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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
Q

3 types of IVDD

A 
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
Q

Degrees of IVDD severity

A
  • Pain only
  • Ambulatory para/tetraparesis
  • Non-amb. para/tetraparesis
  • Non-amb. para/tetraplegia, intact pain perception
  • Non-amb. para/tetraplegia, absent pain perception
27
Q

Dx of IVDD

A

gold standard: MRI

  • CT can visualize mineralized extruded disc material
  • Myelogram
28
Q

Tx of IVDD

A
  • strict cage rest/medical management

- Sx intervention

29
Q

does withdrawal reflex = pain perception?

30
Q

chars. of Degenerative Myelopathy

A
  • slowly progressive
  • begins at T3-L3
  • usually starts after 5yo
  • GSD, Boxers, Corgis
31
Q

CS of Degen. Myelopathy

A
  • proprioceptive ataxia and paraparesis
  • proprioceptive deficits in pelvic limbs
  • late stage: urinary/fecal incontinence
  • can affect thoracic limbs
32
Q

Dx of Degen. Myelopathy

A
  • NO SINGLE DEFINITIVE TEST*
  • MRI usually normal
  • electrodiagnostics may show denervation
  • SOD-1 gene SUGGESTIVE of dx only
33
Q

Tx of Degen. Myelopathy

34
Q

2 types of Cervical Spondylomyelopathy (“Wobblers”)

A

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
Q

classic presentation of Wobblers

A

two-engine gait

36
Q

chars. of Equine Wobblers

A
  • 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
Q

ANOMALOUS differentials for spinal cord dz

A

Atlanto-axial instability
Vertebral Malformations
Syringomyelia

38
Q

chars. of Atlanto-axial instability

A
  • typically due to odontoid (dens) hypoplasia/aplasia
  • abnormal ligamentous support of the dens may also contribute
  • young/toy breeds
  • sx stabilization required
39
Q

chars. of vertebral malformations

A
  • extremely common in French Bulldogs due to breeding for the “screw tail”
  • Hemi/butterfly/wedge/block vertebrae
  • often asymptomatic
40
Q

chars. of Syringomyelia

A
  • 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
Q

CS of Syringomyelia

A
  • CS of cervical myelopathy

- phantom scratching at neck/ears, pain

42
Q

Tx of Syringomyelia

A

reduce CSF production, pain management

43
Q

NEOPLASIA differentials for spinal cord dz

A 
Meningioma
Glioma
Lymhpoma
Nerve sheath tumor
Tumors of vertebrae: osteosarcoma, chondrosarcoma, fibrosarcoma, myeloma
44
Q

3 anatomic locations for tumors affecting the spinal cord

A

1) intra-medullary
2) intra-dural, extra-medullary (underneath dura matter but not in white matter)
3) extra-dural (easiest to remove)

45
Q

INFLAMMATORY differentials for spinal cord dz

A 
NON-infectious myelitis/meningomyelitis
Steroid Responsive Meningitis/Arteritis
Diskospondylitis
Infectious myelitis/meningomyelitis
Equine Protozoal Myelitis (EPM)
46
Q

chars. of NON-infectious myelitis/meningomyelitis

A
  • auto-immune
  • younger terriers and small breeds
  • requiresimmuno-suppressive meds
47
Q

chars. of Steroid Responsive Meningitis/Arteritis

A

-common aseptic inflammatory dz.
-young boxers, beagles, large breeds
-SEVERE cervical pain**
-hallmark = neutrophilic pleocytosis
+/- leukocytosis and fever

48
Q

chars. of Diskospondylitis

A
  • 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
Q

chars. of Infectious myelitis/meningomyelitis

A
  • rapidly progressive, painful, very sick
  • RARELY bacterial
  • can be viral, fungal, protozoa, rickettsiae
50
Q

chars. of Equine Infectious Myelopathies (Equine Protozoal Myelitis)

A
  • ASYMMETRIC: m. atrophy of gluteals, weakness, ataxia, stumbling
  • can be concurrent with intracranial dz
51
Q

TRAUMA differentials for spinal cord dz

A
  • vertebral fractures
  • brachial plexus activation
  • penetrating wounds
52
Q

TOXIN differentials for spinal cord dz

A

Clostridium tetani: inhibits GABA release –> skeletal m. rigidity

53
Q

VASCULAR differential for spinal cord dz

A

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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