Diagnosis and management of spinal cord emergencies

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Most spinal cord injury is seen with trauma. Nontraumatic spinal cord emergencies are discussed in this chapter. These myelopathies are rare but potentially devastating neurologic disorders. In some situations prior comorbidity (e.g., advanced cancer) provides a clue, but in others (e.g., autoimmune myelopathies) it may come with little warning. Neurologic examination helps distinguish spinal cord emergencies from peripheral nervous system emergencies (e.g., Guillain-Barré), although some features overlap. Neurologic deficits are often severe and may quickly become irreversible, highlighting the importance of early diagnosis and treatment. Emergent magnetic resonance imaging (MRI) of the entire spine is the imaging modality of choice for nontraumatic spinal cord emergencies and helps differentiate extramedullary compressive causes (e.g., epidural abscess, metastatic compression, epidural hematoma) from intramedullary etiologies (e.g., transverse myelitis, infectious myelitis, or spinal cord infarct). The MRI characteristics may give a clue to the diagnosis (e.g., flow voids dorsal to the cord in dural arteriovenous fistula). However, additional investigations (e.g., aquaporin-4-IgG) are often necessary to diagnose intramedullary etiologies and guide treatment. Emergency decompressive surgery is necessary for many extramedullary compressive causes, either alone or in combination with other treatments (e.g., radiation) and preoperative neurologic deficit is the best predictor of outcome.

Original languageEnglish (US)
Pages (from-to)319-335
Number of pages17
JournalHandbook of Clinical Neurology
Volume140
DOIs
StatePublished - 2017

Fingerprint

Spinal Cord
Emergencies
Spinal Cord Diseases
Neurologic Manifestations
Magnetic Resonance Imaging
Transverse Myelitis
Aquaporin 4
Epidural Abscess
Central Nervous System Vascular Malformations
Myelitis
Peripheral Nervous System
Neurologic Examination
Nervous System Diseases
Spinal Cord Injuries
Hematoma
Comorbidity
Early Diagnosis
Spine
Immunoglobulin G
Radiation

Keywords

  • epidural abscess
  • metastatic spinal cord compression
  • neuromyelitis optica
  • paraplegia
  • spinal cord infarct

ASJC Scopus subject areas

  • Medicine(all)
  • Neurology
  • Clinical Neurology

Cite this

Diagnosis and management of spinal cord emergencies. / Flanagan, Eoin; Pittock, Sean J.

In: Handbook of Clinical Neurology, Vol. 140, 2017, p. 319-335.

Research output: Contribution to journalReview article

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