Consultation with the specialist
Disorders of the Spinal Cord
Richard S.K. Young MD1
1 Associate Clinical Professor of Pediatrics and Neurology, Yale University School of Medicine; Chair, Department of Pediatrics, Hospital of St. Raphael, New Haven, CT.
History and Physical Examination
More than 10 000 individuals suffer spinal cord injury each year. This article will focus on those mass lesions of the spinal cord that should prompt neurosurgical consultation: epidural abscesses, neoplasms, and hematomas. The presence of pain and spinal cord dysfunction (paralysis, loss of sphincters) makes neurosurgical consultation mandatory.
Because of the anatomy of the spinal cord, it has several classical patterns of involvement (see Table). When obtaining a history, inquire about pain over the spine or pain that radiates down the legs. The presence of paresthesiae suggests involvement of the posterior roots or posterior columns of the spinal cord. Inquire whether the patient's sphincter function is normal. Difficulty in ambulation or refusal to walk are hallmarks of spinal cord disease.
Observe the patient's gait for limp, waddling, or circumduction. Inspect the spine carefully for scoliosis or for neural tube defects. Examine the skin for signs of neurologic disease (café au lait spots, axillary freckles, cutaneous hemangiomas). If cutaneous hemangiomas are present over the spine, auscultate for the presence of arteriovenous malformations. Percuss the spine to elicit pain suggestive of abscesses or radicular disease.
Infections of the Spinal Cord
Case Report: A 4-year-old child who had been adopted from a Korean orphanage was brought to her pediatrician for evaluation of a limp.
