Myelopathy Flashcards
What is the classification of myelopathy?
COMPRESSIVE
V - AVM, hematoma
I - abscess, tuberculoma
N - tumors
D - Atlanto-axial instability
Osteophytes
Central disc herniation
C - syringomyelia/ chiari malformation
T - trauma
NON COMPRESSIVE
V - anterior spinal artery thrombosis
I - transverse myelitis, vasculitis (SLE)
N - vitamin B12 deficiency
D - multiple sclerosis, MND, syringomyelia
I - HIV , syphilis
What is non compressive myelopathy?
Pathologic conditions
That are not the result of mass pressure effects
Which cause damage and/ or dysfunction
To the spinal cord
Spinal meninges
Or perimeningeal spaces
Leading to sensory, motor and bladder-bowel dysfunction
*non compressive myelopathy must only be considered after performing imaging to rule out compressive aetiologies
What is transverse myelitis?
Non compressive myelopathy
Due to acute inflammation of the spinal cord
Restricted to few segments
Leading to loss of motor, sensory and sphincter function below the lesion
Which develop over few hours
Caused by idiopathic, infectious and post-infectious conditions
1/3rd are left with serious disability
How do you diagnose transverse myelitis?
Clinical criteria
- exclude compressive lesion by MRI
- sensory, motor and autonomic dysfunction
- Bilateral signs and symptoms
- clearly defined sensory level
- progressive over hours
Investigation criteria demonstrating spinal cord inflammation
- CSF pleocytosis or high IgG
- gadolinium MRI for inflammation
What are the spinal cord syndromes?
Spinal shock syndrome
Complete cord transection syndrome
Anterior cord syndrome
Central cord syndrome
Brown-Sequard syndrome
What are the features of anterior cord syndrome from vascular infarction?
Below the segment
Acute flaccid hemiparalysis Sensory level for PTT Sparing of JPS and V Sphincter dysfunction Absent anal reflex
AFTER SPINAL SCHOK
#At the segment Bilateral LMN signs
Bilateral UMN signs
Bilateral sensory loss
What is subacute combined degeneration of the cord (SCDC)?
A dorsolateral spinal cord syndrome
Caused by demyelination and degeneration of the posterior and lateral white matter tracts
Following vitamin B12 deficiency
Presenting with combined UMN LMN signs Subacute slowly progressive Paresthesia of the extremities Weakness and numbness Sensory ataxia
Spasticity
Paraplegia
Incontinence
On examination KJ hyper reflexia ABSENT AJ reflex Extensor plantars Stocking sensory loss Loss of JPS
What are the causes for absent ankle jerks with extensor plantars?
SCDC MND Tabes dorsalis Friedrich ‘s ataxia Conus medullaris syndrome Combined pathology (cervical spondylosis plus peripheral neuropathy)
What are the features of central cord syndrome?
After spinal shock
Bilateral LMN signs in segments affected
Bilateral UMN signs below the lesion with sacral sparing (upper limb>lower limb)
Bilateral sensory loss below the lesion with sacral sparing (upper limb>lower limb)
What are the features of Brown-Séquard syndrome?
After spinal shock
Ipsilateral LMN signs in the hemisegment
Ipsilateral UMN signs below the lesion
Ipsilateral anesthetic band in the hemisegment
Ipsilateral loss of dorsal column signs below lesion
Contralateral spinothalamic signs below the lesion
