Diseases of Spinal Cord Flashcards
(74 cards)
Motor signs of cord/root pathology
UMN - no wasting, increased tone, increased reflexes, extensor plantar. Pyramidal pattern of weakness
LMN (root) - reduced tone, absent reflexes, flexor platar, weakness
Sensory signs of cord pathology
Myelopathy - sensory level
Hemicord lesion - Brown Sequard syndrome
- ipsilateral; reduced vibration, reduced joint position sense, weakness
- contralateral - reduced pain, reduced temperature
Sensory signs of root pathology
Radiculopathy –> dermatomal sensory loss
Autonomic signs of cord/root pathology
Bladder/bowel involvement
Signs of C5 cord lesion
Wasting of C5 innervated muscle Increased tone in legs more than arms Reduced reflexes in biceps, increased all lower reflexes Power reduced in C5 innervated muscles Pyramidal pattern below Sensory level
Extrinsic Causes of myelopathy or radiculopathy
Surgical
- Tumour: extradural, intradural, extramedullary, intramedullary
- Vascular abnormlities - haemorrhage, AVVM, dural fistula
- Degenerative
- Trauma
Intrinsic causes of myelopathy or radiculopathy
Congenital/genetic
- Friedrich’s ataxia, spinocerebellar ataxias, hereditary paraparesis
Acquired
-Inflammation - Demyelination;MS, Autoimmune (Ab mediated), Sarcoid
Vascular - Ischaemic v Haemorrhage
-Infective - Viral; Herpes, EBV, CMV, measles, HIV
- Bacterial; TB, borrelia, syphylis, brucella
- Other; schistosomiasis
-Metabolic - B12 deficiency
-Malignant/infiltrative
Idiopathic
Causes of spinal cord ischaemia
Atheromatous disease Thromboembolic disease Arterial dissection Systemic hypotension Thrombotic haematological disease Hyperviscosity syndromes Vasculitis Venous occlusion Endovascular procedures Decompression sickenss Meningovascular syphylis
Spinal cord stroke - presentaion
Vascular risk factors
Onset may be sudden or several hours
Pain - back pain/radicular, visceral referred pain
Weakness - usually paraparesis than quadriparesis (vulnerability of thoracic cord to flow-related ischaemia)
Numbness and paraesthesia
Urinary symptoms - Retnetion followed by bladder and bowel incontinence as aspinal shock settles
Spinal cord stroke on examination
Usually anterior, rarely posterior spinal artery - dorsal columns spared
Occlusion of central sulcal artery - partial Brown Sequard
Mid thoracic
May be spinal shock
Treatment of spinal cord stroke
Maintain adequate BP Reverse hypovolaemia/arrhythmia Antiplatelet therapy OT and physio Manage vascular risk factors
Prognosis for spinal cord stroke
Return of function depends on parenchymal damage
Chance of major recovery low if motor recovery poor within first 24 hours
Pain may be persistent and contribute to disability
20% mortality
Demyelinating myelitis affects which part of the CNS?
White matter
What is required for B12 absorption from the gut?
Intrinsic factor- secreted by gut parietal cells
How is B12 absorption prevented in pernicious anaemia?
Autoimmune - antibodies to intrinsic factor
How does B12 deficiency affect the nervous system?
Myelopathy - L'hermitte's Peripheral neuropathy Brain Eye/optic nerve Brainstem Cerebellum
Signs of B12 deficient myelopathy
Paraesthesia of hands and feet, areflexia
Extensor plantars
Degen of corticospinal tract - paraplegia
Degen of dorsal columns - sensory ataxia
Painless retention of urine
Invesitgation of B12 deficient myelopathy
FBC, blood film, B12
Treatment for B12 deficient myelopathy
Intramuscular B12
Vertebra, number in each region
Cervical - 7 Thoracic - 12 Lumbar - 5 Sacral -3 Coccyx-4
Spinal cord extends from which spinal levels
C1 to L2
Spinal cord progresses to…
Conus medularis
Cauda equina
What is the transition point between UMN and LMN
Anterior horn
C5 innervates…
Elbow flexors
