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1
Taddei, G. L., A. Papucci, and D. Moncini. "Metastasi spinali: Introduzione epidemiologica ed anatomo-patologica." Rivista di Neuroradiologia 8, no. 2 (April 1995): 141–44. http://dx.doi.org/10.1177/197140099500800202.
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Le metastasi spinali comprendono le neoplasie secondarie della colonna vertebrale e del midollo. I dati presenti in letteratura relativi all'incidenza delle metastasi spinali nei pazienti neoplastici sono molto variabili, comunque sempre elevati. L'interessamento vertebrale è presente nella quasi totalità dei casi. I tumori del polmone, della mammella, della prostata e del rene più frequentemente metastatizzano a livello spinale. La modalità di diffusione è prevalentemente ematica, più raramente perineurale, linfatica o liquorale. Le metastasi hanno sul tessuto osseo un effetto prevalentemente osteolitico, raramente osteocondensante (carcinoma prostatico e mammario). A livello del canale vertebrale le metastasi sono localizzate soprattutto in sede extramidollare e rappresentano le lesioni neoplastiche extradurali più frequenti nell'età adulto-avanzata. L'accertamento della primitività o secondarietà di queste lesioni può essere effettuato mediante biopsia a cielo aperto o agobiopsia, spesso per tentare di risolvere i casi dubbi è necessario l'ausilio di tecniche immunoistochimiche che permettono di evidenziare attraverso il citoscheletro cellulare la natura epiteliale, mesenchimale o nervosa delle cellule neoplastiche. Un ulteriore contributo l'anatomopatologo può fornirlo attraverso il riscontro autoptico. Durante tale esame diagnostico si possono evidenziare metastasi spinali in un paziente non rivelate attraverso gli esami clinici (Tomografia Assiale Computerizzata, Risonanza Magnetica), ovvero si può stabilire l'origine di una lesione spinale metastatica rimasta, fino all'obitus, a sede primitiva sconosciuta.
2
Cecchini, A., and F. Zappoli. "Mielografia e Mielo-TC nelle metastasi spinali." Rivista di Neuroradiologia 8, no. 2 (April 1995): 175–80. http://dx.doi.org/10.1177/197140099500800207.
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La mielografia e la mielo-TC sono indagini di rapida ed immediata esecuzione, dotate di bassa invasività, indenni da rischi e senza importanti effetti collaterali (ad eccezione della cefalea post-mielograflca) e, con un elevato apporto diagnostico. La RM con mdc è indubbiamente la metodica di scelta nella ricerca e nella dimostrazione di metastasi spinali, ma l'accoppiamento mielografia/mielo-TC consente una rapida esplorazione dell'intero asse spinale ed un bilancio spaziale della lesione metastatica, sufficienti per gli obbiettivi terapeutici. Data per scontata una decisa prevalenza della RM, la mielografia conserva alcune limitate indicazioni: — sintomatologia mielo-radicolare acuta in paziente con primitività nota; — ricerca di metastasi leptomeningee, in mancanza di RM, o con rilievi RM incerti; — mancanza di RM o controindicazioni al suo uso (protesi metallica, pace-maker, ecc…); — bilancio pre-operatorio rapido in paziente con lesioni vertebrali multiple (scelta del livello trattabile). L'accoppiamento mielografia / mielo-TC mantiene quindi valore nello studio, in particolare, delle lesioni intracanalari.
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Andreula, C. F., and A. Carella. "Lo studio RM delle metastasi spinali extradurali." Rivista di Neuroradiologia 8, no. 2 (April 1995): 181–94. http://dx.doi.org/10.1177/197140099500800208.
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Lo studio delle metastasi vertebrali in risonanza magnetica permette di superare la rigida distinzione in lesioni osteolitiche e osteoaddensanti, uso che inizialmente proposto dalla radiologia tradizionale è stato mantenuto, pur se con critiche, anche con l'avvento di metodiche più moderne. La lesione osteorarefacente e la lesione osteosclerotica sono i due estremi di un continuum che prevede numerosi eventi di transizione non solo nell'ambito dello stesso paziente, ma addirittura in corso di malattia prima e dopo trattamento. Gli elementi di semeiotica RM sono le alterazioni di segnale e le alterazioni morfologiche. Nelle lesioni osteolitiche il processo di infiltrazione si evidenzierà come una tenue ipointensità nelle sequenze dipendenti dal T1 e netta iperintensità nelle sequenze dipendenti dalla densità protonica, dal T2 e dal T2 star. Qualora venga interessato completamente il corpo vertebrale sarà possibile apprezzare una deformazione morfologica dello stesso. Tale alterazione risentirà dei tempi di infiltrazione midollare caratterizzandosi o come esuberante con allargamento degli angoli diedri somatici dando un aspetto di vertebra «rigonfia» o come riduttiva con crollo vertebrale da collasso inizialmente interno. La somministrazione di mdc determinerà una ricostruzione morfologica del corpo vertebrale nel caso di infiltrazione totale e di omogeinizzazione di segnale con la parte sana restante della vertebra nei casi di infiltrazione parziale. Tale comportamento alla somministrazione di mdc spiega la necessità di eseguire preliminarmente le sequenze dipendenti dal T1 prima del mdc e induce ad un atteggiamento critico sulla utilità delle sequenze dopo contrasto. Le lesioni osteoddensanti o osteosclerotiche saranno caratterizzate da segnale nettamente ipointenso nelle sequenze appesantite in T1, e ipointenso nelle sequenze appesantite in T2. Tale comportamento rispecchia la formazione di tessuto osseo prodotto dagli osteoblasti, attivati o da sostanze secrete dal tumore o dalla presenza di tessuto «diverso» dal midollo osseo a capacità irritante. La somministrazione di mdc non determina variazioni del quadro in T1 per l'assenza di fenomeni reattivi vascolari. L'estrinsecazione extradurale è la complicanza più frequente della localizzazione vertebrale metastatica: le neoplasie che più frequentemente causano questo aspetto sono i carcinomi e tra questi l'origine mammaria e polmonare coprono da sole il 50% delle lesioni. Il segnale RM di questo tessuto neoformato risentirà dell'alta componente acquosa della lesione con ipointensità nelle sequenze dipendenti dal T1 e iperintensità nelle sequenze dipendenti dal T2; la somministrazione di mdc determinerà intensa impregnazione sia per l'assenza di barriera nei capillari neoformati, riproducenti il tessuto di origine extraneurale, sia per l'ampio spazio extracellulare. La localizzazione leptomeningea delle metastasi è evento oltremodo raro. Le neoplasie che più frequentemente possono dare disseminazione leptomeningea sono distinguibili in extraneurali, neurali ed ematologiche. Le lesioni hanno aspetto nodulare o a placca, oppure possono estendersi a panno sull'aracnoide, avvolgendo le radici di emergenza. Sedi più frequenti sono le parti più declivi come il cul-di-sacco durale e la cauda equina (73%), verosimilmente per motivi gravitari. In RM le lesioni appaiono come agglomerati focali di segnale isointenso al midollo nelle immagini dipendenti dal T1, e di alto segnale possono mimetizzarsi col liquor nelle sequenze dipendenti dal T2. La somministrazine di mdc rende tali noduli palesi, per l'alto tasso di impregnazione, e permette di svelare lesioni di piccole dimensioni talvolta mimetizzate per la contiguità con strutture di segnale simile. Più difficile è la semeiotica RM della cosiddetta «carcinomatosi» meningea. La diagnosi differenziale nei casi di metastasi leptomeningee nodulari, ad anamnesi oncologica muta, si pone con i neurinomi (schwannomi) della cauda; con i neurinomi multipli della neurofibromatosi tipo 2, con i piccoli ependimomi della cauda. Nel caso della carcinomatosi leptomeningea vanno scartate le leptomeningiti granulomatose (tubercolosi e sarcoidosi) e le aracnoiditi reattive e postchirurgiche.
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Vattimo, A., L. Burroni, P. Bertelli, D. Volterrani, and A. Vella. "Metastasi spinali: Ruolo della medicina nucleare." Rivista di Neuroradiologia 8, no. 2 (April 1995): 157–60. http://dx.doi.org/10.1177/197140099500800204.
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Per lo studio delle metastasi scheletriche ed in particolare del rachide la medicina nucleare riesce a dare il suo apporto mediante la scintigrafia scheletrica con MDP-Tc99m e gamma-camera tradizionale e con F-18 e PET. Il midollo osseo può a sua volta essere indagato con microcolloidi marcati con Tc99m. Siccome numerosi tumori (mammella, prostata, polmone, rene e tiroide) metastatizzano frequentemente nello scheletro e prevalentemente nel midollo rosso, con il rachide come segmento più spesso coinvolto, la scintigrafia scheletrica rappresenta una indagine fondamentale per la stadiazione della malattia. Tale metodica presenta infatti una sensibilità molto elevata (maggiore del 95%) nel rilevare le lesioni ossee ed una specificità egualmente alta quando si tratta di lesioni multiple. Per le metastasi del rachide, la tecnica SPET è più sensibile e più accurata nel rilevare la lesione. Scarsa sensibilità e specificità si hanno invece nel mieloma multiplo. Dal punto di vista scintigrafico la lesione ossea si manifesta come un aumento focale di fissazione dell'indicatore radioattivo, dovuto alla reazione osteoblastica, alla neoformazione di osso ed all'aumento del flusso ematico. Meno frequentemente la lesione si manifesta come riduzione di fissazione dell'indicatore per la sostituzione di minerale in assenza di rimaneggiamento osseo circostante. Nel caso di una lesione unica, in cui la specificità della metodica è meno elevata, si procede alla esecuzione di una scintigrafia del midollo osseo per valutare il grado di invasione midollare. Alcune metastasi (carcinomi tiroidei, surrenalici, intestinali) possono infine essere studiate con indicatori positivi, in grado di legarsi alle cellule tumorali per le loro caratteristiche fisico-chimiche e/o fisiopatologiche.
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Pansini, A., P. Conti, F. Lo Re, R. Conti, S. Mangiafico, S. Carnesecchi, P. Bono, F. Cioffi, P. Gallina, and J. Buric. "Cisti aracnoidee spinali." Rivista di Neuroradiologia 9, no. 1 (February 1996): 59–77. http://dx.doi.org/10.1177/197140099600900107.
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Le cisti aracnoidee spinali costituiscono una causa rara di compressione midollare. Viene discussa la classificazione di questa entità patologica e presentate quattro osservazioni: una cisti intradurale dorsale, una in corrispondenza del tratto lombare, sempre intradurale, una extradurale con doppia localizzazione a livello del tratto dorsale ed una quarta intradurale in corrispondenza del foro di co-niugazione di C6. Dopo aver discusso l'eziopatogenesi delle cisti aracnoidee secondo i diversi autori, viene analizzato il meccanismo di crescita di queste cisti e le lesioni vertebrali associate. La presenza di concomitanti dismorfie vertebrali, il riscontro di una piccola massa lipomatosa in prossimità del polo inferiore della cisti, e l'osservazione della stessa lesione in consanguinei, fanno ritenere estremamente probabile l'eziopatogenesi disembriogenetica. Dopo aver descritto gli aspetti clinici e le diverse indagini neuroradiologiche utili per lo studio delle cisti aracnoidee, vengono riportati i principi di tecnica chirurgica ed i risultati ottenuti.
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Magnaldi, S., and M. Ukmar. "La tomografia computerizzata nella diagnostica delle metastasi spinali." Rivista di Neuroradiologia 8, no. 2 (April 1995): 167–74. http://dx.doi.org/10.1177/197140099500800206.
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Nella diagnosi delle metastasi spinali la TC presenta alcuni punti deboli, che emergono soprattutto nel caso di un suo impiego scorretto. L' avvocato del diavolo deve individuare le indicazioni più corrette della TC e descriverne i limiti. I protocolli diagnostici si differenziano a seconda che il paziente abbia o meno una neoplasia primitiva nota. La ricerca di metastasi ossee in un paziente con neoplasia primitiva nota inizia con la scintigrafia ossea. Se essa risulta negativa, non occorrono altre indagini, soprattutto se alla negatività scintigrafica si associa quella di altri esami di laboratorio. Se la scintigrafia è positiva, si possono eseguire dei radiogrammi mirati ed eventualmente una tomografia convenzionale nelle aree sospette. Se il risultato di queste indagini è positivo, il paziente viene avviato all'oncologo; solo talora può essere utile una TC per una migliore definizione morfologico-volumetrica delle lesioni. Se l'esame radiologico convenzionale è negativo, si preferisce la RM, più panoramica e sensibile. Nel paziente senza una neoplasia primitiva nota ma con sintomi riferiti al rachide, dopo un esame clinico, vengono in genere eseguiti dei radiogrammi convenzionali. Se essi risultano negativi, il paziente può essere sottoposto ad una visita specialistica, ad esempio neurologica o ortopedica; se anche queste indagini risultassero negative, può essere avviata una terapia medica e ulteriori indagini possono essere programmate solo se la sintomatologia non regredisce. Se l'esame neurologico è positivo, si possono eseguire una TC, se la sede della lesione è clinicamente precisabile, o una RM, se il livello della lesione non è clinicamente precisabile. Se nel radiogramma convenzionale si evidenziano dei reperti patologici, il protocollo si differenzia a seconda del loro numero: nel caso di lesioni multiple con l'aspetto delle metastasi, il paziente può essere avviato all'oncologo senza altre indagini di imaging a livello rachideo. Solo in casi selezionati può essere utile il ricorso ad una RM, per visualizzare compressioni o infiltrazioni del midollo o della cauda. Se il radiogramma convenzionale evidenzia una lesione isolata, l'indagine più utile è la scintigrafia ossea. Dai risultati di quest'ultima indagine dipendono le decisioni successive, tra le quali la TC dovrebbe essere eseguita solo come guida per un'eventuale biopsia. Solo raramente dunque la TC è indicata in prima battuta nello studio delle metastasi vertebrali, ponendosi piuttosto a cavallo tra le indagini di primo livello, con scopi diagnostici, e quelle di secondo livello, con finalità terapeutiche. La TC ha anche alcuni limiti. A causa delle acquisizioni sul piano assiale e della qualità non sempre soddisfacente delle ricostruzioni elettroniche su piani diversi, situazioni parafisiologiche possono essere scambiate con metastasi litiche. La scarsa panoramicità della TC può causare il mancato riconoscimento di lesioni a distanza da quella/e responsabile/i della sintomatologia. La sensibilità della TC, sebbene superiore a quella del radiogramma convenzionale, è inferiore a quelle della scintigrafia ossea e della RM soprattutto per quelle con estensione all'interno dello speco vertebrale. La specificità della TC è sovrapponibile a quella delle altre indagini finora considerate: la diagnosi di metastasi spinali è favorita da un'anamnesi positiva del paziente e dalla molteplicità delle lesioni. Le lesioni vertebrali con l'aspetto TC delle metastasi possono porre problemi diagnostici differenziali con numerose altre condizioni patologiche, come i tumori ossei primitivi, le localizzazioni scheletriche di malattie ematologiche, i processi flogistici ossei, gli esiti di traumi, i crolli vertebrali su base osteopenica, le malformazioni congenite, la malattia di Paget e le malattie metaboliche. Gli aspetti che più spesso si associano a processi patologici non metastatici sono l'unicità delle lesioni, la sede cervicale, la localizzazione all'arco vertebrale, il coinvolgimento congiunto di piatti vertebrali contigui e l'interessamento del disco intervertebrale.
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Bernardi, B., and A. Zimmerman. "Valutazione RM delle malformazioni midollari dell'infanzia (0–2 anni)." Rivista di Neuroradiologia 5, no. 1_suppl (April 1992): 57–64. http://dx.doi.org/10.1177/19714009920050s111.
Full textAbstract:
Le malformazioni vertebro-midollari possono essere classificate in diversi gruppi, le forme phù comuni sono comprese in due grandi categorie: 1- disrafismi spinali (spina bifida aperta, disrafismo spinale occulto), 2- altre anomalie spinocaudali. La conoscenza sia dell'embriologia normale che degli aspetti anatomici delle lesioni congenite porta alla comprensione del momento e della fase di sviluppo in cui la normale sequenza era stata interrotta e permette la classificazione delle malformazioni midollari. La risonanza magnetica fornisce la migliore descrizione delle relazioni anatomiche nelle lesioni congenite e quindi rappresenta il modo migliore per pianificare ii trattamento. Alcune anomalie congenite, sebbene presenti alla nascita, non giungono all'attenzione clinica fino all'età adulta. Altre lesioni sono tipicamente evidenti alla nascita o nei primi anni di vita. Il diffuso uso della RM riduce la diagnosi tardiva delle malformazioni occulte e fornisce le informazioni richieste per la pianificazione chirurgica. La proposta di questo lavoro è di utilizzare l'esperienza acquisita dalla revisione della casistica del Children's Hospital di Philadelphia per evidenziare il ruolo della RM nella scoperta e nella valutazione delle malformazioni midollari nei primi due anni di vita. I problemi diagnostici per la giovane eta dei pazienti (0–2 anni), particolarmente importanti nello studio del neonato sono dovuti a considerazioni anatomiche sulla colonna in sviluppo ed alla necessità di ottenere immagini in tempi brevi per avere un controllo del movimento senza anestesia. Sono stati valutati retrospettivamente 64 esami RM di 52 pazienti con evidente o sospetto disrafismo spinale. Sedici presentavano alla nascita una massa dorsale coperta o non coperta da cute. Trentasei erano disrafismi spinali sospetti senza massa dorsale associata (disrafismi spinali occulti) di cui nove presentavano una RM negativa. La RM è attualmente una procedura diagnostica sicura, sensibile e di facile esecuzione e pertanto va utilizzata non appena se ne renda evidente la necessità.
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Magnaldi, S., and M. Ukmar. "La tomografia computerizzata nella diagnostica delle metastasi spinali." Rivista di Neuroradiologia 8, no. 2 (April 1995): 161–66. http://dx.doi.org/10.1177/197140099500800205.
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La TC si rivela di particolare utilità nello studio delle metastasi spinali che coinvolgono i tessuti molli paravertebrali, lo scheletro del rachide e lo spazio epidurale. L'esecuzione della TC prevede uno scout view o topogramma di localizzazione, sul quale si scelgono dei piani assiali focalizzati su un particolare livello. Le scansioni devono essere acquisite e documentate in modo da poter visualizzare sia le parti molli che le strutture scheletriche. Nelle maggior parte dei casi è sufficiente l'esame TC diretto; talora possono essere utili la TC dopo mezzo di contrasto per via endovenosa o la mielo-TC, come pure le ricostruzioni elettroniche su piani diversi da quello assiale. L'aspetto TC delle metastasi vertebrali, che sono le più frequenti, è multiforme e comprende l'osteolisi (che può essere lacunare, a tarlatura o infiltrativa), l'osteosclerosi (che può presentarsi sotto forma di orletto sclerotico, di nodulo sclerotico o di sclerosi diffusa), le deformazioni e i crolli vertebrali (che derivano dall'infiltrazione del tessuto osseo normale da parte del tessuto neoplastico, con conseguenti fratture patologiche) e lo sconfinamento extravertebrale nelle parti molli pre e paravertebrali e verso lo speco vertebrale. Le metastasi vertebrali presentano inoltre aspetti caratteristici per sede rachidea (più spesso multiple e a livello lombare) e localizzazione nell'ambito della singola vertebra (interessamento preferenziale del corpo vertebrale). Nella diagnostica delle metastasi vertebrali, la TC presenta sia vantaggi che limiti. I vantaggi, dovuti all'assenza di fenomeni di sovrapposizione, sono rappresentati dall'ottima dimostrazione di lesioni in «sedi difficili» per la radiologia convenzionale (peduncoli, processi trasversi o passaggio lombo-sacrale), dall'esatta valutazione della presenza e del numero delle lesioni, dalla migliore definizione della natura delle lesioni (valutazione densitometrica e potenziamento delle lesioni solide dopo mezzo di contrasto) e dal bilancio di estensione. I limiti della TC sono rappresentati dall'esposizione alle radiazioni ionizzanti, dalla qualità talora subottimale delle ricostruzioni elettroniche, dalla scarsa panoramicità e dall'insufficiente sensibilità (soprattutto per lesioni con estensione all'interno dello speco vertebrale) e specificità. La TC si pone in una posizione di passaggio tra le indagini cosiddette di primo livello, con scopi meramente diagnostici, e quelle di secondo livello, con finalità terapeutiche. La TC è utile, soprattutto per le lesioni ossee, nella valutazione morfologico-volumetrica della/e metastasi, nella definizione dell'estensione extravertebrale delle lesioni, nella guida alle biopsie e nell'eventuale controllo dopo radioterapia e riveste inoltre un ruolo importante nella pianificazione di ulteriori provvedimenti terapeutici (interventi chirurgici di decompressione e radioterapia).
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Milella, D., A. Tarantino, C. F. Andreula, and A. Carella. "Metastasi del midollo spinale: Studio RM." Rivista di Neuroradiologia 8, no. 2 (April 1995): 235–40. http://dx.doi.org/10.1177/197140099500800215.
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Le metastasi intramidollari, con l'utilizzo della RM, stanno acquisendo sempre più una loro identità nosologica anche per il neuroradiologo, perdendo così la connotazione di patologia di interesse prevalentemente dell'anatomo patologo. La loro frequenza fra le complicanze di un processo neoplastico, è comunque sempre molto rara con un'incidenza infatti che varia dallo 0,9 all'8,5%. Questa rarità di riscontri neuroradiologici è in parte dovuto anche al mezzo tecnico «RM», che deve essere utilizzato sfruttando al massimo le sue potenzialità alla ricerca di queste lesione sovente molto piccole. La neoplasia che più frequentemente realizza lesioni secondarie a livello del midollo spinale è il cancro polmonare, segue poi il cancro mammario, il melanoma, il linfoma, cancro del colon etc. Il nostro studio è stato condotto con un'analisi retrospettiva di 165 esami RM spinali e midollari effettuati a pazienti con una neoplasia primitiva già diagnosticata o la cui diagnosi è scaturita proprio successivamente al riscontro neuradiologico. La sintomatologia di avvio all'esame era quasi sempre aspecifica, priva cioè di un indicazione precisa di sofferenza midollare, ma caratterizzata solitamente da dolore radicolare. Il nostro riscontro è stato di 6 metastasi intramidollari con una percentuale quindi di incidenza di lesioni intramidollari nella nostra casistica del 3,8%. I nostri rilievi neuroradiologici sono stati caratterizzati da alterazione morfologica del midollo spinale, alterazione di segnale, o evidenziazione diretta della lesione dopo somministrazione di mdc. La semeiotica neuroradiologica della lesione midollare sicuramente non patognomonica, ma ugualmente particolare, è comunque elemento indispensabile nell'ambito della diagnosi differenziale, con tutte le altre lesioni intramidollari, che bisogna sempre operare. Tale patologia quindi deve sempre essere tenuta sempre in cosiderazione dal neuroradiologo ogni qual volta viene eseguita una RM del rachide e midollo per la ricerca di metastasi. RM che è da considerare senza alcun dubbio come esame di scelta nella ricerca di possibili lesioni secondarie intramidollari, ma che deve essere eseguita sempre con la massima accortezza e completata con somministrazione ev di mdc paramagnetico, in relazione alle dimensioni solitamente piccole di queste lesioni.
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Gozzoli, L., L. Ambrogio, G. Albertino, M. Borrelli, A. Riva, and C. Ferro. "Sarcoidosi sistemica con localizzazioni encefaliche e spinali." Rivista di Neuroradiologia 9, no. 1 (February 1996): 95–100. http://dx.doi.org/10.1177/197140099600900113.
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Gli autori presentano un caso di sarcoidosi con localizzazioni encefaliche e midollare; vengono descritti gli aspetti clinici e neuroradiologici ed in particolare viene posta l'attenzione sulla localizzazione midollare di raro riscontro in letteratura. L'orientamento diagnostico è basato su una serie longitudinale di esami RM che documentano una progressiva riduzione delle dimensioni delle lesioni dopo terapia corticosteroidea.
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Floris, R., G. L. Sergiacomi, E. Squillaci, D. Lupoi, M. Crecco, E. Fanucci, M. Guazzaroni, and G. Simonetti. "Il ruolo della risonanza magnetica nella diagnosi delle neurofibromatosi." Rivista di Neuroradiologia 5, no. 1_suppl (April 1992): 101–4. http://dx.doi.org/10.1177/19714009920050s120.
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Gli autori prendono in considerazione il ruolo diagnostico della risonanza magnetica nella diagnostica delle neurofibromatosi, su una casistica di 13 osservazioni, di cui 9 casi di NF1 e 4 NF2. Lo studio è stato eseguito mediante sistemi RM superconduttivi da 0,5 e 1,5 Tesla, osservando un pattern di aspetti polimorfo comprendente nelle NF1 lesioni multiple insieme in T1 (6 casi), iperintense in T1 (2 casi), sempre iperintense in T2; inoltre si sono riscontrati gliomi delle vie ottiche (3 casi), xantogranulomatosi dei plessi corioidei e neurinomi multipli cervicodorsali. Nelle NF2 si sono invece reperiti schwannomi bilaterali dei nervi acustici (3 casi) e monolaterali (1 caso), meningiomi (4 casi), uno schwannoma del nervo facciale e neurofibromi spinali multipli (2 casi). Secondo la esperienza degli autori, la RM si è rivelata il metodo di scelta nella diagnostica e nel controllo dei pazienti con NF, grazie alla elevata accuratezza e sensibilità della metodica. I risultati ottenuti dimostrano l'elevata accuratezza della metodica e la sua preminenza nella diagnosi e nel controllo di tali forme neoplastiche.
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Pelliccioli, G. P., O. Presciutti, P. Floridi, S. Campanella, P. Chiarini, R. Tarducci, and M. Zampolini. "La risonanza magnetica funzionale nello studio della riorganizzazione plastica cerebrale, post-ictale." Rivista di Neuroradiologia 10, no. 2_suppl (October 1997): 31. http://dx.doi.org/10.1177/19714009970100s209.
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Negli ultimi anni lo studio dei meccanismi di recupero funzionale dopo ictus è progredito grazie all'utilizzo di nuove tecniche di indagine sia con immagini che con registrazione elettrofisiologiche. L'interesse è accentuato dal potenziale utilizzo di queste conoscenze per mettere a punto opportuni programmi terapeutici e riabilitativi. Scopo di questo lavoro è stato quello di indagare mediante Risonanza Magnetica funzionale (fMR) quali aree motorie fossero coinvolte nel recupero dopo ictus cerebrale. Sono stati studiati 10 pazienti con ictus sottocorticale ischemico (5 con emiparesi destra e 5 con emiparesi sinistra) in buon recupero funzionale. L'età media era 59,1 anni (min 37, max 84). Tutti i pazienti sono stati indagati effettuando uno studio per immagini e funzionale. La fMR è stata realizzata con apparecchiatura General Electric 1,5 T mediante sequenze SPGR (TR/TE 64/48 ms, Flip Angle 17°, FOV 22×6 cm2, matrice 256times128, spessore di strato 6 mm) costituite da 3 sezioni assiali oblique contigue, parallele alla linea inter-commissurale, condotte a livello della corteccia motoria. L'esame funzionale è stato preceduto da uno studio convenzionale utilizzato per dimostrare le lesioni, per programmare le sequenze funzionali e per fornire una correlazione anatomica ai pixel attivati. La fMR è stata effettuata alternando acquisizioni ottenute durante un movimento delle dita con sequenze eseguite in condizioni di riposo sia per la mano paretica che per quella sana. Per l'elaborazione è stata usata la tecnica “cross correlation” con soglia usando la “box-car” come forma d'onda di riferimento. Sono stati considerati “attivati” i pixel con coefficiente di correlazione (CC) ≥ 70% del CC massimo. I pixel selezionati, codificati mediante colorazione e sovrapposti alle immagini anatomiche, sono stati quantificati con apposito programma, suddivisi per aree motorie corticali. I risultati hanno evidenziato un'attivazione bilaterale durante il movimento della mano paretica mentre si è registrata un'attivazione controlaterale più selettiva durante il movimento della mano sana. Nell'emisfero omolaterale alla paresi si è inoltre rilevato un incremento dell'attivazione nelle aree premotoria e supplementare motoria. Questi dati sembrerebbero dimostrare che una maggiore attivazione delle aree motorie corticali omolaterali alla lesione sia un importante meccanismo di compenso al danno funzionale conseguente ad ictus. Tale attivazione può avere un duplice significato: un rinforzo delle vie discendenti cortico-spinali già presenti nel soggetto sano e un ausilio funzionale da parte delle aree premotoria e supplementare motoria verso il lato lesionato.
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Debanath, Abhinav, and Subir Dey. "Spinal epidural Cavernous Hemangioma mimicking Schwannoma: Case report and review of literature." Nepal Journal of Neuroscience 19, no. 2 (July 7, 2022): 64–67. http://dx.doi.org/10.3126/njn.v19i2.43608.
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Pure epidural spinal cavernous hemangiomas are encountered rarely in clinical practice. These lesions are more commonly found in the thoracic region and present with features of myelopathy. Presentation is usually insidious due to slow growth of these tumors, however, acute neurological deterioration is possible in cases with intra-lesional hemorrhage. Surgery is the treatment of choice with patients having good outcomes after complete resection. Due to high vascularity there may be excessive blood loss intra-operatively which might limit complete resection. It is for these reasons that these lesions should be considered in the differential diagnosis of spinal epidural lesions. Literature on these lesions reveals that these tumors are pre-operatively misdiagnosed as schwannomas. We report a case of an elderly male who presented with features of myelopathy and an epidural lesion in the thoracic region. A diagnosis of spinal epidural schwannoma with paravertebral extension was made pre-operatively on the basis of imaging characteristics. However, the lesion was found to be highly vascular during surgery and post-resection histopathology revealed a cavernous hemangioma.
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Becker, Matthew, and David Parker. "Time course of functional changes in locomotor and sensory systems after spinal cord lesions in lamprey." Journal of Neurophysiology 121, no. 6 (June 1, 2019): 2323–35. http://dx.doi.org/10.1152/jn.00120.2019.
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Changes in motor and sensory properties occur either side of spinal cord lesion sites from lower vertebrates to humans. We have previously examined these changes in the lamprey, a model system for studying recovery after spinal cord injury. These analyses were performed 8–12 wk after complete spinal cord lesions, a time when most animals have recovered good locomotor function. However, anatomical analyses have been performed at earlier and later times than this. Because there have been no functional studies at these times, in this study we have examined changes between 2 and 24+ wk after lesioning. Functional changes developed at different times in different regions of the spinal cord. Spinal cord excitability was significantly reduced above and below the lesion site less than 6 wk after lesioning but showed variable region-specific changes at later times. Excitatory synaptic inputs to motor neurons were increased above the lesion site during the recovery phase (2–8 wk after lesioning) but only increased below the lesion site once recovery had occurred (8 wk and later). These synaptic effects were associated with lesion-induced changes in connectivity between premotor excitatory interneurons. Sensory inputs were potentiated at 8 wk and later after lesioning but were markedly reduced at earlier times. There are thus time- and region-specific changes in motor and sensory properties above and below the lesion site. Although animals typically recover good locomotor function by 8 wk, there were further changes at 24+ wk. With the assumption that these changes can help to compensate for the reduced descending input to the spinal cord, effects at later times may reflect ongoing modifications as regeneration continues. NEW & NOTEWORTHY The lamprey is a model system for studying functional recovery and regeneration after spinal cord injury. We show that changes in spinal cord excitability and sensory inputs develop at different times above and below the lesion site during recovery. These changes may occur in response to the lesion-induced removal of descending inputs and may subsequently help to compensate for the reduction of the descending drive to allow locomotor recovery. Changes also continue once animals have recovered locomotor function, potentially reflecting adaptations to further regeneration at later recovery times.
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Ouellette, Russell, Constantina A. Treaba, Tobias Granberg, Elena Herranz, Valeria Barletta, Ambica Mehndiratta, Benjamin De Leener, et al. "7 T imaging reveals a gradient in spinal cord lesion distribution in multiple sclerosis." Brain 143, no. 10 (September 16, 2020): 2973–87. http://dx.doi.org/10.1093/brain/awaa249.
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Abstract We used 7 T MRI to: (i) characterize the grey and white matter pathology in the cervical spinal cord of patients with early relapsing-remitting and secondary progressive multiple sclerosis; (ii) assess the spinal cord lesion spatial distribution and the hypothesis of an outside-in pathological process possibly driven by CSF-mediated immune cytotoxic factors; and (iii) evaluate the association of spinal cord pathology with brain burden and its contribution to neurological disability. We prospectively recruited 20 relapsing-remitting, 15 secondary progressive multiple sclerosis participants and 11 age-matched healthy control subjects to undergo 7 T imaging of the cervical spinal cord and brain as well as conventional 3 T brain acquisition. Cervical spinal cord imaging at 7 T was used to segment grey and white matter, including lesions therein. Brain imaging at 7 T was used to segment cortical and white matter lesions and 3 T imaging for cortical thickness estimation. Cervical spinal cord lesions were mapped voxel-wise as a function of distance from the inner central canal CSF pool to the outer subpial surface. Similarly, brain white matter lesions were mapped voxel-wise as a function of distance from the ventricular system. Subjects with relapsing-remitting multiple sclerosis showed a greater predominance of spinal cord lesions nearer the outer subpial surface compared to secondary progressive cases. Inversely, secondary progressive participants presented with more centrally located lesions. Within the brain, there was a strong gradient of lesion formation nearest the ventricular system that was most evident in participants with secondary progressive multiple sclerosis. Lesion fractions within the spinal cord grey and white matter were related to the lesion fraction in cerebral white matter. Cortical thinning was the primary determinant of the Expanded Disability Status Scale, white matter lesion fractions in the spinal cord and brain of the 9-Hole Peg Test and cortical thickness and spinal cord grey matter cross-sectional area of the Timed 25-Foot Walk. Spinal cord lesions were localized nearest the subpial surfaces for those with relapsing-remitting and the central canal CSF surface in progressive disease, possibly implying CSF-mediated pathogenic mechanisms in lesion development that may differ between multiple sclerosis subtypes. These findings show that spinal cord lesions involve both grey and white matter from the early multiple sclerosis stages and occur mostly independent from brain pathology. Despite the prevalence of cervical spinal cord lesions and atrophy, brain pathology seems more strongly related to physical disability as measured by the Expanded Disability Status Scale.
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Takenouchi, Toshiki, Susan C. Pannullo, Philip E. Stieg, and Ehud Lavi. "Solitary Fibrous Tumor With Multiple Intracranial and Spinal Lesions: Case Report." Neurosurgery 68, no. 4 (April 1, 2011): E1148—E1151. http://dx.doi.org/10.1227/neu.0b013e31820a1573.
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AbstractBACKGROUND AND IMPORTANCE:Solitary fibrous tumor (SFT) has been previously reported for its wide variety of presentations and atypical sites. We report a case of recurrent SFT with multiple intracranial and spinal lesions.CLINICAL PRESENTATION:A 45-year-old female with recurrent right frontoparietal SFT was found to have multiple intracranial and spinal lesions. Most of the lesions are asymptomatic. Each of the intracranial and spinal lesions has been confirmed histologically. In 1999 the patient was found to have a single right temporal SFT and had a gross total resection of the lesion. In 2005 the patient underwent a second gross total resection for the recurrence of the right temporal-parietal lesion, followed by radiation therapy. In 2009 she underwent a third and fourth gross total resection of the right frontoparietal lesion, and the L4-5 mass, as well as a cervical laminectomy for an extramedullary spinal lesion causing spinal compression.CONCLUSION:This is the first case report of recurrent SFT with multiple intracranial and spinal lesions. This case illustrates the nature of recurrence and multiplicity of SFT and raises the importance of a thorough investigation, especially in the entire neuroaxis, in patients with the diagnosis of SFT. This case also questions the justification of the name that was given to this tumor.
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DİKER, Sevda, Amber EKER, Doç Dr Bahar KAYMAKAMZADE, Aysegul EREM, and Uğurcan BALYEMEZ. "Association of spinal cord lesions with cognition in multiple sclerosis." Cukurova Medical Journal 47, no. 3 (September 30, 2022): 1040–49. http://dx.doi.org/10.17826/cumj.1096925.
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Purpose: The effect of spinal cord involvement, which is closely related to physical disability and prognosis, on cognitive functions in multiple sclerosis.
Materials and Methods: Twenty nine MS patients (2 clinically isolated syndrome, 23 relapsing and remitting MS, 2 secondary progressive MS, 2 primary progressive MS) were included in the study. Demographic characteristics, expanded disability status scale (EDSS) score, cognition assessed by brief repeatable battery of neuropsychological tests, brain and spinal cord T2 lesion number were evaluated.
Results: Older age, later age of disease onset, education duration are the features affecting cognitive test results. Brain and spinal cord lesion numbers did not have any effect on cognitive tests. Patients with spinal cord lesions had higher EDSS compared to patients without, however there was no difference regarding cognitive test results between groups.
Conclusion: Spinal cord lesions are associated with physical disability quantified by EDSS. Longitudinal studies with larger samples are needed to investigate the effect of presence and number of cord lesions as well as cervical cord atrophy on cognitive test results.
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Morita, Masahiro, Akira Miyauchi, Shinya Okuda, Takenori Oda, Tomio Yamamoto, and Motoki Iwasaki. "Charcot spinal disease after spinal cord injury." Journal of Neurosurgery: Spine 9, no. 5 (November 2008): 419–26. http://dx.doi.org/10.3171/spi.2008.9.11.419.
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Object The authors investigated the background, risk factors, and treatment strategies for Charcot spinal disease (CSD) after spinal cord injury (SCI). Methods The authors retrospectively examined the clinical and radiological findings in 9 patients with a total of 10 Charcot spine lesions that occurred after SCI. The mean age of the 9 patients was 54 years, and all patients presented with complete SCIs. In all but 1 patient, symptoms did not develop until 10 years postinjury. All 10 Charcot spine lesions were located below the thoracolumbar junction. Surgical treatment was performed in 7 patients (7 lesions), and the mean duration of postoperative follow-up was 84 months. Results All patients reported audible noises when changing posture, 5 of 9 patients reported low-back pain, and 7 patients displayed increasing instability while sitting. In 8 patients, spasticity disappeared and limbs became flaccid several years after SCI. Two patients had associated bacterial infections in the Charcot spine lesions, and 1 patient complained of autonomic dysreflexic symptoms associated with trunk movements. Although postoperative complications occurred in 3 patients, all patients who underwent surgical treatment made a good recovery and were able to return to daily life in a wheelchair. On lateral radiography, the mean range of motion at the lesion site was 43°, and fluid collections between the involved vertebrae were observed in 8 patients on MR images; ankylosing spinal hyperostosis was observed in 7 patients. Charcot spine lesions tended to occur at the junction between or at the end of an ankylosing spinal hyperostotic lesion. Postoperatively, solid arthrodesis was obtained within 6 months in all surgically treated lesions. Conclusions Disappearance of spasticity in the lower extremities is thought to be an important physical sign suggestive of CSD after SCI. Sitting imbalance and the fluid volume of the Charcot spinal lesions are related to range of motion at the lesion site. In addition to a combined approach, a single posterior approach with acquisition of anterior support is an option for surgical treatment even in cases of infected CSD.
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Kerbrat, Anne, Charley Gros, Atef Badji, Elise Bannier, Francesca Galassi, Benoit Combès, Raphaël Chouteau, et al. "Multiple sclerosis lesions in motor tracts from brain to cervical cord: spatial distribution and correlation with disability." Brain 143, no. 7 (June 23, 2020): 2089–105. http://dx.doi.org/10.1093/brain/awaa162.
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Abstract Despite important efforts to solve the clinico-radiological paradox, correlation between lesion load and physical disability in patients with multiple sclerosis remains modest. One hypothesis could be that lesion location in corticospinal tracts plays a key role in explaining motor impairment. In this study, we describe the distribution of lesions along the corticospinal tracts from the cortex to the cervical spinal cord in patients with various disease phenotypes and disability status. We also assess the link between lesion load and location within corticospinal tracts, and disability at baseline and 2-year follow-up. We retrospectively included 290 patients (22 clinically isolated syndrome, 198 relapsing remitting, 39 secondary progressive, 31 primary progressive multiple sclerosis) from eight sites. Lesions were segmented on both brain (T2-FLAIR or T2-weighted) and cervical (axial T2- or T2*-weighted) MRI scans. Data were processed using an automated and publicly available pipeline. Brain, brainstem and spinal cord portions of the corticospinal tracts were identified using probabilistic atlases to measure the lesion volume fraction. Lesion frequency maps were produced for each phenotype and disability scores assessed with Expanded Disability Status Scale score and pyramidal functional system score. Results show that lesions were not homogeneously distributed along the corticospinal tracts, with the highest lesion frequency in the corona radiata and between C2 and C4 vertebral levels. The lesion volume fraction in the corticospinal tracts was higher in secondary and primary progressive patients (mean = 3.6 ± 2.7% and 2.9 ± 2.4%), compared to relapsing-remitting patients (1.6 ± 2.1%, both P < 0.0001). Voxel-wise analyses confirmed that lesion frequency was higher in progressive compared to relapsing-remitting patients, with significant bilateral clusters in the spinal cord corticospinal tracts (P < 0.01). The baseline Expanded Disability Status Scale score was associated with lesion volume fraction within the brain (r = 0.31, P < 0.0001), brainstem (r = 0.45, P < 0.0001) and spinal cord (r = 0.57, P < 0.0001) corticospinal tracts. The spinal cord corticospinal tracts lesion volume fraction remained the strongest factor in the multiple linear regression model, independently from cord atrophy. Baseline spinal cord corticospinal tracts lesion volume fraction was also associated with disability progression at 2-year follow-up (P = 0.003). Our results suggest a cumulative effect of lesions within the corticospinal tracts along the brain, brainstem and spinal cord portions to explain physical disability in multiple sclerosis patients, with a predominant impact of intramedullary lesions.
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Rossignol, S., E. Brustein, L. Bouyer, D. Barthélemy, C. Langlet, and H. Leblond. "Adaptive changes of locomotion after central and peripheral lesions." Canadian Journal of Physiology and Pharmacology 82, no. 8-9 (July 1, 2004): 617–27. http://dx.doi.org/10.1139/y04-068.
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This paper reviews findings on the adaptive changes of locomotion in cats after spinal cord or peripheral nerve lesions. From the results obtained after lesions of the ventral/ventrolateral pathways or the dorsal/dorsolateral pathways, we conclude that with extensive but partial spinal lesions, cats can regain voluntary quadrupedal locomotion on a treadmill. Although tract-specific deficits remain after such lesions, intact descending tracts can compensate for the lesioned tracts and access the spinal network to generate voluntary locomotion. Such neuroplasticity of locomotor control mechanisms is also demonstrated after peripheral nerve lesions in cats with intact or lesioned spinal cords. Some models have shown that recovery from such peripheral nerve lesions probably involves changes at the supra spinal and spinal levels. In the case of somesthesic denervation of the hindpaws, we demonstrated that cats with a complete spinal section need some cutaneous inputs to walk with a plantigrade locomotion, and that even in this spinal state, cats can adapt their locomotion to partial cutaneous denervation. Altogether, these results suggest that there is significant plasticity in spinal and supraspinal locomotor controls to justify the beneficial effects of early proactive and sustained locomotor training after central (Rossignol and Barbeau 1995; Barbeau et al. 1998) or peripheral lesions.Key words: spinal lesions, nerve lesions, locomotion, neuroplisticity, locomotor training.
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Doi, Kazuma, Yukoh Ohara, Takeshi Hara, Hirokazu Iwamuro, Kei Miyagawa, Nozomu Kobayashi, Tatsuya Sato, et al. "Rapid growth of spinal epidural capillary hemangioma associated with isolated intraosseous lesion at the same level: A case report." Journal of Neurology & Stroke 11, no. 3 (June 9, 2021): 91–96. http://dx.doi.org/10.15406/jnsk.2021.11.00461.
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A 47-year-old man presented with a spinal epidural capillary hemangioma manifesting as a 6-month history of worsening low back pain and lower limb pain. Computed tomography and magnetic resonance imaging (MRI) at a previous hospital showed intraosseous abnormal signals and an epidural lesion at the L3 level. One month later, MRI revealed rapid growth of the epidural lesion. Total resection of the epidural tumor and partial removal of the intraosseous tumor were performed. Macroscopically, the intraosseous lesion and epidural lesion seemed to be isolated from each other. Histopathological diagnosis was consistent with capillary hemangioma. Spinal epidural capillary hemangioma sometimes recurs via underlying arteriovenous anastomosis. Progressive clinical symptoms, as seen in our case, indicate the possibility of tumor growth even if the lesions are well demarcated, which suggests of benign tumor. Spinal epidural capillary hemangioma in addition to metastatic spinal tumors should be considered in the differential diagnosis of spinal epidural tumors associated with intraosseous lesions.
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Brownlee, WJ, DR Altmann, P. Alves Da Mota, JK Swanton, KA Miszkiel, CAM Gandini Wheeler-Kingshott, O. Ciccarelli, and DH Miller. "Association of asymptomatic spinal cord lesions and atrophy with disability 5 years after a clinically isolated syndrome." Multiple Sclerosis Journal 23, no. 5 (August 1, 2016): 665–74. http://dx.doi.org/10.1177/1352458516663034.
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Background: Spinal cord pathology is an important substrate for long-term disability in multiple sclerosis (MS). Objective: To investigate longitudinal changes in spinal cord lesions and atrophy in patients with a non-spinal clinically isolated syndrome (CIS), and how they relate to the development of disability. Methods: In all, 131 patients with a non-spinal CIS had brain and spinal cord imaging at the time of CIS and approximately 5 years later (median: 5.2 years, range: 3.0–7.9 years). Brain magnetic resonance imaging (MRI) measures consisted of T2-hyperintense and T1-hypointense lesion loads plus brain atrophy. Spinal cord MRI measures consisted of lesion number and the upper cervical cord cross-sectional area (UCCA). Disability was measured using the Expanded Disability Status Scale (EDSS). Multiple linear regression was used to identify independent predictors of disability after 5 years. Results: During follow-up, 93 (71%) patients were diagnosed with MS. Baseline spinal cord lesion number, change in cord lesion number and change in UCCA were independently associated with EDSS ( R2 = 0.53) at follow-up. Including brain T2 lesion load and brain atrophy only modestly increased the predictive power of the model ( R2 = 0.64). Conclusion: Asymptomatic spinal cord lesions and spinal cord atrophy contribute to the development of MS-related disability over the first 5 years after a non-spinal CIS.
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Karimian-Jazi, Kianush, Ulf Neuberger, Katharina Schregel, Gianluca Brugnara, Daniel Schwarz, Laura Bettina Jäger, Wolfgang Wick, Martin Bendszus, and Michael O. Breckwoldt. "Diagnostic value of gadolinium contrast administration for spinal cord magnetic resonance imaging in multiple sclerosis patients and correlative markers of lesion enhancement." Multiple Sclerosis Journal - Experimental, Translational and Clinical 7, no. 4 (October 2021): 205521732110479. http://dx.doi.org/10.1177/20552173211047978.
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Background Magnetic resonance imaging is essential for monitoring people with multiple sclerosis, but the diagnostic value of gadolinium contrast administration in spine magnetic resonance imaging is unclear. Objective To assess the diagnostic value of gadolinium contrast administration in spine magnetic resonance imaging follow-up examinations and identify imaging markers correlating with lesion enhancement. Methods A total of 65 multiple sclerosis patients with at least 2 spinal magnetic resonance imaging follow-up examinations were included. Spine magnetic resonance imaging was performed at 3 Tesla with a standardized protocol (sagittal and axial T2-weighted turbo spin echo and T1-weighted post-contrast sequences). T2 lesion load and enhancing lesions were assessed by two independent neuroradiologists for lesion size, localization, and T2 signal ratio (T2 signallesion/T2 signalnormal appearing spinal cord). Results A total of 68 new spinal T2 lesions and 20 new contrast-enhancing lesions developed during follow-up. All enhancing lesions had a discernable correlate as a new T2 lesion. Lesion enhancement correlated with a higher T2 signal ratio compared to non-enhancing lesions (T2 signal ratio: 2.0 ± 0.4 vs. 1.4 ± 0.2, **** p < 0.001). Receiver operating characteristics analysis showed an optimal cutoff value of signal ratio 1.78 to predict lesion enhancement (82% sensitivity and 97% specificity). Conclusion Gadolinium contrast administration is dispensable in follow-up spine magnetic resonance imaging if no new T2 lesions are present. Probability of enhancement correlates with the T2 signal ratio.
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Brustein, Edna, and Serge Rossignol. "Recovery of Locomotion After Ventral and Ventrolateral Spinal Lesions in the Cat. I. Deficits and Adaptive Mechanisms." Journal of Neurophysiology 80, no. 3 (September 1, 1998): 1245–67. http://dx.doi.org/10.1152/jn.1998.80.3.1245.
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Brustein, Edna and Serge Rossignol. Recovery of locomotion after ventral and ventrolateral spinal lesions in the cat. I. Deficits and adaptive mechanisms. J. Neurophysiol. 80: 1245–1267, 1998. The recovery of treadmill locomotion of eight adult cats, subjected to chronic ventral and ventrolateral spinal lesions at low thoracic levels (T11 or T13), preserving at least one dorsolateral funiculus and the dorsal columns, was documented daily using electromyographic (EMG) and kinematic methods. The data show that all cats eventually recovered quadrupedal voluntary locomotion despite extensive damage to important pathways (such as the reticulospinal and the vestibulospinal) as verified by injection of wheat germ agglutinin–horseradish peroxidase (WGA-HRP) caudal to the site of lesion. Initially (in the early period after the spinal lesion), all the cats suffered from pronounced locomotor and postural deficits, and they could not support their hindquarters or walk with their hindlimbs. Gradually, during the recovery period, they regained quadrupedal walking, although their locomotion was wobbly and inconsistent, and they suffered from poor lateral stability. EMG and kinematic data analyses showed a tendency for an increase in the variability of the step cycle duration but no major changes in the step cycle structure or in the intralimb coupling of the joints. However, the homolateral fore- and hindlimb coupling was highly perturbed in cats with the largest lesions. Although the general alternating pattern of extensor and flexors was maintained, there were various changes in the duration and amplitude of the EMG bursts as well as a lack of amplitude modulation during walking uphill or downhill on the treadmill. In cats with larger lesions, the forelimbs also seem to take a greater propulsive role than usual as revealed by a consistent increase of the activity of the triceps. In cats with smaller lesions, these deficits were transient, but, for the most extensively lesioned cats, they were pronounced and lasted long term postlesion even after reaching a more or less stable locomotor behavior (plateau period). It is concluded that recovery of quadrupedal locomotion is possible even after a massive lesion to ventral and ventrolateral quadrants, severing the vestibulospinal pathway and causing severe, although incomplete, damage to the reticulospinal tract. The quick recovery in the less lesioned cats can be attributed to remaining pathways normally implicated in locomotor function. However, in the most extensively lesioned cats, the long period of recovery and the pronounced deficits during the plateau period may indicate that the compensation, attributed to remaining reticulospinal pathways, is not sufficient and that other pathways in the dorsolateral funiculi, such as the corticospinal, can sustain and adapt, up to a certain extent, the voluntary quadrupedal walking.
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Chung, Ho Yin, Jin Xian Huang, Kam Ho Lee, Helen Hoi Lun Tsang, Chak Sing Lau, and Shirley Chiu Wai Chan. "MRI lesions in SpA: a comparison with noninflammatory back pain using propensity score adjustment method." Therapeutic Advances in Musculoskeletal Disease 14 (January 2022): 1759720X2211192. http://dx.doi.org/10.1177/1759720x221119250.
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Background: Magnetic resonance imaging (MRI) is important in the management of axial spondyloarthritis (SpA). However, many MRI lesions are not exclusive to axial SpA. Further characterization of these lesions may lead to better clinical decisions. Objective: The objective of this study was to compare the frequency of individual spinal MRI lesions between axial SpA and noninflammatory back pain. The factors associated with individual lesions in participants with axial SpA were also determined. Design: This was a cross-sectional observational study. Methods: MRI lesions in 447 participants with axial SpA and 122 participants with noninflammatory back pain were compared using the propensity score adjustment method. Individual lesions included discovertebral lesions (DVL), Modic type 1 lesions, DVL without Modic type 1 lesions, facet joint lesions, costovertebral joint lesions, corner inflammatory lesions (CIL), and fatty corner lesions (FCL). The factors associated with the lesions were determined using regression analyses. Results: Among participants with axial SpA, 81.9% were HLA-B27-positive, 55.0% had radiographic axial SpA, and 60.5% had radiographic features of spinal damage (mSASSS >2). Almost half (48.6% in axial SpA versus 31.1% in noninflammatory back pain) had inflammatory lesions on spinal MRI. In propensity score matching with noninflammatory back pain, axial SpA had an increased occurrence of DVL without Modic type 1 lesion (OR = 3.43, p = 0.01), costovertebral lesion (OR = 11.89, p = 0.02), number of CIL ( B = 1.19, p < 0.001), and number of FCL ( B = 3.33, p < 0.001). Similar associations were found in the regression models in the radiographic axial SpA subgroup: DVL without Modic type 1 lesion (OR = 2.46, p = 0.001), costovertebral lesion (OR = 3.86, p < 0.001), number of CIL ( B = 1.13, p < 0.001), and FCL ( B = 2.29, p < 0.01). Conclusion: MRI lesions including DVL without Modic type 1, costovertebral joint lesions, CIL, and FCL were more specific in axial SpA.
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Resnick, Daniel K., Christopher H. Comey, William C. Welch, A. Julio Martinez, William W. Hoover, and George B. Jacobs. "Isolated toxoplasmosis of the thoracic spinal cord in a patient with acquired immunodeficiency syndrome." Journal of Neurosurgery 82, no. 3 (March 1995): 493–96. http://dx.doi.org/10.3171/jns.1995.82.3.0493.
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✓ Toxoplasmosis and lymphoma are the two most common causes of intraparenchymal cerebral mass lesions in patients with acquired immunodeficiency syndrome (AIDS). The clinical and radiographic features of the intracranial lesions have been well described. Because of the high frequency of toxoplasmosis in the AIDS population, common therapy for patients presenting with intracranial mass lesions consists of an empirical trial of anti-Toxoplasma chemotherapy, with biopsy reserved for cases demonstrating features considered to be more consistent with lymphoma, or for lesions that do not improve despite adequate anti-Toxoplasma treatment. A similar treatment algorithm does not exist for intramedullary lesions of the spinal cord. The authors describe a patient who presented with paraparesis resulting from an isolated thoracic intramedullary lesion. An open biopsy of the lesion revealed characteristic structures containing Toxoplasma tachyzoites. The clinical and radiographic presentation of the lesion is discussed, the available literature is reviewed, and a treatment strategy for spinal cord lesions in AIDS patients is proposed.
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Justicia Izza Tsuroya, Muhammad Faris, and Paulus Rahardjo. "DIFFERENTIATION OF SPINAL TUBERCULOSIS AND METASTATIC SPINAL TUMOR USING MRI FEATURE: A SYSTEMATIC REVIEW." Majalah Biomorfologi 33, no. 1 (January 10, 2023): 44–51. http://dx.doi.org/10.20473/mbiom.v33i1.2023.44-51.
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Highlights1. Lesions that are regularly diagnosed in the spine include TB of the spine and tumors that have spread throughout the body.2. The examined papers included 35 individuals with tuberculous spondylitis and 31 patients with metastatic spinal malignancies.3. A methodology for MRI imaging and an accurate medical history will aid in establishing an accurate diagnosis. AbstractBackground: Spinal tuberculosis and metastatic tumors are commonly diagnosed lesions in the spine. Tuberculosis spondylitis, also known as Pott's Disease, is the most common extrapulmonary tuberculosis disease. MRI is the gold standard for early diagnosis because there is no significant difference in the results of clinical manifestations and histopathological examination. A biopsy will usually be used for a final exam for diagnosis. Objective: To provide information to confirm the diagnosis of TB spondylitis cases and metastatic spinal tumors. Method: A literature search was conducted via PubMed, Science Direct, and Scopus by selecting studies according to inclusion and exclusion criteria. The quality and risk of bias assessments were performed using Joanna Briggs Institute (JBI) tools. Overall, 35 spinal tuberculosis and 31 metastatic spinal tumor patients from 2 studies were reviewed. Result: Of the 35 patients with tuberculous spondylitis and 31 patients with metastatic spinal tumors from the two studies reviewed. It was found that the thorax was the most common region. The following imaging findings were of statistical significance (p<0.05): skip lesion, solitary lesion, intraspinal lesion, concentric collapse, abscess formation (paraspinal, intraosseous, and epidural lesions), and syrinx formation. Conclusion: An MRI imaging protocol and correct medical history will help establish an accurate diagnosis. Skip lesions, abscesses, and modular lesion margins are considered for diagnosis.
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Ditor, David S., Sunil John, Jason Cakiroglu, Colin Kittmer, Paula J. Foster, and Lynne C. Weaver. "Magnetic resonance imaging versus histological assessment for estimation of lesion volume after experimental spinal cord injury." Journal of Neurosurgery: Spine 9, no. 3 (September 2008): 301–6. http://dx.doi.org/10.3171/spi/2008/9/9/301.
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Object The purpose of this study was to compare measures of lesion volume obtained by means of 1.5-T MR imaging to those obtained by the Cavalieri method, 6 weeks after experimental spinal cord injury. Methods Nine male Wistar rats were subjected to spinal cord injury by clip compression (50 g) at the T-4 level. Six weeks postinjury, the rats were sacrificed, and spinal cords were analyzed ex vivo for lesion volume by means of 1.5-T MR imaging and subsequently, by the Cavalieri method. In the latter method, cords were cut longitudinally in 25-μm sections and stained with solochrome cyanin for myelin. The area of the lesion was determined for each serial section, and the distance-weighted sum of all area measures was then calculated to estimate the total lesion volume. Results Bland–Altman analysis showed that the 2 methods had an acceptable level of agreement for lesion volume estimation, but the Cavalieri method was prone to an overestimation bias. The MR imaging estimates of lesion volume were greater than the Cavalieri method estimates in 3 spinal cords, but the difference between measures was within 1 standard deviation of perfect agreement in these 3 lesions, and the mean difference between measures was 18.3%. In contrast, in those lesions in which the Cavalieri method yielded larger lesion volumes (5 lesions), the difference between measures was 2 standard deviations away from perfect agreement for 2 animals and the mean difference between measures was 72.4%. Conclusions The results illustrate that the overestimation bias of the Cavalieri method is due, in part, to artifacts produced during processing of the spinal cord tissue.
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Romero, Diego Gutierrez, Andre Lima Batista, Jean Christoph Gentric, Jean Raymond, Daniel Roy, and Alain Weill. "Ruptured Isolated Spinal Artery Aneurysms Report of Two Cases and Review of the Literature." Interventional Neuroradiology 20, no. 6 (January 1, 2014): 774–80. http://dx.doi.org/10.15274/inr-2014-10074.
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Isolated spinal artery aneurysms are exceedingly rare vascular lesions thought to be related to dissection of the arterial wall. We describe two cases presenting with spinal subarachnoid haemorrhage that underwent conservative management. In the first patient the radiculomedullary branch involved was feeding the anterior spinal artery at the level of D3 and thus, neither endovascular nor surgical approach was employed. Control angiography was performed at seven days and at three months, demonstrating complete resolution of the lesion. In our second case, neither the anterior spinal artery or the artery of Adamkiewicz could be identified during angiography, thus endovascular management was deemed contraindicated. Magnetic resonance imaging showed a stable lesion in the second patient. No rebleeding or other complications were seen. In comparison to intracranial aneurysms, spinal artery aneurysms tend to display a fusiform appearance and lack a clear neck in relation to the likely dissecting nature of the lesions. Due to the small number of cases reported, the natural history of these lesions is not well known making it difficult to establish the optimal treatment approach. Various management strategies may be supported, including surgical and endovascular treatment, but It would seem that a wait and see approach is also viable, with control angiogram and treatment decisions based on the evolution of the lesion.
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Dekker, Iris, Madeleine H. Sombekke, Lisanne J. Balk, Bastiaan Moraal, Jeroen JG Geurts, Frederik Barkhof, Bernard MJ Uitdehaag, Joep Killestein, and Mike P. Wattjes. "Infratentorial and spinal cord lesions: Cumulative predictors of long-term disability?" Multiple Sclerosis Journal 26, no. 11 (August 2, 2019): 1381–91. http://dx.doi.org/10.1177/1352458519864933.
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Objective: The objective of the study was to determine whether early infratentorial and/or spinal cord lesions are long-term cumulative predictors of disability progression in multiple sclerosis (MS). Methods: We selected 153 MS patients from the longitudinal Amsterdam MS cohort. Lesion analysis was performed at baseline and year 2. Disability progression after 6 and 11 years was measured using the Expanded Disability Status Scale (EDSS) and EDSS-plus (including 25-foot walk and 9-hole peg test). Patients with spinal cord or infratentorial lesions were compared for the risk of 6- and 11-year disability progression to patients without spinal cord or infratentorial lesions, respectively. Subsequently, patients with lesions on both locations were compared to patients with only spinal cord or only infratentorial lesions. Results: Baseline spinal cord lesions show a higher risk of 6-year EDSS progression (odds ratio (OR): 3.6, p = 0.007) and EDSS-plus progression (OR: 2.5, p = 0.028) and 11-year EDSS progression (OR: 2.8, p = 0.047). Patients with both infratentorial and spinal cord lesions did not have a higher risk of 6-year disability progression than patients with only infratentorial or only spinal cord lesions. Conclusion: The presence of early spinal cord lesions seems to be a dominant risk factor of disability progression. Simultaneous presence of early infratentorial and spinal cord lesions did not undisputedly predict disability progression.
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Ley, Jessica C., Jack Jennings, Jonathan C. Baker, Travis Hillen, and Brian Andrew Van Tine. "Targeted radiofrequency ablation of metastatic posterior vertebral body lesions in patients with soft tissue sarcomas." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 10585. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.10585.
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10585 Background: Metastatic spinal lesions can be debilitating with significant impact on patients quality of life. Concern for damage to adjacent neural elements during treatment exist due to high radiation doses required to treat certain radioresistant spinal lesions such as soft tissue sarcoma. Radiofrequency ablation (RFA) of metastatic lesions has been shown to be effective in bone. Spine anatomy presents challenges for minimally invasive (MI) treatment of posterior vertebral body lesions. Targeted RFA (t-RFA) using a novel tumor ablation system, designed for spinal anatomy is evaluated in patients with symptomatic posterior vertebral wall spinal lesions. Methods: Five patients with metastatic leiomyosarcoma or liposarcoma and posterior vertebral body spine lesions, treated by prior radiation with continued progression of lesion size and pain received t-RFA, using a novel spinal tumor ablation system (STAR, DFINE), which contains an articulating bipolar, extensible electrode for navigation. Device thermocouples (TC) permit real time monitoring of the ablation zones to determine size. Sequential post-procedural pain scores, PET and contrast enhanced magnetic resonance imaging, and histopathology of treated area was performed. Results: No complications or thermal injury occurred. Intra-procedural imaging demonstrated the articulated, bipolar instrument was able to navigate to posterior lesions. Post-ablation MRI demonstrated lesion necrosis within a discrete ablation zone. No evidence of malignancy by PET or histopathology was noted through 10 months. All patients reported post procedural pain relief. Systemic therapy was not interrupted. Conclusions: Navigational t-RFA proved a safe and effective, non-ionizing palliative therapy alternative for radio-resistant lesions . Post-ablation imaging and histology confirmed metastatic lesions were necrotic and included in ablation zone with tumor control 10 mos post treatment. Ablation zone was very consistent with real time temperature readings. t-RFA permitted MI targeted treatment of lesions within close proximity of spinal cord, not controlled by systemic therapy. Prospective clinical trial is under preparation.
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Bambakidis, Nicholas C., Pankaj Gore, Jennifer Eschbacher, Stephen Coons, and Felipe C. Albuquerque. "INTRAOSSEOUS SPINAL GLOMUS TUMORS." Neurosurgery 60, no. 6 (June 1, 2007): E1152—E1153. http://dx.doi.org/10.1227/01.neu.0000255463.37634.f2.
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Abstract OBJECTIVE Glomus tumors are rare lesions that can arise intraosseously along the entire spinal axis. Only four cases have been reported, usually manifesting with severe back pain and involving the midthoracic spine or sacrum. The current report describes the largest such lesion reported in the literature to date and summarizes the clinical and pathological characteristics of these rare tumors. METHODS A single, recent case arising from the lumbar vertebra of L3 is described, and the literature of intraosseous spinal glomus tumors is reviewed. RESULTS The lesion described arose in a 44-year-old man with a 1-year history of neurological symptoms and a large dumbbell-shaped lesion involving the lumbar vertebra, which extended through the neural foramen at L3. The lesion was resected using a two-stage approach. Severe intraoperative hemorrhage necessitated emergent angiographic embolization. Histopathological examination confirmed the presence of a glomus tumor arising from the smooth muscle cells of the glomus body. CONCLUSION These rare lesions may extend into the epidural space and through the neural foramina and abdominal compartments; over time, they grow very large. Preoperative embolization may be indicated for large tumors suspected to be glomus tumors.
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Goujon, Adrien, Sonia Mirafzal, Kevin Zuber, Romain Deschamps, Jean-Claude Sadik, Olivier Gout, Julien Savatovsky, and Augustin Lecler. "3D-Fast Gray Matter Acquisition with Phase Sensitive Inversion Recovery Magnetic Resonance Imaging at 3 Tesla: Application for detection of spinal cord lesions in patients with multiple sclerosis." PLOS ONE 16, no. 4 (April 22, 2021): e0247813. http://dx.doi.org/10.1371/journal.pone.0247813.
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Background and purpose To compare 3D-Fast Gray Matter Acquisition with Phase Sensitive Inversion Recovery (3D-FGAPSIR) with conventional 3D-Short-Tau Inversion Recovery (3D-STIR) and sagittal T1-and T2-weighted MRI dataset at 3 Tesla when detecting MS spinal cord lesions. Material and methods This prospective single-center study was approved by an institutional review board and enrolled participants from December 2016 to August 2018. Two neuroradiologists blinded to all data, individually analyzed the 3D-FGAPSIR and the conventional datasets separately and in random order. Discrepancies were resolved by consensus by a third neuroradiologist. The primary judgment criterion was the number of MS spinal cord lesions. Secondary judgment criteria included lesion enhancement, lesion delineation, reader-reported confidence and lesion-to-cord-contrast-ratio. A Wilcoxon’s test was used to compare the two datasets. Results 51 participants were included. 3D-FGAPSIR detected significantly more lesions than the conventional dataset (344 versus 171 respectively, p<0.001). Two participants had no detected lesion on the conventional dataset, whereas 3D-FGAPSIR detected at least one lesion. 3/51 participants had a single enhancing lesion detected by both datasets. Lesion delineation and reader-reported confidence were significantly higher with 3D-FGAPSIR: 4.5 (IQR 1) versus 2 (IQR 0.5), p<0.0001 and 4.5 (IQR 1) versus 2.5 (IQR 0.5), p<0.0001. Lesion-to-cord-contrast-ratio was significantly higher using 3D-FGAPSIR as opposed to 3D-STIR and T2: 1.4 (IQR 0,3) versus 0.4 (IQR 0,1) and 0.3 (IQR 0,1)(p = 0.04). Correlations with clinical data and inter- and intra-observer agreements were higher with 3D-FGAPSIR. Conclusion 3D-FGAPSIR improved overall MS spinal cord lesion detection as compared to conventional set and detected all enhancing lesions.
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Minert, Anne, Mark Baron, and Marshall Devor. "Reduced Sensitivity to Anesthetic Agents upon Lesioning the Mesopontine Tegmental Anesthesia Area in Rats Depends on Anesthetic Type." Anesthesiology 132, no. 3 (March 1, 2020): 535–50. http://dx.doi.org/10.1097/aln.0000000000003087.
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Abstract Background The brainstem mesopontine tegmental anesthesia area is a key node in circuitry responsible for anesthetic induction and maintenance. Microinjecting the γ-aminobutyric acid–mediated (GABAergic) anesthetic pentobarbital in this nucleus rapidly and reversibly induces general anesthesia, whereas lesioning it renders the animal relatively insensitive to pentobarbital administered systemically. This study investigated whether effects of lesioning the mesopontine tegmental anesthesia area generalize to other anesthetic agents. Methods Cell-selective lesions were made using ibotenic acid, and rats were later tested for changes in the dose–response relation to etomidate, propofol, alfaxalone/alfadolone, ketamine, and medetomidine delivered intravenously using a programmable infusion pump. Anesthetic induction for each agent was tracked using five behavioral endpoints: loss of righting reflex, criterion for anesthesia (score of 11 or higher), criterion for surgical anesthesia (score of 14 or higher), antinociception (loss of pinch response), and deep surgical anesthesia (score of 16). Results As reported previously for pentobarbital, on-target mesopontine tegmental anesthesia area lesions reduced sensitivity to the GABAergic anesthetics etomidate and propofol. The dose to achieve a score of 16 increased to 147 ± 50% of baseline in control animals ± SD (P = 0.0007; 7 lesioned rats and 18 controls) and 136 ± 58% of baseline (P = 0.010; 6 lesioned rats and 21 controls), respectively. In contrast, responsiveness to the neurosteroids alfaxalone and alfadolone remained unchanged compared with baseline (94 ± 24%; P = 0.519; 6 lesioned rats and 18 controls) and with ketamine increased slightly (90 ± 11%; P = 0.039; 6 lesioned rats and 19 controls). The non-GABAergic anesthetic medetomidine did not induce criterion anesthesia even at the maximal dose tested. The dose to reach the maximal anesthesia score actually obtained was unaffected by the lesion (112 ± 8%; P = 0.063; 5 lesioned rats and 18 controls). Conclusions Inability to induce anesthesia in lesioned animals using normally effective doses of etomidate, propofol, and pentobarbital suggests that the mesopontine tegmental anesthesia area is the effective target of these, but not necessarily all, GABAergic anesthetics upon systemic administration. Cortical and spinal functions are likely suppressed by recruitment of dedicated ascending and descending pathways rather than by direct, distributed drug action. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Omeis, Ibrahim, Ashley L. Siems, William Harrington, Livette S. Johnson, Sylvie Destian, and Joseph A. DeMattia. "Spinal Kaposi sarcoma presenting without cutaneous manifestations." Journal of Neurosurgery: Spine 7, no. 5 (November 2007): 558–61. http://dx.doi.org/10.3171/spi-07/11/558.
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✓ Kaposi sarcoma (KS) is one of the most common tumors in patients with human immunodeficiency virus (HIV), which characteristically presents with cutaneous lesions. The authors report a rare case of spinal KS with no cutaneous manifestation in a 32-year-old man with the acquired immunodeficiency syndrome who presented with abdominal pain. A computed tomography scan revealed incidental lesions in his lumbar spine, and additional imaging studies revealed numerous lesions in the lumbosacral spine and pelvis. An open biopsy was performed, and histopathological examination of the lesion confirmed the diagnosis of KS. At the time of presentation, the patient had no skin lesion or any other manifestation indicative of KS. The authors suggest that in HIV-positive patients who present with spinal lesions, KS should be included in the differential diagnosis.
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Islam, Salma S., Pavel V. Zelenin, Grigori N. Orlovsky, Sten Grillner, and Tatiana G. Deliagina. "Pattern of Motor Coordination Underlying Backward Swimming in the Lamprey." Journal of Neurophysiology 96, no. 1 (July 2006): 451–60. http://dx.doi.org/10.1152/jn.01277.2005.
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The main form of locomotion in the lamprey (a lower vertebrate, cyclostome) is forward swimming (FS) based on periodical waves of lateral body flexion propagating from head to tail. The lamprey is also capable of backward swimming (BS). Here we describe the kinematical and electromyographic (EMG) pattern of BS, as well as the effects on this pattern exerted by different lesions of the spinal cord. The BS was evoked by tactile stimulation of a large area in the anterior part of the body. Swimming was attributed to the waves of lateral body undulations propagating from tail to head. The EMG bursts on the two sides alternated, and the EMG in more caudal segments led in phase the EMG in more rostral segments. Main kinematical characteristics of BS strongly differed from those of FS: the amplitude of undulations was much larger and their frequency lower. Also, the maintenance of the dorsal-side-up body orientation ascribed to vestibular postural reflexes (typical for FS) was not observed during BS. A complete transection of the spinal cord did not abolish the generation of forward-propagating waves rostral to the lesion. After a lateral hemisection of the spinal cord, the BS pattern persisted on both sides rostral to the lesion; caudal to the lesion, it was present on the intact side and reduced or abolished on the lesioned side. The role of the spinal cord in generation of different forms of undulatory locomotion (FS and BS) is discussed.
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Fanous, Andrew A., Nathan P. Olszewski, Lindsay J. Lipinski, Jingxin Qiu, and Andrew J. Fabiano. "Idiopathic Transverse Myelitis Mimicking an Intramedullary Spinal Cord Tumor." Case Reports in Pathology 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/8706062.
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The differential diagnoses for spinal cord lesions include spinal tumors and inflammatory processes. The distinction between these pathologies can be difficult if solely based on imaging. We report for the first time to our knowledge a case of idiopathic transverse myelitis (ITM) mimicking a discrete cervical spinal lesion in a 66-year-old man who presented with gait instability and neck pain. The patient’s symptoms failed to resolve after an initial course of steroid therapy. Surgical biopsy confirmed the diagnosis of ITM. Subsequent treatment with dexamethasone resulted in complete resolution of the symptoms as well as the intramedullary enhancement. ITM is most common in the cervical and thoracic spine, spanning 3-4 spinal segments. It usually occupies more than 50% of the cross-sectional area of the spinal cord and tends to be central, uniform, and symmetric. It exhibits patchy and peripheral contrast enhancement. These criteria are useful guidelines that help distinguish ITM from neoplastic spinal lesions. A decision to perform biopsy must take into consideration the patient’s clinical symptoms, the rate of progression of neurological deficits, and the imaging characteristics of the lesion. Surgical biopsy for questionable lesions should be reserved for patients with progressive neurological deficits refractory to empirical medical therapy.
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Veznedaroglu, Erol, Peter K. Nelson, Pascal M. Jabbour, and Robert H. Rosenwasser. "Endovascular Treatment of Spinal Cord Arteriovenous Malformations." Neurosurgery 59, suppl_5 (November 1, 2006): S3–202—S3–209. http://dx.doi.org/10.1227/01.neu.0000237409.28906.96.
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Abstract SPINAL CORD ARTERIOVENOUS malformations are rare lesions that represent one-tenth of the brain arteriovenous malformations. Depending on their location and relationship to the dura, these lesions are divided into four categories. Their clinical manifestations may vary from mild symptoms to severe motor deficits. Spinal angiography remains the “gold standard” for diagnosing spinal cord vascular lesions. Although the type of shunting remains difficult to determine by the magnetic resonance imaging, it is well analyzed by spinal angiography. The cure of the shunting is not by itself a therapeutic goal, but the objective is the creation of a new hemodynamic equilibrium between the lesion and the spinal cord to decrease the risk of hemorrhage and prevent the progression of the spinal cord ischemia. The endovascular tools seem to be a reasonable therapeutic option for the treatment of the majority of the spinal cord arteriovenous malformations.
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Keegan, B. Mark, Timothy J. Kaufmann, Brian G. Weinshenker, Orhun H. Kantarci, William F. Schmalstieg, M. Mateo Paz Soldan, and Eoin P. Flanagan. "Progressive motor impairment from a critically located lesion in highly restricted CNS-demyelinating disease." Multiple Sclerosis Journal 24, no. 11 (July 26, 2018): 1445–52. http://dx.doi.org/10.1177/1352458518781979.
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Objective: To report progressive motor impairment from a critically located central nervous system (CNS) demyelinating lesion in patients with restricted magnetic resonance imaging (MRI)-lesion burden. Methods: We identified 38 patients with progressive upper motor-neuron impairment for >1 year, 2–5 MRI CNS-demyelinating lesions, with one seemingly anatomically responsible for progressive motor impairment. Patients with any alternative etiology for progressive motor impairment were excluded. A neuroradiologist blinded to clinical evaluation reviewed multiple brain and spinal-cord MRI, selecting a candidate critically located demyelinating lesion. Lesion characteristics were determined and subsequently compared with clinical course. Results: Median onset age was 47.5 years (24–64); 23 (61%) women. Median follow-up was 94 months (18–442); median Expanded Disability Status Scale Score (EDSS) at last follow-up was 4.5 (2–10). Clinical presentations were progressive: hemiparesis/monoparesis 31; quadriparesis 5; and paraparesis 2; 27 patients had progression from onset; 11 progression post-relapse. Total MRI lesions were 2 ( n = 8), 3 ( n = 12), 4 ( n = 12), and 5 ( n = 6). Critical lesions were located on corticospinal tracts, chronically atrophic in 26/38 (68%) and involved cervical spinal cord in 27, cervicomedullary/brainstem region in 6, thoracic spinal cord in 4, and subcortical white matter in 1. Conclusion: Progressive motor impairment may ascribe to a critically located CNS-demyelinating lesion in patients with highly restricted MRI burden. Motor progression from a specific demyelinating lesion has implications for understanding multiple sclerosis (MS) progression.
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Tude Melo, Jose Roberto, Pollyana Pacheco, and Luiz Eduardo Wanderley. "Unusual Spinal Dysraphic Lesions." Case Reports in Pediatrics 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/210301.
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Human tail and multiple spinal dysraphism are unusual congenital malformations. Human tail appeared as a prominent lesion from the lumbosacrococcygeal region, generally without connection between the tail and the neurospinal axis. Spinal dysraphisms are usually isolated, reaching 0.038% of incidence of multiple spinal dysraphisms in the same child. There were three cases described of unusual spinal dysraphic lesions: two cases of human tail and a case of a multiple thoracic myelomeningocele. The literature about diagnosis and treatment was reviewed. Microsurgical technique was performed to provide better exploration of the lesions, and resection could be done in those congenital malformations, without morbidity.
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Ramdial, Pratistadevi K., Sameer S. Nadvi, and Rene Mallett. "Cervical Spine Dysraphism with Teratoma Exhibiting Pulmonary Differentiation: Case Report and Review of the Literature." Pediatric and Developmental Pathology 1, no. 6 (November 1998): 528–33. http://dx.doi.org/10.1007/s100249900072.
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Spinal dysraphism and teratomas are well-recognized spinal cord lesions, but both entities are rare in the cervical spinal cord. Rarely, teratomas have been described within dysraphic lesions in the thoracic and lumbosacral regions. To date, teratomas contained within cervical spine dysraphic lesions have not been described. Although mature cystic teratomas are renowned for the array of organoid tissue differentiation they display, mature lung differentiation is a rarity. While pulmonary differentiation has been described in six female genital tract teratomas, it has not been reported in spinal teratomas. The clinicopathologic features of a complex cervical lesion, comprising a combination of cervical spine dysraphism with a mature cystic teratoma that exhibited pulmonary differentiation, is presented, and the literature on teratomas exhibiting pulmonary differentiation is reviewed.
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Everts, K. L., and D. K. Armentrout. "Report of Leaf Spot of Spinach Caused by Stemphylium botryosum in Maryland and Delaware." Plant Disease 85, no. 11 (November 2001): 1209. http://dx.doi.org/10.1094/pdis.2001.85.11.1209b.
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In October 2000, leaf spot symptoms were observed on spinach (Spinacia oleracea L. ‘Seven R’) at the University of Maryland Lower Eastern Shore Research and Education Center in Salisbury. In April 2001, a similar leaf spot disease was observed in two commercial spinach fields (cv. Vancouver) in Dorchester County, MD, and Sussex County, DE. Symptomatic plants occurred in foci, and overall disease incidence in the research and commercial fields was <10% of plants with lesions. However, low disease incidence may reduce the value of a spinach crop by requiring additional hand-sorting (fresh market) or lowering the grade (processing). Leaf spot lesions were small (0.2 to 0.7 cm), circular, tan, and papery and lacked visual signs of fungal infestation. Lesions resembled a new leaf spot of spinach reported in California (1) caused by Stemphylium botryosum Wallr. Plating surface-disinfested lesion margins on 0.25-strength potato dextrose agar consistently yielded S. botryosum. Single conidial cultures of three isolates were grown on V8 agar in a growth chamber with a 12 h light/dark regime at 21°C and were used for the pathogenicity test. Conidia were collected from 7-day-old colonies to test pathogenicity. Conidia were suspended in distilled water (1.1 × 105 conidia per milliliter), and sprayed on 4-week-old spinach plants (with four to six true leaves) of cvs. Seven R, Vancouver, and Melody. Noninoculated control plants were sprayed with deionized water. Plants were incubated for 72 h in a dew chamber (18°C, 9 to 15 h light/dark regime where dew formed during the dark periods) and then placed on a greenhouse bench (23°C) for 2 weeks. Plants that had been inoculated with any of the three isolates developed the aforementioned leaf spot lesions after 4 days in the greenhouse. Plants sprayed with deionized water were symptomless. One week after inoculation, more lesions were observed on ‘Seven R’ and ‘Vancouver’ than on ‘Melody’ (41, 39, and 1 lesion per plant, respectively; P< 0.0030), and the lesions were 1.5, 1.2, and 0.5 mm in diameter, respectively (P< 0.0001). S. botryosum was consistently reisolated from leaf spot lesions. The pathogenicity test was repeated with similar results. Isolates grown on V8 agar and incubated for ≈10 days produced conidia with mean dimensions of 31 × 19 μm. To our knowledge, this is the first report of leaf spot of spinach caused by S. botryosum in Maryland and Delaware. Reference: (1) S. T. Koike et al. Plant Dis. 85:126, 2001.
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Brownlee, Richard D., Arthur W. Clark, Robert J. Sevick, and S. Terence Myles. "Symptomatic hamartoma of the spinal cord associated with neurofibromatosis type 1." Journal of Neurosurgery 88, no. 6 (June 1998): 1099–103. http://dx.doi.org/10.3171/jns.1998.88.6.1099.
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✓ The authors present a case in which a symptomatic hamartoma was found in the spinal cord of a patient with neurofibromatosis type 1 (NF-1). This 52-year-old woman presented with painful urinary incontinence. Magnetic resonance (MR) imaging revealed an intramedullary lesion within the lower thoracic spinal cord and conus medullaris, which was surgically removed. Pathological investigation showed a hamartomatous lesion consisting of glial cells, ganglion cells, abundant disoriented axons, and thin-walled vessels. This case provides a pathological correlate to the hamartomatous lesions demonstrated on MR imaging in patients with NF-1 and illustrates that these benign lesions may become symptomatic and require neurosurgical intervention.
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Schramm, L. P., and R. H. Livingstone. "Inhibition of renal nerve sympathetic activity by spinal stimulation in rat." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 252, no. 3 (March 1, 1987): R514—R525. http://dx.doi.org/10.1152/ajpregu.1987.252.3.r514.
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We determined the physiological and anatomical properties of systems mediating renal nerve inhibition elicited by electrical and chemical stimulation of the cervical dorsolateral funiculus of the anesthetized spinally transected rat. Stimulus-response characteristics suggested that this system was well suited for a role in tonic inhibition of sympathetic activity. Inhibition was elicited from a region of the cervical spinal cord extending from a lateral position near the accessory nerve to the dorsal columns. Inhibition could not be elicited by spinal stimulation before lesions had been placed rostral to stimulation sites in the lateral funiculi. Inhibition was blocked by similarly placed lesions caudal to stimulation sites. Therefore, this system may course in the lateral funiculus, and it may be tonically active in intact rats. Renal sympathetic activity could be inhibited by electrical stimulation caudal to large, chronic, spinal lesions. Therefore, some component of the inhibitory system was either antidromically activated or propriospinal. Glutamate applied to the dorsolateral surface of the cervical spinal cord elicited inhibition indistinguishable from that elicited by electrical stimulation, which suggested that neurons with somas located superficially at cervical levels may be responsible for some component of the spinally elicited inhibition.
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Moccia, Marcello, Serena Ruggieri, Antonio Ianniello, Ahmed Toosy, Carlo Pozzilli, and Olga Ciccarelli. "Advances in spinal cord imaging in multiple sclerosis." Therapeutic Advances in Neurological Disorders 12 (January 2019): 175628641984059. http://dx.doi.org/10.1177/1756286419840593.
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The spinal cord is frequently affected in multiple sclerosis (MS), causing motor, sensory and autonomic dysfunction. A number of pathological abnormalities, including demyelination and neuroaxonal loss, occur in the MS spinal cord and are studied in vivo with magnetic resonance imaging (MRI). The aim of this review is to summarise and discuss recent advances in spinal cord MRI. Advances in conventional spinal cord MRI include improved identification of MS lesions, recommended spinal cord MRI protocols, enhanced recognition of MRI lesion characteristics that allow MS to be distinguished from other myelopathies, evidence for the role of spinal cord lesions in predicting prognosis and monitoring disease course, and novel post-processing methods to obtain lesion probability maps. The rate of spinal cord atrophy is greater than that of brain atrophy (−1.78% versus −0.5% per year), and reflects neuroaxonal loss in an eloquent site of the central nervous system, suggesting that it can become an important outcome measure in clinical trials, especially in progressive MS. Recent developments allow the calculation of spinal cord atrophy from brain volumetric scans and evaluation of its progression over time with registration-based techniques. Fully automated analysis methods, including segmentation of grey matter and intramedullary lesions, will facilitate the use of spinal cord atrophy in trial designs and observational studies. Advances in quantitative imaging techniques to evaluate neuroaxonal integrity, myelin content, metabolic changes, and functional connectivity, have provided new insights into the mechanisms of damage in MS. Future directions of research and the possible impact of 7T scanners on spinal cord imaging will be discussed.
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Angevine, Peter D., Christopher Kellner, Raqeeb M. Haque, and Paul C. McCormick. "Surgical management of ventral intradural spinal lesions." Journal of Neurosurgery: Spine 15, no. 1 (July 2011): 28–37. http://dx.doi.org/10.3171/2011.3.spine1095.
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Object Access to the ventral intradural spinal canal may be required for treatment of a variety of lesions affecting the spinal cord and adjacent intradural structures. Adequate exposure is usually achieved through a standard posterior laminectomy or posterolateral approaches, although formal anterior approaches are used to access lesions in the subaxial cervical spine. Modifications of the standard posterior exposure as well as ventral or ventrolateral approaches are increasingly being used for treating intradural spinal pathologies. In this study, the authors review their experience with 35 consecutive cases of ventral intradural spinal lesions. Methods Only patients with intradural lesions located completely ventral to the dentate ligament attachments were included in this retrospective study. Patients with the following lesions were excluded from the study: lesions at the level of the filum terminale/cauda equina, lesions with any component that extended dorsally to the dentate ligament, or lesions with extradural extension (that is, dumbbell tumors) below the C-2 level. Between January 2000 and September 2009, a total of 35 patients (age range 17–72 years, mean 42.6 years) with ventral intradural spinal pathology underwent surgery at the authors' institution. Results There were 28 intradural extramedullary mass lesions: 15 meningiomas, 12 solitary schwannomas, and 1 neuroenteric cyst. Surgical approaches to these lesions included 23 posterior or posterolateral approaches, 4 anterior approaches with corpectomy followed by tumor resection and reconstruction, and 1 lateral transforaminal resection. No patient had evidence of instability at follow-up, which ranged from 6 months to 8 years in duration. One patient had worsened spinal cord function following surgery. There were 7 patients with intramedullary lesions: 2 hemangioblastomas, 2 cavernous malformations, 2 perimedullary fistulas, and 1 astrocytoma. All but 1 were superficial pia-based lesions arising ventral to the dentate ligament. Five of the 6 pia-based lesions were successfully resected via a standard posterior laminectomy, partial facetectomy with dentate section, and spinal cord rotation. One midline pial lesion was successfully removed with a minimally invasive retropleural thoracotomy. The astrocytoma was resected through an anterior cervical corpectomy, which was followed by instrumented reconstruction. There were no significant complications or neurological morbidity at follow-up (range 9 months–6 years). Conclusions Most intradural spinal lesions can be treated with contemporary microsurgical techniques with long-term control or cure of the lesion and preservation of neurological function. Standard posterior approaches provide adequate exposure to safely remove the vast majority of these lesions without the need for a potentially destabilizing resection of the facet or pedicle. Posterior exposures with varying degrees of lateral bone resection, dentate ligament division, and gentle cord rotation may also provide adequate exposure for safe removal of nonmidline ventrolateral superficial pial presenting spinal cord lesions. Nevertheless, in certain cases of ventral intradural lesions, anterior approaches are necessary and should be considered under appropriate circumstances.
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Koch-Wiewrodt, Dorothee, Wolfgang Wagner, and Axel Perneczky. "Unilateral multilevel interlaminar fenestration instead of laminectomy or hemilaminectomy: an alternative surgical approach to intraspinal space-occupying lesions." Journal of Neurosurgery: Spine 6, no. 5 (May 2007): 485–92. http://dx.doi.org/10.3171/spi.2007.6.5.485.
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✓Laminectomy is the most conventional dorsal approach to intraspinal space-occupying lesions and may result in gradually increasing instability or deformity of the vertebral column. Less invasive procedures such as hemilaminectomy and osteoplastic laminotomy have been described by other authors, but an approach that interferes with spinal stability to an even lesser extent seems desirable. In an attempt to further reduce the need for bone removal, the authors used interlaminar fenestration (mostly unilateral) at one or more spinal levels to remove intramedullary, extramedullary, or extradural lesions, and even some lesions that extended over several spine segments. The authors present their experiences with this surgical approach in 78 patients harboring different intraspinal lesions. Up to 16 segments were fenestrated in one patient. Complete removal of the lesion was possible in most patients, and no postoperative spinal instabilities were observed in up to 8 years of follow up. Multilevel interlaminar fenestration, also called “multiple spinal keyhole surgery,” is a feasible, safe, and effective approach to intraspinal lesions.
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Knerlich-Lukoschus, Friederike, Beata von der Ropp-Brenner, Ralph Lucius, Hubertus Maximilian Mehdorn, and Janka Held-Feindt. "Spatiotemporal CCR1, CCL3(MIP-1α), CXCR4, CXCL12(SDF-1α) expression patterns in a rat spinal cord injury model of posttraumatic neuropathic pain." Journal of Neurosurgery: Spine 14, no. 5 (May 2011): 583–97. http://dx.doi.org/10.3171/2010.12.spine10480.
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Object Central neuropathic pain is a frequent challenging complication after spinal cord injury (SCI), and specific therapeutic approaches remain elusive. The purpose of the present investigations was to identify potential key mediators of these pain syndromes by analyzing detailed expression profiles of important chemokines in an experimental SCI paradigm of posttraumatic neuropathic pain in rats. Methods Expression of CCR1, CCL3(MIP-1α), CXCR4, and CXCL12(SDF-1α) was investigated in parallel with behavioral testing for mechanical and thermal nociceptive thresholds after standardized SCI; 100-kdyn (moderate injury) and 200-kdyn (severe injury) force-defined thoracic spinal cord contusion lesions were applied via an Infinite Horizon Impactor at the T-9 level. Sham controls received laminectomies. Hindlimb locomotor function as well as mechanical and thermal sensitivities were monitored weekly by standardized behavioral testing after SCI. Chemokine expression was analyzed by real-time reverse transcriptase polymerase chain reaction in the early (7 days postoperatively) and late (42 days postoperatively) time courses after SCI, and immunohistochemical analysis (anatomical and quantitative) was performed 2, 7, 14, and 42 days after lesioning. Double staining with cellular markers and pain-related peptides (substance P and CGRP) or receptors (TRPV-1, TRPV-2, VRL-1, and TLR-4) was performed. Based on data obtained from behavioral testing, quantified immunohistochemical chemokine expressions in individual animals were correlated with the respective mechanical and thermal sensitivity thresholds 6 weeks after SCI. Results After 200-kdyn lesions, the animals exhibited prolonged reduction in their nociceptive thresholds, while 100-kdyn groups showed pain-related behaviors only in the early time course after SCI. Investigated chemokines were widely induced after SCI, involving cervical, thoracic, and lumbar spinal cord levels far beyond the lesion core. CCR1 and CCL3 were induced significantly in the dorsal horns 2 days after lesioning and remained at high levels after SCI with significantly higher intensities after 200-kdyn than 100-kdyn contusions. CXCR4 and CXCL12 levels continuously increased from 2 to 42 days after moderate and severe lesions. Additionally, chemokines were induced significantly in dorsal columns, with highest density levels 42 days after 200-kdyn lesions. In dorsal horns, CCR1 was coexpressed with TRPV-1 while CXCR4 and CXCL12 were partially coexpressed with substance P and CGRP. In dorsal columns, CCL3/CCR1 colabeled with GFAP, TRPV-2, TRPV-1, TLR-4; CXCR4/CXCL12 coexpressed with GFAP, CD68/ED1, and TLR4. Chemokine immunoreactivity density levels, especially CCL3 and its receptor, correlated in part significantly with nociceptive thresholds. Conclusions The authors report lesion grade–dependent upregulation of different chemokines/chemokine receptors after spinal cord contusion lesions in pain-processing spinal cord regions in a clinically relevant model of traumatic SCI in rats. Prolonged chemokine induction further correlated with below-level pain development in the delayed time course after severe SCI and was coexpressed with pain-associated peptides and receptors, suggesting that chemokines play a crucial role in chronic central pain mechanisms after SCI.
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Phadke, Rajendra V., Avik Bhattacharyya, Akash Handique, Krishan Jain, Alok Kumar, Vivek Singh, Deb Baruah, Tushant Kumar, Sriram Patwari, and B. Madan Mohan. "Endovascular Treatment in Spinal Perimedullary Arteriovenous Fistula." Interventional Neuroradiology 20, no. 3 (January 1, 2014): 357–67. http://dx.doi.org/10.15274/inr-2014-10056.
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This study includes 20 patients with 21 spinal perimedullary fistulae. There were nine Type IVa (42.8%) lesions, ten Type IVb (47.6%) and two Type IVc (9.5%) lesions. The dominant arterial supply was from the anterior spinal artery (47.6%), posterior spinal artery (19%) and directly from the radiculomedullary artery (28.5%). Sixteen lesions in 15 patients were treated by endovascular route using n-butyl-2-cyanoacrylate. Endovascular treatment was not feasible in five patients. Of the ten patients with microfistulae, catheterization failed/was not attempted in 40%, complete obliteration of the lesion was seen in 60% but clinical improvement was seen in 40% of patients. Catheterization was feasible in all ten patients with macrofistulae (nine type IVb and two type IVc lesions). Complete obliteration of the lesions was seen in 60% and residue in 30%. Clinical improvement was seen in 80% and clinical deterioration in 10%. In conclusion, endovascular glue embolization is safe and efficacious in type IVb and IVc spinal perimedullary fistulae and should be considered the first option of treatment. It is also feasible in many of the type IVa lesions.
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Endo, Toshiki, Yoko Takahashi, Atsuhiro Nakagawa, Kuniyasu Niizuma, Miki Fujimura, and Teiji Tominaga. "Use of Actuator-Driven Pulsed Water Jet in Brain and Spinal Cord Cavernous Malformations Resection." Operative Neurosurgery 11, no. 3 (June 25, 2015): 394–403. http://dx.doi.org/10.1227/neu.0000000000000867.
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Abstract BACKGROUND A piezo actuator-driven pulsed water jet (ADPJ) system is a novel surgical instrument that enables dissection of tissue without thermal damage. It can potentially resect intra-axial lesions while preserving neurological function. OBJECTIVE To report our first experience of applying an ADPJ system to brain and spinal cord cavernous malformations. METHODS Four patients (2 women and 2 men, mean age 44.5 years) with brain (n = 3) and spinal cord (n = 1) cavernous malformations were enrolled in the study. All surgeries were performed with the aid of the ADPJ system. Postoperative neurological function and radiological findings were evaluated. RESULTS The ADPJ system was useful in dissecting boundaries between the lesion and surrounding brain/spinal cord tissues. The pulsed water jet provided a clear surgical view and helped surgeons follow the margins. Water jet dissection peeled off the brain and spinal cord tissues from the lesion wall. Surrounding gliotic tissue was preserved. As a consequence, the cavernous malformations were successfully removed. Postoperative magnetic resonance imaging confirmed total removal of lesions in all cases. Preoperative neurological symptoms completely resolved in 2 patients. The others experienced partial recovery. No patients developed new postoperative neurological deficits; facial palsy temporarily worsened in 1 patient who underwent a suprafacial colliculus approach for the brainstem lesion. CONCLUSION The ADPJ provided a clear surgical field and enabled surgeons to dissect boundaries between lesions and surrounding brain and spinal cord gliotic tissue. The ADPJ system is a feasible option for cavernous malformation surgery, enabling successful tumor removal and preservation of neurological function.