Electrophysiological Investigation of Disorders of the Spinal Cord

Eisen, Andrew

doi:10.1007/978-1-4471-0911-2_11

Cited by 4 publications

(9 citation statements)

References 92 publications

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“…Overflow incontinence and inability to empty the bladder characterize a lower motor neuron injury [ 1 ], supporting the hypothesis of damage to the sacral cord segments and/or cauda equina roots S2-S4. In this case, the presence of lumbar trauma with a fractured L5 vertebra favored a lesion to the sacral roots as the most likely cause of urinary dysfunction [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Posing as Ascites: A Case Report on Neurogenic Lower Urinary Tract Dysfunction

Sousa¹,

Andrade²

2023

Cureus

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Lower urinary tract dysfunction (LUTD) is a frequently neglected and underdiagnosed condition, especially in cases of neurogenic etiology where no other neurological deficits are present. The evaluation of the integrity of the spinal cord segments responsible for the neurophysiologic control of the bladder and sphincters is fundamental for correctly establishing a neurogenic etiology.We present the case of a 52-year-old female complaining of abdominal pain, new onset of urinary straining, a slow/intermittent stream, and stress incontinence, following inpatient admission for a history of constitutional syndrome and falls. A fluid wave sign was observed on physical examination. An abdominal CT scan showed bladder hyperdistention and an L5 body compression fracture. A urinary catheter was placed, draining 2,000 mL of urine. On neuro-urological examination, diminished anal sphincter tone, diminished voluntary anal contraction, and absent left anal reflex were noted. Findings on the urodynamic study further favored the diagnosis of lower motor neuron bladder dysfunction. This case report demonstrates how the neurologic examination of the sacral segments S2-S4 allowed the diagnosis and subsequent management of an initially unexplained bladder dysfunction, as our clinical findings were compatible with damage to the sacral roots. The complete neuro-urological examination is fundamental for correctly determining the neurogenic etiology of LUTD and should be routinely integrated into the neurological evaluation.

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Section: Discussionmentioning

confidence: 99%

Posing as Ascites: A Case Report on Neurogenic Lower Urinary Tract Dysfunction

Sousa¹,

Andrade²

2023

Cureus

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“…Spinal interneurons were identified as neurons less than 24 μm in minimal diameter (measured at the nucleolar level) situated in the grey matter of the anterior horn ventral to the central canal, and α-motoneurons as those >32 μm in minimum diameter in the same region [ 3 , 11 ].…”

Section: Methodsmentioning

confidence: 99%

Age-Related Uptake of Heavy Metals in Human Spinal Interneurons

Pamphlett

Jew

2016

PLoS ONE

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Toxic heavy metals have been implicated in the loss of spinal motoneurons in amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). Motoneuron loss in the spinal anterior horn is severe in ALS/MND at the time of death, making this tissue unsuitable for examination. We therefore examined spinal cords of people without muscle weakness to look for any presence of heavy metals that could make these neurons susceptible to damage. Spinal cord samples from 50 individuals aged 1–95 y who had no clinical or histopathological evidence of spinal motoneuron loss were studied. Seven μm formalin-fixed paraffin-embedded sections were stained for heavy metals with silver nitrate autometallography (AMGHM) which detects intracellular mercury, silver or bismuth. Neurons in the spinal cord were classified as interneurons or α-motoneurons based on their site and cell body diameter. Spinal interneurons containing heavy metals were present in 8 of 24 people (33%) aged 61–95 y, but not at younger ages. These AMGHM interneurons were most numerous in the lumbar spinal cord, with moderate numbers in the caudal cervical cord, few in the rostral cervical cord, and almost none in the thoracic cord. All people with AMGHM interneurons had occasional AMGHM staining in α-motoneurons as well. In one man AMGHM staining was present in addition in dorsomedial nucleus and sensory neurons. In conclusion, heavy metals are present in many spinal interneurons, and in a few α-motoneurons, in a large proportion of older people. Damage to inhibitory interneurons from toxic metals in later life could result in excitotoxic injury to motoneurons and may underlie motoneuron injury or loss in conditions such as ALS/MND, multiple sclerosis, sarcopenia and calf fasciculations.

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“…Ultimately this leads to venous hypertension, which, in turn, can precipitate many neurological deficits secondary to mass effect and normal spinal blood flow disruption. Associated arterial aneurysms are common but in rare cases can lead to hemorrhaging [1,3,6,8,9].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Patients often present with sensory and/or motor disturbances. The onset of neurological symptoms may be progressive or abrupt, usually, in the case of hemorrhaging [1,6,11].…”

Section: Clinical Picturementioning

confidence: 99%

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A Rare Case of Cervical Spinal Arteriovenous Malformation: A Case Report

Ošiņa,

Jurjāns,

Kupčs

et al. 2024

Medicina

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Arteriovenous malformation (AVM) is an abnormal connection of vasculature resulting in capillary bed bypassing and leading to neurological deterioration and high risk of bleeding. Intramedullary AVMs in the cervical spinal cord are rare and require precise diagnostics and treatment. We present a clinical case of recurrent AVMs in a 28-year-old Caucasian female with sudden and severe neck pain and variable neurological symptoms along with current diagnostic and treatment modalities. Conservative treatment was partially effective. MRI and DSA confirmed AVMs at C4 level with subsequent several endovascular treatment sessions at the age of 15 and 24 with mild neurological improvement. Afterwards the patient underwent rehabilitation with minor neurological improvement. This case highlights the clinical progression and treatment of AVMs along with showcasing current pathophysiology, classification, and imaging.

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Electrophysiological Investigation of Disorders of the Spinal Cord

Cited by 4 publications

References 92 publications

Posing as Ascites: A Case Report on Neurogenic Lower Urinary Tract Dysfunction

Posing as Ascites: A Case Report on Neurogenic Lower Urinary Tract Dysfunction

Age-Related Uptake of Heavy Metals in Human Spinal Interneurons

A Rare Case of Cervical Spinal Arteriovenous Malformation: A Case Report

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