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
What is the treatment plan for acute myelitis
- general treatment: nursing and prevention of complications
- glucocorticoids
- IVIG
- vitamin B
- rehabilitation
What is the prognosis for acute myelitis
- recovery after 3-6 moths
- bad prognosis in complete paralysis with many spinal segments or wide MRI changes or with complication or cervical lesions
Define: compressive myelopathy
a syndrome of spinal cord compression caused by intraspinal or vertebral occupying lesions, with ptogression spinal cord hemisection syndrome, transverse injury and spinal canal obstruction occurance, soinal nerve root and blood vessels can be affected to varying degrees
what is the etiology of compressive myelopathy
- tumour
- infection
- vertebral trauma
- vertebral degeneration
- congenital disease
- haematologic diseases
List the clinical findings for compressive myelopathy
Acute compression: transverse esion of spinal cord under lesion
Chronic compression:
1. nerve root pain
2. incomplete compression (Brown-sequared syndrome)
3. complete compression (transverse lesion0
- radicular symptoms
- sensory disturbance
- motor isorder
- dysreflexia
0 dysautonomia
- irritation symptoms of spinal meninges
spinothalamic tract: loss of warmth sensation and pain in contralateral part of spinal cord lower 2-3 segments of lesion
What lab examinations should be carried out for compressive myelopathy
CSF:
- protein elevated
- Froin syndrome
*extramedullary and intradural lesion: proteinx3 increased
*extramedullary and epidural: protein increased
vertebral X-ray
CT/MRI
Soinal canal radiography
radioisotope scanning
How is compressive myelopathy diagnosed
- is inury compressive or non-compressive
- determne the compresssion site and the plane of spinal cord, and then analyse whether the compression is in the marrow, extramedullary and intradural or epidural
- determine etiology and nature of compression
- Longitudinal location:
- radiculagia
- sensation decreased
- change of tension reflex
- muscular atrophy
- tenderness and percussion pain spinous process - Transverse location
- lymphoma invading spinal canal via inter-vertebral foramen, compressing dura mater and spinal cord
- miningioma compressing spinal cord and distroting nrve roots
- astrocytoma exposed by longitudinal incision bulging spinal cord
How is compressive myelopathy treated
- remove cause as soon as possible (operation)
-> especially acute compression - rehabilitation
