Neurosurgical emergencies of the back Flashcards
How does Acute cord compression present?
Bilateral pain in the back
LMN signs at cord compression level
UMN signs below cord compression level
Sphincter disturbance
How does Cauda Equina present?
Bilateral or alternating radicular pain in legs
Saddle anaesthesia
Loss of anal tone
Bladder/Bowel incontinence due to urinary retention overflow
What can cause Cauda Equina?
Large prolapse - Laminectomy, Disectomy
Tumours - Radiotherapy, steroids
Abscesses - Decompression
What is Anterior spinal artery syndrome/Anterior cord syndrome?
Spinal cord injury due to ischaemia/infarction of the anterior 2/3 of the spinal cord due to the anterior spinal artery (Made of the branches of the vertebral arteries)
Posterior 1/3 spared (Supplied by Posterior spinal artery)
How does Anterior cord syndrome present?
Complete motor paralysis below the level of the lesion (corticospinal tract)
Loss of pain and temperature at and below the level of injury (lateral spinothalamic tract)
Autonomic dysfunction (orthostatic hypotension)
Bladder/Bowel/Sexual dysfunction may occur depending on level of lesion
Why do patients with Anterior cord syndrome have intact 2-point discrimination, proprioception and vibratory senses?
Because these are transmitted via the DCML (Dorsal column medial lemniscus pathway) which is supplied by the Posterior spinal artery
What are some of the causes of Anterior cord syndrome?
Atheroscleosis
Aortic pathology eg AAA, Aortic dissection, Aortic thrombosis
External compression eg Herniated disc, Neoplastic mass, Posterior osteophyte
Trauma - Stab injury
What is the treatment of Anterior cord syndrome?
Treat the underlying cause
Supportive treatment and care
Prognosis for functional outcome is poor
What is Brown Sequard’s syndrome?
Lesion in one half of the spinal cord eg hemisection or lateral injury of the cord
How does Brown Sequard’s syndrome present?
Ipsilateral hemiplegia
Ipsilateral loss of tactile sensation and proprioception (Due to DCML not crossing over within the spinal cord)
Contralateral pain and temperature sensation deficits (due to crossing of the fibres of the anterolateral spinothalamic tract within the spinal cord)
Brisk reflexes
Sphincter disturbance
What are some of the causes of Brown Sequard’s syndrome?
Trauma to area Spinal cord tumours Multiple sclerosis (Demyelinating disease of brain and spinal cord) Cysts Disc herniation Haemorrhage Ischaemia Infection eg meningitis, empyema, abscess
What investigations can be done in a patient with suspected Brown Sequard’s syndrome?
X-Ray
MRI
CT myelinography if MRI contraindicated
What is the management of Brown Sequard’s syndrome?
A-E assessment
Neurological examination to assess level of lesion
Spinal immobilisation
Identify cause and treat if possible
What are some of the complications of Brown Sequard’s syndrome?
Hypotension (Spinal Shock)
PE
Infection
Depression
