Diseases of Spinal Cord and Nerve Roots (Medical) Flashcards
Define myelopathy.
Aetiology: compression of spinal cord.
Sign: sensory level.
Pathophysiology: lesion at T2 - sensation from beyond this level with not ascend to the brain, resulting in abnormal sensation (T2 = sensory level).
(Brown-Séquard syndrome is the exception.)
What is the aetiology of radiculopathy?
Aetiology: pinching of nerve root at it exits spinal cord.
List the causes of a compressive spinal cord lesion (myelopathy).
Congenital/Genetic;
- Friedrich’s ataxia
- Spinocerebellar ataxias
- Hereditary paraparesis
Acquired... Inflammation; - *Demyelination (MS)* - Autoimmune (lupus) - Sarcoid
Infective;
- Viral: herpes simplex/zoster, EBV, CMV, measles, HIV
- Bacterial: TB, borrelia (Lyme), syphilis, brucella
- Other: schistosomiasis
Metabolic;
- B12 deficiency
Vascular (ischaemic vs. haemorrhage)
Malignant.
Idiopathic.
Understand the clinical features of cauda equina syndrome.
- Leg weakness is flaccid and areflexic (unlike higher lesions, which are spastic and hyperreflexic)
- Pain and radicular pain down legs
- Assymetrical, atrophic, areflexic paralysis of legs
- Sensory loss in a root distribution
- Decreased sphincter tone (PR exam)
Describe the treatment of spinal cord stroke.
Reduce risk of recurrence;
- Maintain adequate BP
- Reverse hypovolaemia/arrhythmia
- Antiplatelet therapy
OT and physiotherapy.
Manage vascular risk factors.
Describe the treatment of spinal cord stroke.
Reduce risk of recurrence;
- Maintain adequate BP
- Reverse hypovolaemia/arrhythmia
- Antiplatelet therapy
OT and physiotherapy.
Manage vascular risk factors.
Describe the treatment of spinal cord stroke.
Reduce risk of recurrence;
- Maintain adequate BP
- Reverse hypovolaemia/arrhythmia
- Antiplatelet therapy
OT and physiotherapy.
Manage vascular risk factors.
Describe the prognosis of spinal cord stroke.
- Unless significant motor recovery in first 24 hours chance of major recovery is low
- Pain may be persistent and significantly contribute to disability
- 20% mortality, only 35-40% have more than minimal recovery
Describe the prognosis of spinal cord stroke.
- Unless significant motor recovery in first 24 hours chance of major recovery is low
- Pain may be persistent and significantly contribute to disability
- 20% mortality, only 35-40% have more than minimal recovery
Describe demyelinating myelitis.
- Usually part of multiple sclerosis
- Common cause of medical spinal cord disease
- Can affect the young
- Characterised by pathological lesions of inflammation and demyelination leading to temporary neuronal dysfunction
- Affects the white matter of the CNS
- One or more lesions anywhere
Describe the presentation of demyelinating myelitis in MS.
- Partial or incomplete transverse myelitis
- May have a chronic progressive myelopathy
Presentation;
- May be the initial presentation of MS
- Subacute onset (slower than ischaemia)
- Spontaneous recovery
- (History of previous neurological or ophthalmological episodes
Describe the investigation of demyelinating myelitis in MS.
- MRI cord long lesions: consider non-MS cause
- CSF: few white cells (<50) in MS
Describe the treatment of demyelinating myelitis in MS.
- Supportive
- Methylprednisolone (corticosteroid to suppress inflammation)
Describe the causes of B12 deficiency.
- Diet (vegans)
- Pernicious anaemia: autoimmune condition in which antibodies to IF prevent B12 absorption
- Total gastrectomy
- Crohn’s disease
- Tape worms
Describe the presentation, investigations and treatment of B12 deficient myelopathy.
Presentation;
- Paraesthesia in hands and feet, areflexia
- Extensor plantar (UMN)
- Painless retention of urine
Degeneration of;
- Corticospinal tracts = paraplegia
- Dorsal columns = sensory ataxia
Investigations;
- FBC/blood film, B12
Treatment;
- Intramuscular B12
