Diseases of the spinal chord and nerve roots Flashcards
Spinal chord damage name
Myelopathy
Myolitis meaning
Damage of the spinal chord due to inflammation
Damage to spinal chord affects which motor neurone?
Upper motor neurone
What are the signs of umn signs?
-> sustained muscle mass (initially at least)
-> Tensed up muscles (high tone)
-> rigidity
-> brisk, increased relexes
Why do you get increased reflexes in UMN lesion?
Because the inhibition and modification comes form the UMN and can be very profound
UMN lesion - what plantar reflex?
extensor - because this is our innate response (as in baby - away from pain), however, in adults and children we learn to walk and so out UMN change this to a flexor response.
UMN lesion: do we get flexors/extension of arms and legs?
Arms = flexion, legs = extension
Usually whichever muscle is strongest wins
Foot postiision umn lesion
slight inversion
Spinal chord ususally bi/uni lateral?
usually bilateral lesion
What is a brown sequard syndrome?
hemi section of the spinal chord, causing:
-motor and vibraion, fine touch, tactile discrimination and proproception loss ipsilateral to the lesion.
-umn affected so umn symptoms
-pain and temperature loss on the contralateral side.
What is syringimyelia?
when there is a small cyst like lesion in the spinal chord, pressing on the spinothalamic tract crossing over and so leading to loss of temperature and pain sensations .
Where is the inflammation in MS - what is spared?
Inflammation in the dorsal chord, meaning that the spinalthalamic tracts might still be spared.
Spinal stroke - cmmmon symptoms
commonly affects the front of the column and so affects the motor and also the spinothalamic tracts as they cross over and move anteriorly
What is the consequence on the bladder/bowels if the spinal chord has been damaged?
If you lose the spinothalamic tract to the bladder/bowl then you will get a loss of sensation, which can lead to bladder becoming overfilled, infections not being picked up etc.
Intrinsic vs extrinsic spinal chrd injuries?
intrinsic = disease of the spinal chord
extrinsic - coming at it outwith the spinal chord eg meningeal tumour etc
Key causes of myelopathy
Vascular
Vit B21 deficiency
Infection (viral, bact - TB/lymes/syphillis, brucella)
Genetic
Inflammation (MS, autoimmune, sarcoid)
malignant
ideopathic
SPinal chord symptoms - investiations
MRI, blood tests - full blood and CSF
What is the spinal chord supplied by?
anterior and posterior spinal arteries
What can cause a spinal stroke?
The same things that can cause a normal stroke, but especially aortic dissection
What are the signs of a spinal chord stroke?
“sudden” loss of motor function/sensation/weakness below a certain level. (may also take several hours for onset)
Back pain/around level
urinary issues
Anterior or posterior spinal artery usually affected?
usually anterior psinal artery.
Otfen mid thoracic
What is spinal shock?
It si when it presents like a lower motor neuron lesion initially eg floppy limbs, loss of reflexes
What is the treatment of a spinal chord stroke?
Nothing acutely… wait, see then manage…
manage recurrance risk and vascular factors:
-maintain bp
-antiplatelet therapy (aspirin/clopidogrel)
-get out of any arryhtmias if they are in any
-OT and physio
How is B12 absorbed and what canb lead to deficiency?
With intrinsic factor then in the illium
If no intrinsic facor: eg gsatrectomy, chron’s
pernicious anaemia (antibodies to intrinsic facor)
vegan (diet)
