Medical Diseases of the Spinal Cord Flashcards
What are the motor signs of UMN Lesion?
No muscle wasting Increase in tone Increase in reflexes Extensor planta Muscle spasticity
What are the motor signs of LMN lesion?
Decrease in tone
Decrease in reflexes
Flexor plantar
Muscle weakness
What is myelopathy?
Injury to the spinal cord due to severe compression
What are the causes of myelopathy?
Inflammation Vascular Infective Metabolic Malignancy Idiopathic
What type of inflammation can cause myelopathy?
MS
Autoimmune e.g lupus
Sarcoidosis
What is a well known disease of demyelination?
Multiple sclerosis
What should autoimmune inflammation be treated with?
Immunosuppression
What viral infections can cause myelopathies?
Herpes simples/zoster, EBV, CMV, measles, HIV
What bacterial infections can cause myelopathies?
TB
Lyme disease
Syphillis
What metabolic conditions can cause myelopathies?
B12 deficiencies
What artery supplies the anterior spinal cord?
Anterior spinal artery
Which artery supples the posterior spinal cord?
Posterior spinal artery
What are the causes of spinal cord ischaemia?
Atheromatous disease Thromboembolic disease Arterial dissection Systemic hypotension Vasculitis Venous occlusion Endovascular procedures Decompression sickness
What is the clinical presentation of spinal cord stroke?
Back pain Visceral referred pain Weakness Paraparesis is more common than quadriparesis Leg weakness Bilateral sudden lower limb weakness Numbness Urinary and bowel incontenence
Which spinal artery is normally affected to cause spinal cord stroke?
Anterior spinal artery
What investigations should be carried out for spinal cord stroke?
MRI
What is the treatment for spinal cord stroke?
Aspirin Ot and physio Maintain BP Reverse arrythmias Antiplatelet therapy Manage vascular risk factors
What is the prognosis for spinal cord stroke?
Unless significant motor recovery in first 24 hours chance of major recovery is low
Pain may be persistent and contribute to disability
What is demyelinating myelitis?
Inflammation which affects the myelin sheath
What is MS characterised by?
Pathological lesions of inflammation and demyelination leading to temporary neuronal dysfunction
What is vitamin B12 abundant in?
Meat, fish and most animal by products
What does B12 absorption require?
Intrinsic factors from the gut
What is gut intrinsic factro released by?
Gastric parietal cells
What is pernicious anaemia?
Autoimmune condition in which antibodies to IF prevent B12 absorption
What is the commonest cause of percinious anaemia?
Inability to absorb B 12 at the terminal ileum
Or failure to produce IF in the stomach
How does Vitamin B 12 deficiency affect the spinal cord?
Myelopathy Paraesthesia in hands and feet First UMN sign Vitamin extensor plantar Degeneration of CTS Painless retention of urine
What is the investigations for vitamin B12 deficiency?
FBC
Blood film
B12
What is the treatment for Vitamin B12 deficiency?
Intramuscular B12
Given daily
Then one every 3 months
What happens if Vitamin B12 deficiency is left untreated?
It becomes permanent
Why does B12 deficiency have to be treated quickly?
Because when left untreated it becomes permanent
What is radiculopathy?
Radiculopathy is compression of the spinal cord at or near the root of the nerve shortly before it exits the spinal cord
