Disease of spinal cord and nerve root Flashcards
What is damage to the upper motor neurone
damage to the brainstem, spinal cord - myelopathy/myelitis
what is damage to the lower motor neurone
damage to the nerve root - radiculopathy/radiculitis
what are motor signs in upper motor neuron lesions
No wasting
↑tone
↑reflexes
Pyramidal pattern of weakness
what is seen in a pyramidal pattern of weakness
weakness in the extensors of the upper limb or flexors of the lower limb
what are the motor signs of lower motor neuron lesions
↓tone
↓reflexes, flexor plantar
weakness
what are the sensory signs of UMN lesions
myelopathy at the sensory level
hemicord lesion = brown squared syndrome
what is seen in brown-sequard syndrome
ipsilateral: ↓ vibration ↓ joint position sense Weakness (because they cross above the lesion)
contralateral:
↓ pain
↓ temperature
(because they cross below th lesion)
what are the sensory signs of LMN lesions
radiculopathy - dermatomal sensory loss
what is an autonomic sign of cord/root pathology
bladder/bowel problems
EXAMPLE: what would the signs be for a C5 cord lesion
wasting of C5 innervated muscles
↑ tone in LL>UL
reflexes ↓biceps, ↑all lower reflexes
power ↓C5 innervated muscles, pyramidal pattern below
sensory level
what are the groups of causes of myelopathy or radiculopathy
intrinsic or extrinsic
can be medical or surgical
what are some surgical causes of myelopathy or radiculopathy
tumour
- extradural, intradural/extramedullary, intramedullary
vascular abnormalities
- haemorrhage
- AVM, dural fistula
degenerative (spine)
trauma
what are the medical causes of myelopathy
Inflammation
vascular - ischaemic vs haemorrhage
infective
metabolic
malignant/infiltrative
congenital/genetic
idiopathic
give examples of inflammatory causes of myelopathy
demyelination (MS)
autoimmune (antibody mediated eg aquporin 4, lupus)
sarcoid
give some examples of infective causes of myelopathy
Viral: herpes simplex/zoster, EBV, CMV, measles, HIV etc
Bacterial: TB, borrelia (Lyme), syphilis, brucella
Other: schistosomiasis
what is a metabolic cause of myelopathy
B12 deficiency
give examples of congenital/genetic causes of myelopathy
friedrichs ataxia
spinocerebellar ataxias
what are ischameic myelopathy
spinal stroke/infarction
what can cause spinal cord ischaemia
Atheromatous disease (aortic aneurysm)
Thromboembolic disease (endocarditis, AF)
Arterial dissection (aortic)
Systemic hypotension
Thrombotic haematological disease
Hyperviscosity syndromes
Vasculitis
Venous occlusion
Endovascular procedures
Decompression sickness
Meningovascular syphilis
how may a spinal cord stroke present
vascular risk factors
onset - sudden or over several hours
pain
- back pain/radicular
- visceral referred pain
weakness
numbness and paraesthesia
urinary symtoms - retention followed by bladder and bowel incontinence as spinal shock settles
what kind of weakness is seen in spinal cord stroke and why
usually paraparesis (lower limbs affected) rather than quadraparesis
due to vulnerability of thoracic cord to flow related ischamia
what artery is usually occluded in spinal cord stroke
anterior spinal artery
very rarely posterior spinal artery - dorsal columns spared
what can occlusion of the central soulful artery cause
partial brown-sequard syndrome
at what level does spinal cord stroke usually occur
mid thoracic
what might you also have for a while in spinal cord stroke
spinal shock
what investigation can be done for spinal cord stroke
MRI
what is the treatment for spinal cord stroke
reduce risk of recurrence
- maintain adequate BP
- reverse hypovolaemia/arrhythmia
- antiplatelet therapy
OT and physio
manage vascular risk factors
what does the returns of function after spinal cord stroke depend on
degree of parenchymal damage
what is the prognosis for spinal cord stroke
unless significant motor recovery in first 24 hrs - chance of major recovery low
pain may be persistent and significantly contribute to disability
only 30-40% have more than minimal recovery
what is the mortality rate for spinal cord stroke
20%
what is demyelinating myelitis
usually part of MS
common cause of medical spinal cord disease
can affect the young
what characterises demyelinating myelitis
pathological lesions leading to inflammation and demyelination - this leads to temporary neuronal dysfunction
affects the white matter of the CNS
one or more lesions anywhere
how does myelitis present in MS
partial or incomplete myelitis
transverse or complete myelitis
can be the initial presentation of MS
subacute onset (slower than ischaemia)
may have a chronic progressive myelopathy - secondary or primary
may be a history of previous neurological or ophthalmological episodes
what investigations can be done for MS
MRI - spinal cord, brain
lumbar puncture - examine CSF
what is the treatment for MS
supportive
methylprednisolone
where is vitamin B12 found in the diet
meat, fish, animal by-productsm, legumes
what is need for absorption of B12
absorption from the gut needs INTRINSIC FACTOR
- binding protein secreted by gastric parietal cells
what is pernicious anaemia
autoimmune condition in which antibodies to IF prevent B12 absorption
what can pernicious anaemia complicate
total gastrectomy, crohns, tape worms
what parts of the nervous system can B12 deficiency affect
most of it
can cause myelopathy peripheral neuropathy brain eye/optic nerve brainstem cerebellum
what symptoms can B12 deficiency myelopathy cause
paraesthesia of hands and feet
areflexia
first UMN sign - extensor plantars
paraplegia (degeneration of corticospinal tract)
sensory ataxia (degeneration of dorsal columns)
painless retention of urine
what investigations can be done for B12 deficiency myelopathy
FBC, blood film, B12
what is the treatment for B12 deficiency myelopathy
intramuscular B12 (the quick the better)
