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N - C > Medical Diseases of the Spinal Cord > Flashcards

Medical Diseases of the Spinal Cord Flashcards

1
Q

What is myelopathy?

A

Pathology of the spinal cord

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2
Q

What is myelitis?

A

Inflammation of the spinal cord

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3
Q

What is radiculopathy?

A

Pathology of nerves (radiculo = nerve)

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4
Q

What is radiculitis?

A

Inflammation of the nerves (not common)

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5
Q

What is myeloradiculopathy?

A

Pathology of the spinal cord and nerve

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6
Q

How can the causes of myelopathy or radiculopathy be divided?

A

Intrinsic or extrinsic

Medical or Surgical

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7
Q

What are the medical causes of myelopathy or radiculopathy?

A 
Inflammation
Infarction
Infiltration
Infection
Degenerative (neurons)
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8
Q

What are the surgical causes of myelopathy or radiculopathy?

A
  • Tumour: extradural, intradural/ extramedullary, intramedullary
  • Vascular abnormalities: haemorrage, AVM, dural fistula
  • Degenerative (spine)
  • Trauma
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9
Q

What are the signs of a Upper Motor Neuron problem?

A

Increased tone

  • Spasticity
  • Clasp knife

Increased reflexes

Pyramidal pattern of weakness

Babinski sign

Pronator drift (associated with spasticity)

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10
Q

What is a pyramidal pattern of weakness?

A

A pattern of weakness in the extensors of upper limbs and flexors in lower limbs

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11
Q

What are the signs in lower motor neuron lesions?

A

Nerve damage causes muscle wasting

Decreased tone
Decreased reflexes
Weakness

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12
Q

What is the difference in paralysis of uper motor neuron lesion and lower motor neuron lesion?

A

Lower motor neuron lesion = flaccid paralysis
-Paralysis accompanied by loss of muscle tone.

This is in contrast to an upper motor neuron lesion, = spastic paralysis -Paralysis accompanied by severe hypertonia.

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13
Q

What are the sensory signs in radiculopathy?

A

Dermatomal pattern of sensory loss

C5,6
L5,S1

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14
Q

What is Brown-Sequard Syndrome?

A

Ipsilateral Side

  • UMN signs (Corticospinal tract damage)
  • Loss of sensory information (vibration, proprioception - Dorsal column)

Contralateral side
-Loss of pain and temperature
(STT)

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15
Q

What are the medical causes of myelopathy?

A 
Demyelination (MS)
Ischaemic
Transverse myelitis
Neurodegenerative
Metabolic, B12 deficiency
Malignant/ infiltrative
Infective
Inflammatory
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16
Q

What are the ischaemic causes of myelopathy?

A 
Atheromatous disease
Thromboembolic disease
Arterial dissection
Systemic hypertension
Hyperviscosity syndromes
Vasculitis
Venous occlusion
Endovascular procedures
Decompression sickness
Meningovascular syphilis
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17
Q

What is transverse myelitis?

A

Transverse myelitis = spinal cord is inflamed across entire width.

Inflammation damages nerve fibers, causes them to lose their myelin coating -> decreased electrical conductivity in the CNS.

Partial transverse myelitis and partial myelitis = inflammation of the spinal cord that affects part of the width of the spinal cord.

18
Q

What neurodegenerative disorders can cause myelopathy?

A

Friedrich’s ataxia

Spinocerebellar ataxias

19
Q

What infections can cause myelopathy?

A

Lyme disease

AIDS

20
Q

Explain the posterior and anterior spinal cord in relation to stroke

A

Anterior 2 thirds of the spinal cord are supplied by a single spinal artery

Posterior 1 third supplied by 2 arteries

Anterior (where all the motor function is) is much more at risk to spinal stroke

21
Q

What is the clinical presentation of spinal cord stroke?

A

May have vascular risk factors

Onset may be sudden or over several hours (unlike brain stroke)

Pain

  • Back pain/ radicular
  • Visceral referred pain

Weakness

Numbness and paraesthesia

Urinary symptoms

22
Q

Describe weakness in spinal stroke

A

Usually paraparesis rather than quadraparesis given vulnerability of thoracic cord flow related ischaemia

23
Q

What urinary symproms may you see in spinal stroke?

A

Retention followed by bladder and bowel incontinence as spinal shock settles

24
Q

Give some general points about spinal cord stroke

A

Very rarely posterior spinal artery -> dorsal column spared

Usually anterior spinal artery

Occlusion of a central sulcal artery can present as a partial Brown-Sequared syndrome

Usually mid thoracic

May be spinal shock

25
Q

What is spinal shock?

A

Spinal shock is a loss of sensation accompanied by motor paralysis with initial loss but gradual recovery of reflexes, following a spinal cord injury (SCI) – most often a complete transection.

Reflexes in the spinal cord below the level of injury are depressed (hyporeflexia) or absent (areflexia), while those above the level of the injury remain unaffected.

26
Q

What is the investigation for spinal cord stroke?

A

MRI

27
Q

What is the treatment for spinal cord stroke?

A

Supportive

Reduced risk of recurrence

  • Maintain adequate BP
  • Bed rest
  • Reverse hypovolaemia/ arrhythmia

Occupational therapy and physiotherapy

Manage vascular risk factors

28
Q

What is the prognosis for spinal cord stroke?

A

Return of function depends of degree of parenchymal damage

Unless significant motor recovery in first 24 hours chance of major recovery is low

Pain may be persistent and significantly contribute to disability

20% mortality, only 35-40% have more than minimal recovery

29
Q

What is demyeliniting myelitis?

A

Usually part of MS

Common cause of medical spinal cord disease

Can affect the young

30
Q

What is demyelinating myelitis of MS?

A

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

31
Q

Describe the presentation of demyelination myelitis of MS

A

Partial or incomplete transverse myelitis

May be the initial presentation of MS
-60-70% have MRI brains typical of MS

Subacute onset (over days to a week)

May be history of previous neurological or ophthalmic episodes

32
Q

How do you diagnose Myelitis in MS?

A

Typical history -> MRI -> diagnosis

If the history and scan are atypical you can go a lumbar puncture

33
Q

What is the treatment of MS Myelitis?

A

Supportive
-lots of options for symptoms

Methylprednisolone

  • Very high dose steroids
  • Helps with current episode
  • Will not prevent future relapse

Disease modifying treatments

34
Q

What are the causes for transverse myelitis?

A 
Idiopathic
Viral
Other infections
Autoimmune
Malignancies
Post vaccination
35
Q

What virus’ may cause transverse myelitis?

A

VZV, HSV, CMV, EBV, influenza, echo virus, HIV, hepA, rubella

36
Q

What other infections may cause transverse myelitis?

A

Syphilis
Measles
LYMES DISEASE

37
Q

What autoimmune disorders may cause transverse myelitis?

A

SLE
sjogren’s syndrome
sarcoidosis

38
Q

Describe vitamin B12 deficiency

A

Abundant in meat, fish and most animal by-products
Legumes

Absorption from gut requires intrinsic factor

Complicates total gastrectomy, Crohn’s, tape worms

39
Q

What is Pernicious anaemia?

A

Autoimmune condition in which antibodies to intrinsic factor prevent B12 absorption

40
Q

Where does B12 deficiency effect in the nervous system

A

Most of it:

  • Myelopathy (L’hermitte’s)
  • Peripheral neuropathy
  • Brain
  • Eye/optic nerves
  • Brainstem
  • Cerebellum
41
Q

What are the signs of B12 deficiency?

A

Parasthesia hands and feet, areflexia

First UMN sign is upturned plantars

Degeneration of:

  • CST -> paraplegia
  • Dorsal column -> sensory ataxia

Painless retention of urine

42
Q

In a patient with absent ankle jerk and upgoing plantars what should you suspect?

A

B12 dieficiency should be investigated

N - C (35 decks)

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