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Flashcards in Cord disease Deck (17):
1

Features of cord compression

Pain: local and deep or radicular
Weakness: LMN (root) - at level, UMN - below level
Sensory level
Sphincter disturbance

2

Causes of cord compression

Trauma: vertebral #
Infection: epidural abscess, TB
Malignancy: breast, thyroid, bronchus, kidney, prostate
Disc prolapse: above L1/2 (below this - cauda equine syndrome)

3

Investigations for cord compression

MRI is definitive modality
CXR for primaries

4

Treatment of cord compression

This is a neurosurgical emergency
Malignancy: dexamethasone IV, consider chemo, radiation, and decompressive laminectomy.
Abscess: antibiotics and surgical decompression.

5

Features of cauda equina lesions

Pain: back pain, radicular pain down legs.
Weakness: bilateral flaccid, areflexic lower limb weakness.
Sensation: saddle anaesthesia.
Sphincters: incontinence or retention of faeces and urine, poor anal tone.

6

Causes of cauda equina lesions

Same as for cord compression.
Trauma: vertebral #
Infection: epidural abscess, TB
Malignancy: breast, thyroid, bronchus, kidney, prostate
Disc prolapse: below L1/2 (above this - cord compression)

7

Treatment of cauda equina lesions

Same as for cord compression.
Neurosurgical emergency.
Malignancy: dexamethasone IV, consider chemo, radiation, and decompressive laminectomy.
Abscess: antibiotics and surgical decompression.

8

Lesion in Anterior Spinal Artery Syndrome AKA Beck's Syndrome

Infarction of spinal cord in distribution of anterior spinal artery: ventral two-thirds of spinal cord.

9

Causes of Anterior Spinal Artery syndrome

Aortic aneurysm dissection or repair

10

Features of Anterior Spinal Artery syndrome

Para/quadri-paresis
Impaired pain and temperature sensation
Preserved touch and proprioception

11

Pathophysiology of syringomyelia

A cyst forms within the central canal of the cord (syrinx), commonly located in the cervical cord. Symptoms may be static for years but then rapidly worsen, e.g. on coughing, sneezing as pressure causes extension of syrinx. Syrinx expands ventrally affecting: decussating spinothalamic neurones, anterior horn cells, and corticospinal tracts.

12

Causes of syringomyelia

1. Blocked CSF circulation, with reduced flow from posterior fossa: Arnold-Chiari malformation (cerebellum herniates through foramen magnum), SOL.
2. Spina bifida.
3. Secondary to trauma, myelitis, cord tumours, AVMs.

13

Cardinal signs of syringomyelia

1. Dissociated sensory loss: loss of pain and temperature (scars from burns), but preserved touch, proprioception and vibration. Root distribution reflects syrinx location - usually upper limbs and chest ("cape").
2. Wasting/weakness of hands ± Claw hand.
3. Loss of reflexes in upper limb.
4. Charcot joints in shoulder and elbow.

14

Investigations for syringomyelia

MRI spine

15

Surgery for syringomyelia

Decompression at the foramen magnum for Arnold-Chiari malformation

16

Geographical distribution of HTLV-1

Prevalent in Japan and Caribbean

17

Features of HTLV-1 infection

Adult T cell leukaemia/lymphoma
Tropical spastic paraplegia AKA HTLV myelopathy:
Slowly progressing spastic paraplegia, sensory loss and parasthesia, bladder dysfunction