Spinal cord diseases Flashcards
How many pairs of spinal nerves are there?
List them
- cervical nerve: 8
- thoracic nerve: 12
- lumbar nerve: 5
- sacral nerve: 5
- coccygeal nerve: 1
Give the locations of the following
- cervical enlargement
- lumbar enlargement
- conus medullaris
- cauda equina
- cervical enlargement: C5-T2 – upper limbs
- lumbar enlargement: L1-S2 – lower limbs
- conus medullaris: S3-S5
- cauda equina: L2 – CO – 10 pairs
How is the spinal cord enveloped
- dura mater spinalis
- arachnoid membrane
- pia mater
What 2 general internal structures can be found in the spinal cord
Grey matter (inner)
White matter (outer)
What are the 4 clinical manifestations of disease of spinal cord
- motor disorder
- sensory disturbance
- sphincter dysfunction
- other dysautonomia
Describe Brown-sequard syndrome
- upper motor neuron paralysis: in ipsilateral spinal cord under lesion
- deep sensory disturbances: in ipsilateral spinal cord under lesion
- sensation of pain and warmth disturbance: in contralateral spinal cord under lesion 2-3 segments
Describe transverse lesion of spinal cord
- upper motor neuron paralysis under lesion
- loss of all sensation under lesion
- sphincter functional incapacitation
Describe spinal shock
- Flaccid paralysis
- 2 to 4 weeks: central paralysis
Define Acute myelitis
Acute transverse inflammatory lesion of spinal cord caused by autoimmune response after various infections
What are the classifications of acute myelitis
- infectious myelitis
- vaccine: mediated myelitis
- demyelinating myelitis
- necrotic myelitis
- paraneoplastic myelitis
Describe the pathology of acute myelitis
- all spinal cord can be involved; the most common part is T3-T5
- then cervical or lumbar cord
List the clinical findings for acute myelitis
- back pain: onset is acute or gradual
- numbness of limbs
- weakness
- urinary urgency
- paralysis (may occur without premonitory symptoms)
Progression over minutes/hours/few days
- upper respiratory infection, alimentary infection or vacination in 1-2 wees before onset
- acute onset, peak time at several hours to a few days
- spinal shock to spasitic paralysis
- complication: pulmonary infection, urinary tract infection, bedsore
What lab examinations should be carried out for acute myelitis
- CSF: WBC- 10 to 100 x 10(6) / L - lymphocytes
protein: normal or mildly elevated
glucose and chloride: normal - VEP: normal
- SEP: amplitude decreases
- EMG: normal loss of nerve conduction
**MRI: thinckening spinal cord, T1 low signal, T2 high signal
How is acute myelitis diagnosed
- acute nset
- infection or vaccination before onset
- transverse lesion
- CSF and MRI support
What is the differential diagosis for acute myelitis
- neuromyelitis optica
- spinal vascular disease
- acute compressive myelopathy
- acute extradural abscess
- acute inflammatory demyelinating poyneuropathy