Diseases of the Spinal Cord and Nerve Roots Flashcards
describe the pathway of upper and lower motor neurons?
motor tracts, running from the motor cortex in the pre-central gyrus of the frontal lobe where the neurons have the nuclei.
They send their axons down through the white matter tracts, through the internal capsule here, down through the brain stem.
And then in the lower part of the medulla, most of those will cross and form the lateral cortico-spinal tract in the spinal cord.
A few of them don’t cross and remain ipsilateral, go down the anterior cortico-spinal tract.
But both of those tracts eventually will synapse down with the anterior horn cell, where,
those nerves will send their axons down through the nerve roots and then out to the individual peripheral nerves.
what is myelopathy?
injury to the spinal cord caused by severe compression that may be a result of spinal stenosis, disc degeneration, disc herniation, autoimmune disorders or other trauma.
what is myelitis?
inflammation of spinal cord
what is radiculopathy?
Commonly referred to as a pinched nerve, radiculopathy is injury or damage to nerve roots in the area where they leave the spine. This condition can affect anyone and can be the result disc degeneration, disc herniation or other trauma
what is radiculitis?
term used to describe the symptoms felt when a nerve or nerve root is pinched, irritated, inflamed, or simply put, just not working properly
what causes of motor signs of cord pathology?
Upper Motor Neuron (UMN)
No wasting
↑tone
↑reflexes, extensor plantar
Pyramidal pattern of weakness
Below level of any lesion
Often bilateral
Spastic tetraparesis/paraparesi
what are causes of sensory signs of cord pathology?
Myelopathy → sensory level
Hemicord lesion → Brown-
Sequard syndrome
what is Brown-
Sequard syndrome?
are neurological condition characterized by a lesion in the spinal cord which results in weakness, paralysis, joint position sense on one side of the body and a loss of sensation (pain, temp) on the opposite side
what are causes of autonomic signs of cord pathology?
bladder/bowel
The most common causes of Autonomic Dysreflexia are bladder and bowel distension. Signs and Symptoms. Raised BP, bradycardia, pounding headache, flushing
what are surgical causes of myelopathy?
Tumour
Vascular abnormalities
Degenerative (spine)
Trauma
what are medical causes of myelopathy?
Congenital / genetic
Hereditary paraparesis, spinocerebellar ataxias
Acquired
Inflammation
Demyelination (Multiple Sclerosis)
Autoimmune (antibody mediated eg aquaporin 4, systemic lupus)
Sarcoid
Vascular: ischaemic vs haemorrhage
Infective
Viral: herpes simplex/zoster, EBV, CMV, measles, HIV, HTLV-1 etc
Bacterial: TB, borrelia (Lyme), syphilis, brucella
Other: schistosomiasis
Metabolic: B12 deficiency
Malignant: infiltrative / paraneoplastic
Idiopathic
what investigations are done for myelopathy?
localise: imaging – MRI best
Investigate cause: bloods, CSF
what are some causes of spinal cord infarction?
Atheromatous disease (NB aortic aneurysm)
Thromboembolic disease (endocarditis, AF)
Arterial dissection (aortic)
Systemic hypotension
Hyperviscosity syndromes / prothombotic disease
Vasculitis
Arteriovenous abnormalities
Endovascular procedures
Meningovascular syphilis
Decompression sickness
how would a spinal cord stroke present clinically?
May have vascular risk factors
Onset may be sudden or over several hours
Pain
Back pain / radicular
Weakness
Usually paraparesis rather than quadraparesis given vulnerability of thoracic cord to flow related ischaemia
Numbness and paraesthesia
Urinary symptoms
Retention followed by bladder and bowel incontinence as spinal shock settles
what are signs of spinal cord stroke?
Usually anterior spinal artery => dorsal columns spared
Occlusion of a central sulcal artery can present as a partial Brown-Séquard syndrome
Usually mid thoracic
May be spinal shock
