Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Loh, Y.
Right arrow Articles by Duckwiler, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Loh, Y.
Right arrow Articles by Duckwiler, G.
Related Collections
Right arrow All Imaging
Right arrow All Spinal Cord
Right arrow Spinal cord infarction
NEUROLOGY 2009;72:e80
© 2009 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImages: Focal ischemia of the spinal micturition center and detrusor-external sphincter dyssynergia

Yince Loh, MD and Gary Duckwiler, MD

From the Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Address correspondence and reprint requests to Dr. Yince Loh, Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Room 2129 MC: 743730, Los Angeles, CA 90095 yincer{at}yahoo.com

A 50-year-old woman presented with subarachnoid hemorrhage from a conus perimedullary fistula (figure 1A) involving the anterior spinal artery (ASA). She underwent liquid embolization, where reflux into the distal ASA occurred (figure 1B).


Figure 116
View larger version (37K):
[in this window]
[in a new window]

  		Figure 1 Angiogram and postembolization cast of spinal fistula

(A) Left L1 anteroposterior spinal angiogram demonstrates a dilated anterior spinal artery (ASA) supplying a perimedullary fistula (arrow) with normal caudal ASA (arrowhead). (B) Unsubtracted view confirms embolic material in normal caudal ASA (arrowhead).

 

Postprocedure, she had difficulty initiating urination. Saddle and perianal sensation, rectal tone, and defecation were normal, as was the remainder of her neurologic examination.

Voiding cystourethrogram demonstrated detrusor- external sphincter dyssynergia (figure 2A). Spinal MRI revealed conus T2 hyperintensity (figure 2B).


Figure 216
View larger version (37K):
[in this window]
[in a new window]

  		Figure 2 Voiding cystourethrogram and MRI after embolization

(A) Typical abrupt urethral sphincter tapering (arrow) of detrusor-external sphincter dyssynergia seen on voiding cystourethrogram. (B) Axial T2 lumbar spine MRI demonstrates conus medullaris hyperintensity (arrow).

 

Sacral cord injury can result in detrusor-external sphincter dyssynergia.1 This case illustrates the location of the Onuf nucleus, the micturition center, which contracts the detrusor while relaxing the urethral sphincter.2 The patient’s symptoms resolved in 2 months.

Disclosure: The authors report no disclosures.

Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the United States Government.


   REFERENCES
Top.
 REFERENCES
 

  1. Uchiyama T, Sakakibara R, Hattori T, Yamanishi T. Lower urinary tract dysfunctions in patients with spinal cord tumors. Neurourol Urodyn 2004;23:68–75.[Medline]
  2. Sakakibara R, Hattori T, Uchiyama T, Yamanishi T, Ito H, Ito K. Neurogenic failures of the external urethral sphincter closure and relaxation; a videourodynamic study. Auton Neurosci 2001;86:208–215.[Medline]




This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Loh, Y.
Right arrow Articles by Duckwiler, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Loh, Y.
Right arrow Articles by Duckwiler, G.
Related Collections
Right arrow All Imaging
Right arrow All Spinal Cord
Right arrow Spinal cord infarction

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS