CC2: spinal cord disorders Flashcards
What is myelopathy?
-Disease or damage to spinal cord causing any neurologic deficit
-Major cause of disability
What are some symtoms of myelopathy?
-motor deficits and primary sensory deficits and distrubances that localize a spinal cord level
1.weakness, ataxia (usually bilateral)
-signs of autonomic dysfunction
1. bladder/bowel disturbance
2. orthostatic hypotension, sexual dysfunction
Where does decussation of spinothalamic fibers occur?
spinal cord (contralateral pinprick pain/temperature deficit
Where does decussation of dorsal colu,ms/medial lemniscus fibers occur?
medulla (Ipsilateral propioception/vibration deficit)
where is the lower motor neuron located?
anterior horn cells
where is the upper motor neuron located?
lateral corticospinal tract
Findings of lower motor neuron?
Hyporeflexia, decreased tone, fasciculations (fine twitching of muscles), atrophy
Findings of upper motor neuron?
Hyperreflexia, spasticity, Babinski reflex(corticospinal tract lesion sign
which reflexes are affected with spinal cord lesions?
-abdominal cutaneous reflexes
-cremasteric reflex
-anal wink
-bulbocavernous reflex
What is the transverse cord lesion?
-all sensory /motor pathways partially or completely interrupted [trauma tumors, myelitis)
What is hemicord lesions: brown-sequard syndrome?
Damage to lat. corticospinal tract: ipsilateral upper motor neuron deficits below level of lesion
Damage to anterior horn cells: ipsilateral lower motor neuron deficits at level of lesion
Damage to posterior columns: ipsilateral loss of position and vibration sense
Damage to anterolateral (spinothalamic) system- contral. loss of pain and temperature sensation
What is central cord syndome?
-If small lesions, spinothalamic fibers crossing affected:
bilateral regions of suspended sensory loss in pain and temperature- may be asymmetric!
-If large lesions, anterior horn cells, corticospinal tract, posterior columns also affected:
1. lower motor neuron deficits at level of lesion
2. upper motor neuron deficit below level of lesion
3. Loss of propioception and vibration below the level
What is posterior cord syndrome?
Lesion of posterior column: loss of propioception and vibration below level
With large lesion, may affect lat. corticospinal tract: upper motor neuron deficits
(syphillis or vit 12 defficiency
What is anterior cord syndrome?
Damage to anterolateral (spinothalamic) system: decreased pain and temperature below lesion
Damage to anterior horn cells: lower motor neuron deficits at level of lesion
If large, damage to corticospinal tract: upper motor neuron deficits below level of lesion
What is cervical spondylotic myelopathy?
Spinal stenosis and compression of spinal cord resulting from age-related degenerative changes of the spine
surgery to decompress the spinal cord
What is the initial phase of trauma of spinal cord?
due to injury, spinal shock flaccid paralysis, los of DTRs
explain anterior spinal artery infarct
most commonly caused by insufficiencies within aorta
aneurysms, dissections, surgery, atherosclerosis…
-bilateral loss of motor fx, pain/temperature sensation/-relative sparing of proprioception and vibratory senses below the level of the lesion
- acute stage with spinal shock
Treatment:
-hypothermia, CSFdrainage, revascularization of Artery of Adamkiewicz under investigation when affected
-ASA
Prevention: identification of Artery of Adamkiewicz prior to thoracoabdominal aortic repairs
explain vitamin b12 deficiency
Myelopathy causing ataxia from affected dorsal columns and weakness from affected lateral corticospinal tract- subacute combined degeneration
-often not a result of poor diet, a result of poor absorption often occurring with age
-Treatment: vitamin B12 replacement
exaplain neurosyphilis tabes dorsalis
Chronic slowly progressive myelopathy causing ataxia from affected dorsal columns accompanied by pain from affected dorsal nerve roots
Treatment: Penicillin G
explain inflammatory myelitis
-Can be idiopathic or secondary to multiple sclerosis, neuromyelitis optica, connective tissue diseases, or sarcoidosis
-Acute or subacute myelopathy
Tx: steroids, immunosuppressant drugs
What is metastatic myelopathy?
metastatic spread to epidural space most common
metastatic spread to vertebral bodies
80% of patients treated after they loose ambulation will remain nonambulatory, 80% of patients treated before loosing ambulation will remain ambulatory for the rest of their lives.
Tx: Radiation and/or sugery
What is spina bifida myelomeningocele?
The most severe type of spina bifida- portion of the neural tube fails to develop or close properly in babies, causing defects in the spinal cord and in the bones of the spine.
Limb deformities , weakness, sensory disturbances , bowel and bladder problems, hydrocephalus
Treatment- surgery
3 important nerve roots in the arm?
C5, C6, C7 (most common in radiculopathies)
3 important nerve roots in the leg
L4, L5 (most common), S1 (most common)