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Yr2 Neuro MA > Diseases of the spinal cord > Flashcards

Diseases of the spinal cord Flashcards

1
Q

What are the collective terms for motor disorders of the Spinal cord and Spinal roots?

A

Spinal cord disorders - myelopathies

Corresponds to Upper motor neurone disease

Spinal root disorders - nerve root/radiculopathies

Corresponds to Lower motor neurone disease

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2
Q

What are the motor signs for an upper motor neuron pathology (spinal cord pathology) and lower motor neurone pathology (root)?

A

Upper motor neurone - cord:

  • No wasting
  • Hypertonia
  • Hyperreflexia, Extensor plantar
  • Pyramidal pattern of weakness

Lower motor neurone - roots:

  • Wasting
  • Hypotonia
  • Hyporeflexia, flexor plantar
  • Weakness
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3
Q

What sensory signs will be seen in a spinal cord pathology?

A

Myelopathies cause a sensory deficit

Hemicord lesions cause Brown-Sequard syndrome:

  • Ipsilateral (ie supply from dorsal column):
    • Decreased Vibration sensitivity
    • Decreased Joint position awareness
    • Weakness
  • Contralateral (ie supply from Spinothalamic tract):
    • Decreased pain sensation
    • Decreased temperature sensation
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4
Q

What are the expected sensory and autonomic signs of a spinal root pathology (radiculopathy)?

A

Dermatomal sensory loss corresponding to the spinal nerve root that is affected

Bladder/bowel dysfunction associated with autonomic loss

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5
Q

Why is C5 nerve root damage an important nerve root pathology to be aware of the signs of?

What are the signs of this?

A

C5 spinal nerve often compressed leading to problems in the arms:

  • Wasting & weakness of C5 innervated muscles
    • Deltoids (shoulder abduction weakened)
    • Pyramidal pattern of weakness below
  • Hypertonia in legs > arms
  • Decreased bicep reflex but increased lower reflexes
  • Sensory deficit

This model of signs can be applied to other nerve root pathologies as well just applying to their muscles

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6
Q

The causes of myelopathies and radiculopathies can be grouped as Intrinsic (ie within the actual spinal cord/nerve) or Extrinsic

What are the extrinsic causes?

A

Pathology from something external to the spinal cord/nerve:

  • Surgery - ie iatrogenic
  • Tumours
  • Vascular abnormalities
  • Degenerative disorders of the spine
  • Trauma
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7
Q

What tumours may cause myelopathies or radiculopathies?

How do they do this?

A

Extradural:

  • Most common
  • Typically a metastasis from elsewhere

Intradural:

1) Extramedullary tumours:

  • Meningiomas
  • Neurofibromas

2) Intramedullary
* Ependymomas

Can either directly compress the Spinal Cord/Nerve

Or Vertebral body destruction by bony metastasis can cause cord compression

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8
Q

What vascular abnormalities can cause extrinsic damage to the spinal cord/nerves?

A

Haemorrhage

Arteriovenous malformation (AVM)

Dural fistula

Both AVM & dural fistulas are abnormal connections between arteries and veins

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9
Q

What are the intrinsic (medical) causes of Myelopathies or radiculopathies?

A
  • Congenital/genetic causes
  • Acquired causes (groups of causes):
  • Inflammatory - incl. Multiple Sclerosis
  • Vascular - incl. Ischaemia
  • Infective
  • Metabolic - Vitamin B12 deficiency
  • Malignant - both infiltrative & paraneoplastic
  • Idiopathic
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10
Q

What are the congenital causes of spinal cord/nerve pathologies?

A

Friedrich’s ataxia

Spinocerebellar ataxias

Hereditary paraparesis

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11
Q

What are the inflammatory causes of spinal nerve/nerve pathologies?

A

Demyelination - Multiple sclerosis!!!

Autoimmune (antibody-mediated) - eg aquaporin, lupus

Sarcoid

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12
Q

What are the vascular causes of Spinal cord/nerve pathology?

A

Ischaemia!!! & haemorrhage

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13
Q

What are the infective causes of spinal cord/nerve pathology?

A

Viral:

  • HIV, Herpes Simplex/zoster, EBV, CMV, Measles

Bacterial:

  • TB, Lyme (borrelia), syphilis, brucella

Other:

  • Schistosomiasis
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14
Q

Why does Vitamin B12 cause spinal cord/nerve damage?

A

Vitamin B12 is essential to the synthesis of myelin

No myelin = not good

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15
Q

What are the causes of spinal cord ischaemia/spinal cord stroke?

Good luck remembering this lol hehe

A

Atheromatous disease (including aortic aneurysms)

Thromboembolic disease - endocarditis, AF

Arterial dissection (aortic)

Systemic hypotension

Hyperviscosity syndromes / prothrombotic disease

Vasculitis

Arteriovenous abnormalities

Endovascular procedures

Meningovascular syphilis

Decompression sickness - ‘the bends’

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16
Q

How does Spinal cord stroke present?

A

Symptoms & signs:

  • Back pain / radicular pain (“radiated” Dermatomally)
  • May have Visceral referred pain
  • Numbness & paraesthesia
  • Urinary symptoms

Signs:

  • Weakness - typically just in lower limbs

History:

  • CVS history/vascular risk factors
  • Onset may be sudden or over several hours
17
Q

What urinary symptoms may be experienced with spinal cord stroke?

A

Retention followed by bladder and bowel incontinence as spinal shock settles

18
Q

Identify the arteries that supply the spinal cord in the diagram below

A

There is also the central sulcal artery - occlusion of this can present as a partial Brown-Séquard syndrome

19
Q

How would motor and sensory function be affected by a spinal cord stroke involving the anterior spinal artery

A

Anterior spinal artery - most common

Loss of:

  • Motor (CST) - paralysis below the level of the lesion (usually mid-thoracic)
  • Pain & temp sensation (LST)
  • Light touch (VST)

Dorsal columns spared - thus no effect to:

  • Deep touch
  • Proprioception
  • Vibration

SC stroke involving the posterior spinal artery would be a contrast to this

20
Q

What is Spinal shock?

A

A combination of areflexia/hyporeflexia and autonomic dysfunction that sometimes accompanies spinal cord injuries

21
Q

What is the prognosis for spinal cord stroke?

A

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

22
Q

Multiple sclerosis is a condition in which there is demyelinating myelitis

How would Demylenating myelitis (MS) generally present?

(not symptoms but just generally)

A

Symptoms corresponding to DM is the most common presentation for MS itself

Presentation is sub-acute, with slower onset (than ischaemia eg)

More common in younger patients than vascular causes - ischaemia etc

May also have previous neurological history

23
Q

What imaging modality is best for identifying myelitis in MS?

A

MRI

24
Q

What are the causes of Vitamin B12 deficiency?

A

Diet (vegans) - Meat, fish etc are sources of B12

Pernicious anaemia: autoimmune condition in which antibodies to IF prevent B12 absorption

Total gastrectomy, Crohn’s, tape worms

25
Q

How does B12 deficiency myelopathy present?

A

Symptoms and signs:

  • Paraesthesia hands and feet
  • Areflexia
  • L’hermitte’s sign*
  • CST degeneration = Paraplegia
  • Dorsal column degeneration = Sensory ataxia
  • Painless retention of urine

*An uncomfortable “electrical” sensation that runs through the back and into the limbs. The sensation can feel like it goes up or down the spine.

26
Q

How is B12 myelopathy investigated and treated?

A

FBC/blood film (can be negative)

B12 levels

MRI?

Treated using IM Vitamin B12 injections (ASAP)

27
Q
A

Yr2 Neuro MA (35 decks)

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