Disease of Spinal Cord Flashcards
what is a myelopathy ?
upper motor neuron disorder
what is radicuopathy?
lower motor neurone disorder
where abouts is the corticospinal tract in the spinal cord?
lateral column
what is myelitis ?
inflammation of the upper motor neurones
what is radiculopathy ?
disease of the spinal roots
what is Myeloradiculopathy ?
when the upper motor neurones and the spinal roots are diseases ?
what are the two main categories of myelopathy and radiculopathy?
- medical (intrinsic)
2. surgical (extrinsic)
give some examples of medical causes of myelopathy and radiculopathy
- Inflammation
- Infarction
- Infiltration
- Infection
- Degenerative
give some examples of surgical causes of myelopathy and radiculopathy
- tumour
- vascular abnormalities
- degenerative
- trauma
state some causes of vascular abnormalities which can cause spinal cord and spinal root disorders?
haemorrhage
dural fistula
AVM (arteriovenous malformation)
what are some upper motor neurone disease signs ?
- no wasting
- increased tone
- increased reflexes
- Pyramidal pattern of weakness
what is Pyramidal pattern of weakness?
A pattern of weakness in the extensors (upper limbs) or flexors (lower limbs)
what are some lower motor neurone disease signs?
- decreased tone
- decreased reflexes
- muscle weakness
what is the pattern of the sensory loss due to radicuopathy?
dermatomal pattern
what is brown-Sequard Syndrome?
ipsilateral upper motor neuron paralysis and loss of proprioception, as well as contralateral loss of pain and temperature sensation
state some causes of myelopathy ?
- demyelination
- ischaemia
- transverse myelitis
- neurodegenerative
- B12 deficiency
- infective
- inflammatory
are spinal tracts laminated ?
yes
what does it mean that spinal tracts are laminated?
that the spinal tracts are in different layers of the different spinal root groups
- cervical
- thoracic
- lumbar
- sacral
what fibres travel up the spinothalamic tract ?
nociception
temperature
what fibres travel up the dorsal columns ?
proprioception and vibrations
What would occur to the - C5 innervated muscles - tone - reflexes - power - sensation if there was a C5 cord lesion?
C5 innervated muscles = wasted
tone = increased in lower limbs
reflexes = decreased in biceps, increased in lower limbs
power = decreased in C5 muscles, pyramidal pattern below
sensation = below C5
is the anterior or posterior part of the spinal cord more affected by strokes?
anterior
how many arteries supply the anterior 2/3rds of the spinal cord?
one artery
- the anterior spinal artery
how many arteries supply the posterior 1/3rd of the spinal cord?
2 arteries
- posterior spinal arteries
why is the anterior of the spinal cord more prone to strokes?
because only one artery supplies that area so there is less blood supply compared to the posterior so ischaemia is more likely
what two areas of the spinal cord have high blood supply?
the top and bottom of the spinal cord
what artery supplies the bottom of the spinal cord ?
artery of Adamkiewicz
what artery supplies the middle section of the spinal cord?
branches of the aorta
is a stroke likely at the top of the spinal cord?
no
-because there is rich blood supply at the top of the spinal cord
where is the most likely area of the spinal cord to have a stroke?
middle part anteriorly
state some causes of spinal cord ischaemia
- atheromatous disease
- thromboembolic disease
- arterial dissection
- hypotension
- composition of blood
- vasculitis
- venous occlusion
- depression sickness
state some risk factors of spinal cord strokes?
- diet
- smoking
- lack of exercise
- alcohol
- diabetes
does the patient experience pain with a spinal cord stroke ?
yes
where does a spinal cord stroke patient experience pain?
back (radiating) pain
visceral referred pain
what is the clinical significance of the referred pain with spinal cord stroke patients ?
the referred pain can be misleading for the doctor as the neurological signs don’t come till later
what symptoms would a spinal cord stroke patient experience ?
back pain weakness - paraparesis numbness paraesthesia urinary symptoms
what is paraparesis ?
partial paralysis in lower limbs
what are three management options ?
- Supportive
- Reduce risk of recurrence
- Physiotherapy for functional recovery
- Manage risk factors
what does the time of recovery depend on ?
The degree of parenchymal damage
- more damage = longer recovery time
what is the mortality rate for spinal cord strokes?
20%
what is the most common demyelination myelitis disease?
multiple sclerosis
what age is MS commonly diagnosed at?
young people
>20 yrs
what matter does multiple sclerosis affect?
white matter in the CNS
what causes temporary neuronal dysfunction during multiple sclerosis ?
inflammation and demyelination which means conduction isn’t as good
what symptoms does MS have?
weakness in muscles over a period of a few days
what are the two types of MRI scans?
T1
T2
what is the difference between MRI T1 and T2 scans ?
White matter is brighter than grey matter in T1-weighted images
White matter is darker than grey matter in T2-weighted images.
what two investigation should be done for MS ?
MRI scan
Lumbar scan
what drugs can be given to MS to stop the relapse being so bad?
methylprednisolone
- steroids
what foods do you get B12 from?
meat
fish
legumes
what does B12 require to be absorbed?
intrinsic factor
what does pernicious anaemia result in ?
B12 deficiency
what areas of the brain does a B12 deficiency affect?
peripheral neuropathy cerebrum eyes brain stem cerebellum
if there was degeneration of the dorsal column what would the effects be?
sensory ataxia
- loss of sensory input of muscle coordination
if there was degeneration of the corticospinal tracts what would the effects be?
impairment in motor or sensory function of the lower extremities.
what are the symptoms of B12 deficiency ?
paresthesia in hands and feet
areflexia - absent reflexes
painless retention of urine
what is a good way to test for sensory ataxia during neurology examination ?
get patient to stand and close their eyes
- they may sway and lose balance due to proprioception not working
when would treatment be too late for B12 deficiency ?
if the disease affected the spinal cord and not just the peripheral nerves
what is a very rare type of demyelination ?
transverse myelitis
state some causes of transverse myelitis ?
idiopathic viral infections autoimmune malignancies post vaccinations
how would demyelination be described during MS?
patchy
why is a lumbar puncture used for MS?
antibodies showing immune response to inflammation
why is lumbar puncture used for sub arachnoid haemorrhage ?
blood for subarachnoid bleed would mean there would be blood in the CSF
a lumbar puncture is done 12 hours after the onset of symptoms to give the blood time to breakdown to bilirubin
