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Flashcards in Myelopathy Deck (46)
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1

Myelopathy

Any disease that affects the spinal cord

2

Spinal Cord Ends at what level

L1-L2

3

Spinal Taps are done where?

L4-5...Far below the end of the spinal cord

4

Pt says back pain is in the thoracic region?

BE CONCERNED

5

What is the only tract that crosses in the spinal cord?

Spinothalamic...all others stay ipsilateral within the spinal cord and cross in the brain

6

KNOW THE spinal cord antomy slide

ok

7

Damage to the Corticospinal tract results in

- Hyper-reflexia
- Spasticity
- Babinski signs
- weakness

8

Damage to the posterior columns results in:

Loss of vibration, proprioception, pts will show a Romberg sign because of loss of proprioception

9

Damage to the spinothalamic tract results in

Loss of Pain, Temperature

10

Damage to the anterior horn cells results in:

Flaccid weakness, hypo-reflexia, fasciculations

11

Damage to the Dorsal Root

numbness, lancinating pain, hyporeflexia

12

Romberg sign is NOT A CEREBELLAR SIGN.

IT is a posterior column sign

13

Spinothalamic and corticospinal are organized medually to laterally

ARM , Trunk Leg

14

KNOW spinal cord anatomy from inside to out

Starting inside
- Parenchyma of the spinal cord itself
- Pia mater
- subarachnoid space
- arachnoid
- Subdural space
- dura
- epidural space (filled with fat)
- Bone

15

Epidural really means

extradural

16

Intradural really means

subdural

17

Within the subarachonoid space

leptomeningeal

18

Within the spinal cord parenchyma

Intramedullary

19

Nipple line sensory level

T4...KNOW

20

Umbilicus sensory level

T10...KNOW

21

Describe the two general kinds of bladder symptoms present in spinal cord lesions

1) In acute lesions we generally see urinary retention

2) In chronic lesions there is a small spastic bladder that doesn't completely empty with spasms and urge incontinence

22

Acute and subacute myelopathies are:

EMERGENCIES

23

In pts with acute myelopathy

do immediate neuroradiologic testing
therapy is usually IV steroids

24

Approach to the pt with myelopathy

- General Exam:
Fever
Ask the pt to show you where it hurts
Check for tenderness on vertebral body
- Neuro exam looking at motor, sensory, reflexes, gait

25

Early symptoms of an EPIDURAL LESION

- Dorsal root may be compressed which would lead to numbness, allodynia (hypersensitivity to touch)

- If the spinothalamic tract has been injured, very subtle changes in sensory symptoms are seen in the CONTRALATERAL lower extrmity

- Urinary urgency is common

- some hyper-reflexia, babinski signs and difficulty walking

26

As time passes, epidural lesion symptoms change how?

- Legs become weak
- Sensory symptoms worsen
- Bladder and bowel dysfunction

27

What is Partial Brown Sequard>

hemi-cord syndrome where you see weakness and numbness to touch on the ipsilateral side (corticospinal and medial lemniscal pathways)
and loss of pain sensation and temp on the CONTRA side because of the crossing over of spinothalamic tract

28

Full blown spinal cord compression

Flaccid areflexic

If this was an acute injury there is complete sensory loss at lesion level

29

Treatment for acute spinal cord injury

IV methyprednisolone

30

Cancer can affect the spinal cord at EVERY level

ok