Diseases of the Spinal Cord Flashcards
ASIA Impairment Scale
A. Complete: no sensory or motor function below the level of the lesion B. Sensory incomplete: sensory function is preserved but motor function is lost below the zone of injury
C. Motor incomplete (first grade): motor function is reduced in more than half of key muscles below the level of the lesion
D. Motor incomplete (second grade): motor function is reduced in fewer than half of key muscles below the level of the lesion
E. Normal: reflexes may be abnormal
estimated duration of spinal shock
1-6 weeks or longer
These terms refer to a transient loss of motor sensory function of the spinal cord that recovers within minutes or hours but may persist in mild form for days or more
Transient Cord Injury
Spinal Cord Concussiom
central cord (schneider syndrome) cruciate paralysis
location of fibers
The weakness is very selective, being practically limited to the arms, a feature that is attributable to the segregation within the pyramidal decussation of corticospinal fibers to the arms (being rostral) and to the legs (more caudally situated)
True or False
In Spinal Cord injury, bacteriuria alone warrants treatment with antibiotics
false, it should be accompanied with pyuria
An “early” type of radiation myelopathy (appearing 3 to 6 months after radiotherapy) is characterized mainly by spontaneous uncomfortable sensations in the extremities
Transient Radiation Myelopathy
most common sites of vertebral injuries
first and second cervical,
fourth to sixth cervical, and
eleventh thoracic to second lumbar vertebrae
It is a progressive myelopathy that follows, after a variable latent period, the radiation
of malignant lesions in the vicinity of the spinal cord.
Delayed Progressive Radiation Myelopathy
Imaging findings in Delayed Progressive Radiation Myelopathy
early: cord may be swollen, heterogeneous enhancement with gadolinium infusion
MRI: abnormal signal intensity , decreased in T1, increased in T2
Pathologic findings in Delayed Progressive Radiation Myelopathy (3)
irregular zone of coagulation necrosis involving white and gray matter
secondary degeneration in the ascending and descending tracts
vascular changes- necrosis of arterioles or hyaline thickening of their walls and thrombotic occlusion of their lumens
Prevention of radiation injury
dose and duration
dose of 6000cGy
given over a period of 30-70 days
each daily fraction is not greater than 200cGy and the weekly dose does not exceed 900cGy
factor that governs the damage to the nervous system is the
amount of current or amperage
part of spinal cord injured in cases of spinal atrophic paralysis (focal muscular atrophy after an electric shock)
gray matter/
Mortality rate when lightning strikes the head
30%
enteroviruses have the affinity to:
herpes zoster affinity to:
enteroviruses have the affinity to anterior horns of the SC and motor nuclei of the brainstem
herpes zoster affinity to dorsal root ganglia
Elsberg syndrome
acute lumbosacral radiculitis with urinary retention from HSV type 2 and CMV infections
findings in vacuolar myelopathy in HIV
white matter of the spinal cord is vacuolated, by which is meant a ballooning within myelin sheaths of the long tracts
most severe in thoracic
segments with the posterior and lateral columns are
affected diffusely
characteristic finding in Sarcoid Myelitis
multifocal subpial nodular enhancement of the meninges adjacent to a lesion within the cord or nerve roots – picture that resembles neoplastic meningeal infiltration
Most frequent etiologic agent in Spinal Epidural abscess
Staphylococcus aureus followed by Steptococci, gram neg bacilli, anaerobic organisms
Most affected part of spine in vertebral bacterial osteomyelitis
lumbar region
the SC is a common target for three formms of schistosoma
most particularly S. mansoni
then
S. haematobium, S. japonicum
treatment for Schistosomiasis
praziquantel
CSF findings in Schostosomiasis
slightly elevated protein, WBC 5-500/cc
glucose is normal or minimally reduced
True or False
CSf eosinophilia is a dependable diagnosis for Schistosomiasis
False
Schistosoma parasite can be found in which part of the colon
rectosigmoid mucosa
Infarction of the spinal cord may occur during hypotension and affect the most vulerable region of the spinal cord namely
thoracic
TRUE or FALSE
In cardiac and aortic surgery, which requires clamping of the aorta for more than 30 mins, and aortic arteriography may also be complicated by infarction in the anterior spinal artery, more often the damage to central neuronal elements is greater than that to anterior and lateral funiculi
TRUE
Spinal infarction sometimes follows the procedures e.g. cardiac and aortic surgery by up to ___ weeks
3
In rare cases, infarction of SC is preceded by spinal transient ischemic attacks and has been emphasized in cases related to _____
cocaine use
TRUE or FALSE
Most vascular malformations of the spinal cord do not cause hemorrhage but instead produce a progressive presumably ischemic myelopathy
TRUE
most common location of spinal dural AV fistula
low thoracic cord or the conus
other names for intramedullary AVM (2)
angioma racemosum venosum or dorsal extramedullary AVM
prognosis for intramedullary AVM
severe disability
chair bound
surivival
severe disability of gait present within 6 months
in 50% of patients chair bound in 3 years
average survival 5-6 years
Imaging features of spinal Dural AVF
enlargement of spinal cord
T2 bright signal of the swollen cord over several segments
peripherally located regions of T2 hypointense signals
part of SC mostly affected in Caisson Disease
posterior column
Most frequently observed myelopathy in general practice
Spondylitic Myelopathy
The range acquired of narrowing of the canal that produces symptomatic cervical spondylosis is generally ____
normal canal diameter
7-12mm
Normal Canal Diameter 17-18mm
True or False
The gait abnormality produced by spondylotic myelopathy may also be mistaken for that of NPH. A marked increase of imbalance with removal of visual cues (Romberg sign) is a feature of spondylosis but not of hydrocephalus, and short stepped and magnetic quality of walking that is characteristic of hydrocephalus is not seen in cervical myelopathy.
true
regions mostly affected in ankylosing spondylitis
sacroiliac joints
lumbar spine
Most Common Complications in Ankylosing Spondylitis
Spinal Stenosis and Cauda Equina Syndrome
True or False
Surgical decompression and corticosteroid therapy are beneficial fro patients with arachnoidal diverticula
False
Most HAZARDOUS complication of Ankylosing Spondylitis
Compression of the Cord
The ligaments that attach the odontoid to the atlas and to the skull and the joint tissue are weakened by the destructive inflammatory process
Rheumatoid Arthritis of the Spine
MND is considered a differential because of chronic wasting of one or both hands and forearms without sensory changes or long tract signs
from intermittent compression of the lower cervical cord and gradual deterioration of the motor neurons in the anterior grey matter
Cervical Dural Sac Myelopathy
Hirayama Disease
Enlargement of vertebral bodies , pedicles, laminae in Paget Disease may result in narrowing of the Spinal Canal
High plasma alkaline phosphatase
medical managementL NSAID, calcitonin
Paget Disease of the Spine
Osteitis Deformans
Most common primary extramedullary tumors of intraspinal neoplasms
neurofibromas
meningiomas
intradural>extradural
predilection of neruofibromas
lumbar and thoracic region
Most common primary intramedullary tumors of the spine
ependymomas 60%
astrocytomas 25%
astrocytoma is the MC intramedullary tumor excluding arising from filum terminale
True or False
Spinal ependymomas are considered to be benign, intraspinal spread can occur and local recurrence after resection occurs in 10 percent of cases, even decaeds after surgery.
True
Froin syndrome
xanthochromia and clotting of CSF from greatly elevated protein content
Most common of all spinal tumors
extradural metastases
carcinoma, lymphoma, myeloma
Classification of Syringomyelia
Type I syringomyelia with obstruction of the foramen magnum and dilatation of the central canal
A. with type I chiari mal
B. with other obstructive lesions
Type II Syringomyelia without obstruction of the forman magnum
Type III Syringomyelia with other diseases of the spinal cord
A. Sc tumors
B. traumatic myelopathy
C. Spinal arachnoiditis and pachymeningitis
D. Secondary myelomalacia from cord compression
Type IV Pure hydromyelia
