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Neuro 2 > Spinal Cord Syndromes > Flashcards

Spinal Cord Syndromes Flashcards

(48 cards)

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1
Q

Myopathy

A

-any disease that affects the spinal cord

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2
Q

Spinal Cord Anatomy

A
  • ends at L1-L2
  • Spinal Taps: done b/w L4 & S1
  • most back pain is lumbar
  • bad things happen in thoracic area
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3
Q

Parts of Spinal Cord

A
    1. Corticospinal tract (hyper-reflexia, spasticity, Babinski, weakness)
      1. Post. Columns (loss of vibration, position sense, Romberg sign)
      2. Spinothalamic tract (loss of pain & temp)
      3. Anterior Horn Cells (flaccid weakness, hypo-reflexia fasiculations)
      4. Root (lancinating pain, numbness, hypo-reflexia)
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4
Q

Anatomy of Spinal Cord: Inside to Outside

A
  • cord
  • pia mater
  • subarachnoid space
  • subdural space
  • dura
  • epidural space (fat)
  • bone
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5
Q

Leptomeningeal

A

-within subarachnoid space

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6
Q

extrdural

A

-epidural

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7
Q

intradural

A

subdural

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8
Q

Intramedullary

A

-within spinal cord parenchymal

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9
Q

Conus

A
  • end of spinal cord

- L1/L2

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10
Q

Nipple Line

A

T4

-sensory level

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11
Q

Umbilicus Line

A

T10

-sensory level

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12
Q

What is common in spinal cord lesions?

A
  • sphincter dysfunction
  • micturition ultimately controlled by CNS
  • bladder symptoms

-long axons from the frontal lobe of brain synapse in the thoracic & sacral areas of the spinal cord (those tracts are vulnerable to injury)

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13
Q

2 types of bladder symptoms that occur with spinal cord lesions?

A
  1. acute lesions - urinary retention with some overflow incontinence
  2. chronic lesions - small spastic bladder that does not completely empty with spasms and urge incontinence
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14
Q

Acute & Subacute myelopathies are?

A

emergencies

  • recognize signs & symptoms, neuro-radiologic testing, lumbar puncture if neuro neg.
  • Therapy is usually IV steroids
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15
Q

Chronic Myelopathy Approach to Patient

A
  • signs & symptoms
  • neurotesting
  • lumbar if neuro neg
  • therapy directed to cause of treatment
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16
Q

History/Exam of patient with Myelopathy

A
  • other illness, fever, location of pain, neuro symptoms, pace of symptoms
  • neuro exam: motor, sensory, reflexes, gait
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17
Q

Progression of Epidural Lesion A

A

hours to days

  • motor symptoms usually early (hyperreflexia, Babinski sign, hard to walk) may NOT be weak
  • Sensory: root irritation, hypersensitive to touch, band or girdle-like sensation in abdomen
  • Urinary Urgency
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18
Q

Progression of Epidural Lesion B

A
  • Motor: legs are spastic & weak, brisk reflexes, babinski sign +
  • Sensory: root area totally numb (ipsilateral), pain in contralateral LE is dec. (spinothalamic)
  • Partial Brown-Sequard (hemi-cord syndrome)
  • Definite sphincter dysfunction
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19
Q

Progression of Epidural Lesion C

A

hours to days (may be acute)

  • Motor: flaccid, arflexic due to spinal cord shock or spastic paraparesis if more chronic or subacute
  • Sensory: complete sensory level to all modalities at level of lesion
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20
Q

Myelopathy - Disc Disease

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A

-severe disc disease in the cervical or thoracic cord - can cause epidural cord compression & myelopathy
(herniated & degenerative)
Treatment: steroids & surgery

21
Q

Spinal Cord Trauma

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A
  • Paraparesis/paraplegia
  • Quadriparesis/Quadriplegia
  • Vertebral body compression
  • Hematoma
  • Spinal Cord Infarct
  • Cord transection
22
Q

Spinal Cord Trauma: Injury Protocol

Study These Flashcards
A

-Methyprednisolone

23
Q

Causes of Spinal Cord Dysfunction in Patients with Cancer

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A
  • Epidural cord compression: tumor, abscess, hematoma
  • Intramedllary processes: metastases, abscess, hematoma, syrinx
  • Other: radiation, chemo, paraneoplastic
  • Neoplastic meningitis
  • Spinal arachnoiditis
24
Q

Epidural Myelopathy due to metastatic cancer

Study These Flashcards
A
  • compression is common complication
  • cancer enters vertebral body (weakens, expands then compresses the spinal cord)
  • Lung, breast, prostate
25
When to get spinal tap?
-when no evidence of cord compression form imaging
26
Where does most metastatic cancer begin>
-vertebral body
27
Where does most spinal abscesses begin?
-disc space | then expand to cause spinal cord compression
28
Most common spinal cord infection?
-staph aureus (IV drug users)
29
Test of choice for spine?
-MRI
30
Epidural Abscess
- fever, pain on percussion, elevated white count, elevated ESR - Risk factors: IV drug use, HIV, immunosuppression
31
Osteomyelitis
- infection of vertebral bodies - causes weakness of the bones, collapse of the vertebral body & subsequent cord compression - irregular vertebral body end plates
32
Pott's Disease
-class neurologic syndrome of osteomyelitis resulting from TB infection
33
Spinal Meningioma
- intradural, extramedullary - common in thoracic spine - although occasional benign herniated disc can occur in thoracic spine, most are bad - middle age women
34
Nerve Sheath Tumors
- schwannoma & neurofibroma are extramedullary, intradural - Classic: dumbbell shape (not common) - middle-age - symptoms mimic disc herniation
35
Central Cord Lesion
A: begins with pain in shoulders (cervical lesion) -loss of pain & temp, crossing spinothalamic tracts are involved early B: as lesion involves root entry zones, reflexes are lost in arms, loss of pain & temp is sever (burn), Horner's syndrome (involve sympathetic path), Touch & joint position are intact "dissociated sensory level", legs develop spastic paraparesis, Babinski, hyperreflexia due to corticospinal change C: worsening of symptoms, Sacral sparing b/c these fibers are the most lateral of the spinothalamics, may involve face due to sensory nucleus of trigeminal nerve
36
Syrinx
- Central Spinal Cord Syndrome - large expanding space in spinal cord - result of trauma or tumor
37
Spinal Cord Astrocytoma
- enhancement with gadolinium | - large amount of edema
38
Vascular disease of spinal cord
- Aneurysm, AVM, less common | - "watershed zone" at periphery of central gray matter
39
Anterior Spinal Artery Syndrome (artery of Adamkiewicz = great radicular artery)
- supplies anterior 2/3 of spinal cord (located in mid thoracic region) - symptoms referable to spinothalamic (loss of pain & temp., sensory level), corticospinal function (weakness), but intact posterior column function (vibration & joint position sense)
40
Acute Non-compressive myelopathies
- Transverse myelitis | - NMO
41
Complete Transection of the Spinal Cord - Spinal Cord Shock
- Transverse myelitis - other causes - acute = spinal shock - flaccid paralysis - complete sensory level to all modalities - loss of bladder, bowel & sexual function - autonomic malfunction - chronic - no shock (spastic paralysis with above)
42
Brown-Sequard Syndrome
- hemi-section - rare: stab wound or myelitis - on side of lesion: ipsilateral spastic paralysis (after spinal shock) below the level of the lesion - Hyper-reflexia, Babinski signs - Ipsilateral loss of vibration & joint position sense - Contralateral loss of pain & temp
43
Subacute Combined Degeneration of Spinal Cord
- B12 deficiency - pernicious anemia - spastic weakness of lower extremities - dec. sensation to vibration & postision - Romberg's sign - Ataxia (non-cerebellar) - Babinski signs & hyperreflexia - peripheral neuropathy (mixed signs)
44
Treatment for Subacute Combined Degeneration of Spinal Cord
-IM injections of vit B12
45
HTLV-1
- human T-lymphotropic virus type 1 - first human retrovirus discovered - reservoir is CD4+ T-lymphocytes - associated with (HAM/TSP, ATL, uveitis, polymyositis, arthritis, ALS) - causes spastic paraparesis & spinal cord disease
46
HAM/TSP
- HTLV-1 associated myelopathy/tropical spastic paaraparesis - patients infected with HTLV-1 - develop paraparesis - CNS is infiltrated by monocytes - CNS demyelination & axonal degeneration (corticospinal tract > posterior columns) - CFS shows ligoclonal bands & inc. IgG
47
Vacuolar Myelopathy
- neurologic complication of HIV infection (late with AIDS) - progressive spastic paraparesis (hyperreflexia, extensor plantar responses) - sensory ataxia & incontinence - vacuolation & myelin pallor (posterior & lateral columns) - Resembles B12 deficiency
48
Tabes Dorsalis
- one complication of neurosyphilis - posterior column dysfunction - loss of vibration & joint position sense - Romberg sign

Neuro 2 (16 decks)

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