Spinal Cord Compression Flashcards
What sensation is the spinothalamic tract associated with?
Coarse touch
Pain
Temperature
A lesion affecting the spinothalamic tract will affect which side of the body?
Affects contralateral side since fibres decussate at spinal level
What sensation is the dorsal column associated with?
Fine touch
Proprioception
Vibration
A lesion affecting the dorsal column will affect which side of the body?
Affects ipsilateral side since fibres decussate at brainstem
List some causes of acute spinal cord compression
Trauma (especially the neck)
Tumours including syringomyelia (causing haemorrhage or collapse)
Infection
Spontaneous haemorrhage
List some causes of chronic spinal cord compression
Tumours
Degeneration (spondylosis)
Rheumatoid arthritis
How would a complete cord transection present?
Motor and sensory loss below level of lesion
Initially a flaccid areflexic paralysis ‘spinal shock’
Upper motor neurone signs appear later
Which part of the spinal cord is affected in Brown-Sequard syndrome?
Hemisection of the cord
Ipsilateral motor and dorsal loss below the sensory level
Contralateral spinothalamic loss below the sensory level
How would a central cord syndrome present?
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)
Tumours compression spinal cord are usually from metastases. True/False? Where are the metastases typically from?
True - typically extradural
Lung, breast, kidney, prostate
Give examples of degenerative diseases causing spinal cord stenosis
Osteophyte impingement
Facet joint hypertrophy
Bulging intervertebral discs
Subluxation
A lesion affecting the corticospinal tract will affect which side of the body?
Affects ipsilateral side as fibres decussate at medullary level
What is the typically aetiology of central cord syndrome?
Hypereflexion or extension injury to already stenotic neck
How does chronic spinal cord compression present?
Same as acute but UMN signs e.g. spasticity and brisk reflexes are preserved
List types of primary intradural brain tumours
EXTRAMEDULLARY: meningioma, schwannoma
INTRAMEDULLARY: astrocytoma, ependyoma
List aetiology of infectious epidural abscess
Blood-borne (typically staph)
TB
What are the principles of management for traumatic compression of the spinal cord?
Immobilise
Imaging
Decompress and stabilise
What drug should be administered as a bolus after traumatic spinal cord compression?
Methylprednisolone
What drug should be administered if a tumour is causing spinal cord compression? What is the most effective form of additional treatment?
Dexamethasone
Radiotherapy > Surgical decompression and stabilisation
What are the principles of management for infectious compression of the spinal cord?
Antimicrobial therapy
Surgical drainage
Stabilisation if required
What are the principles of management for haemorrhagic compression of the spinal cord?
Reverse anticoagulation
Surgical decompression
What are the principles of management for degenerative compression of the spinal cord?
Surgical stabilisation +/- decompression
What is the most common mechanism of injury in Brown-Sequard syndrome?
Penetrating injury
State a common cause of central cord syndrome
Syringomyelia
