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Z Year3 Neuro Conditions > Spinal Cord Compression > Flashcards

Spinal Cord Compression Flashcards

1
Q

What are causes of spinal cord compression?

A
  1. Trauma (age 16-30)
  2. Vertebral compression fracture
  3. Intervertebral disc herniation (30-50)
  4. Primary or metastatic spinal tumour (40-75)
  5. Infection
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2
Q

What are different types of spinal cord compression?

A
  • acute
  • subacute
  • chronic
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3
Q

What are RF for spinal cord compression?

A
  1. Trauma

2. High risk occupation or sports activity

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4
Q

What are possible symptoms and signs of spinal cord compression?

A
  1. Acute/chronic onset and duration of symptoms
  2. Back pain
  3. Numbness or paraesthesia’s
  4. Weakness or paralysis
  5. Bladder or bowel dysfunction
  6. Hyper-reflexia
  7. Sensory loss
  8. Muscle weakness or wasting
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5
Q

What are DDx for spinal cord compression?

A
  1. Transvere myelitis
  2. Guillain-Barre syndrome (GBS)
  3. HIV-related myelopathy
  4. ALS
  5. MS
  6. Diabetic neuropathy
  7. Polymyositis
  8. Hereditary Muscular dystrophy
  9. Peripheral neuropathy
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6
Q

What investigations may you do for spinal cord compression?

A
  1. MRI spine
  2. Gadolinium-enhanced MRI spine
  3. Plain spine X ray
  4. CT spine
  5. CT myelography
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7
Q

What may an MRI spine show?

A
  1. disc displacement
  2. epidural enhancement
  3. mass effect
  4. T2 cord signal
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8
Q

What can gadolinium enhanced MRI spine?

A
  1. infection: epidural space and bone involvement

2. metastatic disease: visualisation of tumour

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9
Q

What would a plain spine X ray show for which type of condition?

A
  1. decreased disc space height (disc compression)
  2. loss of bony detail (tumour, infection)
  3. misalignment of vertebral elements (trauma)
  4. loss of end-plate definition (infection)
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10
Q

What is the 1st line management for spinal cord compression unknown cause?

A

1st line: immobilisation + decompressive/stabilisation surgery

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11
Q

What would you add to the management of spinal cord compression?

A
  • IV corticosteroid e.g. methylprednisolone
  • Prevention of DVT
  • Maintenance of volume and BP
  • Prevention of gastric stress ulcers
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12
Q

What is the 1st line treatment for cauda equina?

A

decompressive laminectomy

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13
Q

What is the the 1st line treatment of a malignant spinal cord compression?

A

1st line: Corticosteroids, surgery, radiotherapy

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14
Q

What is the 1st line treatment of epidural abscess?

A

1st line: antibiotics and surgery

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15
Q

What are possible complications of spinal cord compression?

A
  1. Pressure ulcers
  2. Post-op autonomic dysfunction
  3. Cardiovascular dyfunction
  4. DVT
  5. UTI
  6. Etc
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16
Q

What is the prognosis of spinal cord compression?

A

Recurrence rates of malignant spinal cord compression: 7-9%

17
Q

What is spinal cord compression?

A

Injury to the spinal cord with neurological symptoms dependent on the site and extent of injury

18
Q

What are the motor symptoms?

A
  1. Limb weakness (hemiplegia/paraplegia)
  2. UMN symptoms below the level of the lesion
  3. LMN symptoms at the level of the lesion
19
Q

What are the sensory symptoms?

A
  1. Sensory loss below a specific level

2. Back pain

20
Q

What are the autonomic symptoms in spinal cord compression?

A
  1. Constipation
  2. Urinary retention
  3. Erectile dysfunction
21
Q

What radiological investigations are used?

A
  1. Definitive diagnosis – MRI
  2. May also use CT
  3. Lateral x-rays of spine for loss of alignment , fractures
22
Q

What bloods are done?

A

FBC, U&Es, calcium, ESR, immunoglobulin electrophoresis (multiple myeloma?)

23
Q

What urine tests are done?

A

Ø Bence Jones proteins (multiple myeloma?)

24
Q

What is cauda equina syndrome?

A

Lumbosacral nerves roots that form the cauda equina in the spinal canal become compressed

25
Q

What causes cauda equina?

A
  1. disc herniation

2. compression and stenosis of the spinal canal

26
Q

What are the signs and symptoms of cauda equina?

A
  1. LMN signs (hypotonia, hyporeflexia)
  2. Perianal paresthesia/numbness
  3. Lax anal tone
  4. Bladder retention
  5. Leg weakness
27
Q

What investigation is done for cauda equina?

A

Urgent MRI spine: May reveal compression by disc herniation, abscess etc

28
Q

What is management for cauda equina?

A
  1. A to E: analgesia once stable
  2. Inset catheter
  3. Surgery
29
Q

What surgery is used for cauda equina?

A
  1. Urgent referral to neurosurgery

2. Surgical decompression by laminectomy (removal of vertebral lamina) or discectomy (removal of intervertebral disc)

30
Q

What are possible complications of cauda equina?

A
  1. Paraplegia
  2. Chronic urinary retention
  3. Bowel incontinence

Z Year3 Neuro Conditions (34 decks)

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