Diseases of the spinal cord Flashcards
What does the prefix “myelo” refer to?
The cord
What does the prefix “radiculo” refer to?
Nerve roots
What are some signs of UMN damage?
Hypertonia
Hyperreflexia
Pyramidal pattern of weakness (extensors in the arms, flexors in the legs)
Would UMN damage show wasting?
No
What are some signs of LMN damage?
Wasting
Hypotonia
Hyporeflexia
Weakness
Why would you not do a lumbo-sacral MRI for UMN signs in the legs?
Spinal cord is already done at L1 for that area
How will a cord lesion affect senses?
Abnormal sensation up to the level of the lesion from inferior
Which side will show weakness in a lesion of the cord?
The side the lesion affects
Will a cord lesion affect pain/temperature sensation?
Yes, there will be a loss
Will a lesion of the dorsal column affect pain/temperature sensation?
No
How will a lesion of the dorsal column affect senses?
Loss of vibration sense below lesion
What is a congenital cause of myelopathy?
Friedrich’s ataxia
What are some inflammatory causes of myelopathy?
MS
Sarcoidosis
Autoimmune
What are some metabolic causes of myelopathy?
B12 deficiency
What are some acquired causes of myelopathy?
Inflammation Vascular Infection Metabolic Malignant Idiopathic
Why do spinal strokes tend not to affect the arms?
Innervation of the arms branches off T1 and above
How may a spinal stroke present?
Back pain Visceral referred pain Weakness Numbness Paraesthesia
What is Brown-Séquard syndrome?
Damage to one half of the spinal cord (i.e. hemisection of spinal cord) resulting in paralysis and loss of proprioception on the side of the injury
What are some useful investigations for spinal stroke?
CT
MRI
How would we treat a spinal stroke?
OT and physio
Manage vascular risk factors
Reduce risk of recurrence (Maintain BP, reverse arrhythmia, antiplatelet therapy)
How would we treat demyelinating myelitis?
Methylprednisolone
What investigation may be useful for disc prolapse?
MRI
How is disc prolapse managed?
Rehab
Nerve root inject
Lumbar/cervical disectomy
What are some red flags for cauda equina syndrome?
Bilateral sciatica
Saddle anaesthesia
Urinary dysfunction
How is cauda equina syndrome managed?
Urgent MRI
Emergency lumbar disectomy
Describe the pain experienced as a result of lumbar spinal stenosis.
Pain down both legs “spinal claudication”
Worse on standing/walking
Relieved by sitting or bending forward
How is lumbar spinal stenosis managed?
Lumbar laminectomy
What triad for epidural abscess would warrant an urgent MRI?
Back pain
Pyrexia
Focal neurology
What organisms may cause epidural abscess?
Staph Aureus
Streptococcus
E. Coli
