Diseases of the Spinal Cord and Nerve Roots (Medical) Flashcards
(43 cards)
What is a myelopathy?
spinal cord
an injury to the spinal cord due to severe compression that may result from trauma, congenital stenosis, degenerative disease or disc herniation
Myelopathy describes any neurologic deficit related to the spinal cord
What is a radiculopathy?
spinal roots/nerve roots
refers to a set of conditions in which one or more nerves are affected and do not work properly (a neuropathy)
image showing corticospinal tracts and where myelopathy and a rediculopathy would affect
What makes up the CNS and PNS
Everything in CNS is brain, brain stem and spinal cord and your PNS is anterior horn cells and nerve root and beyond
What are some signs of UMN cord pathology?
- No wasting
- ↑tone - spasticity, UMN normally cause inhabition of reflex arc
- ↑reflexes, extensor plantar, clonus
- Pyramidal pattern of weakness - decreased control of active movement, particularly slowness
What are some signs of LMN cord pathology?
- wasting
- ↓tone
- ↓reflexes, flexor plantar
- weakness
What are expected sensory signs of cord pathology?
Myelopathy → sensory level
Hemicord lesion → Brown- Sequard syndrome (an incomplete spinal cord lesion characterized by findings on clinical examination which reflect hemisection of the spinal cord (cutting the spinal cord in half on one or the other side))
IMage explaining Brown-Sequard syndrome
What sensory signs would you see in rediculopathy?
dermatomal sensory loss
What signs would you see if there was a pathology of the autonomic fibres?
bladder and bowel problems
What would you see in a C5 cord lesion
Wasting of C5 innervated muscles
↑ tone in legs > arms
Power ↓C5 innervated muscles, pyramidal pattern below
Reflexes ↓biceps, ↑all lower reflexes
Sensory level
Anything above the lesion has weaker tone and reflexes - UMN symptoms present below the level of the lesion
What are surgical causes of myelopathy or radiculopathy?
Tumour - Extradural, intradural/extramedullary, intramedullary
Vascular abnormalities - Haemorrhage, AVM, dural fistula
Degenerative (spine)
Trauma
What are congenital/genetic medical causes of myelopathy
Friedrich’s ataxia, spinocerebellar ataxias, hereditary paraparesis
What are aquired medical causes of myelopathy
• 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/paraneoplastic
- Idiopathic
Iatrogenic
What does ischaemic myelopathy cause?
spinal stroke/infarction
Where do the posterior and anterior spinal arteries arise?
posterior - comes from little small vessels form the aorta
anterior - branch of the vertebral arteries
What is it called when arteries perfusing an area meet and why is this important?
watershed areas
this area is most vulnerable to ischemia as pressure here is lowest
What are causes of spinal cord ischaemia?
- Atheromatous disease (aortic aneurysm)
- Thromboembolic disease (endocarditis, AF)
- Arterial dissection (aortic)
- Systemic hypotension
- Hyperviscosity syndromes/prothombotic disease
- Vasculitis
- Arteriovenous abnormalities
- Endovascular procedures
- Meningovascular syphilis
- Decompression sickness - happens when diving, air bubbles block arteries
What is the clinical presentation of a spinal cord stroke?
- 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 quadraparesis given vulnerability of thoracic cord to flow related ischaemia - if cervical tehn will attack armds aswell but often just legs
- Numbness and paraesthesia
- Urinary symptoms - Retention followed by bladder and bowel incontinence as spinal shock settles
What are some general examination points for a spinal cord stroke?
- Usually anterior spinal artery => dorsal columns spared
- Occlusion of a central sulcal artery can present as a partial Brown-Séquard syndrome
- Usually mid thoracic
- May be spinal shock
How may imaging appear in a spinal stroke
imaging during a spinal stroke may look normal even though one is present
What is the treatment of a spinal cord stroke
• Reduce risk of recurrence
Maintain adequate BP
Reverse hypovolaemia/arrhythmia
Antiplatelet therapy
- OT and physiotherapy
- Manage vascular risk factors
What is the prognosis of a spinal cord stroke?
unless significant motor recovery in the first 24 hours, chance of major recovery is low
pain may be persistent and significantly contribute to disability
20% mortality, only 35-40% have more than minimal recovery
Variable but often poor prognosis
What is demyelinating myelitis?
usually part of MS
common cause of medical spinal cord disease
can affect the young
spinal cord stroke is vascular but this is inflammation
