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year 2 neuro - Robbie > Diseases of the Spinal Cord and Nerve Roots (Medical) > Flashcards

Diseases of the Spinal Cord and Nerve Roots (Medical) Flashcards

1
Q

What is a myelopathy?

A

spinal cord

an injury to the spinal cord due to severe compression that may result from trauma, congenital stenosis, degenerative disease or disc herniation

Myelopathy describes any neurologic deficit related to the spinal cord

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2
Q

What is a radiculopathy?

A

spinal roots/nerve roots

refers to a set of conditions in which one or more nerves are affected and do not work properly (a neuropathy)

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3
Q

image showing corticospinal tracts and where myelopathy and a rediculopathy would affect

A
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4
Q

What makes up the CNS and PNS

A

Everything in CNS is brain, brain stem and spinal cord and your PNS is anterior horn cells and nerve root and beyond

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5
Q

What are some signs of UMN cord pathology?

A
  • No wasting
  • ↑tone - spasticity, UMN normally cause inhabition of reflex arc
  • ↑reflexes, extensor plantar, clonus
  • Pyramidal pattern of weakness - decreased control of active movement, particularly slowness
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6
Q

What are some signs of LMN cord pathology?

A
  • wasting
  • ↓tone
  • ↓reflexes, flexor plantar
  • weakness
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7
Q

What are expected sensory signs of cord pathology?

A

Myelopathy → sensory level

Hemicord lesion → Brown-
Sequard syndrome (an incomplete spinal cord lesion characterized by findings on clinical examination which reflect hemisection of the spinal cord (cutting the spinal cord in half on one or the other side))
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8
Q

IMage explaining Brown-Sequard syndrome

A
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9
Q

What sensory signs would you see in rediculopathy?

A

dermatomal sensory loss

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10
Q

What signs would you see if there was a pathology of the autonomic fibres?

A

bladder and bowel problems

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11
Q

What would you see in a C5 cord lesion

A

Wasting of C5 innervated muscles

↑ tone in legs > arms

Power ↓C5 innervated muscles, pyramidal pattern below

Reflexes ↓biceps, ↑all lower reflexes

Sensory level

Anything above the lesion has weaker tone and reflexes - UMN symptoms present below the level of the lesion

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12
Q

What are surgical causes of myelopathy or radiculopathy?

A

Tumour - Extradural, intradural/extramedullary, intramedullary

Vascular abnormalities - Haemorrhage, AVM, dural fistula

Degenerative (spine)

Trauma

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13
Q

What are congenital/genetic medical causes of myelopathy

A

Friedrich’s ataxia, spinocerebellar ataxias, hereditary paraparesis

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14
Q

What are aquired medical causes of myelopathy

A

• 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/paraneoplastic
  • Idiopathic

Iatrogenic

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15
Q

What does ischaemic myelopathy cause?

A

spinal stroke/infarction

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16
Q

Where do the posterior and anterior spinal arteries arise?

A

posterior - comes from little small vessels form the aorta

anterior - branch of the vertebral arteries

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17
Q

What is it called when arteries perfusing an area meet and why is this important?

A

watershed areas

this area is most vulnerable to ischemia as pressure here is lowest

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18
Q

What are causes of spinal cord ischaemia?

A
  • Atheromatous disease (aortic aneurysm)
  • Thromboembolic disease (endocarditis, AF)
  • Arterial dissection (aortic)
  • Systemic hypotension
  • Hyperviscosity syndromes/prothombotic disease
  • Vasculitis
  • Arteriovenous abnormalities
  • Endovascular procedures
  • Meningovascular syphilis
  • Decompression sickness - happens when diving, air bubbles block arteries
19
Q

What is the clinical presentation of a spinal cord stroke?

A
  • May have vascular risk factors
  • Onset may be sudden or over several hours
  • Pain - Back pain/radicular, Visceral referred pain
  • Weakness - Usually paraparesis rather than quadraparesis given vulnerability of thoracic cord to flow related ischaemia - if cervical tehn will attack armds aswell but often just legs
  • Numbness and paraesthesia
  • Urinary symptoms - Retention followed by bladder and bowel incontinence as spinal shock settles
20
Q

What are some general examination points for a spinal cord stroke?

A
  • Usually anterior spinal artery => dorsal columns spared
  • Occlusion of a central sulcal artery can present as a partial Brown-Séquard syndrome
  • Usually mid thoracic
  • May be spinal shock
21
Q

How may imaging appear in a spinal stroke

A

imaging during a spinal stroke may look normal even though one is present

22
Q

What is the treatment of a spinal cord stroke

A

• Reduce risk of recurrence

Maintain adequate BP

Reverse hypovolaemia/arrhythmia

Antiplatelet therapy

  • OT and physiotherapy
  • Manage vascular risk factors
23
Q

What is the prognosis of a spinal cord stroke?

A

unless significant motor recovery in the 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

Variable but often poor prognosis

24
Q

What is demyelinating myelitis?

A

usually part of MS

common cause of medical spinal cord disease

can affect the young

spinal cord stroke is vascular but this is inflammation

25
Q

What is demyelinating myelitis in MS characterised by?

A

Characterised by pathological lesions of inflammation and demyelination leading to temporary neuronal dysfunction

one or more lesions

26
Q

Where does demyelinating myelitis in MS effect?

A

white matter of the CNS

27
Q

Does MS affect the PNS

A

no only the CNS

28
Q

What may be the intial presentation of MS?

A

demyelinating myelitis

29
Q

What is the onset of demyelinating myelitis like?

A

Subacute onset (slower than ischaemia)

30
Q

What is the recovery of demyelinating myelitis like?

A

Spontaneous recovery

31
Q

What is important to ask and remeber whena patient presents with demyelinating myelitis?

A

There may be a history of previous neurological or ophthalmological episodes so always ask

32
Q

When investigation myelitis in MS what is important to look at during investigations?

A

the brain as will show if the patient has had any previous episodes

33
Q

When a MRI cord lesion is present what is important to consider

A

MS as well as non MS causes such as vascular causes

34
Q

What is the CSF like in MS?

A

few white cells (<50)

35
Q

What is the treatment of MS myelitis?

A

supportive

methylprednisolone - a corticostreioid used to supress the immune system and decrease inflammation

36
Q

What deficiency is a metabolic cause of myeelopathy?

A

B12 deficiency

37
Q

Where can you get B12 from?

A

Abundant in meat, fish, animal by-products

38
Q

What is absorption of B12 done by?

A

Absorption from the gut requires intrinsic factor (IF), a binding protein secreted by gastric parietal cells

39
Q

What is a B12 deficiency due to?

A
  • Diet (vegans)
  • Pernicious anaemia: autoimmune condition in which antibodies to IF prevent B12 absorption
  • Total gastrectomy, Crohn’s, tape worms
40
Q

Where does B12 deficiency have an affect on?

A

Effect most of the nervous system:

  • Myelopathy
  • Peripheral neuropathy
  • Brain
  • Eye/optic nerves
  • Brainstem
  • cerebellum
41
Q

What symtpoms does B12 deficiency myelopathy cause?

A
  • Paraesthesia hands and feet, areflexia - abnormaly sensation, pins and needles
  • First UMN sign extensor plantars
  • Degeneration of:

Corticospinal tracts → paraplegia

Dorsal columns → sensory ataxia

• Painless retention of urine

(mix of UMN and LMN signs)

42
Q

What are the investigations that may be used for B12 deficiency myelopathy

A

FBC/blood film (can be N)

B12 levels

43
Q

What is th treatment of B12 deficiency myelopathy?

A

Intramuscular B12 (quicker the better)

year 2 neuro - Robbie (48 decks)

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