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At least 19 recordsLinked to original sources
PubMed1991

Medical complications of spinal cord disease.

Spinal cord injury increases the risk of many life-threatening medical problems, including respiratory failure, pulmonary embolism, and renal failure. Respiratory failure results from paralysis of muscles of inspiration (which impairs oxygen transport to alveoli) and of expiration (which impairs cough and predisposes to pneumonia and atelectasis). Respiratory failure in patients with spinal cord injury can be prevented by proper positioning of the patient, training of ventilatory muscles, pulmonary toilet, and aggressive use of antibiotics and bronchodilators. When respiratory failure occurs, it can be managed by administration of oxygen, intubation, and mechanical ventilation, and in instances of paralysis of the diaphragm, by diaphragmatic pacing. The risk of deep vein thrombosis and pulmonary embolism in acute spinal cord disease is increased by the immobilization of the patient and abnormalities in clotting factors. Thrombotic disease in spinal cord disease can be prevented by intermittent calf compression and heparinization. If pulmonary embolism develops, the patient should be started on a regimen of warfarin for at least 3 months. If anticoagulation is contraindicated, a Greenfield filter can be placed. However, concurrent use of quad cough places the patient at increased risk for complications from the Greenfield filter. Chronic pyelonephritis and systemic amyloidosis are the most common causes of renal failure in the patient with spinal cord disease. Renal failure can be prevented by maintaining a low postvoid residual volume, avoidance of indwelling catheters, use of medications that are not nephrotoxic, and rapid treatment of infection. Hemodialysis and peritoneal dialysis can extend the life of the patient with spinal cord disease in whom renal failure develops, and successful use of renal transplantation has recently been reported.

Humans↗
PubMed1991

Rehabilitation of patients with spinal cord disease.

Spinal cord injury and disease have multisystem consequences and many potential medical complications. This article addresses the various medical, psychosocial, and vocational issues associated with spinal cord injury and describes how the patient's lifestyle may be affected. The role of the physician and other rehabilitation professionals in the rehabilitation process is described. In addition, various medical concerns, complications, and available treatment modalities are discussed.

Humans↗
PubMed1987

Medical management of spinal cord disease.

In spinal cord disease of horses, a complete history, neurologic examination, and adjunctive diagnostic procedures are very helpful in establishing a tentative diagnosis; however, a definitive diagnosis may be difficult or impossible to establish antemortem. Medical management should be initiated with full consideration of possible etiologies and knowledge of the effects and consequences of medical therapies. This article discusses the drugs commonly used in the management of spinal cord disease and the rationale for their use.

Adrenal Cortex Hormones↗
PubMed1987

Spinal-evoked potentials in dogs with acute compressive thoracolumbar spinal cord disease.

Spinal evoked potentials (SpEP) were recorded on an electromyograph from electrodes placed percutaneously in the ligamentum flava at the lumbosacral junction and between the 10th and 11th thoracic vertebrae following tibial nerve stimulation in 31 anesthetized dogs with acute compressive spinal cord injuries. The neurologic status of each dog was determined by clinical examination before SpEP recordings, and the neurologic status was monitored for 2 months in dogs that had surgical or conservative treatment. Two months after spinal injury, the response to treatment (outcome) of each dog was evaluated and graded as favorable (ambulatory and urinary continent) or unfavorable (nonambulatory, urinary incontinent, or euthanatized with confirmation of myelomalacia). Onset latencies, conduction velocities, amplitudes and durations of the wave forms, and the ratio of conduction velocity to combined durations of the first positive (P1) and first negative (N1) waves (CV/DPN index) were determined and were compared with reference data from clinically normal (control) dogs. Single SpEP recordings were of value in determining the prognosis for recovery. Significant differences were not found in the L7-S1 recordings between the reference (control) and spinal injury groups. Analysis of data from the T10-11 recordings indicated significant differences between the reference and spinal injury groups and between the favorable and unfavorable outcome groups within the spinal injury group. A CV/DPN index was less than 30 in dogs with unfavorable outcomes and greater than 30 in dogs with favorable outcomes. Stepwise discriminant analysis of data from the spinal injury group predicted outcome correctly in all dogs.

Animals↗
PubMed1992

Repair and regeneration: experimental aspects of spinal cord disease.

Regeneration of spinal cord neurons after injury depends on first, the presence of trophic factor(s) which prevent death, induce growth and maintain the viability of the neurone and second, the regenerating neurites must overcome glial scars, extracellular matrices and white matter barriers to reinnervate their target. Attempts at promoting regeneration by using grafts of prosthetic material, Schwann cells and neural tissue have largely been unsuccessful. Although growth could be induced, penetration of regenerating neurites through damaged areas of the spinal cord has been limited. There is as yet very little beneficial functional recovery.

Animals↗
PubMed1986

Magnetic resonance imaging of spinal cord disease of childhood.

Correct diagnosis of spinal cord disease in childhood is often delayed, resulting in irreversible neurologic deficits. A major reason for this delay is the lack of a reliable means to noninvasively visualize the spinal cord. Magnetic resonance imaging (MRI) should be useful in the evaluation of diseases of the spinal cord. A 1.5 Tesla MRI unit with a surface coil was used to study 41 children, including eight patients with intrinsic spinal cord lesions, eight patients with masses compressing the cord, 12 patients with congenital anomalies of the cord or surrounding bony structures, three patients with syrinxes, and three patients with vertebral body abnormalities. Intrinsic lesions of the cord were well seen in all cases as intrinsic irregularly widened, abnormally intense cord regions. MRI was helpful in following the course of disease in patients with primary spinal cord tumors. Areas of tumor were separable from syrinx cavities. Extrinsic lesions compressing the cord and vertebral body disease were also well visualized. Congenital anomalies of the spinal cord, including tethering and lipomatous tissue, were better seen on MRI than by any other radiographic technique. MRI is an excellent noninvasive "screening" technique for children with suspected spinal cord disease and may be the only study needed in many patients with congenital spinal cord anomalies. It is also an excellent means to diagnose and follow patients with other forms of intra- and extraspinal pathology.

Adolescent↗
PubMed1985

Magnetic resonance imaging in the diagnosis of spinal cord diseases.

Experience with magnetic resonance imaging in 22 patients with diseases of the spinal cord is reported. Important additional diagnostic information as compared to conventional neuroradiological techniques (myelography, spinal CT) was gained especially in cases of hydrosyringomyelia, intraspinal tumour and multiple sclerosis. It is suggested that magnetic resonance imaging may become the method of choice in the diagnosis of structural spinal cord diseases.

Adult↗
PubMed1991

Paraparesis (paraplegia), tetraparesis (tetraplegia), urinary/fecal incontinence. Spinal cord diseases.

Paraparesis (paraplegia) refers to partial (-paresis) or complete (-plegia) loss of voluntary motor function in the pelvic limbs. Similar involvement of all four limbs is termed tetraparesis (tetraplegia). Paraparesis generally results from spinal cord lesions caudad to the second thoracic spinal cord segment, whereas tetraparesis occurs because of lesions craniad to this segment (see discussion of spinal cord lesion localization in The Neurologic Examination and Lesion Localization, on page 328). The limbs may be affected equally; however, asymmetric lesions cause greater clinical involvement on the ipsilateral side. Strictly unilateral lesions at C1-T2 result in clinical involvement on only the affected side of the body (hemiparesis, hemiplegia). Monoparesis (monoplegia) occurs subsequent to unilateral T2-S1 lesions. Trauma and neoplasia are the most common spinal cord diseases affecting cats. Urinary and fecal incontinence often occur concomitant with paresis. General concepts relating to disorders of micturition are discussed at the conclusion of this chapter.

Animals↗
PubMed1989

[Changes in bladder contractility in spinal cord diseases].

Changes in bladder contractility were studied by repeated cystomanometry in 147 patients suffering from central medullary lesions of sudden onset, including 93 cases of spinal shock. The morphology of contraction was always modified in the same fashion though intermediate stages were apparent, some being quite characteristic of neurological dysfunction. This process, which ends in a phasic contraction reproduces the stages of ontogenesis. When contractions are present, but do not produce complete bladder emptying, spontaneous improvement is unlikely in the presence of a complete lesion; sphincterotomy should therefore be considered at an early stage.

Adolescent↗
PubMed1992

[Magnetic resonance imaging in spinal cord diseases: 127 cases].

Acute or chronic spinal cord syndromes with or without evidence of cord compression are a common diagnostic problem in neurology. Magnetic resonance imaging (MRI) was performed on 127 patients to assess the sensitivity of this examination in detecting local spinal cord lesions. The most common location noticed in this study were the cervico-thoracic (40.9%) and cervical regions (33.8%). A total spine examination accounted for 14.9% of the examinations performed, and the lumbar spine was evaluated in 10.2%. An increased signal corresponding to plaques of multiple sclerosis was the most frequent diagnosis (25 cases), followed by cervical narrowing of the spinal canal and cervical disk diseases (23 cases), neoplasms (15 cases), spinal cord infarctions (12 cases), spinal infections (6 cases) and spinal cord injuries (3 cases). A myelopathy of undetermined etiology was diagnosed in 19 cases. MRI is very sensitive in multiple sclerosis, but it is not possible to diagnose the disease from abnormal scan only, other supportive laboratory results, such as oligoclonal bands, are necessary. MRI is very useful in evaluating intraspinal cord parenchymal lesions, such as neoplasms or congenital abnormalities.

Adult↗
PubMed1986

The value of paraxial slices in MR-imaging of spinal cord disease.

Paraxial slices in MRI of the spinal cord reveal information about anatomical structures and pathological processes not available from orthogonal plane images or other diagnostic methods. They also yield a profit in diminishing the artifacts that occur from heart movement and respiration when triggering is not employed.

Adult↗
PubMed1986

Incidence, presentation, and outcome of spinal cord disease in children with systemic cancer.

During a 40-month period, in 24 of 643 (4%) newly diagnosed patients with systemic cancer younger than 18 years of age (range: 3 months to 17 years) spinal cord disease developed. Patients with spinal cord disease included 21 children with metastatic spinal cord compression, two with treatment-related transverse myelopathies, and one with an anterior spinal artery stroke. Spinal cord disease occurred in 13 of 102 children (12%) with sarcomas, six of 82 (7%) with neuroblastomas, and four of 94 (4%) with lymphomas. Spinal cord compression occurred as the presenting sign of malignancy in six children (four with sarcomas and two with lymphomas). In the remaining 15 patients, cord compression occurred a median of 13 months after initial diagnosis, and in four patients it occurred at the time of first relapse. Symptoms of metastatic cord compression included back pain in 17 patients (80%), weakness in 14 (67%), sphincter dysfunction in 12 (57%), and sensory abnormalities in three (14%). Findings on plain radiographs of the spine were abnormal in only seven of 20 patients with cord compression, and myelography was needed to differentiate compression from other causes of spinal cord disease. Treatment included high-dose corticosteroids followed by operation (seven patients) or radiotherapy (14 patients). After treatment, nine of 15 nonambulatory patients became ambulatory, and five of 10 incontinent patients regained sphincter control. None of the patients with nonmetastatic spinal cord disease had a satisfactory outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Somatosensory evoked potentials in spinal cord diseases.

Somatosensory evoked potentials (SEPs) were studied in 115 patients with spinal cord diseases (multiple sclerosis, amyotrophic lateral sclerosis, cervical myelopathy, subacute combined degeneration, myelitis, spinal cord injury, tumours). The SEPs were recorded at three levels: parietal, spinal (cervical or lumbar), and at the Erb point. The central conduction time was also estimated (N9-N13 and lumbar potential (LP): LP-P37). The most sensitive test (95% abnormalities) was represented by the cortical recording of the SEPs when the tibial nerve was stimulated. The interval LP-P37 was increased, the SEPs being delayed or unrecordable and desynchronized (in cases of polyneuropathies only the latency was increased whereas the waveform was normal). In 50 patients with definite form of multiple sclerosis (MS) abnormalities of the cervical potential N13 were obtained in 96% of cases. The cortical SEPs to the median nerve stimulation were abnormal in 64% of cases only (32 patients). Of 10 patients with amyotrophic lateral sclerosis (ALS), cortical SEPs to the lower limb stimulation were abnormal in 6 patients (20%) and only 2 patients had also abnormal N13 and N20. Of 15 patients with cervical myelopathy, SEPs to the tibial nerve stimulation were abnormal and N9-N13 delayed in all but 2 patients. All the 5 patients with subacute combined degeneration had abnormal SEPs to the tibial nerve stimulation. In all the 15 patients with inflammatory spinal cord diseases, the SEPs were abnormal and the central conduction time was delayed. In 5 cases with spinal cord injury the SEPs were absent above the lesion. In 15 patients with tumoral compression SEPs to the stimulation of the nerve dependent on the sensitive root compressed as well as the lower limb SEPs were abnormal.

Adult↗
PubMed1992

The diagnostic impact of magnetic resonance imaging on the evaluation of suspected spinal cord disease.

The data from 262 patients studied consecutively for suspected spinal cord disease were analysed to determine the utility of magnetic resonance imaging (MRI) in this clinical setting. Damage to the spinal cord was detected in a total of 188 (72%) patients and was caused by myelocompression in two thirds and by intramedullary lesions in one third of the patients. Misleading sensory levels 5 to 12 segments below the actual lesion site were seen in 26% of patients with both extra- and intramedullary types of abnormality. A negative spinal MRI implied predominantly demyelinating or inflammatory origin of the clinical symptomatology, as was indicated by additional MRI studies of the brain and CSF findings. It is concluded that MRI is the procedure of choice for assessing patients with medullary symptoms. Irrespective of localizing neurologic findings the evaluation of the entire spine and even of the brain may be necessary to obtain maximum diagnostic information.

Adolescent↗
PubMed1988

Cerebrospinal fluid immunoreactive substance P and somatostatin in neurological patients with peripheral and spinal cord disease.

We have measured substance P-like (SPLI) and somatostatin-like (SLI) immunoreactivities in cerebrospinal fluid of 49 patients with peripheral (polyneuropathy, lumboischialgia) and spinal cord disease and in 16 control patients. The patient groups showed significantly higher CSF SPLI levels than controls while the mean SLI levels were unchanged. Fractionated sampling of CSF (total volume 30 ml) in 20 patients with various neurological diseases showed no significant differences between early and late fractions for SLI. In contrast, lumbar-cisternal concentration gradients were negative for SPLI, total protein and IgG, and positive for the dopamine metabolite homovanillic acid and the serotonin metabolite 5-hydroxyindolacetic acid. This suggests that SPLI may be released into the lumbar CSF from lower levels of the neuraxis, presumably the spinal cord and spinal ganglia, whereas SLI stems from diffuse CSF secretion without spinal preponderance.

Adult↗