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Flashcards in Myelopathy Deck (46):
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

31

Epidural myelopathy is a common complication of metastatic cancer from what locations

LUng, Breast, Prostate

32

If you are suspicious of a spinal cord lesion in a cancer pt...

treat with steroids first (dexamethasone), arrange for a spinal cord MRI with Gadolinium

33

What if the spine MRI is negative in a pt you suspect of a spinal cord lesion?

lumbar puncture

34

Separating mets from infection

Cancer affects the vertebral body, infection begins in the disc

35

The most common culprit of spinal cord infection

staph aureus....be very suspicious of IV drug abusers

36

Epidural abscess signs and symptoms
KNOW

Fever, pain on percussion, elevated white count, elevated ESR, Risk factors such as drug use, immunosuppression, etc...

37

What is osteomyelitis

infection of vertebral body.....causes weakness of the vert bodies and subsequent compression

38

What the hell is Pott's disease

Osteomyelitis resulting from TB infection

39

Spinal meningiomas located where

Intradural, extramedullary lesion

- Classic in the thoracic spine

- Classic in middle aged women

40

Examples of nerve sheath tumors

Schwannoma or neurofibroma

- DUMBBELL SHAPE IS CLASSIC

- most lesions common with neurofibromatosis

41

Progression of a CENTRAL cord lesion (lesions that begin in the parenchyma of the cord)

- Many start right around where the spinothalamic fibers cross so that loss of pain and temp are early signs
- First sign may be pain in shoulders however
- Posterior columns are spared until late, this is called Dissociate Sensory Level where vibration and proprioception are preserved compared to pain and temp.

- Injury to dorsal root entry zone means reflex arcs are screwed up leading to hyporeflexia.

- Sacral dermatomes may be spared until the very end becuase they are the most lateral

42

Syrinx

Large expanding space in the spinal cord, a result of trauma or tumor

43

Anterior Spinal Artery syndrome

KNOW

Artery of Adamkiewicz (Great Radicular Artery)- Pts have symptoms referable to spinothalamic and corticospinal loss because these tracts are located in teh anterior 2/3 of the spinal cord but they will retain Epicritic sensation coming through the posterior columns. Yet another examples of DIssociate Sensory Level

44

Spinal Cord Shock

Complete Transection of SC

The big three things to look for are: FLACCIDITY, URINARY RETENTION, and COMPLETE SENSORY LEVEL

45

How does B12 deficiency present as a spinal cord system

Epicritic and corticospinal damage

- spastic weakness of lower extremities
- decreased vibration and position sense
- Romberg's sign (remember that it is a medial lemniscus test)
- Ataxia
- Hyperreflexia

Treatment is IM injections of B12

46

HTLV-1

Human T lymphotrophic virus 1 causes spastic paraperesis