Spinal Cord Disease Flashcards
Define Myelopathy vs Radiculopathy [2]
Myelopathy is a lesion compressing spinal cord
Radiculopathy is a lesion compressing spinal nerve root
How could a myelopathy affecting UMNs appear?
- Spasticity
- Hyperreflexia & Plantar Extension
- Pyramidal pattern of weakness
Weakness in lower limb flexors and upper limb extensors
How could a myelopathy affecting LMNs appear?
- Decreased Tone
- Hyporeflexia
- Weakness & Wasting
What is Brown-Sequard Syndrome? [5]
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
What kind of ANS symptoms can come from spinal cord disease? [2]
Bowel & Bladder problems
Sexual Dysfunction
Difference in presentation between C5 myelopathy [2] and C5 radiculopathy [3]
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)
How do we categorise the causes of spinal cord lesions? [2]
Into intrinsic causes which are non-compressive and largely medical
Into Extrinsic causes which are compressive and largely surgical
List the categories of Spinal cord tumours? (Type of extrinsic spinal cord lesion) [3]
Extradural
Intradural & Extramedullary
Intramedullary (These are intrinisic spinal cord lesions)
What are the causes of intrinsic (Non-compressive) spinal cord lesions? [7]
Name 6 causative organisms for infection causing intrinsic spinal cord lesions
- 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
Whats another name for Ischaemic Myelopathies?
Spinal Stroke
And what causes Ischaemic Myelopathies? [6]
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)
How would ischaemic myelopathy present? [5]
- 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
What does radicular pain mean? [2]
Pain radiating down a dermatome due to irritation of the nerve root
What kind of weakness is more common in ischaemic myelopathy? [1]
Paraparesis (partial paralysis of lower limbs) rather than quadraparesis because the thoracic cord is the most likely area to be damaged
How would you investigate a suspected Spinal Stroke? [2]
Exam:
- Most often Ant spinal art (so dorsal columns spared) and mid thoracic
- May be spinal shock present
Sagittal MRI