Diseases of the Spinal Cord and Nerve Roots Flashcards
Where do injuries causing myelopathy/myelitis tend to occur? Radiculopathy/radiculitis?
Myelopathy/myelitis - tends to affect the spinal cord (UMNs)
Radiculopathy/radiculitis - affects the spinal nerve roots (LMNs)
Signs of upper motor neuron pathology?
- Delayed muscle wasting (disuse)
- Increased tone
- Increased reflexes
- Extensor plantar / + Babinski (toes up)
- Pyramidal pattern of weakness
Signs of lower motor neuron pathology?
- Muscle wasting (denervation)
- Decreased tone
- Decreased reflexes
- Flexor plantar (- Babinski)
- Weakness
What is Brown-Sequard Syndrome? What are the characteristic sensory signs?
- Hemicord (half-cord) lesion of SC at certain level
- Loss of mechanoreceptors/proprioception on ipsilateral side of lesion. Weakness on this side also
- Loss of pain and temperature sense on contralateral side of lesion
sensory signs of nerve root damage?
Dermatomal sensory loss
What is Myelopathy?
Injury to the nerves located in the spinal cord (UMNs)
What is radiculopathy?
Injury to specific nerve roots (LMNs)
Autonomic nervous signs of radiculopathy?
Bladder/bowel incontinence
What is pyramidal pattern weakness?
- UMN lesion weakness
Causes of myelopathy/radiculopathy?
- Congenital disease
- Inflammation (MS/Sarcoid)
- Infection
- Tumours
- Vascular abnormalities (haemorrhage/dural fistula)
- Degeneration (spine)
- Metabolic (B12 deficiency)
- Trauma
Most common causes of acquired myelopathy?
- MS (demyelination)
- Ischaemia (vascular cause)
- B12 Deficiency
Look at arterial supply to the spinal cord
Print a diagram
Causes of spinal cord ischaemia?
Vascular pathology
- Atheroma
- Thromboembolism
- Arterial dissection
- Hypotension
- etc.
Clinical presentation of spinal cord stroke?
- Pain (flank/visceral referred)
- Weakness (usually in lower limbs more than upper)
- Numbness and paraesthesia
- Urinary symptoms (retention followed by incontinence)
Which artery is usually occluded during spinal cord stroke? Where along the spine does occlusion usually occur?
- Usually anterior spinal artery (dorsal columns spared)
- Usually in mid-thoracic region
Treatment of spinal cord stroke?
Reduce risk of recurrence:
- Maintain adequate BP
- Reverse hypovolaemia/arrhythmia
- Antiplatelets
What’s the prognosis like for spinal cord stroke?
- Unless significant motor function is recovered within first 24 hours chance of major recovery is low
- 20% mortality, 35-40% have more than minimal recovery
What is often the initial presentation of MS?
Demyelinating myelitis
Can occur without MS, subacute onset and spontaneous recovery
How to determine if demyelinating myelitis is MS related or not?
- CSF has few white cells (<50) in MS
Nervous system effects of vitamin B12 deficiency?
- Myelopathy
- Peripheral neuropathy
- Eye/optic nerve issues
- Brain/brainstem pathology
Signs of B12 deficiency myelopathy?
- Paraesthesia
- Areflexia
- Positive Babinsky
- Painless retention of urine
Investigations and treatment for B12 deficient myelopathy?
Investigations:
- FBC/blood film (check B12)
Treat with intramuscular B12
