spinal cord neoplasm
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Etiology
- extradural
- intradural/extramedullary tumors
- schwannomas, meningiomas most common
- meningiomas arise preferentially at foramen magnum and thoracic spine
- other - vascular tumors, chordomas, epidermoids
- schwannomas, meningiomas most common
- intramedullary tumors
- ependymomas - 40%
- most involve conus medullaris and cauda equina
- astrocytomas of low - mid anaplasia next most common
- distributed throughout spinal cord
- oligodendroglioma, ganglioglioma, medulloblastoma, hemangiomas, hemangioblastomas less common
- ependymomas - 40%
Epidemiology
- ~10% - 19% of primary CNS tumors
Pathology
- most tumors extradural
- most primary tumors intradural
Clinical manifestations
- sensorimotor spinal tract syndrome
- due to compression of cord
- gradual onset over weeks to months
- initial presentation asymmetric
- motor symptoms predominate
- dorsal column involvement - paresthesia on contralateral side to motor weakness
- radicular spinal cord syndrome
- external compression & infiltration of spinal cord roots
- sharp pain in distribution of sensory nerve root
- exacerbated by maneuvers that increase intracranial pressure (ie coughing)
- local paresthesia
- impairment of pain & touch sensations
- weakness and muscle wasting
- central syringomyelic syndrome
- destruction & cavitation in central gray matter
- lower motor neuron destruction with segmental muscle weakness, muscle wasting & loss of reflexes
- dissociated loss of pain & temperature sensation with preservation of touch initially
More general terms
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References
- ↑ Cancer, Principles and Practice of Oncology; 6th ed. deVita et al (eds); Lippincott, Williams & Wilkins, 2001, pg 2152-4