Spinal Cord Disease Flashcards
How do Spinal cord diseases differ from peripheral neuropathy in progression?
spinal cord - constant/variable rapidity or no progression after initial insult
peripheral - intermitten intially - later progressive
What is Lhermitte’s Sign? what does it suggest?
tilting head forward gives shock-like sensation down spine
–suggests spinal cord problem
What kind of nerve disorder:
No truncal pain
Nocturnal distal paresthesias common
“Restless leg” symptoms at rest
Peripheral nerve disorder
What are some toxins that cause damage to:
- Spinal cord
- Peripheral neuropathy
- Alcohol - B12 deficiency
2. Heavy metals (arsenic, lead, mercury, insecticides, chemotherapy)
What is the blood supply for the spinothalamic tract and Corticospinal tract
Anterior spinal Artery
What is the blood supply for the Posterior columns of the spine?
Posterior spinal artery
What are acute and progressing motor symptoms of a spinal cord injury above lumbar enlargement (motor tone, power)
Acutely - Flaccid
1-2 weeks = Increased muscle tone
Motor power:
- hemisection: monoplegia ipsilateral to and below hemicord lesion
- complete cord lesion: Diplegia
What are Sx of motor
1. tone
2. power
in peripheral neuropathy?
- normal or reduced tone
2. distal extremity decreased in power, confined to affected peripheral nerves
What kind of fibers transmit the following peripheral sensations
- Vibration/proprioception/touch
- light touch
- pain, temperature, paresthesias, dysethesias
- Nociceptive (deep burning, poorly localized)
- Type 1a Heavily myelinated
- all fiber sizes
- small fibers poorly myelinated
- Unmyelinated
How do Spinal cord injuries differ from peripheral injuries in respect to
- Reflexes
- Babinski
- Autonomic reflexes
- spinal - increased (unless acute spinal cord shock)
peripheral - lost/reduced - spinal - present
peripheral - absent (EXCEPT for Vit b12 deficiency) - spinal - initially lost but later returns
peripheral - variable loss
Name the Syndome annd cause:
Arm>leg weakness, variable sensory loss often with a suspended sensory level
Central Cord syndrome
syringomyelia
hydromyelia
Tumor
Name the Syndrome and cause:
Bilateral motor and sensory loss sparing vibratory and position sense
Anterior Cord syndrome
–anterior spinal artery occlusion
Name the Syndrome and causes:
loss of Vibratory and proprioceptive sense
Posterior cord syndrome
–B12 deficiency, Syphilis, MS
Name the syndrome
ipsilateral: weakness and Vibratory and position sense loss
contralateral: pain and temperature sense loss
Brown-Sequard Syndrome
-Hemisection of spinal cord
What is a common cause of transverse myelitis
Viral: HSV, herpes zoster, CMV, EBV
What is the disease:
bilateral sensorimotor and autonomic spinal cord dysfxn
spinal cord inflammation
CSF pleocytosis
Transverse Myelitis
What are two demyelinating spinal cord syndromes?
SLE, MS
What type of inflammatory deficit do Enteroviruses (Coxsackie and poliomyelitis) and West Nile virus usually have on the spinal cord?
Motor neuron predilection
What type of inflammatory deficit does Herpes Zoster have on the spinal cord? what are Sx?
Dorsal root Ganglion
–painful paresthesia
where are the most common origin sites for tumor metastasis to the thoracic spinal cord?
Ovarian, Prostate
Subacute, occasionally acute
localized spinal pain
radicular myelopathic
Spinal tumor
What is the most common origin signs for epidural, subdural, intramedullary spinal tumors?
Breast, lung, myeloma, kidney, lymphoma
What are 4 common organisms in Spinal abscesses?
Staph, Strep, anaerobes, TB
acute or subacute onset localized spine pain fever localized radicular or myelopathy radiology - spinal involvement crosses disk spaces
Spinal abscess
white appearing plaque in spinal cord?
MS
How do you differentiate Conus Medularis and Cauda Equina Syndrome? - Pain
CM: no intense
CES: moderate- sever asymmetric in L4-S1 (thighs, back, legs, perineum)
How do you differentiate Conus Medularis and Cauda Equina Syndrome? - Motor loss
CM: mild and symmetric S1
CES: more sever symmetric w atrophy
How do you differentiate Conus Medularis and Cauda Equina Syndrome? - Sensory loss
CM: symmetric (saddle distribution)
CES: asymmetric loss in lumbar and sacral distribution
How do you differentiate Conus Medularis and Cauda Equina Syndrome? - Reflex
CM: loss S1 symmetric (achilles)
CES: Loss knee and ankle, asymmetric
How do you differentiate Conus Medularis and Cauda Equina Syndrome? - Bowel and bladder
CM: EARLY AND SEVERE LOSS OF CONTINENCE
CES: late and less severe
