Chapter 191: Spinal Cord Diseases

Chapter 191: Spinal Cord Diseases is a topic covered in the Harrison's Manual of Medicine.

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Spinal cord disorders can be devastating, but many are treatable if recognized early (Table 191-1). Knowledge of relevant spinal cord anatomy is often the key to correct diagnosis (Fig. 191-1).

TABLE 191-1: Treatable Spinal Cord Disorders
Compressive
 Epidural, intradural, or intramedullary neoplasm
 Epidural abscess
 Epidural hemorrhage
 Cervical spondylosis
 Herniated disk
 Posttraumatic compression by fractured or displaced vertebra or hemorrhage
Vascular
 Arteriovenous malformation and dural fistula
 Antiphospholipid syndrome and other hypercoagulable states
Inflammatory
 Multiple sclerosis
 Neuromyelitis optica
 Transverse myelitis
 Sarcoidosis
 Sjögren-related myelopathy
 Systemic lupus erythematosus-related myelopathy
 Vasculitis
Infectious
 Viral: VZV, HSV-1 and 2, CMV, HIV, HTLV-1, others
 Bacterial and mycobacterial: Borrelia, Listeria, syphilis, others
 Mycoplasma pneumoniae
 Parasitic: schistosomiasis, toxoplasmosis, cystercercosis
Developmental
 Syringomyelia
 Meningomyelocele
 Tethered cord syndrome
Metabolic
 Vitamin B12 deficiency (subacute combined degeneration)
 Copper deficiency
Abbreviations: CMV, cytomegalovirus; HSV, herpes simplex virus; HTLV, human T cell lymphotropic virus; VZV, varicella-zoster virus.
FIGURE 191-1
hmom20_ch191_f001.png
Transverse section through the spinal cord, composite representation, illustrating the principal ascending (left) and descending (right) pathways. The lateral and ventral spinothalamic tracts ascend contralateral to the side of the body that is innervated. C, cervical; D, distal; E, extensors; F, flexors; L, lumbar; P, proximal; S, sacral; T, thoracic.

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Spinal cord disorders can be devastating, but many are treatable if recognized early (Table 191-1). Knowledge of relevant spinal cord anatomy is often the key to correct diagnosis (Fig. 191-1).

TABLE 191-1: Treatable Spinal Cord Disorders
Compressive
 Epidural, intradural, or intramedullary neoplasm
 Epidural abscess
 Epidural hemorrhage
 Cervical spondylosis
 Herniated disk
 Posttraumatic compression by fractured or displaced vertebra or hemorrhage
Vascular
 Arteriovenous malformation and dural fistula
 Antiphospholipid syndrome and other hypercoagulable states
Inflammatory
 Multiple sclerosis
 Neuromyelitis optica
 Transverse myelitis
 Sarcoidosis
 Sjögren-related myelopathy
 Systemic lupus erythematosus-related myelopathy
 Vasculitis
Infectious
 Viral: VZV, HSV-1 and 2, CMV, HIV, HTLV-1, others
 Bacterial and mycobacterial: Borrelia, Listeria, syphilis, others
 Mycoplasma pneumoniae
 Parasitic: schistosomiasis, toxoplasmosis, cystercercosis
Developmental
 Syringomyelia
 Meningomyelocele
 Tethered cord syndrome
Metabolic
 Vitamin B12 deficiency (subacute combined degeneration)
 Copper deficiency
Abbreviations: CMV, cytomegalovirus; HSV, herpes simplex virus; HTLV, human T cell lymphotropic virus; VZV, varicella-zoster virus.
FIGURE 191-1
hmom20_ch191_f001.png
Transverse section through the spinal cord, composite representation, illustrating the principal ascending (left) and descending (right) pathways. The lateral and ventral spinothalamic tracts ascend contralateral to the side of the body that is innervated. C, cervical; D, distal; E, extensors; F, flexors; L, lumbar; P, proximal; S, sacral; T, thoracic.

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