15 Jan 24 Flashcards
(52 cards)
Closed spinal dysraphism CF
🎯A/S
🎯Cutaneous , lumbosacral anomalies (hair tuft or mass)
🎯tethered cord ;
Back Pain Neurologic: LMN signs (weakness, hyporeflexia ) below T2/L1 Urologic : incontinence /retention, recurrent UTI Orthopedic: Back pain, scoliosis, foot deformities
Foot deformities of tethered cord ?
Peroneus muscle weakness (pes cavus- high arch)
Tight foot ligaments (hammer toe)
Hammer toe :
Dorsal flexion at DIP joint
Dorsal flexion at MTP
Platar flexion at PIP
Bladder dysfunction types
UMN type ;
Cerebral cortex - urge incontinence
Pons (sp cd injury) : neurogenic bladder
LMN type ;
Sacral spinal cord
( cauda equina /tethered cord)
Overflow incontinence
Ttt of spinal dysraphism
MRI
Surgical detethering of cord if symptomatic
Spastic diplegia vs tethered cord
Common features:
Urinary incontinence
Muscle atrophy
Weakness
Spastic diplegia has UMN features :
Tethered has LMN features
Transverse myelitus CF
B/L motor weakness (early flaccid later spastic). LE = UE
BL sensory dysfunction
Distinct sensory level
Autonomic dysfunction (bowel/bladder)
DX of TM
MRI. :
No compressive features
T2 hyperintensity
LP:
Pleocytosis
Inc IgG
Syringomyelia causes
Chiari type 1
Infection
Neoplasm
Trauma
Syringomyelia CF
Loss of pain / temp in a cape distribution
Due to crossing of STT in anterior white commissure.
Continued syrinx expansion encroaches the central aspect of Lateral corticospinal tract (upper extremity fibers caught first)
Hence UL> LL
Affects motor fibers in ventral horns (flaccid paralysis).
Dissociated sensory loss of syringomyelia
Loss of pain/temp sensation but not vibratory/proprioceptive (dorsal column spared
Neurogenic shock mechanism
Acute spinal cord injury ➡️ massive sympathetic stimulation ➡️ hypertension tachycardia (inc NE)
➡️ sympathetic tone plummets (descending tracts that carry sympathetic neurons to lateral horn are cut )➡️ unopposed parasympathtic stimulation ➡️hypotension hypothermia bradycardia
Lasts 1-5w
Hypothermia is due to lack of peripheral vasoconstriction
Cauda equina syndrome cause
Compression of > or equals 2 spinal nerve roots in the lumbar cistern
Cauda equina CF
CE carries nerve roots L2- sacrum
L2-L5, S1-S5 , coccygeal nerve
Radicular pain plus > 1 of the following:
MOTOR deficits - LMN signs UL or BL
Sensory loss - saddle anesthesia
(Buttock, perineum , perianal area)
Rectal sphincter , bladder :
Hesitency , dribbling , sexual dysfunction due to S3-S5 compression.
CE management
MRI
Surgical decompression in 24-48 hrs.
Conus medullaris CF
UMN deficits (L1-L2)
Symmetric
Symmetric perianal numbness
Vs CE
LMN (L2- sacrum)
Asymmetric
Asymmetric saddle numbness
RA cervical myelopathy S/S
🛞(early) Neck pain radiating to occiptal region
🛞slowly prog spastric quadriparesis
🛞Painless sensory deficits in hands and feet
🛞Resp dysfunction (vertebral artery compression)
Signs
🛞Protruding anterior arch of atlas
🛞Scoliosis with loss of cervical lordosis
🛞UMN (spastic paresis, hyperreflexia, babinski)
🛞Hoffman sign
RA cervical myelopathy cause
Neck extension during intubation results in atlantoaxial subluxation causing cord compression and cervical myelopathy.
Dx MRI
Ttt: Cervical collar
Neurosurgical intervention
Spinal dysraphism
Failure of posterior vertebral arch to close
Spinal cord anomalies lipoma ,cyst
Tethered cord
Brown sequard findings
IL hemiparesis (LST tract ) at the level if injury and below
IL proprio vib light touch : at and below level
CL pain and temp; LST tract
1-2 levels below injury and below
If injury at cervical levels ;
Horners syndrome
Central cord syndrome cause ;
Hyperextension (whiplash) injury in elderly with preexisting cervical spine degenerative changes (cervical spondylosis).
This compresses the spinal cord between hypertrophied ligamentum flavum posteriorly and bulging disc /osteophyte complex anteriorly causing damage to central spinal cord (grey matter)
Deficits same as syringomyelia:
Loss of pain and temp in upper extremity
Disproportionate upper extremity weakness.
Dx of central cord syndrome
Cervical myelogram (cord compression)
Ttt of central cord syndorme
Steroids
Surgery
L5 radiculopathy
Sensory loss ;
Lateral shin.
Dorsum foot
Weakness
Foot dorsiflexion
Toe extension
Foot eversion (peroneus)
S1 radiculopathy
Reflex. : Achilles
Sensory: Posterior calf
Sole and lateral foot
Weakness.
Hip extension
Knee flexion