Spinal Cord Compression Flashcards
The upper motor neurone of the corticospinal tract runs from where?
Motor cortex to anterior grey horn and decussates at medullary level.
What signs are suggestive of an UMN lesion?
- Increased tone.
- Muscle wasting NOT marked.
- No fasciculations.
- Hyper-reflexia.
What is a fasciculation?
Brief spontaneous contraction affecting a small number of muscle fibres, often causing a brief flicker of movement under the skin.
What signs are suggestive of a LMN lesion?
- Decreased tone.
- Muscle wasting.
- Fasciculation.
- Diminished reflexes.
Describe function of spinothalamic tracts.
SENSORY PATHWAY.
- Pain, temperature and crude touch.
- Contralateral.
- Decussates at spinal level.
Describe function of dorsal columns.
SENSORY PATHWAY
- Fine touch, proprioception, vibration.
- Ipsilateral.
- Decussate at medullary level.
Describe broad categories of spinal cord compression.
- Acute or chronic.
- Complete or incomplete.
What may cause acute spinal cord compression?
- Trauma.
- Tumours: haemorrhage or collapse.
- Infection.
- Spontaneous haemorrhage.
What may cause chronic spinal cord compression?
- Degenerative disease e.g. spondylosis.
- Tumours.
- Rheumatoid arthritis.
Describe spinal cord transection?
A complete lesion affecting all motor and sensory modalities.
What is the initial effect of a spinal cord transection?
- Flaccid arreflexic paralysis: “spinal shock”.
UMN signs appear later.
What is Brown-Sequard syndrome?
- Ipsilateral motor level.
- Ipsilateral dorsal column sensory level.
- Contralateral spinothalamic sensory level.
What is central cord syndrome?
Hyperflexion or extension injury to an already stenotic neck.
How does central cord syndrome present?
- Predominantly as distal upper limb weakness.
- “Cape-like” spinothalamic sensory loss.
Lower limb power is preserved.
Dorsal column is preserved.
How does chronic spinal cord compression present?
Predominant UMN signs.
What may cause traumatic spinal cord compression?
- High energy injury. Esp. in mobile spine segments e.g. cervical.
What extradural tumours that commonly cause spinal cord compression?
Usually metastases from lung, breast, kidney, prostate.
What intradural tumours commonly cause spinal cord compression?
Extramedullary meningioma, Schwannoma.
Intramedullary astrocytoma, ependymoma.
How do tumours cause spinal cord compression?
- Slowly compress.
- Cause acute compression by collapse or haemorrhage.
Spinal canal stenosis is a degenerative, displaying what features?
- Osteophyte formation.
- Bulging of intervertebral discs.
- Facet joint hypertrophy.
- Subluxation.
What are causes of infection within the spinal cord?
- Epidural abscess: bloodborne, Staph., TB.
- Surgery or trauma.
How is haemorrhage within the spinal cord managed?
- Immobilise.
- Investigate.
- Decompress and stabilise.
- Methylprednisolone?
How is haemorrhage of spinal cord decompressed and stabilised?
- Surgery, traction and external fixation.
How is methylprednisolone administered in spinal cord haemorrhage?
Bolus 24 hour infusion.
How is spinal cord haemorrhage investigated?
X-ray, CT or MRI.
Although treatment for metastatic tumours of the spinal cord is dependent on patient and tumour, what is the general management plan?
- Dexamethasone.
- Radiotherapy.
- Chemotherapy.
- Surgical decompression and stabilisation.
How are primary tumours of the spinal cord managed?
Surgical excision.
How is infection of the spinal cord managed?
- Antimicrobial therapy.
- Surgical drainage.
- Stabilisation where required.
How is haemorrhage of spinal cord managed?
- Reverse anti-coagulation.
- Surgical decompression.
How is degenerative disease of the spinal cord managed?
Surgical decompression +/- stabilisation.
Is spinal cord compression an emergency or not?
Acute compression is an emergency.
Chronic compression requires rapid treatment.
What is the aim of treatment in spinal cord compression?
Usually only prevents further deterioration.
