Diseases of the Spinal Cord and Nerve Roots (Medical) Flashcards
what are motor signs of cord/root pathology
Upper Motor Neuron (UMN) - cord No wasting ↑tone ↑reflexes, extensor plantar Pyramidal pattern of weakness
Upper Motor Neuron (UMN)
↑tone
↑reflexes, extensor plantar
Pyramidal pattern of weakness
Lower Motor Neuron (LMN) – root wasting ↓tone ↓reflexes, flexor plantar weakness
what are sensory signs of cord pathology?
Myelopathy → sensory level
Hemicord lesion → Brown-
Sequard syndrome
what are the sensory signs of root pathology?
Radiculopathy → dermatomal sensory loss
what are signs of C5 cord lesion?
Wasting of C5 innervated muscles ↑ tone in legs > arms Power ↓C5 innervated muscles, pyramidal pattern below Reflexes ↓biceps, ↑all lower reflexes Sensory level
causes of myelopathy or radiculopathy?
intrinsic or extrinsic Surgical Tumour Extradural, intradural/extramedullary, intramedullary Vascular abnormalities Haemorrhage AVM, dural fistula Degenerative (spine) Trauma
what are medical causes of myelopathy?
Congenital / genetic
Friedrich’s ataxia, spinocerebellar ataxias, hereditary paraparesis
Acquired 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
causes of spinal cord ischaemia?
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
clinical presentation of spinal cord stroke
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
Numbness and paraesthesia
Urinary symptoms
Retention followed by bladder and bowel incontinence as spinal shock settles
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 demyelinating myelitis?
Characterised by pathological lesions of inflammation and demyelination leading to temporary neuronal dysfunction
Affects the white matter of the CNS
One or more lesions anywhere
whats treatment of MS myelitis?
Methylprednisolone
where is B12 abundant?
in meat, fish, animal by-products
how is B12 absorbed?
Absorption from the gut requires intrinsic factor (IF), a binding protein secreted by gastric parietal cells
how are people deficient to B12?
Diet (vegans)
Pernicious anaemia: autoimmune condition in which antibodies to IF prevent B12 absorption
Total gastrectomy, Crohn’s, tape worms
what does B12 deficiency affect?
Myelopathy L’hermitte’s Peripheral neuropathy Brain Eye/optic nerves Brainstem cerebellum
