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Neurology (Spring 2015) > L04: Myelopathies: Diseases of the Spinal Cord (Senneca) > Flashcards

L04: Myelopathies: Diseases of the Spinal Cord (Senneca) Flashcards

1
Q

vertebral scale

A

C7 T13 L7 Sa3

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2
Q

Spinal cord segments scale

A

C8 T13 L7 Sa3 Ca5

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3
Q

blood supply of spinal cord

A

dorsolateral arteries connected by an anastomosing network to ventral spinal artery
-venous return via ventral vertebral venous plexus

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4
Q

Dorsal funiculus of spinal cord holds:

A

ascending tracts for proprioception and nociception (pain perception)

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5
Q

Lateral funiculus of spinal cord hold:

A

upper motor neuron tracts facilitory to limb flexors and inhibitory to extensors. Some ascending sensory tracts.

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6
Q

Ventral funiculus of spinal cord holds:

A

upper motor neuron tracts facilitory to extensors and inhibitory to flexors

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7
Q

main fx of upper motor neurons

A

control motor activity

-originate in brain and communicate with LMN (which innervate the muscles)

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8
Q

UMN signs seen with lesions affecting the descending motor pathways

A
  • paresis, paralysis, postural reaction deficits, ataxia
  • hypertonic, spastic
  • hyperreflexia
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9
Q

LMN signs seen with lesions affecting the ventral horn of the spinal cord

A
  • flaccid paresis/paralysis
  • hyporeflexia
  • neurogenic muscle atrophy (RAPID)
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10
Q

Horner’s Syndrome occurs at what segment?

A

T1-3 sympathetic fibers

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11
Q

Phrenic nerve at what segment?

A

C5-7

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12
Q

Lateral thoracic nerve at what segment?

A

C8-T1 (for cutaneous trunci panniculus)

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13
Q

LMN areas of clinical importance (2)**

A

C6-T2: Cervical intumescence

L4-S3: Lumbosacral intumescence (swelling)

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14
Q

CS of spinal cord disease

A

-paresis or plegia
-proprioceptive deficits (ipsilateral)
-proprioceptive ataxia
-loss of spinal reflexes depending on location
+/- abn. panniculus
-m. atrophy
+/- spinal pain
-micturition (urination) abnormalities
-respiratory difficulty with severe cervical lesions

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15
Q

CS NOT seen when disease affects ONLY spinal cord

A
  • change in mentation/attitude
  • cn deficits
  • seizure
  • vestibular signs
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16
Q

Does reflex response talk to brain?

A

NO

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17
Q

Does placing response talk to brain?

A

YES

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18
Q

Chart slide 14**

A

:)

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19
Q

C1-C5 lesions will have what responses/reflexes?

A

TL and PL reflexes only. No placing responses.

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20
Q

C6-T2 lesions will have what responses/reflexes?

A

PL reflexes only.

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21
Q

T3-L3 lesions will have what reflexes/responses?

A

TL and PL reflexes. TL placing response

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22
Q

L4-S3 lesions will have what reflexes/responses?

A

TL reflexes and responses. No PL.

23
Q

Dx of spinal cord dz

A

Hx, PE, minimum database
+/- spinal rads, CSF analysis, infectious dz testing
MRI or CT
Electrodiagnostics

24
Q

DEGENERATIVE differentials for spinal cord dz

A

IVDD
Degenerative Myelopathy
Cervical Spondylomyelopathy (CSM)
Equine Wobblers

25
3 types of IVDD
``` Hansen Type 1: -chondrodystrophics -nucleus pulposus EXTRUSION -usually acute Hansen Type 2: -non-chondrodystrophics -annulus fibrosis PROTRUSION -usually chronic signs Type 3: -traumatic disc -high velocity/low volume -temporary signs ```
26
Degrees of IVDD severity
- Pain only - Ambulatory para/tetraparesis - Non-amb. para/tetraparesis - Non-amb. para/tetraplegia, intact pain perception - Non-amb. para/tetraplegia, absent pain perception
27
Dx of IVDD
gold standard: MRI - CT can visualize mineralized extruded disc material - Myelogram
28
Tx of IVDD
- strict cage rest/medical management | - Sx intervention
29
does withdrawal reflex = pain perception?
NOO
30
chars. of Degenerative Myelopathy
- slowly progressive - begins at T3-L3 - usually starts after 5yo - GSD, Boxers, Corgis
31
CS of Degen. Myelopathy
- proprioceptive ataxia and paraparesis - proprioceptive deficits in pelvic limbs - late stage: urinary/fecal incontinence - can affect thoracic limbs
32
Dx of Degen. Myelopathy
* NO SINGLE DEFINITIVE TEST* - MRI usually normal - electrodiagnostics may show denervation - SOD-1 gene SUGGESTIVE of dx only
33
Tx of Degen. Myelopathy
PT only
34
2 types of Cervical Spondylomyelopathy ("Wobblers")
Disc-associated: -disc protrusion causing cord compression -Dobbies, Weimeraners Osseous-associated: -vertebral malformation/malarticulation, ligamentous hypertrophy (centers at joints/ligaments) -large and giant breed dogs most commonly
35
classic presentation of Wobblers
two-engine gait
36
chars. of Equine Wobblers
- young horses 1-2yo - compressive myelopathy due to BONY change - often have acute ataxia/gait abnormality after a traumatic incident - PL deficits more severe than thoracic usually
37
ANOMALOUS differentials for spinal cord dz
Atlanto-axial instability Vertebral Malformations Syringomyelia
38
chars. of Atlanto-axial instability
- typically due to odontoid (dens) hypoplasia/aplasia - abnormal ligamentous support of the dens may also contribute - young/toy breeds - sx stabilization required
39
chars. of vertebral malformations
- extremely common in French Bulldogs due to breeding for the "screw tail" - Hemi/butterfly/wedge/block vertebrae - often asymptomatic
40
chars. of Syringomyelia
- fluid dilatation within the spinal cord outside of the central canal that may or may not communicate with the central canal. - often 2ary to Caudal Occipital Malformation Syndrome (COMS)
41
CS of Syringomyelia
- CS of cervical myelopathy | - phantom scratching at neck/ears, pain
42
Tx of Syringomyelia
reduce CSF production, pain management
43
NEOPLASIA differentials for spinal cord dz
``` Meningioma Glioma Lymhpoma Nerve sheath tumor Tumors of vertebrae: osteosarcoma, chondrosarcoma, fibrosarcoma, myeloma ```
44
3 anatomic locations for tumors affecting the spinal cord
1) intra-medullary 2) intra-dural, extra-medullary (underneath dura matter but not in white matter) 3) extra-dural (easiest to remove)
45
INFLAMMATORY differentials for spinal cord dz
``` NON-infectious myelitis/meningomyelitis Steroid Responsive Meningitis/Arteritis Diskospondylitis Infectious myelitis/meningomyelitis Equine Protozoal Myelitis (EPM) ```
46
chars. of NON-infectious myelitis/meningomyelitis
- auto-immune - younger terriers and small breeds - requiresimmuno-suppressive meds
47
chars. of Steroid Responsive Meningitis/Arteritis
-common aseptic inflammatory dz. -young boxers, beagles, large breeds -SEVERE cervical pain** -hallmark = neutrophilic pleocytosis +/- leukocytosis and fever
48
chars. of Diskospondylitis
- infection of intervertebral disc and adjacent vertebral endplates by staph, strep, E. coli, or Brucella - can see on rads - good prognosis but requires long term tx with cephalosporins, sulfas
49
chars. of Infectious myelitis/meningomyelitis
- rapidly progressive, painful, very sick - RARELY bacterial - can be viral, fungal, protozoa, rickettsiae
50
chars. of Equine Infectious Myelopathies (Equine Protozoal Myelitis)
- ASYMMETRIC: m. atrophy of gluteals, weakness, ataxia, stumbling - can be concurrent with intracranial dz
51
TRAUMA differentials for spinal cord dz
- vertebral fractures - brachial plexus activation - penetrating wounds
52
TOXIN differentials for spinal cord dz
Clostridium tetani: inhibits GABA release --> skeletal m. rigidity
53
VASCULAR differential for spinal cord dz
Fibrocartilagenous Embolic Myelopathy (FCEM) - embolism of small piece of cartilage into vessel supplying spinal cord - large breeds, Mini Schnauzers - younger age - acute onset - spina infarct may be visualized on MRI - variable recovery rate

Neurology (Spring 2015) (7 decks)

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