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neuro > SC compression > Flashcards

SC compression Flashcards

1
Q

aetiology of SC compression

A

trauma

degenerative

tumour

infection

epidural hemorrhage/haematoma

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2
Q

degenerative causes

A
  • spondylotic/disc disease and spinal canal stenosis
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3
Q

tumour causes

A
  • Myeloma
  • Metastasise: breast, thyroid, bronchus, kidney, prostate
  • Spinal cord tumours:
    • intramedullary: tumour w/i the substance of the spinal cord – malignant e.g. glioma, ependymoma or astrocytoma
    • Intradural but extramedullary: meningioma (surface of cord), schwannoma or neurofibroma (from spinal root)
    • Extradural: epidural space or within/between vertebrae - metastatic carcinoma, lymphoma, myeloma, or can be other mass lesions, e.g. abscess, lipoma.
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4
Q

infective causes:

A
  • epidural abscess, TB, HIV
  • Typical site of infections: in facet joint (septic arthritis) or the intervertebral disc (discitis) or the vertebral bodies (osteomyelitis)
  • Epidural abscess: Infection in epidural space
    • Pathophysiology: staph aureus – via bloodstream from skin/soft tissue infection or sites of invasive procedures or surgeries
    • Clinical featues: triad - fever, spinal pain and neurological deficits
    • Ix: MRI, LP
    • Rx: Abx, surgical drainage
  • TB:
    • Pathophysiology: infection in disc space àform epidural or paravertebral abscess
    • Clinical features: pott’s paraplegia - destruction of vertebral bodies à spread of infection along the extradural space = cord compression and paraparesis
    • Ix: MRI, LP – culture of Mycobacterium tuberculosis
    • Rx: anti-TB therapy – triple or quadruple therapy
  • HIV: ↑ risk of pyrogenic spinal infection – staph aureus, TB, opportunistic infection
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5
Q
A
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6
Q
  • Epidural haemorrhage andHaematoma:

*

A
  • Aetiology: warfarin, bleeding diatheses and trauma, including lumbar puncture
  • Clinical features: rapidly progressive cord or cauda equina lesion – severe pain

Rx: surgical decompression, Mx underlying condition

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7
Q

what factors would you include when assessing cord compression clinically?

A
  • Pain
  • Progressive UMN weakness and sensory loss below lesion
  • T1 lesion: not affect arms
  • C5-T1 lesion: LMN and some UMNN signs in arm and UMN signs in leg
  • Lesion above C5: UMN signs legs and arms
  • Incontinence, hesitancy, urgency → painless retention

Faecal incontinence

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8
Q

degenerative disease SPONDYLOSIS definition

A

Degenerative changes within the spine – 2O to ageing or trauma or rheumatologically disease

eg. spondylotic/disc disease and spinal canal stenosis

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9
Q

pathophys of degenerative disease SPONDYLOSIS

A
  • Dehydration and disintegration of the nucleus pulposus -> reduction in discheight and tears in the annulus fibrosis
  • Loading and hypertrophy of facets -> bulging of disc à ligamentum flavum hypertrophy (posteriorly) = narrowing of spinal cord
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10
Q

SPONDYLOSIS- DISC PROTRUSION S/S

A
  • Disc protrusion: herniation of nucleus pulposus
  • Herniation:
    • Commonly - laterally = compression of nerve roots = LMN lesion
    • Can occur – centrally and posteriorly = cord compression

· Above L1: spastic paraparesis, tetraparesis

· Below L1: cauda equina – LMN signs affecting legs and bladder

  • Common locations – mobile parts of spinal cord:
    • Cervical: C5/6 and C6/7 discs = C6 andC7 radiculopathies
    • Lumbar: L4/5 and L5/S1 discs, involving the L5 and S1 spinal nerves in the lower limbs
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11
Q

SPONDYLOSIS- SPINAL CANAL STENOSIS S/S

A
  • compression of spinal cord
  • Presentation:
    • Radiculopathy: compression of individual spinal root = stabbing, radicular pain in a dermatomal distribution
    • cervical spondylotic myelopathy: canal stenosis = compression of spinal cord = stepwise neurological deterioration

Cauda equina and neurogenic claudication: lumbar stenosis = calf pain, weakness and sensory disturbance – worse on walking, standing, eased on bending forwards, sitting, lying (↑ diameter of spinal canal)

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12
Q

SPONDYLOSIS RX

A
  • Conservative: analgaesia, NSAIDs, exercise, PT

- Surgical: if there is neurological compromise

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13
Q

CERVICAL SPONDYLOSIS: DEFINITION

A
  • Degeneration due to trauma or ageing
  • Intervertebral disc / vertebral collapse
  • Osteophytes

May → narrow the spinal canal and intervertebral foramina - central (myelopathy) and/or lateral (radiculopathy) pathology

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14
Q

CERVICAL SPONDYLOSIS: EPIDEMIOLOGY

A

90% of men > 60 and women > 50

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15
Q

CERVICAL SPONDYLOSIS S/S

A
  • Presentation
  • Usually asympto
  • Neck stiffness ± crepitus on moving neck
  • Stabbing / dull arm pain (brachialgia)
  • Forearm and wrist pain
  • Root compression (radiculopathy):
  • Pain/electrical: arms or fingers – at level of compression
  • Reflexes: dull reflexes
  • Dynatomal sensory disturbances: numbness, tingling, ↓ pain and temperature
  • Level of affected root: LMN weakness + wasting of innervated muscles
  • Below level of affected root: UMN signs – cord compression
    • spasticity, weakness, brisk reflexes and up-going plantars
  • Specific Signs
  • Lhermitte’s sign: neck flexion → tingling down spine
  • Hoffman reflex: flick to middle finger pulp → brief pincer flexion of thumb and index finger
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16
Q

CERVICAL SPONDYLOSIS IX

A
  • Imaging: MRI – localise lesion

- Time to walk 30m: monitor progress

17
Q

CERVICAL SPONDYLOSIS MX

A
  • Conservative – indication - spinal transverse area >70mm2, elderly and motor conduction time is normal
  • stiff collar: restricts anterior and posterior movements – help w/ pain
  • analgesia
  • Medical: transforaminal steroid injection
  • Surgical: decompression: laminectomy or laminoplasty

Complication: anterior spinal fusion

18
Q

CERVICAL SPONDYLOSIS COMPLICATIONS

A
  • Diaphragm paralysis
  • spinal artery syndrome
19
Q

CERVICAL SPONDYLOSIS DDX

A
  • MS
  • Nerve root neurofibroma
  • subacute combined degeneration of the spinal cord: ↓ B12
  • compression by bone or tumour
  • intramedullary spinal sarcoidosis
20
Q

VASCULAR CORD LESION DEFINITION

A

Infarction of the spinal cord

21
Q

VASCULAR CORD LESION- AETIOLOGY

A
  • Occlusion of anterior or posterior spinal arteries: thrombus or emboli

severe hypotension or cardiac arrest

22
Q

VASCULAR CORD LESION

A
  • Sudden onset
  • Back pain
  • Paralysis, loss of bladder function and loss of pain and temperature below the level of the lesion
  • Position and vibration sense are spared
  • Acute stage – spinal shock à flaccid weakness à progress to spasticity
23
Q

TRANSVERSE MYELITIS DEFINITION

A

broad term used to describe segmental inflammation of the cord with resultant paraparesis (or tetraparesis), arising from a wide range of diseases

24
Q

TRANSVERSE MYELITIS- AETIOLOGY

A
  • Idiopathic
  • autoimmune: MS
  • Infection: viral infection (EBV, VZ, CMV, HSV, Hep C), parasitic infection (schistosomiasis)
  • Sarcoidosis
  • connective tissue disease: RA, SLE
25
Q

TRANSVERSE MYELITIS- S/S

A
  • Inflammation: restricted to 1 or 2 segments
  • Onset: hours

loss of distal motor (weak limbs), sensory (↓, pain, tingling, radicular pain) and sphincter function

26
Q

TRANSVERSE MYELITIS- IX

A
  • Clinical
  • MRI
  • LP
27
Q

TRANSVERSE MYELITIS MX

A
  • Rx underlying cause
  • Steroids
28
Q

METABOLIC + TOXIC CORD DISEASE

A

Subacute combined degeneration of cord

metabolic disease affecting the spinal cord and is caused by deficiency of vitamin B12

29
Q

METABOLIC + TOXIC CORD DISEASE

A
  • Nutritional deficiencies: vegans
  • pernicious anaemia

Gastrectomy or disease of the terminal ileum

30
Q

Metabolic and toxic cord disease pathology

A
  • Deficiency causes - dorsal spinal cord syndrome: degeneration of the dorsal and lateral white matter of the spinal cord
31
Q

Metabolic and toxic cord disease- s/s

A

slowly progressive weakness, sensory ataxia and paraesthesias, and, ultimately, spasticity, paraplegia and incontinence

32
Q

Metabolic and toxic cord disease - mx

A
  • Vitamin B12 – risk of damage to peripheral nerves

neuro (30 decks)

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