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Internal Medicine pt. 2 > Spinal Cord Disorders > Flashcards

Spinal Cord Disorders Flashcards

1
Q

What are the divisions of the ascending sensory tracts?

A
  • posterior column -> proprioception, vibration, & fine touch
  • lateral spinothalamic tracts -> pain, temperature, & crude touch
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2
Q

Where does the descending tract lie?

A

the lateral part of the spinal cord

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3
Q

What is the hallmark of spinal cord lesions?

A
  • symmetric UMNL pattern weakness

- spinal sensory level

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4
Q

Where will the sensory impairment occur in relation to the level on the spinal cord injury?

A 
T1 -> medial arm 
T3 -> 3rd-4th interspace 
T4 -> nipple line & 4th-5th intercostal space '
T6 -> xiphoid process 
T10 -> Navel 
T12 -> pubis
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5
Q

What are the superficial reflexes tested in a physical exam?

A
  • abdominal reflex -> T8 - T12
  • Cremasteric reflex -> L1 - L2
  • Sacral sparing & rectal exam -> if present then it’s not a complete transection
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6
Q

What is the clinical presentation of spinal shock?

A

acute spinal cord injury (mot commonly traumatic)

  • LMNL pattern first (due to acute disconnect between brain & muscles) -> weakness, areflexia, hypotonia, & absent babinski
  • in 5 - 7 days -> turns into UMNL pattern
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7
Q

What spinal cord lesion causes neurogenic shock?

A

lesions above T6 -> disrupt sympathetic pathway -> PARASYMPATHETIC overtake

  • cardiovascular collapse -> hypotension & bradycardia
  • poikilotherma

TREAT WITH PRESSORS

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8
Q

How is a complete spinal cord injury differentiated from a partial one?

A

COMPLETE PARTIAL

  • loss of all motor, sensory, autonomic functions - partial loss
  • early (LMNL) spinal shock then UMNL
  • sensory level - always a sensory level but may be asymmetric

test sacral sensation, posterior column sensations, & superficial reflexes before deciding if its complete or not

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9
Q

What is the most common type of incomplete cord syndrome?

A

CENTRAL CORD SYNDROME

  • caused by whiplash injury in old patients with cervical spondylosis
  • demyelinating lesions
  • syringomyelia
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10
Q

What is the cause of Brown-Sequard syndrome?

A

cord hemisection due to penetrating traumas or other pathologies

  • ipsilateral loss of posterior column & motor function
  • contralateral loss of pain & temperature
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11
Q

How are traumatic spinal cord injuries managed?

A
  • ABC -> neurogenic shock
  • C-collar in cervical spine injuries
  • surgical fixation of a fracture
  • supportive treatment
  • DVT prophylaxis
  • neuropathic pain treatment -> TCA (duloxetine)
  • rehabilitation
  • if C1-C4 is damaged -> intubate (phrenic nerve might be damaged)
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12
Q

What is the cause of syringomyelia?

A

disruption of CSF drainage from the central canal due to

  • chiari malformation
  • previous trauma to the cervical or thoracic spine
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13
Q

What is the clinical presentation of syringomyelia?

A
  • loss of pain & temperature sensations -> due to destruction of crossing anterior comissure fubers from the spinothalamic tract
  • LMNL weakness on the same level
  • UMNL below level
  • CAPE-LIKE DISTRIBUTION
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14
Q

What is the cause of arnold-chiari malformation type 1?

A
  • cervicomedullary junction anomalies -> caudal displacement of cerebellum with/without the medulla oblongata through the foramen magnum
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15
Q

What are the symptoms of Arnold-Chiari Malformation type 1?

A
  • parasthesia
  • myelopathy
  • neck pain
  • brain stem compression
  • sudden death

diagnose with MRI
treated with decompressive surgery if symptomatic

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16
Q

What is the cause of anterior cord syndrome?

A

damage to the anterior 2/3rds of the spinal cord as a result of reduced blood flow or occlusion to the anterior spinal artery due to

  • iatrogenic after major cardiac or aortic surgery
  • atherosclerosis
  • vasculitis
  • traumatic
17
Q

What is the clinical picture of anterior cord syndrome?

A

loss of motor, autonomic, pain & temperature sensations below the level of the lesion
- sparing posterior cord sensations

18
Q

What are the causes & symptoms of posterior cord syndrome?

A

occlusion of the posterior spinal artery due to

  • syphilis
  • vasculitis
  • nutritional

leading to symmetric loss of posterior column sensation (proprioception & vibration)

19
Q

What are the causes of nutritional myelopathy?

A

increasing due to gastrectomy procedures -> deficiency in vitamin B12, Copper, & vitamin E

  • test for specific vitamins/minerals
  • do MRI
20
Q

What are the causes of subacute combined degeneration of the spinal cord?

A

vitamin B12 deficiency either from malnutrition or malabsorption

  • malnutrition -> vegans, anorexia, & old age
  • malabsorption -> autoimmune to IF, gastrectomy, iliectomy, IBD, pancreatic insufficiency
21
Q

What is the clinical picture of subacute combined degeneration?

A

decreased vitamin B12

  • macrocytic anemia
  • neurological disorders -> polyneuropathy & SCD
  • symmetric loss of posterior column sensations
  • symmetric UMNL weakness
  • sparing of spinothalamic sensation
22
Q

What are the causes of infectious myelopathy?

A
  • HSV
  • HIV
  • HTLV
  • Tryponema Pallidus -> syphilis (tapes dorsalis)
23
Q

What is the cause of Tabes Dorsalis?

A

untreated syphilis -> slow demyelination of posterior column fibers -> loss of proprioception & vibration -> ROMBERGISM

24
Q

How should Tabes dorsalis be diagnosed & treated?

A
  • diagnose -> serology & lumbar puncture

- treatment -> Penicillin

25
Q

What is the clinical picture & treatment of HIV myelopathy?

A
  • untreated HIV -> loss of posterior column & lateral corticospinal
  • sparing of spinothalamic
  • diagnose -> MRI
  • Treat -> HAART
26
Q

What are the causes of inflammatory myelopathies?

A

autoimmune disorders that affect the spinal cord & brain

  • Primary -> MS, NMO, ADEM
  • Secondary -> SLE, RA, Sjogren’s
27
Q

What is the hallmark of inflammatory myelopathies?

A

inflammatory demyelination of the white matter -> affects ascending & descending pathways

28
Q

How are inflammatory myelopathies diagnosed & treated?

A
  • MRI -> demyelinating plaques -> enhaces with gadollinium contrast
  • Lumbar puncture -> elevated oligoclonal bands

treat by immunosuppression

  • acute -> steroids
  • chronic -> DMT

Internal Medicine pt. 2 (19 decks)

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