NEUROPATHOLOGY- SPINAL CORD DISEASE

---

[ CATS Home | About CATS | CATS Teaching Modules | Course Outline | Neuropathology | UVM Department of Pathology | Other Pathology Sites | UVM College of Medicine | UVM ]

---

I. STRUCTURE
II. DEVELOPMENTAL
III. SYSTEMS DEGENERATION
IV. VASCULAR DISORDERS
V. TRAUMA
VI. INFECTION
VII. DISORDERS OF THE SPINE
VIII. DEFICIENCY DISEASE
IX. TUMORS

VOCABULARY TERMS
Terms you should be familiar with:

Syringomyelia
Syrinx
Systems degeneration
Friedreich's ataxia
Spinocerebellar degeneration
Wernig Hoffman disease
Spinal muscular atrophy
Artery of Adamkiewcz
Hangman's fracture
Neurosyphilis
Tabes dorsalis
Herpes zoster
Prolapsed disc
Nucleus pulposus
Annulus fibrosis
Cervical spondylosis
Myelopathy
Radiculopathy
Subacute combined degeneration
Pernicious anemia

OBJECTIVES: The objectives of this hour are to review briefly the anatomy of the spinal cord, to understand the principles of lesion localization, and to survey some of the important diseases that affect this structure.

I. STRUCTURE

The structure of the human spinal cord is unique in many ways and is reflected in the particular features encountered in its diseases. The diagnostic approach to spinal cord disease is aimed at separating extrinsic disease from intrinsic disease and then establishing a clinical level (reflex, motor, or sensory) of involvement. The diseases to be discussed are primarily restricted to the cord and as such are considered separately from the rest of the central nervous system.

II. DEVELOPMENTAL

Syringomyelia is a disease whose pathologic basis is the development of progressive spinal cord cavitation in the form of a pipe. This leads clinically to a peculiar dichotomy of sensory loss reflecting the location of the syrinx.

III. SYSTEMS DEGENERATION

A group of diseases characterized by a selective degeneration of certain anatomic patterns of neurons or spinal tracts.

• Friedreich's Ataxia (spinocerebellar degeneration)- This is the most common form of the various types of spinocerebellar degeneration. The predominant clinical symptoms and signs are those of ataxia. The main findings are long tract degeneration in the spinal cord, accompanied by a hypertrophic cardiomyopathy.
  
  
• Wernig Hoffman Disease (hereditary spinal muscular atrophy)- Disease of infants and young children that resembles clinically the progressive muscular atrophy form of amyotrophic lateral sclerosis. Pathological changes are confined to the anterior horn cells of the cord and the cranial nerve motor nuclei.

Back to Top

IV. VASCULAR DISORDERS

The spinal cord has one of the most complex blood supplies of any part of the body and it is necessary to understand some of its complexity before discussing the problem of its vascular disorders.

• Anterior Spinal Artery Syndrome- A true stroke of the spinal cord producing a stereotyped clinical picture.
  
  
• The Great Radicular Artery of Adamkiewcz- an aortic source of borderzone infarction.

V. TRAUMA

• Flexion Injuries
  
  
• Compression Injuries
  
  
• Extension Injuries (hangman's fracture)
  
  
  • early changes
  • late changes

VI. INFECTION

• Neurosyphilis (tabes dorsalis)- The syndrome of lightning pains, pupillary changes, loss of deep tendon reflexes and ataxia. Pathologically, there is thickening of the leptomeninges posteriorly with lymphocytic infiltration around root sleeves, and gliosis of posterior columns.
  
  
• Herpes Zoster (shingles)- Inflammation of one or more posterior root (or cranial nerve root) ganglia with an associated skin eruption in the appropriate dermatome.

Back to Top

VII. DISORDERS OF THE SPINE

• Prolapsed Intervertebral Disc- Commonly involves the lower three lumbar discs and consequently affects the spinal nerve roots rather than the spinal cord. The basis of the condition is herniation of the fluid nucleus pulposus through a weakened or torn annulus fibrosis.
  
  
• Cervical Spondylosis- A spreading outward of the whole disc beyond the margins of the vertebral body combined with bony cartilaginous and fibrous overgrowth. Pathologic changes are reflected clinically in myelopathy, radiculopathy or both.

VIII. DEFICIENCY DISEASE

Subacute Combined Degeneration of the cord is a neurologic complication of vitamin B12 deficiency seen in malabsorption syndromes (e.g., pernicious anemia) and in nutritional disorders (e.g. alcoholism). Gray matter is not affected. The spinal cord manifestations may precede any hematologic abnormality.

IX. TUMORS

• Gliomas
  
  
• Meningiomas and Schwannomas
  
  
• Metastatic

Back to Top

Go Back to Course Outline

Go Back to Neuropathology

[ Introduction and Objectives | Basic Reactions of the CNS | Vascular Disease | Trauma to the CNS | Alcohol and the CNS | Infections of the CNS | Tumors of the CNS | Diseases of the Myelin Sheath | Spinal Cord Disease | Muscle Disease | Congenital Anomalies of the CNS | Neuropathology of AIDS | Degenerative Diseases of the CNS | Dementia and Related Issues | Unconventional Transmissible Agent (Prion) Diseases ]

---

[ CATS Home | About CATS | CATS Teaching Modules | UVM Department of Pathology | Other Pathology Sites | UVM College of Medicine | UVM ]

---

Questions? Comments? Send a message to the CATS guru: jkessler@salus.uvm.edu