approach to myelopathy (PBL) Flashcards
what is myelopathy
disease of the spinal cord
where is deccuation for CST, STT, DC
CST - after pyramids
STT - 1-2 segments above level
DC - after nucleus
classic pyramidal muscle loss pattern
upper extensors weaker, lower flexors weaker
where is lesion of loss of motor on one side and isolated loss of sense on other
spinal cord
what do limbs involved tell us
upper and lower - cervical
lower only - thoracic or cervical
what does bladder and bowel dysfunction tell us
bilateral lesion
what does temporal onset of Sx tell us
sudden - vascular
days - inflammatory or acute disc
weeks - abscess or tumor
year - spondylosis
5 cord syndromes
- complete cord
- dorsal cord
- ventral cord
- central cord
- brown-sequard (hemicord)
Motor, sense, and autonomic patter in complete cord
motor- LMN bilateral at level, UMN bilateral belowe
sensory - complete loss of all belowe
autonomic - bladder, bowel and sex dysfunciton
2 other issues with complete cord
- spinal shock for first few days - get LMN below
2. above c3 can cause resp. failure
Motor, sense, and autonomic patter in dorsal cord
motor- UMN bilateral belowe
sensory - bilateral loss of fine touch
autonomic -
Motor, sense, and autonomic patter in ventral cord
motor- UMN bilateral below
sensory - bilateral loss of pain and temp
autonomic -
Motor, sense, and autonomic patter in central cord
motor- normal above and below
sensory - suspended loss of pain and temp - in the area of cord affected
autonomic -
Motor, sense, and autonomic patter in brown-sequard cord
motor- UMN ipsilateral below
sensory - ipsilateral loss of fine touch, contraltetal loss of pain/temp -
3 ways to think about causes of myelopathy
- intramedularry
- intradural, extramedullary
- extradural,
