Diseases Of The Spinal Cord Flashcards
What is radiculopathy?
Disease of lower motor neurone
(Out-with the spinal cord)
Damage of the motor root resulting in dermatomal damage
What is myelopathy?
Damage to the spinal cord usually due to severe compression
what are signs of upper motor neurone lesion?
no wasting
increased tone (rigidity or spasticity)
hyperreflexia , extensor plantar
pyramidal pattern of weakness
what are signs of lower motor neurone lesion?
wasting
decreased tone
decreased reflexes, flexor plantar
weakness
brown-sequard syndrome results from what type of lesion?
hemicord lesion (damage to one half of the spinal cord)
what is the presentation of brown-sequard syndrome?
causes weakness/paralysis (hemiparaplegia) on one side of the body and loss of sensation on the other side
what affects does Brown squared syndrome cause on the ipsilateral side?
decrease vibration, joint position sense and weakness
what affects doesn’t brown seuquard syndrome causes eon the contralateral side?
contralateral loss of pain and temperature
how can you differentiate between a spinal cord lesion and motor neurone diseasE?
spinal cord lesion will also cause sensory symptoms whereas motor neurone is only motor effects
what are congenital causes of myelopathy?
fredrick’s ataxia
spinocerebellar ataxia
hereditary paraparesis
what are the 3 most common causes of myelopathy?
demyelination ie. in MS ischaemic myelopathy (spinal cord infarction) Vitamin B12 deficiency
what is the main blood supply to the spinal cord?
anterior and posterior spinal arteries
anterior S.A branch of the vertebral artery
posterior S.A branch of the inferior cerebellar artery
what artery is the most common culprit for ischameic myelopathy and at what point int he spinal cord this most common?
the anterior spinal artery
most commonly in the mid thoracic
what is the clinical presentation of ischaemic myelopathy/spinal cord infarction?
onset may be sudden or over several hours
back pain , radicular pain
visceral referred pain
weakness - paraparesis (usually only weakness of the legs)
numbness and paraesthesia
urinary symptoms
how would you investigate a suspected spinal cord infarction?
MRI
what is the treatment/management of a spinal cord infarction/ ishcameic myelopathy?
reduce risk of recurrence; - maintain BP - reverse hypokalaemia/arrhythmia - anti platelet therapy manage vascular risk factors - physiotherapy , OT
what does the recovery of spinal cord infarction depend on?
the extent of parenchymal damage
what is the prognosis of spinal cord infarction?
20% mortality, with only 35-40% have more than minimal recovery
what is the treatment for demyelinating myelitis?
supportive
methylpredinosolone (speeds up recovery from myelitis but not progression of MS)
what are the main causes of vitamin B 12 deficiency?
gastrectomy - vit B 12 is absorbed in the small intestine by intrinsic factor
pernicious anaemia
veganism
what affects on the CNS does vitamin B12 cause?
myelopathy - L'hermitte's peripheral neuropathy brain eyes/optic nerves brainstem cerebellum
vitamin B12 can cause degeneration of the corticospinal tract, what symptom would this cause?
paraplegia
vitamin B12 can cause degeneration of the dorsal columns, what symptom would this cause?
sensory ataxia
what are the investigations and treatment for vitamin B 12 deficiency?
investigations: FBC, blood film, B12
treatment = intramuscular B12
how can a gastrectomy cause vitamin B12 deficiency?
Vitamin B12 absorption from the ileum requires intrinsic factor - produced from gastric parietal cells.
therefore if someone has a gastrectomy, then Vitamin B12 won’t be absorbed to be taken and stored in the liver
if there radiculopathy of C5 what symptoms would this cause?
= damage to the C5 spinal root decreased power in C5 innervated muscles wasting of the C5 innervates muscle decreased reflex of bicep muscle but increased reflexes below C5 increased tone in legs > arms
is muscle wasting a symptom of upper motor neurone or lower motor neurone lesion?
lower motor neurone
in which spinal cord/root pathology causes back pain and what is its pattern like?
ischaemic spinal cord / spinal cord infarction
radicular pain - radiates out along the course of the spinal nerve
what does paraparesis mean?
partial paralysis of the lower limbs
what does paraesthesia mean?
burning/tingling sensation
what does paraplegia mean?
impairment of the motor or sensory function of the lower limbs
would u find extensor plantar in an UMN or LMN lesion?
extensor plantar = UMN
would you find flexor plantar in UMN or LMN lesion?
flexor plantar = LMN
What is radiculopathy and what is the presentation like?
Damage of the nerve root
- unilateral
- single myotome
- single dermatome
- decreased reflexes
- LMN
What is myelopathy and what does it present like?
Damage to the spinal cord
- bilateral
- motor and sensory level
- UMN
Would damage to a peripheral nerve cause unilateral or bilateral symptoms?
Would this be motor, sensory or both?
Unilateral
Motor and sensory deficit
If a patient presents with signs such as clonus, up going plantars and brisk reflexes, what type of lesion would you suspect ?
Spinal cord lesion / myelopathy / UMN
What are the long tract signs of myelopathy?
Brisk reflexes Increased tone Up going plantars Clonus Hoffmans signs Proprioception impairement
Does myelopathy cause a possitive Babinski’s sign?
Yes
UMN show possitive sign whereas LMN doesn
Does radiculopathy cause fasciculations
No, nerve root compression doesnt cause fasciculations
UMN (myelopathy) causes fasciculations
What are the 5 main ligaments in the vertebral column?
Anterior longitudinal Posterior longitudinal Ligamentum flavum Interspinal ligament Supraspinous ligament
Would upper or lower motor neurone cause brisk reflexes?
UMN
Disc prolapse tends to occur in what age group?
Younger patients
What is the main feature of a disc prolapse?
Acute onset pain
Does a disc prolapse cause myelopathy or radiculopathy?
If central herniation = myelopathy
If lateral herniation = radiculopathy
What is the presentation of a lateral disc herniation ?
Acute onset pain down leg/arm of side affected
Weakness and numbness in distrubution of nerve root involved
What is the management of a disc prolapse?
Rehabillitation
Nerve root injection
Lumbar/cervical discectomy
What are the red flag symptoms of causes equina syndrome?
Bilateral sciatica
Saddle anaesthesia
Urinary dysfunction
What is the treatment for cauda equina syndrome?
Emergency lumbar discectomy
What age group are degenerative spinal diseases commonly found in?
Older patients
What is cervical spondylosis?
Umbrella term for degenerative change in the cervical spine that leads to spine and nerve root compression
What is the presentation of cervical spondylosis?
Can presentwith either radiculopathy or myelopathy
Speed of onset if usually months to years
What is the management of cervical spondylosis?
Conservative if no/mild myelopathy
Surgery for progressive moderate/severe myelopathy
What is lumbar spinal stenosis?
Spinal canal narrows and compresses the nerves at the lumbar vertebrae
What is the presentation of lumbar stenosis?
Pain down both legs ‘spinal claudication’
Pain eases with sitting down or bending forwards
Worse on walking / standing
What is the treatment for lumbar stenosis?
Lumbar laminectomy
Metastases to the spinal cord are usually ;
Extra dural ? Intramural ? Intramedullary ?
Extra dural
What is the triad presentation of a malignant cord compression?
Pain
Weakness
Sphincter dysfunction.
What is the management for a malignant spinal cord compression?
Surgical decompression
Radiotherapy
What are the 3 main spinal infections?
Osteomyelitis
Discitis
Epidural abscess
What are the risk factors for osteomyelitis?
IV drug abusers
Alcoholics
Diabetic
Chronic renal failure
What are the causative organisms of osteomyelitis?
Staph aureus
Streptococcus
E. coli
What is the triad presentation of osteomyelitis?
Pain
Pyrexia
Focal neurology
What is the management of osteomyelitis?
Urgent surgical decompression
Long term IV antibiotics
What is discitis?
Infection of the intervertebral disc
Describe the clinical presentation of vitamin a B12 deficient myelopathy
Paraesthesia of hands and feet
Hyporeflexia
Extensor plantar (first UMN sign)
Degeneration of the corticospinal tract causing paraplegia
Degeneration of the dorsal columns causing sensory ataxia
Painless retention of urine
What sign suggests myelopathy caused by vitamin B12 deficiency?
L’hermittes
Flex your neck and you get a rush of electricity down your back
