Cord compression Flashcards
Name of the main spinal motor tract
Corticospinal tracts (anterior and lateral)
Where does the corticospinal tract decussate?
At the medulla- tract is ipsilateral
Signs of upper motor neurone lesion (4)
Increased tone
Muscle wasting not marked
No fasciculation
Hyper-reflexia
Signs of lower motor neurone lesion (4)
Decreased tone
Muscle wasting
Fasciculation
Absent or reduced reflexes
Name of the sensory pathway carrying information relating to pain, temperature and crude touch
Spinothalamic tracts
Where does the spinothalamic tract decussate?
At the spinal level
Name of the sensory pathway carrying information relating to proprioception, pressure and light touch
Dorsal column/medial lemniscus
Where does the dorsal column decussate?
Medulla
Four causes of acute spinal cord compression (4)
Trauma
Tumours (collapse or haemorrhage)
Infection
Haemorrhage
Three causes of chronic spinal cord compression (3)
Spondylosis
Tumours
Rheumatoid arthritis
Initial signs in acute cord transection
Spinal shock- flaccid arreflexic paralysis
Describe the symptoms of Brown-Sequard syndrome (3)
Ipsilateral motor level (UMN weakness)
Ipsilateral dorsal column level (proprioception, pressure, light touch)
Contralateral spinothalamic level (pain, temperature, crude touch)
How is sensory loss classically experienced in central cord syndrome?
“Cape-like” spinothalamic sensory loss, with preservation of the dorsal columns
What usually causes central cord syndrome?
Hyperflexion or extension injury to an already stenotic neck
How does central cord syndrome usually present?
Distal upper limb weakness
How is traumatic spinal cord damage treated? (4)
Immobilise
Investigate (imaging)
Methylprednisolone
Decompress and stabilise
Commonest cause of cord compression
Secondary malignancy
Management of spinal cord compression due to malignancy
Dexamethasone whilst considering further treatment e.g. radio, chemo, surgical decompression
What is syringomyelia?
Expansion of the central cord canal due to CSF blockage, causing slowly progressive sensory and motor symptoms
Symptoms of syringomyelia
Cape-like distribution of pain/temperature sensation loss
LMN signs in upper limbs
Spastic paraparesis of low limbs
What is a malformation commonly underlying syringomyelia?
Chiari malformation- extension of the lower part of the brain into the spinal cord
Signs suggestive of a root compression (radiculopathy)
Dermatomal distribution of sensory disturbance (pain/tingling/numbness)
LMN pattern of weakness for muscles innervated by the root
Below the level of a compressed root, what signs might there be? (2) What do these suggest?
UMN signs (spastic weakness, hyperreflexia, upgoing plantars)
Sensory level
These suggest cord compression starting below the radiculopathy
Lhermitte’s symptom
Neck flexion producing tingling down the spine- suggestive of cervical spondylosis
Worrying symptoms in suspected cord compression (3)
Nocturnal pain
Weight loss
Fever
What is radiculopathy?
Compression of the nerve root as it leaves the spinal cord
