Neurological and muscular disorders

This chapter describes the anaesthetic management of the patient with those neurological or muscular disorders which are relevant to anaesthetic practice, including malignant hyperthermia (MH). Other topics covered include epilepsy, cerebrovascular disease; Parkinson’s disease; spinal cord lesions; myasthenia gravis; multiple sclerosis; Guillain-Barré syndrome; motor neuron disease; dystrophia myotonica and the muscular dystrophies. For each topic, pre-operative investigation and optimisation, treatment, and anaesthetic management are described.

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Neurological and muscular disorders

10.1093/med/9780198719410.003.0011_update_001 ◽

2018 ◽

Author(s):

Andrew Teasdale ◽

Jane Halsall

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Myasthenia Gravis ◽

Malignant Hyperthermia ◽

Anaesthetic Techniques ◽

Anaesthetic Management ◽

Muscular Dystrophies ◽

Dystrophia Myotonica ◽

Spinal Cord Lesions ◽

Muscular Disorders

This chapter describes the anaesthetic management of the patient with those neurological or muscular disorders which are relevant to anaesthetic practice, including malignant hyperthermia. Other topics covered include epilepsy, cerebrovascular disease, Parkinson’s disease, spinal cord lesions, myasthenia gravis, multiple sclerosis, Guillain-Barré syndrome, motor neuron disease, dystrophia myotonica, and the muscular dystrophies. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. For malignant hyperthermia, trigger-free anaesthetic techniques are described, as well as the management of an acute episode.

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Neurological and muscular disorders

10.1093/med/9780198719410.003.0011 ◽

2016 ◽

Author(s):

Andrew Teasdale ◽

Jane Halsall

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Myasthenia Gravis ◽

Malignant Hyperthermia ◽

Anaesthetic Techniques ◽

Anaesthetic Management ◽

Muscular Dystrophies ◽

Dystrophia Myotonica ◽

Spinal Cord Lesions ◽

Muscular Disorders

This chapter describes the anaesthetic management of the patient with those neurological or muscular disorders which are relevant to anaesthetic practice, including malignant hyperthermia. Other topics covered include epilepsy, cerebrovascular disease, Parkinson’s disease, spinal cord lesions, myasthenia gravis, multiple sclerosis, Guillain-Barré syndrome, motor neuron disease, dystrophia myotonica, and the muscular dystrophies. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. For malignant hyperthermia, trigger-free anaesthetic techniques are described, as well as the management of an acute episode.

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MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

Diagnostics ◽

10.3390/diagnostics11081424 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1424

Author(s):

Esben Nyborg Poulsen ◽

Anna Olsson ◽

Stefan Gustavsen ◽

Annika Reynberg Langkilde ◽

Annette Bang Oturai ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Cervical Spinal Cord ◽

Brain Mri ◽

Anatomical Location ◽

Spinal Cord Lesions ◽

Chi Square ◽

Exact Test ◽

Mcdonald Criteria ◽

Chi Square Test

Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

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Multiple Sclerosis Of The Spinal Cord: Is Gadolinium Irreplaceable In Assessing Lesion Activity?

Acta Medica Marisiensis ◽

10.2478/amma-2013-0037 ◽

2013 ◽

Vol 59 (3) ◽

pp. 158-161

Author(s):

Constantina Andrada Treabă ◽

M Buruian ◽

Rodica Bălașa ◽

Maria Daniela Podeanu ◽

I P Simu ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Magnetic Resonance ◽

Contrast Enhancement ◽

Signs And Symptoms ◽

Magnetic Resonance Images ◽

Type I ◽

Focal Lesions ◽

Spinal Cord Lesions ◽

Active Lesion

Abstract Purpose: To evaluate the relationship between the T2 patterns of spinal cord multiple sclerosis lesions and their contrast uptake. Material and method: We retrospectively reviewed the appearance of spinal cord lesions in 29 patients (with relapsing-remitting multiple sclerosis) who had signs and symptoms of myelopathy on neurologic examination and at least one active lesion visualized on magnetic resonance examinations performed between 2004 and 2011. We correlated the T2 patterns of lesions with contrast enhancement and calculated sensitivity and specificity in predicting gadolinium enhancement. Results: Only focal patterns consisting of a lesion’s center homogenously brighter than its periphery on T2-weighed images (type I) correlated significantly with the presence of contrast enhancement (p = 0.004). Sensitivity was 0.307 and specificity 0.929. In contrast, enhancement was not significantly related to uniformly hyperintense T2 focal lesions (type II) or diffuse (type III) pattern defined as poorly delineated areas of multiple small, confluent, subtle hyperintense T2 lesions (p > 0.5 for both). Conclusions: We believe that information about the activity of multiple sclerosis spinal cord lesions in patients with myelopathy may be extracted not only from contrast enhanced, but also from non-enhanced magnetic resonance images.

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