum
● E. Spinal tumors
A. Chari type 1 malformation
Major theories of formation of cyst include the following except?
● A. Hydrodynamic (water hammer) theory of Gardner: systolic pulsations are transmitted with each heartbeat from the intracranial cavity to the central canal
● B. William’s (craniospinal dissociation) theory: maneuvers that raise CSF pressure (Valsalva, coughing) cause hydrodissection through the spinal cord tissue
● C. Heishima maneuver theory which states that obstruction in the path of CSF causes back pressure which results in formation of syrinx
● D. Heiss-Oldfield theory: occlusion at the foramen magnum causes CSF pulsations during cardiac systole to be transmitted through the Virchow-Robin spaces, which increases the extracellular fluid, which coalesces to form a syrinx
C. Heishima maneuver theory which states that obstruction in the path of CSF causes back pressure which results in formation of syrinx
A patient presents with suspended (cape) dissociated sensory loss (loss of pain and temperature sensation with preserved touch and joint position sense). This patient also has pain in the cervical and occipital region and lower motor
weakness of the hand and arm. This patient has low attenuation area within the cord seen on either plain CT or myelogram, and MRI shows hyperintense area within the cord. What is the most likely diagnosis in this patient?
● A. Tumor cyst
● B. Syringomyelia
● C. Central spinal canal
● D. Ventriculus terminalis
● E. None of the above
B. Syringomyelia
The central canal is present within the spinal cord at birth and normally gradually involutes with age. Persistence of the cyst is the normal variant. Which of the following are the differences between syringomyelia and central spinal canal?
● A. Central spinal canal is fusiform or linear on sagittal MRI
● B. Central spinal canal is less than or equal to 4 mm in maximal width while it is wider in case of syringomyelia
● C. Central spinal canal is singular or may be several discontinuous regions in the rostral caudal direction
● D. Central canal is perfectly round in cross section and centrally located on axial MRI
● E. There should be no contrast enhancement in case of central spinal canal if contrast is given
● F. All of the above
F. All of the above
Treatment of syrinx consist of treating the underlying pathology to re-establish subarachnoid CSF flow which includes posterior decompression in case of posterior anomalies like Chiari malformation or decompression if feasible if a site of compression or blockage or tethering is identified. Syrinx
shunts indications include syrinx diameter more than 3 to 4 mm with no identifiable cause or blockage that cannot be circumvented due to thick adhesions. What is the syrinx catheter option?
● A. K tube
● B. T tube
● C. M tube
● D. B tube
● E. Both A and B
E. Both A and B
In the “American/English/French Connection” classification for spinal vascular malformations, an AVM fed by the radicular artery, which forms an AV shunt at the dural root sleeve, and drains into an engorged spinal vein on the posterior cord is what?
● A. Dural AVM
● B. Intradural AVM
● C. Juvenile spinal AVM
● D. Spinal glomus
● E. Intramedullary
A. Dural AVM
An intradural perimedullary AVM where there is a direct fistula between anterior spinal artery or artery of Adamkiewicz and draining veins is which subtype of intradural AVMs?
● A. I
● B. II
● C. III
● D. IV
● E. V
D. IV
Spetzler classification of spinal AVMs has also added which lesions not included in the “American/English/French Connection” and Hôpital Bicêtre classifications?
● A. Neoplastic lesions
● B. Dorsal malformations
● C. Intramedullary lesions
● D. Extramedullary lesions
● E. Intradural fistulas
A. Neoplastic lesions
An acute or subacute neurologic deterioration in a patient with a spinal venous malformation (SVM) without evidence of hemorrhage is what?
● A. Coup de poignard of Michon
● B. Foix-Alajouanine syndrome
● C. Artery of Bernasconi & Cassinari
● D. Subacute subarachnoid sclerosis
B. Foix-Alajouanine syndrome
Spinal intradural meningeal cysts are what type?
● A. I
● B. IIA
● C. IIB
● D. IIC
● E. III
E. III
