0:01

I'd like to summarize what we've learned in.

0:03

This series of sessions on intradural

0:07

intramedullary cord lesions.

0:09

So let's start with our Mnemonic.

0:12

On the V side of things,

0:14

we emphasize that the most common vascular.

0:16

malformation in the spinal.

0:17

cord is the cavernoma.

0:19

There are numerous vascular malformations.

0:22

that can be evaluated and this sometimes.

0:26

requires dynamic MRA. For best evaluation,

0:31

we talked about cord infarcts and usually.

0:33

in the setting of aortic disease either.

0:37

treatment thereof or dissections.

0:40

of the aorta or its branches.

0:43

From the standpoint of infectious.

0:45

inflammatory lesions we emphasize that viral.

0:49

etiologies for myelitis are the most common.

0:52

and there are a whole wealth of infectious.

0:55

etiologies that we consider.

0:57

in patients who have AIDS.

0:59

Of the noninfectious inflammatory lesions,

1:02

sarcoidosis will predominate but we do have.

1:05

all of those other collagen vascular.

1:07

diseases including lupus.

1:10

Trauma to the spinal cord is unusual when it.

1:14

occurs in association with hemorrhage.

1:16

The patient's prognosis is quite poor.

1:19

Particularly when you have a long segment.

1:21

Hematomyelia, in which case the patient's.

1:24

Unlikely to have complete recovery.

1:26

Of their neurologic deficits.

1:28

From the standpoint of acquired and.

1:30

Metabolic, we think about vitamin B12.

1:33

Folate and copper deficiency as potential causes.

1:37

Of subacute combined degeneration affecting the posterior.

1:40

Columns with the eye.

1:42

We're usually thinking about idiopathic.

1:45

Disorders, and for that is where we put our.

1:47

Demyelinating disorders, be it adem.

1:52

Multiple sclerosis, neuromyelitis.

1:55

Optica in alphabetical order.

1:58

Those etiologies may have multifocal lesions.

2:03

They may have brain lesions as well, and we.

2:06

Usually say to make sure that you.

2:07

Scan the entire neuroaxis.

2:09

When we're considering patients with.

2:11

Multiple sclerosis, neuromyelitis.

2:18

The end of neoplasm is usually separated.

2:22

Depending upon whether we're dealing with.

2:23

Children and cervical spine, in which case.

2:26

We favor astrocytoma, and adults.

2:29

And the lumbosacral spine.

2:30

Where we're usually favoring ependymoma.

2:33

That said,

2:33

there are other potential etiologies of

2:38

neoplasms, including hemangioblastomas, in the

2:41

setting of von Hippolindal disease, and

2:44

metastases in patients who generally

2:47

have breast or lung cancer.

2:50

Of the congenital lesions,

2:52

we focused on Chiari I malformation that

2:57

is cerebellar tonsillar descent

2:59

through the foramen magnum.

3:00

And magnum in association with

3:02

hydromyelia, that is,

3:04

dilatation of the central canal of the

3:06

spinal cord, which occurs in about one third

3:09

of cases who have Chiari I malformation.

3:12

I also showed that bizarre norenteric

3:15

cyst case where you can have both

3:20

intradural extramedullary and intradural

3:23

intramedullary manifestations

3:25

of norenteric cysts.

3:28

Within this category,

3:30

I would probably also include the

3:32

neurodegenerative disorders of the spinal

3:34

cerebellar ataxia, which may be transmitted

3:38

in a genetic fashion. Finally,

3:41

we have drugs, and the drug that I mentioned

3:43

was nitrous oxide toxicity that can occur

3:49

in both recreational use or occasionally

3:52

iatrogenic overdose of nitrous

3:55

oxide used as an anesthetic.

3:58

This too will influence the posterior

4:01

columns of the spinal cord.

4:04

So clinical history is very important.

4:06

This is the opportunity for you to make the

4:09

optimal use of the review of the

4:12

electronic medical record.

4:14

Remember that not all enlarged

4:16

cords are neoplasms.

4:17

We saw cases of inflammatory lesions,

4:21

rare demyelinating lesions, including

4:23

transverse myelitis.

4:25

The acute setting of spinal cord strokes

4:28

and some of these may also show faint

4:32

enhancement like neoplasm.

4:34

So some of your myelidities,

4:36

infectious and noninfectious myelidities,

4:39

may simulate neoplasm in this instance.

4:42

Again,

4:42

refer to the electronic medical record or

4:45

recommend specific CSF or blood laboratory

4:50

tests that might point to

4:53

a correct diagnosis.

4:55

So search for corroborative findings

4:57

elsewhere on the scans or in scans

4:59

of the entire CNS axis.

5:02

By that, I mean if you're looking at a

5:04

patient who has a neoplasm in

5:06

the thoracic lumbar region,

5:08

look for renal cell carcinoma or cysts or

5:12

other regions that might suggest

5:14

von Hippolindal disease.

5:15

Look in the paraspinal location or in the

5:18

neural pharamina in order to potentially

5:21

make the diagnosis of neurofibromatosis type

5:24

one or neurofibromatosis type two.

5:27

Remember that neurofibromatosis type 1 may

5:29

lead to dural ectasias and posterior

5:32

scalloping of the bone, and that might be

5:34

useful in identifying the etiology for a

5:38

cord mass that would be an astrocytoma

5:41

associated with NF one.

5:44

Similarly,

5:44

if you find lesions in the spinal cord,

5:48

look at the brain.

5:50

This is useful for the demyelinating

5:52

disorders of multiple sclerosis, but

5:54

also for the fake comatoses,

5:56

including von Hippolindal disease

5:58

and neurofibromatosis type.

6:00

One or type two and for the presence of

6:03

Menostatic disease if there are multiple

6:05

lesions. On that basis,

6:07

clearly, the intraduro intermediary

6:11

evaluation of the spinal canal is replete

6:15

with multiple fascinating lesions.

6:17

And I hope you enjoyed this session.

6:20

Thank you very much for your attention.