4. =Inner Meninges.= Normally gray, transparent, delicate. Note
intrameningeal pressure, contents of subarachnoid space, color,
thickness and translucency of arachnoid and pia, blood-vessels,
presence of blood, pus, fibrinous exudates, localized thickenings,
calcification, etc. Most common pathologic conditions are acute and
chronic leptomeningitis, results of trauma, hemorrhage, syphilis,
tuberculosis, cerebrospinal meningitis, leprous meningitis, etc.
Bony plates (osteomata) are found in the arachnoid of the majority
of people over forty-five years of age. In small number and size
they have no pathologic significance; they are often large and very
numerous in old cases of syphilitic leptomeningitis, sometimes
encasing the cord. Primary tumors (fibroma, myxoma and sarcoma) are
rare. Teratoid tumors (lipoma, myolipoma, neuroma) are occasionally
found in the lumbosacral region, often associated with spina bifida.
Secondary carcinoma and sarcoma, and metastases of the so-called
glioma of the eye are also rarely found.
5. =Cord.= Size and form. Average length about 45 cms.; weight, 30
grms.; weight of cord to that of brain, 1:48.
Anteroposterior diameter of cervical cord 0.9 cm.
Anteroposterior diameter of dorsal cord 0.8 cm.
Anteroposterior diameter of lumbar cord 0.9 cm.
Transverse diameter of cervical cord 1.4 cm.
Transverse diameter of dorsal cord 1.0 cm.
Transverse diameter of lumbar cord 1.2 cm.
Adhesions to inner meninges, consistence (should be uniform; changes
in form and consistence are often the results of postmortem changes),
color (gray-white, as seen through the pia), translucency (sclerotic
areas in the white matter are firmer, depressed and gray or
brownish-gray in color, and more translucent when present in the gray
matter), moisture, color and blood-content of cut surface, relation
of white and gray matter, symmetry of parts, size of central canal,
presence of cavities, areas of softening (soft, yellowish-white,
loss of structure), hemorrhages, congestion, anæmia, œdema, gumma,
tubercle, tumors, parasites, etc. The normal consistence of the lower
portion of the cord is usually somewhat firmer than that of the upper
part. The “butterfly-figure” should stand out distinctly on the
freshly-cut surface; the outlines between the white and gray matters
should be sharp, and the gray matter should be grayish-red in color.
Normally the white matter tends to rise above the gray. Inasmuch
as the cord is often injured accidentally during its removal it is
important to distinguish such artefacts from pathologic softenings.
This can be easily done by taking a small portion of the doubtful
area and examining in the fresh state under the microscope. In true
softening numbers of “fat-granule” cells and also capillary walls
showing fat-degeneration are seen.
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