Spinal Cord Compression

Question 1

the corticospinal tract is a _ neurone tract?

Answer 1

2

Question 2

where does upper motor neurone of corticospinal tract begin and end?

Answer 2

from motor cortex to anterior grey horn

decussates (crosses over) at medullary level

Question 3

what is the lower motor neurone?

Answer 3

anterior horn cell

Question 4

is corticospinal tract contralateral or ipsilateral?

Answer 4

ipsilateral

Question 5

what symptoms do you get with an upper motor neurone lesion?

Answer 5

increased tone
muscle wasting not marked
no fasciculation
hyper-reflexia

Question 6

what symptoms do you get with a lower motor neurone lesion?

Answer 6

decreased tone
muscle wasting
fasciculation
diminished reflexes

Question 7

what do spinothalamic tracts control?

Answer 7

pain
temperature
crude touch

this is a sensory pathway

Question 8

is spinothalamic tracts contralateral or ipsilateral?

Answer 8

contralateral

Question 9

where do spinothalamic tract decussate (cross over to other side of CNS)?

Answer 9

spinal level

Question 10

what do dorsal columns control?

Answer 10

fine touch
proprioception
vibration

Question 11

are dorsal columns contralateral or ipsilateral?

Answer 11

ipsilateral

Question 12

where do dorsal columns decussate (cross over to other side of CNS)?

Answer 12

medullary level

Question 13

what causes acute spinal cord compression?

Answer 13

trauma
tumour - haemorrhage or collapse
infection
spontaneous haemorrhage

Question 14

what causes chronic spinal cord compression?

Answer 14

degenerative disease - spondylosis, spinal cord stenosis
tumours - slowly compress
rheumatoid arthritis

Question 15

acute spinal cord compression can either be complete or incomplete, what does this mean?

Answer 15

complete - all motor and sensory modalities affected

Question 16

what are symptoms of an acute cord transection?

Answer 16

initially a flaccid arreflexic paralysis - spinal shock

upper motor neurone signs appear later

Question 17

what occurs in brown-sequard syndrome (cord hemisection)?

Answer 17

no ipsilateral motor level

no ipsilateral dorsal column sensory level

no contralateral spinothalamic sensory level

Question 18

how does central cord syndrome occur?

Answer 18

hyperflexion or extension injury to already stenotic neck

Question 19

what are the symptoms of central cord syndrome?

Answer 19

predominantly distal upper limb weakness

“cape-like” spinothalamic sensory loss

lower limb power and dorsal columns preserved

Question 20

what are symptoms of chronic spinal cord compression?

Answer 20

same as acute except upper motor neurone signs predominate

Question 21

what kind of trauma causes spinal cord compression?

Answer 21

high energy injury

especially mobile segments of spine (cervical)

Question 22

what types of extradural tumours cause spinal cord compression?

Answer 22

usually mets - lung, breast, kidney, prostate

Question 23

what types of intradural tumours cause spinal cord compression?

Answer 23

extramedullary - meningioma, schwannoma

intramedullary - astrocytoma, ependymoma

Question 24

what causes spinal canal stenosis?

Answer 24

osteophyte formation
bulging of intervertebral discs
facet joint hypertrophy
subluxation

Question 25

what kind of infections can compress spinal cord?

Answer 25

epidural abscess - bloodborne staph or tuberculosis surgery or trauma

Question 26

what types of haemorrhage can compress spinal cord?

Answer 26

epidural subdural intramedullary

Question 27

what can cause haemorrhage which suppresses spinal cord?

Answer 27

trauma bleeding diatheses anticoagulants arterio-venous malformations

Question 28

how do you treat spinal cord compression caused by trauma?

Answer 28

immobilise investigate decompress + stabilise ? methylprednisolone

Question 29

what investigations should take place in spinal cord compression caused by trauma?

Answer 29

X-ray / CT | MRI

Question 30

how do you decompress + stabilise spinal cord compression caused by trauma?

Answer 30

surgery traction external fixation

Question 31

is the use of methylprednisolone in spinal cord compression caused by trauma disputed?

Answer 31

yes - this lecturer said probably no useful benefit

Question 32

how do you treat spinal cord compression caused by tumour?

Answer 32

``` depends on pt and tumour dexamethasone radiotherapy chemotherapy surgical decompression + stabilisation ```

Question 33

how do you treat spinal cord compression caused by infection?

Answer 33

antimicrobial therapy surgical drainage stabilisation where required

Question 34

how do you treat spinal cord compression caused by haemorrhage?

Answer 34

reverse anticoagulation surgical decompression

Question 35

how do you treat spinal cord compression caused by degenerative disease?

Answer 35

surgical decompression +/- stabilisation

Question 36

is acute spinal cord compression an emergency?

Answer 36

yes

Question 37

chronic compression requires rapid treatment - true or false?

Answer 37

true

Question 38

what is usually the outcome of treatment of spinal cord compression?

Answer 38

prevents further deterioration