Diseases of the Spinal Cord and Nerve Roots Flashcards
what is Myelopathy?
any neurologic deficit related to the spinal cord
what is myelitis?
infection or inflammation of the spinal cord
what is Radiculopathy?
consequence of nerve root damage
what is radiculitis?
Inflammation of nerve root
what is myeloradiculopathy
Disease involving the spinal cord and nerve roots
what are the intrinsic causes of myelopathy or radiculopathy?
Inflammation Infarction Infiltration Infection Degenerative (neurones)
what are the extrinsic causes of myelopathy or radiculopathy?
Degenerative (spine) Tumour Extradural, intradural/extramedullary, intramedullary Vascular abnormalities Haemorrhage AVM, dural fistula Trauma
how do you treat extrinsic and intrinsic factors?
extrinsic-surgical
intrinsic-medical
what are upper motor neurone signs of disorders affecting the spinal cord or nerve roots
No wasting
↑tone
↑reflexes
Pyramidal pattern of weakness
what are lower motor neurone signs of disorders affecting the spinal cord or nerve roots
wasting
↓tone
↓reflexes
weakness
what are sensory signs of radiculopathy
dermatomal pattern of sensory loss
what does laminated tracts refer to?
any external pressure exerted on spinal cord in region of spinothalamic tracts will first experience a loss of pain and temp sensation in the sacral dermatome of the body
name the ipislateral spinal tracts
UMN- Corticospinal
Dorsal columns
name the contralateral spinal tracts
spinothalamic also called your ventrolateral/anterolateral tract
what would be the signs of a c5 cord lesion?
Wasting of C5 innervated muscles ↑ tone in LL>UL Reflexes ↓biceps, ↑all lower reflexes Power ↓C5 innervated muscles, pyramidal pattern below Sensory level
give some medical causes of myelopathy
Demyelination (MS)
Ischaemic
Transverse Myelitis
Metabolic, B12 deficiency
where is a stroke most likely to occur on the spinal cord?
Thoracic cord and very bottom of cord have poor blood supply- most likely to get stroke
what are causes of spinal cord ischaemia?
Anything that can throw off a clot/make blood slow or sticky: Atheromatous disease Thromboembolic disease Arterial dissection Systemic hypotension Hyperviscosity Vasculitis
what is the clinical presentation of spinal cord stroke?
May have vascular risk factors Onset may be sudden or over several hours Pain: -Back pain/radicular -Visceral referred pain Weakness-usually paraparesis Numbness and paraesthesia Urinary symptoms Retention followed by bladder and bowel incontinence as spinal shock settles
which artery is usually affected in spinal cord stroke?
Usually anterior spinal artery
Very rarely posterior spinal artery => dorsal columns spared
Occlusion of which artery can present as a partial Brown-Séquard syndrome?
central sulcal artery
what is the difference between T1 & T2 MRI?
T1-looks at structure(CSF black)
T2-looks at pathology(CSF white)
what is the treatment of spinal cord stroke?
Supportive Reduce risk of recurrence: -Maintain adequate BP -Bed rest -Reverse hypovolaemia/arrhythmia OT and physiotherapy Manage vascular risk factors
what is the prognosis of spinal cord stroke?
Unless significant motor recovery in first 24 hours chance of major recovery is low
Pain may be persistent
20% mortality, only 35-40% have more than minimal recovery
when does demyelinating Myelitis occur?
Usually part of MS
Common cause of medical spinal cord disease
Can affect the young
what characterises myelitis: multiple sclerosis?
pathological lesions of inflammation and demyelination leading to temporary neuronal dysfunction
Affects the white matter of the CNS
One or more lesions anywhere
describe demyelination myelitis of MS
Partial or incomplete transverse myelitis
May be the initial presentation of MS
Subacute onset (slower than ischaemia)
may be history of previous neurological or ophthalmological episodes
what is the treatment of MS myelitis?
Supportive
Methylprednisolone
what are the causes of transverse myelitis?
Idiopathic Viral: VZV, HSV, CMV, EBV, influenza, echo virus, HIV, hepA, rubella Other infections: Syphilis, measles, Lyme Autoimmune: SLE, sjögren’s syndrome, sarcoidosis Malignancies Post vaccination: Chicken pox, rabies
what is Pernicious anaemia?
Autoimmune condition in which antibodies to IF prevent B12 absorption
how does B12 deficiency affect the nervous system?
Myelopathy-L’hermitte’s
Peripheral neuropathy
(Brain, Eye/optic nerves, Brainstem, cerebellum)
what are the symptoms of B12 deficient myelopathy?
Paraesthesia hands and feet, areflexia First UMN sign ↑plantars Degeneration of : -corticospinal tracts→paraplegia -Dorsal columns→sensory ataxia Painless retention of urine
