Spinal Cord Syndromes Flashcards Preview

Neuro 2 > Spinal Cord Syndromes > Flashcards

Flashcards in Spinal Cord Syndromes Deck (48):
1

Myopathy

-any disease that affects the spinal cord

2

Spinal Cord Anatomy

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

3

Parts of Spinal Cord

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

4

Anatomy of Spinal Cord: Inside to Outside

-cord
-pia mater
-subarachnoid space
-subdural space
-dura
-epidural space (fat)
-bone

5

Leptomeningeal

-within subarachnoid space

6

extrdural

-epidural

7

intradural

subdural

8

Intramedullary

-within spinal cord parenchymal

9

Conus

-end of spinal cord
-L1/L2

10

Nipple Line

T4
-sensory level

11

Umbilicus Line

T10
-sensory level

12

What is common in spinal cord lesions?

-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)

13

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

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

14

Acute & Subacute myelopathies are?

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

15

Chronic Myelopathy Approach to Patient

-signs & symptoms
-neurotesting
-lumbar if neuro neg
-therapy directed to cause of treatment

16

History/Exam of patient with Myelopathy

-other illness, fever, location of pain, neuro symptoms, pace of symptoms
-neuro exam: motor, sensory, reflexes, gait

17

Progression of Epidural Lesion 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

18

Progression of Epidural Lesion B

-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

19

Progression of Epidural Lesion C

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

20

Myelopathy - Disc Disease

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

21

Spinal Cord Trauma

-Paraparesis/paraplegia
-Quadriparesis/Quadriplegia
-Vertebral body compression
-Hematoma
-Spinal Cord Infarct
-Cord transection

22

Spinal Cord Trauma: Injury Protocol

-Methyprednisolone

23

Causes of Spinal Cord Dysfunction in Patients with Cancer

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

24

Epidural Myelopathy due to metastatic cancer

-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