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Cerebral Spinal Fluid

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121. Cardiovascular Concerns in Spinal Cord Injury (Overview)

lead to increased blood pressure. Corticosteroids cause sodium and fluid retention to improve symptomatic orthostatic hypotension, and sympathomimetics augment coronary and cerebral blood flow. Anticholinergics are administered to improve conduction through the atrioventricular (AV) node; this is accomplished by a reduction of vagal tone by way of muscarinic receptor blockade. Previous References Partida E, Mironets E, Hou S, Tom VJ. Cardiovascular dysfunction following spinal cord injury. Neural (...) in the management of orthostatic hypotension Atropine: Drug of choice for bradycardia but rarely used in rehabilitation settings except during emergencies (phenylephrine and dopamine also can be considered) Alpha-adrenergic agonists: Improve the patient's hemodynamic status by increasing myocardial contractility and heart rate Corticosteroids: Cause sodium and fluid retention, resulting in improvements in symptomatic orthostatic hypotension Sympathomimetics: Augment coronary and cerebral blood flow

2014 eMedicine.com

122. Spinal Cord Hemorrhage (Overview)

embolizations vs. surgical resection Spinal cavernoma Family or personal history of cavernomas “Popcorn”-like lesions with associated hemosiderin rings Possible surgery if recurrent bleeds Coagulation deficits History of warfarin, heparin, or other medications; elevated PTT or INR; sudden onset of deficits; genetic causes; liver or autoimmune disease; malignancy Possible air-fluid levels Anticoagulation reversal; correction of deficient coagulation factor(s); treatment of underlying problem Spinal cord (...) ”-like lesions with associated hemosiderin rings Possible surgery if recurrent bleeds Coagulation deficits History of warfarin, heparin, or other medications; elevated PTT or INR; sudden onset of deficits; genetic causes; liver or autoimmune disease; malignancy Possible air-fluid levels Anticoagulation reversal; correction of deficient coagulation factor(s); treatment of underlying problem Spinal cord tumor Progressive neurological deficits; known history of cancer (especially renal cell carcinoma

2014 eMedicine.com

123. Spinal Orthotics (Overview)

management - The cervical spine must be maintained in neutral alignment at all times; clearing of oral secretions and/or debris is essential to maintaining airway patency and preventing aspiration Hypotension - Hypotension may be hemorrhagic and/or neurogenic in acute spinal cord injury; a diligent search for occult sources of hemorrhage must be made Neurogenic shock - Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial treatment of choice; maintain adequate (...) are organized somatotopically within the spinal cord. The corticospinal tracts are descending motor pathways located anteriorly within the spinal cord. Axons extend from the cerebral cortex in the brain as far as the corresponding segment, where they form synapses with motor neurons in the anterior (ventral) horn. They decussate (cross over) in the medulla before entering the spinal cord. The dorsal columns are ascending sensory tracts that transmit light touch, proprioception, and vibration information

2014 eMedicine.com

124. Spinal Cord Injury: Definition, Epidemiology, Pathophysiology (Overview)

Emergency department care Airway management - The cervical spine must be maintained in neutral alignment at all times; clearing of oral secretions and/or debris is essential to maintaining airway patency and preventing aspiration Hypotension - Hypotension may be hemorrhagic and/or neurogenic in acute spinal cord injury; a diligent search for occult sources of hemorrhage must be made Neurogenic shock - Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial (...) (ascending) information. These tracts are organized somatotopically within the spinal cord. The corticospinal tracts are descending motor pathways located anteriorly within the spinal cord. Axons extend from the cerebral cortex in the brain as far as the corresponding segment, where they form synapses with motor neurons in the anterior (ventral) horn. They decussate (cross over) in the medulla before entering the spinal cord. The dorsal columns are ascending sensory tracts that transmit light touch

2014 eMedicine.com

125. Spinal Cord Hemorrhage (Follow-up)

Spinal cavernoma Family or personal history of cavernomas “Popcorn”-like lesions with associated hemosiderin rings Possible surgery if recurrent bleeds Coagulation deficits History of warfarin, heparin, or other medications; elevated PTT or INR; sudden onset of deficits; genetic causes; liver or autoimmune disease; malignancy Possible air-fluid levels Anticoagulation reversal; correction of deficient coagulation factor(s); treatment of underlying problem Spinal cord tumor Progressive neurological (...) Spinal Cord Hemorrhage (Follow-up) Spinal Cord Hemorrhage Follow-up: Further Outpatient Care, Deterrence/Prevention, Prognosis Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE2NDEzOC1mb2xsb3d1cA== processing

2014 eMedicine.com

126. Cardiovascular Concerns in Spinal Cord Injury (Follow-up)

lead to increased blood pressure. Corticosteroids cause sodium and fluid retention to improve symptomatic orthostatic hypotension, and sympathomimetics augment coronary and cerebral blood flow. Anticholinergics are administered to improve conduction through the atrioventricular (AV) node; this is accomplished by a reduction of vagal tone by way of muscarinic receptor blockade. Previous References Partida E, Mironets E, Hou S, Tom VJ. Cardiovascular dysfunction following spinal cord injury. Neural (...) in the management of orthostatic hypotension Atropine: Drug of choice for bradycardia but rarely used in rehabilitation settings except during emergencies (phenylephrine and dopamine also can be considered) Alpha-adrenergic agonists: Improve the patient's hemodynamic status by increasing myocardial contractility and heart rate Corticosteroids: Cause sodium and fluid retention, resulting in improvements in symptomatic orthostatic hypotension Sympathomimetics: Augment coronary and cerebral blood flow

2014 eMedicine.com

127. Spinal Cord Injury: Definition, Epidemiology, Pathophysiology (Diagnosis)

Emergency department care Airway management - The cervical spine must be maintained in neutral alignment at all times; clearing of oral secretions and/or debris is essential to maintaining airway patency and preventing aspiration Hypotension - Hypotension may be hemorrhagic and/or neurogenic in acute spinal cord injury; a diligent search for occult sources of hemorrhage must be made Neurogenic shock - Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial (...) (ascending) information. These tracts are organized somatotopically within the spinal cord. The corticospinal tracts are descending motor pathways located anteriorly within the spinal cord. Axons extend from the cerebral cortex in the brain as far as the corresponding segment, where they form synapses with motor neurons in the anterior (ventral) horn. They decussate (cross over) in the medulla before entering the spinal cord. The dorsal columns are ascending sensory tracts that transmit light touch

2014 eMedicine.com

128. Spinal Orthotics (Diagnosis)

management - The cervical spine must be maintained in neutral alignment at all times; clearing of oral secretions and/or debris is essential to maintaining airway patency and preventing aspiration Hypotension - Hypotension may be hemorrhagic and/or neurogenic in acute spinal cord injury; a diligent search for occult sources of hemorrhage must be made Neurogenic shock - Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial treatment of choice; maintain adequate (...) are organized somatotopically within the spinal cord. The corticospinal tracts are descending motor pathways located anteriorly within the spinal cord. Axons extend from the cerebral cortex in the brain as far as the corresponding segment, where they form synapses with motor neurons in the anterior (ventral) horn. They decussate (cross over) in the medulla before entering the spinal cord. The dorsal columns are ascending sensory tracts that transmit light touch, proprioception, and vibration information

2014 eMedicine.com

129. Spinal Cord Hemorrhage (Diagnosis)

embolizations vs. surgical resection Spinal cavernoma Family or personal history of cavernomas “Popcorn”-like lesions with associated hemosiderin rings Possible surgery if recurrent bleeds Coagulation deficits History of warfarin, heparin, or other medications; elevated PTT or INR; sudden onset of deficits; genetic causes; liver or autoimmune disease; malignancy Possible air-fluid levels Anticoagulation reversal; correction of deficient coagulation factor(s); treatment of underlying problem Spinal cord (...) ”-like lesions with associated hemosiderin rings Possible surgery if recurrent bleeds Coagulation deficits History of warfarin, heparin, or other medications; elevated PTT or INR; sudden onset of deficits; genetic causes; liver or autoimmune disease; malignancy Possible air-fluid levels Anticoagulation reversal; correction of deficient coagulation factor(s); treatment of underlying problem Spinal cord tumor Progressive neurological deficits; known history of cancer (especially renal cell carcinoma

2014 eMedicine.com

130. Spinal Stenosis (Treatment)

by experienced injectionists. Transient corticosteroid dose-related side effects include facial flushing, low-grade fever, insomnia, anxiety, agitation, hyperglycemia, and fluid retention. Steroids may suppress the hypothalamic-pituitary axis for 3 months following the injection. Lastly, vasovagal reaction, nerve root injury, injectate allergy, and temporary pain exacerbation can occur as well. Results of ESI for spinal stenosis Recent studies assessing efficacy of fluoroscopically guided, contrast-enhanced (...) after surgery include the following: Sustained axial and radicular pain Progressive spinal deformity Cerebrospinal fluid leak Epidural hematoma Pulmonary embolism (PE) Some authors report spondylolisthesis as a complication of lumbar decompression without arthrodesis, especially after total facetectomy. Preoperative risk factors for postoperative development or progression of L4 or L5 spondylolisthesis include the following: Absence of degenerative osteophytosis Small and sagittally oriented facets

2014 eMedicine Surgery

131. Congenital Spinal Deformity (Overview)

Congenital Spinal Deformity (Overview) Congenital Spinal Deformity: Background, Embryology of Spine, Pathophysiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTI2MDQ0Mi1vdmVydmlldw== processing > Congenital (...) Spinal Deformity Updated: Mar 20, 2017 Author: Mark C Lee, MD; Chief Editor: Jeffrey D Thomson, MD Share Email Print Feedback Close Sections Sections Congenital Spinal Deformity Background Congenital deformities of the spine are spinal deformities identified at birth that are a byproduct of anomalous vertebral development in the embryo. Minor bony malformations of all types occur in up to 12% of the general population and are usually not apparent, often identified only on routine chest films

2014 eMedicine Surgery

132. Spinal Stenosis (Treatment)

by experienced injectionists. Transient corticosteroid dose-related side effects include facial flushing, low-grade fever, insomnia, anxiety, agitation, hyperglycemia, and fluid retention. Steroids may suppress the hypothalamic-pituitary axis for 3 months following the injection. Lastly, vasovagal reaction, nerve root injury, injectate allergy, and temporary pain exacerbation can occur as well. Results of ESI for spinal stenosis Recent studies assessing efficacy of fluoroscopically guided, contrast-enhanced (...) after surgery include the following: Sustained axial and radicular pain Progressive spinal deformity Cerebrospinal fluid leak Epidural hematoma Pulmonary embolism (PE) Some authors report spondylolisthesis as a complication of lumbar decompression without arthrodesis, especially after total facetectomy. Preoperative risk factors for postoperative development or progression of L4 or L5 spondylolisthesis include the following: Absence of degenerative osteophytosis Small and sagittally oriented facets

2014 eMedicine Surgery

133. Congenital Spinal Deformity (Treatment)

Congenital Spinal Deformity (Treatment) Congenital Spinal Deformity: Background, Embryology of Spine, Pathophysiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTI2MDQ0Mi1vdmVydmlldw== processing > Congenital (...) Spinal Deformity Updated: Mar 20, 2017 Author: Mark C Lee, MD; Chief Editor: Jeffrey D Thomson, MD Share Email Print Feedback Close Sections Sections Congenital Spinal Deformity Background Congenital deformities of the spine are spinal deformities identified at birth that are a byproduct of anomalous vertebral development in the embryo. Minor bony malformations of all types occur in up to 12% of the general population and are usually not apparent, often identified only on routine chest films

2014 eMedicine Surgery

134. Spinal Stenosis (Follow-up)

by experienced injectionists. Transient corticosteroid dose-related side effects include facial flushing, low-grade fever, insomnia, anxiety, agitation, hyperglycemia, and fluid retention. Steroids may suppress the hypothalamic-pituitary axis for 3 months following the injection. Lastly, vasovagal reaction, nerve root injury, injectate allergy, and temporary pain exacerbation can occur as well. Results of ESI for spinal stenosis Recent studies assessing efficacy of fluoroscopically guided, contrast-enhanced (...) after surgery include the following: Sustained axial and radicular pain Progressive spinal deformity Cerebrospinal fluid leak Epidural hematoma Pulmonary embolism (PE) Some authors report spondylolisthesis as a complication of lumbar decompression without arthrodesis, especially after total facetectomy. Preoperative risk factors for postoperative development or progression of L4 or L5 spondylolisthesis include the following: Absence of degenerative osteophytosis Small and sagittally oriented facets

2014 eMedicine Surgery

135. Spinal Stenosis (Follow-up)

by experienced injectionists. Transient corticosteroid dose-related side effects include facial flushing, low-grade fever, insomnia, anxiety, agitation, hyperglycemia, and fluid retention. Steroids may suppress the hypothalamic-pituitary axis for 3 months following the injection. Lastly, vasovagal reaction, nerve root injury, injectate allergy, and temporary pain exacerbation can occur as well. Results of ESI for spinal stenosis Recent studies assessing efficacy of fluoroscopically guided, contrast-enhanced (...) after surgery include the following: Sustained axial and radicular pain Progressive spinal deformity Cerebrospinal fluid leak Epidural hematoma Pulmonary embolism (PE) Some authors report spondylolisthesis as a complication of lumbar decompression without arthrodesis, especially after total facetectomy. Preoperative risk factors for postoperative development or progression of L4 or L5 spondylolisthesis include the following: Absence of degenerative osteophytosis Small and sagittally oriented facets

2014 eMedicine Surgery

136. Spinal Cord Injuries (Diagnosis)

management - The cervical spine must be maintained in neutral alignment at all times; clearing of oral secretions and/or debris is essential to maintaining airway patency and preventing aspiration Hypotension - Hypotension may be hemorrhagic and/or neurogenic in acute spinal cord injury; a diligent search for occult sources of hemorrhage must be made Neurogenic shock - Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial treatment of choice; maintain adequate (...) are organized somatotopically within the spinal cord. The corticospinal tracts are descending motor pathways located anteriorly within the spinal cord. Axons extend from the cerebral cortex in the brain as far as the corresponding segment, where they form synapses with motor neurons in the anterior (ventral) horn. They decussate (cross over) in the medulla before entering the spinal cord. The dorsal columns are ascending sensory tracts that transmit light touch, proprioception, and vibration information

2014 eMedicine Emergency Medicine

137. Spinal Cord Injuries (Overview)

management - The cervical spine must be maintained in neutral alignment at all times; clearing of oral secretions and/or debris is essential to maintaining airway patency and preventing aspiration Hypotension - Hypotension may be hemorrhagic and/or neurogenic in acute spinal cord injury; a diligent search for occult sources of hemorrhage must be made Neurogenic shock - Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial treatment of choice; maintain adequate (...) are organized somatotopically within the spinal cord. The corticospinal tracts are descending motor pathways located anteriorly within the spinal cord. Axons extend from the cerebral cortex in the brain as far as the corresponding segment, where they form synapses with motor neurons in the anterior (ventral) horn. They decussate (cross over) in the medulla before entering the spinal cord. The dorsal columns are ascending sensory tracts that transmit light touch, proprioception, and vibration information

2014 eMedicine Emergency Medicine

138. Efficacy of diffusion-weighted MRI in diagnosing spinal root disorders in lumbar disc herniation. (PubMed)

captures diffusion of water molecules in intracellular or extracellular fluid, allowing visualization of edematous changes, and is therefore used in diagnosis of hyper-acute cerebral infarction. In addition, it is possible to quantify the degree of diffusion using ADC calculated from the DWI data. Meanwhile in lumbar disc herniation, edematous changes occur in DRG of affected nerve root. If DWI enables visualization of these edematous changes, it will be possible to diagnose objectively the affected (...) Efficacy of diffusion-weighted MRI in diagnosing spinal root disorders in lumbar disc herniation. Prospective study based on magnetic resonance imaging for lumbar disc herniation.In this study, we captured diffusion-weighted imaging (DWI) of dorsal root ganglion (DRG) of the affected nerve root in lumbar disc herniation and examined the relationship between apparent diffusion coefficient (ADC) and clinical symptoms to evaluate the efficacy of DWI in the diagnosis of lumbar spinal disorders.DWI

2013 Spine

139. A Study to Assess the Safety and Pharmacokinetics of ISIS SMNRx in Infants With Spinal Muscular Atrophy

of multiple doses of nusinersen administered intrathecally to participants with infantile-onset SMA and to examine the cerebral spinal fluid (CSF) and plasma Pharmacokinetics (PK) of multiple doses of nusinersen administered intrathecally to participants with infantile-onset SMA. Condition or disease Intervention/treatment Phase Spinal Muscular Atrophy Drug: nusinersen Phase 2 Expanded Access : An investigational treatment associated with this study is available outside the clinical trial. Detailed (...) or inadequately treated active infection requiring systemic antiviral or antimicrobial therapy at any time during the screening period History of brain or spinal cord disease that would interfere with the lumbar puncture (LP) procedures, CSF circulation, or safety assessments Presence of an implanted shunt for the drainage of cerebrospinal fluid (CSF) or an implanted central nervous system (CNS) catheter History of bacterial meningitis Clinically significant abnormalities in hematology or clinical chemistry

2013 Clinical Trials

140. Epidural Volume Extension During a Combined Spinal-Epidural Technique for Labor Analgesia.

Information provided by (Responsible Party): Ronald George, IWK Health Centre Study Details Study Description Go to Brief Summary: Combined spinal-epidurals (CSE) involve the injection of pain relief medication into the cerebral spinal fluid (CSF) and the insertion of an epidural catheter in the epidural space to continue to give pain relief medication. During a CSE, after injection of the medication in the CSF and before inserting the epidural catheter, if normal saline is injected into the epidural (...) Not Applicable Detailed Description: Regional analgesia (pain relief) for labor can be an epidural, a spinal or a combination of the two. Combined spinal-epidurals (CSE) are popular because of their rapid pain relief and high patient satisfaction. At the IWK Health Centre, many anesthesiologists routinely use this method of pain relief. It involves the injection of pain relief medication into the cerebral spinal fluid (CSF) and the insertion of an epidural catheter (slim plastic tube) in the epidural space

2013 Clinical Trials

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