Scribd Logo
Upload

Welcome to Scribd!

  • 33 views

    03 Prezentaredecaz

    Uploaded by

    Karina Teodora

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    03 Prezentaredecaz

    Uploaded by

    Karina Teodora
    33 views21 pages

    Original Title

    03_prezentaredecaz

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    33 views21 pages

    03 Prezentaredecaz

    Uploaded by

    Karina Teodora

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 21

    Cervical medular compression

    case presentation
    MD. Phd. Amalia Cornea
    University of Medicine and Pharmacy ”V. Babes”
    Clinica Neurologie II – Clinical Emergency Hospital “Pius Brinzeu”
    Timisoara
    Admission:
    • CC, 41 years
    • quadriparesis
    Onset of symptoms:
    • 2 weeks ago ER presentation with R hemiparesis (A>L)
    • Over a month ago paresthesia R hand and arm > R leg , shortly followed
    by motor deficit in the same territory
    • A couple of days ago – motor deficit in L leg > Larm

    Admission date :06 Apr 2020


    Past medical history
    • Lumbar disc hernia

    Life conditions
    • Anteriorly fully ambulatory and independent (before the onset of the
    symptoms)

    Anterior treatment
    • No chronic medication
    Admission Neurologic examination I

    Physical examination: Overweight, otherwise normal


    Neurologic examination
    • Romberg and Gait – sitting possible
    • Coordination
    • L MS dysmetria; R MS not possible
    • Muscle force
    • R MS 1/5 - R MI 2/5
    • L MS 4/5 – L MI 3/5
    Admission Neurologic examination II
    • Sensation
    • R hemi body hypoesthesia but…
    • T8/T10
    • Paraesthesia arms and legs R>L
    • ROT normal
    • PCR: bilateral extension
    • Negative Hoffman - bilateral
    Admission Neurologic examination III (continuation)
    Cranial nerves
    • CN II: normal visual field, normal photo motor response
    • CN III, CN IV, CN IV normal
    • CN V normal
    • CNVII facial symmetry, normal face grimaces
    • CN VIII: normal
    • CN IX, X: normal
    • CN XI (trapezius and SCM), XII (tongue): Normal
    • Oriented to himself, place and time
    Clinical Syndrome?
    • Onset - subacute/chronic – weeks, steady progressing

    • MAIN “complaint” – at the moment of evaluation


    • Tetra paresis
    • Level of sensory impairment

    • Level of the lesion?


    • UMN/LMN?
    • Please identify the anatomical structures involved and mark them on a MRI
    spinal chord image-sagittal view

    https://pubs.rsna.org/doi/full/10.1148/rg.2018170178
    Nerve roots and peripheral nerves
    corresponding to the principal movements of
    the upper extremity
    Location of lesion in dorsal cord syndrome

    Location of lesion in central


    cord syndrome

    Location of
    lesion in
    Brown-Sequard
    syndrome

    Official reprint from UpToDate®


    © 2020 UpToDate, Inc. and/or its affiliates. All
    Rights Reserved.www.uptodate.com
    Typical Atypical

    • Large or disproportionate amount of associated


    • Smooth contour
    edema Intratumoral cystic change
    • Homogeneous
    • Extensive bone involvement
    enhancement
    • Brain or leptomeningeal invasion
    • Dural tail
    • Low apparent diffusion coefficient
    • Calcification
    • Elevated cerebral blood volume
    Presentation and course
    • a chronic compression syndrome
    • displacement of the spinal cord
    • back pain
    • Meningiomas at a high cervical level or the foramen magnum
    • quadriparesis
    • lower cranial nerve involvement
    • dysphagia
    • respiratory disturbances
    • Horner syndrome
    • facial hypo/paresthesis - compression of the descending sensory root of
    the trigeminal nerve.
    Treatment
    Etiologic treatment:
    Neurosurgery

    Anatomopathologic result:

    • Meningioma grade I
    Location of Meningioma and Site-Specific Symptoms

    Tumor location Site-specific symptoms


    Convexity Headaches, seizures, motor and sensory deficits
    Parasagittal Anterior: chronic headaches, memory and behavior changes
    Middle: motor and sensory deficits
    Posterior: homonymous hemianopsia
    All: venous occlusion
    Sphenoid ridge Medial: visual loss, cranial nerve III, IV, V1, VI palsies
    Lateral: headaches, seizures, motor and sensory deficits
    Lateral ventricle Headaches, seizures, hydrocephalus
    Location of Meningioma and Site-Specific Symptoms

    Tentorium Ataxia, headaches, visual loss, diplopia


    Cerebellar convexity Headaches, ataxia, dizziness, facial pain, dysarthria
    Tuberculum-sellae Visual loss, headaches, optic atrophy, noncongruent
    homonymous hemianopsia
    Optic nerve sheath Visual loss
    Cerebello-pontine angle Hearing loss, headaches, ataxia, dizziness, tinnitus, facial
    palsy
    Olfactory groove Anosmia, Foster Kennedy syndrome, headaches
    Foramen magnum Nuchal and occipital pain, emesis, ataxia, dysphagia, motor
    and sensory deficits
    Clivus Headaches, emesis, ataxia, motor and sensory deficits
    Other —————
    This posterolateral approach shows the deviation of the
    spinal cord by the tumor. (Contributed by Dr. Sherman
    Stein.)

    Contrast enhanced, T1-weighted, sagittal image, showing


    an enhancing, discrete, intradural tumor lateral to the
    deviated spinal cord. (Contributed by Dr. Sherman Stein.)
    INTRAMEDULLARY TUMORS Pilocytic astrocytoma
    Ependymomas Cervical spine MRI postenhancement in a 20-year-
    old male.
    (A) The sagittal image demonstrates a contrast-
    enhancing, circumscribed lesion at the C6-7 level
    (arrow).

    Sagittal and axial C+ a small, cauda equine


    lesion (arrow) found in a 49-year-old
    woman with left buttock and leg pain.
    diagnosis of myxopapillary ependymoma
    was confirmed.

    (B) Axial images


    INTRADURAL EXTRAMEDULLARY TUMORS

    A 70-year-old woman presented with a several-


    week history of confusion. Panels (A, B): Non-
    contrast and contrast-enhanced head CT shows a
    large bifrontal lesion with calcifications and
    surrounding edema. Panels (C, D): Non-contrast
    and contrast-enhanced T1-weighted axial MR
    images of the head also demonstrate large flow
    voids representing blood vessels in the center of
    the tumor. Panel (E): Non-contrast T1- weighted
    sagittal MR image. Panel (F): Contrast-enhanced
    T1-weighted coronal MR image.
    Neurofibromas
    NF1
    INTRADURAL EXTRAMEDULLARY TUMORS
    NF2
    Schwanommas

    Malignant nerve sheath tumors – sarcomas


    neurofibromatosis type 1 (NF1), peripheral N

    33-year-old presented with a three-


    month history of biologic pain and
    progressive perineal numbness. MRI T1-
    weighted contrast image revealed a
    heterogeneously enhancing lesion at L2-
    3; Sagittal (a) and Axial (b) images show
    the lesion filling the thecal sac. The
    tumor was approached via an L2-3
    laminectomy with intradural exploration.
    The tumor was debulked followed by
    sacrifice of the sensory roots from which
    it arose. Patient had increased perineal
    numbness postoperatively which
    completely resolved at one month.
    EXTRADURAL PRIMARY TUMORS Thoracic spine osteoblastoma on MRI
    Chondrosarcoma

    Bone window of a coronal CT scan


    shows a chondrosarcoma of the right
    clivus.

    A 15-year-old male who presented with back pain and was found to have an osteoblastoma of the
    thoracic spine. Image A is an axial MRI T2-weighted image of the thoracic spine (arrow).

    You might also like