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Neurology > Myelopathy > Flashcards

Myelopathy Flashcards

1
Q

Myelopathy

A

Any disease that affects the spinal cord

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2
Q

Spinal Cord Ends at what level

A

L1-L2

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3
Q

Spinal Taps are done where?

A

L4-5…Far below the end of the spinal cord

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4
Q

Pt says back pain is in the thoracic region?

A

BE CONCERNED

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5
Q

What is the only tract that crosses in the spinal cord?

A

Spinothalamic…all others stay ipsilateral within the spinal cord and cross in the brain

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6
Q

KNOW THE spinal cord antomy slide

A

ok

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7
Q

Damage to the Corticospinal tract results in

A
  • Hyper-reflexia
  • Spasticity
  • Babinski signs
  • weakness
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8
Q

Damage to the posterior columns results in:

A

Loss of vibration, proprioception, pts will show a Romberg sign because of loss of proprioception

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9
Q

Damage to the spinothalamic tract results in

A

Loss of Pain, Temperature

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10
Q

Damage to the anterior horn cells results in:

A

Flaccid weakness, hypo-reflexia, fasciculations

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11
Q

Damage to the Dorsal Root

A

numbness, lancinating pain, hyporeflexia

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12
Q

Romberg sign is NOT A CEREBELLAR SIGN.

A

IT is a posterior column sign

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13
Q

Spinothalamic and corticospinal are organized medually to laterally

A

ARM , Trunk Leg

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14
Q

KNOW spinal cord anatomy from inside to out

A

Starting inside

  • Parenchyma of the spinal cord itself
  • Pia mater
  • subarachnoid space
  • arachnoid
  • Subdural space
  • dura
  • epidural space (filled with fat)
  • Bone
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15
Q

Epidural really means

A

extradural

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16
Q

Intradural really means

A

subdural

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17
Q

Within the subarachonoid space

A

leptomeningeal

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18
Q

Within the spinal cord parenchyma

A

Intramedullary

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19
Q

Nipple line sensory level

A

T4…KNOW

20
Q

Umbilicus sensory level

A

T10…KNOW

21
Q

Describe the two general kinds of bladder symptoms present in spinal cord lesions

A

1) In acute lesions we generally see urinary retention

2) In chronic lesions there is a small spastic bladder that doesn’t completely empty with spasms and urge incontinence

22
Q

Acute and subacute myelopathies are:

A

EMERGENCIES

23
Q

In pts with acute myelopathy

A

do immediate neuroradiologic testing

therapy is usually IV steroids

24
Q

Approach to the pt with myelopathy

A
  • General Exam:
    Fever
    Ask the pt to show you where it hurts
    Check for tenderness on vertebral body
  • Neuro exam looking at motor, sensory, reflexes, gait
25
Q

Early symptoms of an EPIDURAL LESION

A
  • Dorsal root may be compressed which would lead to numbness, allodynia (hypersensitivity to touch)
  • If the spinothalamic tract has been injured, very subtle changes in sensory symptoms are seen in the CONTRALATERAL lower extrmity
  • Urinary urgency is common
  • some hyper-reflexia, babinski signs and difficulty walking
26
Q

As time passes, epidural lesion symptoms change how?

A
  • Legs become weak
  • Sensory symptoms worsen
  • Bladder and bowel dysfunction
27
Q

What is Partial Brown Sequard>

A

hemi-cord syndrome where you see weakness and numbness to touch on the ipsilateral side (corticospinal and medial lemniscal pathways)
and loss of pain sensation and temp on the CONTRA side because of the crossing over of spinothalamic tract

28
Q

Full blown spinal cord compression

A

Flaccid areflexic

If this was an acute injury there is complete sensory loss at lesion level

29
Q

Treatment for acute spinal cord injury

A

IV methyprednisolone

30
Q

Cancer can affect the spinal cord at EVERY level

A

ok

31
Q

Epidural myelopathy is a common complication of metastatic cancer from what locations

A

LUng, Breast, Prostate

32
Q

If you are suspicious of a spinal cord lesion in a cancer pt…

A

treat with steroids first (dexamethasone), arrange for a spinal cord MRI with Gadolinium

33
Q

What if the spine MRI is negative in a pt you suspect of a spinal cord lesion?

A

lumbar puncture

34
Q

Separating mets from infection

A

Cancer affects the vertebral body, infection begins in the disc

35
Q

The most common culprit of spinal cord infection

A

staph aureus….be very suspicious of IV drug abusers

36
Q

Epidural abscess signs and symptoms

KNOW

A

Fever, pain on percussion, elevated white count, elevated ESR, Risk factors such as drug use, immunosuppression, etc…

37
Q

What is osteomyelitis

A

infection of vertebral body…..causes weakness of the vert bodies and subsequent compression

38
Q

What the hell is Pott’s disease

A

Osteomyelitis resulting from TB infection

39
Q

Spinal meningiomas located where

A

Intradural, extramedullary lesion

  • Classic in the thoracic spine
  • Classic in middle aged women
40
Q

Examples of nerve sheath tumors

A

Schwannoma or neurofibroma

  • DUMBBELL SHAPE IS CLASSIC
  • most lesions common with neurofibromatosis
41
Q

Progression of a CENTRAL cord lesion (lesions that begin in the parenchyma of the cord)

A
  • Many start right around where the spinothalamic fibers cross so that loss of pain and temp are early signs
  • First sign may be pain in shoulders however
  • Posterior columns are spared until late, this is called Dissociate Sensory Level where vibration and proprioception are preserved compared to pain and temp.
  • Injury to dorsal root entry zone means reflex arcs are screwed up leading to hyporeflexia.
  • Sacral dermatomes may be spared until the very end becuase they are the most lateral
42
Q

Syrinx

A

Large expanding space in the spinal cord, a result of trauma or tumor

43
Q

Anterior Spinal Artery syndrome

KNOW

A

Artery of Adamkiewicz (Great Radicular Artery)- Pts have symptoms referable to spinothalamic and corticospinal loss because these tracts are located in teh anterior 2/3 of the spinal cord but they will retain Epicritic sensation coming through the posterior columns. Yet another examples of DIssociate Sensory Level

44
Q

Spinal Cord Shock

A

Complete Transection of SC

The big three things to look for are: FLACCIDITY, URINARY RETENTION, and COMPLETE SENSORY LEVEL

45
Q

How does B12 deficiency present as a spinal cord system

A

Epicritic and corticospinal damage

  • spastic weakness of lower extremities
  • decreased vibration and position sense
  • Romberg’s sign (remember that it is a medial lemniscus test)
  • Ataxia
  • Hyperreflexia

Treatment is IM injections of B12

46
Q

HTLV-1

A

Human T lymphotrophic virus 1 causes spastic paraperesis

Neurology (38 decks)

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