Spinal Cord Compression

Question 1

What sensation is the spinothalamic tract associated with?

Answer 1

Coarse touch
Pain
Temperature

Question 2

A lesion affecting the spinothalamic tract will affect which side of the body?

Answer 2

Affects contralateral side since fibres decussate at spinal level

Question 3

What sensation is the dorsal column associated with?

Answer 3

Fine touch
Proprioception
Vibration

Question 4

A lesion affecting the dorsal column will affect which side of the body?

Answer 4

Affects ipsilateral side since fibres decussate at brainstem

Question 5

List some causes of acute spinal cord compression

Answer 5

Trauma (especially the neck)
Tumours including syringomyelia (causing haemorrhage or collapse)
Infection
Spontaneous haemorrhage

Question 6

List some causes of chronic spinal cord compression

Answer 6

Tumours
Degeneration (spondylosis)
Rheumatoid arthritis

Question 7

How would a complete cord transection present?

Answer 7

Motor and sensory loss below level of lesion
Initially a flaccid areflexic paralysis ‘spinal shock’
Upper motor neurone signs appear later

Question 8

Which part of the spinal cord is affected in Brown-Sequard syndrome?

Answer 8

Hemisection of the cord
Ipsilateral motor and dorsal loss below the sensory level
Contralateral spinothalamic loss below the sensory level

Question 9

How would a central cord syndrome present?

Answer 9

Distal upper limb weakness (UL part of lateral CST (medial) damaged)
Cape-like spinothalamic sensory loss (CST crosses at the anterior commissure at the spinal cord level and it is damaged)
Lower limb power + dorsal column sensory preservation (LL part of lateral CST (lateral) is preserved)

Question 10

Tumours compression spinal cord are usually from metastases. True/False? Where are the metastases typically from?

Answer 10

True - typically extradural

Lung, breast, kidney, prostate

Question 11

Give examples of degenerative diseases causing spinal cord stenosis

Answer 11

Osteophyte impingement
Facet joint hypertrophy
Bulging intervertebral discs
Subluxation

Question 12

A lesion affecting the corticospinal tract will affect which side of the body?

Answer 12

Affects ipsilateral side as fibres decussate at medullary level

Question 13

What is the typically aetiology of central cord syndrome?

Answer 13

Hypereflexion or extension injury to already stenotic neck

Question 14

How does chronic spinal cord compression present?

Answer 14

Same as acute but UMN signs e.g. spasticity and brisk reflexes are preserved

Question 15

List types of primary intradural brain tumours

Answer 15

EXTRAMEDULLARY: meningioma, schwannoma
INTRAMEDULLARY: astrocytoma, ependyoma

Question 16

List aetiology of infectious epidural abscess

Answer 16

Blood-borne (typically staph)

TB

Question 17

What are the principles of management for traumatic compression of the spinal cord?

Answer 17

Immobilise
Imaging
Decompress and stabilise

Question 18

What drug should be administered as a bolus after traumatic spinal cord compression?

Answer 18

Methylprednisolone

Question 19

What drug should be administered if a tumour is causing spinal cord compression? What is the most effective form of additional treatment?

Answer 19

Dexamethasone

Radiotherapy > Surgical decompression and stabilisation

Question 20

What are the principles of management for infectious compression of the spinal cord?

Answer 20

Antimicrobial therapy
Surgical drainage
Stabilisation if required

Question 21

What are the principles of management for haemorrhagic compression of the spinal cord?

Answer 21

Reverse anticoagulation

Surgical decompression

Question 22

What are the principles of management for degenerative compression of the spinal cord?

Answer 22

Surgical stabilisation +/- decompression

Question 23

What is the most common mechanism of injury in Brown-Sequard syndrome?

Answer 23

Penetrating injury

Question 24

State a common cause of central cord syndrome

Answer 24

Syringomyelia

Question 25

How would an anterior cord syndrome present?

Answer 25

Complete motor paralysis below the lesion (CST)
Loss of pain and temperature sense at and below the lesion due (STT)
Retained proprioception and vibration (intact DCML)