Diseases of the Spinal Cord and Nerve Roots Flashcards
What motor signs would you expect to see with an UMN pathology?
- Increased tone (spasticity)
- Increased reflexes, extensor plantar
- Pyramidal pattern of weakness
What motor signs would you expect to seen with a LMN pathology?
- Decreased tone
- Decreased reflexes, flexor plantar
- Weakness
What sensory sign would you expect to see in a myelopathy?
Sensory level
What sensory sign would you expect to see with a hemicord lesion?
Brown-Sequard syndrome
What are the features of Brown-Sequard syndrome?
Ipsilateral
-Decreased vibration
-Decreased joint position sense
Weakness
Contralateral
- Decreased pain
- Decreased temperature
What are the dorsal columns responsible for?
- Deep touch
- Joint position sense (proprioception)
- Vibration
What is the ventral corticospinal tract responsible for?
Motor
What is the ventral spinothalamic tract responsible for?
Light touch
What is the lateral spinothalamic tract responsible for?
- Pain
- Temperature
What is the lateral corticospinal tract responsible for?
Motor
What sensory sign would you expect to see in a radiculopathy?
Dermatomal sensory loss
What autonomic signs may be present with a cord/root pathology?
Bladder/bowel dysfunction
What signs would be present in a C5 cord lesion?
- Wasting of C5 innervated muscles
- Increased tone in lower limbs > more upper limbs
- Reflexes decreased in biceps, increased in all lower reflexes
- Power decreased in C5 innervated muscles, pyramidal pattern below
- Sensory level
What surgical causes of myeleopathy/radiculopathy are there?
- Tumour (extradural, intradural/extramedullary, intramedullary
- Vascular abnormalities (haemorrhage, AVM, dural fistula
- Degenerative (spine)
- Trauma
What medical causes of myelopathy are there?
- Inflammation
- Vascular (ischaemic vs haemorrhage)
- Infective
- Metabolic (B12 deficiency)
- Malignant/infiltrative
- Congenital/genetic
- Idiopathic
What inflammatory causes of myelopathy are there?
- Demyelination (Multiple sclerosis)
- Autoimmune (antibody mediated e.g. aquaporin 4, lupus)
- Sarcoid
What infective causes of myelopathy are there?
- Viral: herpes simplex/zoster, EBV, CMV, measles, HIV et.
- Bacterial: TB, borrelia (Lyme), syphilis, brucella
- Other: schistosomiasis
What congenital/genetic causes of myelopathy are there?
- Friedrich’s ataxia
- Spinocerebellar ataxias
What can cause spinal cord ischaemia?
- Atheromatous disease (aortic aneurysm)
- Thromboembolic disease (endocarditis, AF)
- Arterial dissection (aortic )
- Systemic hypotension
- Thrombotic haematological disease
- Hyperviscosity syndromes
- Vasculitis
- Venous occlusion
- Endovascular procedures
- Decompression sickness
- Meningovascular syphilis
How does a spinal cord stroke present clinically?
- Onset: sudden or over several hours
- Pain (back pain/radicular which radiates to the front, visceral referred pain)
- Weakness (usually paraperesis rather than Quadra paresis 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)
- May have vascular risk factors
What are the general examination points of spinal cord?
- Very rarely posterior spinal artery => dorsal columns spared
- Usually anterior spinal artery
- Occlusion of a central sulcal artery can present as a partial Brown-Séquard syndrome
- Usually mid thoracic
- May be spinal shock
What investigation is key in spinal cord stroke?
MRI
What is the treatment for spinal cord stroke?
- Reduce risk of recurrence (Maintain adequate BP, reverse hypovolaemia/arrhythmia, antiplatelet therapy)
- OT and physiotherapy
- Manage vascular risk factors
What is the prognosis of spinal cord stroke?
- Return of function depends on degree of parenchymal damage
- 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
