Spinal Cord Compression Flashcards
Name 2 ipsilateral tracts.
Corticospinal tract and Dorsal Column-ML tract
Name 4 ways in which Acute Cord Compression may come about.
- tumors (collpase or hemorrhage)
- Spontaneous hemorrhage
- Infection
- trauma (esp. of the neck- very vulnerable)
What causes CHRONIC Cord Compression?
- degenerative disease (SPONDYLOSIS)
- tumors
- rheumatoid arthritis > synovitis (C1 and C2 are vulnerable)
How may a cord transection present as?
- could be Complete or incomplete
- If C5 complete cord transection (Motor and Sensory innervation ONLY up to THIS level is PRESENT - after which it dies) —-no sensation after C5
`What occurs immediately after a cord transection?
Spinal shock; an initial flaccid ARREFLEXIC paralysis (aka SPINAL shock) —UMN lesion signs appear a few days after.
What occurs in Brown-sequard $ symptomatically, if the RIGHT hemisection occurs?
- Right hemiparesis and right loss of proprioception, fine touch and vibration
- Left loss of Crude touch sensation, pain and temp.
How does Central CORD $ occur?
by HYPEREXTENSION and HYPERFLEXION injury to an already STENOTIC neck
How does Central Cord $ present?
- DISTAL upper limb (> lower limbs) weakness (HANDS)
- band-like SPINOTHALAMIC sensory loss (at level of lesion)—-(numbness/pins&needles across shoulders and upper back)– ALLODYNIA
Why is the central bit of the spinal cord more vulnerable to injury?
- it is further away from the blood supply; so when it is impinged in a hyperextended/flexed movement; ISCHEMIC injury occurs to the central cord
Why are the Upper limbs only affected in the central cord syndrome?
it is more medial (than the lower limb Lateral corticospinal tract) towards the central canal
How is Chronic Spinal Cord Compression different in presentation from Acute cord compression?
- occurs much more SLOWLY
- No spinal shock seen
- progressively worsening of spastic paraparesis
Which part of the spinal cord is most likely injured in trauma?
cervical segment (most mobile)
What is the most common tumor to cause spinal cord compression?
Metastasis of the bone - arising from Lung, breast, kidney, prostate
What is meant by being extramedullary?
Name 2 extramedullary, intradural tumors.
- within the spinal canal and dural sac but OUTSIDE the spinal cord (free from the nerves)
- MENINGIOMA, SCHWANNOMA
How does degenerative disease cause cord compression?
by osteoarthritis, formation of:
- osteophyte formation
- bulging intervertebral discs
- facet joint hypertrophy
- subluxation
How may one get spinal cord Infection?
EPIDURAL ABSCESS : -with bloodborne Staph or TB
-via Surgery or Trauma
What would occur with compression of the spinal cord at C1?
death by respiratory arrest; the phrenic nerve arises from C3.
What may predispose a patient to hemorrhage in the spinal cord?
- trauma
- bleeding diatheses/conditions
- anticoagulants
- AVMs
Describe from where to where the Upper motor neurone travels from?
- form the Motor Cortex to the ANTERIOR grey horn
Where does the corticospinal tract decussate?
at the medulla
List the signs of a Lower Motor neurone lesion.
- hyporeflexia
- decr. tone
- marked MUSCLE wasting
- FASCICULATIONS
What does the spinothalamic tract pick up on?
- sensory info. from the contralateral side
- PAIN, TEMPERATURE and CRUDE touch
Where does the spinothalamic tract decussate?
at the SPINAL level
What info does the dorsal column tract relay?
proprioception, fine touch and vibration
Describe the patient who may come in with a potential Central Cord syndrome.
- an Older patient (50+ y.o)
- PC: he/she fell on the the their head > bump on front or back of head; car accident
In Brown sequard $, how does the neurological presentation for the levels BELOW the injury present as?
- ipisilateral loss of vibration and proprioception
- ipsilateral motor weakness (UMN lesion)
- c.l loss of PAIN and T*
If a hemisection of the spinal cord was to occur above T1, what may result?
- Horner’s Syndrome
- —ipsilateral constricted pupil and eyelid droop
What sign is proof that it is an UMN lesion?
- +ve Babinski sign on side of lesion
Name an intramedullary, Intradural tumor?
- astrocytoma and ependyoma
How may a tumor cause ACUTE compression of the cord?
- by collapse or hemorrhage
How to treat trauma to the spinal cord?
- Immobilize the pt
- Ivx: XRAY/ CT/ MRI
- Decompress the cord and stabilise : surgery/ traction/ external fixation
- useless methyprednisolon
What procedural tactics for the spine AVOIDS surgery?
- external fixation
- traction
How to manage tumors of the spinal cord>
- dexamethasone
- radiotherapy (for PAIN and symptoms)
- chemotherapy (multiple myeloma)
- —surgical decompression and stabilisation
- surgical EXCISION (even of BENIGN tumors)
How is infection of the spine managed?
- antimicrobial therapy
- surgical drain
- stabilisation
How is hemorrhage in to the spinal canal managed?
- REVERSE anti-coagulation
- surgical decompression
How is degenrative disease managed?
- surgical decompression +/- stabilisation
What scenarios are often seen with central cord syndrome?
- MVA
- Fell to the ground CHIN first
- syringomyelia
- osteoporosis
How does Anterior Spinal Cord Syndrome present as?
- ACUTE: Back/chest pain; Spinal shock; B/L loss of PAIN and Temperature sensation and MOTOR and autonomic fxn BELOW the lesion
- Later—spastic paraparesis; hyperreflexia AND continued sensory and autonomic loss
Best ivx to confirm Anterior Spinal cord Syndrome?
- MRI
