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Dorn Spinal Therapy

Dorn Spinal Therapy has been in uses in the past 40 years. The credit of this method goes to Dieter Dorn, who has made a significant impact in the medical field. DORN- Method has been used on various patients where results could get witnessed instants. Due to the impact, this method has brought in the country. It has been declared the standard practice in treating Pelvical Disorders, Spinal, and Back pain. Dieter Dorn first used this method on his family, which was a sign of confidence in a method, which later gained much attention from different people in the country and also globally. Every day Dorn was able to offer treatment to 15- 20 patients in a day. His services were purely free which attracted attention both in the local and also global. The primary treatment that DORN-Method which could be treated using this method include spine healing therapy, misalignments of the spine, resolving pelvis and joints, and also solving out significant problems which could get attributed to vertebrae. Read more...

Dorn Spinal Therapy Summary

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Differences In Spinal Pathways

Once transmission has occurred at a spinal level, the information must be passed to higher sites of processing. There is good evidence that visceral pain follows pathways that are different from those used for the perception of superficial pain. There now exist at least 10 clinical reports from six different neurosurgical groups in the United States, Europe, and Asia who have demonstrated that a midline myelotomy of the spinal cord (ablation of dorsal midline region) produces analgesia for visceral pain related to pelvic and lower abdominal organs (30-37) and for upper abdominal organs such as the stomach, pancreas, and hepatobiliary systems (38,39). Traditionally, it has been taught that the primary pathways for pain-related information from the dorsal horn of the spinal cord to the brain are via the ventrolateral quadrant white matter of the spinal cord. Tracts located within the ventrolateral quadrant include the classic spinothalamic and spinoreticular tracts as well as the...

Spine Formation and PSD Proteins

Psd Grip1 Spine

Polymerization of F-actin in dendritic spines regulates spine morphogenesis and synaptic plasticity (Segal 2005). The Rac1, RhoA, and Cdc42 Rho family small GTPases are important regulators of F-actin remodeling in spines. For instance, Rac1 promotes spine density and maturation, whereas RhoA PSD proteins directly associate with the Racl signaling pathway proteins (Fig. 2), promoting their recruitment to synapses and possibly facilitating their functional coupling. GRIP1 interacts with the EphB receptor tyrosine kinase (Torres et al. 1998), which regulates spine morphogenesis through its action on downstream effectors including the Racl guanine-nucleotide exchange factor (GEF) kalirin-7 and the Cdc42 GEF intersectin (Irie and Yam-aguchi 2002 Henkemeyer et al. 2003 Penzes et al. 2003). NMDAR associates with ligand-activated EphB receptor (Dalva et al. 2000) as well as with the Racl GEF Tiaml (Tolias et al. 2005). PSD-95 interaction is required for synaptic localization of kalirin-7...

Pharmacology Of Spinal Processing Of Visceral Pain Excitatory Amino Acid Receptors and Visceral Pain

It is generally accepted that the excitatory amino acid acid (AMPA) receptors, but not NMDA receptors, are involved in signaling acute noxious and innocuous somatic stimuli in the spinal cord. Following persistent noxious stimulation (inflammation following injury and neuropathic injury), a cascade of events including activation of signal transduction pathways, protein kinases and phosphatases, and NMDA receptor activation induce central sensitization and hyperalgesia (141,142). In contrast to somatic stimuli, experimental data support a role for NMDA receptor activity in addition to AMPA receptor activity in spinal processing of acute innocuous and noxious visceral stimuli. NMDA receptor antagonists attenuate the pressor response evoked by noxious ureter distention, but have no effect on the pressor response evoked by noxious somatic stimulation (143). Likewise, NMDA receptor antagonists attenuate changes in mean arterial pressure and the visceromotor response to urinary bladder...

The Lunar Spine Phantom

The Lunar spine phantom is a rectangular aluminum bar which is intended to replicate the lower half of T12, all of L1, L2, L3, and L4, and the upper half of L5. Each vertebra has a different density that is achieved by varying the thickness of the aluminum. The area of each vertebra is different as well. The densities of L1 to L4 are 0.92, 1.076, 1.239, and 1.403 g cm2, respectively. The L2-L4 BMD is 1.256 g cm2. To simulate soft tissue, the aluminum phantom is submerged in a water bath with a depth of approximately 15 cm. The aluminum phantom is also available encased in an epoxy-resin block, avoiding the necessity of a water bath and improving ease of use.

The European Spine Phantom

The development of the European Spine Phantom (ESP) resulted from efforts to develop a more perfect spine phantom that could be used on all central devices. It was developed independently of any manufacturer under the direction of the Committee d'Actions Concertes-Biomedical Engineering (COMAC-BME) (6). The ESP is a semi-anthropomorphic phantom. Its three vertebrae are made of hydroxyapatite and vary in density, with standardized BMDs of 500, 1000, and 1500 mg cm2 (7). The vertebrae are encased in a plastic and epoxy-resin material equivalent to about 10 fat that is molded into an oval shape with flattened sides measuring 28 cm by 18 cm. The use of the ESP has generally been restricted to clinical research trials, primarily because of its expense. It was originally hoped that the ESP could be used to standardize BMD on any central bone densitometer. Unfortunately, this has not proven to be the case. It is an excellent phantom for cross-calibration of central DXA densitometers however.

Dissimilar Spine and Femoral BMDs in Perimenopausal Women

Eighty-five Caucasian women between the ages of 45 to 60 who were within 6 months to 3 years past menopause underwent spine and proximal femur bone density testing using DXA (Lunar DPX) (15). These values were compared with reference values (mean and SD) from a group of 30 healthy women between the ages of 40 to 45. Thirty-nine women had both spine and femoral neck z-scores that were better than -1. Seventeen women had both spine and femoral neck z-scores that were both poorer than -1. Out of the 85 women, 22 (26 ) had dissimilar spine and femoral neck z-scores. Eight had spine z-scores that were better than -1 but femoral neck z-scores that were poorer than -1. Fourteen had femoral neck z-scores that were better than -1 but spine z-scores that were poorer than -1. In a similar study, Lai et al. (16) evaluated 88 Caucasian women, ages 44 to 59, who were within 5 years past menopause. BMD measurements of the lumbar spine and proximal femur were made using DXA (Hologic QDR-1000). The...

Spinal Cord

Posterior Spinocerebellar Tract

The spinal cord, as seen in cross section (Fig. 14), contains central grey matter and peripheral white matter. The grey matter contains many neuronail cell bodies and synapses. The white matter contains ascending and descending fiber pathways. The ascending pathways relay sensory information to the brain. The descending pathways relay motor instructions down from the brain. The number of synapses within a pathway is not very important to know clinically. However, it is vital to remember the sites of contralateral crossing over of the various pathways and also the location of the pathways within the white matter as seen in cross section (Fig. 14). Fig. 14 Major subdivisions of the spinal cord. The posterior columns consist of the fasciculus gracilis plus fasciculus cuneatus. There are 3 main sensory systems entering the spinal cord The pathway for pain and temperature enters the spinal cord, crosses over to the opposite half of the cord almost immediately (actually within one or two...

Spinal and Supra Spinal Modulation of Pain Perception

Descending Pain Modulatory System

Working with rats and using simple withdrawal reflexes as pain measures, Reynolds (31) showed that stimulation of a specific region of the midbrain periaqueductal gray (PAG) inhibited behavioral responses to noxious stimulation, giving rise to the term stimulation produced analgesia.'' Stimulation of these sites inhibited responses of spinal neurons to noxious stimuli suggesting that the brain could modulate spinal activity. The PAG receives direct inputs from the hypothalamus and from the limbic forebrain, including several regions of the frontal neocortex and the central nucleus of the amygdala (Fig. 3). The PAG controls nocicep-tive transmission by means of connections through neurons in the rostral ventromedial medulla (RVM) and the dorsolateral pontine tegmentum (DLPT). These two regions project through the spinal cord dorsolateral funiculus and selectively target the dorsal horn laminae that accommodate nociceptive relay neurons. This circuit can therefore selectively modulate...

Evidence for Spinal and Supra Spinal Pain Modulation

A number of animal and human studies have assessed the role of spinal nociceptive processes using DNIC paradigms. Recently, Coffin et al. assessed the spinal process of nociceptive signals in IBS patients by analyzing the effects of rectal distensions on electromyographic recordings of the somatic nociceptive flexion (RIII) reflex (107). They reported a significant progressive inhibition of the RIII reflex in healthy volunteers during slow ramp distension, with biphasic effects (facilitation and inhibition) observed during rapid distensions. In contrast, the RIII reflex was significantly facilitated in IBS patients during slow ramp distension and inhibitions induced by rapid distensions were significantly reduced, suggesting hyperexcitability of spinal nociceptive processes in a subgroup of IBS patients. Mayer studied the perceptual responses to rectosigmoid distension in IBS patients and controls with functional brain imaging using H215O positron emission tomography and found that...

Artifacts in PA or AP Spine Densitometry

Osteoporosis Lumbar Spine

The PA lumbar spine has been, and continues to be, used extensively in densitometry for diagnosis, fracture prediction, and monitoring. Unfortunately, it is also the skeletal site most often affected by structural changes and artifacts that may limit its utility. The BMD of a fractured vertebra will be increased because of the fracture itself. This increase in density could erroneously lead the physician to conclude that the bone strength is better and the risk for fracture, lower, than is the case. Vertebral fractures in osteoporosis frequently occur in the T7-T9 region and in the T12-L2 region (14,15). Because DXA measurements of the lumbar spine are often employed in patients with osteoporosis, osteoporotic fractures in the lumbar spine, particularly at L1 and L2, are a common problem, rendering the measurement of BMD inaccurate if the fractured vertebrae are included. An increased precision error would also be expected if the fractured vertebrae were included in BMD measurements...

Divergence of Visceral Afferents in the Spinal Cord

Nociceptor Afferent Fiber

Figure 1 The sensory innervation of the gastrointestinal tract. The splanchnic afferent Innervation Is shown on the left, the vagal pelvic afferent innervation is shown on the right. The splanchnic afferent nerves have cell bodies in the thoracolumbar dorsal root ganglia (DRG) and project centrally through the dorsal roots into the spinal cord. The vagal pelvic afferents that innervate the esophagus to the middle of the transverse colon project in the vagus nerve with cell bodies in the nodose ganglia. These afferents project centrally to the nucleus tractus solitarius. Pelvic afferents innervating the lower bowel have cell bodies in the lumbosacral DRG and project centrally into the lumbosacral spinal cord. Source From Ref. 16. Figure 1 The sensory innervation of the gastrointestinal tract. The splanchnic afferent Innervation Is shown on the left, the vagal pelvic afferent innervation is shown on the right. The splanchnic afferent nerves have cell bodies in the thoracolumbar dorsal...

The Hologic Spine and Hip Phantoms

The Hologic anthropomorphic spine phantom, although intended for use with Hologic DXA devices, is often used with DXA devices from other manufacturers. The phantom itself consists of four anatomically correct vertebrae made of calcium hydroxyapatite. The vertebrae are encased in an epoxy resin to simulate soft tissue. The four vertebrae have similar densities and areas and the soft tissue simulation of the epoxy-resin approaches 60 fat. Each Hologic spine phantom will have a factory-specified L1-L4 BMD. Consistent daily calibration can be obtained with the Hologic anthropomorphic spine phantom, although the lack of a range of BMD values make it less suitable for cross-calibration of central DXA devices. The Hologic anthropomorphic hip phantom has found less of a role in clinical medicine. It does not offer any quality control testing capabilities to the clinician that cannot be obtained with the anthropomorphic spine phantom other than proximal femur edge detection, which is under the...

The Spine in the Lateral Projection

Dxa Lumbar Spine

The effect on BMD measured in the AP or PA projection from aortic calcification, facet sclerosis, osteophytes, and other degenerative changes in the spine can be nullified by quantifying the bone density of the spine in the lateral projection as shown in Fig. 2-15B. In addition, the highly cortical posterior elements and a portion of the cortical shell of the vertebral body can be eliminated from the measurement, resulting in a more trabecular measure of bone density in the spine. The measurement is not a 100 trabecular measure as portions of the cortical vertebral body shell will still be included in the measurement. In addition to the elimination of artifact or confounding degenerative changes, the lateral spine BMD measurement is desirable in those circumstances in which a trabecular measure of bone density is indicated and particularly in circumstances in which changes in trabecular bone are being followed over time. The higher metabolic rate of trabecular bone compared to...

Spinal Cord Compression And Radiculopathy

Extension of vertebral body plasmacytoma and collapse of bony structures lead to compression of the spinal cord or dorsal roots by epidural tumors. Occasionally, paravertebral tumor invades the spinal canal through intervertebral foramina. The incidence of this complication is about 15 .58 59 The thoracic spine is more commonly involved. IgA myeloma and extensive cortical bone involvement appear to pose a greater risk.59 Plain radiographs of the spine may reveal vertebral collapse and or vertebral or paravertebral masses. Uncommon neurologic manifestations may occur with cranial plasmacytoma, either as a part of multiple myeloma or as a solitary lesion.

Morphological changes after spinal cord injury

Spinal cord injury can evoke significant changes in sympathetic preganglionic neurons, as well as depriving them of input from the brain. While neurons at the site of a cord injury can be killed, sympathetic preganglionic neurons that lie distant from the lesion site may also be affected, at least in the acute phase of injury. Within 3 days of a complete spinal cord transection at thoracic segment 4 5, the dendrites of sympathoadrenal preganglionic neurons in the intermediolateral cell column of mid-thoracic cord have retracted to about one-third of their original length and the diameter of their cell bodies has decreased to about 60 of that in intact cord (Llewellyn-Smith and Weaver, 2001). This reduction in soma size and dendrite length is less pronounced 7 days after transection and, by 14 days post-operatively, the sympathetic preganglionic neurons and their dendrites are not significantly different in size from those in intact cord (Krassioukov and Weaver, 1996 Krenz and Weaver,...

Bulbospinal Muscular Atrophy Kennedys Disease

Muscular Atrophy Histological

The histology is confined to the bulbar and spinal motor neurons. Remnant motor neurons display nuclear Infantile spinal muscular atrophy. A 6-year-old boy suffered from generalized muscle wasting that had begun in early infancy. By 3 years of age, he was unable to sit, walk, or talk. Family history was negative. The medulla shows neuronal losses, neuronal atrophy, and neuronophagia in the hypoglos-sus nucleus (Cresyl violet stain). Infantile spinal muscular atrophy. A 6-year-old boy suffered from generalized muscle wasting that had begun in early infancy. By 3 years of age, he was unable to sit, walk, or talk. Family history was negative. The medulla shows neuronal losses, neuronal atrophy, and neuronophagia in the hypoglos-sus nucleus (Cresyl violet stain).

Spinal sympathetic interneurons are identified both physiologically and anatomically

Ideally, we could identify each spinal sympathetic interneuron, whether characterized physiologically or anatomically, by tracing its axon to synapses upon sympathetic preganglionic neurons. However, this is possible under only special conditions, usually in vitro (see, for example, Deuchars et al., 2001). In all other cases, the sympathetic nature of spinal sympathetic interneurons must either be inferred from their neurophysiological properties or by tracing their connections to sympathetic preganglionic neurons using specialized, trans-synaptic, retrograde labeling methods. Gebber and colleagues pioneered neurophysio-logical identification of spinal sympathetic inter-neurons by identifying spinal neurons with discharge patterns that were correlated with the discharge patterns in either pre- or postganglionic sympathetic axons (Gebber and McCall, 1976 Barman and Gebber, 1984). These investigators cross-correlated the ongoing activity of single spinal interneurons and the ongoing...

Spinal interneurons play a more important role in generating sympathetic activity after spinal cord lesions in rats

Although most investigators have found that activity is reduced in sympathetic nerves of unanest-hetized people (Wallin, 1986) and rats (Krassioukov and Weaver, 1995 Randall et al., 2005) after spinal cord transection, many investigators report that detectable levels of ongoing activity remain in some nerves. Therefore, spinal sympathetic interneurons must provide ongoing excitatory input to sympathetic preganglionic neurons in the absence of pathways from the brain-stem sympatho-excitatory systems. Although in anesthetized, surgically prepared rats with acute spinal transections, sympathetic activity is substantially reduced in some nerves, it is maintained or even increased in others (Meckler and Weaver, 1985 Taylor and Schramm, 1987). The observations of decreased activity in some nerves are easily explained by the decrease in supraspinal drive to some sympathetic preganglionic neurons after spinal cord injury. Maintenance and even increases in sympathetic activity after spinal...

The generation of ongoing sympathetic activity after spinal transection is localized to a restricted number of spinal

As described above, after acute spinal transection, activity persists in some sympathetic nerves. To what extent is this ongoing activity generated locally, and to what extent does it represent activity common to the entire spinal cord Chau et al. (1997) searched the spinal cord from T2 to the 2nd lumbar (L2) segment for interneurons with activities correlated to renal sympathetic nerve activity in rats with acute spinal transections. Although the ongoing activities of almost 50 of the interneu-rons recorded at T10 were correlated to ongoing renal sympathetic nerve activity, the activities of only 16 of interneurons at T8 were correlated with renal sympathetic nerve activity. The activities of no interneurons at T2, T13 or L2 were correlated with renal sympathetic nerve activity. In unpublished studies (Chau and Schramm), this exploration extended to C2 and L5 without detecting additional interneurons correlated with renal sympathetic nerve activity. Because anatomical data indicate...

Long propriospinal pathways affecting sympathetic activity are multisynaptic

Although distant spinal segments appear to play little or no role in generating ongoing sympathetic activity in a given segment after spinal transection, sympathetic reflexes can be evoked by stimulating afferents to distant segments (see Weaver and Polosa, 1997, for review). To what extent are the sympathetic reflexes elicited from distant segments mediated by monosynaptic projections to sympathetic preganglionic neurons Cabot et al. (1994) noted that spinal sympathetic interneurons retro-gradely labeled by injecting wheat germ agglutinin into the superior cervical ganglion exhibited a strict segmental organization with respect to their associated sympathetic preganglionic neurons. In other words, wheat germ agglutinin-labeled neurons (spinal sympathetic interneurons) were not found in segments that did not contain cholera toxin B-labeled neurons (sympathetic preganglion-ic neurons). These observations were confirmed in the renal sympathetic system using the retrograde transport of...

Schwannomas of the Spinal Nerve Roots

Nerve Van Gieson

The tumors constitute about 15 to 30 of spinal tumors. They are more common on the sensory roots, preferentially occurring on the cauda equina. Clinically, they present with pain and sensory and motor deficits in a radicular distribution. If they reach a large size, symptoms and signs of spinal cord compression develop. Hourglass or dumbbell schwannoma refers to extension of the tumor through the intervertebral foramen into the mediastinum or peritoneal cavity. Intraparenchymal schwannomas are rare in the brain or spinal cord. They derive from Schwann cells of the nerves that supply small arteries or from ectopic Schwann cells.

Fl The Subarachnoid Space Piaarachnoid Arachnoid Villi and Cerebrospinal Fluid

Subdural Space Cerebrospinal Fluid

The leptomeninges form a complete investment for the brain and spinal cord. The arachnoid and pia mater are connected by dentate ligaments in the spinal canal and numerous trabeculae in the cranial subarachnoid space. They comprise the leptomeninges and are relatively avascular. The arachnoid membrane in man is formed by two layers of cells (Fig. 4.3). Basement membrane separates the superficial dark cells (electron dense) from the collagen fibers of the inner layer of the arachnoid membrane which occurs among elongated cells similar to fibroblasts. Macrophages are observed within the subarachnoid space (Fig. 4.4). Sometimes the arachnoid and pia mater are in contiguity, in which case the subarachnoid space is not in evidence. In humans the outer arachnoid cells have long interweaving processes containing numerous vacuoles. Desmosomes are frequent between the cells (1). The dural arachnoid junctions are apparently tight collagenous dural areas in continuous contact with the outer...

Cerebrospinal Fluid Protein Electrophoresis

Cerebrospinal fluid (CSF), a clear colorless fluid with a viscosity similar to water, is produced at a rate of approx 500 mL p d. The volume averages 135-150 mL in an adult and approx 40 mL in neonates with a turnover rate of 6 h. Approximately two-thirds of the CSF is secreted by the choroid plexuses, whereas the rest comes from leakage of plasma from the capillary bed found in the central nervous system (CNS) and the metabolism of glucose by cells in the CNS.

M Spinal Reflexes The Deep Tendon Response

To elicit a deep tendon reflex, briskly tap the tendon of a partially stretched muscle. For the reflex to fire, all components of the reflex arc must be intact sensory nerve fibers, spinal cord synapse, motor nerve fibers, neuromuscular junction, and muscle fibers. Tapping the tendon activates special sensory fibers in the partially stretched muscle, triggering a sensory impulse that travels to the spinal cord via a peripheral nerve. The stimulated sensory fiber Because each deep tendon reflex involves specific spinal segments, together with their sensory and motor fibers, an abnormal reflex can help you to locate a pathologic lesion. You should know the segmental levels of the deep tendon reflexes. You can remember them easily by their numerical sequence in ascending order from ankle to triceps S1 L2, 3, 4, C5, 6, 7. Reflexes may be initiated by stimulating skin as well as muscle. Stroking the skin of the abdomen, for example, produces a localized muscular twitch. These superficial...

The ventricular system and the cerebrospinal fluid circulation

The cerebrospinal fluid (C.S.F.) is formed by the secretory activity of the epithelium covering the choroid plexuses in the lateral, 3rd and 4th ventricles it circulates through the ventricular system of the brain and drains into the subarachnoid space from the roof of the 4th ventricle before being reabsorbed into the dural venous system. The 4th ventricle is diamond-shaped when viewed from above and tent-shaped as seen from the side. Its floor is formed below by the medulla and above by the pons. Its roof is formed by the cerebellum and the superior and inferior medullary vela. The C.S.F. escapes from the 4th ventricle into the subarachnoid space by way of the median and lateral apertures (of Magendie and Luschka respectively) and then flows over the surface of the brain and spinal cord. About one-fifth of the C.S.F. is absorbed along similar spinal villi or escapes along the nerve sheaths into the lymphatics. This absorption of C.S.F. is passive, depending on its hydrostatic...

Spinal and Spinal Cord Defects

Dysraphic disorders of the spine and spinal cord comprise a broad spectrum of malformations, ranging from total absence of the cord to asymptomatic bony defects and cord anomalies. Familial occurrences are common. The clinical manifestations vary from mild motor and sensory deficits to paraplegia with severe sensory impairment and loss of sphincter control. Amyelia, total absence of the spinal cord occurs with anencephaly (see Fig. 13.2). The cord is replaced with a mixture of fibrous tissue, blood vessels, and neural elements (area myelovasculosa). Meningocele and meningomyelocele consist of her-niations of the meninges or meninges, spinal cord, and Schematic drawing of a lumbar meningomyelocele. The cystic sac covered with skin contains the spinal cord, meninges, and nerve roots. Schematic drawing of a lumbar meningomyelocele. The cystic sac covered with skin contains the spinal cord, meninges, and nerve roots. In tethered spinal cord, the conus is fixed to a bony defect by a...

Dxa Lumbar Spine

Dxa Lumbar Spine

PA and lateral DXA lumbar spine images acquired on the Hologic QDR-4500. The arrow seen in (A) indicates the faint outline of the calcified aorta that is easily seen on the lateral study in (B). Case courtesy of Hologic Inc., Bedford, MA. Fig. 2-15. PA and lateral DXA lumbar spine images acquired on the Hologic QDR-4500. The arrow seen in (A) indicates the faint outline of the calcified aorta that is easily seen on the lateral study in (B). Case courtesy of Hologic Inc., Bedford, MA. Effect of Facet Sclerosis on BMD. Unlike aortic calcification, facet sclerosis can have a profound effect on the measured BMD in the AP or PA projection. In the study by Drinka et al. (25) noted earlier, 113 elderly men were evaluated with standard AP and lateral lumbar spine films and DPA of the lumbar spine. A grading system for facet sclerosis was developed with a grade of 0 indicating no sclerosis and a grade of 3 indicating marked sclerosis. As shown in Table 2-7, grade 1 sclerosis had no...

Spinal Problems

Five other patients with a variety of spinal problems have benefited from using nabilone but have had to stop either because of side effects or because of difficulties in assessment. Two patients found nabilone completely ineffective to manage the pain. Both of them had had multiple spinal operations and suffered both mechanical spinal pain and neurogenic pain from nerve scarring.

The spinal cord

The spinal cord is 18 in (45 cm) long. It is continuous above with the medulla oblongata at the level of the foramen magnum and ends below at the lower level of the 1st, or the upper level of the 2nd lumbar vertebra. Inferiorly, it tapers into the conus medullaris from which a prolongation of pia mater, the filum term nale, descends to be attached to the back of the coccyx. At each intervertebral foramen the anterior and posterior nerve roots unite to form a spinal nerve which immediately divides into its anterior and posterior primary rami, each transmitting both motor and sensory fibres.

Spinal Cord L4

Melanoma Skin Spinal Cord

Preservation of other sensations points to disease of the posterior columns, while loss of all sensations from the waist down, together with paralysis and hyperactive reflexes in the legs, indicates transection of the spinal cord (see Table 16-5, p. 603). Crude and light touch are often preserved despite partial damage to the cord because impulses originating on one side of the body travel up both sides of the cord. A knowledge of dermatomes also aids in localizing neurologic lesions. A dermatome is the band of skin innervated by the sensory root ofa single spinal nerve. Dermatome patterns are mapped in the next two figures. Their lev

The Spine

The vertebral column, or spine, is the central supporting structure of the trunk and back. Note the concave curves of the cervical and lumbar spine and the convex curves of the thoracic and sacrococcygeal spine. These curves help distribute upper body weight to the pelvis and lower extremities and cushion the concussive impact of walking or running. 5. Posterior superior iliac spines, usually marked by skin dimples. Bony Structures. The vertebral column contains 24 vertebrae stacked on the sacrum and coccyx. A typical vertebra contains sites for joint articulations, weight bearing, and muscle attachments, as well as foramina for the spinal nerve roots and peripheral nerves. Anteriorly, the vertebral body supports weight bearing. The posterior vertebral arch encloses the spinal cord. Review the location of the vertebral processes and foramina, with particular attention to The vertebral foramen, which encloses the spinal cord, the intervertebral foramen, formed by the inferior...

Section I Introduction And Overview Of Visceral And Abdominal Pain

Ness Introduction 1 Clinical Visceral Pain 1 Clinical Superficial Pain 2 Psychophysical Studies of Visceral Sensation 3 Neuroanatomy of Visceral Pain 4 Differences in Spinal Pathways 5 Functional Imaging of Visceral Sensation 6 Effects of Stress on Visceral Pain 6 Silent Afferents in the Viscera 7 Are All Visceral Pains the Same 7 References 8

Components of the PSD

Fig. 1 Schematic diagram of PSD proteins. Examples of PSD proteins are shown along with their domain structures. PDZ domains are shown as gray ellipses. Other domains are indicated Actl, actin regulatory domain 1 Act2, actin regulatory domain 2 AD, association domain Ank, ankyrin repeats ArfGAP, Arf GTPase-activating protein C2, calcium lipid binding domain 2 CAM kinase, Ca2+ calmodulin-dependent kinase (CAME)-like domain CC, coiled coil domain CRIB, Cdc42 Rac-interactive binding EVH1, ENA VASP homology domain 1 GH1, GKAP homology domain 1 GK, guanylate kinase-like domain GKBD, PSD-95 GK binding domain GRKBD, GRK2 binding domain Kinase, serine threonine kinase domain L27, domain initially found in LIN2 and LIN7 PDZ, PSD-95 Dlg ZO-l domain LRR, leucine rich repeat PH, pleckstrin homology domain RapGAP, Rap GTPase-activating protein RasGAP, Ras GTPase-activating protein RCB, Rac binding domain SAM, sterile a motif SH3, Src homology 3 domain SHD, Spa2 homology domain WW, domain with two...

Silent Afferents In The Viscera

The awakening of previously silent afferents gives a neurophysiological substrate to explain a transition from minimal sensation to intense sensation, but given the quantitative scarcity and diffuse distribution of visceral afferents to the spinal cord, such an awakening must produce its profound neurophysiological effects either due to the direct potent actions of the neurotransmitters released or due to an amplification process of the central nervous system. Our own studies suggest the latter (61-63). In our study, most neurons excited exclusively by cutaneous stimuli appear to be subject to counter-irritation (noxious stimuli presented to distant sites produce neuronal inhibition), whereas half of the neurons excited by visceral stimuli are not subject to this negative-feedback effect, but rather appear to be part of a positive-feedback loop where nonsegmental excitatory inputs lead to neuronal activation. A formal study of this phenomenon by others may test the validity and...

Are All Visceral Pains The Same

Organization of structures related to most, if not all, viscera follows a similar pattern of diffuseness at a peripheral level and utilizes similar spinal mechanisms of processing and transmission. Visceral structures with a matched pair (i.e., ovaries, kidneys), based on clinical symptomatology, appear to have some lateralization of their afferents to the central nervous system. The chemical and mechanical stimuli adequate to activate primary afferents of differing organ systems appear to vary according to organ and according to afferent pathway (64). This is logical, given the differing functions performed by these organs and their exposure to the external world (i.e., the bladder is sterile, whereas the lower GI tract is full of coliform bacteria). Ascending pathways of sensation that utilize the dorsal midline region of the spinal cord appear to vary in their distance from the midline. All in all, every organ system is unique in some ways, but systems related to the various...

Approach To Urinary Incontinence Definitions

Overflow incontinence Loss of urine associated with an overdistended, hypotonic bladder in the absence of detrusor contractions. This condition often is associated with diabetes mellitus, spinal cord injuries, or lower motor neuropathies. It may be caused by urethral edema after pelvic surgery.

Orchestrated Expression of Chemokines and Chemokine Receptors Within the CNS Following Infection with MHV

By day 12 p.i., MHV-infected mice that have survived the acute stage of disease develop an immune-mediated demyelinating disease. Mice have cleared infectious virus (as determined by plaque assay) by 12 days, yet viral RNA and protein can be detected within white matter tracts for months after infection. As the level of CNS infiltration subsides following reduction of viral burden there is a corollary reduction in the expression of chemokine transcripts. Analysis of chemokine message expression within the brains and spinal cords of MHV-infected mice during the demyelinating phase of disease (days 12 and onward) indicates that CXCL10 and CCL5 are the two prominent chemokines expressed 52 . In situ hybridization for chemokine transcripts indicated expression was limited primarily to areas of viral persistence within white matter tracts undergoing active demyelination 52 . Similar to what was found during acute disease, astrocytes were determined to be the cellular source of CXCL10 at...

Permanently Ionised Drugs

The capillaries of the cerebral circulation differ from those in most other parts of the body in that they lack the filtration channels between endothelial cells through which substances in the blood nominally gain access to the extracellular fluid. Tight junctions between adjacent capillary endothelial cells, together with their

The Central System 51 The Dorsal Horn

Spinal cord input, and local interneurons that are predominantly inhibitory. These inhibitory interneurons contain y-aminobutyric acid (GABA) and glycine. The main transmitter between peripheral afferents and the dorsal horn is a-amino-3-hydroxyl-5-methyl-4-isoxazole proprionic acid. Subunits of the a-amino-3-hydroxyl-5-methyl-4-isoxazole proprionic acid receptor have been shown to play a role in central sensitization and decreased pain thresholds (32).

Image Analysis Inc Columbia

Analyze Hip Dxa Delphi Qdr

DPA studies of the spine required approximately 30 minutes to complete. Studies of the proximal femur took 30 to 45 minutes to perform. Total body bone density studies with DPA required 1 hour. Skin radiation dose was low during spine or proximal femur studies at 15 mrem. Accuracy of DPA measurements of the spine ranged from 3 to 6 and for the proximal femur, 3 to 4 (48). Precision for measurements of spine bone density was 2-4 and around 4 for the femoral neck. DPA was considered a major advance from SPA because it allowed the quantification of bone density in the spine and proximal femur. DPA did have several limitations, however. Machine maintenance was expensive. The 153Gd source had to be replaced yearly at a cost of 5000 or more. It had also been noted that as the radioactive source decayed, values obtained with DPA increased by as much as 0.6 per month (49). With replacement of the source, values could fall by as much as 6.2 . Although mathematical formulas were developed to...

The muscle split or gridiron approach to the appendix

The oblique skin incision centred at McBurney's point (two-thirds of the way laterally along the line from the umbilicus to the anterior superior iliac spine) is now less popular than an almost transverse incision in the line of the skin crease forwards from, and 1 in (2.5 cm) above, the anterior spine.

Mechanisms of Sensitization Structural Changes

Structural changes in primary afferent neurons may also contribute to the manifestation of injury-induced increases in excitability. While sensitization of transducers or changes in the properties of ion channels may contribute to an increase in receptive field size, there is also evidence of a sprouting in peripheral terminals. In the presence of inflammation, increases in neuropeptides such as calcitonin gene-related peptide (CGRP) have been reported, as well as the growth-associated protein, GAP-43 (102,103). Sprouting within central terminals would also be manifest as an increase in receptive field size, and there is evidence for sprouting of central terminals in the presence of (104,105), or in response to (106,107) inflammation and nerve injury (108). Another structural change that may contribute to an increased pain associated with tissue injury or disease has been referred to as a phenotypic switch.'' This term has been applied to sensory neurons that begin to express...

Effect of Artifacts on BMD in the Forearm

The forearm sites are relatively free from the confounding effects of most of the types of artifacts that are often seen in the lumbar spine. The presence of a prior fracture in the forearm will affect the BMC or BMD measurements in the forearm close to the prior fracture site. A study from Akesson et al. (43), suggested that in women with a prior fracture of the distal radius, the BMC was increased by 20 at the distal radius of the fractured arm in comparison to the nonfractured arm, irrespective of arm dominance. It is obviously important for the technologist to ask if the patient has experienced a prior wrist or forearm fracture. Unfortunately, this same study from Akesson et al. noted that in a group of older women who were known to have previously had a distal radial fracture, many of the women did not recall the fracture or incorrectly recalled which arm was fractured. It was noted however, that the forearm most often fractured was the dominant forearm.

Mechanisms of SensitizationCNS Changes

Many of the processes underlying central sensitization are analogous to those observed in the peripheral nervous system. For example, there is evidence that central sensitization reflects an increase in synaptic strength (analogous to transduction in the periphery), which reflects changes in the biophysical properties (144), density (145-148), and or distribution of receptors critical to enabling postsynaptic neurons in the spinal cord dorsal horn (or at higher sites) to respond to excitatory input from nociceptive afferents. Similarly, there is evidence of changes in VGSCs (149) and VGPCs (150) associated with tissue injury, which mediate increases in the excitability of dorsal horn neurons. Interestingly, upregulation of a VGSC a subunit NaV1.3 occurs in both the spinal cord and the thalamus following spinal cord injury, where it appears to be critical for mediating sensitization of these CNS neurons (151). There is also evidence of phenotypic changes in CNS neurons following injury...

Peripheral Pathways The Enteric Nervous System

The gastrointestinal (GI) tract and accessory organs (e.g., liver and biliary tree) have a rich sensory innervation (1). Sensory afferents from the digestive tract project to the central nervous system (CNS) in the vagus and spinal sensory nerves. However, some enteric reflexes (e.g., mucosal stroking) are retained after connections to the CNS are severed indicating that the neural network of the enteric nervous system (ENS) contains the elements necessary for assimilation of information and coordinated motor output (2). These intrinsic sensory neurons in the enteric neural networks do not project to the CNS and therefore are not believed to contribute to gut sensations per se. This chapter will focus on extrinsic primary afferents because these tend to be more involved in visceral sensory processing and relay to the CNS.

Projections to the Central Nervous System

Unlike somatic (i.e., nonvisceral) tissue, the viscera are innervated by two sets of primary afferent fibers that project to distinct regions of the CNS. Innervation of the GI tract from the esophagus through the transverse colon is provided by vagal afferent fibers originating in the nodose ganglia and projecting centrally to the nucleus of the solitary tract. The remaining lower bowel is innervated by pelvic nerve afferent fibers, originating in the sacral (human lumbosacral in rat) dorsal root ganglia, and projecting centrally to the sacral spinal cord. The entire GI tract is also innervated by afferent fibers in the splanchnic nerves projecting to the T5-L2 segments of the spinal cord. For example, colonic afferent fibers project in both the pelvic and the splanchnic nerves (3,4). Because these afferents run in mixed-nerve bundles that contain the autonomic outflow from the CNS, they are often referred to as parasympathetic and sympathetic afferents. This terminology is a misnomer...

Pathways in the Anterolateral Quadrant

Pathways ascending in the ALQ of the spinal cord, such as the STT, are known to be important in transmitting signals evoked by noxious cutaneous stimuli and have been proposed to carry nociceptive information of visceral origin (19). The role of the ALQ in cutaneous nociception is supported by a large amount of experimental and clinical evidence however, the data pertinent to the role of the ALQ in processing noxious visceral information is not conclusive. Transection of the ventral quadrant of the spinal cord in the dog raised the threshold for cutaneous nociception (20) this observation was used as an experimental basis for the introduction of cordotomy as a treatment of pain in humans (21). Several investigators have found that ventrolateral cordotomy produced somatic analgesia on the side contralateral to the lesion in monkeys (22-24). It is interesting, however, that reactions to painful stimuli applied to one side of the body in cats are not prevented by hemisecting the...

The Autonomic Visceral Nervous System

The pathways mentioned above belong to the somatic motor and somatic sensory systems. Somatic motor fibers innervate striated skeletal muscle. Somatic sensory fibers innervate predominantly the skin, muscle and tissues other than the viscera. Viscera means cardiac muscle, smooth muscle (as in the gut) and glands. Visceral (autonomic) motor nuclei are located in between the somatic sensory and motor areas of the spinal cord grey matter. It is useful to think of the autonomic system as consisting of visceral sensory and visceral motor components (Fig. 19). The chemical and functional differences between sympathetic and parasympathetic autonomic fibers will be discussed in Chapter 6. For the present, simply note that sympathetic motor fibers synapse relatively near the spinal cord, whereas parasympathetic motor fibers synapse very close to or within the end organs (Fig. 45).

Chemokines and Chronic Viral Induced Demyelination

Expression of chemokines has been associated with demyelinating plaque lesions present in MS patients 3, 4, 26, 27 . Elevated levels of chemokines, notably CXCL10, were found in the cerebral spinal fluid (CSF) of MS patients during periods of clinical attack 25, 89 . Indeed, the concentration of CXCL10 within the CSF of MS patients correlated with numbers of inflammatory cells and the severity of clinical disease 2, 89, 90 . Moreover, when CXCL10 levels decreased, there was a corresponding decrease in inflammation and disease severity 89 . Astrocyte expression of CXCL10 has been reported in active plaque lesions present in MS patients, and the majority of T cells infiltrating into the CNS of MS patients express the CXCL10 receptor, CXCR3. Collectively, these studies highlight a potentially important role for CXCL10 in the pathogenesis of demyelinating diseases such as MS by attracting CXCR3-expressing T cells into the CNS and support targeting chemokines and their receptors for...

Cns Injury In Surgery Of The Descending Aorta

For some patients, up to 45 minutes of descending aortic occlusion is well tolerated, while in others paraplegia occurs after only 10 minutes. The discrepancy may be related to variability in the blood supply to the spinal cord. There are three major regions of blood supply 1) cervical cord is supplied from the vertebral branch of the subclavian artery via the anterior spinal artery 2) the mid-thoracic cord is supplied by spinal arteries rising from the level of about T7 3) the lower cord is supplied from the large unpaired artery of Adamkiewitz arising in 90 of patients from T9 to L2 and in about 10 from T5 to T8. This contributes to the anterior spinal artery which can provide collateral circulation throughout the spinal cord. The anterior spinal artery can be continuous along the entire spinal cord or can be discontinuous. Anterior spinal occlusion causes paraplegia, incontinence, and loss of superficial sensation. Deep pin, vibration and position sensation, transmitted via the...

Irritable Bowel Syndrome

Neurons, and modulation of the brain responses to information signalled by the gut. Recent evidence from behavioral and functional imaging studies of patients with IBS suggests that changes occur at the level of the primary afferent neuron and or spinal cord but not in higher cortical centers (16,17), thereby supporting the notion that peripheral mechanosensation plays an important role in the etiology of this disease. In particular, there is circumstantial evidence suggesting that hypersensitivity of lumbar splanchnic afferents induces hyperalgesia in IBS patients (16,18). Consistent with the role of peripheral mechanisms, subsets of IBS patients have increased numbers of inflammatory cells in the colonic mucosa (19), while activated mast cells have been found in close proximity to colonic nerves, which correlate with abdominal pain in IBS patients (15), suggesting that activation or sensitization of extrinsic sensory endings within the gut wall may play a key role in IBS. Recent...

The moment of the accident

A cervical spinal cord injury may be life threatening. When the level of lesion is above the third cervical segment (C3), the injured person needs immediate assistance of respiration due to the loss of the supraspinal excitatory drive of the phrenic motor neurons located at C3-C4. Even when the level of the lesion is below C3, the cord-injured person may suffer from life-threatening conditions due to autonomic nervous system dysfunction. Cardiac arrest may be one of the causes of death in the first few minutes following a cervical spinal cord injury due to the disruption of central sympathetic control and the concomitant unopposed vagal outflow. The incidence of this complication is difficult to estimate, although some data indicate a decreasing incidence during the last decades. The number of patients who reach hospital alive has increased more than twofold from the 1940s to the late 1970s. This probably reflects improved skill in treatment of a potential spinal cord injury by the...

Neuronal Development

Nervous system development occurs in three stages with the formation of neurons from neural stem cells (neurogenesis), the guidance of axons to target cells, and the formation of synapses. Heparan sulfate proteoglycans have been shown to play a significant role in these stages of neural development due to their regulation of growth factor signaling, cell adhesion, and assembly of the extracellular matrix. Syndecan-2 has been shown to be involved in the morphogenesis of dendritic spines during synaptogenesis. Dendritic spines are small protusions on the surface of dendrites and are the sites of synapse formation, and receive the majority of excitatory synapse information. The lack of dendritic spine formation results in mental retardation as illustrated by fragile X syndrome (63). The C2 domain EFYA tetrapeptide of syndecan-2 binds to the synaptic PDZ domain protein CASK. Ethell and Yamaguchi (64) showed that in vitro transfec-tion of syndecan-2 in rhippocampal neurons results in early...

Calreticulin in Intracellular Calcium Storage

Mery et al. (1996) transfected a mouse fibroblast cell line with an expression vector carrying a calreticulin cDNA insert. In the transfectant cells, a 1.6-fold overexpression of calreticulin was found, and concurrently, intracellular calcium levels rose to nearly two-fold. Furthermore, most of this calcium originated from intracellular stores, as indicated by thapsigargin sensitivity. A study of the intracel-lular distribution of calreticulin in motor neurones of rat spinal cord has revealed that it is localised not only in the ER but also in coated vesicles (Copray et al. 1996). Copray et al. (1996) suggested that these vesicles may be counterparts of calciosomes, which are calcium storage vesicles found in liver cells and in cerebellar Purkinje cells. It ought to be pointed out, nonetheless, that Coppolino et al. (1996) found that the intracellular calcium stores were unaffected in cells in which the calreticulin gene had been knocked out.

What is Human Material

Somatic cells are cells from any body organ, including stem cells from the umbilical cord or bone marrow, but not sperm, ovula, and embryonic stem cells. Gonadic cells include sperm and ovula. Embryonic (stem) cells are cells obtained from a human embryo. Body fluids include blood, products derived from blood and cerebrospinal fluid. Hair, nails, and body waste products (urine, stool) are components of the human body that are traditionally excluded from the categories above. It is important to note that a given sample can eventually change category (e.g. products derived from an embryonic stem cell might be used in tissue engineering or in organ transplantation).

Muscular Mucosal Afferents

Muscular mucosal afferents, a class of afferent that responds to both circumferential stretch and low-intensity mucosal stroking (10 mg), comprise 23 of the pelvic nerve afferent innervation of the mouse colon (80) and display similar properties to the vagal tension mucosal afferents recorded from the ferret esophagus (71). Muscular mucosal afferents are found only in the pelvic nerves, not in the LSN, and are clustered in the lower distal colon and rectum. In response to fine mucosal stroking, these afferents display similar graded responses to mucosal receptors. However, a proportion of them display greater responses to circumferential stretch than muscular afferents. Thus these afferents are able to detect both low-threshold events in the lumen plus distension of the rectum. In order to achieve this, it is likely that the muscular mucosal afferent has two receptive fields. Overall, these data suggest that pelvic muscular mucosal and mucosal afferents contribute equally in the...

Serosal Mesenteric Afferents

Spinal afferent fibers with endings within the serosa and mesenteric attachment of the colon have been reported in the cat, rat, and mouse (65,67,74,76,77,80). These afferents have endings that are located close to or on blood vessels or branching points of capillaries supplying the serosa and can have between one and seven punctate receptive fields (36,65,67,69,73,74,76,83). Recordings from the LSN show that punctate mechanical stimulation or stretch of the mesentery elicits afferent firing (65,67). These afferents are also capable of responding to distension with a rapidly adapting response, particularly at noxious intensities of distension (67), and are polymodal as the majority respond to chemical stimuli including 5-HT, NaCl, HCl, bile, bra-dykinin, and capsaicin (73,76,77). Recent in vitro studies in rat colon have demonstrated that serosal mesenteric afferents account for between 50 and 80 of the afferents recorded from the LSN (76,77). These afferents are classified by their...

Diffuse Cortical Dementias Alzheimers Disease

Specific laboratory tests are used to eliminate endocrine dysfunction and vitamin deficiency. Cerebrospinal fluid (CSF) examination is indicated when an infectious etiology of dementia is suspected. Commercially available biomarkers for AD are not used routinely in the evaluation of patients. A definite diagnosis is based on the clinical criteria of probable AD (Clinical diagnosis of Alzheimer's disease report of the NINCDS, ADRDA Work Group, 1984) along with histologic verification by autopsy, rarely by biopsy.

Transient Receptor Potential Vanilloid Receptor

The response to TRPV1 activation is generally regarded as involving two phases an initial excitation leading to transmitter release, followed by desensitization and damage after prolonged or repeated exposure (94,96,144,152,153). In the gastrointestinal tract, capsaicin evokes a powerful excitation of discharge in all classes of vagal and spinal afferents however, the relative proportion varies between location and species (71,74,109,154-156). Early reports in the cat found that the majority of vagal and spinal afferents were activated by capsai-cin (157). Similarly, in the mouse, 80 of isolated retrogradely labeled colonic lumbosacral DRG cells responded to capsaicin (158). By contrast, in the rat, in isolated retrogradely labeled cells capsaicin evoked responses in 42 of nodose ganglion cells (154), and 46 of colonic lumbosacral DRG cells (155). Capsaicin activated 29 of rat colonic LSN afferents, including 17 of mucosal afferents, 40 of serosal afferents, and no muscular afferents....

Trans Synaptic Degeneration

Degeneration of the fasciculus graci-lis from compression of the sensory nerve roots by a meta-static carcinoma in the lumbar spine (myelin stain). Wallerian degeneration. Degeneration of the fasciculus graci-lis from compression of the sensory nerve roots by a meta-static carcinoma in the lumbar spine (myelin stain). (b) the mammillary body following degeneration of the fornix (Fig. 2.15) and (c) the neurons of the gracile and cuneate nuclei of the medulla following degeneration of the posterior columns in the spinal cord.

Parental Chronic Pain and Its Impact on the Children

A study of single mothers with spinal disorder investigated their response to a treatment program designed for functional restoration, Gatchel and associates (2005) found that the single mothers displayed a greater level of depression pre-treatment compared to other groups. However, they were no different at follow-up than the single fathers, and the conclusion was that single parents can show similar chronic pain rehabilitation outcomes relative to other chronically disabled work-related spinal disorder patients. While the study was only indirectly related to the children, there was no suggestion that the children of the single mothers were at any greater risk or susceptible to the consequences of having a depressed mother.

Estimated Time To Complete

Osteoporosis Trabecular Ray

Quantitative spine morphometry. The vertebrae on this lateral lumbar spine X-ray demonstrate marked accentuation of the vertical trabecular pattern and thinning of the cortical shell. This is a Grade 2 spine. Fig. 1-1. Quantitative spine morphometry. The vertebrae on this lateral lumbar spine X-ray demonstrate marked accentuation of the vertical trabecular pattern and thinning of the cortical shell. This is a Grade 2 spine. Qualitative Spinal Morphometry Qualitative morphometric techniques for the assessment of bone density have been in limited use for more than 50 years. Grading systems for the spine relied on the appearance of the trabecular patterns within the vertebral body and the appearance and thickness of the cortical shell (4). Vertebrae were graded from IV down to I as the vertical trabecular pattern became more pronounced with the loss of the horizontal trabeculae and the cortical shell became progressively thinned. The spine shown in Fig. 1-1 demonstrates a...

Motor Neuron Diseases

The three groups of MNDs are (Table 5.7) (a) ALS, entailing concurrent degeneration of upper and lower motor neurons (b) spinal muscular atrophies, entailing degeneration of lower motor neurons only and (c) primary lateral sclerosis and hereditary spastic paraparesis, entailing degeneration of upper motor neurons only.

Dementias Lacking Distinctive Histologic Features

Amyotrophic Lateral Sclerosis Spinal muscular The clinical presentation is characterized by a concurrence of symptoms and signs involving both the lower and upper motor neurons. The disease usually begins in the spinal cord, with weakness in extremities, increased or diminished to absent tendon reflexes, Babinski sign, increased or diminished muscle tone, muscle wasting, and fasciculations. Bulbar symptoms usually develop late in the course of the disease but, in

Introduction to Clinical Neuropathology

Spinal Cord Stained With Toluidine Blue

The objectives of the neuropathologic examination are twofold First, to identify and localize any lesion(s), interpret histologic changes and ultimately, formulate a diagnosis. Second, to correlate the location and histopathologic features of the lesion(s) with the clinical presentation. Fulfilling these goals requires familiarity with the anatomy and histology of the nervous system. For this purpose, photographs of representative brain and spinal cord slices and myelin-stained sections are provided (Figs. 1.1 through 1.5). Myelin-stained sections of the spinal cord. Myelin-stained sections of the spinal cord.

Classification of supraspinatus muscle atrophy in MRI according to Zanetti [142

Scapular Mri

For quantitative assessment, areas and SIs of the rotator cuff muscle and the area of the fossa supraspinata were measured at the most lateral image on which the scapular spine is in contact with the rest of the scapula (Fig. 14 a). Tangent Sign Qualitative assessment of atrophy of the supraspinatus muscle For quick qualitative evaluation of atrophy of the supraspinatus muscle a morphologic sign was introduced. A line (tangent) was drawn through the superior borders of the scapular spine and the superior margin of the coracoid (Fig. 14 d). The tangent sign was defined as abnormal (positive) (Fig. 14e,f) when the supraspinatus muscle did not cross the tangent. The tangent sign is a qualitative sign of muscle atrophy with a high predictive value. Obviously, its use is limited to the su-praspinatus muscle, which is not adequate for all types of tears. Fig. 14A-F. A The most lateral image on which the scapulars spine is in contact with the rest of the scapula was chosen as reference...

Blood pressure control and the syndrome of inappropriate antidiuretic hormone secretion

After the extent of the injury is visualized radio-graphically, the injured patient is transported either to an operating theatre, an intensive care unit or to a spinal cord injury unit. Careful monitoring of blood pressure, heart rate, respiratory rate and body temperature begins. A mean arterial blood pressure above 80 mmHg is recommended (Hadley, 2002), and this level is sometimes maintained by intravenous fluid supply and or by the use of pressor agents. Urine output in the cord-injured patient usually is low during the first days postinjury, probably due to an inappropriate secretion of anti-diuretic hormone. Three to six days postinjury urine output reaches 5-6 l day the accumulated water is excreted. If urine output is strictly monitored daily, this polyuria may be misinterpreted as a sign of inability to concentrate the urine, and if the loss of water is fully substituted by intravenous fluids, or vasopressin is given, hypo-natremia may develop. Some years ago a 28-year-old...

Hemorrhagic Shock And Trauma

With respect to trauma, another recent study has demonstrated the role of PARP in a head trauma model in the mouse. PARP-deficient mice had a faster recovery and better neurological performance than wild-type animals subjected to severe head trauma induced by a blunt device.40 Similarly, the activation of PARP has been demonstrated in spinal cord trauma.41 Although an in vitro study points toward the possibility that PARP activation plays a central role in the process,42 the effect of PARP inhibition or PARP deficiency in this latter model remains to be tested in vivo.

Spinocerebellar Degenerations

The cerebellum, brainstem, and spinal cord are usually affected. Additional lesions occur in various subcortical gray structures and peripheral nerves. The presence of neuronal nuclear inclusions that derive from aggregations of expanded polyglutamine-containing proteins are characteristic of triplet-repeat diseases.

Clinical features

Anaesthetic solution injected here will travel extradurally to bathe the spinal roots emerging from the dural sheath, which terminates at the level of the 2nd sacral segment. The perineal anaesthesia can be used for low forceps delivery, episiotomy and repair of a perineal tear.

Voltage Sensitive Calcium Channels

Voltage-sensitive calcium channels (VSCC) are activated during depolarization and allow the influx of calcium, thereby contributing to depolarization. The current flux generated by the movement of this divalent ion is relatively small compared to sodium and potassium currents. However, calcium is not only a charge carrier it also functions as a second messenger within cells, opening calcium-dependent ion channels, triggering neurotransmitter release in presynaptic terminals and activating calcium-dependent enzymes within the cytosol. Ten molecularly distinct pore-forming calcium channel subunits have been described (96). Based on electrophysiological properties, these can be differentiated into high- or low-threshold VSCC, both of which can be found in visceral sensory neurons. The high-threshold VSCC can be separated into L, N, P Q, and R type currents based on their pharmacological properties. The N and P Q type calcium currents are blocked by ra-conotoxin GIVA and ra-agatoxin,...

Synaptic Transmission

Glutamate is the main transmitter within the spinal cord and in the case of the vagus the nucleus of the solitary tract (113,114). In many nerve terminals, glutamate coexists with neuropeptides, which are stored in larger vesicles that appear dense in electron microscopic images (115). Substance-P plays a unique role in this context because it is primarily found in unmyelinated C fibers. Chemical ablation of these nerve fibers with the neurotoxin capsaicin blunts responses to painful stimuli, pointing at an important role of substance-P-containing neurons in nociception (116,117). Consistent with this assumption, innocuous stimulation generally does not trigger substance-P release, while noxious stimuli or visceral inflammation cause the release of this transmitter (118). Conversely, substance-P antagonists or knockout mice deficient in substance-P or its receptor exhibit blunted responses to painful visceral stimulation (119-122). Inflammation rapidly activates the transcription of...

Clinical Implications

Peptide transmitters such as substance-P- or calcitonin-gene-related peptide, play an important role in synaptic transmission of nociceptive information from first- to second-order neuron in the spinal cord. Selective antagonists have been developed to block this information transfer. While effective in animal experiments, initial human studies did not show significant analgesic properties of these agents. Central terminations of primary afferent neurons sprout in the rostrocaudal axis within the spinal cord in response to injury and inflammation. This mechanism may contribute to the wider pain referral area in patients with chronic visceral pain syndromes.

Tuberculous Granulomatous Meningitis

The primary infection, commonly in the lungs or lymph nodes, may be active or latent, although, in some cases, no clinical evidence of an extraneural infectious focus is found. The microorganisms reach the meninges or the vessel wall via the bloodstream and produce a small tubercle. From here, the microorganisms invade the sub-arachnoid space and evoke a granulomatous meningeal reaction. Grossly, this reaction is characterized by multiple small meningeal tubercles and a thick gelatinous exudate. The exudate is typically confined to the basal cisterns and subarachnoid space, extending into the spinal subarachnoid space (Fig. 6.5).

Ventricular Lead Positioning

Once it is in the right ventricle, the shaped stylet may be replaced with a straight one to facilitate positioning at the apex. The proper fluoroscopic appearance of the right ventricular apical lead is one in which the lead's tip is well to the left of the spine and is pointing anteriorly and slightly caudal (Fig. 5.8). Figure 5.8. A RAO and LAO views of right ventricular apical lead position at the time of implant. The patient has a prosthetic mitral valve in place. The ventricular lead is positioned with the tip at the right ventricular apex, well beyond the spine shadow, as shown here. The slight downward position of the tip is desirable. Some indentation of the ventricular lead at the level of the tricuspid valve is common. In LAO the lead lies against the ventricular septum. B PA and lateral views of dual chamber system after implant. The right ventricular lead is positioned in the midright ventricular septum. Note the anterior direction of this lead in the lateral projection....

The Glial Scar and Axon Regeneration

Numerous in vivo experiments have shown that the glial scar inhibits axon regeneration. There is obviously a correlation between the environment in which axon regeneration fails and scar formation, since a scar will form where ever axons are cut. Even very small lesions, which are insufficient to excite an visible disruption of glial architecture can cause changes in the CNS environment sufficient to block axon regrowth.9 In order to show more than a correlation between glia scarring and inhibition of axon growth various transplant experiments have been performed. CNS tissue, even immature CNS tissue containing largely astrocytes and few oligodendrocytes blocks axon regeneration when it is transplanted to peripheral nerves, and tissue removed from scarred areas is very inhibitory.10 13 Until recently the question of whether all CNS tissue is equally inhibitory to axon regeneration, or whether scar tissue is particularly inhibitory was not resolved. Two experiments from Davies and...

Noncholinergic Toxicity

Reports on the non-cholinergic biochemical effects such as inhibition of NTE due to low-dose exposure to nerve agents in certain species of animals are scanty. The inhibition of NTE activity in central and peripheral tissues of animals exposed to low-dose nerve agents at different time points are shown in Table 3.5. In most of the studies, subcutaneous, inhalation, and oral routes of exposure were used. NTE activity in platelets, lymphocytes, spinal cord, whole brain, and brain regions, such as cerebral cortex and corpus striatum, was significantly decreased in mice,17,95 rats,18 and hens19,40 days and weeks after low-dose exposure to nerve-agent sarin. However, studies have been carried out in protected hens, which are a suitable model for OPIDN evaluation with relatively high doses of nerve agents (at lethal

Physiology of Dorsal Horn Neurons Responding to Visceral Stimulation

Extracellular single unit recordings from neurons in the spinal dorsal horn indicate three general categories of responses (abrupt, sustained, inhibited) to stimulation of visceral organs. The organs studied include the esophagus (47,48,95), stomach (96), gall bladder (97,98), ureter (49,99), bladder (42,55,100) and descending colon rectum (8,37-39,41,101118) Although the terminology used to describe responses of these neurons to a distending stimulus differs, response profiles are fundamentally similar for all organs studied, suggesting some constant in the way the nervous system processes innocuous and noxious stimuli from the viscera. Sustained neurons (short latency-sustained, long-lasting excitatory) constitute 0 to 50 of visceroceptive dorsal horn neurons. These cells begin to discharge at the onset of the stimulus, but do not reach a peak discharge until 10 to 20 seconds after the start of the stimulus (the stimulus duration is 20 second). At the cessation of the distention,...

Response of Visceroceptive Dorsal Horn Neurons to Inflammation

Visceroceptive dorsal horn neurons have heterogeneous responses to organ inflammation. In male rats, the response of Abrupt neurons to CRD increases in the thoracolumbar spinal cord, but decreases in the lumbosacral spinal cord. In contrast, the response of Sustained neurons in the lumbosacral spinal cord increases (there are only a few Sustained neurons in the thoracolumbar spinal cord) (42,115,117,124). Other investigators, however, report in comparable populations of lumbosacral neurons (Abrupt neurons), increasing responses following colonic inflammation in male (36) or female rats (125) or no change in the response of abrupt neurons following inflammation in intact female rats, but increasing responses following ovariectomy and subsequent estrogen replacement (123).

Microvascular Oculomotor Pareses

Microvascular ischemia of the oculomotor nerve arises from small-vessel disease of the vasa vasorum supplying the third nerve. It is the most common cause of oculomotor paresis in most ophthalmic practices. Though not specific, the presentation is characteristic, including acute onset of diplopia, complete or partial palsies of the muscles supplied by the third nerve, sparing of the pupillary sphincter, and ipsilateral retrobulbar and or temporal pain. The pain is thought to stem from the acute inflammatory response to the infarcted nerve within the subarachnoid space, i.e., a locus of sterile meningitis. The pupillary sparing reflects the surface location of the autonomic fibers, providing some oxygen supply via the cerebral spinal fluid. The fibers are also small and have lower metabolic requirements than the larger, more quickly conducting oculomotor fibers. It also explains their greater susceptibility to compressive lesions (see Chap. 5, Fig. 5.6 c).

Ten Aspects To Consider for Future Research into Brain Mechanisms Involved in Wasting and Cachexia

Characterisation of brain region cytokines and their system components (ligands, receptors, soluble receptors, signalling proteins) profiles in disease conditions associated with wasting and cachexia of different aetiologies. This includes cerebrospinal fluid profile in clinical subpopulations and clinical stages, and during treatment.

Gonadal Hormone Modulation Of Visceral Pain

Several labs have demonstrated that gonadal hormones modulate behavioral responses to noxious visceral stimuli and there is a large body of evidence that estrogen increases nociceptive sensitivity. From most studies it cannot be determined where the gonadal hormones are exerting their influence, be it peripherally or centrally, and a full discussion of this topic is beyond the scope of this chapter. There are, however, a few studies indicating hor-monally mediated nociceptive plasticity is spinally mediated. Dorsal horn neurons express estrogen receptors (ERs) (205-207), providing an anatomical framework for estrogen modulation of viscerosensory processing at the level of the dorsal horn. Additionally, the cytostolic estrogen receptor (ER) concentration in the spinal cord is positively correlated with the serum estrogen concentration (208), further suggesting that estrogen can increase nociceptive sensitivity by modulating activity in dorsal horn neurons. Indeed, it was recently...

Inhibitory Glial Boundaries

Oligodendrocytes produce several molecules which are extremely inhibitory to axon growth, and which play an important part in the inhibition of axon growth in the CNS. The subject of this review is the glial scar-related molecules, so only a brief description is given here. NogoA is a molecule of the reticulon family, expressed in oligodendrocytes and also some classes of neuron, which is inhibitory to all classes of axon except some embryonic axons.22 Much work has been done with a blocking antibody, IN-1 and more recently with other antibodies with blocking activity. These antibodies have been shown to stimulate axon regeneration in a variety of lesion models in the spinal cord and elsewhere.23 A receptor molecule has recently been identified.24'25 MAG is expressed in myelinating oligodendrocytes, and is also released from the cell surface to diffuse more widely. It is inhibitory to many types of axon, although inhibition varies with axonal type and age.26 28 A MAG knockout showed...

Correlations with Cognition

Although correlations between the age-related defects in the structure of the myelin and conduction velocity have not been examined, there have been several studies of the effects of age on conduction velocity in old animals. For example, Aston-Jones 69 examined the conduction velocity along nerve fibers connecting nucleus basalis to frontal cortex in rats and found a significant reduction in conduction velocity in old animals. Similarly, Morales et al. 70 have shown a reduction in conduction velocity of lumbar motor neurons in the spinal cords of cats, and Xi et al. 71 have shown a reduction in conduction velocity along nerve fibers in the pyramidal tracts of old cats. Interestingly, in proteolipid deficient mice, in which

Conclusions And A Hypothesis

Clearly, peripheral and spinal processing mediates visceral pain and hyperalgesia. But, what is the evidence that central sensitization and the dual innervation of the internal organs contribute to spinal processing of visceral pain Healthy volunteers report that the area of referred pain and the magnitude of the pain sensation increase following repetitive CRD (34). In experimental animals, repetitive CRD does not sensitize colonic primary afferents (212), yet there is an initial sensitization of the visceromotor response (62), and an upregulation of Fos expression in the absence of colonic inflammation (78), suggesting repetitive visceral afferent activity evokes central changes. More importantly, somatic primary afferents are not injured, even during colonic inflammation. Therefore, any change in the response of dorsal horn neurons to somatic stimulation must be due to central sensitization. What is the role of the dual innervation IBS patients report increased colorectal...

Blood pressure and mobilization

When the fracture is stabilized and the neurological level of lesion is stable, the person with spinal cord injury needs to be mobilized. The low blood pressure and the inability to increase blood pressure by vasoconstriction below lesion level make mobilization of the person with cervical injury difficult. It has to be done gradually by tilting the patient 10 day while blood pressure and neurological status are continuously monitored. When the patient tolerates a 40 tilt, they are usually able to sit in a wheelchair. Age at injury seems to affect the ability to mobilize the patients, since the elderly usually need more time to become mobilized. Whether this is due to a lower tolerance to low blood pressure or to greater decreases in blood pressure during mobilization is not known. The renin-angiotensin system plays a role in blood pressure control in cervical spinal cord injury (Johnson et al., 1971 Sutters et al., 1992). This was clearly demonstrated when we treated a man in his 40...

Myeloproliferative Symptoms

Increases in circulating mature (i.e., neutrophils) and immature (i.e., myelocytes, metamyelocytes, myeloblasts, etc.) myeloid cells occur in varying degrees in MMM. These cells have a propensity for accumulation in the reticuloendothelial system, particularly in the spleen and liver.8 These organs expand to accommodate the burden of myeloid cells, and the resulting hepatosplenomegaly may lead to pain, early satiety, sequestration of erythrocytes and platelets, and portal hypertension.9 Extramedullary hematopoiesis also can occur in the lungs (leading to pulmonary hypertension10), abdomen, spine,11 and pericardium.12

How is Pain Measured in an Animal Model

As indicated above, stimuli that are noxious to somatic structures (i.e., those that damage or threaten to damage) are not reliably so in the viscera. Instead, hollow organ distension, traction on the mesentery, ischemia, inflammation, and chemical stimuli are adequate, in the context proposed by Sherrington, for the activation of visceral nociceptors. To evaluate pain in an animal model, a suitably measured variable must be chosen that correlates with the pain evoked by a given stimulus. Candidates are numerous and range from pseudaffective responses such as vasomotor, visceromotor, and respiratory reflexes, to the expression of intermediate-early genes such as c-fos in the dorsal horn of the spinal cord or brainstem. Typically, contractile responses of the abdominal muscles are recorded using mechanical (force transduc-tion equipment) or electrophysiological electromyography (EMG) methods. It should be noted, however, that anesthesia will affect pseudaffective responses (6). More...

Syphilitic Infections

Neurosyphilis may manifest clinically from 1 year to as long as 15 to 20 years after the initial infection. It presents under several forms, depending on the site of involvement meninges, blood vessels, or parenchyma of the brain and spinal cord. The diagnosis is confirmed by examination of the CSF, which shows mild to moderate pleocytosis with lymphocytes and plasma cells, moderately increased protein and IgG immunoglobulin, and a positive serology for syphilis.

Replacing a densitometer

Kalender W, Felsenberg D, Genant HK, Fischer M, Dequeker J, Reeve J. The European spine phan-tom a tool for standardization and quality control in spine bone mineral measurements by DXA and QCT. Eur J Radiol 1995 20 83-92. 7. Pearson J, Dequeker J, Henley M, et al. European semi-anthropomorphic spine phantom for the calibration of bone densitometers assessment of precision, stability and accuracy. The European Quantitation of Osteoporosis Study group. Osteoporos Int 1995 5 174-184.

How to Tell Them Apart

Spines Fin spine never branched or segmented Fin spine never branched or segmented Spines They also measure the number of hard, unbranehed spines in each fin (using abbreviations such as D for dorsal fin, A For anal fin, pc for pectoral fin, pv for pelvic fin, and C for caudal fin). The spines are indicated with Roman numerals (XI). Behind the spines are the soft, branched rays, indicated with Arabic numerals (1,2,3). Angelfish species differ in the number of rays (not spines) in the dorsal and anal fins.

Purulent Leptomeningitis

Purulent leptomeningitis occurs at all ages from birth through old age. The age-related preferences of common bacteria are listed in Table 6.2. The onset is sudden, with fever, headaches, photophobia, and nuchal rigidity. Severe cases are complicated by an altered state of consciousness, seizures, cranial nerve deficits, and focal neurologic symptoms and signs. The cerebrospinal fluid (CSF) shows elevated cell count, chiefly with polymorphonuclear leukocytes (PNLs), increased protein levels, and decreased glucose levels. The causative microorganisms are identified in the sediment of the CSF using Gram stain and by culturing the CSF and blood. Polymerase chain reaction (PCR) and immunologic techniques identify the bacteria within hours of onset.

Mechanisms Of Analgesia

Spinal cord and brain constitute a pain inhibitory system they are activated by nociceptive and other inputs (including treatments such as transcutaneous nerve stimulation, and acupuncuture) and mediate their effects through specific receptors. Activation of opioid receptors prevents the release of substance P (a neurotransmitter and local hormone involved in pain transmission) with the result that

Other Laboratory Test Results That Correspond With Liver Disorders

Beta Gamma Bridging

Cerebrospinal Fluid Proteins Cerebrospinal fluid (CSF) is an ultrafiltrate of plasma formed in the choroid plexuses and ventricles of the brain. CSF contains much less protein than serum and cannot be analyzed by biuret reactions or other methods used in measurement of total serum proteins. The proportion of proteins found in CSF is also different than that of serum, with a predominance of low molecular weight proteins such as

Role of Hypothalamic Neuroimmune Interactions

Recent data suggested that hypothalamic sero-tonergic neurotransmission may be critical in linking cytokines and the melanocortin system. Fenfluramine is a serotonin agonist once widely prescribed in the treatment of obesity. It has been recently shown that fenfluramine raises hypothal-amic serotonin levels, which in turn activate POMC CART neurons in the arcuate nucleus, therefore inducing anorexia and reduced food intake 54 . It is also well-documented that cytokines, and particularly IL-1, stimulate the release of hypothalamic serotonin 55 . Thus, it could be speculated that during disease cytokines increase hypothalamic serotonergic activity, which in turn contributes to persistent activation of POMC CART neurons, leading to the onset of anorexia and reduced food intake. Supporting the role of serotonin in the pathogenesis of anorexia, we demonstrated that in anorectic tumour-bearing animals hypothalamic serotonin levels are increased when compared with the levels in control rats...

Magnetic Resonance Imaging

Figure 2 Multiple imaging modalities are available for small-animal molecular imaging. (A) Small animal PET whole-body coronal image of a rat injected with 18F -FDG, showing uptake of tracer in tissues including muscles, heart, brain, and bladder due to renal clearance. (B) MicroCT coronal image of a mouse abdomen after injection of intravenous iodinated contrast medium. (C) MicroSPECT coronal image of a mouse abdomen and pelvis regions after injection of 99mTc -methylene diphosphonate, showing spine, pelvis, tail, vertebrae, and femurs due to accumulation of tracer in bone. (D) Optical fluorescence image of a mouse showing GFP-expressing tumors that have spread to the liver, abdomen, spine, and brain. (E) MicroMRI coronal T2-weighted image of a mouse brain. (F) Optical bioluminescence image of a mouse with a subcutaneous xenograft expressing renilla luciferase (Rluc) in the left shoulder region, after tail-vein injection of the reporter substrate coelentrazine. Images were obtained...

Clinical Picture of HIV Infection

Although most of the attention given to the HIV virus has gone to suppression of the immune system or AIDS, the virus is associated also with brain diseases and several types of cancer. The brain and spinal cord disease caused by HIV was first detected in brain and spinal cord tissues from AIDS patients in 1984. The chief pathologies observed in the brain, which appears to be independent of the immune deficiency, are an abnormal proliferation of the glial cells that surround the neurons and lesions resulting from loss of white matter (which is, along with gray matter, one of the two main types of brain tissue). This can ultimately give rise to a wide range of neurological symptoms such as dementia and multiple sclerosis.

Urinary system bladder control

The autonomic nervous system dysfunction involves the urinary system during the initial postinjury stage of spinal shock'' and for the lifetime of the person. The dysfunction entails loss of control of the urinary outlet and, during spinal shock, loss of sensation from the bladder wall making the patient at risk of over-distension of the bladder. During spinal shock the bladder is atonic irrespective of level of lesion. When the stage of spinal shock is past, which may take 3-4 months, people with cervical or thoracic lesions develop a spinal reflex bladder that expels urine under high intra-vesical pressure at a certain amount of bladder filling, a condition categorized as upper motor neuron lesion. People with lower lumbar and or sacral levels of lesion retain an atonic bladder, a lower motor neuron lesion. Regulation of bladder emptying appears rather robust and might be normalized even if the person suffers from some degree of paresis and loss of sensation. In a retrospective...

Common causes of pain in the posterior aspect of the lower leg

Pain in the calf is common in patients suffering from prolapsed intervertebral discs. Claudication pain is a feature of vascular insufficiency and spinal stenosis. Lesions of the foot and ankle that lead to protective muscle spasm on standing and walking frequently give rise to marked calf and leg pain.

Gene Portal Inspection

From the descriptions above it should be possible to locate any known gene or genetic marker such as an STS or a SNP. Descriptions of the genome viewer features for Ensembl, UCSC and NCBI are included in the chapter by Semple. However two examples are included below (Figures 4.2 and 4.3) because they illustrate technical differences and highlight the deviations from the standard gene model. The UCSC display (Figure 4.2) includes 12 mRNA sequences for BACE where Ensembl (Figure 4.1) has included accession number links for only eight. The display in Figure 4.2 also shows there are significant differences in the lengths of the 5' and 3' ends. Clearly AF201468 (5878 bp) and AB032975 (5814 bp) are the longest reads but in fact AB032975 is labelled as a partial CDS because of what may be a sequencing error at the 5' end. The matches to the spliced ESTs together with the rat and mouse mRNAs suggest the 5' UTR may be full-length for these entries i.e. they extend to the start of...

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