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NEUROLOGY > Spinal Cord Compression > Flashcards

Spinal Cord Compression Flashcards

1
Q

Name 2 ipsilateral tracts.

A

Corticospinal tract and Dorsal Column-ML tract

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2
Q

Name 4 ways in which Acute Cord Compression may come about.

A
  • tumors (collpase or hemorrhage)
  • Spontaneous hemorrhage
  • Infection
  • trauma (esp. of the neck- very vulnerable)
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3
Q

What causes CHRONIC Cord Compression?

A
  • degenerative disease (SPONDYLOSIS)
  • tumors
  • rheumatoid arthritis > synovitis (C1 and C2 are vulnerable)
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4
Q

How may a cord transection present as?

A
  • 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
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5
Q

`What occurs immediately after a cord transection?

A

Spinal shock; an initial flaccid ARREFLEXIC paralysis (aka SPINAL shock) —UMN lesion signs appear a few days after.

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6
Q

What occurs in Brown-sequard $ symptomatically, if the RIGHT hemisection occurs?

A
  • Right hemiparesis and right loss of proprioception, fine touch and vibration
  • Left loss of Crude touch sensation, pain and temp.
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7
Q

How does Central CORD $ occur?

A

by HYPEREXTENSION and HYPERFLEXION injury to an already STENOTIC neck

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8
Q

How does Central Cord $ present?

A
  • 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
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9
Q

Why is the central bit of the spinal cord more vulnerable to injury?

A
  • 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
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10
Q

Why are the Upper limbs only affected in the central cord syndrome?

A

it is more medial (than the lower limb Lateral corticospinal tract) towards the central canal

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11
Q

How is Chronic Spinal Cord Compression different in presentation from Acute cord compression?

A
  • occurs much more SLOWLY
  • No spinal shock seen
  • progressively worsening of spastic paraparesis
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12
Q

Which part of the spinal cord is most likely injured in trauma?

A

cervical segment (most mobile)

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13
Q

What is the most common tumor to cause spinal cord compression?

A

Metastasis of the bone - arising from Lung, breast, kidney, prostate

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14
Q

What is meant by being extramedullary?

Name 2 extramedullary, intradural tumors.

A
  • within the spinal canal and dural sac but OUTSIDE the spinal cord (free from the nerves)
  • MENINGIOMA, SCHWANNOMA
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15
Q

How does degenerative disease cause cord compression?

A

by osteoarthritis, formation of:

  • osteophyte formation
  • bulging intervertebral discs
  • facet joint hypertrophy
  • subluxation
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16
Q

How may one get spinal cord Infection?

A

EPIDURAL ABSCESS : -with bloodborne Staph or TB

-via Surgery or Trauma

17
Q

What would occur with compression of the spinal cord at C1?

A

death by respiratory arrest; the phrenic nerve arises from C3.

18
Q

What may predispose a patient to hemorrhage in the spinal cord?

A
  • trauma
  • bleeding diatheses/conditions
  • anticoagulants
  • AVMs
19
Q

Describe from where to where the Upper motor neurone travels from?

A
  • form the Motor Cortex to the ANTERIOR grey horn
20
Q

Where does the corticospinal tract decussate?

A

at the medulla

21
Q

List the signs of a Lower Motor neurone lesion.

A
  • hyporeflexia
  • decr. tone
  • marked MUSCLE wasting
  • FASCICULATIONS
22
Q

What does the spinothalamic tract pick up on?

A
  • sensory info. from the contralateral side

- PAIN, TEMPERATURE and CRUDE touch

23
Q

Where does the spinothalamic tract decussate?

A

at the SPINAL level

24
Q

What info does the dorsal column tract relay?

A

proprioception, fine touch and vibration

25
Q

Describe the patient who may come in with a potential Central Cord syndrome.

A
  • an Older patient (50+ y.o)

- PC: he/she fell on the the their head > bump on front or back of head; car accident

26
Q

In Brown sequard $, how does the neurological presentation for the levels BELOW the injury present as?

A
  • ipisilateral loss of vibration and proprioception
  • ipsilateral motor weakness (UMN lesion)
  • c.l loss of PAIN and T*
27
Q

If a hemisection of the spinal cord was to occur above T1, what may result?

A
  • Horner’s Syndrome

- —ipsilateral constricted pupil and eyelid droop

28
Q

What sign is proof that it is an UMN lesion?

A
  • +ve Babinski sign on side of lesion
29
Q

Name an intramedullary, Intradural tumor?

A
  • astrocytoma and ependyoma
30
Q

How may a tumor cause ACUTE compression of the cord?

A
  • by collapse or hemorrhage
31
Q

How to treat trauma to the spinal cord?

A
  1. Immobilize the pt
  2. Ivx: XRAY/ CT/ MRI
  3. Decompress the cord and stabilise : surgery/ traction/ external fixation
  4. useless methyprednisolon
32
Q

What procedural tactics for the spine AVOIDS surgery?

A
  • external fixation

- traction

33
Q

How to manage tumors of the spinal cord>

A
  • dexamethasone
  • radiotherapy (for PAIN and symptoms)
  • chemotherapy (multiple myeloma)
  • —surgical decompression and stabilisation
    • surgical EXCISION (even of BENIGN tumors)
34
Q

How is infection of the spine managed?

A
  • antimicrobial therapy
  • surgical drain
  • stabilisation
35
Q

How is hemorrhage in to the spinal canal managed?

A
  • REVERSE anti-coagulation

- surgical decompression

36
Q

How is degenrative disease managed?

A
  • surgical decompression +/- stabilisation
37
Q

What scenarios are often seen with central cord syndrome?

A
  1. MVA
  2. Fell to the ground CHIN first
  3. syringomyelia
  4. osteoporosis
38
Q

How does Anterior Spinal Cord Syndrome present as?

A
  1. ACUTE: Back/chest pain; Spinal shock; B/L loss of PAIN and Temperature sensation and MOTOR and autonomic fxn BELOW the lesion
  2. Later—spastic paraparesis; hyperreflexia AND continued sensory and autonomic loss
39
Q

Best ivx to confirm Anterior Spinal cord Syndrome?

A
  • MRI

NEUROLOGY (36 decks)

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