Diseases of the spinal cord and nerve roots (clinical) Flashcards Preview

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Flashcards in Diseases of the spinal cord and nerve roots (clinical) Deck (7)
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1
Q

What are the expected signs of nerve/ root pathology

A
• Motor
- Upper motor neuron
	○ Increased reflexes
	○ Increased tone
	○ Pyramidal pattern of weakness
- Lower motor neuron
	○ Decreased reflexes
	○ Decreased tone
	○ Weakness
• Sensory
	○ If the spine is damaged then the sense from below that area will vanish
2
Q

What are the medical causes of myelopathy?

A

Inflammation
- Demyelination (Multiple Sclerosis)
- Autoimmune (antibody mediated eg aquaporin 4, lupus)
- Sarcoid
Vascular: ischaemic vs haemorrhage
Infective
- Viral: herpes simplex/zoster, EBV, CMV, measles, HIV etc
- Bacterial: TB, borrelia (Lyme), syphilis, brucella
- Other: schistosomiasis
Metabolic
- B12 deficiency
Malignant / infiltrative
Congenital / genetic
- Friedreich’s ataxia, spinocerebellar ataxias
Idiopathic (~20%)

3
Q

What are the causes of spinal cord ischaemia?

A
  • Atheromatous disease (aortic aneurysm)
  • Thromboembolic disease (endocarditis, AF)
  • Arterial dissection (aortic )
  • Systemic hypotension
  • Thrombotic haematological disease
  • Hyperviscosity syndromes
  • Vasculitis
  • Venous occlusion
  • Endovascular procedures
  • Decompression sickness
  • Meningovascular syphilis
4
Q

What is the clinical presentation of spinal cord stroke?

A
  • May have vascular risk factors
  • Onset may be sudden or over several hours
  • Pain
    • Back pain/radicular
    • Visceral referred pain
  • Weakness
    • Usually paraparesis rather than quadriparesis given vulnerability of thoracic cord to flow related ischaemia
  • Numbness and paraesthesia
  • Urinary symptoms
    • Retention followed by bladder and bowel
    • incontinence as spinal shock settles
5
Q

What is the treatment of spinal cord stroke?

A
  • Reduce risk of recurrence
  • Maintain adequate BP
  • Reverse hypovolaemia/arrhythmia
  • Antiplatelet therapy
  • OT and physiotherapy
  • Manage vascular risk factors
6
Q

Explain MS

A
  • Characterised by pathological lesions of inflammation and demyelination leading to temporary neuronal dysfunction
  • Affects the white matter of the CNS
  • One or more lesions anywhere
  • Treatment
    * Supportive
    * Methylprednisolone
  • May have a chronic progressive myelopathy
    * 2˚ or 1˚ progressive
7
Q

Explain B12 deficiency?

A
  • Paraesthesia hands and feet, areflexia
  • First UMN sign extensor plantars
  • Degeneration of:
    • Corticospinal tracts → paraplegia
    • Dorsal columns → sensory ataxia
  • Painless retention of urine
  • Investigations: FBC/blood film (can be N), B12
  • Treatment
    • Intramuscular B12 (quicker the better)