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CNS CLERKSHIP > Spinal Cord Compression > Flashcards

Spinal Cord Compression Flashcards

1
Q

The upper motor neurone of the corticospinal tract runs from where?

A

Motor cortex to anterior grey horn and decussates at medullary level.

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2
Q

What signs are suggestive of an UMN lesion?

A
  • Increased tone.
  • Muscle wasting NOT marked.
  • No fasciculations.
  • Hyper-reflexia.
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3
Q

What is a fasciculation?

A

Brief spontaneous contraction affecting a small number of muscle fibres, often causing a brief flicker of movement under the skin.

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4
Q

What signs are suggestive of a LMN lesion?

A
  • Decreased tone.
  • Muscle wasting.
  • Fasciculation.
  • Diminished reflexes.
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5
Q

Describe function of spinothalamic tracts.

A

SENSORY PATHWAY.

  • Pain, temperature and crude touch.
  • Contralateral.
  • Decussates at spinal level.
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6
Q

Describe function of dorsal columns.

A

SENSORY PATHWAY

  • Fine touch, proprioception, vibration.
  • Ipsilateral.
  • Decussate at medullary level.
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7
Q

Describe broad categories of spinal cord compression.

A
  • Acute or chronic.

- Complete or incomplete.

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8
Q

What may cause acute spinal cord compression?

A
  • Trauma.
  • Tumours: haemorrhage or collapse.
  • Infection.
  • Spontaneous haemorrhage.
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9
Q

What may cause chronic spinal cord compression?

A
  • Degenerative disease e.g. spondylosis.
  • Tumours.
  • Rheumatoid arthritis.
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10
Q

Describe spinal cord transection?

A

A complete lesion affecting all motor and sensory modalities.

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11
Q

What is the initial effect of a spinal cord transection?

A
  • Flaccid arreflexic paralysis: “spinal shock”.

UMN signs appear later.

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12
Q

What is Brown-Sequard syndrome?

A
  • Ipsilateral motor level.
  • Ipsilateral dorsal column sensory level.
  • Contralateral spinothalamic sensory level.
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13
Q

What is central cord syndrome?

A

Hyperflexion or extension injury to an already stenotic neck.

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14
Q

How does central cord syndrome present?

A
  • Predominantly as distal upper limb weakness.
  • “Cape-like” spinothalamic sensory loss.

Lower limb power is preserved.
Dorsal column is preserved.

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15
Q

How does chronic spinal cord compression present?

A

Predominant UMN signs.

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16
Q

What may cause traumatic spinal cord compression?

A
  • High energy injury. Esp. in mobile spine segments e.g. cervical.
17
Q

What extradural tumours that commonly cause spinal cord compression?

A

Usually metastases from lung, breast, kidney, prostate.

18
Q

What intradural tumours commonly cause spinal cord compression?

A

Extramedullary meningioma, Schwannoma.

Intramedullary astrocytoma, ependymoma.

19
Q

How do tumours cause spinal cord compression?

A
  • Slowly compress.

- Cause acute compression by collapse or haemorrhage.

20
Q

Spinal canal stenosis is a degenerative, displaying what features?

A
  • Osteophyte formation.
  • Bulging of intervertebral discs.
  • Facet joint hypertrophy.
  • Subluxation.
21
Q

What are causes of infection within the spinal cord?

A
  • Epidural abscess: bloodborne, Staph., TB.

- Surgery or trauma.

22
Q

How is haemorrhage within the spinal cord managed?

A
  • Immobilise.
  • Investigate.
  • Decompress and stabilise.
  • Methylprednisolone?
23
Q

How is haemorrhage of spinal cord decompressed and stabilised?

A
  • Surgery, traction and external fixation.
24
Q

How is methylprednisolone administered in spinal cord haemorrhage?

A

Bolus 24 hour infusion.

25
Q

How is spinal cord haemorrhage investigated?

A

X-ray, CT or MRI.

26
Q

Although treatment for metastatic tumours of the spinal cord is dependent on patient and tumour, what is the general management plan?

A
  • Dexamethasone.
  • Radiotherapy.
  • Chemotherapy.
  • Surgical decompression and stabilisation.
27
Q

How are primary tumours of the spinal cord managed?

A

Surgical excision.

28
Q

How is infection of the spinal cord managed?

A
  • Antimicrobial therapy.
  • Surgical drainage.
  • Stabilisation where required.
29
Q

How is haemorrhage of spinal cord managed?

A
  • Reverse anti-coagulation.

- Surgical decompression.

30
Q

How is degenerative disease of the spinal cord managed?

A

Surgical decompression +/- stabilisation.

31
Q

Is spinal cord compression an emergency or not?

A

Acute compression is an emergency.

Chronic compression requires rapid treatment.

32
Q

What is the aim of treatment in spinal cord compression?

A

Usually only prevents further deterioration.

CNS CLERKSHIP (43 decks)

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