Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

1360 Spermatocele Spine & Spinal Cord Injury

tests

■usually transilluminates

■ultrasound

differential diagnosis

■exclude tumor of testis or spermatic cord

management

n/a

specific therapy

■observation strongly advised unless large and painful

■surgical excision; risks testis infarction or epididymal obstruction

follow-up

n/a

complications and prognosis

n/a

SPINE & SPINAL CORD INJURY

MICHAEL J. AMINOFF, MD, DSc

history & physical

■History of injury to head, spine or both

■Pain over neck or back often present, may be worse w/movement

■Weakness, paralysis or sensory disturbance below level of injury;

symptoms are transient w/mild injuries

■Sphincter disturbance may be present

■No deficit w/mild injuries

■Spinal tenderness or misalignment of spinal processes may be present

■Weakness or paralysis depending on level and severity of injury

➣Cervical injury: all limbs may be affected

➣Injury below T1: weakness confined to legs

➣Lateral cord injury: weakness ipsilateral to injury

➣Central cord injury: LMN weakness at level of lesion

■Sensory impairment below lesion level; perianal sensation may be

impaired; w/lateral cord injury or hemisection, ipsilateral hyperes-

thesia & contralateral analgesia occur

■Tone may be reduced acutely below lesion level & then increased

(spasticity)

■Tendon reflexes may be normal, absent or increased; Babinski res-

ponses indicate pyramidal deficit