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Spinal Cord Disease Flashcards

1
Q

Define Myelopathy vs Radiculopathy [2]

A

Myelopathy is a lesion compressing spinal cord

Radiculopathy is a lesion compressing spinal nerve root

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2
Q

How could a myelopathy affecting UMNs appear?

A
  • Spasticity
  • Hyperreflexia & Plantar Extension
  • Pyramidal pattern of weakness
    Weakness in lower limb flexors and upper limb extensors
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3
Q

How could a myelopathy affecting LMNs appear?

A
  • Decreased Tone
  • Hyporeflexia
  • Weakness & Wasting
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4
Q

What is Brown-Sequard Syndrome? [5]

A

Caused by lateral hemisection of the spinal cord
Features
1. ipsilateral weakness below lesion
2. ipsilateral loss of proprioception and vibration sensation
3. contralateral loss of pain and temperature sensation
4. development of Horner’s syndrome on ipsilateral side of lesion

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5
Q

What kind of ANS symptoms can come from spinal cord disease? [2]

A

Bowel & Bladder problems

Sexual Dysfunction

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6
Q

Difference in presentation between C5 myelopathy [2] and C5 radiculopathy [3]

A

Cord

  • UMN signs below C5
  • Loss of sensation below C5

Root:

  • Numbness in C5 dermatome
  • Weakness in C5 muscles (Deltoids/biceps)
  • Hyporeflexia in Biceps reflex (C5 LMN is compressed)
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7
Q

How do we categorise the causes of spinal cord lesions? [2]

A

Into intrinsic causes which are non-compressive and largely medical

Into Extrinsic causes which are compressive and largely surgical

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8
Q

List the categories of Spinal cord tumours? (Type of extrinsic spinal cord lesion) [3]

A

Extradural
Intradural & Extramedullary
Intramedullary (These are intrinisic spinal cord lesions)

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9
Q

What are the causes of intrinsic (Non-compressive) spinal cord lesions? [7]

Name 6 causative organisms for infection causing intrinsic spinal cord lesions

A
  • Vascular (mostly Ischaemic vs haemorrhagic)
  • Inflammatory e.g. Demyelinating Myelitis such as MS
  • Infection
  • Neoplasm e.g. intramedullary tumour or paraneoplastic
  • Metabolic e.g. B12 Deficiency
  • Idiopathic
  • Congenital & Genetic

Causative organisms:

  • Viral e.g. HIV, EBV, CMV, Herpes simplex
  • Bacterial e.g. TB
  • Schistosomiasis
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10
Q

Whats another name for Ischaemic Myelopathies?

A

Spinal Stroke

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11
Q

And what causes Ischaemic Myelopathies? [6]

A

Literally anything that can damage your arteries incl:

  • Atheromatous disease
  • Thromboemboli from Endocarditis or AF
  • Hypotension
  • Vasculitis
  • Venous Occlusion
  • Air emboli (A possible presentation of decompression sickness)
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12
Q

How would ischaemic myelopathy present? [5]

A
  • The onset will be sudden or over several hours
  • Radicular Back Pain and/or visceral referred pain
  • Tighteness radiates circumferentially followed by:
  • Bilateral flaccid weakness and sensory loss
  • Urinary retention in spinal shock and incontinence after
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13
Q

What does radicular pain mean? [2]

A

Pain radiating down a dermatome due to irritation of the nerve root

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14
Q

What kind of weakness is more common in ischaemic myelopathy? [1]

A

Paraparesis (partial paralysis of lower limbs) rather than quadraparesis because the thoracic cord is the most likely area to be damaged

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15
Q

How would you investigate a suspected Spinal Stroke? [2]

A

Exam:

  • Most often Ant spinal art (so dorsal columns spared) and mid thoracic
  • May be spinal shock present

Sagittal MRI

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16
Q

How would we treat Ischaemic Myelopathy and whats the prognosis? [3]

A
  • OT & physio
  • Manage vascular risk factors
  • Reduce recurrence risk by maintaining adequate BP, antiplatelets and reversing any hypovolaemia or arrythmia.

20% die and only 30/40% have more than a minimal recovery

17
Q

How does a B12 deficiency trigger a spinal cord lesion?

A

SUBACUTE COMBINED DEGENERATION OF THE SPINAL CORD
It causes the spinal cord to slowly degenerate over time
degeneration of dorsal column and corticospinal tract

18
Q

What care the common causes for a B12 deficiency? [3]

A
  • Dietary Failure e.g. Vegan
  • Loss of ileum to surgery or disease (e.g. Crohn’s)
  • Loss of intrinsic factor such as pernicious anaemia where antibodies attack intrinsic factor
19
Q

What neurological features can be caused by B12 deficiency? [6]

A 
Paresthesia
Weakness
Sensory deficit
Sensorimotor and peripheral neuropathy
Eye/optic nerve issues
20
Q

How do we investigate [4] and treat [1] for a B12 deficiency?

A
  • FBC (macrocytic anaemia)
  • Blood Film
  • B12 blood test
  • Intrinsic factor

Intramuscular B12

21
Q

What other symptoms can you see in subacute combined degeneration of SC [3]

A

Irritability
Depression
Painless urine retention (ANS neurons lost)

22
Q

Describe how these will present:

- degeneration of dorsal column and corticospinal tract

A

degeneration of:

  • dorsal column (sensory ataxia)
  • corticospinal tract (paraplegia)
23
Q

Syringomelia or syringobulbia
Ep
Ax [7]

A

Ep: F>M
Ax:
- Arnold Chiari malformation
- intramedullary tumour (ependymoma, hemangioblastoma)
- basal arachnoiditis (infection, irradiation or SAH)
- mass (cyst, rheumatoid pannus, encephalocele, tumour)
- myelitis
- spinal cord injury
- AV malformation

24
Q

Ddx: synringomelia and -bulbia [3]

A
  • Syringomyelia: formation of syrinx (fluid filled cavity) [1] in spinal column due to blocked CSF circulation [1] putting pressure on anterolateral spinal cord [1]
  • Syringobulbia: involves brain
25
Q

Syringomelia sx [6]

A
  • dissociated sensory loss
  • in cape distribution
    (pain and temperature loss with preservation of vibration and joint position)
  • Central cord syndrome
  • UMN signs in lower limbs
  • Horner syndrome
  • Charcot joints
26
Q

Syringomelia Ix [2]

Features of syringobulbia [4]

A

Ix:
- MRI spine, brainstem
Syringobulbia
- nystagmus, tongue atrophy, dysphagia, tongue/palatial weakness

27
Q

Syringomelia Mx

A

Chiari malformations: surgical decompression at foramen magnum to promote CSF free flow and prevent syrinx dilatation

Neuro (42 decks)

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