Diseases of the Spinal Cord & Nerve Roots (Medical) Flashcards
(43 cards)
What is the difference between a myelopathy and radiculopathy?
Myelopathy is a disorder of the spinal cord - UMN; from pressure on the cord
Radiculopathy is a disorder of the spinal roots - LMN; compression of nerve root
What are the motor signs of an upper motor neuron lesion - myelopathy?
Increased tone
Increased reflexes, extensor plantar
Pyramidal pattern of weakness
What are the motor signs of a lower motor neuron lesion - radiculopathy?
Decreased tone
Decreased reflexes, flexor plantar
Weakness
Why is the plantar reflex significant?
The abnormal extensor plantar response reliably indicates metabolic or structural abnormality in the corticospinal system upstream from the segmental reflex (has been observed in structural lesions e.g. haemorrhage, brain and spinal cord tumors, and multiple sclerosis, and in abnormal metabolic states e.g. hypoglycemia, hypoxia, and anesthesia)
What are the sensory signs for a spinal cord pathology?
Myelopathy - sensory level
Hemicord lesion - Brown-Sequard syndrome
What is Brown-Sequard syndrome?
A rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side (results from hemisection of spinal cord due to injury or pathology)
Describe the sensory loss in (complete) Brown-Sequard?
On ipsilateral side: Reduced vibration Reduced joint position sense +WEAKNESS [Dorsal Column] On contralateral side: Reduced pain Reduced temperature [Spinothalamic]
What are the sensory signs of a root pathology?
Radiculopathy - dermatomal sensory loss
What are the autonomic signs of a cord/root pathology?
Bladder/bowel problems
What are some congenital causes of myelopathy?
Friedrich’s ataxia
Spinocerebellar ataxias
Hereditary paraparesis
What are the categories of acquired medical causes of myelopathy?
Inflammation (demyelination, autoimmune, sarcoid) Vascular Infective (viral bacterial, other) Metabolic Malignant/infiltrative Idiopathic
What are the inflammatory causes of myelopathy?
Demyelination - MS
Autoimmune - antibody mediated e.g. aquaporin 4, lupus
Sarcoid (inflammatory cells forming granulomas)
(treated via immunosuppression)
What are the vascular causes for myelopathy?
Ischaemic v haemhorrage
What are viral infective causes of myelopathy?
Herpes simplex/zoster, EBV, CMV, measles, HIV etc
What are bacterial infective causes of myelopathy?
TB, borrelia (Lyme), syphilis, brucella
What is another infective cause of myelopathy?
Schistomiasis
What is a metabolic cause of myelopathy?
B12 deficiency
What are causes of spinal cord ischaemia?
A, A, T, T, V, V, S, H, E, D, M
Atheromatous disease (aortic aneurysm) Arterial dissection (aortic) Thromboembolic disease (endocarditis, AF) Thrombotic haematological disease Vaculitis Venous occlusion Systemic hypotension Hyperviscosity syndromes Endovascular procedures Decompression sickness Meningovascular syphillis
What are some of the features of the clinical presentation of spinal cord stroke?
- may have vascular risk factors
- onset sudden or over few hours
- pain
- weakness
- numbness + parasthesia
- urinary symptoms
What type of pain is found in spinal cord stroke?
Back pain/radicular
Visceral referred pain
What type of weakness is found in spinal cord stroke?
Usually paraparesis rather than quadraparesis given vulnerability of thoracic cord to flow related ischaemia
What urinary symptoms are found in spinal cord stroke?
Retention followed by bladder and bowel incontinence as spinal shock settles
What artery is usually affected in spinal cord stroke?
Anterior spinal artery
Occlusion of which artery can present as a partial Brown-Sequard syndrome?
Central sulcal artery
