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
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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