Spinal cord disorders Flashcards
What is a spinal cord compression
Spinal cord compression (SCC) results from processes that compress or displace arterial, venous, and cerebrospinal fluid spaces, as well as the cord itself.
Spinal cord compression can lead to …
- acute
- sub- acute
- chronic spinal cord injury
most common causes of SCC
- Trauma- car accidents, falls
- Vertebral compression fractures: osteoporosis
- Disc prolapse
- Tumors
- Epidural haemotoma
Risk factors for SCC
- Trauma
- High risk sporting activity
- high risk occupation
- malignancy
- age
Symptoms of SCC
- acute onset
- back pain
- parasthesia
- weakness
- bladder or bowel dysfunction
Signs of SCC
- upper motor neuron weakness below lesion
- sensory deficit
- spinal shock
- neurogenic shock
What would UMN weakness show
- Loss of muscle power
- Increased tone
- Hypereflexia
how would sensory deficit be presented
pinprick, fine-touch, vibration, temperature, joint-position sense
What are the different pattersn fo SCC
- complete
- central cord syndrome
- anterior cord syndrome
- brown sequard syndrome
- posterior cord syndrome
features of complete spinal cord injury
- All motor and sensory function below the SCI level
- high cervical cord level - quadriplegia, respiratory insufficiency, loss of bladder and bowel function, neurogenic shock
features of central cord syndroem
- Usually involves cervical spine
- Weakness in upper extremities > weakness in lower extremities
- Variable sensory loss below the level of injury
most common pattern of SCI
Central cord syndrome
Features of anterior cord syndrome
- Disruption of anterior spinal cord or anterior spinal artery
- Loss of motor function below the level
- Loss of pain and temperature sensation (anterior column)
- Preservation of fine touch and proprioception
Features of posterior cord syndrome
- Disruption of posterior spinal cord or posterior spinal artery (rare)
- Loss of fine touch and proprioception (posterior column)
- Preservation of pain and temperature sensation
Features of brown sequard syndroem
- Hemisection lesion of the spinal cord
- Unilateral spastic paralysis
- Ipsilateral loss of vibration and proprioception
- Contralateral loss of pain and temperature sensation
- Ipsilateral Hyperreflexia
Investigations for SCI
- MRI whole spine
- Full neurological examination: tone, power, sensation, reflexes, proprioception
Management of SCI
If prescence of malignancy on MRI administer dexamethasone 16mg daily with PPI cover
Spinal chord decompression
Define cauda equina
compression of the cauda equina
What is cauda equina
collection of nerve roots which extend beyond the termination of the spinal cord at L1 to exit the spinal column in L and S region
Mc cause of Cauda equina
The most common cause is lumbar disc herniation at the L4/5 and L5/S1 level.
other causes of cauda equian
neoplasms (metastatic or primary),
abscesses and iatrogenic causes
Clinical features of cauda equina
- lower back pain with alternating or bilateral radicular pain and saddle anaesthesia
- cant feel toilet paper when wiping - saddle paraesthesia
- bladder and bowel disturbance
management of cauda equia
- urgent WHOLE SPINE MRI to surgically decompress in 48 hrs
DD for cauda equina
- connus medullaris syndrome
- vertebral fracture
- peripheral neuropathy
- mechanical lower back pain
