Spinal Cord Compression Flashcards
Signs of an Upper Motor Neurone Lesion (4)
Increased tone
Muscle wasting not marked
No fasciculation
Hyper reflexia
Signs of a Lower Motor Neurone Lesion (4)
Decreased tone
Muscle wasting
Fasciculation
Diminished
What occurs in complete spinal cord compression?
Lose all motor and sensory below level
What occurs in incomplete spinal cord compression
Still some function
Causes of acute spinal cord compression (4)
Trauma
Tumours - haemorrhage or collapse
Infection
Spontaneous haemorrhage
Causes of chronic spinal cord compression (3)
Degenerative disease - spondylosis
Tumours
Rheumatoid Arthritis
Describe clinical presentation of acute compression in cord transection
Complete lesion - all motor and sensory modalities affected
Initially a flaccid arreflexic paralysis “spinal shock”
Upper motor neurone signs appear later
What do we call the hypotensive shock after spinal cord injury?
This is called spinal shock - different from arreflexic spinal shock
What is Brown Sequard Syndrome?
Cord hemisection
Describe clinical presentation of acute compression in cord hemisection
Ipsilateral motor level
Ipsilateral Dorsal Column sensory level
Contralateral spinothalamic sensory level
one half damaged - right or left - eg right - right sided paralysis, right sided fine touch, vibration and proprioception lost, however lose left side pain and temp sensation
Describe clinical presentation of acute compression in central cord syndrome
Hyperflexion or extension injury to already stenotic neck Predominantly distal upper limb weakness “Cape-like” spinothalamic sensory loss Lower limb power preserved Dorsal Columns preserved
weak hands and wrists
weak movement at elbow
legs fine
sensory exam - band of spinothalamic sensory loss across a few dermatomes e.g. c5 c6
corticospinal tract only partially affected in medial area - lower limb most lateral, hands medial
hence weak hands and wrists
spinothalamic deficit as cross at anterior white commissar - crossing over fibres damage, tracts ok
only crossing over fibres at area damaged eg c5 c6 and not below
What is different between the clinical presentation of acute and chronic cord compression?
Chronic compression presentation is the same as acute except upper motor neurone signs predominate
Compression of spinal cord due to trauma
High energy injury
Especially in mobile segments of the spine - CERVICAL
Where do extradural tumours usually start?
Usually metastasis from lung, breast, kidney, prostate
What are the two types of intradural tumour?
Extramedullary (outside spinal cord)
Intramedullary
