Acute Spinal Cord Dysfunction

Acute Spinal Cord Dysfunction is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Spinal cord dysfunction is demonstrated by a level below which motor, sensory, and autonomic functions are interrupted.
  • Traumatic spinal cord injury (TSCI) may be obvious from history or examination but should also be considered in unconscious, confused, or inebriated patients with trauma.
  • Spinal cord concussion refers to posttraumatic spinal cord symptoms and signs that resolve rapidly (hours to days).

Etiology

See Table 27-8.

Table 27-8: Causes of Acute Spinal Cord Dysfunction
Structural
  • Tumor (primary or metastatic)
  • Herniated disk
  • Epidural abscess or hematoma
  • Osteomyelitis
  • Trauma ± fracture of bony elements
  • Atlantoaxial instability (e.g., rheumatoid arthritis)
  • Fibrocartilaginous
Ischemia/infarction (particularly after aortic surgery)
  • Aortic dissection or surgery
  • Embolic (cardiogenic, gaseous embolus)
  • Prolonged hypotension with underlying vascular disease
  • Intravascular lymphoma
Toxic
  • Nitrous oxide (typically in the setting of vitamin B12 deficiency)
  • Heroin
Vascular malformations (e.g., AVM)
Inflammatory/infectious (transverse myelitis)
  • Multiple sclerosis
  • Neuromyelitis optica (classically longitudinally extensive, >3 spinal segments)
  • Anti–myelin oligodendrocyte protein (anti-MOG) disease
  • Acute disseminated encephalomyelitis
  • Parainfectious processes (e.g., after Mycoplasma pneumoniae)
  • Sarcoidosis
  • Paraneoplastic (amphiphysin and CRMP-5)
  • Systemic lupus erythematosus
  • Sjögren syndrome
  • Behçet disease
  • Viruses (e.g., enterovirus, HSV, HIV, VZV, CMV, WNV)
  • Fungal (extremely rare)
  • Lyme disease
  • TB
  • Syphilis

AVM, arteriovenous malformation; CMV, cytomegalovirus; CRMP-5, collapsing response mediator protein 5; HSV, herpes simplex virus; TB, tuberculosis; VZV, varicella-zoster virus; WNV, West Nile virus.

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