Patho- Spinal cord disease Flashcards
What are the two main conditions affecting the spinal cord?
Compression
Lesions
What areas of the spinal cord can be lesioned?
Cord
Roots
Brain stem
What damage can occur to a dorsal root?
Sectioning
Compression
What does sectioning a dorsal root do?
Complete sensory loss from dermatome
What are some symptoms of dorsal root compression?
Pain in the myotomes supplied
Tingling in the dermatome supplied
Pain worse on movement
Pain worse on increased ICP- Cough etc
What can cause dorsal root compression?
Herniated disc
What symptoms does lesioning the posterior column of the spinal cord cause?
Tingling Electric-shock-like sensations Clumsiness Numbness Band-like sensations Lateralized but vague Stamping gait Lhermitte’s sign- electric shock down legs
What symptoms can a Spinothalamic tract lesion cause?
Contralateral pain and temp loss
How much of the spinal cord can be lesioned?
Partial- hemi
Complete
What is a chronic spinal cord lesion?
Compression
What forms can an acute spinal cord lesion take?
Complete transection
Brown-sequard syndrome
Central Cord Syndrome
What can cause an acute spinal cord lesion?
Trauma
Tumour
What are some symptoms of complete spinal cord transection?
All sensory and motor affected below lesion
What can complete spinal cord transection cause?
Spinal shock- Flaccid areflexic paralysis
What causes Brown-sequard syndrome?
Hemisectioning
What are some symptoms of Brown-sequard syndrome?
Contralateral pain and temp loss
Ipsilateral weakness/paralysis and loss of proprioception
What can cause central cord syndrome?
Generally hyperextension of neck in already stenosis or spondylosis spine.
What are some symptoms of central cord syndrome?
Cape-like sensory loss
Upper limb weakness
Lower limb strength preserved
What parts of the brain stem can be lesioned?
Pons
Thalamus
Cortex (not BS)
What can cause pons lesions?
MS
What is the symptom of pons lesion?
Full contralateral sensory loss
What can cause thalamus lesion?
Infarct
What are some symptoms of thalamus lesions?
Hemiparesis and sensory loss: Weankness tends to improve but chronic pain remains
What can a cortex lesion cause?
Sensory loss
Side neglect
Apraxia
No patho pain
What can cause spinal cord compression?
Tumor TB Disc herniation Abscess Bleeding B12 deficiency Syringomyelia and syringobulbia
What is Syringomyelia and syringobulbia?
Fluid filled cavity in spinal cord (myelia) or the brain stem (bulbia)
What is Syringomyelia and syringobulbia associated with?
Arnold-Chiari Malformation
What is the pathology of Syringomyelia and syringobulbia?
ACM cerebellar down into foramen magnum
What areas can be affected by Syringomyelia and syringobulbia?
Spinothalamic
Anterior horn
Lateral corticospinal tracts
What are some symptoms of Syringomyelia and syringobulbia?
Develop 20-30
Upper limb pain worse on coughing
Spinothalamic sensory loss- Pain and temp
Loss of upper limb reflexes
What are some signs of spinal cord compression?
UMN signs
Progressive spastic paresis -Para or tetra depending on level
Radicular pain at level affected- Can be absent
Sensory loss from all levels below
Sphincter disturbance
What are the UMN signs?
Muscle weakness Hyper-reflex Rigidity Clonus Babinski sign
How do you treat spinal cord compression?
Medical emergency!!! MRI CSF for infection or tumor Decompress immediately Can use radio for tumor
How do you manage para/tetraplegia?
Treat issues: Bladder Bowels Skin Limb
How do you manage bladder issues in para/tetraplegia?
Catheterise
Reflexes can return with time
How do you manage bowel issues in para/tetraplegia?
Manuel evacuation
How do you manage skin issues in para/tetraplegia?
Turning to avoid pressure sores
Cleaning to prevent infection
How do you manage limb issues in para/tetraplegia?
Physio to prevent contractures
Baclofen for contractures
