129 - Spinal Cord Compression Flashcards
What signs might you expect in Brown-Sequard Syndrome at T5 (legs spinal level) - where the L side of the spinal cord is lesioned?
Arms fine
R leg motor, reflexes and autonomic fine
R leg pain and soft touch imparied (as this crosses and travels up contralateral side)
Left leg motor weakness/paralysis, abnormal reflexes (brisk as no dampenign down)
L leg pain and temp fine (as already crossed and so spared)
L leg soft touch impaired (as travels up ipsilateral side)
What observations might you expect after an anterior spinal artery infarction (at T5)?
Affects decending tracts on both sides - paraplegia
Reflexes abnormal and brisk
Autonomic issues - as travels up middle
But soft touch and proprioception sensation is preserved (as it travels up in dorsal column)
What observations would you expect from a cavity forming in the central canal of the spinal cord (C3-8) (Syringomyelia)?
Motor and reflexes probably have no effect if not too expanded
Sensation of pain and temp of the arms at the levels while they are decussating will be affected.
Case:
20 year old, Pain in ribs, clumsy legs -> legs giving way.
Difficulty climbing stairs
develops numbness from the nipples down
Develops constapation
Compression of the spinal cord at T3
Sensory level at T4 (nipples)
Cause? Tumour eg. Neurofibroma
Case:
67 year old
Dragging left leg. Can’t use L arm
Numbness L arm
Develops paraesthesia of R hand
Examination - clonnus, wasting hands, spastic gait, positive babinski
Cervical spondylotic myolopathy
eg. disk prolapse - pushing on spinal cord
Case:
Progressive weakness L arm and leg
Apathetic and disinterested in hobbies
Headaches
Papilloedema - swelling of eyes
Subacute motor cortex tumour
Cortex lesion
Case:
R sided foot drop, difficulty voiding, poor stream
Bilateral sciatica
Pain on straght leg raise
Bilateral loss of ankle reflexes (S1)
Loss of anal tone
Sensory loss over genitalia region
Cauda equina!
saddle anaesthesia
URGENT treatment - surgical correction of ?slipped disk in lower spine
Case:
6 months progressive stiffness in both legs
Catches toe on step
Pain down outer arm
4 weeks of consapation and bladder urgency
Absent biceps reflex (C5)
Brisk other reflexes
Cervical myelopathy
(spinal cord damage in cervical region)
Case:
3 months increasing difficulty climbing stairs
Pain and tender muscles
Rash over face
Preserved reflexes
No eye weakness
Muscle disease! (polymyositis?)
Case:
6 months: progressive weakness in R hand
3 months: choking on food, lost weight
Speech harder to understand
Examination:
UMN - dysarthuric, slow tongue movements, brisk jaw jerk, brisk arm reflexes
LMN - weakness, wasting, fasiculations
Motor Neurone Disease
Has both UMN and LMN signs
Case:
2 months: mid-thoracic back pain
Difficulty walking
Weak legs, trips over
Constipated, urgency to wee
Arms, speech, swallowing normal
Examination: CN ok, upper limbs ok
Tenderness on spine T7
Increased tone bilaterally to legs
Weakness in flexors
Ankle clonus, brisk reflexes to leg, positve babinski
Sensory pin prick level to T8, impaired proprioception
Spastic paraparysis
Due to myelopathy (spinal cord injury) with a sensory level of T8
Case:
25 year old
Severe lower back pain, radiates down R leg
After picking up bricks
Can’t straighten up, cant pick R foot up properly
Examination:
CN and upper limbs normal
Limited R straight leg raise
Weakness to dorsiflexion (L5)
Sensation reduced over anterior aspect of right calf to foot
Reflexes present
Foot drop with radiculopathy
Damage to nerve root
Cause? Slipped disk, fracture, tumour?
Case:
63 yr old
Sudden loss of power in both legs
No pain
Has diabetes and had coronary artery bypass
Examination:
CN normal
Upper limbs normal
Increased tone bilaterally of legs, severe weakness (flexion weaker than extension muscles)
Brisk reflexes, positive babinski
Sensory level to pain at umbilicus
BUT soft touch and proprioception normal
Anterior spinal artery infarction
Stroke in the anterior part of spinal cord
Sudden, effects pain and temp but spares proprioception and soft touch
Case:
23 yr old
Emergency admission, fell from horse
on O2, stable from resp point of view
Cant feel arms or legs properly
Hasn’t moved them since accident
Not passed water
Examination:
No sensation below collar
Limbs are flaccid and areflexic
Spinal shock - straight after acute trauma of spinal cord they act differently to you would expect (ie. hyperreflexive and spastic)
= Flaccid tetraparesis in spinal shock
Define monoparesis
Weakness in 1 limb
Define paraparaesis
Weakness in 2 legs
Define hemiparaesis
weakness to 1 side
Define quadraparaesis
Weakenss to all limbs
Define Hemiplegia
1 side paralysed
Define Paraplegia
Both legs paralysed
What would you call a conditon of the spinal cord?
Myelopathy
What would you call a condition of the nerve root?
Radiculopathy
What would you call a condition of the peripheral nerves?
Neuropathy
What would you call a condition of the muscles?
Myopathy
What are the key features of UMN damage?
Increased tone
Hyper-reflexia
Weakness/paralysis of affected muscles
Positive Babinski
What are common causes of UMN damage?
Stroke, slipped disk, tumour, MS, infection
What are the characteristic features of LMN damage?
Weakness/paralysis to the muscle that that nerve innervates
Hyporeflexia
Wasting/atrophy
Fasiculations
What are the common causes of LMN damage?
Trauma, viral infection, compression
What are features of muscle disease?
Wasting or hypertrophied
Reflexes preserved
Pain
Proximal weakness
? Rash
What are the features of damage to the cortex?
Seizures
Dementia
Agnosias (inability to recognise objects)
Apraxias (can’t coordinate movements)
Visual field defects
Dysphagia (difficulty swollowing)
What are the featurss of damage to the Brainstem/Cerebellum?
CN palsies, dysphagia, dysarthria, vertigo, ataxia, horners syndromes
What is a myotactic reflex? Describe its process.
Reflex involving one joint
Hit tendon (ie. patella)
Muscle spindles detect stretch
1a Afferent nerve travels into spinal cord
Synapses with efferent alpha motor neurone
This constricts homonymous muscle (Quad - leg kicks out)
Afferent also synapses with an inhibatory interneurone, this inhibits the alpha motor neurone of the heteronymous muscle to ensure it stays relaxed, allowing reflex to occur.
What do muscle spindle musculoskeletal receptors do?
Detect changes in muscle length
Stretch them - action potential fired
Sit parallel to muscle fibres
Describe alpha and gamma coactivation of muscle spindles
Ensures that the msucle spindle is always at the right tension to detect changes
Asjusts sensitivity
alpha motor neurone causes muscle contraction
so the spindle is flaccid
Gamma motor neurone contacts the spindle - respiring tension
What are golgi tendon organs?
Respond to tension in isometric contractions
Act at muscle-tendon junctions
Activated by prolonged stretch, so then inhibits the muscles, relaxation - drops heavy object
protective mechanism
What is the biggest descending motor tract?
Corticospinal
What is the route of the corticospinal tract?
Originates in the cortex (various parts)
descends through the internal capsule
Crosses at the pyramids of decussation in the medulla
Decends in a lateral tract in the spinal cord and an anterior/medial tract
What ascending tract carries pain and temperature sensation?
Spinothalamic
On Anterior side of spinal cord
Enters spinal cord and crosses within a few levels of entering and travels up the contralateral side
What tract carried soft touch and proprioception sensation?
Dorsal columns
enters spinal cord, travels up on ipsilateral side (same), then crosses in the brainstem/medulla
What is the 3rd ascending spinal tract that just carried proprioception?
Spinocerebellar tract
