Tethered Cord--Overt, Occult, and Confusing скачать в хорошем качестве

Tethered Cord--Overt, Occult, and Confusing

Tethered Cord is often the flip side of the coin: CCI on one side and TC on the other. The diagnosis is not easy and the imaging is often not definitive. And like CCI, it can cause systemic symptoms both neurologically and via mast cell degranulation. Overview of Tethered Cord Syndrome Tethered cord syndrome is a neurological condition where the spinal cord is abnormally attached to the spinal canal, limiting its movement. It often coexists with craniocervical instability (CCI) and is increasingly recognized in adults as an acquired condition. Key Points Tethered cord can be difficult to diagnose radiologically It's important to have a high index of suspicion, especially in patients with connective tissue disorders Symptoms can include back/leg pain, urinary dysfunction, and sensory/motor issues MRI of the lumbar spine is used for diagnosis, but may appear normal even with tethered cord present Diagnosis Detailed history and neurological exam are crucial Look for urinary symptoms, back/leg pain, weakness, sensory changes Physical exam tests: Heel and toe walking Flexion/extension movements Reflexes and muscle tone (can be variable) Urodynamic studies can be helpful if available MRI of lumbar spine, interpreted by experienced neurosurgeon Treatment Surgical untethering (section filum terminale) is the main treatment Post-op care focuses on reducing inflammation and promoting healing Peptides like BPC-157 and GHK may be used Limiting flexion/extension movements initially after surgery Connection to Mast Cell Activation Syndrome (MCAS) High density of mast cells found in tethered cord tissue MCAS may potentially contribute to development of tethered cord Aggressive MCAS treatment may help prevent tethering Key Takeaways Tethered cord often coexists with CCI and should be evaluated Diagnosis requires high suspicion and expert interpretation of imaging Earlier diagnosis and treatment of underlying conditions like MCAS could potentially prevent tethered cord More research is needed on the connections between tethered cord, CCI, and MCAS Sources