PARAPLEGIA/SPINAL CORD LESION Flashcards

Question

Other Disease of the Spinal Cord

Answer 1

• Hereditary spastic paraparesis • Usually autosomal dominant • Infectious process of the vertabrae • TB, bacterial • Herniated disc with cord compression • Most herniated dises are lateral and only compress a nerve root • Degenerative disease of the vertabrae • Cervical spondylosis with a myelopathy • Spinal stenosis

Answer 2

• Radiographic exams • Plain films • Myelography • CT scan with myelography • M R I • Spinal tap • If you suspect: inflammation, MS, rupture of a v a s c u l a r m a l f o r m a t i o n

Answer 3

• Radiographic exams • Plain films • Myelography • CT scan with myelography • M R I • Spinal tap • If you suspect: inflammation, MS, rupture of a v a s c u l a r m a l f o r m a t i o n

Answer 4

• Complete cord syndrome • Brown-Sequard Hemicord syndrome • Central Cord Syndrome • Conus medulary syndrome • Cauda equina syndrome • Anterior two-third Syndrome

Answer 5

Cord hemisection • Trauma or tumor • Dissociated sensory loss • loss of pain and temperature contralateral to lesion, one or 2 levels below • crossing of spinothalamic tracts 1-2 segments above where they enter • loss of vibration/proprioception ipsilateral to the lesion • these pathways cross at the level of the brainstem • Weakness and UMN findings ipsilateral to lesion At the level of lesion • LMNL • Radicular pain • Hyperpathia

Answer 6

Central Cord Syndrome TallateS hesition No tactile anaesthesia • Sparing of sensation in perianal and sacral area • Medial corticospinal → arm weakness more than leg weakness. Late and less prominent est signs • Normal or minimally altered esf. • Trauma, syringomyelia, tumors

Answer 7

Syringomyelia • Fluid filled cavitation in the center of the cord • Cervical cord most common site • Loss of pain and temperature related to the crossing fibers occurs early • cape like sensory loss - Weakness of muscles in arms with atrophy and hyporeflexia (AHC) • Later - CST involvement with brisk reflexes in the legs, spasticity, and weakness • May occur as a late sequelae to trauma • Can see in association with Arnold Chiari malformation

Answer 8

• Extensive bilateral disease that spares the posterior column • Motor, pain, temperature and autonomic are lost below the level of lesion. • Intact JPS and Vibration • Etiology is vascular- affecting the anterior spinal artery either thrombo-embolism or compression lesions.

Answer 9

• Cervical region • Thoracic region • Lumbar region • Sacral cord / conus medullaris • Conus syndrome • Cauda equina lesion

Answer 10

High cervical • Life threatening • Quadriplegia • Respiratory paralysis (phrenic C3-5) • Extension to medulla → fatal • C4-5 may preserve respiration • C5-6 relative sparing of shoulder muscles, and loss of biceps and brachioradialis reflexes. • C7 spares biceps but produces weakness of finger and wrist flexors and loss of triceps reflex • C8 finger and wrist flexor are paralysed and finger flexor reflex is lost. • In general cervical cord disorders are best localized by the pattern or weakness that occurs whereas sensory deficits have less localizing value. • A Horner's syndrome may occur ipsilateral to cervical cord lesion

Answer 11

High cervical • Life threatening • Quadriplegia • Respiratory paralysis (phrenic C3-5) • Extension to medulla → fatal • C4-5 may preserve respiration • C5-6 relative sparing of shoulder muscles, and loss of biceps and brachioradialis reflexes. • C7 spares biceps but produces weakness of finger and wrist flexors and loss of triceps reflex • C8 finger and wrist flexor are paralysed and finger flexor reflex is lost. • In general cervical cord disorders are best localized by the pattern or weakness that occurs whereas sensory deficits have less localizing value. • A Horner's syndrome may occur ipsilateral to cervical cord lesion

Answer 12

• Best localized by sensory level using dermatomes • Weakness of the legs and bowel, bladder and sexual dysfunction also occur. • Abdominal muscle • T9-10 lesion → Beevor's sign • Unilateral lesions umbilicus moves to the opposite side. • Accompanying lesion of abdominal reflexes • Midline back pain is useful in localizing lesion.

Answer 13

• Progressive reduction in size of segments makes localization more difficult. L2-4 • Paralyse flexion and adduction of thigh • Weakness at knee extension • Abolish patellar reflex L5-S1 • Paralyse mvts of foot and ankle • Paralyze flexion at the knee - Paralyse extension of the thigh • Abolish ankle jerk • A cutaneous reflex useful in localizing of lumbar region disease is the cremasteric reflex which is segmentally innervated by L1-2.

Answer 14

• Conus medullaris is the tapered end of cord. Isolated lesion causes • Bilateral saddle anesthesia S3-5 • Prominent bladder dysfunction, retention and incontinence • Prominent bowel dysfunction, lax anal tone • Impotence • Bulbocavernosus reflex S2-4 absent • Anal reflex S4-5 absent • Muscle strength is largely preserved

Answer 15

• Conus medullaris is the tapered end of cord. Isolated lesion causes • Bilateral saddle anesthesia S3-5 • Prominent bladder dysfunction, retention and incontinence • Prominent bowel dysfunction, lax anal tone • Impotence • Bulbocavernosus reflex S2-4 absent • Anal reflex S4-5 absent • Muscle strength is largely preserved

Answer 16

• Severe low back pain or radicuar pain • Asymmetric leg weakness (Flaccid paraparesis) or sensory loss (saddle anaesthesia) • Variable areflexia LMNL in the lower extremities • Sphincteric dysfunction • Mass lesions in the lower spinal cord may produce a mixed clinical picture in which elements of cauda equina and conus medullaris syndromes coexist

Answer 17

• X-ray Spine • CT Myelography, • MRI • CSF analysis • CSF > Obstruction / impediment of esf circulation from caudal sac to the intracranial S.Arachnoid space • cytology for malignant cells, esf protein and glucose • VDRL • HIV • B12 assay, • Bld film for hypersegmented polymorhs • macrocytic picture

Answer 18

• Tailored to the cause • High dose steroids; • laminectomy • fractionated radiation Rx • surgery. • DO NOT FORGET ANTICOGULATION

Answer 19

• Pott's disease is a presentation of extrapulmonary tuberculosis that affects the spine. Precisely it is called tuberculous spondylitis and the original name was formed after Percivall Pott, a London surgeon.

Answer 20

• Pott's disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. • The infection then spreads from two adjacent vertebrae into the adjoining disc space If only one vertebra is affected, the disc is normal, but if two are involved the intervertebral disc, which is avascular, cannot receive nutrients and collapses. • The disc tissue dies and is broken down by caseation, leading to vertebral narrowing and eventually to vertebral collapse and spinal damage). A dry soft tissue mass often forms and superinfection is rare.

Answer 21

1. Clinical • The disease progresses slowly. Signs and symptoms include: • Localised back pain • Paravertebral swelling may be seen • Systemic signs and symptoms of TB may be present • Neurological signs may occur, leading to paraplegia. 2.Microbiology • Needle biopsy of bone or synovial tissue. Numbers of tubercle bacilli present are usually low but are pathognomonic. • Acid-fast stain and culture for Mycobacterium tuberculosis, plus fungi and other pathogens, should be performed. 3. Imaging • Spinal x-ray may not show early disease as 50% of bone mass must be lost for changes to be visible on x-ray. However, plain radiographs can show vertebral destruction and narrowed disc space. • MRI is useful to demonstrate the extent of spinal compression and can show changes at an earlier stage than plain radiographs. Bone elements visible within the swelling, or abscesses, are strongly indicative of Pott's disease as opposed to malignancy. • CT scans and nuclear bone scans can also be used

Answer 22

• Drug treatment is generally sufficient for Pott's disease. • With spinal immobilisation if required. • Surgery is required if there is spinal deformity or neurological signs of spinal cord compression. • Duration of antituberculosis treatment: • If debridement and fusion with bone grafting are performed, treatment can be for six months • If debridement and fusion with bone grafting are NOT performed a minimum of 12 months' treatment is required.