Spinal Cord Diseases Flashcards
what upper motor neuron signs would you expect to see in spinal cord pathology?
> no wasting
increased tone
increased reflexes
pyramidal pattern of weakness
what lower motor neuron signs would you expect to see in cord or root pathology?
> decreased tone
decreased reflexes
flexor plantar
weakness
what would a hemicord lesion present with?
brown-sequard syndrome
describe the ipsilateral affects of brown-sequard syndrome
> decreased vibration
decreased joint position sense
weakness
describe the contralateral affects of brown sequard syndrome
> decreased pain sensation
> decreased temperature
what is radiculopathy?
dermatomal sensory loss
give an example of how the autonomic system is affected in spinal cord/root pathology
bladder and bowel control
what would the signs be for a C5 cord lesion?
> wasting of C5 innervated muscle
increased tone
reflexes decreased in biceps and increased in lower levels
decreased power to C5 innervated muscles, pyramidal pattern below
sensory level
what can cause myelopathy/radiculopathy surgically?
surgical (extrinsic): > tumour > vascular abnormalities > degenerative > trauma
name some medical causes of myelopathy
> inflammation (demyelination and autoimmune) > vascular (ischaemic/haemorrhage) > infective > metabolic > malignant/infiltrate > congenital/genetic > idiopathic
what can cause spinal cord ischaemia?
> atherothrombosis > thromboembolism > arterial dissection > systemic hypotension > vasculitis > venous occlusion > endovascular procedure > decompression sickness > meningovascular syphilis
how may spinal cord stroke present?
> onset sudden or over few hours > pain: back, visceral > weakness: parapresis > numbness/ paraesthesia > urinary symptoms (incontinence)
what artery is usually involved in a spinal cord stroke?
anterior spinal artery
what treatment is available for spinal cord stroke?
> reduction of risk: BP maintaince, reverse hypovolaemia, antiplatelet therapy
OT and physiotherapy
manage vascular risk factors
what is the prognosis for spinal cord stroke?
> function return depends on degree of parenchymal damage
unless significant motor recovery in first 24 hours major recovery chance is very low
20% mortality
what is demyelinating myelitis characterised by?
pathological lesions of inflammation and demyelination leading o temporary neural dysfunction. affect the white matter of the CNS
describe the onset of demyelinating myelitis
subacute
what may there be in the history of demyelinating myelitis?
previous neurological or ophthalmological episodes
what is the treatment for MS myelitis?
supportive
methylpredinosolone
what does B12 absorption relay on?
intrinsic factor
what secretes intrinsic factor?
gastric parietal cells
what is pernicious anaemia?
an autoimmune condition in which antibodies to intrinsic factor prevent b12 absorption
what can b12 deficiency be a complication of?
> total gastrectomy
crohns
tape worms
describe the effects of B12 deficient myelopathy
> paraethesia
extensor plantars
degeneration of cortical spinal tracts and dorsal columns
painless retention of urine
what investigations would you carry out for b12 deficiency myelopathy?
> FBC
> blood film
what is the treatment for B12 deficient myelopathy?
intramuscular B12
