Spinal cord and nerve roots disease Flashcards
Differences between radiculopathy and myelopathy
- Myelopathy is the compression of the whole spinal cord
- Radiculopathy is the pinching of the nerves as they exit the spinal cord- affects the LMN.
- Myelopathy may be accompanied by radiculopathy.
Symptoms in spinal cord disease
If UMN damaged: The UMN is responsible for suppressing -Increased reflexes -Increased Tone -No wasting -Pyrimidal pattern of weakness
If LMN damaged:
- Decreased Tone
- Decreased reflexes
- Muscle wasting
- Decreased plantar flexion
Signs in spinal cord disease
In myelopathy : Sensory level loss- from that level downwards
In hemicord lesion:
- Brown- Sequard syndrome
- Contralateral pain and temperature receptor loss
- Ipsilateral vibration reception loss
- Ipsilateral joint sense reception loss
In Radiculopathy: Dermatomal sensory loss
Causes of myelopathy
Medical Congenital/ Genetic: Fredericks ataxia, spinocerebellar ataxia, hereditary paraparesis Inflammatory: -demyelination e.g. MS -autonomic -Sarcoid Vascular: -Ischaemic -Hemorragic Infective: -Viral -Bacterial Metabolic : -B12 deficiency Malignant Idiopathic
Presentation of spinal cord Ischaemia
- Usually presents in anterior spinal artery rather than posterior
- Usually presents in mid-thoracic cord
- Spinal shock may present (temporary loss of reflexes due to spinal cord injury)
- If occlusion of central sulcal artery occurs then Brown-sequard syndrome may present
Causes of spinal cord stroke
- Atheromatous disease
- Thromboembolic disease
- Arterial dissection
- Systemic hypotension
- Vasculitis
- Hyperviscosity syndromes
- Venous occlusion
- Endovascular problems
- Decompression sickness
- Meningovascular syphilis
Symptoms of spinal cord ischaemia
- Pain : Back and/or visceral referred pain
- Weakness : usually paraparesis (lower limb) than quadraparesis (all four limbs)
- Numbness and paraestesia (tingly feeling)
- Urinary symptoms : retention followed by incontinence as spinal shock settles in
what is spinal shock
Temporary loss of reflexes following spinal cord injury
Treatment of spinal cord stroke
Manage risk factors -OT -Physio Reduce risk of reoccurrence: -Keep an eye on BP -Antiplatelet therapy -Treat arrhythmia
Prognosis for Spinal cord Ischaemia
-Depends on level of parenchymal damage (functional unit of the muscle)
-If motor damage lasts more than 24 hours, small chance of recovery
-Pain could be persistant and lead to disability
-20% risk of mortality
35-40% have more than minimal recovery
Demyelinating myelitis presentation
Usually part of multiple sclerosis
Affects the young
- Inflammation and Demyelination lesions which leads to temporary neuronal dysfunction
- Affects the white matter
- May be initial presentation of MS
- May partial or incomplete transverse myelitis (spans across the spinal cord)
- May be a history of previous episodes
- Can be subacute presentation
Investigation/ treatment of demyelinating myelitis
Investigation: CSF
Treatment:
-Supportive
-Methylpredinosole
How is B12 deficiency related to NS?
Vitamin present in fish, meat, legumes
- Requires an intrinsic factor to be absorbed in the gut
- Penicious anaemia is a condition which prevents B12 from binding to the intrinsic factor.
- Affects most of the nervous system
How does B12 present in myelopathies
- Paraestsia in hands and feet
- First UMN sign is plantar extension
- Painless retention of urine
- Degeneration of Corticospinal tracts leads to: paraplegia
- Degeneration of dorsal columns leads to sensory ataxia
Investigations and treatment of B12 deficiency
Investigations: FBC
Treatment: Intramuscular B12
