1. DIFFERENTIATION BETWEEN EXTRAMEDULLARY AND INTRAMEDULLARY SPINAL CORD LESIONS
INTRAMEDULLARY EXTRADURAL INTRADURAL
DIFFERENTIATION BETWEEN EXTRADURAL AND INTRADURAL LESIONS OF SPINAL CORD
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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. 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: