Spinal Cord and Root Dysfunction Flashcards
What are the main tracts of the spinal cord?
Corticospinal tract, spinothalamic tract and the dorsal columns
What are some features of the corticospinal tract?
2 neuron tract
Tract is ipsilateral
What are the symptoms of an UMN lesion?
Increased tone, muscle wasting not marked, no fasciculation, hyperreflexia
What are the symptoms of a LMN lesion?
Decreased tone, muscle wasting, fasciculation, diminished reflexes
What are some features of the spinothalamic tract?
Responsible for pain, temperature and crude touch
Contralateral and decussates at spinal level
What are the dorsal columns responsible for?
Fine touch, proprioception and fine touch
What are the types of spinal cord compression?
Acute or chronic
Complete or incomplete
What are the causes of acute cord compression?
Trauma, tumour, infection, haemorrhage
What are the causes of chronic cord compression?
Spondylosis, tumours, rheumatoid arthritis
What is cord transection?
Complete lesion = all motor and sensory modalities affected
What are the symptoms of cord transection?
Present with sensory or motor level = flaccid arreflexic paralysis initially (spinal shock), UMN signs appear later
What is Brown-Sequard syndrome?
Cord hemisection = ipsilateral motor level and dorsal column sensory level, spinothalamic sensory level affected contralaterally
What causes central cord syndrome?
Hyperflexion or extension injury to already stenotic neck = best recovery rates of all syndromes
What does central cord syndrome present with?
Predominantly distal upper limb weakness
Cape-like spinothalamic sensory loss
Lower limb power and dorsal column preserved
What are the causes of spinal cord compression?
Trauma, tumour, degenerative disease, infection or haemorrhage
What kind of trauma causes spinal cord compression?
High energy or fall from height = mobile segments especially affected
What kind of tumours cause spinal cord compression?
Extradural, intradural and intramedullary
Haemorrhage may cause acute compression
What are some features of extradural tumours?
Usually metastasis = especially haematological malignancy, lung, breast, prostate and kidney
What are some examples of intradural tumours?
Extramedullary, meningioma and schwannoma
What are some examples of intramedullary tumours?
Astrocytoma and ependymoma
What are some causes of spinal canal stenosis?
Osteophytes, bulging of IV discs, facet joint hypertrophy, subluxation
What are some features of infections that can cause compression?
Epidural abscess = bloodborne, staph, TB, strep in IV drug users and children
Spread from surgery or trauma
What are some features of haemorrhages that can cause compression?
Epidural, subdural or intramedullary haemorrhages
May be due to trauma, bleeding diathesis or AV malformations
Less common cause of compression
How is trauma causing compression treated?
Immobilise and investigate, decompress and stabilise to aid rehabilitation
How are metastatic tumours treated?
Dexamethasone, radio/chemotherapy, decompression and stabilisation = need life expectancy of at least 6 months to qualify for surgery
How are primary tumours treated?
Surgical excision = not done very often as it’s difficult to qualify
How is infection treated?
Antibiotics, surgical drainage, stabilisation when needed = surgery only done if there is neurological deficit
How are haemorrhages treated?
Reverse anticoagulation and perform surgical decompression
How is degenerative disease treated?
Surgical decompression and stabilisation
