CH42: Spinal Cord Flashcards by Robert Sarmiento

Most vulnerable part of the spine to injuries (p. 1258)

Cervical spine

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If the legs are paralyzed and the arms can still be abducted and flexed, the lesion is likely o be at (p. 1259)

5th and 6th vertebrae

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The spinal cord ends at (p. 1259)

first lumbar vertebrae

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The prognosis is more favorable for spinal cord injury if any movement or sensation is eligible during the first ____ hours (p. 1259)

48-72

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Jefferson Fracure
Hangman fracure
Chance fracture

Which areas are affected (p. 1260)

Jefferson C1
Hangman C2
Chance thoracolumbar, aka seat belt injury

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ASIA
A
B
C
D
E 
(p. 1260)

A- Complete sensory or motor function absence
B- Sensory incomplete
C- Motor incomplete; more than half
D- Motor incomplete; less than half
E- Reflexes may be abnormal

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Low risk of spine injury per NEXUS group (p. 1261)

absence of posterior mid cervical spine tenderness
no evidence of intoxication
normal level of alertness
no focal neuro deficits
no other painful injuries that distract the patient from reporting neck pain

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Canadian CT rule per high risk for spine injury (p. 1261)

age older than 65
dangerous mechanisms of injury
limb paresthesias

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Pathology traumatic spinal cord injury (p. 1261)

traumatic necrosis maximal at the level of injury and one or two segments above and below it.

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Earliest tissue alteration in traumatic spine injury (p. 1262)

hyperemia and small hemorrhages in the central gray matter

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Which reflexes is first to return in spinal cord injury? (p. 1262)

bulbocavernosus reflex

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Stimulation of the skin of the legs or by interoceptive stimulus, such as full bladder (p. 1263)

mass reflex

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Describe autonomic dysreflexia (p. 1263)

release of adrenaline from the adrenal medulla and of norepinephrine from the disinhibited sympathetic terminals caudal to the lesion but exaggerated by defective baroreceptor compensatory reflexes

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anatomic basis of cruciate paralysis (p. 1264)

pyramidal decussation of corticospinal fibers to the arms being rostral than the legs.

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CSF findings in HIV myelopathy (p. 1270)

small number of lymphocytes, a slight elevation of protein and occasional bizarre giant cells

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CSF findings in HTLV1 (p. 1270)

T lymphocytes 10-50/mm3; normal concentrations of protein and glucose, and an increased content of immunoglobulin (Ig) G with antibodies of HTLV1

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Treatment of HTLV1 (p. 1270)

Mogamulizumab

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May be used to check for sarcoid myelitis (p. 1271)

angioensin-converting enzyme levels

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MRI finding in sarcoid myelitis (p. 1271)

multifocal subpial nodular enhancement of the meninges adjacent to a lesion within the cord or nerve roots

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Most frequent etiologic agent for spinal epidural abscess (p. 1271)

S aureas

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Most frequently affected by spinal epidural abscess (p. 1271)

Thoracic spine

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Implicated in vertebral bacterial osteomyelitis (p. 1273)

coagulase- negative staphylococci

prorionobacterium

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Region most affeced by vertebral bacterial osteomyelitis (p. 1273)

Lumbar spine

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Most common virus- related myelopathy (p. 1275)

Epstein- Barr; Cytomegalovirus

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Pathologic findings in postinfectious or post vaccinal myelitides (p. 1276)

numerous subpial and perivenular zones of demyelination w perivascular and meningeal infiltrations of lymphocytes and other mononuclear cells and para- adventitial pleomorphic histiocyes and microglia

Most typical clinical expression of dmeulinating myelinitis (p. 1276)

numbness that spreads over one or both sides of the body from the sacral segments to the feet, anterior thighs up over the trunk with coincident but variable and usually asymmetric weakness and then paralysis of the legs

Amyotrophic paraplegia running over months (p. 1277)

Foix- alajounine myelopathy

Pathologic findings of Foix- alajounine myelopathy (p. 1277)

severe necrosis of both gray and white matter in the LS region and a marked increase in the number of small vessels, their walls thickened, cellular and fibrotic yet without vascular occlusion

Antibodies in Sjogren myelopathy (p. 1278)

AntiSSA (Ro) Anti SSV (La)

Bagel sign is found in which myelopathy (p. 1278)

Behcet Disease Myelopathy

Pathologic findings n Subacute Spinal neuronitis (p. 1279)

Widespread loss of internuncial neurons with relative sparing of anterior horn cells, reactive gliosis and microglial proliferation, conspicuous lymphocyte cuffing of small blood vessels and scanty meningeal inflammation

Arterial system of spine (p. 1280)

Upper or cervicothoracic from anterior spinal arteries and branches of thyrocervical and costocervical Intermediate or middle thoracic from single T7 radicular artery Lower or thoracolumbar from large T10 or L1 anterior radicular artery

Severe upper lumbar and thoracic pain after followed by progressive paraparesis or parplegia and urinary retention (p. 1282)

Surfer myelopathy

Pattern of symptoms of vascular malformations of the spinal cord (p. 1283)

Subacute or saltatory evolution, presumably from fluctuating venous congestion within the cord

MRI or CT myelography findings of vascular lesions of spinal cord (p. 1284)

one or more enlarged and serpiginous draining vessels in the subarachnoid space; just as often not also visualized

Mainly affects the upper thoracic spinal cord as a result of nitrogen bubbles that form in the vessels (p. 1286)

Caisson Disease | Treatment: recompression in a hyperbaric chamber; PT; antispasticity

Cervical spondylolysis with myelopathy pathologic findings (p. 1288)

fraying of the annulus fibrosus with extrusion of disc material into the spinal canal

The range acquired of narrowing of the canal that produces symptomatic cervical spondylosis ___ (p. 1289)

7-12mm

To confidently attribute neurologic symptoms to spondylosis, ___ (p.1290)

there should be considerable encroachment on and obliteration of the circumferential CSF space at that level, not simply an impingement or slight deformation of the normal oval shape of the cord.

What differentiates neuropathy from myelopathy? (p. 1290)

Examination of tendon reflexes)

Differentiate myelopathy and NPH (p.1290)

Marked increase of imbalance w removal of visual --> spondylosis Short- stepped and magnetic quality of walking, characteristic of hydrocephalus and not seen in cervical myelopathy

Affected in akylosing spondyliis (p. 1291)

sacroiliac joints and lumbar spine

Affected in Rheumatoid arthritis (p. 1291)

Ligaments connecting odontoid to the atlas and to the skull and the joint tissue

Chronic wasting of one or both hands and forearms without sensory changes or long tract signs (p. 1291)

Hirayama disease

Mechanism of cord damage in Hirayama disease (p. 1291)

buckling of the dorsal dural sac and intermittent anterior displacement and ligamentous compression of the cord during the flexion of the neck.

The concentration is high in Paget Disease (p. 1292)

Plasma alkaline phosphatase

Treatment for Paget disease (p. 1292)

Plicamycin and etidronate disodium

Most common anomalies of the craniocervical junction (p. 1292)

Fusion of atlas and foramen magnum

Typical feature of this syndrome is absence or severe hypoplasia of the odontoid process (p. 1292)

Morquio syndrome

Syndrome where in there is fusion of upper cervical vertebrae or of the atlas to the occiput (p. 1292)

Klippel Feil syndrome

Most common presenting symptoms of copper deficiency myelopathy (p. 1293)

Imbalance

CT myelographic finding in arachnoiditis (p. 1294)

Patchy dispersion of the column of dye with candle guttering appearance most evident with oil- based contrast media

Most common primary extramedullary tumors (p. 1295)

NF and Meningiomas

Xanthochromia and clotting of CSF from greatly elevated protein content (p. 1296)

Froin syndrome

Two most common intramedullary tumors.(p. 1297)

Ependymomas and astrocytoma

Lathyrism toxicity (p. 1330)

BOAA beta-N-oxalylaminoalanine

Syringomyelia with an intramedullary tumor (p. 1301)

Type III

Most characteristic feature of syringomyelia (p. 1301)

Painless injury and burns of the hands

Horner syndrome may result from ipsilateral involvement of the cell column at what levels (p.1301)

C8, T1 and T2

Only therapy of lasting value for Type 1 syringomyelia (p. 1303)

Surgical decompression of the foramen magnum and upper canal