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Extramedullary

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Extramedullary

  1. 1. DIFFERENTIATION BETWEEN EXTRAMEDULLARY AND INTRAMEDULLARY SPINAL CORD LESIONS INTRAMEDULLARY EXTRADURAL INTRADURAL DIFFERENTIATION BETWEEN EXTRADURAL AND INTRADURAL LESIONS OF SPINAL CORD ` References : Diseases of the Spine and Spinal Cord by Thomas N. Byrne, Edward C. Benzel, Stephen G. Waxman Dr. L.SUJA 2nd year PG email: EXTRAMEDULLARY SPINAL CORD LESION INTRAMEDULLARY SPINAL CORD LESION Site of involvement Outside the cord Intradural or extradural Within the cord Symmetry Asymmetrical Symmetrical Spontaneous pain Radicular , localized distribution , early and important symptom Funicular , burning type , poorly localized usually bilateral , often involves large areas of body Sensory changes Contralateral loss of pain and temperature , ipsilateral loss of proprioception ( Brown sequard type ) Dissociative sensory loss, spotty changes Changes in Saddle area pain & temperature More marked than at any level of lesion sensory level below site of lesion Less marked than at level of lesion. sensory loss suspended Dissociative sensory loss ( loss of spinothalamic senses & preservation of posterior column senses ) Rare Characteristic feature Location of sensory loss May present with ascending sensory level Can cause suspended sensory loss most prominent at level of lesion LMN involvement Segmental marked and widespread with atrophy and fasciculation UMN involvement Prominent Can be late and less prominent Distribution of motor weakness Cervical lesions cause ipsilateral arm weakness followed by ipsilateral leg weakness before spreading to contra lateral side Cervical lesions can cause unilateral or bilateral upper limb paresis and sparing of lower limbs in early stages ( suspended weakness ) DTR Increased early late Bladder and bowel Late Early Trophic changes Not marked Can be marked Spinal subarachnoid block and changes in spinal fluid Early and marked Late and less marked Etiology Intadural ( meningioma , nerve sheath tumor) epidural ( herniated disc, metastases , myeloma , osteoma ) Ependymoma , astrocytoma , syrinx, hemangioblastoma, multiple sclerosis, myelitis SYMPTOM EXTRADURAL EXTRAMEDULLARY INTRADURAL EXTRAMEDULLARY Radicular pain Marked Less Marked Tenderness Present Absent CSF Changes Less Changes Marked changes Deformity May be present Absent Etiology TB Spine , traumatic compressive myelopathy Meningioma , neurofibroma in spinal root
  2. 2. References : Diseases of the Spine and Spinal Cord by Thomas N. Byrne, Edward C. Benzel, Stephen G. Waxman Dr. L.SUJA 2nd year PG email:

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