Interactive Transcript
0:01
Well, up till now we have discussed the neoplastic category of
0:07
diseases with schwannomas and meningiomas dominating.
0:10
We've talked about congenital lesions and discussed
0:15
various cysts, as well as lipomas and the various
0:19
congenital lesions including epidermoids and dermoids.
0:23
We also discussed the entities associated with
0:28
vascular malformations of the spinal cord.
0:31
I want to conclude this section with some discussion
0:36
about infectious inflammatory etiologies,
0:38
the so-called "I" of VITAMIN C and D.
0:42
So within the infectious inflammatory etiologies, we're
0:44
usually talking about some form of meningitis or neuritis.
0:48
And this is usually manifested as nerve root enhancement
0:52
of the cauda equina nerve roots and there are
0:55
various etiologies of that enhancement.
1:00
We're going to start off by talking about
1:01
infectious inflammatory lesions.
1:03
You can have enhancement of the nerve roots purely
1:06
on the basis of operative irritation.
1:09
This is what we sometimes call arachnoiditis,
1:12
or adhesive arachnoiditis.
1:15
We have Guillain Barré syndrome,
1:17
which is kind of an autoimmune entity that
1:20
is associated with a previous infection.
1:24
You can have irritation from chemicals such as pantopaque,
1:28
which is one of the agents that we used to use for
1:31
myelography that irritates the nerve roots.
1:34
And of course,
1:34
we have the subarachnoid seeding neoplastic category,
1:37
which we've already described.
1:38
And here you see, once again, that patient who had the
1:42
breast cancer with the enhancing nerve roots
1:44
at the cauda equina and conus medullaris.
1:47
When we think about infectious causes of nerve root
1:51
enhancement, there are a variety of etiologies,
1:55
most common of which are going to be viral etiologies.
1:58
So West Nile virus, Cytomegalovirus, and Herpes Zoster, are three
2:04
viruses that will lead to irritation of the nerve roots
2:08
and a secondary neuritis and/or meningitis.
2:12
With respect to the infectious bacterial diseases,
2:17
we would worry about things like
2:18
Lyme's disease or tuberculosis.
2:22
You may have fungal infections also and there may be
2:25
other bacterial infections that are associated with
2:28
patients having a discitis or osteomyelitis in the
2:32
extradural compartment. Here we have an example of
2:35
thickened nerve roots that are very faintly enhancing.
2:38
And this was cryptococcus,
2:40
a type of fungal infection that was leading to
2:44
the cauda equina syndrome. As I mentioned,
2:47
Guillain-Barré syndrome is syndrome that kind of crosses
2:52
the boundaries between infectious and autoimmune
2:56
inflammatory condition, sometimes called an acquired
3:00
demyelinating polyneuropathy.
3:02
This is typically manifested by diffused
3:04
nerve root enhancement.
3:06
It tends to favor the motor nerves
3:09
over the sensory nerves.
3:10
And that's why you may see selective anterior
3:13
nerve root enhancement. With treatment,
3:16
and the treatment is usually sort
3:17
of immunosuppressive treatment,
3:19
you may see diminution in the contrast enhancement.
3:23
Many of these patients have a GI infection,
3:26
a Campylobacter infection, that may
3:28
be the antecedent infection.
3:30
That leads to the autoimmune reaction on the cauda equina
3:35
nerve roots, the peripheral nerve roots.
3:37
And here you see a pretty dramatic example.
3:39
This looks like a child based on
3:41
the configuration of the spine.
3:42
But you see this diffuse enhancement on the conus medullaris
3:46
extending to the nerve roots of the cauda equina.
3:50
Of the noninfectious inflammatory conditions,
3:54
we usually think about sarcoidosis.
3:56
Sarcoidosis, like lymphoma,
4:00
can affect all parts of the spinal canal.
4:02
So it can be extradural in the bone,
4:05
it can be intradural extramedullary affecting the nerve roots,
4:08
and it can be intramdulary with an inflammatory
4:11
condition that leads to a myelitis.
4:14
The signal intensity is variable. Most of the time
4:17
you'll see this on the surface of the spinal cord
4:20
or on the surface of the nerve roots.
4:22
And the spinal abnormality may or may not be
4:27
associated with intracranial involvement.
4:29
Here's an example of a patient who had sarcoidosis in
4:33
which there was manifestation on the surface of the
4:35
spinal cord which eventually grew into the cord.
4:39
So this is both superficial intradural extramedullary,
4:43
as well as intramedullary involvement with sarcoidosis.
4:47
The same phenomenon can occur in the brain where we
4:50
initially see the sarcoidosis affecting the
4:52
meninges, and then in its severe form,
4:55
it grows into the parenchyma of the brain, as well.
4:58
This is another example of sarcoidosis, but in this case,
5:02
basically mostly affecting the cauda equina nerve roots.
5:05
These all look alike, so this could be Guillain-Barré,
5:08
this could be subarachnoid seeding.
5:10
It's effectively enhancement of the nerve
5:12
roots and sparing of the spinal cord, in this example.
5:17
I'm showing this as an intracranial manifestation
5:20
of sarcoidosis where the patient had fifth nerve
5:23
enhancement, as well as right third
5:25
nerve enhancement intracranially.
© 2024 Medality. All Rights Reserved.