Medical Diseases of the Spinal Cord

Question 1

What are the motor signs of upper motor neuron pathology?

Answer 1

No wasting, increased tone, increased reflexes, extensor plantar and pyramidal pattern of weakness
Is often bilateral

Question 2

What is myelopathy?

Answer 2

Sensory level
Spinal cord is compressed causing nerve problems

Question 3

What can cause Brown-Sequard syndrome?

Answer 3

Hemicord lesion - UMN

Question 4

What are the clinical features of Brown-Sequard syndrome?

Answer 4

Ipsilateral - decreased vibration and joint position sense, weakness (dorsal column)
Contralateral - loss of pain and temperature (spinothalamic affected)

Question 5

What is a syrinx?

Answer 5

Small lesion in spinal cord which usually affects the spinothalamic tract

Question 6

What does an anterior lesion of spinal cord cause?

Answer 6

Lose spinothalamic tract but dorsal column intact
UMN signs below level

Question 7

What are some autonomic signs of cord pathology?

Answer 7

Bladder and bowel

Question 8

What are the causes of myelopathy?

Answer 8

Intrinsic or extrinsic
Can be surgical or medical
Surgical - tumour, vascular abnormalities, degeneration and trauma

Question 9

What are some medical causes of myelopathy?

Answer 9

Congenital/ genetic - hereditary paraparesis and spinocerebellar ataxias
Acquired - Inflammation (demyelination, autoimmune and sarcoid), vascular, infective, B12 deficiency, infiltrative/ paraneoplastic, idiopathic

Question 10

What are the investigations used for myelopathy?

Answer 10

Imaging - MRI best
Investigate causes - bloods and CSF

Question 11

Describe the vascular supply of the spinal cord

Answer 11

Supplied in 2 halves - anterior and posterior
Anterior is branch of vertebral artery

Question 12

What are some causes of spinal cord infarction?

Answer 12

Atheromatous disease, thromboembolic disease, arterial dissection, systemic hypotension, hyper-viscosity syndromes, vasculitis, endovascular procedures

Question 13

What is the clinical presentation of spinal cord stroke?

Answer 13

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

Question 14

What are some signs of spinal cord stroke?

Answer 14

Usually anterior spinal artery - dorsal column is spared
Occlusion of central sulcal artery - partial Brown-Sequard syndrome
Usually mid thoracic
May be spinal shock

Question 15

What is used for investigation of spinal cord?

Answer 15

MRI of spinal stroke - can be high signalling in anterior cord
Look for a cause

Question 16

What is the treatment for a spinal cord stroke?

Answer 16

Reduce risk of recurrence - maintain BP, reverse arrhythmia/ hypovolaemia and antiplatelet therapy (aspirin, clopidogrel)
OT and physiotherapy
Manage vascular risks

Question 17

What is the prognosis of a spinal stroke prognosis?

Answer 17

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

Question 18

How is B12 absorbed?

Answer 18

Abundant in meat, fish, animal by products
Absorption from gut requires intrinsic factor - binding protein secreted by gastric parietal cells

Question 19

What is B12 deficiency due to?

Answer 19

Diet -vegans
Pernicious anaemia - antibodies to IF prevent B12 absorption
Total gastrectomy, Chron’s and tape worms

Question 20

What does B12 deficiency affect in the nervous system?

Answer 20

Myelopathy, peripheral neuropathy, brain, eye/optic nerves, brainstem and cerebellum

Question 21

Describe B12 deficient myelopathy

Answer 21

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

Question 22

What is the investigations and treatment for B12 deficient myelopathy?

Answer 22

FBC/ blood film, B12, B12 metabolites
Can do MRI - usually see high signalling in posterior
Treatment is intramuscular B12