Cord, Small/Atrophic



Cord, Small/Atrophic


Bryson Borg, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Focal Cord Atrophy



    • Compressive Myelopathy, Chronic


    • Multiple Sclerosis, Other Noncompressive Myelopathies


    • Cord Trauma, Chronic


    • Infarction, Spinal Cord, Chronic


    • Radiation Myelitis, Chronic


  • Diffuse Cord Atrophy



    • Multiple Sclerosis (or Other Noncompressive Myelopathy)


    • Chronic, Severe Cord Trauma (e.g., Transection)


    • Severe Cerebral Atrophy


    • Infarction, Spinal Cord, Chronic


    • Collapsed Syrinx


Rare but Important



  • Spinal Cord Herniation


  • Spinocerebellar Ataxia (Friedreich Ataxia), Other Hereditary Paraplegia/Ataxia Syndromes


  • Segmental Spinal Dysgenesis


ESSENTIAL INFORMATION


Helpful Clues for Common Diagnoses



  • Compressive Myelopathy, Chronic



    • Chronic cord injury due to mechanical impingement by disc herniation, spondylolisthesis, or spinal canal mass


    • Offending lesion may have been surgically decompressed


  • Multiple Sclerosis, Other Noncompressive Myelopathies



    • Diverse group of etiologies: Non-MS diagnoses include ADEM, SLE, sarcoidosis, HIV, syphilis, Lyme disease, and paraneoplastic syndromes


  • Cord Trauma, Chronic



    • Patient history usually reveals diagnosis


    • Atrophy may be focal; in severe and proximal cases, holocord involvement may be present


  • Infarction, Spinal Cord, Chronic



    • Uncommon due to vascular supply of cord


Alternative Differential Approaches



  • Cervical cord typically occupies 75% of spinal canal diameter; less than 50% generally accepted as cord atrophy


  • Maximal cervical cord dimensions



    • MR and CT myelography: 7.2 mm AP x 13.8 mm transverse (C4-5) (Fountas)


    • Autopsy: 0.9 mm AP x 14.9 mm transverse (C4-5) (Nordqvist)


Tags:
Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Cord, Small/Atrophic

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