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Neurology > Spinal Cord Compression > Flashcards

Spinal Cord Compression Flashcards

1
Q

Categories of lesions which may cause spinal cord compression?

A
  1. Extradural
  2. Intradural / extramedullary
  3. Intramedullary
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2
Q

Common pathological causes of spinal cord compression?

A
  1. Tumour (primary, met)
  2. Degenerative (disc prolapse, osteoporosis, spondylosis)
  3. Infection (vert body, disc space, extradural, intramural)
  4. Haematoma (spontaneous, trauma, AVM)
  5. Developmental (syrinx, AVM, arachnoid cyst)
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3
Q

What are the major presenting features of spinal cord compression?

A
  • Pain

- Neurological deficit

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4
Q

What is the result of cervical spinal canal stenosis?

A

Cervical myelopathy due to cord compression

  • UL: predominately LMN signs
  • LL: UMN (spastic paraparesis)
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5
Q

What is the result of lumbar spinal canal stenosis?

A

Sciatic and neurogenic claudication due to cauda equina compression

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6
Q

What causes the stenosis of degenerative spinal canal stenosis?

A
  • Spondylosis with hypertrophy and osteophytes of the facet joints
  • Hypertrophy of the ligament flavum
  • Bulging or prolapsed IV discs and associated osteophytes
  • Excessive mobility
  • Often congenitally narrow canal
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7
Q

What are the neurological symptoms due to in degenerative spinal canal stenosis?

A

Neurological symptoms result from:

  • direct pressure on neural structures
  • Ischaemia of neural structures
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8
Q

What is the result of degenerative spinal canal stenosis (in terms of cell/structure reaction)?

A
  • Degeneration and loss of nerve cells
  • Spinal cord cavitation
  • Glial cell proliferation
  • Demyelination
  • Wallerian degeneration of tracts above and below the level of compression
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9
Q

Treatment of degenerative canal stenosis?

A
  • Conservative for mild, non progressive disease of the very elderly / unfit for sure
  • Surgery: halt further disability, preventing defects may be irreversible
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10
Q

Posterior surgical approach?

A

Laminectomy

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11
Q

Anterior surgical approaches?

A

Discectomy, vertebrectomy

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12
Q

Ddx of intramural, extra medullary lesion?

A
  • Schwannoma
  • Myxopapillary ependymoma
  • Dermoid or epidermoid cyst
  • Mets (rare)
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13
Q

Major sensory levels on trunk?

A
  • T4 = nipple
  • T7 = xiphisternum
  • T10 = umbilicus
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14
Q

Weakness of cervical / thoracic lesion?

A
  • Progressive spastic paraparesis with UMN weakness
  • little or no wasting
  • hypertonia
  • hyperreflexia
  • eventual paraplegia
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15
Q

Brown Sequard syndrome pattern of sensory loss?

A

Laterally placed mass:

  • Contralateral impairment of pain and temp
  • Ipsilateral weakness and impairment of proprioception, vibration and light touch
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16
Q

Syringomyelia pattern of sensory loss?

A

Cape like loss of pain and temp sensation (also in intrinsic lesions of the central spinal cord)

17
Q

Regions of compression most predisposed to causing sphincter disturbance?

A
  • Occurs with compression at any region

- Particularly conus medularis and cauda equina

18
Q

First symptoms of sphincter disturbance in spinal cord compression?

A

-Difficulty initiating urination
–> urinary retention / incontinence
Subsequent constipation and faecal incontinence

19
Q

Which cancers most commonly cause spinal cord compression?

A
  • Breast Ca
  • Lung Ca
  • Prostate Ca
  • Kidney Ca
  • Lymphoma
  • Myeloma
20
Q

Treatment of malignant spinal cord compression?

A

-Commence dexamethasone
-Palliation / symtpom control
OR
-Radiotherapy
OR
-Surgery

21
Q

When is radiotherapy preferred Mx of malignant spinal cord compression?

A

In radiosensitive tumours and only if neurological deficit is mild and non-progressive, without significant neural compression on imaging

22
Q

When is palliation most appropriate management of malignant spinal cord compression?

A

If death from primary cancer imminent or if deficit has been present for more than a few days and is fixed

23
Q

Where is epidural abscess most common i.e. site?

A

Thoracolumbar region

24
Q

Origin of spinal abscess?

A
  • Haematogenous spread to disc or epidural space from distant infected site
  • Direct spread from adjacent infection including vertebral body, decubitus ulcer, paraspinal or psoas abscess
25
Q

Why does cord ischaemia occur in spinal abscess?

A

Results from thrombosis of arteries and veins (may lead to rapid and irreversible neurological deterioration)

26
Q

How does spinal abscess present?

A
  • Severe local spinal pain
  • Rapidly progressive neuro deficit
  • Systemic features of infection
27
Q

Treatment of spinal abscess?

A
  • Emergency investigation and transfer for neurosurgical assessment
  • Emergency surgical decompression
  • Broad spec ABx until sensitivities known

Neurology (38 decks)

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