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Neurology Week 5 2018/19 > 4: Spinal cord compression > Flashcards

4: Spinal cord compression Flashcards

1
Q

Which

a) ascending pathways
b) descending pathways

are found in the spinal cord?

A

Important ones (for me anyway) are:

a) DC/ML pathway (fine touch, proprioception, vibration), Spinothalamic tract (firm touch, temperature, pain)

b) Corticospinal tracts (voluntary movement)

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2
Q

Which two tracts does the corticospinal tract split into?

A

Anterior corticospinal tract (15% of fibres, cross at spinal cord level of muscle)

Lateral corticospinal tract (85% of fibres, have already crossed over at medulla)

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3
Q

Which structures are connected by the upper motor neurons of the corticospinal tract?

A

Motor cortex TO Anterior horn of spinal cord

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4
Q

Which structures are connected by the lower motor neurons of the corticospinal tract?

A

Anterior horn of spinal cord TO Skeletal muscle

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5
Q

Where do 85% of corticospinal tract fibres decussate?

A

Pyramids of the medulla

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6
Q

Compare muscle tone in UMN versus LMN problems.

A

UMN - hypertonia

LMN - hypotonia

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7
Q

Does atrophy tend to occur in UMN or LMN problems?

A

LMN

muscle can’t contract, so atrophies due to underuse

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8
Q

In which type of motor neuron pathology are fasciculations seen?

A

LMN

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9
Q

Describe reflexes in

a) UMN
b) LMN problems.

A

a) Brisk

b) Slow / absent

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10
Q

In which type of motor neuron problem do you see the Babinski reflex?

What does this look like?

A

UMN disease

When plantar surface of the foot is stroked, toes extend and fan out (abnormal, they should flex)

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11
Q

Describe upper motor neuron disease in terms of

a) reflexes
b) atrophy
c) fasciculations
d) muscle tone?

A

In UMN disease:

a) brisk reflexes
b) little / no atrophy
c) no fasciculations
d) increased muscle tone

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12
Q

Describe lower motor neuron disease in terms of

a) reflexes
b) atrophy
c) fasciculations
d) muscle tone?

A

In LMN disease:

a) Slow / absent reflexes
b) Marked atrophy
c) Fasciculations present
d) Decreased muscle tone

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13
Q

Which sensations are carried by the spinothalamic tract?

A

Firm touch

Temperature

Pain

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14
Q

Where does the spinothalamic tract decussate?

A

Spinal cord

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15
Q

Where does the DC/ML pathway decussate?

A

Medulla

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16
Q

What can happen to the spinal cord to cause disease?

A

Compression

Transection

17
Q

What are some acute causes of spinal cord compression?

A

Trauma

Disc prolapse

Tumour

Infection

Haemorrhage into cord / subarachnoid space

18
Q

What are some chronic causes of spinal cord compression?

A

Spondylosis - degenerative spinal diseases

Tumour

Arthritis (especially RA)

19
Q

Why is it important to know where the motor and sensory pathways cross over in terms of spinal cord injuries?

A

If you know where the tract is in the spinal cord

i.e DC/ML pathway and corticospinal tracts will be ipsilateral, spinothalamic tract will already have crossed to be contralateral

You can predict what will be affected by spinal cord injuries

20
Q

Which pathways are affected by a cord transection?

A

All of them

Sensory and motor symptoms

21
Q

Sensory AND motor innervations are totally disrupted bilaterally, below the lesion by which type of spinal cord injury?

A

Complete cord transection

22
Q

What occurs acutely below the level of a spinal cord injury?

A

Spinal shock

23
Q

Describe spinal shock.

A

Loss of reflexes below the level of an acute spinal cord injury

can occur in injuries like cord transection

24
Q

Spinal shock is a loss of ___ below the level of a spinal cord injury.

Is it permanent?

A

reflexes

usually not

25
Q

What type of spinal injury causes Brown-Sequard syndrome?

A

Spinal cord hemisection

Damage to one side of the spinal cord

26
Q

Think about where the crossing over of the DC/ML, spinothalamic and corticospinal tracts occur.

If a patient suffers a cord hemisection, what symptoms will they have and what side will each symptom be felt on relative to the lesion?

A

Brown-Sequard syndrome:

IPSILATERAL loss of fine touch, proprioception and vibration (DC/ML runs ipsilateral to skin it supplies and decussates at medulla)

CONTRALATERAL loss of firm touch, temperature and pain (spinothalamic tract decussates at spinal level and runs contralaterally to skin it supplies, upwards)

IPSILATERAL loss of motor function (corticospinal tracts decussate at medulla and run down the spinal cord, ipsilateral to the muscles they control)

27
Q

What type of injury causes central cord syndrome?

A

Hyperflexion

Hyperextension

neck injuries

28
Q

Which pathway is primarily affected by central cord syndrome?

A

Spinothalamic tract

Firm touch, temperature, pain

29
Q

What sort of distribution does sensory disturbance often have in patients with central cord syndrome?

Which tract is involved, and which senses are lost?

A

Cape distribution

Spinothalamic tract (firm touch, temperature, pain)

30
Q

What is the difference between the clinical presentation of acute and chronic cord compression?

A

Chronic is the same but also has UMN signs (increased tone, hyperreflexia, upgoing plantars, clonus)

31
Q

High-___ trauma can cause spinal cord compression.

A

high-energy

32
Q

What disease causes insidious cord compression?

A

CNS cancer - e.g meningiomas, Schwannomas, astrocytomas, ependymomas

33
Q

How may CNS tumours cause cord compression acutely?

A

Haemorrhage

?Collapse

34
Q

Which spinal disease, causing neurogenic claudication, can also cause spinal cord compression?

A

Spinal stenosis

35
Q

Pus-forming bacteria can form ___ which compress the spinal cord.

A

abscesses

36
Q

How is suspected spinal cord compression investigated?

A

Imaging

X-ray, CT or MRI scan

37
Q

How is spinal cord compression managed surgically?

A

Decompression (draining of fluid, removal of tumour, clearing up basically)

+/- Traction (use of a device to straighten the bones involved)

+/- Fixation (use of screws, rods etc. to keep broken bones held together, internally or externally)

+/- Antibiotics, chemo/radiotherapy

Neurology Week 5 2018/19 (11 decks)

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