Spinal cord ultrasonography in children with myelomeningocele
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Abstract:
Secondary tethering of the spinal cord in people with myelomeningocele (MMC) is almost universal but there is a relatively low incidence of the secondary tethered cord syndrome (S‐TCS). In view of this, we wish to explore the notion that cord pulsation, as demonstrated by ultrasound of the spinal cord, can become an independent measure for increased tension of the spinal cord in patients with MMC. One‐hundred and six patients with MMC underwent ultrasonographic examination of their back, a thorough physical examination, and a careful review of their clinical history. Of these patients, 53 had MRI of their back. Cord pulsation was graded and the statistical relation between pulsation and various clinical and MRI findings was analysed. Age and arm span were not correlated with grades of cord pulsation. The absence of cord pulsation correlated with the presence of symptoms but this relation may be explained by MRI findings of certain structural cord malformations and not by tethering per se. Assuming that cord pulsation is a reliable marker for the tension within the spinal cord, the results of our study suggest that overstretching of the cord is not the main cause for the development of the S‐TCS.Keywords:
Cord blood
Cord blood
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Spinal cord lipid content was analyzed in 50 pigs that had experienced a simulated dive known to produce 20-80% incidence of neurologic decompression sickness (DCS). Using air and heliox as breathing mixtures, these animals underwent chamber dives ranging from 200-250 feet of seawater (fsw). These dives were designed to generate spinal cord DCS, which was detected by observing the animals for gross neurologic deficits. Using a standardized method, cylindrical samples of cord were cut from different spinal levels and analyzed for total lipid (TL) content, which produced two cervical, three thoracic, and two lumbar samples. All areas with gross hemorrhage were also sampled. The range of TL (mean) in milligrams per gram from the cervical, thoracic, and lumbar regions were 118-679 (319), 140-635 (366), and 109-658 (307), respectively. Although this implies that TL varies markedly between cords, values within each cord were fairly consistent (+/- 20% from cord mean). The difference in TL values between cord regions with and without hemorrhage was not significant (P > 0.1). This reveals that increased spinal cord TL levels, together with their presumed dissolved inert gas, do not play a major role in the location or incidence of spinal cord hemorrhages in pigs with clinical signs of spinal cord DCS.
Lumbar Spinal Cord
Spinal decompression
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Objective To evaluate the efficacy of ultrasound in the diagnosis of tethered cord syndrome(TCS). Methods Ultrasound examination was performed on 20 neonates with TCS. The ultrasound findings were compared with the pre operative MRI features and operative findings in 5 patients. Results Ultrasound findings correlated with the operative findings well. It also provides vascular information of the cord. Conclusion Ultrasound is a reliable, safe and easy mean of diagnosis of tethered cord syndrome in the newborns.
Tethered Cord
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We performed MRI of brain and spinal cord on 80 patients with multiple sclerosis (MS). Using multi-array coils and fast spin echo, 139 intrinsic lesions were identified in 59 patients (74%). Lesions were more common in the cervical than in the thoracic cord. Cross-sectional areas of the cord, measured from axial images at four levels, showed atrophy in 40%. Clinical disability correlated with cord atrophy but not with cord lesion load. These results show that the use of multi-array coils and fast spin echo allows rapid and sensitive detection of spinal cord lesions in MS and that the cord is involved in the majority of patients. A lack of association between cord lesions and disability may relate to limitations in MR resolution but also suggests that the mechanisms of disability in MS are complex and multifactorial.
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Pulsatile motion of the spinal cord was examined with phase imaging techniques. Sagittal images of the spinal cord were obtained at different times of the cardiac cycle in healthy volunteers, as well as in patients in whom the spinal cord either was tethered, was compressed, or contained an intramedullary lesion. Pulsatile velocity changes of the spinal cord, observed on the phase images, were most marked at the cervical-upper thoracic level. Cord motion was found to be significantly decreased in cases in which the cord was either tethered or compressed. Cord enlargement due to an intramedullary lesion generally did not lead to decreased cord motion. Imaging of pulsatile cord motion may be clinically useful in evaluating diseases restricting cord motion or changing the status of parenchymal compliance.
Pulsatile flow
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Secondary tethering of the spinal cord in people with myelomeningocele (MMC) is almost universal but there is a relatively low incidence of the secondary tethered cord syndrome (S‐TCS). In view of this, we wish to explore the notion that cord pulsation, as demonstrated by ultrasound of the spinal cord, can become an independent measure for increased tension of the spinal cord in patients with MMC. One‐hundred and six patients with MMC underwent ultrasonographic examination of their back, a thorough physical examination, and a careful review of their clinical history. Of these patients, 53 had MRI of their back. Cord pulsation was graded and the statistical relation between pulsation and various clinical and MRI findings was analysed. Age and arm span were not correlated with grades of cord pulsation. The absence of cord pulsation correlated with the presence of symptoms but this relation may be explained by MRI findings of certain structural cord malformations and not by tethering per se. Assuming that cord pulsation is a reliable marker for the tension within the spinal cord, the results of our study suggest that overstretching of the cord is not the main cause for the development of the S‐TCS.
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Summary The anatomy of the spinal cord segments was studied and recorded for the impala. The root attachment lengths were greatest at C 3 , T 10 and L 3 cord segment levels in the respective regions. As to the root emergence length the greatest lengths were observed at C7, T ]0> L5 and S 1 cord segment levels respectively. The interroot interval was longest at C 2 , T 8 and L 1 segments respectively. The longest cord segments were C2, T13, L 2 and S 2 segments. The widest cord segments of their respective regions were C 7 , T 1 , L5 and S 1 cord segments. As to segment volume C3, T 13 , L 2 and S 1 were the most voluminous cord segments in the respective cord regions. Statistical analysis revealed a high correlation among all of the study parameters suggesting a high degree of multicolinearity. Gross anatomical relationships concerning the location of the spinal cord segments with respect to the vertebrae were studied. The cord segments C], T s –T 4 and Li–L 3 were within their vertebral limits. In the impala the spinal cord terminated at the midlevel of S 4 vertebra.
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We report a case of HTLV-I associated myelopathy (HAM) with a spinal cord MRI showing abnormal multifocal and patchy lesions. A 50-year-old woman suffering from progressive paraparesis was admitted to our hospital. HTLV-I antibodies in the serum and CSF were positive, and a diagnosis of HAM was made. Her T2 weighted spinal cord MRI showed scattered areas of high signal intensity from the cervical to the thoracic cord. The lesions were enhanced with gadolinium-DTPA on T1 weighted imaging. Atrophy of the thoracic cord has been reported in many patients with HAM. In rare cases, T2 weighed thoracic cord MRI showed diffuse high signal intensity. The pattern of high signal intensity in our case, however, was multifocal and patchy, thus differing from the findings of previous reports. And we believe this is the first such report. This case suggests that the MRI of HAM patient may show multifocal and scattered lesions in the spinal cord.
Spinal Cord Diseases
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Serum T4, T3, r-T3, TSH and Tg Levels in Cord Blood and Maternal Circulation at the Time of Delivery
The concentrations of T4, T3, r-T3, TSH and Tg were determined in parallel in maternal serum at the time of delivery and in cord blood. The serum T3 concentration in cord blood was significantly lower than that in the serum of the mother. However contrary to T3, r-T3 in cord serum was significantly higher than in maternal serum. Also, the level of TSH in cord blood was considerably higher than in maternal serum. The concentrations of total T4 in maternal and cord serum did not differ markedly, even though the values (mean and individual) were somewhat lower in the cord serum. The concentrations of Tg in cord and maternal serum varied widely, although the mean value for Tg in cord serum was somewhat higher than in maternal serum. No correlation was found between Tg concentration and TSH level in cord or maternal serum.
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Serum concentration
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To determine and compare the usefulness of cord blood screening for free thyroxine (FT4) and thyroid stimulating hormone (TSH).There is a vast amount of literature on capillary heel prick screening tests, but relatively little on cord blood testing particularly FT4. For a decade all infants born at Tawam Hospital had cord blood FT4 and at Oasis Hospital cord TSH measured through the hospital-based screening programme. On January 1st 1998, the national screening programme (NSP) for congenital hypothyroidism (CH) in the United Arab Emirates (UAE) started using capillary TSH measurement (Delfia method). Since then newborns in both hospitals have been screened both ways, i.e. cord blood and capillary blood screening.We reviewed retrospectively all infants born from January 1998 until the end of June 2004 with CH who had double screening: cord FT4 or TSH and 4th-5th day TSH screening.Thirteen infants (one in 1,778) had CH in Tawam Hospital. In six of these the cord blood FT4 was low (<9.1 pm/l) (0.73 ng/dl) and in seven the cord blood FT4 was normal, i.e., over half were missed. Eight infants (one in 1,198) had CH in the Oasis Hospital. Cord blood TSH was high in six of them (>13 IU/l) and two were normal. Cord FT4 detected the most severe cases, but missed most others. Cord TSH detected six out of eight cases, but there was a recall rate of one in 23.Cord FT4 identifies only infants with severe CH. Cord TSH is more sensitive than cord FT4 screening. Capillary TSH dried blood spot testing on the 3rd-5th day is the most sensitive method.
Cord blood
Congenital hypothyroidism
Thyroid-stimulating hormone
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