Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Tumors, Spinal Typhus Fevers 1473

tests

■Imaging studies (MRI or CT myelography) to localize lesion

■CSF may be xanthochromic w/ high protein concentration, espe-

cially if subarachnoid block is present

differential diagnosis

■Tumor may be primary or secondary, intramedullary or extrame-

dullary (extra- or intradural); intramedullary tumors usually ependy-

moma or glioma; primary extramedullary tumors include menin-

giomas and neurofibromas; carcinomatous or lymphomatous

deposits usually extradural

■Imaging studies help localize lesion & distinguish from other disor-

ders (eg, disc protrusion, hematomas)

management

■High-dose steroids (eg, dexamethasone) to reduce cord edema and

relieve pain; analgesics may be needed; urgent decompression may

be needed if sphincter function threatened

specific therapy

■Extradural metastases: dexamethasone, w/ taper depending on

response; irradiation; surgical decompression if poor response (or

previously irradiated)

■Intramedullary tumors: surgical excision or irradiation

■Extramedullary primary tumors: surgical excision

follow-up

■Depends on tumor site & type

complications and prognosis

■Prognosis is poor for extradural metastases; prognosis of intra-

medullary lesions depends on lesion type & severity of cord compres-

sion before treatment; prognosis good for primary extramedullary

tumors, but degree of recovery depends on severity of deficit before

surgery

TYPHUS FEVERS

RICHARD A. JACOBS, MD, PhD

history & physical

■Epidemic Typhus: Body contact with body louse carrier 1 week before

onset of symptoms. Living in unsanitary, crowded conditions, espe-

cially during cold weather.