Spinal Cord Disorders Flashcards
What are the divisions of the ascending sensory tracts?
- posterior column -> proprioception, vibration, & fine touch
- lateral spinothalamic tracts -> pain, temperature, & crude touch
Where does the descending tract lie?
the lateral part of the spinal cord
What is the hallmark of spinal cord lesions?
- symmetric UMNL pattern weakness
- spinal sensory level
Where will the sensory impairment occur in relation to the level on the spinal cord injury?
T1 -> medial arm T3 -> 3rd-4th interspace T4 -> nipple line & 4th-5th intercostal space ' T6 -> xiphoid process T10 -> Navel T12 -> pubis
What are the superficial reflexes tested in a physical exam?
- abdominal reflex -> T8 - T12
- Cremasteric reflex -> L1 - L2
- Sacral sparing & rectal exam -> if present then it’s not a complete transection
What is the clinical presentation of spinal shock?
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
What spinal cord lesion causes neurogenic shock?
lesions above T6 -> disrupt sympathetic pathway -> PARASYMPATHETIC overtake
- cardiovascular collapse -> hypotension & bradycardia
- poikilotherma
TREAT WITH PRESSORS
How is a complete spinal cord injury differentiated from a partial one?
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
What is the most common type of incomplete cord syndrome?
CENTRAL CORD SYNDROME
- caused by whiplash injury in old patients with cervical spondylosis
- demyelinating lesions
- syringomyelia
What is the cause of Brown-Sequard syndrome?
cord hemisection due to penetrating traumas or other pathologies
- ipsilateral loss of posterior column & motor function
- contralateral loss of pain & temperature
How are traumatic spinal cord injuries managed?
- 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)
What is the cause of syringomyelia?
disruption of CSF drainage from the central canal due to
- chiari malformation
- previous trauma to the cervical or thoracic spine
What is the clinical presentation of syringomyelia?
- 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
What is the cause of arnold-chiari malformation type 1?
- cervicomedullary junction anomalies -> caudal displacement of cerebellum with/without the medulla oblongata through the foramen magnum
What are the symptoms of Arnold-Chiari Malformation type 1?
- parasthesia
- myelopathy
- neck pain
- brain stem compression
- sudden death
diagnose with MRI
treated with decompressive surgery if symptomatic
What is the cause of anterior cord syndrome?
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
What is the clinical picture of anterior cord syndrome?
loss of motor, autonomic, pain & temperature sensations below the level of the lesion
- sparing posterior cord sensations
What are the causes & symptoms of posterior cord syndrome?
occlusion of the posterior spinal artery due to
- syphilis
- vasculitis
- nutritional
leading to symmetric loss of posterior column sensation (proprioception & vibration)
What are the causes of nutritional myelopathy?
increasing due to gastrectomy procedures -> deficiency in vitamin B12, Copper, & vitamin E
- test for specific vitamins/minerals
- do MRI
What are the causes of subacute combined degeneration of the spinal cord?
vitamin B12 deficiency either from malnutrition or malabsorption
- malnutrition -> vegans, anorexia, & old age
- malabsorption -> autoimmune to IF, gastrectomy, iliectomy, IBD, pancreatic insufficiency
What is the clinical picture of subacute combined degeneration?
decreased vitamin B12
- macrocytic anemia
- neurological disorders -> polyneuropathy & SCD
- symmetric loss of posterior column sensations
- symmetric UMNL weakness
- sparing of spinothalamic sensation
What are the causes of infectious myelopathy?
- HSV
- HIV
- HTLV
- Tryponema Pallidus -> syphilis (tapes dorsalis)
What is the cause of Tabes Dorsalis?
untreated syphilis -> slow demyelination of posterior column fibers -> loss of proprioception & vibration -> ROMBERGISM
How should Tabes dorsalis be diagnosed & treated?
- diagnose -> serology & lumbar puncture
- treatment -> Penicillin
What is the clinical picture & treatment of HIV myelopathy?
- untreated HIV -> loss of posterior column & lateral corticospinal
- sparing of spinothalamic
- diagnose -> MRI
- Treat -> HAART
What are the causes of inflammatory myelopathies?
autoimmune disorders that affect the spinal cord & brain
- Primary -> MS, NMO, ADEM
- Secondary -> SLE, RA, Sjogren’s
What is the hallmark of inflammatory myelopathies?
inflammatory demyelination of the white matter -> affects ascending & descending pathways
How are inflammatory myelopathies diagnosed & treated?
- MRI -> demyelinating plaques -> enhaces with gadollinium contrast
- Lumbar puncture -> elevated oligoclonal bands
treat by immunosuppression
- acute -> steroids
- chronic -> DMT
