Causes of spinal cord disease

Question 1

spinal cord transection definition

Answer 1

= result of trauma following anterior dislocation of one vertebra on another. – forces required to do this oft result in associated fractures.

Question 2

aetiology os spinal cord transection

Answer 2

• Trauma:
• anterior dislocation of one vertebra on another
• #

Question 3

complete spinal cord transection define

Answer 3

immediate loss of motor, sensory and autonomic function below level of lesion

Question 4

partial spinal cord transection- define

Answer 4

• loss within a few hrs à due to 2^O oedema involving whole spinal cord at the site of the partial lesion

Question 5

2 clinical signs of severe acute spinal cord transection

Answer 5

• Spinal shock: initial loss of all reflexes below level of lesion
  
  • flaccid limbs: ↓ tone
  • Atonic bladder: fills normally but failure to void à overflow incontinence
  • Atonic bowel – gastric dilation
  • loss of genital reflexes
  • loss of vasomotor control

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• Heightened reflex activity: 1-2 wks post lesion
  
  • spasticity of limbs
  • brisk reflexes
  • extensor planter response
  • Spastic bladder: small capacity urgency, frequency and automatic emptying

hyperactive autonomic function: sweating and vasomotor changes

Question 6

2 important clinical features to note

Answer 6

NB: supply to diaphragm is via phrenic nerve (C3, C4 and C5) therefore any cord lesion above C3 may cause neuromuscular respiratory failure.

NB: bilateral UMN signs in the legs (with or w/out arm involvement) with no cranial nerve signs usually indicate spinal cord pathology. The lesion must be above body of L1, because the spinal cord ends at this level and lesions below this level involve the cauda equina and so cause lower motor neuron signs.

Question 7

ddx in absence of trauma

Answer 7

In absence of trauma, similar symptoms and signs of a very severe cord lesion should make one consider;

• Ischaemic infarction of the cord:
• Occlusion of a maj segmental artery
• Dissecting aortic aneurysm
• Vasculitis
• Anterior spinal artery thrombosis
• Haemorrhage into spinal cord from AVM, epidural or subdural haemorrhage
• Acute or subacute necrotising or demyelinating myelopathy
• Epidural abscess
• Acute vertebral collapse – usually associated with neoplastic disease of vertebrae.

Question 8

ix you’d do

Answer 8

CT/MRI

Question 9

Rx of spinal cord transection

Answer 9

• Complete transection: poor neurological outcome
• Partial transection:
• vital to Rx spinal fracture and instability – prevent 2^O damage
• corticosteroids (high dose): to decrease SC oedema