Spine Healing Therapy

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. Continue reading...

Dorn Spinal Therapy Summary


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Epidural Spinal Cord Compression

Magnetic resonance imaging (MRI) and myelography may identify most spinal epidural illnesses causing myelopathy from spinal cord compression, such as intramedullary tumors, leptomeningeal metastases, radiation myelopathy, arteriovenous malformations, and epidural lipomato-sis. Some epidural diseases, however, can be confused both clinically and radiologically with epidural spinal cord compression from systemic tumor, e.g. epidural hematoma, epidural abscess, herniated disk, and, rarely, extradural hematopoiesis.

Malignant Spinal Cord Compression

Spinal cord compression is a debilitating complication of metastatic cancer identified in 5 -14 of cancer patients (Patchell et al. 2005). Among urologic malignancies, it is most commonly seen with prostate cancer (PCa), which accounts for 9 -24 of cases overall (van der Linden et al. 2005 Flynn and Shipley 1991). In fact, PCa is the second most common cause of malig nant spinal cord compression, with a cumulative incidence of 7 (Manglani et al. 2000 Rosenthal et al. 1992 Sorenson et al. 1990). Although RCC and TCC account for 6 and 2 of cases, respectively, PCa, by virtue of its higher incidence and preponderance for vertebral metastases, warrants the bulk of discussion. However, despite a few minor variances, the treatment Prostate cancer is the most commonly diagnosed noncutaneous malignancy in American men today and the second most common cause of cancer death (Jemal et al. 2005). Screening through the use of serum prostate-specific antigen (PSA) has led to both stage and risk...

Multiple Sclerosis Myelopathies and Spinal Cord Injury

Multiple sclerosis (MS) is a progressive neurologic disease that results from multiple demyelinating lesions within the CNS and that shows a variety of clinical presentations and courses determined by the location and number of the same lesions. Bladder and bowel dysfunction is the third most important discomfort in MS patients after spasticity and fatigue 33, 34 . Genitourinary dysfunctions in MS patients frequently occur due to the spinal involvement, with an incidence of 78 35-38 . Bowel-related disorders in MS patients are very common. The prevalence of bowel dysfunction, fecal incontinence, and or constipation is reported to be between 52 and 66 39-41 . Hinds et al. 42 found that 51 of 280 MS patients experienced fecal incontinence it occurred at least weekly in 25 . The authors also demonstrated a strong correlation between fecal incontinence and the duration of MS and degree of disability 42 . Conversely, Chia et al. 39 found no correlation between the presence of bowel...

Spinal Intradural Cysts

Intraspinal neurenteric cysts form a spectrum that merges with intraspinal teratomas and intraspinal der-moids and epidermoids. More than 60 of the cases are diagnosed in the first 20 years of life 44 are located totally or partially in the cervical spinal canal, 37 are located in the thoracic spinal canal, and 19 in the lumbosacral spinal canal. The neurological signs and symptoms of a slowly progressing mass are associated by congenital anomalies, such as thickened or pigmented skin, a cutaneous dimple or dermal sinus, or a tuft of hair may occur in the midline of the back These account for 0.2 - 2 of primary spinal tumors in adults in children, however, these cysts represent 3-13 of such spinal tumors, and within the first year of life the incidence is even higher, at 17 . At least 62 of dermoid cysts and 63 of epidermoid cysts occur at or below the thoracolumbar junction. Among intraspinal dermoids, 30 are wholly or partially intramedullary in location, and 28 of intraspinal...

Multiple Lumbar Spine Surgery Failed Back Syndromes

A history of failed lumbar spine surgery represents a diagnostic and therapeutic challenge for the physician. The first step is to distinguish between patients whose back or leg pain originates from a systemic cause (e.g., pancreatitis, diabetes, abdominal aneurysm) and those with a mechanical problem a thorough medical evaluation should therefore be undertaken in this group at the same time as the neurosurgical evaluation is carried out.

Spinal Neurochemistry In Diabetes

The structural and electrophysiological properties of the spinal cord during diabetes described earlier present a picture that resembles the paradox often noted in studies of the peripheral nerve, namely structural and electrophysiological indices of progressive degeneration and functional loss that are accompanied by increased activity in some sensory fibers and associated with hyperalgesia, allodynia, or spontaneous pain. There has been speculation that the spontaneous or enhanced activity of spinal sensory pathways is responsible for diabetic neuropathic pain and is secondary to enhanced excitatory input from peripheral nerve primary afferent fibers. This is difficult to verify in clinical studies, whereas evidence of spontaneous or exaggerated evoked activity of primary afferents in animal models of diabetes has been reported in some studies (56-59) but also discounted in others (60,61). Of course, electrical activity of sensory fibers is only one component of any altered input to...

Neurogenic Bladder and Spinal Shock

Directly after the spinal cord injury, all reflexes below the neurologic lesion have disappeared. This is called spinal shock. In this phase, the bladder is hypotonic. This phase takes normally 4-6 weeks, sometimes up to 6-8 months. When the spinal shock phase ends, bladder dysfunction will develop and a urodynamic investigation is needed to treat the dysfunction properly. Bladder rehabilitation should beapartof the overall rehabilitation routine after spinal cord injury and should be adjusted to the result of the urodynamic investigation.

Development Of Neuroprotective Pharmacotherapy For Spinal Cord Injury

The glucocorticoid steroids, mainly dexamethasone and methylprednisolone, were extensively used in the clinical treatment of spinal cord trauma beginning in the mid 1960s and throughout the 1970s. The mechanistic rationale for their use initially centered on the expectation that they would reduce posttraumatic spinal cord edema. This notion was based on the rather remarkable reduction of peritu-moral brain edema that glucocorticoids can induce in brain tumor patients (Reulen and Schurmann, 1972). Furthermore, steroid pretreatment became a standard of care before neurosurgical procedures to prevent intraoperative and postoperative brain swelling. A limited amount of experimental evidence supported the possibility that gluco-corticoid dosing in animal SCI models might be neuroprotective (Reulen and Schurmann, 1972). In the mid-1970s, a randomized, multicenter clinical trial was organized to try to determine if steroid dosing was beneficial in improving neurological recovery in humans...

Descending Motor Tracts In The Spinal Cord

Reflex activity generated from motor programs in the spinal cord represents the foundation of the motor hierarchy. These programs provide the basic plans by which movement can be achieved in a coordinated fashion. In addition, they facilitate the transfer of information about more complex movements and about volitional movement from brain to appropriate groups of lower motor neurons. Motor input to spinal cord levels is received in two major pathways (1) the ventromedial pathway, consisting of four major tracts from various brain stem structures primarily concerned with posture and locomotion, and (2) the lateral corticospinal tract, which carries information for volitional movement of proximal and distal muscles under direct cortical control (Fig. 5). The tectospinal tract originates from the superior colliculi, a structure that forms part of the tectum, or roof of the midbrain. The superior colliculus is a coordinating center for visual information, gathering visual input from the...

Some Basic Electrotonic Properties Of Dendritic Spines

The smaller the size and the narrower the stem, the higher the input resistance this gives a large-amplitude synaptic potential for a given synaptic conductance. Such a large depolarizing excitatory postsynaptic potential (EPSP) can have powerful effects on the local environment within the spine. Low spine membrane capacitance. The small size also means a small single spine membrane capacitance, implying that synaptic (and any active) potentials may be rapid this means that spines on dendrites can be involved in rapid information transmission. Increases in total dendritic membrane capacitance. Although the membrane capacitance of an individual spine is small, the combined spine population increases the total capacitance of its parent dendrite. This increases the filtering effect of the dendrite on transmission of signals through it. Decrement of potentials spreading from the spine. There is an impedance mismatch between the spine head and its parent dendrite...

Brain and Spinal Cord Cancers

Brain and spinal cord tumors are the second most common childhood cancer, accounting for 21 of all childhood cancers (American Cancer Society, 2004). Brain tumors involve the brain structures either by growing on or in a structure, or by causing pressure on brain tissues (Armstrong & colleagues, 1999). Possible symptoms of brain tumors include epileptic seizures and pressure within the skull, which may result in headaches, nausea, vomiting, or blurred vision. Some children experience crossed eyes and double vision as a result of the pressure, and some children lose their vision totally. Symptoms of skull pressure in school-age children include decreased school performance, fatigue, personality changes, and headaches. In younger children, symptoms include irritability, decreased appetite, developmental delays, and losing previously acquired intellectual and motor skills infant symptoms include increased head size, vomiting, and failure to thrive. Possible symptoms of spinal cord tumors...

Disorders of the Spinal Nerve Roots

E.g., brachialgia, girdle pain, sciatica. Pain is aggravated by cough (increased intraspinal pressure) movement of that part of the spine and stretching (e.g., straight leg raising L4, L5, SI femoral stretch test L2, L3, L4) Lower motor neuron type (e.g., weakness, tendon reflexes decreased or absent, flaccidity, fasciculations, and atrophy if existing for long enough) E.g., all modalities decreased or absent in dermatome dermatomes often overlap, so that sensory loss may be subtle. The disorders may affect the spinal roots in the spinal canal or intervertebral foramen Spinal stenosis

Spinal Electrophysiology In Diabetes

In contrast, there have been relatively few evaluations of spinal electro-physiology in diabetic subjects and such measurements are rarely included in global assessments of neuropathy. Increased latencies, indicative of conduction slowing are described in diabetic subjects (43-45), but it is not definitively established that this disorder shares a common presentation or aetiology with peripheral conduction slowing. For example, evaluation of a series of diabetic subjects indicated that relatively few showed both spinal and PNS conduction slowing, with many cases of either PNS or CNS dysfunction (46) and there is not a strong correlation between conduction slowing in the PNS and CNS (47). It had also been reported that slowing in sensory (ascending) tracts precedes that of motor (descending) tracts (48). The aetiology of CNS conduction slowing is poorly understood and the extent to which it precedes or reflects the pathological changes that occur in the spinal cord...

Organization Of The Spinal Cord

To better understand somatotopic and modality-specific arrangements, it is helpful to review the general organization of the spinal cord (Figs. 1 and 2). Dorsal roots carrying sensory information and ventral roots transmitting motor signals occur in left and right pairs attached at 30 regular intervals along the spinal cord. Each point of attachment establishes a separate spinal segment. Rootlets from individual segments merge just distal to the dorsal root ganglia to form spinal nerves, which must pass through the vertebral column at notches between the vertebrae. Vertebrae and associated spinal brain stem spinal cord spinal nerves vertebrae

Traumatic Brain And Spinal Cord Injury

Traumatic brain (TBI) and spinal cord injuries (SCI) remain a major health and social problem. These types of injuries often occur in early adulthood and have a major impact for society. Traumatic brain and spinal cord insults result in both immediate mechanical damage and subsequent tissue damage and loss. The frequency, complexity, severity, and diversity of head and spinal cord injury are myriad with extensive long-term disabilities. Approximately 15 million people sustain a TBI or SCI each year in North America. According to the Centers for Disease Control and Prevention, TBI and SCI cost the nation an estimated tens of billions of dollars each year, and treatment of secondary conditions comes at still much higher costs. The leading causes of TBI and SCI are motor vehicle accidents, falls, and being struck by a foreign object. TBI can be quite diverse, depending upon the areas of the brain that are involved. Trauma to the vertebral column alters the spinal cord's ability to send...

Spinal Extradural Cysts

Congenital extradural spinal cysts Spontaneous spinal nerve root diverticula and cysts (Tarlov cysts) Spinal ganglion cysts and spinal synovial cysts Extradural spinal hy-datidosis These cysts arise as an evagination or herniation of the arachnoid that gradually enlarges. Its neck eventually closes, creating a cyst that no longer communicates with the CSF space. The cysts are located exclusively or primarily in the thoracic spine in 86 of cases, and less frequently in the cervical region (2.5 ) and lumbosacral region (11.5 ). Nearly 40 of patients with congenital extradural spinal cysts have Scheuermann's disease (kyphosis dorsalis juvenilis) or preoperative dorsal kyphosis without definite vertebral epiphysitis These cysts are extensions of the subarachnoid space along spinal nerve roots primarily located on the posterior spinal nerve roots and spinal ganglia, containing fluid that is either clear and colorless or faintly yellow. Occasionally, a perineural cyst can become large...

Spinal Cord Injury

The influence of spinal cord injury on continence is complex, being dependent upon the level and completeness of the injury as well as time since the event. The majority of patients suffer with constipation, but faecal incontinence is experienced by 75 , with up to one third having accidents at least monthly 36 . In the acute phase (spinal shock), complete cord severance leads to permanent loss of all voluntary and sensory function and a temporary loss of reflex functions in all segments below the lesion. There is loss of facilitation from above and loss of inhibitory reflexes from below the lesion. The termination of spinal shock, up to 4 weeks following injury, is heralded by a return and then exaggeration of reflex activity. Supraconal lesions are associated with delayed proximal colonic transit (loss of sympathetic activity compounded by muscle weakness and being bedridden), but with exaggerated rectal contractions and anal relaxation in response to relatively low rectal...

Transmission and Tissue Tropism

Coxsackieviruses affect a wide range of susceptible tissues and organs striated muscles, myocardium, brain and spinal cord, pancreatic islets, lung, skin and conjunctivae. Mutants with special pathogenic properties have been reported, for example cardiotropic and pancreatropic CB for mice. Much effort has been devoted to the characterization of the genetic determinants responsible for this virulence.

Pathology and Histopathology

Severe infections by TBE complex viruses show swelling, congestion and petechial hemorrhages. Monkeys infected intracerebrally show degenerative spongiform lesions and astrocytic proliferation. Histopathologic alterations in humans include meningeal and perivascular inflammation, neuronal degeneration and necrosis, neuronophagia and glial nodule formation involving cerebral and cerebellar cortex, brainstem, basal ganglia and spinal cord. Kyasanur Forest disease in humans causes parenchymal degeneration of the liver and kidneys, hemorrhagic pneumonitis and an increase in reticuloendothelial tissue in liver and spleen, with marked erythrophagocytosis.

Details of the study

Eligible patients were between 2 and 21 years of age with biopsy proven high grade astrocytoma (Kernohan grade II-IV). Brain stem and spinal cord tumors were excluded. Patients were grouped into those with anaplas-tic astrocytoma or glioblastoma multiforme. The latter was defined as one or more foci of necrosis in malignant astrocytes. There was central review of both pathology and radiotherapy planning fields.

Primary Nursing Diagnosis

ICP monitoring may be used in patients with severe head injuries who have a high probability of developing intracranial hypertension. Some physicians use a Glasgow Coma Scale score of less than 7 as an indicator for monitoring ICP. The goal of this monitoring is to maintain the ICP at less than 10 mm Hg and the CPP at greater than 80 mm Hg. Management of intracranial hypertension can also be done by draining cerebrospinal fluid through a ventriculostomy.

Headache Related to Intrathecal Injections

Tali ET, Ercan N, Kaymaz M, Pasaoglu A, Jinkins JR. Intrathecal gadolinium (gadopentetate dimeglumine)-enhanced MR cisternography used to determine potential communication between the cerebrospinal fluid pathways and intracranial arachnoid cysts. Neuroradiology 2004 46 744-754.

Clinical Features of Infection

JE is a typical acute encephalitis with sudden onset of high fever and headache after incubation for 1-2 weeks. After a few days of prodromal stage, full symptoms of encephalitis appear with impaired consciousness. Nuchal rigidity is present in all cases, with frequent signs and symptoms of chills, vomiting, malaise, photophobia, pareses and tremors. Cerebrospinal fluid (CSF) findings are moderately elevated pressure and protein content, and lymphocytic pleo-cytosis with normal sugar level. The peripheral blood picture shows moderate leukocytosis with relative lymphopenia. The case fatality rate is high, around 25-50 , and most of the deaths occur around 5-9 days after onset. Respiratory dysfunction, abnormal reflexes, seizures, prolonged fever, albuminuria, infectious virus and absence of anti-JE antibodies in the CSF are correlated with poor prognosis. There is no specific treatment for JE except supportive care. Grave sequelae with neurological and psychiatric disorders are...

Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive degeneration of spinal motor neurons. Systemic delivery of ciliary neurotrophic factor (CNTF) has therapeutic potential but is limited clinically because of systemic side effects, short half-life, and the inability to cross the BBB. 10 Continuous intrathecal delivery of CNTF proximal to the nerve roots in the spinal cord could result in less side effects and better efficacy of CNTF in ALS patients. 11 After safety, toxicology, and preclinical evaluation, a clinical trial was performed to establish the safety of encapsulated CNTF-producing cells in ALS patients. Six ALS patients with early-stage disease received BHK cells that were encapsulated into 5 cm long x 0.6-mm diameter hollow membranes and implanted into the lumbar intrathecal space. CNTF from the cells was found in all six patients at 3-4 months postimplantation. All six explanted devices had viable cells and detectable CNTF secretion. More recently, a phase I II clinical...

Clinical Manifestations

The first group includes three disorders that in the past had been considered to be separate clinical entities the Zellweger syndrome (ZS) (Bowen, et al., 1964 Wilson, et al., 1986 Zellweger, 1987) neonatal adrenoleukodystrophy (NALD) (Ulrich, et al., 1978 Kelley, et al., 1986) and infantile Refsum disease (IRD) (Scotto, et al., 1982). ZS, NALD, and IRD are now considered to represent a clinical continuum, with ZS the most severe, NALD intermediate, and IRD the mildest compared to the other forms, even though in absolute terms it still causes marked disability. Classical ZS is a very severe disorder, often leading to death during the first year and psychomotor development is severely compromised and sometimes absent. It is associated with a striking and characteristic defect in neuronal migration (Evrard, et al., 1978). NALD and IRD share many of the features of the features of ZS, but are somewhat milder. Patients live longer a few have survived to the fourth...

Leptomeningeal Metastases

The clinical findings consist of early multifocal cranial or spinal nerve dysfunction, symptoms or signs of meningeal irritation, and even changes in the cerebrospinal fluid (CSF), such as mild pleocytosis and high protein. Differentiating between leptomeningeal metastases and other parenchymal or epidural metastases requires the following. - MRI with gadolinium enhancement of the brain and spine to reveal or exclude any mass lesions CSF cerebrospinal fluid MRI magnetic resonance imaging.

Progressive myelopathy

During the acute stage, MRI reveals spinal cord swelling, which may lead to a complete spinal block, and contrast enhancement of the area of damage. During the late stages, the spinal cord appears to be atrophic - Motor conduction velocity in the spinal cord pathways is reduced Spinal cord hemorrhage (8-30 years after radiotherapy, and only in a few - MRI reveals acute or subacute hemorrhage in the spinal cord, which may be atrophic, but no other lesions are found CSF cerebrospinal fluid MRI magnetic resonance imaging.

Transverse and Ascending Myelopathy

Primarily from posterior column involvement, such as painful electric shock-like sensations, elicited by neck flexion or extension (Lhermitte's sign), which involve the body below the neck. The pathogenesis of Lhermitte's sign is thought to be reversible damage to myelin in the ascending sensory tracts of the spinal cord, causing axons to become abnormally sensitive to mechanical deformation.

The differential diagnosis of Lhermittes signs includes

Spinal metastasis Cervical spondylosis Cervical disk herniation Multiple sclerosis Posttraumatic syndrome Subacute combined degeneration Cisplatin chemotherapy Cervical radiation - MRI usually shows a normal spinal cord on T1-weighted images, but hyper-intensity can occasionally be identified on T2-weighted images contrast enhancement may be observed CSF cerebrospinal fluid MRI magnetic resonance imaging.

Patient Selection and Indications

Today, fecal incontinence from a variety of causes can be treated with SNS. The current spectrum of applications reflects the evolution and expansion of the initial indication. Initially, SNS was confined to patients with deficient function of the striated anal sphincter and levator ani but with no morphologic defect 4 , as residual function of the continence organ would be recruited by electrical stimulation. Thus, initial patient selection for the SNS protocol was based on clinical and physiologic finding of reduced or absent voluntary sphincteric function but existing reflex activity, indicating an intact nerve-muscle connection (confirmed by intact anocutaneous reflex activity or by muscular response to pudendal stimulation with the St. Mark's electrode) 7 . In this group of patients, the causes varied and covered a spectrum from postoperative sphincteric weakness consequent to anal and rectal procedures to total lack of voluntary sphincteric control as a sequela of cauda syndrome...

Principles of Serological Assays

Other clinical specimens than sera can be used for antibody assays. IgM and IgG antibody determinations from cerebrospinal fluid are used for diagnosis of virus infections in the central nervous system although new molecular methods are increasingly replacing them. Recently, increasing attention has been given to the use of noninvasive sample materials such as saliva or urine. They are becoming important for public health purposes but their value for diagnosing individual patients is still limited.

Acid Base Changes and Dehydration

Several studies have shown that a nearly complete compensation occurs in children receiving the KD. Animal studies support the notion that acidosis does not have a major influence on seizure parameters. For example, acidosis did not significantly alter maximal electroshock or PTZ seizure parameters (Hendley et al., 1948). Furthermore, brain and cerebrospinal fluid pH did not change significantly in rats maintained on a KD for 5 wk (Withrow, 1980). Finally, chronic administration of the classic KD or MCT oil does not alter the intracellular pH of neurons (Davidian et al., 1978 Al-Mudallal et al., 1996).

Chronic Effects of the Ketogenic Diet

Kainic-acid-treated rats normally display hyperexcitable hippocampal circuitry (Tauck & Nadler, 1985 Cronin & Dudek, 1988 Mathern et al., 1997). To determine whether the KD could ameliorate KA-induced hyperexcitability changes, we examined hippocampal slices obtained from KA-treated rats on normal and ketogenic diets. Significantly fewer CA1 population spikes were evoked by Schaffer collateral stimulation in slices from KD-fed rats than from controls, suggesting that this neuronal network is less excitable after KD treatment (Stafstrom et al., 1999b). Because slices were perfused in normal artificial cerebrospinal fluid (without ketones), this reduction in excitability is independent of ketosis, reflecting a chronic stabilizing effect of the KD. It is tempting to speculate that such long-term effects may involve membrane lipid alterations.

Early Specification Of The Neural Tube

The vertebrate central nervous system (CNS) is initially derived from a cytologically homogeneous sheet of epithelial cells termed the neural plate, which arises from dorsal ectoderm during the cytological reorganization that occurs during gastrulation. Somewhat remarkably, the specification of the neural plate appears to result not from the actions of active inducer molecules but rather through local suppression or the avoidance of the molecular signals responsible for the induction of nonneural cells in the surrounding ectoderm. As embryogenesis proceeds, the neural plate subsequently undergoes a series of morphogenetic movements to form the neural tube, a process that involves establishment of the dorsal-ventral axis, differential cell proliferation, infolding, segregation from the overlying ectoderm, and fusion of the lateral margins of the neural tube. Anterior-posterior patterning in the emerging CNS is established very early, and during neural tube closure the rostral or...

In The Prevention Of

Prophylactic administration of acetazolamide at 10 mg per kg given in two to three oral doses 8 hr apart beginning prior to ascent significantly improves arterial Po2 upon acute exposure to high altitude. Lower doses (250-500 mg qhs) are also effective and the minimum dose should be established individually. After drug administration the greatest increase in arterial Po2 is seen after 24 hr at high altitude, suggesting that cerebrospinal fluid alkalosis is corrected first before ventilatory augmentation occurs. In prospective trials, prophylaxis significantly reduces the frequency and severity of symptoms of AMS but does not clearly improve exercise performance at high altitude. The duration of treatment or prophylaxis is highly individualized but the drug may be continued for 5 to 7 days if necessary. Side-effects are frequent but generally mild, including paresthesia of the face and extremities, gastrointestinal upset, somnolence, and altered taste of carbonated beverages. For...

Viral Genomic Determinants in Pathogenesis

Figure 4 Histopathology of TMEV-induced demyelinating disease (late disease) in an SJL mouse. (a) H&E-stained longitudinal section (6 mm) of the spinal cord showing intense mononuclear inflammatory cell infiltrates in the leptomeninges (right) and parenchyma where many vacuolated macrophages are observed. (b)Toluidine blue-stained, Epon-embedded coronal section (1 mm) of a spinal cord showing a discrete plaque-like area of demyelination (many naked axons present) and lipid-laden macrophages at the cord margin and surrounded by normal myelinated axons. Magnification x400 (a) x300 (b). Figure 4 Histopathology of TMEV-induced demyelinating disease (late disease) in an SJL mouse. (a) H&E-stained longitudinal section (6 mm) of the spinal cord showing intense mononuclear inflammatory cell infiltrates in the leptomeninges (right) and parenchyma where many vacuolated macrophages are observed. (b)Toluidine blue-stained, Epon-embedded coronal section (1 mm) of a spinal cord showing a discrete...

Pathogenesis and Histopathology

Motor neurons in the brainstem and spinal cord are the main targets of infection during poliomyelitis, but sensory neurons and astrocytes are also infected. TMEVs do not replicate in endothelial and ependymal cells. A brisk microglial reaction is elicited, with the appearance of numerous microglial nodules, particularly in the anterior gray matter of the spinal cord. Examples of neurono-phagia are quite frequent at this time, but little lympho-cytic response is seen. The poliomyelitis phase lasts 1-4 weeks, after which time little residual gray matter involvement is inapparent other than for astrocytosis. As early as 2 weeks post infection, inflammation of the spinal leptomeninges begins to appear, followed by involvement of the white matter. Initially, the inflammatory infiltrates are almost exclusively composed oflymphocytes, but at later times plasma cells and macrophages become numerous (Figure 4(a)). The influx of macrophages is in close temporal and anatomic relationship with...

Regional Specification Of The Developing

Similar environmental signals are important for the appropriate development of other regions of the CNS. Studies using molecular markers for BMP gene expression demonstrated that BMPs are expressed from the caudal spinal cord to the lamina terminalis at the base of the telencephalon 20,32,33,34 . Furthermore, during early development, BMP7 is expressed by the prechordal mesoderm that underlies the Dorsal cell patterning in the hindbrain is also controlled by inductive signals mediated by BMPs in a similar manner to that in spinal cord 20,33,36,37,38,39,40 . At the level of the hindbrain, the neural tube is subdivided by a series of transient constrictions into domains termed rhombomeres 41 . The elimination of neural crest cells from r3 and r5 in response to repressive signals from even numbered rhom-bomeres appears to depend on induction of BMP4 expression in the dorsal neural tube in r3 and r5 42 . In vitro studies in isolated explants found that BMP4 can stimulate apoptosis that...

Determination Of Precise Cellular Identity In The

FIGURE 6.2 (A) EGF and FGF are important in regulating neural stem cell proliferation. Differentiation of embryonic stem (ES) cells in medium supplemented with the BMP4 antagonist-noggin resulted in neurons comprising 91 of surviving cells after 72 hours. Similarly, addition of chordin, another antagonist of BMP4, increases neural differentiation with lower (55 ) efficiency. When cultured in vitro for 3-7 days, addition of BMPs (BMP2,4,5,6,7) induces the elaboration and irreversible differentiation of astrocytes in a dose and time-dependent manner. When cultured for a shorter period of time (2 days), addition of BMP2, 4, 7 in combination with IL-6 family members resulted in astrocyte differentiation. (B) In spinal cord, coordinated expression of SHH and BMP antagonist-noggin in ventral regions contributes to the induction of motoneurons and oligodendrocytes in the same domain from neuroepithelial cells. FIGURE 6.2 (A) EGF and FGF are important in regulating neural stem cell...

American Academy of Neurology Diagnostic Criteria for Chronic Inflammatory Demyelinating Polyneuropathy

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a diagnosis of pattern recognition based on clinical signs and symptoms, electrodiagnostic studies, cerebrospinal fluid examination, laboratory tests appropriate to the specific clinical situation, and, on occasions, results from nerve biopsy. Four features are used as the basis of diagnosis clinical, electrodiagnostic, pathological, and cerebrospinal fluid (CSF) studies. These are further divided into mandatory, supportive, and exclusion. Mandatory features are those required for diagnosis and should be present for all definite cases. Supportive features are helpful in clinical diagnosis, but by themselves, do not make a diagnosis and are not part of the diagnostic categories. Exclusion features strongly suggest alternative diagnoses.

Multiple Sclerosis DRG 013

M ultiple sclerosis (MS) is a chronic, progressive degenerative disease that affects the myelin sheath of the white matter of the brain and spinal cord. Each year 25,000 people are newly diagnosed with MS. The disease affects quality rather than duration of life. In MS, nerve impulses are conducted between the brain and the spinal cord along neurons protected by the myelin sheath, which is a highly conductive fatty material. When plaques form on the myelin sheath, causing inflammation and eventual demyelination, nerve transmission becomes erratic. Areas commonly involved are the optic nerves, cerebrum, and cervical spinal cord. MS is the most common demyelinating disorder in the United States and Europe.

Meralgia Paresthetica Bernhardt Roth syndrome

The lateral cutaneous nerve is a purely sensory branch arising from the lumbar plexus (L2-L3). It passes obliquely across the iliac muscle, and enters the thigh under the lateral part of the inguinal ligament. It supplies the skin over the anterolateral aspect of the thigh. Meralgia pares-thetica is a condition caused by entrapment of this nerve as it passes through the opening between the inguinal ligament and its attachment 1 - 2 cm medial to the anterior superior iliac spine. Numbness is the earliest and most common symptom. Patients also complain of pain, paresthesias (tingling and burning) and often touch - pain - temperature hyp-esthesia over the anterolateral aspect of the thigh. The condition occurs particularly in obese individuals who wear constricting garments (e.g., belts, tight jeans, corsets and camping gear). Intra-abdominal or intra-pelvic processes may directly impinge on the nerve during its long course the condition can also be due to abdominal distension (as a...

Applications in Qualitative PCR

The nPCR systems are currently widely employed in both qualitative, simple 3,4 or multiplex, 5-13 and quantitative1-14,15-1 diagnostic tests, as well as in PCR systems employed in the identification of viruses. 16-19 Regarding the above mentioned qualitative nPCRs, the primer design allows to detect from 10 to 100 genome copies per microliter of any adenovirus 4 or lyssavirus, 3 and can be performed from a variety of samples including cerebro-spinal fluid (CSF), urine, stools, respiratory swabs, conjunctival swabs, or brain necropsies. These nPCRs can be included in multiplex systems, especially adenovirus nPCR, 12 as the range in hybridization temperatures and biochemical conditions is very high. A multiplex nPCR was also developed for differentiating simultaneously the DNA of polyomaviruses JC, BK, and SV40. 9 In the first amplification step the same set of primers were used to amplify a conserved DNA region of the large T antigen gene of JCV, BKV, and SV40. The second round of...

Concluding Remarks

The nature of the causative agent of poliomyelitis was identified 90 years ago by Karl Landsteiner and Erwin Popper. On 18 December 1908, they reported to the k.k. Society of Physicians in Vienna the successful transfer of poliomyelitis from a deceased victim to Cynocephalus hamadryas monkeys. Since the human specimen from the spinal cord was free of bacteria, Landsteiner and Popper concluded correctly that 'a so-called invisibles e.g. a virus belonging to the class of Protozoa, must have caused the disease'.

Scoliosis Introduction

Scoliosis is a lateral curvature of the spine with the thoracic area being the most commonly affected. It can be classified as functional or structural. Functional scoliosis is the result of another deformity and is corrected by treating the underlying problem. Structural scoliosis is most often idiopathic although it may be congenital or secondary to another disorder. There is a growing body of evidence that idiopathic scoliosis is probably genetic but the etiology is not completely understood. Structural scoliosis is more progressive and causes changes in supporting structures, such as the ribs. Management includes observation, bracing, and surgical fusion. Patients with idiopathic curves of less than 25 degrees are observed for progress until they have reached skeletal maturity. Bracing is recommended for adolescents with curves between 30 and 45 degrees, while curves greater than 45 degrees usually require surgery. The deformity may occur at any age, from infancy through...

Growth Factors And Differential Survival

In those systems that have been carefully studied (spinal cord of Xenopus, various parts of chick CNS, etc.) the over-production ranges from 40 to well over 100 . The cell loss, moreover, does not occur at random, spread over a lengthy period of time. It occurs at a definite period in development which can be predicted with some certainty. In the lateral motor column of the chick's spinal cord, for instance, a population of over 20 000 neurons is reduced to just over 12000 in 72 hours (Figure 19.24A) in Xenopus spinal cord a reduction from 4000 to 2000 cells occurs in about the same period of time. It can be shown that the degenerating cells are not merely the last to arrive, denied their 'place in the sun'. Rather the evidence points to the causal agent being at the far end of the axons, at the growth cones. If, for instance, the target field is partially or completely extirpated the loss of cell bodies is proportionately greater, and this loss, moreover, occurs at the same time as...

Prions proteinaceous infectious particles

Recent reports have been published alluding that new approaches may spin off diagnostic tests. One test may involve a genetic screen. A trait found in yeast that can spark the appearance of some known yeast prions may be capitalized for use in prion diagnosis. Another technique utilizes confocal, dual-color fluorescence cross-correlation spectroscopy and claims to have high specificity and sensitivity for prions in the cerebrospinal fluid. Another method based on modification of other tests exploits the combination of fluorescently labeled PrP and peptide antibodies and size-exclusion high performance liquid chromatography to separate free peptides from antibody-bound peptides (sensitive to detect 1 to 2 pg of PrPSc).

Neurologic System Basic Care Plan Introduction

The neurologic system includes the central nervous system (CNS) consisting of the cerebrum, cerebellum, brain stem, and the spinal cord the peripheral nervous system consisting of the motor (efferent) and sensory (afferent) nerves and the autonomic nervous system (ANS) consisting of the sympathetic and parasympathetic systems that provide control of vital body functions. Alterations in the neurologic system affect the process of receiving, integrating, and responding to stimuli that enter the system. This results in disturbances with signs and symptoms dependent on the type and site of the impairment and the normal functioning of the system. The disturbances may be manifested by alterations in consciousness, sensation, or muscle function. Changes in the system also occur as the child develops neurologically and completes the growth and development requirements for adulthood this system is one of the last to complete development after birth.

Deficiencies In Gestation And Psychiatric Outcomes

Birch et al., 2000 Gibson and Makrides, 2000 Carlson and Neuringer, 1999). Thus, we postulated that some portion of the increased risk for aggressive and depressive behaviors among the nursery-raised rhesus monkey described could be the result of the very low levels of dietary AA and DHA. It is known that maternal-infant interactions clearly have profound effects on early development and maturation, so a nutrition deprivation could at best contribute to only a small portion of the behavioral differences observed when mother-raised and nursery-raised infants are compared. In our experiment (Hibbeln et al., 2000c) infant rhesus monkeys were removed from their mothers at birth, and for 6 mo, received one of the two formulas while being raised in a stringently controlled nursery. The DHA AA group received formulas supplemented with AA (0.8 ) and DHA (0.8 ) that were similar to the milk of rhesus monkey mothers. The control formulas were similar to commercially produced human infant...

Human Data On Omega3 Fatty Acids And Neurotransmitter Metabolites

Correlational data from human studies are consistent with the proposition that omega-3 status is related to cerebrospinal fluid (CSF) neurotransmitter metabolite concentrations. We observed that plasma concentrations of DHA and AA predicted CSF 5-HIAA and CSF homovanillic acid concentrations in 234 subjects (Hibbeln, 1998a Hibbeln et al., 1998b). In healthy control subjects and late-onset alcoholics, higher concentrations of plasma DHA predicted higher concentrations of CSF 5-HIAA. It is remarkable that this correlational relationship was found between a cerebrospinal fluid measure of a neu-rotransmitter metabolite and a plasma level of a fatty acid. We have also replicated this finding among 104 adult rhesus monkeys. Higher concentrations of the omega-3 fatty acids DHA and EPA in plasma predicted higher concentrations of CSF 5-HIAA (Hibbeln, et al., unpublished data). Among these animals, higher EPA and DHA plasma concentrations also predicted more functional dominance behaviors....

The El Escorial Diagnostic Criteria for Amyotrophic Lateral Sclerosis

A careful history, physical and neurological examination must search for clinical evidence of UMN and LMN signs in four regions (brainstem, cervical, thoracic, or lumbosacral spinal cord of the central nervous system). Ancillary tests should be reasonably applied, as clinically indicated, to exclude other disease processes. These should include electrodiagnostic, neurophysiological, neuroimaging, and clinical laboratory studies.

Clinical evidence of LMN and UMN degeneration is required for the diagnosis of ALS

The clinical diagnosis of ALS, without pathological confirmation, may be categorized into various levels of certainty by clinical assessment alone depending on the presence of UMN and LMN signs together in the same topographical anatomic region in either the brainstem (bulbar cranial motor neurons), cervical, thoracic, or lumbosacral spinal cord (anterior horn motor neurons). The terms clinical definite ALS and clinically probable ALS are used to describe these categories of clinical diagnostic certainty on clinical criteria alone (Table 13).

Role of Complement in Motor Neuron Disease Animal Models and Therapeutic Potential of Complement Inhibitors

Amyotrophic lateral sclerosis (ALS) is one of the major forms of motor neuron disease (MND), a group of degenerative disorders causing progressive motor neuron death leading to eventual paralysis and death. The pathogenesis of MND is poorly understood and may include genetic and or environmental factors, with a common end-stage outcome. The majority of cases are sporadic, with a small percentage of familial cases identified. Mutations in the copper zinc superoxide dismutase (SOD1) enzyme are frequent in familial ALS, and have allowed for the development of transgenic SOD1 rodent models of ALS. There has been evidence for immune system involvement in the disease, and activated components of the classical complement pathway have been observed in the serum, cerebrospinal fluid and neuronal tissue of diseased individuals. Furthermore, motor neurons and spinal cord tissue from SOD1 transgenic mice show an upregulation in C1q mRNA transcript and protein, in some cases prior to...

Description Medical Red Blood Cell Disorders

Complications caused by pernicious anemia include macrocytic anemia and gastrointestinal disorders. Pernicious anemia impairs myelin formation and thus alters the structure and disrupts the function of the peripheral nerves, spinal cord, and brain. Patients have a high incidence of benign gastric polyps, peptic ulcers, and gastric carcinoma. Low hemoglobin levels and consequent hypoxemia of long duration can result in congestive heart failure and angina pectoris in the elderly. If it is left untreated, pernicious anemia can cause psychotic behavior or even death.

Nongenomic Mechanisms

BOX 20.1 Dendritic spines We noted in Chapter 1 that the dendrites of many of the neurons in the cerebral cortex are covered with minute protuberances the dendritic 'spines' or 'thorns'. These protuberances form the major synaptic surfaces of the principal input output cells of the cerebral cortex. Although they are reasonably permanent structures they have been shown to vary in size, shape and number in response to brain activity. We saw something of their dynamism in the developing brain in Section 19.4. They have long been thought to be crucially involved in the plastic changes underlying long-term memory. The dimensions of spines vary by an order of magnitude from one brain region to another. The smallest have a length of 0.2 mm and volume of about 0.04 mm3 and the largest a length of 6.5 mm and volume of 2 mm3. A typical spine is shown in Figure 1.21B, but there are many variations and spines frequently branch. Typically, however, the mature spine has a bulbous 'head' attached to...

Folate Status The Nature Of Folate In Physiological Fluids

Plasma and Cerebrospinal Fluid Cerebrospinal fluid contains approximately three times the level of folate that plasma does. The form found in CSF is exclusively 5CH3-H4folate1, which is concentrated in the spinal fluid from the blood by a transport system localized in the choroid plexus. The increased CSF level of 5CH3-H4folate1 may reflect the demand of neuronal tissue for methyl groups (see below), although it also undoubtedly acts as a buffer protecting the brain from the fluctuating dynamics of plasma levels of the vitamin.

Clinical Evidence for Complement Involvement

A study conducted in 1973 by Whittaker and colleagues, measured immunoglobulins and C3 in the serum of 38 MND patients in an attempt to identify an immune component of the disease. Although this initial study found no change in serum C3 levels, numerous studies have subsequently detected elevated complement factors in patients with MND (Table 1). In particular, components of the classical (or lectin) activation pathway have been frequently identified. The first of these studies examined C3 immunofluorescence in postmortem tissue obtained from 16 ALS patients (Donnenfeld et al. 1984). The study found significant C3 deposition in the spinal cord of six patients and in the motor cortex of five patients, which appeared to be on astrocyte-like cells, with no apparent neuronal staining (Donnenfeld et al. 1984). Subsequently Annunziata and Volpi (1985) measured C3c, C4, C1 inactivator, and C3 activator fractions in the serum and cerebrospinal fluid (CSF) of 13 ALS patients. They detected an...

Early Developmental Stages Of The Nervous System

The steps of neuronal development include (1) formation of the neural plate, (2) folding of the plate to form the neural tube, and (3) bulging and bending of the tube to form a curved configuration of five brain vesicles attached to a straight tubular spinal cord (Figs. 1 and 2). The neural plate, from which the nervous system develops, is formed by a thickening of the ectoderm during the third week of gestation in humans. Through a process called neural induction, regions of the neural plate become genetically programmed to form particular regions of the nervous system. Growth of the neural plate is accelerated along its lateral edges, causing the edges to curve toward each other, eventually fuse, and form an open neural tube with both cranial and caudal openings called neuropores. Closure of both neuropores is normally complete by the fourth week. Preferential growth at three nodes along the cranial portion of the sealed neural tube causes intermittent bulging of tissue, formation...

Development Of Brain Vesicles

Cerebrospinal fluid fills the ventricles, providing a cushion of support for delicate neuronal tissue. It is generated by the choroid plexus, which is composed of a capillary network surrounded by cuboidal or columnar epithelium lining the ventricular walls, in particular the roof of the lateral and fourth ventricles. Structurally similar to the distal and collecting tubules of the kidney, the choroid plexus maintains the chemical stability of the CSF. It has directional capabilities in that it continually produces CSF and actively transpors metabolites out of the ventricles. Cerebrospinal fluid circulates through the ventricles, exits through openings in the fourth ventricle to the subarachnoid space surrounding the outer surface of the brain, is reabsorbed by the arachnoid granulations, and eventually collects in the venous system of the meningeal covering of the cortex. This circulation serves an important function in maintaining the appropriate ionic milieu necessary for neuronal...

Overview Of Sensory Pathways

It is apparent from the descriptions given earlier that specific areas of brain, spinal cord, or peripheral nervous tissue are assigned specific functional roles based on their relative position with the nervous system (Fig. 5). A general rule for neurons might be stated, Where you are is what you are.'' However, the nervous system should not be viewed as a series of isolated modules with specified duties rather, it more correctly resembles spinal cord FIGURE 5 Sensory axis of the nervous system. Primary sensory neurons carrying pain and temperature information project to the dorsal part of the spinal cord their cell bodies are located in the dorsal root ganglia. Neurons carrying pain and temperature information from the face project through the trigeminal nerve to the lateral part of the pons their cell bodies are in the trigeminal ganglion. Pain information is relayed through synaptic connections to second-order and on to higher order neurons in areas shown in blue. Pain relay areas...

Pathogenesis Of Secondary Posttraumatic Cns Injury

In the case of SCI, the secondary events occur initially in the central gray matter and then spread to the surrounding white matter. As implied previously, the key issue in predicting recovery of function is the degree of preservation of the ascending and descending white matter tracts. Many of the axons that do survive, however, do not conduct impulses as a result of posttraumatic demyelination. Therefore, the goal of neuroprotective pharmacotherapy is to preserve as many of the white matter axons and as much of their investing myelin as possible. In TBI, a key determinant in neurological recovery is also the loss of axons. Based on the often widespread loss of axons in the injured brain, this phenomenon is referred to as diffuse axonal injury. It should be realized, however, that a significant factor in influencing the extent of neural injury both in TBI and SCI is a decrease in brain or spinal cord microvascular perfusion (i.e., secondary ischemia). When this occurs, the result is...

Fireworks Factory Explosion

As an example, we positively identified a lower torso by comparing antemortem and postmortem radiographs (Fig. 3) of the attached right foot ankle (the left thigh was also attached). This right foot was morphologically distinctive, with an unusually long great toe, enabling us to reassociate the lower torso and right leg with a separate left foot ankle with a matching biographic profile and the same distinctive configuration, including an unusually long great toe. A separate upper torso with neck was also positively identified as this same individual by comparison of antemortem and postmortem radiographs of the cervical spine and shoulder. A body diagram (Fig. 4) illustrates the reassociation of these parts from three separate body bags. Unfortunately, there were some portions that could not be reassociated or positively identified by the above techniques and were therefore considered common tissue and buried in a common grave.

Role Of Pglycoprotein In Drug Therapy

Blockade of Pgp with modulators can have dramatic effects on systemic drug disposition by decreasing drug elimination through the intestine, bile, and urine. Initially, the focus was on using modulators with anticancer drugs to improve the efficacy of chemotherapy treatment,190 but later it was realized that modulators could be useful in altering the pharmacological behavior of many drugs, to improve their delivery. Modulators may enhance intestinal drug absorption and increase drug penetration through biologically important protective barriers such as the blood-brain, blood-cerebrospinal fluid, and maternal-fetal barriers. Delivery of drugs to the brain, either to treat epilepsy and other central nervous system diseases, AIDS, or brain tumors such as gliomas might therefore be increased by addition of an effective modulator. This has been shown to be feasible in a mouse model using highly effective modulators such as PSC833 and GF120918.191-193 The future development of more...

General Properties Of Central Sensory Pathways

Cell bodies of somatic sensory neurons are located in the dorsal root ganglia and are designated as first-order sensory afferents because they provide the first link within the chain of neurons constituting the primary sensory pathways. Their central fibers project within short dorsal spinal rootlets to their synaptic targets on second-order sensory neurons in designated areas of the spinal cord and brain stem. Action potentials, generated by stimulation of receptor end organs, travel back to the cell body and along the central process. This wave of depolarization stimulates the release of a variety of neuroactive substances (including substance P, calcitonin-gene-related product CGRP , and glutamate) that act as chemical neurotransmitters to excite or inhibit second-order neurons. Sensory information is thus transmitted along individual cells by action potentials and between neurons within the pathway by chemical transmission. This basic Cell bodies from all types of somatic sensory...

Pike Fry Rhabdo Virus

The PFV belongs to the vesiculo-like genus of the Rhabdoviridae family. It is involved in two diseases of fry of the northern pike (Esox lucius L.) a 'head disease' identified by swelling or lumps on the body, or a 'red disease' identified by swelling and reddish color of large areas of the body. These diseases were first seen in the Nieuw-Vennep hatchery in The Netherlands around 1959. Both diseases have a high mortality rate. The hydrocephalus associated with the 'head disease' makes the fish lose equilibrium and swim erratically near the surface of the water. Clinical symptoms are poor growth, hemorrhages in the brain, spinal cord, spleen and pancreas, and degenerative necrotic changes in kidney tubules. The 'red disease' is characterized by pale gills, hemorrhages in trunk and muscle connective tissue, and red swollen areas above the pelvic fins. The virus is detected in the hematopoietic tissues of the kidney. At the molecular level, the PFV is similar to VSV, encoding the...

Anterolateral Pathway

The second major ascending sensory system is called the spinothalamic or anterolateral pathway, which carries information about pain and temperature from the body. This pathway is best understood as two subdivided tracts. The first is called the neospinothalamic tract, which carries information about sharp pain within A-delta (small myelinated) fibers. Unlike the dorsal column-lateral lemniscal pathway, the first-order neurons in this pathway synapse with neurons within the dorsal horn of the spinal cord. Projection fibers then cross the midline of the cord and form the lateral portion of the anterolateral tract as they ascend the cord to the VPL nucleus of the thalamus. The paleospinothalamic subdivision carries information about dull, aversive pain temperature and crude touch within small, unmyelinated C fibers. There are two synaptic relays with cells in the dorsal horn of the spinal cord. Axons of projection neurons then cross the cord and join the anterolateral tract, terminating...

Experimental Evidence for Complement Involvement

The first study to demonstrate experimentally an involvement of complement products in a SOD1 transgenic mouse model was performed by Perrin and colleagues in 2005. This group used laser-capture microdissection techniques to specifically isolate ventral motor neurons from the lumbar spinal cord of SOD1G93A mice. Using microarray analysis they detected a significant upregulation of all polypeptide subcomponents of C1q in early symptomatic (P90) and end-stage (P120) diseased mice, compared to motor neurons from non-transgenic, wild-type mice (-fivefold and eightfold respectively) (Perrin et al. 2005). In 2007, Lobsiger and colleagues published their findings in two separate SOD1 transgenic mouse models, indicating a strong involvement of C1q in these ALS models. In these studies, the authors were careful to select an appropriate control, aware of previous studies' lack of specificity towards gene identification. Transgenic mice overexpressing human SOD1WT were used as a comparison...

Somatosensory Pathways In The Head Region

Somatic sensory cranial nerve pathways are homologous in many ways to the medial lemniscal and spino-thalamic pathways of spinal nerves. The trigeminal nerve, or cranial nerve V, is the primary sensory nerve involved in transmitting touch and pain information from the face and neck. It contains fibers from mechanoreceptors, thermoreceptors, and nociceptors for the face, oral mucosa, distal part of the tongue, portions of the dura mater covering of the cerebral cortex, and tooth pulp. First-order neuronal cell bodies are located in the trigeminal ganglia adjacent to the brain stem. Central fibers enter the pons and separate into two main tracts. Axons that carry information about light touch and proprioception synapse in the principal or main sensory nucleus of cranial nerve V, which in turn sends fibers across the midline to ascend to the ventral posterior medial nucleus (VPM) of the thalamus. This pathway is analogous to the medial lemniscal pathway ofthe spinal cord. First-order...

Thalamic Projections To Subcortical Regions And Somatosensory Cortex

Another important ascending system forms the afferent arm of protective reflex pathways that operate on the subconscious level. As they ascend to the thalamus, all spinal and cranial sensory tracts send collateral branches to the brain stem reticular formation, a diffuse network of neurons within the core of the brain stem. Various nuclear groups within the reticular formation function as coordinating centers that extract relevant sensory information and in turn activate appropriate muscle groups through their motor axons. Different regions of the reticular formation have been identified that elicit the cough reflex, blink reflex, and gag reflex. Respiratory and cardiovascular centers within the reticular formation regulate breathing rate and heart rate. Dubner R, Bennett GJ. Spinal and trigeminal mechanisms of nociception. Annu Rev Neurosci 1983 6 381-418. Willis WD, Coggeshall R. Sensory mechanisms of the spinal cord, 2nd ed., New York Plenum Press, 1991.

Trocar Configuration

Five laparoscopic ports are used three 10- 12-mm ports and two 5-mm ports. Veress needle is used to establish pneumoperitoneum at the umbilicus. A 10- 12-mm port is then inserted at that site. The second 10- 12-mm port is inserted between the umbilicus and the left anterior superior iliac spine. The third 10- 12-mm port is inserted at the lateral border of the right rectus abdominis muscle 2 fingerbreadths below the umbilicus. The third trocar may be 5 mm, but cannot then be used to introduce the needle during anastomosis. The entrapment sac also requires a 10- 12-mm port. The fourth 5-mm port is inserted between the third port and the right anterior superior iliac spine. The fifth 5-mm port is inserted between the umbilicus and the pubic symphysis in the midline (Fig. 1, left). Urachal tissue may need to be held up to the abdominal wall with a gasper during introduction of the last trocar. The surgeon operates through the two ports on either side of the umbilicus. In tall patients,...

Gender Ethnicracial And Life Span Considerations

Pressure ulcers can occur at any age and across both genders but are more prevalent in the elderly population over 70 years of age. About 25 of the elderly have some type of pressure ulcer, and most of these individuals are women because of their survival advantage over men. Pressure ulcers are also common in individuals who are neurologically impaired and immobile most younger individuals suffering from pressure ulceration are males, which reflects the greater number of young men suffering traumatic spinal cord injuries. There are no known racial and ethnic considerations.

Surgical Transurethral Prostatectomy with CC

Adenocarcinomas compose 99 of the prostate cancers. They most frequently begin in the outer portion of the posterior lobe in the glandular cells of the prostate gland. Local spread occurs to the seminal vesicles, bladder, and peritoneum. Prostate cancer metastasizes to other sites via the hematologic and lymphatic systems, following a fairly predictable pattern. The pelvic and perivesicular lymph nodes and bones of the pelvis, sacrum, and lumbar spine are usually the first areas to be affected. Metastasis to other organs usually occurs late in the course of the disease, with the lungs, liver, and kidneys being most frequently involved.

Spina Bifida Introduction

Spina bifida is a defect of the central nervous system that involves the failure of neural tube closure during embryonic development. There are two types of spina bifida spina bifida occulta and spina bifida cystica. Spina bifida occulta is a defect in the closure without the herniation and exposure of the spinal cord or meninges at the surface of the skin in the lumbosacral area. Spina bifida cystica (meningocele or myelomeningocele) is a defect in the closure with a sac and herniated protrusion of meninges, spinal fluid and possibly some part of the spinal cord and nerves at the surface of the skin in the lumbosacral or sacral area. Hydrocephalus is often associated with spina bifida cystica. The neurologic effects are related to the anatomic level and nerves involved in the defect and range from varying degrees of sensory deficits, to partial or total motor impairment resulting in flaccidity, partial paralysis of lower extremities, and loss of bladder and bowel control. Children...

Ezio Carboni 1 Introduction

Microdialysis technique coupled with electrochemical detection (ED) is a relatively new method that allows detection of neurotransmitters and other substances from brain and other tissues. It is based on the insertion of a dialysis probe in a specific area and perfusing it with artificial cerebrospinal fluid (CSF), which, passing in a chamber delimited by the dialysis fiber, becomes enriched with small molecular weight substances diffusing into the fiber because of their concentration gradient. Substances recovered can be assayed by highperformance liquid chromatography (HPLC) to evaluate their concentration in the dialysate, that is closely related to their extracellular concentration in the area investigated. After recovery from surgery, therefore, the effects of drugs or other treatments on the assayed substance can be evaluated in freely moving animals (1).

Vestibular Nuclei And Central Vestibular Pathways

Cell bodies of the vestibular nuclei occupy a substantial area on the lateral aspect of the medulla (Fig. 5). Four divisions of the nucleus are recognized. The lateral vestibular nucleus receives input from all vestibular organs and sends out descending fibers in the lateral vestibulospinal tract. These second-order vestibular processes terminate on motor neurons in the spinal cord and provide the excitatory drive to maintain body posture. The lateral vestibular nucleus also receives inhibitory innervation from the cerebellum. This serves to coordinate and control the normal excitatory output of the lateral vestibular nucleus. Patients who have head injuries that damage the incoming cerebellar fibers to the vestibular nuclei suffer a pronounced motor imbalance in the extremities called decerebrate rigidity. Decerebration (loss of input from higher centers) removes the inhibitory input from the cerebellum and other cortical areas, leaving the motor neurons exposed

Diagnosis and Prevention

Detection, and reverse transcriptase polymerase chain reaction (RT PCR) amplification. Detection of immunoglobulin M (IgM) by immunoassay is a common diagnostic test for flaviviruses, but in some cases persistence of high IgM levels from previous infections with other flaviviruses can complicate the diagnosis of recent infections. Detection of IgM antibody in cerebrospinal fluid is of use in cases of flavivirus encephalitis. RT PCR of serum is a sensitive and rapid technique that has increasing application for flaviviruses, but must be carried out during the viremic stage, which can differ from one flavivirus infection to another. For instance, RT PCR for dengue viruses loses sensitivity after the first week of infection due to clearance of viremia.

Sacral Nerve Stimulation

Sacral spinal nerve stimulation is a new therapeutic approach for patients with fecal incontinence that is associated with structurally intact anal sphincters. This technique is an extension of the successful use of this modality for urinary voiding and continence disorders, with the realization that stimulating electrodes implanted into pelvic floor muscles are prone to infection, migration, and fibrous tissue reactions. The procedure involves the following three phases 1. Location of sacral spinal nerves by percutaneous probing with a needle electrode to identify the nerve root that maximally stimulates anal sphincter contraction.

Proinflammatory Cytokine Profiles In

IL-6 is a pleiotropic cytokine known to regulate hematopoiesis and contribute significantly to inflammation and immune responses 1 . Although it has been implicated in numerous autoimmune diseases, its role in MS was first suggested by several studies describing its upregulation in the blood, cerebrospinal fluid (CSF), and brain tissue of MS patients 2 . More recently, microarray analysis from MS lesions revealed that the nuclear factor that mediates IL-6 transcription (NF-IL6) was highly upregulated in all the MS samples examined 3 . In EAE, IL-6 gene expression is also markedly upregulated in CNS tissue and correlates well with clinical severity 4 .

Discharge And Home Healthcare Guidelines

Cerebral perfusion pressure (CPP mean arterial pressure - ICP). Furthermore, the expanding hematoma acts as a space-occupying lesion, as it compresses or displaces brain tissue. Blood in the subarachnoid space may impede the flow and reabsorption of cerebrospinal fluid (CSF), thus resulting in hydrocephalus. The bleeding ceases with the formation of a fibrin-platelet plug at the point of the rupture and by tissue compression. As the clot, which forms initially to seal the rupture site, undergoes normal lysis or dissolution, the risk of rebleeding increases. More than 27,000 people in the United States have a ruptured intracranial aneurysm each year, although the annual incidence is probably underestimated because death is attributed to other reasons.

Pathophysiology of Double Incontinence

Numerous studies suggest a common etiology for the development of UI, FI, and POP. These are due to damage to the muscles and connective tissue of the pelvic floor and to pudendal nerve injury 26, 27 . The presence of crossed reflexes between the bladder, urethra, and anorectum in animal studies could explain the contemporary association of UI and FI 28 . There exist vesicoanal and urethroanal reflex arcs that are probably mediated within the spinal cord. Distention or irritation of the bladder or urethra causes a reflex increase in internal 29 and external sphincter activity 30 .

Regulation of Skin Temperature

Cutaneous blood flow is determined by the relative degree of vasoconstriction of precapillary sphincters in the vascular bed just below the dermis. As in other vascular beds, these are under local as well as central regulation (see Chapter 17). Local irritants and heat can cause vasodilation and warming of the immediate skin surface. When a larger area of the skin is warmed, temperature receptors in the skin lead to a reflex increase of blood flow in that area. This response is mediated at the level of the spinal cord. For example, putting your hand in hot water leads to increased blood flow, which is indicated by the redness and relative engorgement of circulation in that hand. Local cooling leads to the opposite reaction.

Regulation of Heat Production

Physiologically, the most important route of increasing heat production is through shivering. Shivering is an asynchronous contraction of the skeletal muscles resulting in increased muscle tone and tremors that occur at a rate of 10 to 20 s. Shivering is produced by descending neural pathways in the lateral columns of the spinal cord that facilitate the spindle stretch reflex arc of major muscle groups and can increase the rate of heat production up to five or six times normal. Shivering is an involuntary response to a fall in the body core temperature, but it can be reduced or stopped by voluntary pathways.

Physiology And Pathophysiology Of Responses To Heat And Cold

Body temperature is regulated by a feedback mechanism that matches net heat loss from the body to the rate of heat production by metabolism. This feedback mechanism is integrated by the hypothalamus, particularly the preoptic anterior area. Although the control of thermo-regulatory processes such as shivering and sweating has been attributed to various other regions of the hypothalamus, discrete localization no longer seems valid. In fact, some thermoregulation occurs even in the absence of brain centers above the medulla. Nevertheless, the most sensitive regulation occurs in the hypothalamus and may be ascribed to an integrative center'' that may or may not have an anatomic correlate. The sensors for the feedback regulation of body heat content or temperature, called thermoreceptors, are located both in the periphery and in the central nervous system. The preoptic anterior hypothalamus contains temperature-sensitive neurons that increase firing with increasing core temperature. Other...

Guidelines for Osteoporosis Screening

The accepted screening and diagnostic test for osteoporosis is an assessment of BMD using the DXA scan. The criteria for the diagnosis of osteoporosis based on DXA BMD are listed in Table 3. There are other methods to measure BMD including quantitative computed tomography (CT) of the spine, forearm, or hip, quantitative ultrasound of the heel, forearm, tibia, phalanges, or metatarsals, and single-energy x-ray absorptiometry (9). However, the DXA remains the standard for assessment of BMD. Some studies have found heel ultrasound to be equal to DXA, when screening for osteoporosis, in renal transplant patients and children with rheumatic diseases (67,68). In these studies the authors recommend that, if the heel ultrasound is abnormal, then patients should be referred for DXA scan and more definitive evaluation. Heel ultrasound in at-risk patients may prove to be a less expensive, more available way of screening high-risk populations (such as patients with known secondary causes) for...

Specific Forms of Shock

Neurogenic shock may be caused by spinal cord or brain injury. It will be recalled that peripheral vascular control by the CNS is accomplished by varying the tone of the sympathetic nerves that constrict the peripheral vasculature (Chapter 17). Because the sympathetic nerves are unopposed, dilation is accomplished simply by reducing sympathetic tone. The sympathetic nerves course through the spinal cord hence, transection of the cord will cause a profound vasodilation that will persist for weeks following the event. Hypotension due to a reduction of both filling pressure and peripheral resistance will occur immediately after the lesion, and the shock syndrome will soon follow unless aggressive resuscitation is instituted. Anaphylactic shock can occur when an antigen-antibody reaction occurs in the circulation. An example would be transfusion with an incompatible blood type. The reaction stimulates mast cells in the tissues to secrete histamine and related substances that cause...

Special Treatment Considerations

Alendronate (35 or 70 mg per wk), intermittent etidronate, and intermittent pamidronate have all been shown to increase BMD at the spine and hip in patients on glucocorticoids (83-85). Therefore, individuals requiring more than 7.5 mg of prednisone (or its equivalent) per d for at least 3 wk, should take a bisphosphonate (alendronate or risedronate orally) in addition to calcium and vitamin D supplementation (9).

Molecular Characterization

Recently, the genome of two different strains of T. whipplei has been entirely sequenced. 22 Sequencing of T. whipplei Twist, propagated from the cardiac valve of a patient, revealed a 927,303-bp genome which encodes 808 predicted protein-coding genes and presents a GC of 47 . 22 Sequencing of T. whipplei TW08 27, propagated from the cerebrospinal fluid of a patient, revealed a 925,938-bp genome which encodes 784 predicted protein-coding genes and presents a GC of 46.3 . 24 T. whipplei presents a unique circular chromosome and is the only known reduced genome species ( 1 Mb) within the Actinobacteria. 22,24 The two genomic sequences of the two strains are mostly ( 99 ) identical at the nucleotide sequence level and encode quasi-identical

Molecular Testing

The histology analysis of biopsies using the PAS staining, which has been considered for a long time, as pathognomonic of WD, is not completely specific. Polymerase chain reaction assays could be performed on various biopsies (duodenum, adenopathy, cardiac valve, kidney, brain, synovial biopsy), liquid samples (cerebrospinal fluid, joint fluid, aqueous humor, blood), saliva, or stools. 27 The DNA extraction is a clue step and different protocols have been proposed. 27 These protocols could be applied in fresh sample or included in paraffin. Before the genome sequencing, all the five identified genes were used as targets for the molecular diagnosis of the WD. 28-31 For each PCR assay, it is necessary to include positive (DNA extracted from a suspension of T. whipplei) and negative controls. Indeed, samples must be separated every five samples by a negative control, including water and DNA extracted from control tissues (intestinal or other biopsies). The positive and negative controls...

Clinical Description Presentation

Patients with VHL are predisposed to develop tumors, predominantly retinal and central nervous system (brain and spinal cord) hemangioblastomas (HABs), clear cell renal cell carcinomas (CCRCCs), pheochromocytoma (PHEO), and, occasionally, extraadrenal paragangliomas (PGLs) (reviewed in Ref. 4 ). Clear cell renal cell carcinomas are the major cause of morbidity. In addition, VHL patients may develop endolymphatic sac tumors, pancreatic islet cell tumors, papillary cystade-nomas of the epididymus (males), or, occasionally, broad ligament (females) and visceral cysts of the kidneys and pancreas.

Clinical Management of VHL

Clinical management of a patient with VHL requires comprehensive serial screening with regular follow-up as well as surgical intervention. Von Hippel-Lindau patients have a greater than 70 lifetime risk of CRCCs, which cause death of 15-50 of patients. Annual imaging computed tomography (CT) and or ultrasonography is suggested, in addition to renal surgery. Once symptomatic, CCRCCs have already undergone metastasis and respond poorly to chemotherapy or radiotherapy. Surgical resection is also recommended for central nervous system HABs (located in the cerebellum, spine, and brain stem)

Vertebrate Nervous Systems

Figure 1.4 Embryology of the vertebrate brain idealised sagittal section of five-vesicle stage. The figure shows the telencephalon growing backwards over the surface of the thalamencephalon. This only occurs in animals which develop large cerebral hemispheres, such as mammals. From the roof of the thalamencephalon grows the pineal gland while from its floor develops the neural part of the pituitary. The cerebellum grows from the roof of the metencephalon while the floor of this region expands to form the pons. The whole structure contains a cavity continuous with the central canal of the spinal cord and filled with cerebral spinal fluid (CSF).

Anterolateral Approach To The Iliac Wing

The patient is placed supine on a radiolucent operating table. Stapled sheets are placed under the back to elevate the pelvis on the ipsilateral side. Free draping of the ipsilateral leg must be ensured to allow intraoperative reduction by axial traction. The opposite side of the pelvis should be braced by a support on the operating table in order to enable a safe intraoperative tilting to the contralateral side. A curved skin incision is made parallel to the iliac crest, beginning approximately 5 cm dorsal to the anterior superior iliac spine, and continuing for an additional 5 cm ventro-medially along the line of the inguinal ligament (Fig. 2). After deepening the skin incision through the subcutaneous fat, the aponeurosis of the oblique external abdominal muscle is exposed and detached from the iliac crest in a subperiostal fashion. At this time, the lateral cutaneous femoral nerve, which runs ventrally to the anterior superior iliac crest, has to be spared (Fig. 2). From the inner...

Organisation Of Neurons In The Brain

Neuron Transistors

Figure 1.19 Synaptic contacts on the perikaryon of a spinal motor neuron. This reconstruction from serial electron micrographs shows how densely covered the perikaryon of a motor neuron is with large and small synaptic endings. From Poritsky (1969), Journal of Comparative Neurology, 135, 423452 with permission. Figure 1.19 Synaptic contacts on the perikaryon of a spinal motor neuron. This reconstruction from serial electron micrographs shows how densely covered the perikaryon of a motor neuron is with large and small synaptic endings. From Poritsky (1969), Journal of Comparative Neurology, 135, 423452 with permission. In the early embryo the grey matter is situated in the centre of the CNS immediately surrounding the central fluid-filled cavity (central canal in spinal cord, ventricle in brain). It retains this primitive position throughout life in the spinal cord, but in the brain many of the neurons migrate during embryological development along the processes of radial glia to form...

Urinary frequency and urgency

Cystitis Symptoms Women

Identified, intravenous urography and cystoscopy should be performed and the patient referred to a urologist. In cases of impaired renal function serum urine electrolyte concentration and urine osmolarity should be estimated. A plain radiograph of the abdomen (kidneys, ureter and bladder) is useful in the diagnosis of a calculus and if a significant urinary residual volume is discovered then an X-ray of the lumbar sacral spine should be obtained.

Develop A Flow Diagram

Using a cause-and-effect diagram, the relationship between a given effect or problem and all identified causes of that effect can be narrowly focused. The effect or problem (e.g., microbiological contamination) is represented by a horizontal arrow or spine, and principal causes are identified by arrows entering the spine. Principal causes of any effect are inherently found in six major sources of variability, namely, machines, materials, methods, measurement, personnel, and the environment, all of which are part of any process. Each principal arrow can have secondary arrows representing sub-causes. Figure 4.5 illustrates part of a cause-and-effect diagram highlighting the environment as a possible source of Listeria contamination to fresh-cut lettuce. Once a comprehensive cause-and-effect diagram has been constructed and all possible causes of a problem verified, appropriate measures must be instituted to control the hazard.

Innervation Of The Gastrointestinal Tract

Esophagus Enteric Neurons

The medulla of the brain (vagus) and the sacral region of the spinal cord (pelvic). These predominantly choliner-gic fibers synapse with ganglion cells located in the enteric nervous system (Fig. 3). Thus, vagal activity can affect secretion, motility, or the release of hormones, as indicated in Fig. 3. The mediator at the target cells is generally acetylcholine, but this is not always the case. In many cases, the chemical mediator has not been identified. Unlike the parasympathetic system, preganglionic fibers from the sympathetic system synapse outside of the GI tract in prevertebral ganglia (Fig. 2). Preganglionic, cholinergic efferent fibers from the cord synapse in four major ganglia the celiac, superior mesenteric, inferior mesenteric, and hypogastric. Postganglionic adrenergic fibers from these ganglia innervate the cells of the myente-ric and submucosal plexuses. Elements from the enteric system then innervate smooth muscle, secretory, and endocrine cells. Some blood vessels,...

Preoperative Assessment

Defecating proctography is a dynamic fluoroscop-ic examination performed by instilling thick barium contrast into the rectum and capturing lateral images during defecation. It is useful in assessing both anatomy and function of the anal canal and pelvic floor during defecation. PNTML is the measurement of the time from stimulation of the pudendal nerve at the ischial spine to the response of the external anal sphincter. Normal PNTML is

Mri In Multiple Sclerosis

Although published in 1983, the Poser criteria already acknowledged MRI as a paraclinical tool for the diagnosis of MS. In those early days, MRI was a much less sensitive tool, especially with the lack of contrast agents. With advances in technology, MRI reveals ten times as many lesions as CT (Bergers and Barkhof, 2001 Mushlin et al., 1993) and provides a means to characterize demyelination in the spine. As MRI technology has progressed, criteria for the MRI diagnosis of MS have been published (Barkhof et al., 1997 Fazekas et al., 1988 Paty et al., 1988). The topic has been reviewed elsewhere in detail (Bergers and Barkhof, 2001). In brief, although T2-weighted image demonstrates foci of chronic demyelination and new lesions with edema, the diagnostic yield of FLAIR is substantially better because of the predominantly periventricu-lar localization of MS lesions and CSF artifact (Hashemi et al., 1995). FLAIR studies have been espe- abnormal cerebrospinal fluid (CSF) 1 Attack + 2...

Ventilatory Acclimatization And Acidbase Homeostasis At Altitude [11

Active transport of HCO-r out of the cerebrospinal fluid (CSF) has been postulated to begin within the first 24 hr at high altitude 21 , with the effect of rapidly lowering pH and HC03 concentration in the CSF, stimulating central respiratory drive and counteracting the inhibition of peripheral chemoreceptors by alkalosis. Both carbonic anhydrase and the Na+ K+ ATPase pump mediate HCO3 and H+ transport between blood and the CSF however, the importance of active transport in enhancing the rate of ventilatory acclimatization at different altitudes is unclear 7 , Another source for the rapid fall in pH of the CSF during early ventilatory acclimatization is increased lactate formation in the brain in response to hypoxia and alkalosis 27 although this mechanism alone could not entirely account for the fall in CSF HC03 concentration. In the periphery, the acute alkalemia induced by hyperventilation is partially ameliorated by the release of H+ from nonbicarbonate buffers in the...

Karyotype and other tests

Woman Who Have Lost 100lbs With Pcos

Measurement of bone mineral density (BMD) is indicated in amenorrhoeic women who are oestrogen deficient. Measurements of density are made in the lumbar spine and femoral neck. The vertebral bone is more sensitive to oestrogen deficiency and vertebral fractures tend to occur in a younger age group (50-60 years) than fractures at the femoral neck (70+ years). However, it should be noted that crush fractures can spuriously increase the measured BMD. An X-ray of the dorsolumbar spine is therefore often complimentary, particularly in patients who have lost height.

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