spinal cord disease Flashcards
where does the cord extend from and to
from C1-L1 then becomes conus medullaris
what supplies the cord
anterior spinal artery, plexus on posterior cord
how does chronic or subacute cord compression present
spastic para/tetraparesis, radicular pain at level of compression, sensory loss below the compression, retention of urine and constipation
signs of chronic cord compression
UMN signs below the lesion (spastic, incr reflexes), LMN at the site of the lesion and normal above
signs in acute cord compression
LMN signs below- flaccid and arreflexic
what is the sensory level
numbness rises up to the level of compression. it is 2-3 dermatomes below the level of anatomical compression
causes compression
disc and vertebral lesions (disc prolapse, cervical spondylosis); trauma; spinal cord tumours; mets from primary site; TB; spinal epidural abscess; epidural haemorrhage or haematoma
what are the spinal cord tumours compressing
extramedullary- meningiomas, neurofibromas which develop over weeks to months with root pain and sensory level. intramedullary- glioma, ependymoma. progress more slowly
what is the imaging of choice (compression)
MRI
what investigations can be done (compression)
MRI, biopsy or surgical exploration to identify mass. screening- FBC, U&E, ESR, B12, syphilis, LFT, PSA, CXR for primary lung
treatment of compression
laminectomy- decompression. remove tumours and haematomas. treat cord malignancies- dexamethasone whilst deciding. radiotherapy cord malignancy
what are the signs in cauda equina
leg weakness is flaccid and areflexic. back pain and radicular down the legs. asymmetrical atrophic areflexic paralysis, sensory loss in a root distribution, decr sphincter tone do PR
what are the signs in conus medullaris lesion
mixed UMN/LMN signs, early urinary retention and constipation, back pain, sacral sensory disturbance, erectile dysfunction
what is shown in transverse myelitis on MRI and CSF
cord swelling, oedema. CSF may be inflammatory with excess of lymphocytes.
causes of transverse myelitis
inflam after viral infection immunisation or in MS; system inflam disorders eg SLE, sjogrens, sarcoidosis; infection- Herpes EBV HIV; neuromyelitis optica
