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Spinal Cord Normal & Pathology Flashcards

1
Q

At which cervical segment does the spinal cord fill 75% of the canal, thereby making it vulnerable to pathologic entities?

A

C6

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2
Q

A measurement less than how many mm indicates stenosis in the lumbar spine?

A

12mm

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3
Q

What % of disc herniations occur in the thoracic spine?

A

1% (lower segments)

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4
Q

At what segment does the cord terminate in a child?

A

L3 disc level

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5
Q

What connects the pia mater with the dura mater?

A

Denticulate ligament

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6
Q

What is the innermost meningeal membranes that encases the spinal cord?

A

Pia mater

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7
Q

Which areas are supplied by the anterior spinal artery?

A

Anterior and central spinal cord (67%).

Mostly C/S!

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8
Q

Which areas are supplied by the posterior spinal artery?

A

Posterior column

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9
Q

Which artery supplies the lower thoracic cord, the lumbar cord and cous medullaris?

A

Artery of Adamkiewicz

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10
Q

What supplies the cord in the middle (not extraspinal part)?

A

ASA & PSA penetrating arteries that anastomose.

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11
Q

What is the M/C/C for debilitation cord compression?

A

vertebral fx/dislocation

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12
Q

Where is the M/C level for a cord contusion?

A

C5 (than C4 & C6)

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13
Q

What is the CT imaging difference between contusion and hematoma?

A 
Contusion = hypodense
Hematoma = hyperdense
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14
Q

What are the causes for intraspinous hemorrhage?

A

a) Spontaneous (33%)
b) Therapeutic anti-coagulation
c) Instrumentation
d) Vascular malformation

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15
Q

What is the difference btwn hydromyelia and syringomyelia?

A

Hydromyelia = cystic central canal dilation

Syringomyelia = cystic spinal cord cavity not contiguous with central spinal canal

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16
Q

How does CSF get into the cord?

A

Through the perivascular spaces

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17
Q

What is the clinical features of a syrinx?

A
  • “cloak-like” pain
  • temperature sensory loss
  • preservation of position sense, proprioception and light touch
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18
Q

What are some causes of arachnoiditis?

A

a) infection
b) non-traumatic hemorrhage
c) trauma
d) spinal surgery
e) injection of substance into subarachnoid space

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19
Q

Acute meningitis is almost always caused by which type of infection?

A

Bacterial (same organisms as those for the brain according to age).

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20
Q

Subacute meningitis is mostly caused by which type of infection?

A

Viral

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21
Q

The M/C organisms involved in chronic meningitis are:

A

a. TB
b. Syphilis
c. Fungal (eg. coccidiodomycosis, cryptococcus, aspergillosis)

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22
Q

Where is the M/C location for an abscess in the spine?

A

Epidural space (anterior) – abscess extends beneath the PLL.

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23
Q

What is the difference between an abscess and a phlegmon?

A

Phlegmons = active inflammation containing pus that can spread (in the spine, it is often associated with spondylodiscitis)
Enhance homogeneously

Abscess = inflammation that is walled off and can contain necrotic material
Enhance peripherally

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24
Q

Where is the M/C spinal location for a subdural abscess?

A

Thoracolumbar region

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25
Q

What are the 2 M/C organisms seen with granulomatous osteomyelitis of the spine and which locations do they M/C involve?

A

i) Tuberculosis – mid-thoracic spine

ii) Brucellosis – lower lumbar spine/sacroiliac joints

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26
Q

Why does TB of the spine spare the IVD initially?

A

B/c of lack of proteolytic enzymes

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27
Q

An acute inflammatory insult to the spinal cord d/t direct viral infection or post-viral immunologic attack will result in what condition to the spinal cord?

A

Transverse myelitis

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28
Q

Which location and age group is typical for transverse myelitis?

A

Mid-thoracic and young individuals

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29
Q

Which organism is the M/C/C for transverse myelitis?

A

Enteroviruses (eg. coxsackie, echovirus, hepatitis, rubella, measles, mumps)

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30
Q

Within the cervical spinal cord, what area is M/C involved in MS (eg. anterior, posterior etc.)

A

Lateral columns

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31
Q

What sensory information does the anterior spinothalamic tract carry?

A

Crude touch/firm pressure

32
Q

What sensory information does the lateral spinothalamic tract carry?

A

Pain & temperature

33
Q

What information does the spinocerebellar tract convey?

A

Joint & limb position (proprioception)

34
Q

What sensory information does the dorsal column (fasciculus gracilis and cuneatus) provide?

A

Proprioception, deep touch, vibration and visceral pain
Gracilis (medial) = T7 and lower
Cuneatus (lateral) = T6 and higher

35
Q

What information does the reticulospinal tract carry?

A

Locomotion & postural control

36
Q

What information does the corticospinal tract carry?

A

Voluntary movement

37
Q

What information does the rubrospinal tract carry?

A

Voluntary movement

38
Q

What information does the tectospinal tract carry?

A

Head & eye movements

39
Q

What is Brown-Sequard syndrome?

A

Damage to one half of spinal cord –>

  • ipsilateral hemiparaplegia
  • ipsilateral loss of proprioception
  • contralateral loss of pain & temperature
40
Q

Where is the M/C location in the spine for epidural lymphoma?

A

Thoracic > lumbar > cervical

41
Q

Where is the M/C location in the spine for intradural lymphoma?

A

Cervical > thoracic > lumbar

42
Q

Where are the common locations within the spinal cord for lymphoma? (eg. dural related)

A

Extradural > Intradural > Intramedullary

43
Q

What is the M/C malignancy of the epidural space?

44
Q

What % of patients who present with spinal MS lesions also have brain lesions?

45
Q

What is Devic’s syndrome?

A

aka. neuromyelitis optica (NMO)

CNS demyelinating syndrome characterized by optic neuritis & myelitis.

46
Q

What condition can Devic’s syndrome present identical to in the spine?

A

MS (consider NMO if brain lesions of MS are absent)

47
Q

What is Guillain-Barre syndrome?

A

Ascending paralysis.
Immune-mediated attack on myelin sheath of schwann cells of motor peripheral nerves. Starts bilateral, symmetric in lower extremities first.

48
Q

What are the imaging findings associated with Guillain-Barre?

A
  • enlargement & enhancement of spinal nerve roots of cauda equina
  • NORMAL spinal cord
49
Q

What part of the spinal cord is M/C involved in sarcoidosis (not looking for region eg. T/S, L/S)?

A

Leptomeningeal or dural involvement is prominent.

50
Q

Which is M/C: extradural or intradural CNS tumors?

A

Extradural (80%)

51
Q

Where is the M/C location for an angiolipoma?

A

Extradural – mid-thoracic

52
Q

List as many intradural-extramedullary spinal tumors.

A
  • Meningioma
  • Neurofibroma
  • Schwanoma
  • Hemangioblastoma
  • CSF disseminated mets
  • Hemangiopericytoma
  • Ependymoma
  • Lymphoma
  • Arachnoid cyst
  • Dermoid cyst
53
Q

What are the 1st & 2nd M/C intradural/extramedullary tumor?

A 
1st = schwannoma
2nd = meningioma
54
Q

True or false: neurofibromas occur exclusively in NF-1.

A

False. Only 50-60%.

55
Q

List as many intramedullary spinal lesions.

A
  • Ependymoma
  • Astrocytoma
  • Hemangioblastoma
  • Lipoma
  • Mets
  • Schwannoma
  • Paraganglioma
  • AVM
  • Syringohydromyelia
  • Cord ischemia/infarct
  • Viral myelitis
56
Q

What is the M/C primary spinal cord tumor in adults?

A

Ependymoma (60%)

57
Q

What is the M/C primary spinal cord tumor in children? What is the 2nd M/C?

A 
1st = Astrocytoma (60%)
2nd = Ependymoma (30%)
58
Q

Which subtype of ependymoma M/C occurs at the conus/filum terminale?

A

Myxopapillary ependymoma

59
Q

What % of spinal hemangioblastoma is associated with VHL?

60
Q

What is the M/C primary tumor to metastasis to the spinal cord? What is the 2nd?

A 
1st = lung
2nd = breast
61
Q

Where is the M/C location for a paraganglioma in the spine?

A

Cauda equina/filum terminale

62
Q

Where is the M/C location for a paraganglioma overall in the body?

A

Adrenal medulla (eg. pheochromocytoma)

63
Q

Where is the M/C location for an extra-adrenal paraganglioma?

A

Carotid body (80-90%) –> glomus tumor

64
Q

Spinal cord cellular ependymomas is M/C seen where?

A

Cervical spine > cervicothoracic spine = thoracic spine

65
Q

What is an aka for Tarlov’s cyst?

A

Perineural (root sleeve) cyst

66
Q

A primary arachnoid cyst is thought to form how?

A

Congenital diverticulum of the arachnoid/dural mater w/ a ball-valve mechanism.

67
Q

What is the classical clinical sx associated with a cervical syrinx?

A

“Cloak-like” pain. Temperature sensory loss; preservation of position sense/proprioception.

68
Q

What is the difference btwn diplomyelia and diastematomyelia?

A 
Diplomyelia = duplicated spinal cord
Diastematomyelia = spinal cord splits
69
Q

What is the difference btwn type 1 and type 2 diastematomyelia?

A

Type 1:

  • duplicated dural sac
  • midline spur (osseous/fibrous) often present
  • often associated with vertebral anomalies
  • tethered cord common
  • hairy patch & skin pigmentation
  • more symptomatic

Type 2:

  • single dural sac
  • no spur
  • few vertebral anomalies
  • less symptomatic
70
Q

A tethered spinal cord may or may not present with what other finding at the conus medullaris?

A
  • fibrolipoma

- lipoma

71
Q

Enhancing gray matter pattern in the spinal cord is seen in which conditions?

A

Ischemic encephalitis (stroke) & viral encephalitis

72
Q

What is the M/C/C of spinal pachymeningitis?

73
Q

What are some extradural spinal lesions?

A

Degenerative:

  • herniated disc
  • rheumatoid pannus
  • osteophytes
  • synovial cysts

Nondegenerative:

  • metastasis
  • abscess
  • hematoma
  • epidural lipomatosis
74
Q

What are 2 ddx to consider when nodular densities are seen along the spinal cord?

A

Drop mets & fungal infections

75
Q

What is a ddx for enhancing nerves?

A
  • Guillain-Barre
  • CMV radiculopathy
  • Arachnoiditis
  • Meningitis

Neuroradiology (7 decks)

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