Diseases of the Spinal Cord and Nerve Roots (Medical) Flashcards
What are the motor signs of upper mtor neurone root pathology?
- No wasting
- ↑tone
Increased tone in terms of spasticity – tone is not the same over the whole range of the joint
- ↑reflexes - Babinski sign
- Pyramidal pattern of weakness
Pattern of weakness – flexors are stronger than extensors in the arm – drives the arm into flexion, in the leg it is the opposite – legs get driven into extension
What are lower motor neurone signs?
- ↓tone
- ↓reflexes, flexor plantar
- weakness
What are sensory signs of root pathology?
Myelopathy
Hemicord lesion: Brown-Sequard syndrome (BSS) is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.
In Brown sequard syndrome, what function is lost on the ipsilateral side and what function is lost on the contralateral side?
Ipsilateral: Decreased vibration
Decrease in joint position sense
Weakness
Contralateral: Pain and temperature
What tracts are motor tracts?
Lateral corticospinal
Ventral corticospinal
What tract does pain travel in ?
Lateral spinothalamic tract
What tract does light touch travel in?
Ventral spinothalamic
What travels in the dorsal column?
Deep touch, proprioception and vibration
Overview
Define radiculopathy?
Pain, numbness or weakness to part of the body as a result of injury to a nerve root (such as compression)
Results in dermatomal sensory loss
What is autonomic effect of root pathology?
Bladder / Bowel dysfunction
Incontinence?
Constipation?
What are the signs of a C5 cord lesion?
•Wasting of C5 innervated muscles
LMN features in C5 - los of biceps jerk and weakness
UMN features below C5 - tone in legs is greater than tone in the arms
- Reflexes ↓biceps, ↑all lower reflexes
- Power ↓C5 innervated muscles, pyramidal pattern below
- Sensory level
Sensation all the way down may be lost because of ascending pathways
What are intrinsic causes of myelopathy / radiculopathy?
Medical
What are extrinsic causes of radiculopathy / myelopathy?
Surgical:
Tumour (Extradural, intradural/extramedullary, intramedullary)
Vascular abnormalities
- Haemorrhage
- AVM, dural fistula
Degenerative (spine)
Trauma
What are the medical causes of myelopathy?
•Inflammation
–Demyelination (Multiple Sclerosis)
–Autoimmune (antibody mediated eg aquaporin 4, lupus)
–Sarcoid
- Vascular: ischaemic vs haemorrhage
- Infective
–Viral: herpes simplex/zoster, EBV, CMV, measles, HIV etc
–Bacterial: TB, borrelia (Lyme), syphilis, brucella
–Other: schistosomiasis
•Metabolic
–B12 deficiency
- Malignant / infiltrative
- Congenital / genetic
–Friedrich’s ataxia, spinocerebellar ataxias
•Idiopathic
In the case of ischaemic myelopathy (spinal stroke) - what function is most likely to be lost if there is anterior spinal artery occlusion?
Motor function
What are the causes of 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
What is the clinical presentaion of spial cord stroke?
- May have vascular risk factors
- Onset may be sudden or over several hours
- Pain
–Back pain/radicular
–Visceral referred pain
•Weakness (everythin below the level of infarction)
–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
Which artery does spinal cord stroke normally affect?
Anterior spinal artery
•Very rarely posterior spinal artery => dorsal columns spared
What is the result of occlusion of a central sulcal artery?
Can present as a partial brown-sequard syndrome
What is the treatment of spinal cord stroke?
•Reduce risk of recurrence
–Maintain adequate BP
–Reverse hypovolaemia/arrhythmia
–Antiplatelet therapy
- OT and physiotherapy
- Manage vascular risk factors
What is prognosis for spinal shock?
Depends on degree of parenchymal damage
•Unless significant motor recovery in first 24 hours chance of major recovery is low
Pain may be consistent
20% mortality, only 35-40% have more than minimal recovery
What is demyelating myelitis often part of?
MS
- Common cause of medical spinal cord disease
- Can affect the young
What part of the nervous system does MS attack?
All central nervous system - UMN
What causes the temporary neuronal dysfunction in MS?
Pathological lesions of inflammation and demyelination
One or more lesions anywhere
Where do we get vitamin B12?
- Abundant in meat, fish and most animal by-products
- Legumes
How do we absorb vitamin B12?
Intrinsic factor - produced by gastric parietal cells
What causes pernicious anaemia?
Antibodies to intrinsic factor prevent vitamin B12 absorption
Vitamin B12 affects most of the nervous system
•Myelopathy
–L’hermitte’s
- Peripheral neuropathy
- Brain
- Eye/optic nerves
- Brainstem
- cerebellum
What are the features of B12 deficient myelopathy?
- Paraesthesia hands and feet, areflexia
- First UMN sign extensor plantars
- Degeneration of:
– corticospinal tracts → paraplegia
–Dorsal columns → sensory ataxia
•Painless retention of urine
