Medical Diseases of the Spinal Cord Flashcards
What are the motor signs of upper motor neuron pathology?
No wasting, increased tone, increased reflexes, extensor plantar and pyramidal pattern of weakness
Is often bilateral
What is myelopathy?
Sensory level
Spinal cord is compressed causing nerve problems
What can cause Brown-Sequard syndrome?
Hemicord lesion - UMN
What are the clinical features of Brown-Sequard syndrome?
Ipsilateral - decreased vibration and joint position sense, weakness (dorsal column)
Contralateral - loss of pain and temperature (spinothalamic affected)
What is a syrinx?
Small lesion in spinal cord which usually affects the spinothalamic tract
What does an anterior lesion of spinal cord cause?
Lose spinothalamic tract but dorsal column intact
UMN signs below level
What are some autonomic signs of cord pathology?
Bladder and bowel
What are the causes of myelopathy?
Intrinsic or extrinsic
Can be surgical or medical
Surgical - tumour, vascular abnormalities, degeneration and trauma
What are some medical causes of myelopathy?
Congenital/ genetic - hereditary paraparesis and spinocerebellar ataxias
Acquired - Inflammation (demyelination, autoimmune and sarcoid), vascular, infective, B12 deficiency, infiltrative/ paraneoplastic, idiopathic
What are the investigations used for myelopathy?
Imaging - MRI best
Investigate causes - bloods and CSF
Describe the vascular supply of the spinal cord
Supplied in 2 halves - anterior and posterior
Anterior is branch of vertebral artery
What are some causes of spinal cord infarction?
Atheromatous disease, thromboembolic disease, arterial dissection, systemic hypotension, hyper-viscosity syndromes, vasculitis, endovascular procedures
What is the clinical presentation of spinal cord stroke?
May have vascular risk factors
Onset mainly sudden but can be several hours
Pain in back or radicular (radiates to anterior abdomen or thorax)
Weakness
Numbness and paraesthesia
Urinary symptoms
What are some signs of spinal cord stroke?
Usually anterior spinal artery - dorsal column is spared
Occlusion of central sulcal artery - partial Brown-Sequard syndrome
Usually mid thoracic
May be spinal shock
What is used for investigation of spinal cord?
MRI of spinal stroke - can be high signalling in anterior cord
Look for a cause
What is the treatment for a spinal cord stroke?
Reduce risk of recurrence - maintain BP, reverse arrhythmia/ hypovolaemia and antiplatelet therapy (aspirin, clopidogrel)
OT and physiotherapy
Manage vascular risks
What is the prognosis of a spinal stroke prognosis?
Unless significant motor recovery in first 24 hours then chance of major recovery is low
Pain may be persistent
20% mortality and 35-40% have more than minimal recovery
How is B12 absorbed?
Abundant in meat, fish, animal by products
Absorption from gut requires intrinsic factor - binding protein secreted by gastric parietal cells
What is B12 deficiency due to?
Diet -vegans
Pernicious anaemia - antibodies to IF prevent B12 absorption
Total gastrectomy, Chron’s and tape worms
What does B12 deficiency affect in the nervous system?
Myelopathy, peripheral neuropathy, brain, eye/optic nerves, brainstem and cerebellum
Describe B12 deficient myelopathy
Parasethesia of hands and feet and araflexia (absence of reflexes)
First UMN sign is extensor plantars
Painless retention of urine and degeneration of corticospinal tracts and dorsal columns
What is the investigations and treatment for B12 deficient myelopathy?
FBC/ blood film, B12, B12 metabolites
Can do MRI - usually see high signalling in posterior
Treatment is intramuscular B12
