diseases affecting the spinal cord [myelopathy]

Question 1

anatomy of spinal cord

Answer 1

• Spinal cord extends from top of C1 to bottom of the body of the L1 or L2 vertebra in adults.
• There is an expansion in diameter of the cord in the cervical and lumbar regions due to increased numb of anterior horn motor cells to arms and legs.
• Lower end of spinal cord is known as conus medullaris.
• Spinal cord is continuous with medulla oblongata superiorly and inferiorly with cauda equina and filum terminale.

Question 2

what are the 3 main motor syndromes associated with spinal cord disease

Answer 2

1. paraparesis
2. tetraparesis
3. brown sequard syndrome

Question 3

paraparesis- define

Answer 3

• Paraparesis indicates bilateral upper motor neuron damage involving the axons that innervate the legs from both corticospinal tracts.

Question 4

paraparesis s/s

Answer 4

Clinical signs:

• Increased tone with spasticity
• Pyramidal distribution of weakness
• Increased reflexes with clonus and extensor plantar responses
• Abdominal and cremasteric reflexes or ‘cutaneous reflexes’ may be absent
• Also involvement of the 2 sensory pathways from level below the lesion – this is called a ‘sensory level’.
• Sphincter dysfunction is also typical of spinal cord lesions and later in the course of extrinsic spinal cord lesions.

Question 5

types of tetraparesis

Answer 5

(spastic tetraparesis, tetraplegia, quadriparesis and quadriplegia)

Question 6

define tetraparesis

Answer 6

same clinical features as paraparesis but lesion is higher up

Question 7

brown sequard lesion- define

Answer 7

= unilateral cord lesion causing UMN involvement of one side

Question 8

brown sequard lesion- aetiology

Answer 8

This syndrome may be produced by compression or inflammatory disease of the spinal cord and, occasionally with vascular lesions.

Causes of Brown-Sequard syndrome include:

• trauma
• vertebral disease
• multiple sclerosis
• angioma
• trauma
• myelitis
• post-radiation myelopathy
• Rare in its pure from but partial forms are more common.

Question 9

brown sequard lesion- s/s

Answer 9

ipsilateral upper motor neurone signs below the hemisection

ipsilateral lower motor neurone signs at the level of the hemisection

ipsilateral impairment of joint position and vibration sense below the hemisection

contralateral impairment of pain and temperature at the level of the hemisection

minimal bladder impairment