Diseases of the Spinal Cord and Nerve Roots (Medical) Flashcards
Define Myelopathy
Disease that affects from the spinal cord down to the anterior horn cell
Define Radiculopathy
Disease that affects from the anterior horn cell to proximal nerve
What motor neurones are involved in myelopathy
Upper motor neurone
What motor neurones are involved in radiculopathy
Lower motor neurones
What is expected signs of upper motor neurone disorder
No Muscle wasting (in early stage, but with weakness can develop later)
Increased tone
Increased reflexes
Pyramidal pattern of weakness s
What kind of increased tone is seen in an Upper motor neurone disorder
Spasticity - normal tone then a build up cause tone to heighten
What is a sign on increased reflexes in Upper motor neurone disease
Extensor plantar - Toe extend due to withdraw
Why are reflexes increased in Upper motor neurone disorder
Damage to upper motor neurone means they no longer have control over suppressing primitive reflexes
What are primitive reflexes
Generated by the spinal cord reflex arch, these are reflexes that are exhibited by normal infants that you don’t not require as you grow older e.g. how we can walk without a reflex occurring
What are the causes and signs of a pyramidal pattern of weakness
Flexors stronger than extensors in the arm - drives arm into the body
Extensors stronger than flexors in the leg - leg extended at hip and knee
Circumduction when walking
What is the upper motor neurones affect on the reflex arc
Suppresses it (so when damaged = hyperflexia)
What generates the reflex arc
Lower motor neurone and sensory system
What are the signs of a lower motor neurone disorder
Decreased tone
Decreased reflexes
Weakness
Wasting
Fasciculation
How is decreased tone shown in lower motor neurone disorder
Floppiness
Why are reflexes decreased in lower motor neurone
As reflex arc not working - cant produce reflex
How does weakness, wasting and fasciculation occur in lower motor neurone disorder
Due to degeneration of nerve fibres (weakness) causing shrinkage (wasting) and therefore you can see nerve fibres flickering under the skin (fasciculation)
What is a sensory level
What level the lesion/damage occurs in the spinal cord as no sensory sensation is felt below that level
What is Brown squared syndrome
A hemicord/half cord lesion that results in a cross sensory deficit
How does a cross sensory deficit occur in a hemicord lesion
As different sensory signals go up different pathways in the body
Spinothalmic crosses at entry of spinal cord and Dorsal column doesn’t cross over in the spinal cord but the medulla
What tract is responsible for the ipsilateral symptoms of a hemicord lesion
Dorsal column
What tract is responsible for the contralateral symptoms of a hemicord lesion
Spinothalmic
What is the ipsilateral symptoms of a hemicord lesion
Decreased vibration
Decreased joint position sense
Weakness
What is the contralateral symptoms of a hemicord lesion
Decreased pain
Decreased temperature
What are other signs noted on a spinal cord lesion
Autonomic signs - e.g. bladder and bowel
What is the specific signs of a root lesion
Restricted deficit: Dermatonal loss of sensory and motor sensation
What is the commonest cause of root lesion
Herniated disc
What are the extrinsic causes o myelopathy
Tumour
Vascular abnormalities
(Haemorrhage, dural fistula)
Degenerative (spine)
Trauma
What are the tumours that can occur in and around the spine
Extradural,
intradural/extramedullary,
intramedullary
What are the medical causes of myelopathy
De-myelination
Auto-immune
Sarcoid
Ischaemic
Heamorrhage
Infection
B12 deficiency
Malignant/infiltrative
Congenital/genetic
Idiopathic
What are antibody mediated autoimmune cause of myelopathy
aquaporin 4
Lupus
What Viral and bacterial infections can cause myelopathy
Viral: herpes simplex/zoster, EBV, CMV, measles, HIV
Bacterial: TB, borrelia (Lyme), syphilis, brucella
Schistosomiasis
What is a congenital /genetic cause of myelopathy
Friedrich’s ataxia,
Spinocerebellar ataxias
What is an example of a malignant/infiltrative cause of myelopathy
Glioma
a malignant tumour of the glial tissue of the nervous system
What is the causes of spinal cord ischaemia
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
What is the clinical presentation of spinal cord stroke
Onset may be sudden or over several hours
Back pain +- radiates
Visceral referred pain
Weakness/numbness
Paraparesis - paralysis waist down
Urinary symptoms (retention)
Why does paraparesis occur rather than quadraparesis
due to vulnerability of thoracic cord to flow related ischaemia
What is a follow up symptom as spinal cord shock settles
Bladder and bowel incontinence
The arteries of the spinal cord is anterior and posterior spinal arteries
What does the anterior spinal artery supply
The central area of the spinal cord which is pre-dominatly a motor area
What is usually the spinal artery affected that causes spinal cord stroke (what area does this affect)
Anterior spinal artery - the ventral/motor area
Where would an occlusion to occur for partial Brown-sequard syndrome
Central sulcal artery
What area in the spine would spinal cord stroke usually occur
Mid thoracic
What investigation occurs in spinal cord stroke
MRI
What treatment is used to reduce the risk of a recurrent spinal cord stroke
Maintain adequate BP
Reverse hypovolaemia/arrhythmia
Antiplatelet therapy
What needs to be managed in a spinal cord stroke
Vascular risk factors
What healthcare professionals are involved in the treatment of spinal cord stroke
Occupational therapist
Physiotherapist
What sign usually suggests major recovery is low
No significant motor recovery in first 24 hours
What is the commonest cause of medical spinal cord disease
demyelinating myelitis - part of MS
What is the characteristic pathology of demyelinating myelitis MS
Lesions of inflammation and demyelination in the white matter of the CNS leading to temporary neuronal dysfunction
What is causes of B12 definceny
Percinous anaemia
Total gastrectomy
Crohns
Tape worms
What parts of the nervous system does B12 deficiency affect
Myelopathy
Peripheral neuropathy
Brain
Eye/optic nerves
Brainstem
cerebellum
What is the presentation of B12 deficient myelopathy
Paraesthesia hands and feet, (absent reflexes)
Extensor plantar
paraplegia
Sensory ataxia
Painless retention of urine
What sign occurs when B12 deficient myelopathy cause degeneration of corticospinal tracts
paraplegia
What sign occurs when B12 deficient myelopathy cause degeneration of dorsal columns
Sensory ataxia
What is the investigations for vitamins B12 deficient myelopathy
FBC/ Blood film
B12 test
What is the treatment of B12 deficient myelopathy
Intramuscular B12
