Spinal cord diseases & infections Flashcards by Heo Mun Ho

Define myelopathy

DISEASE OF SPINAL CORD

=neurological deficit due to compression of spinal cord

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List motor (4) /sensory (1) /autonomic (2) signs of a spinal cord lesion

UMN signs (4)

Sensory:
Sensory level (loss of sensation at level damaged and below) - i.e. loss of pain, temp, vibration, JPS etc

Autonomic:
Bladder/ bowel dysfunction

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Motor/sensory signs of a C5 cord lesion (6)

UMN lesion signs below C5, LMN signs at C5,
No sensation below C5

Wasting of C5 innervated muscles
↑ tone in legs > arms
Biceps reflex decreased, ↑ lower limb reflexes
Weakness at shoulder and below
Babinski +Ve
Sensory level (loss of sensation at and below C5)

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What does pyramidal weakness mean

extensors become weaker than flexors in arms and vice versa for legs

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What is a hemicord lesion and what syndrome does it cause

Damage to just one half of spinal cord

Brown-sequard syndrome

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Signs of a hemicord lesion (brown sequard syndrome) [2]

IPSILATERAL loss of vibration and joint position sense

CONTRALATERAL loss of pain and temperature

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Causes of a non-compressive spinal cord lesion (6)

Vit B12 deficiency

Inherited - hereditary spastic paraplegia, friedrich’s atxia

Infection – viral/bacterial/fungal, e.g. HSV, tropical spastic paraplegia

Autoimmune – e.g. sarcoidosis

Paraneoplastic

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Causes of a compressive spinal cord lesion (6)

Spine trauma - e.g. gun shot wound, car accident

vertebral fracture,

intervertebral disc herniation,

primary or metastatic spinal tumour

infection - e.g. discitis, epidural abscess

Vascular - e.g. AVM

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What is Friedrich’s taxia (cause of non-compressive spinal cord lesion)

Rare inherited disease that causes progressive nervous system damage and movement problems (difficulty walking, a loss of sensation in the arms and legs, and impaired speech)

Leads to impaired muscle coordination (ataxia) that worsens over time

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Causes of spinal stroke (ischaemic myelopathy) (2)

Either ISCHAEMIA (e.g. blood clot in artery supplying spinal cord)

or HAEMORRHAGE (bursting and bleeding of arteries supplying spinal cord usually due to hypertension)

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Spinal strokes are usually due to lack of blood supply from what artery

Anterior spinal artery

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Risk factors of spinal stroke (4)

Aortic disease

aortic aneurysm
aortic dissection

Atherosclerosis

Thromboembolic disease - e.g. AF

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Symptoms (2) /signs (4) of spinal stroke

Back pain
Visceral referred pain

Paraparesis (partial paralysis/weakness of both legs)
Numbness
Paraesthesia - tingling sensations
Urinary retention

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What is spinal shock

Temporary loss of reflex, motor and sensory function below the level of a spinal cord injury

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How is B12 deficiency related to the spine

B12 deficiency can cause myelopathy

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Symptoms/signs of B12 deficient myelopathy (just think myelopathy is UMN)

L’hermitte’s sign - sensation like an electric shock moving down neck into your spine triggered by bending head forward

Paraesthesia - of hands and feet

Areflexia (hyporeflexia)

Paraplegia – partial motor OR sensory paralysis of lower limbs

Sensory ataxia (due to degeneration of dorsal column)

PAINLESS retention of urine

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What is l’hermittes sign + what conditions do you get it in (4)

sensation like an electric shock moving down neck into your spine triggered by bending head forward

MS 
cervical spondylosis (degeneration of the disc spaces between the vertebrae), 
herniation of a cervical disc, 
a cervical spinal cord tumor
vitamin B12 deficiency myelopathy

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Treatment of B12 deficiency myelopathy

Intramuscular B12

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3 types of spinal tumours

Intradural
Extradural
Intradural-extramedullary

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What type of tumour is the most common cause of compressive spinal cord lesion

Extradural

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Extradural spinal tumours are usually metastases from (3) or a primary tumour of (1)

Metastases (from lung, bone, prostate)

Primary bone tumours

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Symptoms (1) /signs (6) of malignant spinal tumours

Back pain
Muscle weakness in limbs
Numbness in limbs
Sphincter disturbance --> bladder/bowel dysfunction --> urinary/bowel incontinence
Difficulty walking
Reduced sensation

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Define incontinence in terms of bladder and bowel dysfunction

Incontinence = lack of voluntary control

Urinary/bowel incontinence = can’t control when you go, may suddenly go

Investigation of spinal tumours

MRI spine

Treatment of malignant spinal tumours (2)

Surgical decompression | Radiotherapy

Intervertebral disc can compress what 2 things

Spinal cord and/or spinal nerve roots

Label whether the following disc prolapses cause myelopathy or radiculopathy: Cervical prolapse centrally --> Cervical prolapse laterally --> Lumbar prolapse centrally --> Lumbar prolapse laterally -->

Cervical prolapse centrally --> CERVICAL MYELOPATHY Cervical prolapse laterally --> CERVICAL RADICULOPATHY Lumbar prolapse centrally --> CAUDA EQUINA SYNDROME (radiculopathy) Lumbar prolapse laterally --> LUMBAR RADICULOPATHY

IV disc prolapse symptoms (1) /signs (2)

Pain down leg/arms (Acute onset) Numbness of muscles innervated by nerve root involved Weakness of muscles innervated by nerve root involved

Investigations of IV disc prolapse

MRI

Treatment of IV disc prolapse (4)

Analgesics Rehabilitation Nerve root injection - local anaesthetic to relieve pain Lumbar/cervical discectomy

What is the umbrella term for degeneration of the cervical spine

Cervical spondylosis

What can cervical spondylosis cause (2)

Myelopathy and/or radiculopathy

Cervical spondylosis is a result of what 3 things

1) Disc prolapse 2) Ligamentum hypertrophy 3) Osteophyte formation

Symptoms (3) /signs (3) of cervical spondylosis

Neck pain - sudden onset Pain may radiate down arm Headache Cervical muscle spasm Mild weakness in muscles and skin innervated by nerve root damaged Mild sensory loss in muscles and skin innervated by nerve root damaged

Treatment of cervical spondylosis - conservative (3) if mild myelopathy - surgical (1) if moderate-severe myelopathy

Conservative (i.e. non-invasive so not surgical) if mild myelopathy - analgesia e.g. NSAIDs - physio - epidural anaesthesia or cervical nerve root block Surgical decompression if moderate-severe myelopathy

Name 2 degenerative spinal diseases

Cervical spondylosis | Lumbar spinal stenosis

What is lumbar spinal stenosis

Spinal canal narrows and compresses the nerves at the level of the lumbar vertebrae. Usually due to spinal degeneration that occurs with aging

Signs of lumbar spinal stenosis

Spinal claudication - pain down both legs Leg pain worse on walking/standing

Treatment of lumbar spinal stenosis (2)

Analgesia, e.g. NSAIDs | Lumbar laminectomy

Level of spinal cord

C1 - L2

Name conditions with back pain (8)

``` Malignant spinal tumour Spinal stroke Disc prolapse Spinal stenosis Vertebral fracture Epidural abscess Discitis Osteomyelitis ```

Name 3 spinal infections

Osteomyelitis Discitis Epidural abscess

What is osteomyelitis

Infection of the bone and bone marrow of the vertebrae

Risk factors of vertebral osteomyelitis (5)

``` lV drug abuse, diabetes, chronic renal failure, alcoholism, AIDS ```

Symptoms (2) /signs (2) of vertebral osteomyelitis

Back pain Night sweats Fever Swelling around infection site

Treatment of vertebral osteomyelitis (2)

Long term IV antibiotics Surgery if evidence of neurological deficit

What is discitis + what can it lead to if not treated

Infection of IV disc space, usually bacterial Epidural abscess

Discitis often co-exists with

Vertebral osteomyelitis

Symptoms/signs (2) of discitis

Back pain | Fever

Treatment of discitis

Long term IV antibiotics

What is an epidural abscess

Infection in the epidural space - pus collects outside dura

Causative organisms of epidural abscess (3)

Staph aureus Streptococcus E. coli

Risk factors of epidural abscess (6)

``` lV drug abuse, diabetes, chronic renal failure, alcoholism Vertebral osteomyelitis Recent spine surgery ```

Symptoms/signs of an epidural abscess (Triad)

Back pain Pyrexia Focal neurology

Treatment of epidural abscess

Long term IV antibiotics Surgical decompression if progressive neurological loss or not responsive to antibiotics

List sinister features associated with back pain (6)

Fever (spinal tumour or spinal infection) weight loss (spinal tumour, maybe spinal infection) Leg weakness or pain Sphincter disturbance - urinary/bowel incontinence (spinal tumour, spinal stroke ) Focal neurological deficits

Elbow flexors innervated by what nerve root Elbow extensors innervated by what nerve root Wrist extensors innervated by what nerve root Finger extensors innervated by what nerve root Hip flexors innervated by what nerve root Knee extensors innervated by what nerve root Ankle dorsiflexors innervated by what nerve root Ankle plantar flexors innervated by what nerve foot

C5 C7 C6 C8 L2 L3 L4 S1