Ch. 15 - Spinal cord compression Flashcards Preview

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Flashcards in Ch. 15 - Spinal cord compression Deck (44):
1

What are the 3 types of spinal cord compression?

Extradural, intradural/extramedullary, intramedullary

2

Most common intrathecal tumor

Schwannoma (neurofibroma)

3

Most common causes of malignant spinal cord compression

Lung CA > breast CA > prostate CA > kidney CA > lymphoma > myeloma

4

What is the most common type of spinal cord compression?

Extradural (80%) - most from metastases

5

What are the most common causes of extradural spinal cord compression?

Metastatic tumor, extradural abscess

6

What are the most common causes of intradural/extramedullary spinal cord compression?

Schwannoma > meningioma

7

What are the most common causes of intramedullary spinal cord compression?

Glioma (ependymoma > astrocytoma), syrinx

8

What 2 major presenting features are the hallmarks of spinal cord compression?

1. Pain (common early feature)

2. Neurologic deficit (esp. sensory level)

9

Describe ‘girdle’ pain

Pain radiating around chest wall 2/2 thoracic cord compression, with involvement of thoracic nerve roots

10

Lhermitte’s sign

Flexion or extension of neck causing ‘electric shock’ or tingling radiating down through body to extremities; associated with cervical cord involvement

11

What do the neurological features of spinal cord compression consist of?

Progressive weakness, sensory disturbance, sphincter disturbance

12

Describe the pattern of weakness in spinal cord compression

‘Pyramidal’ pattern with flexor movements most severely affected and extensor movements (e.g. hip extension, knee extension, plantar flexion) preserved

13

What nerve root weakness will be demonstrated by a mass below T1 in the thoracic area?

NO clinically demonstrable weakness!

14

What pattern of weakness is seen with conus medullaris involvement? Cauda equina compression?

Conus medullaris – mixture of LMN and UMN signs

Cauda equina – LMN signs

15

At what level does the T4 dermatome lie? T7? T10?

T4 – nipples

T7 – xiphisternum

T10 – umbilicus

16

Brown-Sequard syndrome

Hemisection causing contralateral impairment of pain and temperature sensation, with ipsilateral pyramidal weakness and impairment of joint position sense, vibration, and fine touch

17

Clinical signs of sphincter disturbance

Enlarged, palpable bladder (2/2 urinary retention), diminished perianal sensation, and decreased anal tone

18

Best imaging modality for spinal cord compression

MRI

19

Tx of spinal cord compression

Urgent decompression except for some malignant tumors (high-dose steroids and radiotherapy)

20

Surgical tx options for malignant spinal cord compression

Decompressive laminectomy (posterior approach) OR vertebrectomy and fusion (anterior approach)

21

Why are glucocorticoids often used prior to spinal cord decompression?

Reduce local edema

22

A poor prognosis for neurological recovery is suggested by how many hours of complete paraplegia?

36 hours

23

‘Dumb-bell’ tumor

Intrathecal tumor (e.g. schwannoma) extending through intervertebral foramen

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24

Population most commonly affected by spinal meningiomas

Middle-aged or elderly with marked FEMALE predominance

25

Most common site for spinal meningioma

Thoracic region

26

Most common site for ependymoma

Filum terminale leading to compression of cauda equina

27

Cauda equina compression sxs

Low back and leg pain, progressive leg weakness, saddle anesthesia, sphincter disturbance

28

Spinal cord ependymoma tx? Astrocystoma?

Ependymoma – macroscopic excision

Astrocytoma – NOT resectable; radiotherapy only 

29

Central posterior cervical disc herniation presentation? Most common levels?

Sudden onset of severe neck pain with rapidly progressive paralysis (LMN features at level of compression and UMN below); usually C5/6 or C6/7

30

Why is the low thoracic region considered a ‘watershed’ area?

T8-L2 often largely supplied by a single unilateral radicular vessel (artery of Adamkiewicz); can contribute to disc degeneration

31

Etiology of spinal epidural abscess?

Hematogenous spread from distant or occult infection OR direct spread from adjacent intervertebral disc or vertebral column (esp. pedicle or neural arch)

32

Most common site of primary infection causing epidural spinal abscess?

Skin/soft tissue > respiratory tract

33

Most common causative organism of epidural spinal abscess?

Staphylococcus aureus >> Streptococcus sp.

34

Tx of epidural abscess?

Urgent laminectomy + complete evacuation of abscess + high-dose abx

35

Pott’s disease

Spinal tuberculosis (osteomyelitis) affecting 2 or more adjacent vertebral bodies with destruction of intervening disc space

36

Spinal AVMs more common in males or females?

Males 4x more likely than females

37

'Steal' phenomenon seen with spinal AVMs

AVM steals blood from normal neural tissue causing local spinal cord hypoxia

38

Subarachnoid hemorrhage associated with sudden severe back pain. What is the diagnosis?

Spinal AVM (15% of patients present with subarachnoid hemorrhage)

39

What causes cervical myelopathy?

Cervical cord compression 2/2 narrow cervical vertebral canal

40

DDx for cervical myelopathy

Spinal tumor, multiple sclerosis, motor neuron disease, syringomyelia, subacute combined degeneration of cord

41

Identify the lesion

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Pott's disease

42

Identify the lesion

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Epidural abscess

43

Spinal column region most commonly affected by mets?

Thoracic

44

Is meningitis more common with epidural or subdural abscesses?

Subdural