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Neuroradiologie Scan 2019; 09(04): 295-321
DOI: 10.1055/a-0873-6879
CME-Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Inkomplette Querschnittsyndrome: Überblick über Klinik und Bildgebung

Incomplete cord syndromes: clinical and imaging review
Vamsi K. Kunam
,
Vinodkumar Velayudhan
,
Zeshan A. Chaudhry
,
Matthew Bobinski
,
Wendy R. K. Smoker
,
Deborah L. Reede
Verantwortlicher Herausgeber dieser Rubrik: Wissenschaftlich verantwortlich gemäß Zertifizierungsbestimmungen für diesen Beitrag ist Prof. Dr. med. Michael Forsting, Essen.
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Publikationsverlauf

Publikationsdatum:
14. November 2019 (online)

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Die Kenntnis der Anatomie des Rückenmarks und der klinischen Merkmale von Rückenmarksyndromen vereinfacht die Bildgebung und Lokalisierung von spinalen Anomalien, die sich bei klassischen inkompletten Querschnittsyndromen darstellen. Der folgende Beitrag schildert die erforderlichen anatomischen Grundlagen und zeigt typische bildgebende Befunde.

Abstract

The ability to localize the three spinal tracts (corticospinal tract, spinothalamic tract, and dorsal [posterior] columns) involved in incomplete spinal cord syndromes at cross-sectional imaging and knowledge of the classic clinical manifestations of the various syndromes enable optimized imaging evaluation and provide clinicians with information that aids in diagnosis and treatment. The requisite knowledge for localizing these tracts is outlined. The authors review the spinal cord anatomy, blood supply, and course of these tracts and describe the various associated syndromes: specifically, dorsal cord, ventral cord, central cord, Brown-Séquard, conus medullaris, and cauda equina syndromes. In addition, they describe the anatomic basis for the clinical manifestation of each syndrome and the relevant imaging features of the classic causes of these entities. Knowledge of the anatomy and clinical findings of the spinal cord is essential for examining and treating patients with cord abnormalities.

Kernaussagen

  • Eine Schädigung der Neuronen im motorischen Kortex und im Tractus corticospinalis führt zu Defiziten der oberen Motoneuronen. Dagegen kommt es bei einer Schädigung der Neuronen in den Vorderhörnern und peripheren Nerven zu Defiziten der unteren Motoneuronen.

  • Die Axone im Bereich des Tractus corticospinalis und des Tractus spinothalamicus weisen eine ähnliche laminäre somatotopische Anordnung auf. Die Axone der Zervikal- und Thorakalsegmente, die die oberen Extremitäten und den Thorax innervieren, sind medial lokalisiert. Die Axone der Lumbal- und Sakralsegmente, die ihrerseits das Abdomen und die unteren Extremitäten innervieren, sind hingegen lateral positioniert.

  • Die Neuronen 2. Ordnung im Hinterhorn, die für die Übertragung der Schmerz- und Temperaturwahrnehmung zuständig sind, kreuzen durch die vordere spinale Kommissur und ziehen dort in der kontralateralen anterolateralen weißen Substanz als Tractus spinothalamicus aufwärts. Von den beschriebenen Trakten ist der Tractus spinothalamicus der einzige, der auf Höhe des Rückenmarks kreuzt.

  • Das zentrale Rückenmarksyndrom stellt die häufigste Form des inkompletten Querschnittsyndroms dar. Es entsteht infolge einer Verletzung oder Läsion im Bereich des Zentralkanals. Die häufigste Ursache eines zentralen Rückenmarksyndroms ist ein Trauma.

  • Der primäre Unterschied zwischen einem Konus- und einem Cauda-equina-Syndrom besteht in der Art des motorischen Defizits: Das Konussyndrom verursacht gemischte Defizite der oberen und unteren Motoneuronen, das Cauda-equina-Syndrom dagegen ein reines Defizit der unteren Motoneuronen.

Schlüsselwörter

Inkomplettes Querschnittsyndrom - Rückenmarkanatomie - Brown-Séquard-Syndrom - Konussyndrom - Cauda-equina-Syndrom

Keywords

Incomplete cord syndromes - spinal cord anatomy - Brown-Séquard syndrome - conus medullaris syndrome - cauda equina syndrome
 

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