4: Spinal cord compression

Question 1

Which

a) ascending pathways
b) descending pathways

are found in the spinal cord?

Answer 1

Important ones (for me anyway) are:

a) DC/ML pathway (fine touch, proprioception, vibration), Spinothalamic tract (firm touch, temperature, pain)

b) Corticospinal tracts (voluntary movement)

Question 2

Which two tracts does the corticospinal tract split into?

Answer 2

Anterior corticospinal tract (15% of fibres, cross at spinal cord level of muscle)

Lateral corticospinal tract (85% of fibres, have already crossed over at medulla)

Question 3

Which structures are connected by the upper motor neurons of the corticospinal tract?

Answer 3

Motor cortex TO Anterior horn of spinal cord

Question 4

Which structures are connected by the lower motor neurons of the corticospinal tract?

Answer 4

Anterior horn of spinal cord TO Skeletal muscle

Question 5

Where do 85% of corticospinal tract fibres decussate?

Answer 5

Pyramids of the medulla

Question 6

Compare muscle tone in UMN versus LMN problems.

Answer 6

UMN - hypertonia

LMN - hypotonia

Question 7

Does atrophy tend to occur in UMN or LMN problems?

Answer 7

LMN

muscle can’t contract, so atrophies due to underuse

Question 8

In which type of motor neuron pathology are fasciculations seen?

Answer 8

LMN

Question 9

Describe reflexes in

a) UMN
b) LMN problems.

Answer 9

a) Brisk

b) Slow / absent

Question 10

In which type of motor neuron problem do you see the Babinski reflex?

What does this look like?

Answer 10

UMN disease

When plantar surface of the foot is stroked, toes extend and fan out (abnormal, they should flex)

Question 11

Describe upper motor neuron disease in terms of

a) reflexes
b) atrophy
c) fasciculations
d) muscle tone?

Answer 11

In UMN disease:

a) brisk reflexes
b) little / no atrophy
c) no fasciculations
d) increased muscle tone

Question 12

Describe lower motor neuron disease in terms of

a) reflexes
b) atrophy
c) fasciculations
d) muscle tone?

Answer 12

In LMN disease:

a) Slow / absent reflexes
b) Marked atrophy
c) Fasciculations present
d) Decreased muscle tone

Question 13

Which sensations are carried by the spinothalamic tract?

Answer 13

Firm touch

Temperature

Pain

Question 14

Where does the spinothalamic tract decussate?

Answer 14

Spinal cord

Question 15

Where does the DC/ML pathway decussate?

Answer 15

Medulla

Question 16

What can happen to the spinal cord to cause disease?

Answer 16

Compression

Transection

Question 17

What are some acute causes of spinal cord compression?

Answer 17

Trauma

Disc prolapse

Tumour

Infection

Haemorrhage into cord / subarachnoid space

Question 18

What are some chronic causes of spinal cord compression?

Answer 18

Spondylosis - degenerative spinal diseases

Tumour

Arthritis (especially RA)

Question 19

Why is it important to know where the motor and sensory pathways cross over in terms of spinal cord injuries?

Answer 19

If you know where the tract is in the spinal cord

i.e DC/ML pathway and corticospinal tracts will be ipsilateral, spinothalamic tract will already have crossed to be contralateral

You can predict what will be affected by spinal cord injuries

Question 20

Which pathways are affected by a cord transection?

Answer 20

All of them

Sensory and motor symptoms

Question 21

Sensory AND motor innervations are totally disrupted bilaterally, below the lesion by which type of spinal cord injury?

Answer 21

Complete cord transection

Question 22

What occurs acutely below the level of a spinal cord injury?

Answer 22

Spinal shock

Question 23

Describe spinal shock.

Answer 23

Loss of reflexes below the level of an acute spinal cord injury

can occur in injuries like cord transection

Question 24

Spinal shock is a loss of ___ below the level of a spinal cord injury.

Is it permanent?

Answer 24

reflexes

usually not

Question 25

What type of **spinal injury** causes **Brown-Sequard syndrome?**

Answer 25

**Spinal cord hemisection** Damage to one side of the spinal cord

Question 26

Think about where the **crossing over** of the **DC/ML, spinothalamic** and **corticospinal tracts** occur. If a patient suffers a **cord hemisection**, what **symptoms** will they have and what **side** will each symptom be felt on relative to the lesion?

Answer 26

**Brown-Sequard syndrome:** **IPSILATERAL loss of fine touch, proprioception and vibration** (DC/ML runs ipsilateral to skin it supplies and decussates at medulla) **CONTRALATERAL loss of firm touch, temperature and pain** (spinothalamic tract decussates at spinal level and runs contralaterally to skin it supplies, upwards) **IPSILATERAL** **loss of motor function** (corticospinal tracts decussate at medulla and run down the spinal cord, ipsilateral to the muscles they control)

Question 27

What type of injury causes **central cord syndrome**?

Answer 27

**Hyperflexion** **Hyperextension** neck injuries

Question 28

Which pathway is primarily affected by **central cord syndrome**?

Answer 28

**Spinothalamic tract** Firm touch, temperature, pain

Question 29

What sort of **distribution** does sensory disturbance often have in patients with **central cord syndrome**? Which tract is involved, and which senses are lost?

Answer 29

**Cape** distribution **Spinothalamic tract** (firm touch, temperature, pain)

Question 30

What is the difference between the **clinical presentation** of **acute and chronic cord compression**?

Answer 30

**Chronic** is the same but also has **UMN signs** (increased tone, hyperreflexia, upgoing plantars, clonus)

Question 31

High-\_\_\_ trauma can cause spinal cord compression.

Answer 31

**high-energy**

Question 32

What disease causes **insidious cord compression?**

Answer 32

**CNS cancer** - e.g meningiomas, Schwannomas, astrocytomas, ependymomas

Question 33

How may **CNS tumours** cause cord compression acutely?

Answer 33

**Haemorrhage** **?Collapse**

Question 34

Which spinal disease, causing **neurogenic claudication**, can also cause **spinal cord compression**?

Answer 34

**Spinal stenosis**

Question 35

Pus-forming bacteria can form ___ which compress the spinal cord.

Answer 35

**abscesses**

Question 36

How is suspected **spinal cord compression** investigated?

Answer 36

**Imaging** X-ray, CT or MRI scan

Question 37

How is **spinal cord compression** managed surgically?

Answer 37

**Decompression** (draining of fluid, removal of tumour, clearing up basically) +/- **Traction** (use of a device to straighten the bones involved) +/- **Fixation** (use of screws, rods etc. to keep broken bones held together, internally or externally) +/- Antibiotics, chemo/radiotherapy