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NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS
Official Journal of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics
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spinal cord
'.
1.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 6, 2010, No. 2
,
,
,
in Patients with
Spinal
Cord
Tumors
in Patients with Spinal Cord Tumors
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Intraoperative Neurosonography in Patients with
Spinal
Cord
Tumors
Intraoperative Neurosonography in Patients with Spinal Cord Tumors
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spinal
cord
,
spinal cord,
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spinal
cord
tumors
spinal cord tumors
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To analyze the application of the ultrasonic methods in surgery of
spinal
cord
tumors and the correlations between echographic, magnetic resonance and surgical findings.
To analyze the application of the ultrasonic methods in surgery of spinal cord tumors and the correlations between echographic, magnetic resonance and surgical findings.
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Ultrasound anatomy of
spinal
cord
next to the pathologic processes was investigated.
Since 2007, eighteen patients with spinal tumors, diagnoseg by MRI have been treated with ultrasound-guided surgery.
Ultrasound anatomy of spinal cord next to the pathologic processes was investigated.
Ultrasound exploration was performed during laminectomy on the dural surface in all cases and after the dural opening of the spinal cord surface for intramedullary tumors.
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Ultrasound exploration was performed during laminectomy on the dural surface in all cases and after the dural opening of the
spinal
cord
surface for intramedullary tumors.
Since 2007, eighteen patients with spinal tumors, diagnoseg by MRI have been treated with ultrasound-guided surgery. Ultrasound anatomy of spinal cord next to the pathologic processes was investigated.
Ultrasound exploration was performed during laminectomy on the dural surface in all cases and after the dural opening of the spinal cord surface for intramedullary tumors.
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All tumors originating from the
spinal
cord
, adjacent
spinal
nerve roots and
spinal
cord
meninges are determined as
spinal
cord
tumors.
All tumors originating from the spinal cord, adjacent spinal nerve roots and spinal cord meninges are determined as spinal cord tumors.
They account for approximately 10% of all tumors of the central nervous system. About 30% of the spinal cord tumors are intramedullary. The most common extramedullary tumors are meningioma, neurinoma and filum terminale ependymoma [14]. The surgical treatment of spinal cord tumors began in 1887, when Victor Horsley performed the first successful operation of a spinal cord meningioma. In 1913 Freiher von Eiselsberg performed in Vienna the first successful operation of an intramedullary tumor [17].
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About 30% of the
spinal
cord
tumors are intramedullary.
All tumors originating from the spinal cord, adjacent spinal nerve roots and spinal cord meninges are determined as spinal cord tumors. They account for approximately 10% of all tumors of the central nervous system.
About 30% of the spinal cord tumors are intramedullary.
The most common extramedullary tumors are meningioma, neurinoma and filum terminale ependymoma [14]. The surgical treatment of spinal cord tumors began in 1887, when Victor Horsley performed the first successful operation of a spinal cord meningioma. In 1913 Freiher von Eiselsberg performed in Vienna the first successful operation of an intramedullary tumor [17]. Presently, microsurgical techniques play an important role in the treatment of most tumors, as modern imaging examinations precede the detailed preoperative planning. The structures located in the spinal canal are, however morphologically and functionally delicate and, therefore there is a certain risk of postoperative neurologic complications.
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The surgical treatment of
spinal
cord
tumors began in 1887, when Victor Horsley performed the first successful operation of a
spinal
cord
meningioma.
All tumors originating from the spinal cord, adjacent spinal nerve roots and spinal cord meninges are determined as spinal cord tumors. They account for approximately 10% of all tumors of the central nervous system. About 30% of the spinal cord tumors are intramedullary. The most common extramedullary tumors are meningioma, neurinoma and filum terminale ependymoma [14].
The surgical treatment of spinal cord tumors began in 1887, when Victor Horsley performed the first successful operation of a spinal cord meningioma.
In 1913 Freiher von Eiselsberg performed in Vienna the first successful operation of an intramedullary tumor [17]. Presently, microsurgical techniques play an important role in the treatment of most tumors, as modern imaging examinations precede the detailed preoperative planning. The structures located in the spinal canal are, however morphologically and functionally delicate and, therefore there is a certain risk of postoperative neurologic complications.
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The development of ultrasound imaging technologies has specified the sonographic characteristics of most common
spinal
cord
tumors [3, 6, 12].
In 1978, Reid demonstrated the usefulness of ultrasound in the surgical treatment of a cystic astrocytoma in the cervical spine [15]. Later, in the early 1980s Dohrman and Rubin introduced neurosonography in neurosurgical practice, as its first application was in syringomyelia operations [2, 16].
The development of ultrasound imaging technologies has specified the sonographic characteristics of most common spinal cord tumors [3, 6, 12].
In 2005 F. Kolstad et al. reported the application of ultrasound-based neuronavigation in surgical interventions of spinal cord tumors [8]. G. Unsgarg et al. developed this technique by introducing the 12 MHz linear transducer in microneurosurgical interventions [19].
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reported the application of ultrasound-based neuronavigation in surgical interventions of
spinal
cord
tumors [8]. G.
In 1978, Reid demonstrated the usefulness of ultrasound in the surgical treatment of a cystic astrocytoma in the cervical spine [15]. Later, in the early 1980s Dohrman and Rubin introduced neurosonography in neurosurgical practice, as its first application was in syringomyelia operations [2, 16]. The development of ultrasound imaging technologies has specified the sonographic characteristics of most common spinal cord tumors [3, 6, 12]. In 2005 F. Kolstad et al.
reported the application of ultrasound-based neuronavigation in surgical interventions of spinal cord tumors [8]. G.
Unsgarg et al. developed this technique by introducing the 12 MHz linear transducer in microneurosurgical interventions [19]. In Bulgarian medical literature there are some reports on the use of intraoperative ultrasound in neurosurgery, but the application of ultrasound during a spinal cord tumor operation is described in only one report [1].
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In Bulgarian medical literature there are some reports on the use of intraoperative ultrasound in neurosurgery, but the application of ultrasound during a
spinal
cord
tumor operation is described in only one report [1].
In 2005 F. Kolstad et al. reported the application of ultrasound-based neuronavigation in surgical interventions of spinal cord tumors [8]. G. Unsgarg et al. developed this technique by introducing the 12 MHz linear transducer in microneurosurgical interventions [19].
In Bulgarian medical literature there are some reports on the use of intraoperative ultrasound in neurosurgery, but the application of ultrasound during a spinal cord tumor operation is described in only one report [1].
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The aim of this study is to evaluate the role of neurosonography in
spinal
cord
tumor surgery by examining the correlations between the magnetic resonance imaging (MRI), intraoperative neurosonography and surgical evaluation of the actual operative situation.
The aim of this study is to evaluate the role of neurosonography in spinal cord tumor surgery by examining the correlations between the magnetic resonance imaging (MRI), intraoperative neurosonography and surgical evaluation of the actual operative situation.
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Since 2007, 18 patients (10 women and 8 men) with
spinal
cord
tumors were operated at the Clinic of Neurosurgery in Military Medical Academy, Sofia.
Since 2007, 18 patients (10 women and 8 men) with spinal cord tumors were operated at the Clinic of Neurosurgery in Military Medical Academy, Sofia.
The mean age of the patients was 51±19 years. All patients were diagnosed by MRI preoperatively and evaluated by neurosonography intraoperatively.
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Intraoperative Neurosonography in
Spinal
Cord
Tumors
Intraoperative Neurosonography in Spinal Cord Tumors
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Neurosonographic
spinal
cord
anatomy.
Neurosonographic spinal cord anatomy.
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Axial view of cervical astrocytoma (grade II) with an increased transverse diameter of the
spinal
cord
and isoechogenic tumor formation.
Axial view of cervical astrocytoma (grade II) with an increased transverse diameter of the spinal cord and isoechogenic tumor formation.
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of the
spinal
cord
tissues adjacent to the tumor were registered.
of the spinal cord tissues adjacent to the tumor were registered.
In these areas the arachnoid spaces were dilated, due to the closely situated extramedullary tumor. During the sonographies with 10 MHz and 12 MHz transducers, images of the spinal cord, central canal, anterior median fissure, dental ligamentum and arachnoid membranes were obtained (fig. 1).
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During the sonographies with 10 MHz and 12 MHz transducers, images of the
spinal
cord
, central canal, anterior median fissure, dental ligamentum and arachnoid membranes were obtained (fig. 1).
of the spinal cord tissues adjacent to the tumor were registered. In these areas the arachnoid spaces were dilated, due to the closely situated extramedullary tumor.
During the sonographies with 10 MHz and 12 MHz transducers, images of the spinal cord, central canal, anterior median fissure, dental ligamentum and arachnoid membranes were obtained (fig. 1).
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Intraoperative Neurosonography in
Spinal
Cord
Tumors
Intraoperative Neurosonography in Spinal Cord Tumors
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Mostauthorssupporttheuseofneurosonography as a valuable tool with minimal invasiveness in
spinal
cord
tumor surgery [9, 18].
Mostauthorssupporttheuseofneurosonography as a valuable tool with minimal invasiveness in spinal cord tumor surgery [9, 18].
Even at the stage of initial resection, neurosonography can be used as a preliminary ultrasound inspection of the pathological process, to obtain a minimal/limited surgical opening. Some authors recommend the application of transligamentary sonography prior to initial resection [5]. Extramedullary tumors, particularly neurinomas, may change their position against the reference bone marks, chosen by the surgeon, depending on the patient’s position (usually MRI and operative position of the patient are different) [4, 10]. The incision of dura mater is
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Intraoperative Neurosonography in
Spinal
Cord
Tumors
Intraoperative Neurosonography in Spinal Cord Tumors
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The dorsal (Key et Racius) arachnoid septum, which develops into pia mater along the posterior surface of the
spinal
cord
with its fixed venous blood vessels, is of great importance: the excessive traction of this arachnoid membrane may result in venous bleeding, a precondition for the development of additional neurologic complications [13].
limited to the zone immediately above the tumor, which will result in reducing the bleeding into the arachnoid space. The visualization of arachnoid membranes around the tumor is also beneficial, because it is important to keep them intact during durotomy.
The dorsal (Key et Racius) arachnoid septum, which develops into pia mater along the posterior surface of the spinal cord with its fixed venous blood vessels, is of great importance: the excessive traction of this arachnoid membrane may result in venous bleeding, a precondition for the development of additional neurologic complications [13].
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Spinal
cord
ependymomas are mostly of meningotheliomatous type.
Spinal cord ependymomas are mostly of meningotheliomatous type.
In some cases, there are microscopically visible zones of hyaline degeneration, surrounded by calcium deposits and psammoma bodies. On MRI, these calcificates are visualized as T1-hypointense zones. On the intraoperative ultrasonogram these zones are presented as hyperechogenic areas in tumor’s background [12].
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In conclusion, there are distinct correlations between the morphological structure of
spinal
cord
tumors and their magnetic resonance and intraoperative sonographic images.
In conclusion, there are distinct correlations between the morphological structure of spinal cord tumors and their magnetic resonance and intraoperative sonographic images.
Therefore, intraoperative neurosonography is a valuable diagnostic tool, applicable in any surgical intervention of spinal cord tumors.
read the entire text >>
Therefore, intraoperative neurosonography is a valuable diagnostic tool, applicable in any surgical intervention of
spinal
cord
tumors.
In conclusion, there are distinct correlations between the morphological structure of spinal cord tumors and their magnetic resonance and intraoperative sonographic images.
Therefore, intraoperative neurosonography is a valuable diagnostic tool, applicable in any surgical intervention of spinal cord tumors.
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Intraoperative ultrasound imaging of the
spinal
cord
: syringomyelia, cysts, and tumors-a pre-
Dohrmann GJ, Rubin JM.
Intraoperative ultrasound imaging of the spinal cord: syringomyelia, cysts, and tumors-a pre-
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Three-dimensional neurosonography navigation in
spinal
cord
tumor surgery.
Kolstad F, Rygh OM, Selbekk T, Unsgaard G, Nygaard OP.
Three-dimensional neurosonography navigation in spinal cord tumor surgery.
Technical note.
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The spine and
spinal
cord
during neurosurgical operations: real-time neurosonography.
Rubin JM, Dohrmann GJ.
The spine and spinal cord during neurosurgical operations: real-time neurosonography.
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The evolution of intramedullary
spinal
cord
tumor surgery.
Sciubba DM, Liang D, Kothbauer KF, Noggle JC, Jallo GI.
The evolution of intramedullary spinal cord tumor surgery.
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2.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 8, 2012, No. 1
,
,
,
– muscle) is measured after cervical or lumbar
spinal
cord
stimulation.
– muscle) is measured after cervical or lumbar spinal cord stimulation.
CMCT is calculated by subtracting the peripheral latency from the MEP latency after cortical stimulation. Prolonged CMCT is an indication for demyelination of central motor tracts, loss of long neurons or delayed summation of descendent excitatory motor potentials caused by TMS I-waves [10].
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In
spinal
cord
surgery the function of anterior and lateral tracts is monitored by TMS in contrast to somatosensory evoked potentials (SSEP) evaluating the conductivity of posterior tracts.
TMS is used for preoperative assessment of specific cortical areas (identification of the dominant hemisphere, localization of speech or motor areas), and intraoperative monitoring of corticospinal tract. Combining TMS with functional MRI optimizes surgery and reduces the risk of postoperative deficit [39, 40]. Application of high-frequency rTMS at lower frontal lobe of the dominant hemisphere leads to "speech arrest", which allows precise localization of cortical speech areas [14].This test is used as an alternative to the Wada test in preoperative preparation for temporal lobectomy.
In spinal cord surgery the function of anterior and lateral tracts is monitored by TMS in contrast to somatosensory evoked potentials (SSEP) evaluating the conductivity of posterior tracts.
The combined use of both methods, monitoring afferent and efferent conduction pathways, significantly reduces postoperative risk. The negative influence of inhalatory anesthetics on MEP generation at this stage is overcome by the application of
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diabetes, amiloidosis, uremia,
spinal
cord
injuries.
diabetes, amiloidosis, uremia, spinal cord injuries.
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Robot-assisted practice may be helpful by implementation of repetitive training tasks; body weight-supported treadmill training promotes gait improvement after traumatic brain injury, stroke or partial
spinal
cord
injury (fig. 3).
It has been shown that reduced activation of the ipsilateral hemisphere improves motor function in both healthy individuals and those with traumatic brain injury or stroke. The combined use of transcranial magnetic stimulation improves cortical activation and may be a useful therapy adjunct [27].
Robot-assisted practice may be helpful by implementation of repetitive training tasks; body weight-supported treadmill training promotes gait improvement after traumatic brain injury, stroke or partial spinal cord injury (fig. 3).
An important fact is that general aerobic exercise programs stimulate CNS plasticity. Functional electrical stimulation enhances somatosensory input to the brain. Continued activity and training after formal therapy is necessary to preserve functional gains [17].
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Spinal
cord
injuries.
Spinal cord injuries.
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Recovery depends on the location, severity and type of the
spinal
cord
injury, genetic possibilities for brain reorganization, adequacy of provided intensive care and neuroprotection, degree of
spinal
cord
regeneration and possibilities of cell transplantation.
Clinical trials of animal models suggest that only a small number (5% to 10%) of surviving axons are needed to support functional recovery.
Recovery depends on the location, severity and type of the spinal cord injury, genetic possibilities for brain reorganization, adequacy of provided intensive care and neuroprotection, degree of spinal cord regeneration and possibilities of cell transplantation.
Gray matter hypoperfusion and axonal demyelization areas are influenced [16].
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To increase the functional capacity of the
spinal
cord
, various neurorehabilitation techniques are used [3].
To increase the functional capacity of the spinal cord, various neurorehabilitation techniques are used [3].
In Th6 level injury or above there is a risk of life-threatening autonomic dysreflexia. Demineralization of bones is common in spinal cord injuries and appears very quickly after paralysis. Bone loss reaches 22% within three months. Pulmonary function is impaired in all patients with spinal cord traumas. Ultrasound imaging contributes to early detection of vascular complications [4].
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Demineralization of bones is common in
spinal
cord
injuries and appears very quickly after paralysis.
To increase the functional capacity of the spinal cord, various neurorehabilitation techniques are used [3]. In Th6 level injury or above there is a risk of life-threatening autonomic dysreflexia.
Demineralization of bones is common in spinal cord injuries and appears very quickly after paralysis.
Bone loss reaches 22% within three months. Pulmonary function is impaired in all patients with spinal cord traumas. Ultrasound imaging contributes to early detection of vascular complications [4].
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Pulmonary function is impaired in all patients with
spinal
cord
traumas.
To increase the functional capacity of the spinal cord, various neurorehabilitation techniques are used [3]. In Th6 level injury or above there is a risk of life-threatening autonomic dysreflexia. Demineralization of bones is common in spinal cord injuries and appears very quickly after paralysis. Bone loss reaches 22% within three months.
Pulmonary function is impaired in all patients with spinal cord traumas.
Ultrasound imaging contributes to early detection of vascular complications [4].
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Neurorehabilitation in multiple sclerosis aims to affect the spasticity, urination problems, sensory and motor impairments, which are treated in a similar way as
spinal
cord
traumas.
Neurorehabilitation in multiple sclerosis aims to affect the spasticity, urination problems, sensory and motor impairments, which are treated in a similar way as spinal cord traumas.
Over 40% of the patients have cognitive deficit [26].
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Locomotor pattern in paraplegic patients: training effects and recovery of
spinal
cord
function.
Dietz V, Wirz M, Curt A, Colombo G.
Locomotor pattern in paraplegic patients: training effects and recovery of spinal cord function.
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Spinal
Cord
Spinal Cord
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What matters in cellular transplantation for
spinal
cord
injury: the cells, the rehabilitation or the best mix?
Dobkin BH.
What matters in cellular transplantation for spinal cord injury: the cells, the rehabilitation or the best mix?
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3.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2012, No. 2
,
,
,
Cooling is widely used for preserving organs for transplantation, the induced hypothermia is used as a treatment in neonatal encephalopathy, cardiac arrest, myocardial infarction, ischemic stroke, traumatic brain or
spinal
cord
injury without fever and neurogenic fever after stroke or brain trauma [22].
Cooling is widely used for preserving organs for transplantation, the induced hypothermia is used as a treatment in neonatal encephalopathy, cardiac arrest, myocardial infarction, ischemic stroke, traumatic brain or spinal cord injury without fever and neurogenic fever after stroke or brain trauma [22].
An overview of these treatment options in different conditions is provided below:
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Traumatic injuries of the brain and
spinal
cord
Traumatic injuries of the brain and spinal cord
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The aim of the treatment of brain and/or
spinal
cord
injuries is the recovering of adequate perfusion; surgical evacuation of hematomas (if necessary) and oedema prophylaxis.
The aim of the treatment of brain and/or spinal cord injuries is the recovering of adequate perfusion; surgical evacuation of hematomas (if necessary) and oedema prophylaxis.
Animal studies show the positive effect of hypothermia in central nervous system injuries. Basic science evidence also suggests that cooling affects many secondary biochemical cascades that are activated after acute injury. The potential benefit of this non-specific therapy is based on the observation that hypothermia reduces brain metabolism and energy consumption which might be feasible for improving the outcome of the injury [2, 19]. Comparing with the pharmacologic treatment which acts to a single neurochemical process, hypothermia interferes and inhibits multiple pathological processes simultaneously acting non-specifically. The results from the studies in humans are quite controversial and inconsistent.
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Systemic hypothermia for the treatment of acute cervical
spinal
cord
injury in sports.
Dietrich W, Cappuccino A, Cappuccino H.
Systemic hypothermia for the treatment of acute cervical spinal cord injury in sports.
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4.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 2
,
,
,
Technical Aspects for Ultrasound Visualization of
Spinal
Cord
Vasculature.
Technical Aspects for Ultrasound Visualization of Spinal Cord Vasculature.
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TECHNICAL ASPECTS FOR ULTRASOUND VISUALIZATION OF
SPINAL
CORD
VASCULATURE
TECHNICAL ASPECTS FOR ULTRASOUND VISUALIZATION OF SPINAL CORD VASCULATURE
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A noninvasive method of visualization of the
spinal
cord
vasculature such as ultrasound that can be utilized in different clinical setting of
spinal
cord
ischemia.
A noninvasive method of visualization of the spinal cord vasculature such as ultrasound that can be utilized in different clinical setting of spinal cord ischemia.
We assessed the feasibility of imaging and characterizing blood flow in the anterior spinal artery using Ultrasound with concurrent validation using a cadaveric model.
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The current study describes a technique for noninvasive imaging of
spinal
vasculature using ultrasound which may enhance our diagnostic capabilities for
spinal
cord
ischemia.
The current study describes a technique for noninvasive imaging of spinal vasculature using ultrasound which may enhance our diagnostic capabilities for spinal cord ischemia.
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spinal
cord
vasculature, ultrasound.
spinal cord vasculature, ultrasound.
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5.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 10, 2014, No. 2
,
,
,
The basic motor patterns for stepping are generated in the
spinal
cord
, where networks of nerve cells, named Central Pattern Generators (CPGs), generate movements and enclose information necessary to activate motor neurons in the suitable sequence for motor patterns.
The basic motor patterns for stepping are generated in the spinal cord, where networks of nerve cells, named Central Pattern Generators (CPGs), generate movements and enclose information necessary to activate motor neurons in the suitable sequence for motor patterns.
These “innate” networks have a capacity to generate intrinsic pattern of rhythmic activity independently of sensory inputs. The CPGs are under supraspinal control of walking that involves various
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The final motor output is generated from one side – by the preserved CPGs in the
spinal
cord
, which are programmed to operate in a stereotyped manner under supraspinal motor control mechanisms, and from other side – reflect some newly and
These findings suggest that motor behavior of chronic stroke patients reflects the complex relationship between morphological lesion at the onset of stroke and associated structural and functional brain reorganization that may result in a newly and bilaterally organized control of ambulation in the presence of motor deficit.
The final motor output is generated from one side – by the preserved CPGs in the spinal cord, which are programmed to operate in a stereotyped manner under supraspinal motor control mechanisms, and from other side – reflect some newly and
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6.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 2
,
,
,
They form the rear part of the Willis' circle and are responsible for the blood supply of the cerebellum, pons, middle ear, and the upper parts of the
spinal
cord
and its meninges [24].
Vertebral arteries are responsible for one third of the brain's blood supply.
They form the rear part of the Willis' circle and are responsible for the blood supply of the cerebellum, pons, middle ear, and the upper parts of the spinal cord and its meninges [24].
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