Spinal Cord Compression Syndrome Flashcards
What is acute compression usually due to?
Trauma
Tumour haemorrhage/collapse
Infection
Spontaneous bleed
Chronic compression usually due to?
Degeneration (spondylosis/OA of spine)
Tumours
RA
What is cord transection?
Complete lesion means all motor and sensory modalities below lesion affected
What initially happens in spinal cord transection?
Flaccid areflexic paralysis called spinal shock
Later UMN signs appear
What is anterior cord syndrome?
Cord infarction to area supplied by anterior spinal artery
What does anterior cord syndrome produce?
Paralysis
Loss of pain and temp below level of injury with preserved proprioception and vibration sensation
Why is proprioception and vibration preserved in anterior cord syndrome?
DCML system is located posteriorly
The dorsal column-medial lemniscal pathway
Why do you get paralysis in anterior cord syndrome?
Lost corticospinal tracts (main voluntary motor tracts)
Why do you lose pain and temperature in anterior cord syndrome?
Spinothalamic tracts located anteriorly
What is another term for cord hemi-section?
Brow-Sequard syndrome
Common cause of brown-Sequard syndrome?
Penetrating injury
Presentation of BSS?
- Ipsilateral UMN paralysis and loss of proprioception below lesion
- Contralateral loss of pain and temperature sensation beginning at 1 or 2 segments below lesion
Why is there ipsilateral paralysis and loss of proprioception in BSS?
Motor tracts and DCML decussate at the level of medulla
-So if cut after medulla the tract s providing innervation to same side of body
Why is there contralateral loss of pain and temperature in BSS?
Because spinothalamic tract decussates at level of spinal cord
-So if you cut at the spinal cord the fibres have already crossed so will affect contralateral side
Causes of central cord syndrome?
Acute extension injury to already stenotic neck or syringomyelia or tumour
Predominant presentation of central cord syndrome?
Bilateral upper limb weakness more than lower limb weakness
Cape like spinothalmic sensory loss of pain and temperature
What is preserved in central cord syndrome?
Dorsal columns
Why is their bilateral weakness in upper limb for CCS?
Because fibres supplying upper limbs in lateral corticospinal tracts are more medial to fibres supplying the lower limbs
Therefore lesion in the centre more likely to damage upper limb fibres
Diagram of various spinal cord injuries and where they affect?
Ascending and descending tracts picture?
