Spinal vascular lesion

Mascalchi M, Quilici N, Ferrito G et al (1997) Identification of the feeding arteries of spinal vascular lesions via phase-contrast MR angiography with three-dimensional acquisition and phase display. AJNR Am J Neuroradiol 18 351-358... 

Spinal vascular lesions constitute a rare disease entity that includes spinal arteriovenous fistula and malformations, and is characterized by a shunt between dilated feeding arteries and usually engorged draining veins. 

Ischemic infarction of the spinal cord is difficult to establish in the early phase, only 50% of the patients show early demarcation within 24 h. The role of MRI in the acute phase is to exclude hematomyelia, spinal vascular malformation (which requires spinal angiography in special cases) or a compressive lesion. 

Spinal DAVMs are considered the most common spinal vascular malformations, constituting 80% of all spinal AVMs (Anson and Spetzler 1992 Lee et al. 1998). The majority of these lesions are located in the thoracolumbar region. 

Cerebritis is focal inflammation of brain parenchyma myelitis in the spinal cord). Cerebritis precedes abscess formation but requires an early biopsy to be seen (see Tables 20.2 and 20.10). The inflammatory infiltrate is composed of neutrophils, macrophages, lymphocytes, and plasma cells, with or without parenchymal necrosis. Septic cerebritis is usually caused by bacterial agents, most often streptococci or staphylococci, and less commonly by gram-negative organisms, such as Escherichia coli. Pseudomonas, and Haemophilus influenzae. Cerebritis also occurs around neoplasms, ruptured vascular malformations, infarcts, and traumatic lesions. 

A comprehensive set of practice parameters on the use of spinal cord stimulation in the treatment of chronic neuropathic pain has been developed [42]. Indications include failed back surgery syndrome, complex regional pain syndrome, peripheral neuropathic pain, phantom limb/post-amputation syndrome, recalcitrant PHN, root injury pain, and spinal cord injury or lesions. It also is being used in the management of pain associated with multiple sclerosis, pain due to ischemic peripheral vascular disease, and interstitial nephritis. 

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