Spinal Cord Compression Flashcards
Corticospinal tract is a ___ neurone tract. Upper motor neuron is from ____ _____ to _______ ____ ____. It decussates at ________ level.
The tract is ___lateral.
The lower motor neurone is an _______ _____ ____.
Corticospinal tract is a two neurone tract. Upper motor neuron is from motor cortex to anterior grey horn. It decussates at medullary level.
The tract is ipsilateral.
The lower motor neurone is an anterior horn cell.
UMN lesion causes ______ tone, muscle _____ NOT ______. No _____. ____-reflexia.
UMN lesion causes increased tone, muscle wasting NOT marked. No fasciculations. Hyper-reflexia.
LMN lesions cause _____ tone, muscle _____, _______ and ______ reflexes.
LMN lesions cause decreased tone, muscle wasting, fasciculations and diminished reflexes
Spinothalamic tracts are responsible for;
Pain, temperature and crude touch
Spinothalamic tracts are _____lateral and deccusate at _____ level.
Spinothalamic tracts are contralateral and deccusate at spinal level.
Dorsal columns are responsible for;
_____, ______, ____ _____
They are ____lateral and decussate at ______ level
Dorsal columns are responsible for;
proprioception, vibration, fine touch
They are ipsilateral and decussate at medullary level
Spinal cord compression can be (duration) _____ or ____.
Severity- _____ or _____.
Spinal cord compression can be (duration) acute or chronic.
Severity- complete or incomplete.
What causes acute spinal cord compression?
Trauma
Tumours- haemorrhage/collapse
Infection
Spontaeneous haemorrhage
What causes chronic spinal cord compression?
Degenerative disease- spondylosis
Tumours
Rheumatoid arthritis
How does cord transection present?
Initially a flaccid arreflexic paralysis ‘ spinal shock’
UMN signs appear later.
Cord transection is a _____ lesion- all _____ and ______ modalities are affected below the _____ and _____ level.
Cord transection is a complete lesion- all motor and sensory modalities are affected below the sensory and motor level.
What is affected in brown-sequard syndrome?
Ipsilateral motor level
Ipsilateral dorsal column sensory level
Contralateral spinothalamic sensory level
What is central cord syndrome?
Occurs after hyperflexion or extension of neck to injure an already stenotic neck
How does central cord syndrome present?
Predominantly distal upper limb weakness
“cape-like’’ spinothalamic sensory loss
Lower limb power preserved
Dorsal columns preserved
What is the presentation of chronic spinal cord compression?
Same as acute but UMN signs predominate
What traumatic injuries cause spinal cord compression?
High energy injury
to mobile sements of spine: cervical
What types of extradural tumours cause spinal cord compression?
Metastasis; lung, breast, kidney, prostate
What kind of intradural tumours cause spinal cord compression?
Extramedullary: meningioma, schwanoma
Intramedullary: astrocytoma, ependymoma
Tumours can slowly compress and can cause acute compression by ______ or _______.
Tumours can slowly compress and can cause acute compression by collapse or haemorrhage.
What happens in spinal canal stenosis?
- osteophyte formation
- bulging of intervertebral discs
- facet joint hypertrophy
- subluxation
What infecions can cause spinal cord compression?
Epidural abscess- bloodborne, staph aureus, tuberculosis
Surgery or trauma
What is the management for head trauma?
- immobilise
- investigate
- decompress + stabilise
- Methylprednisosolone
Which investigations are carried out in head trauma?
X-ray/CT/MRI
How is decompression + stabilisation achieved after trauma?
Surgery
Traction
External fixation
Methylprisnisolone is probably of…
No useful benefit
What is the treatment for metastatic tumours causing spinal cord compression?
Depends on patient and on tumour;
- Dexamethasone
- Radiotherapy
- Chemotherapy
- Surgical decompression and stabilisation
What is the treatment for infection causing spinal cord comrpession?
Antimicrobial therapy
Surgical drainage
Stabilisation where required
What is the management of haemorrhage?
Reverse anticoagulation
Surgical decompression
What is the management for degenerative disease?
Surgical decompression +/- stabilisation
