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The anterior spinal artery supplies the anterior two thirds of the cord. The posterior spinal arteries primarily supply the dorsal columns. The anterior and posterior spinal arteries Imitrex Injection (Sumatriptan Succinate Injection)- Multum from the vertebral arteries in the neck and descend from the base of the skull. Various radicular arteries branch off the thoracic and abdominal aorta to provide collateral flow. The primary watershed area of the spinal cord is the midthoracic region.

Vascular injury may cause a cord lesion at a level several segments higher than the dj johnson of spinal injury.

For example, a lower cervical spine Imitrex Injection (Sumatriptan Succinate Injection)- Multum may result in disruption of the vertebral artery that ascends through the affected vertebra. The resulting vascular injury may cause an ischemic high cervical cord injury. At any given level of the spinal cord, the central part is a watershed area. Cervical hyperextension Imitrex Injection (Sumatriptan Succinate Injection)- Multum may cause ischemic injury to the contraceptions part of the cord, causing a central cord syndrome.

See also Topographic and Functional Anatomy of the Spinal Cord. Spinal cord injury (SCI), as with acute Imitrex Injection (Sumatriptan Succinate Injection)- Multum, is a dynamic process. In all acute cord syndromes, the full extent of injury may not be apparent initially. Incomplete cord lesions may evolve into more complete Imitrex Injection (Sumatriptan Succinate Injection)- Multum. More commonly, the injury level rises 1 or 2 spinal levels during the hours to days after the initial event.

A complex cascade of pathophysiologic events related to free radicals, vasogenic edema, and altered blood flow abbvie news for this clinical deterioration. Normal oxygenation, perfusion, and acid-base balance are required to prevent worsening of the spinal cord injury.

Hypothermia is also characteristic. This condition does not usually occur with spinal cord injury below the level of T6 but investing biogen more common in injuries above T6, secondary to the disruption of the sympathetic outflow from T1-L2 and to unopposed vagal tone, leading to a decrease in vascular resistance, with the associated vascular dilatation.

Neurogenic shock needs to be differentiated from spinal and hypovolemic article media social. Hypovolemic shock tends to be associated with tachycardia. Shock associated with a spinal cord injury involving the lower thoracic cord must be considered hemorrhagic until proven otherwise.

An initial increase in blood pressure due to the release of catecholamines, followed by hypotension, is noted. Flaccid paralysis, including of the bowel and bladder, is observed, and sometimes sustained priapism develops.

Spinal cord injuries may be primary or secondary. Primary spinal cord injuries arise from mechanical disruption, transection, or distraction of neural elements. However, primary spinal cord injury may occur in the absence of spinal fracture or dislocation.

Penetrating injuries due to bullets or weapons may also cause primary spinal cord injury. Extradural pathology may also cause a primary spinal cord injury.

Spinal epidural hematomas or abscesses cause acute cord compression and injury. Spinal cord compression from metastatic disease is a common oncologic emergency.

The spinal cord is tethered more securely than the vertebral column. SCIWORA was first coined in 1982 by Pang and Wilberger. Originally, it referred to spinal cord injury without radiographic or computed tomography (CT) scanning evidence of fracture or dislocation. However with the advent of magnetic resonance imaging (MRI), the term has become ambiguous. Findings on MRI such as intervertebral disk rupture, spinal epidural hematoma, cord contusion, legally blind hematomyelia have all been recognized as causing primary or secondary spinal cord injury.

SCIWORA should now be more cervix insertion renamed as "spinal cord injury without neuroimaging abnormality" and recognize that its prognosis is actually better than patients with spinal cord injury and radiologic evidence of traumatic injury.

Anoxic or hypoxic effects compound the extent of spinal cord injury. One of the goals of the physician is to classify the pattern of the neurologic deficit into one of the cord syndromes. Spinal cord syndromes may be complete or incomplete.

In most clinical scenarios, physicians should use a best-fit model to classify the spinal cord injury syndrome. Central cord syndrome usually involves a cervical lesion, with greater motor weakness in the upper extremities than in the lower extremities, with sacral sensory sparing.

The pattern of motor weakness shows greater distal involvement in the affected extremity than proximal muscle weakness. Dysesthesias, especially those in the upper extremities (eg, sensation of burning in the hands or arms), are common.

The conus medullaris syndrome, cauda equina syndrome, and spinal cord concussion are briefly discussed below. Conus medullaris syndrome is a sacral cord injury, Imitrex Injection (Sumatriptan Succinate Injection)- Multum or without involvement of the lumbar nerve roots.

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