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Neurology > Spinal Cord Compression > Flashcards

Spinal Cord Compression Flashcards

1
Q

What are the names of the 3 most important spinal cord tracts?

A

Corticospinal tracts.
Spinothalamic tracts.
Dorsal columns.

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2
Q

What does the white matter contain?

A

Nerve fibres

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3
Q

Where do motor tracts sit?

A

In the lateral white columns

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4
Q

Where does the spinothalamic tract sit?

A

In the anterolateral white matter

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5
Q

The corticospinal tract is a __ neurone tract

A

2

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6
Q

Where does the UMN go to and from in the corticospinal tract?

A

From motor cortex, to anterior grey horn

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7
Q

Where does the UMN decussate in the corticospinal tract?

A

At the medullary level

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8
Q

Is the CST ipsilateral or contralateral?

A

Ipsilateral – on the same side as the side of the body it supplies

(because of decussation at medulla)

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9
Q

What is the LMN in the CST?

A

Anterior horn cell

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10
Q

What signs are associated with an UMN lesions in the motor pathways?

A
  • Increased tone.
  • Muscle wasting NOT marked.
  • No fasciculation.
  • Hyper-reflexia.
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11
Q

If you damage your spinal cord, it is the LMN that tends to be damaged

A

FALSE - UMN

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12
Q

What signs are associated with a LMN lesion?

A
  • Decreased tone.
  • Muscle wasting.
  • Fasciculation.
  • Diminished reflexes.
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13
Q

What are the spinothalamic tracts responsible for?

A

Pain, temperature and crude touch

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14
Q

What should you ask when trying to find out about someones spinothalamic tract?

A

Ask if they can feel cold or hot while in the shower

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15
Q

Is the STT contralateral or ipsilateral?

A

Contralateral

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16
Q

Where do the STT’s decussate?

A

At spinal level

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17
Q

What are dorsal columns responsible for?

A

Fine touch, proprioception, vibration.

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18
Q

How are dorsal columns tested?

A

Low frequency tuning fork

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19
Q

Are dorsal columns ipsilateral or contralateral?

A

Ipsilateral

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20
Q

Where do dorsal columns decussate?

A

At medullary level

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21
Q

Spinal cord compression can be……

A

Acute OR Chronic

Complete OR Incomplete

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22
Q

What 4 things can acute spinal cord compression be due to?

A
  • Trauma.
  • Tumours – haemorrhage or collapse. (most common)
  • Infection.
  • Spontaneous haemorrhage.
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23
Q

What is the most common cause of acute spinal cord compression?

A

Tumour - mets

24
Q

What 3 things can chronic spinal cord compression be due to?

A
  • Degenerative disease – spondylosis.
  • Tumours.
  • Rheumatoid arthritis
25
Q

If there is a complete spinal cord transection, what will be affected?

A

All sensory and motor modalities

26
Q

Do UMN signs appear in spinal cord transection?

A

Yes - but later

27
Q

Initially what happens in spinal cord transection?

A

There is initially a FLACCID ARREFLEXIC PARALYSIS  ‘spinal shock.’

28
Q

Outline how each of the 3 spinal tracts are affected in Brown-Sequard syndrome.

A
  • IPSILATERAL motor level
  • IPSILATERAL dorsal column sensory level
  • CONTRALATERAL spinothalamic sensory level
29
Q

If there is a right hemisection of the spinal cord, what are the clinical features?

A
  • Right-sided paralysis (due to damage to right CST)
  • Right-sided loss of fine touch, proprioception, vibration (due to damage to right dorsal column)
  • Left-sided loss of pain, temperature and crude touch (due to damage to right STT)
30
Q

Brown-Sequard Syndrome

A

Cord hemisection

31
Q

What does central cord syndrome occur due to?

A

A hyperflexion or hyperextension injury to an already stenotic neck

32
Q

Describe how a patient with central cord syndrome presents.

A
  • ‘Cape-like’ spinothalamic sensory loss.
  • Lower limb power preserved.
  • Dorsal columns preserved.
33
Q

Describe the process behind central cord syndrome.

A

Blood supply to the central spinal cord is momentarily interrupted leading to ischaemic spinal cord damage

This wipes out the upper limb fibres (medial) of the CST but not the lower limb fibres (lateral)

34
Q

If the STT isn’t affected in central cord syndrome, why does numbness occur?

A

Because although the STT isn’t affected, the crossing over neurone is

35
Q

What is the presentation of central spinal cord syndrome like?

A

Same as acute, but upper motor neurone signs predominate

also more gradual and progressive

36
Q

What type of injury is trauma?

A

High energy

37
Q

What parts of the spine are usually affected by trauma?

A

Mobile segments - especially the spine (cervical)

38
Q

What are extradural tumours usually?

A

Mets

39
Q

What cancers typically metastasise to bone?

A

Lung, breast, kidney, prostate

40
Q

What can intradural tumours be again divided into?

A

Intramedullary OR extramedullary

41
Q

Give 2 examples of extramedullary intradural tumours

A

Meningiona

Schwannoma

42
Q

Give 2 examples of intramedullary intradural tumours

A

Astrocytoma

Ependymoma

43
Q

How can tumours cause compression of the spinal cord?

A
  • Either by growing, and slowly compressing
    or
  • Can cause acute compression by collapse or haemorrhage
44
Q

What can spinal cord stenosis result from?

A
  • Osteophyte formation.
  • Bulging of IVD’s.
  • Facet joint hypertrophy.
  • Subluxation.
45
Q

What can an epidural abscess arise due to?

A
  • Bloodborne infection.
  • Staph.
  • Tuberculosis.
46
Q

What else can lead to spinal cord infection?

A

Surgery or trauma

47
Q

Haemorrhage can be either…..

A
  • Epidural.
  • Subdural.
  • Intramedullary.
48
Q

What factors can lead to haemorrhage?

A

Trauma.
Bleeding diatheses.
Anticoagulants.
AVM’s.

49
Q

How should a haemorrhage, cause by trauma, be managed?

A
  1. Immobilise
  2. Investigate - xray, CT, MRI
  3. Decompress + stabilise
  4. Methyprednisolone
50
Q

What ways can the spinal cord be decompressed?

A
  • surgery
  • traction
  • external fixation
51
Q

How are primary spinal tumours managed?

A

Surgical excision

52
Q

How are spinal infections treated?

A
  • ABx
  • Surgical drainage
  • Stabilisation if required
53
Q

How are spinal haemorrhages treated?

A
  • Reverse anticoagulation

* Surgical decompression

54
Q

How is degenerative spinal disease managed?

A

Surgical decompression +/- stabilisation

55
Q

Acute spinal cord compression is an ____________

A

EMERGENCY

56
Q

Outline the treatment of metastatic spinal tumours

A
  • Dexamethasone
  • Radiotherapy
  • Chemo
  • Surgical decompression and stabilisation
57
Q

Why is radiotherapy the GOLD STANDARD treatment for metastatic spinal tumours?

A
  • Just as good as surgery
  • Good for pain relief
  • Non-invasive

Neurology (42 decks)

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