Spinal Cord Compression Flashcards
the corticospinal tract is a _ neurone tract?
2
where does upper motor neurone of corticospinal tract begin and end?
from motor cortex to anterior grey horn
decussates (crosses over) at medullary level
what is the lower motor neurone?
anterior horn cell
is corticospinal tract contralateral or ipsilateral?
ipsilateral
what symptoms do you get with an upper motor neurone lesion?
increased tone
muscle wasting not marked
no fasciculation
hyper-reflexia
what symptoms do you get with a lower motor neurone lesion?
decreased tone
muscle wasting
fasciculation
diminished reflexes
what do spinothalamic tracts control?
pain
temperature
crude touch
this is a sensory pathway
is spinothalamic tracts contralateral or ipsilateral?
contralateral
where do spinothalamic tract decussate (cross over to other side of CNS)?
spinal level
what do dorsal columns control?
fine touch
proprioception
vibration
are dorsal columns contralateral or ipsilateral?
ipsilateral
where do dorsal columns decussate (cross over to other side of CNS)?
medullary level
what causes acute spinal cord compression?
trauma
tumour - haemorrhage or collapse
infection
spontaneous haemorrhage
what causes chronic spinal cord compression?
degenerative disease - spondylosis, spinal cord stenosis
tumours - slowly compress
rheumatoid arthritis
acute spinal cord compression can either be complete or incomplete, what does this mean?
complete - all motor and sensory modalities affected
what are symptoms of an acute cord transection?
initially a flaccid arreflexic paralysis - spinal shock
upper motor neurone signs appear later
what occurs in brown-sequard syndrome (cord hemisection)?
no ipsilateral motor level
no ipsilateral dorsal column sensory level
no contralateral spinothalamic sensory level
how does central cord syndrome occur?
hyperflexion or extension injury to already stenotic neck
what are the symptoms of central cord syndrome?
predominantly distal upper limb weakness
“cape-like” spinothalamic sensory loss
lower limb power and dorsal columns preserved
what are symptoms of chronic spinal cord compression?
same as acute except upper motor neurone signs predominate
what kind of trauma causes spinal cord compression?
high energy injury
especially mobile segments of spine (cervical)
what types of extradural tumours cause spinal cord compression?
usually mets - lung, breast, kidney, prostate
what types of intradural tumours cause spinal cord compression?
extramedullary - meningioma, schwannoma
intramedullary - astrocytoma, ependymoma
what causes spinal canal stenosis?
osteophyte formation
bulging of intervertebral discs
facet joint hypertrophy
subluxation
what kind of infections can compress spinal cord?
epidural abscess - bloodborne staph or tuberculosis
surgery or trauma
what types of haemorrhage can compress spinal cord?
epidural
subdural
intramedullary
what can cause haemorrhage which suppresses spinal cord?
trauma
bleeding diatheses
anticoagulants
arterio-venous malformations
how do you treat spinal cord compression caused by trauma?
immobilise
investigate
decompress + stabilise
? methylprednisolone
what investigations should take place in spinal cord compression caused by trauma?
X-ray / CT
MRI
how do you decompress + stabilise spinal cord compression caused by trauma?
surgery
traction
external fixation
is the use of methylprednisolone in spinal cord compression caused by trauma disputed?
yes - this lecturer said probably no useful benefit
how do you treat spinal cord compression caused by tumour?
depends on pt and tumour dexamethasone radiotherapy chemotherapy surgical decompression + stabilisation
how do you treat spinal cord compression caused by infection?
antimicrobial therapy
surgical drainage
stabilisation where required
how do you treat spinal cord compression caused by haemorrhage?
reverse anticoagulation
surgical decompression
how do you treat spinal cord compression caused by degenerative disease?
surgical decompression +/- stabilisation
is acute spinal cord compression an emergency?
yes
chronic compression requires rapid treatment - true or false?
true
what is usually the outcome of treatment of spinal cord compression?
prevents further deterioration
