Spinal Cord Disease

Question 1

What is acute spinal cord compression most commonly due to?

Answer 1

Trauma

Question 2

List some causes of acute spinal cord compression?

Answer 2

Trauma
Tumours causing acute haemorrhage or acute vertebral body collapse
Infection
Spontaneous haemorrhage

Question 3

List some causes of chronic spinal cord compression?

Answer 3

Degenerative disease such as spondylosis, tumours or rheumatoid arthritis

Question 4

Describe tumours in relation to compression of spinal cord?

Answer 4

Most common primary tumours are meningiomas and neurofibromas which cause compression gradually over weeks to months often with root pain and a sensory level
Vertebral body destruction by bony metastases particularly from breast and prostate is also common
Intramedullary tumours eg. ependymomas are much less common

Question 5

Globally what is a common cause of spinal cord compression?

Answer 5

spinal tuberculosis

Question 6

Acute spinal cord compression is a ______

Answer 6

medical emergency

Question 7

Describe some principal feature of chronic and subacute cord compression?

Answer 7

spastic paraparesis or tetraparaparesis, radicular pain at the level of the compression and sensory loss below the compression
symptoms develop over time

Question 8

What is the imaging technique of choice in a suspected spinal cord compression?

Answer 8

MRI

Question 9

Treatment of spinal cord compression? Timescale?

Answer 9

Decompression needs to be performed promptly to stop irreversible cord damage

Question 10

Define myelopathy

Answer 10

Myelopathy is an injury to the spinal cord caused by severe compression that may be a result of spinal stenosis, disc degeneration, disc herniation, autoimmune disorders or other trauma.

Question 11

Define anterior cord syndrome and what it produces?

Answer 11

Cord infarction by the area supplied by the anterior spinal artery.
It produces paralysis and loss of pain and temperature below the level of injury with preserved proprioception and vibration sensation.

Question 12

Define cord transection and what it produces?

Answer 12

Cord Transection (complete spinal cord lesion):
Complete Lesion – all motor and sensory modalities affected below the lesion.
Initially a flaccid arreflexic paralysis “Spinal Shock”.
Upper motor neurone signs appear later.

Question 13

Define central cord syndrome and what it produces?

Answer 13

Causes: Acute extension injury to already stenotic neck or syringomyelia or tumour …
Predominantly bilateral upper limb weakness>lower limb (the fibers supplying the upper limbs in the lateral corticospinal tracts are more medial to the fibers supplying the lower limbs, hence a lesion in the central cord is more likely to damage the upper limb fibers).
“Cape-like” spinothalamic sensory loss (pain and temperature).
Dorsal Columns preserved.

Question 14

Define brown sequard syndrome and what it produces?

Answer 14

Brown-Sequard Syndrome (Cord Hemisection can be due to penetrating injury or other cause):
Ipsilateral upper motor neuron paralysis and loss of proprioception below the lesion.
Contralateral loss of pain and temperature sensation beginning at 1 or 2 segments below the lesion.