14 Jan 24 Flashcards
Spinal epidural abscess causes ?
💩Staph aureus
💩Distant infection (cellulitis ,joint/bone)
💩Spinal procedure(epidural catheter)
Direct inoculation
💩Injection drug use
💩 immunocompromised state DM , alcoholic
💩trauma and epidural hematoma (that gets infected )
Spinal Epidural abscess CF
➡️Fever (50%)
➡️Focal/severe back pain
➡️Neurologic findings (motor/sensory change, bowel bladder dysfunction,paralysis)
SEA dx
🖍⤴️ ESR
🖍Blood and aspirate cultures
🖍MRI OF SPINE with contrast (to see presence and extent of infection that cannot be seen on CT or Xray)
Ttt of SEA
🛞Broad spectrum antibiotics (vancomycin plus ceftriaxone)
🛞Aspiration/ surgical decompression
SEA progression ……
Progressive symptoms due to compression of spinal cord
Focal back pain
➡️ nerve root pain (shooting , electric-shock sensation)
➡️ motor weakness , sensory changes, bowel / bladder dysregulation
➡️ paralysis
SEA and trauma
Trauma can lead to dev of epidural hematoma that may expand and become infected. Leading to abscess.
Cervical spine injury management
High risk injury
High mechanism
Trauma causing concomitant closed head injury
Do CT with contrast
Low risk injury
Do NEXUS low risk criteria for cervical spine imaging
NEXUS low risk criteria for cervical spine imaging
Any of the following NSAID
🤡Neurologic deficit. N
🤡spinal tenderness S
🤡Altered mental status A
🤡intoxication I
🤡distracting injury D
If none present NO CT scan indicated
Transverse myelitis mechanism
Immune mediated infiltration of inflammatory cells in a segment of spinal cord causing oligodendrocyte cell death and demyelination.
Trigger: recent infection
Bimodal peak
Transverse myelitis CF
> or equals 1 contiguous spinal cord segment inflammation (mostly thoracic cord) causing rapid progressive myelopathy
➡️ motor weakness progresses from flaccid to spastic paraparesis (UMNS)
➡️autonomic dysfunction
Bowel/bladder incontinence or retention sexual dysfunction
➡️ sensory dysfunction
Pain , paresthesia , numbness with distinct sensory level
Dx of transverse myelitis
MRI
Enhaced affected cord segments
Ttt of TM
High dose IV steroids
Spinal cord injury managament
ABC
Catheterisation (disruption of autonomic fibers)
Tethered cord (spinal dysraphism) CF
▶️Back/leg pain worse with activity
▶️Neurologic findings eg weakness , hyporeflexia
▶️New onset scoliosis
▶️Lumbosacral cutaneous abnormailty
(Lipoma)
Tethered cord dx
MRI
Tethered cord mechanism
Stretch induced dysfunction of spinal cord
In closed spinal dysraphism the posterior arches fail to fuse while overlying skin remains intact
The spinal cord abnormally attaches to surrounding tissues (lipoma) extending from spinal canal to subcut tissues.
As the child grows inferior end of spinal cord remains fixed and stretches rather than rising in spinal canal.
Stretching due to repetitive movements exacerbates cord dysfunction leading to progressive back buttock leg pain.
Cervical myelopathy (compression)
Cause :
Degenerative changes in vertebral bodies discs joints due to age
Cervical myelopathy CF:
Radiculomyelopathy with
Compression at spinal cord;
UMN signs below lesion (hyperreflexia , spasticity)
Compression at spinal nerve roots ;
LMN findings (atrophy,hyporeflexia) at the same level.
Urinary symptoms
Sensory deficits
Lhermitte sign
Radiculopathy
Neck arm pain with 4th 5th digit sensory deficit
C8 radiculopathy (nerve root compression)
Neck movements worsen the impingement causing radiation down the arm.
Mechanism of radiculopathy
Compression of nerve root ;
Disc herniation
Osteophytes (spondylosis is degeneration of disc and bones in neck)
Radiculopathy dx and ttt
Clinical
Ttt: Gradual resolution
NSAIDS and avoidance of provocative maneuvers.
Moderate physical activity
Oral steroids for severe pain
Indications for MRI:
MRI only when malignancy or abscess is suspected , progressive symptoms , B/L symptoms.
Xray has limited use
Patient with right arm pain , loss of biceps reflex on rt side and loss of elbow flexion. Pain improved with shoulder abduction.
C6 radiculopathy
Reflexes : biceps brachioradialis
Sensory : thumb , index finger
Weaknes :
Elbow flexion(biceps)
Forearm supination pronation (brachioradialis)
Wrist extension
Radiculopathy pain pattern
Shoulder abduction reduces tension on impinged nerve and improves pain when hand is placed on top of head
Shoulder abduction relief test
Lateral flexion and rotation of neck (cradling phone between head and shoulder) narrows neural foramina worsening compression on nerve root.
C6 radiculopathy vs median nerve injury
Median nerve would not cause neck pain
