Chapter 22: Disorders of the Spinal Cord Flashcards
Where does corticospinal tract cross?
Medulla
Sensory dermatome of C1
Doesn’t have any sensory fibers
Spinal cord ends at…
L1 (so you can only scan thoracic and cervical cord)
Respiratory insufficiency with what spinal level
C3,4,5 keeps your diaphragm alive
Horner’s localization
Can be from cervical
Abdominal reflexes
Lost with lesions above T6
Blowel and bladder dysfunction
Lesions above sacral cord leel
Transverse myelitis may mimic
Transection, but it develops over a longer period and with evidence of inflammation such as CSF pleocytosis
Does compressing the spinal cord hurt
Nope, only compressing the nerve roots, etc.
Infection causes of pain
Epidural abscesses following skin infections or TB or from a local osteomyelitis. Radicular and other local pain.
Epidural abscesses…benign or bad
Very dangerous, need to surgically drain and Abx
Intradural, extramedullary compressive lesions
Meningiomas, neurofibroma masses
Intramedullary lesions
MS plaques and CNS gliomas, Primary spinal cord tumors are rare
Brown-Sequard syndrome
Hemicord
Ipsilateral Motor, Touch, Vibration, Pinprick
Contralateral Pain and Temperature
Trauma; cord compression; MS
Why do central cord lesions affect the Spinothalamic tract first?
Because they cross just in front of the central canal!
Central Cord presentation
Cape-like loss of sensation over the shoulders and arms, with preservation of the same sensations above and below the lesion. LMN signs (weakness leading to atrophy of arm muscles)
Pain and temperature sensation is affected, touch and position sense is not. “Dissociated” sensory loss
Central cord example
Syringomyelia
Syringomyelia symptoms
Numbness in hands, some wasting, over many months/years
Dorsal columns are preserved
Associated with Chiari malformations
Syringomyelia tx
Shunt
Vitamin B12 Deficiency causes
Posterior column dysfunction
If you damage below lumbar cord
Leg strength and reflexes intact while severely affecting bowel, bladder, and sexual function.
Blood supply for the anterior 2/3 of the spinal cord
The solitary Longitudinal Anterior Spinal Artery (ASA)
ASA superior origin
From branches of the two vertebrals joining at the top of the cord.
ASA inferior origin
From artery of Adamkiewicz, originating from perforating arteries from the aorta (L2 level)
