Spinal Cord Disorders Flashcards
What are the expected signs of cord/root pathology?
UMN signs
- no wasting
- increased tone
- increased reflexes
- pyramidal pattern of weakness
LMN
- decreased tone
- decreased reflexes, flexor plantar
- weakness
Sensory
- myelopathy > sensory level
- hemicord lesion > Brown-Sequard syndrome
- radiculopathy > dermatomal
Autonomic
- bladder/bowel
What is Brown-Sequard syndrome? What is the importance?
Ipsilateral symptoms - dorsal column
- decreased vibration
- decreased position sense
- weakness
Contralateral (spinothalamic)
- decreased pain
- decreased temperature
If patient has syndrome - CANNOT be brain lesion
What is a radiculopathy?
Compression of nerve root leading to dermatomal and myotomal deficits
What are the possible causes of a myelopathy/radiculopathy?
Tumour Vascular abnormalities Degenerative Trauma Inflammation Infective Metabolic Malignancy Congenital/genetic Idiopathic
What can cause degenerative myelo/radiculopathies?
Disc prolapse
Ligamentum hypertrophy
Osteophyte formation
What are the effects of B12 deficiency?
Myelopathy
Peripheral neuropathy
Brain, brainstem, cerebellum problems
Eye/optic nerve problems
What are the symptoms of a B12 deficient myelopathy?
Paraesthesia hands and feet, areflexia
First UMN sign extensor plantaris
Degeneration of CST (paraplegia), dorsal columns (sensory ataxia)
Painless retention of urine
What are example causes of spinal cord ischaemia?
Atheroma (aortic aneurysm) Thromboembolic disease Arterial dissection Hypotension Hyperviscosity Vasculitis Venous occlusion Meningovascular syphilis
Symptoms/Signs of spinal cord ischaemia?
Onset may be sudden or over several hours
Pain (back pain/radicular, visceral referred pain)
Weakness (usually paraparesis rather than quadraparesis)
Numbness paraesthesia
Urinary symptoms
Very rarely posterior spinal artery (dorsal columns spared)
Investigations that may be done in suspected spinal cord ischaemia?
MRI
Examination
How is spinal cord ischaemia treated?
Reduce risk of recurrence
- maintain BP
- reverse hypovolaemia/arrhythmia
- antiplatelets
OT/Physio
Manage vascular risk factors
What are the symptoms of a disc prolapse?
Acute pain down leg/arm
Numbness and weakness in distribution of root involved
What are the symptoms of Cauda Equina Syndrome? How is it managed?
Bilateral sciatica
Saddle anaesthesia
Urinary dysfunction
Medical emergency
Requires urgent MRI, emergency lumbar discectomy
What is cervical sponylosis? What are the symptoms and management?
Umbrella term for degenerative change in cervical spine leading to spine and nerve root compression
Myelopathy and/or radiculopathy
Onset months-years
Conservative if no/mild myelopathy
Surgery for progressive moderate to severe myelopathy
Symptoms/management of Lumbar Spinal Stenosis?
Pain down both legs - ‘spinal claudication’
Lumbar laminectomy for treatment
What are the broad different types of spinal tumours?
Extra dural (55%)
Intradural (40%
Inframedullary (5%)
What are the different types of extradural tumours?
Metastases - lung, breast, prostate
Primary bone tumours - chordoma, osteoblastoma, osteoid osteoma
What are the different types of intradural tumours?
Meningioma
Neurofibroma
Lipoma
What are the different types of intramedullary tumours?
Astrocytoma
Ependymoma
Teratoma
Haemangioblastoma
What are the symptoms of spinal cord tumours? How are they managed?
Pain
Weakness
Sphincter disturbance
Urgent MRI if back pain
Surgical decompression
Radiotherapy
What are the different types of spinal infections?
Osteomyelitis
- within vertebral body
Discitis
- infection of intervertebral disc
Epidural abscess
- in epidural space
What are the risk factors for osteomyelitis? Management?
IVDU Diabetes Chronic renal failure Alcoholism AIDS
Antibiotics or surgery if evidence of neurology
Risk factors for epidural abscess? What are common organisms? How is it managed?
IVDU
Diabetes
Chronic renal failure
Alcoholism
SA, streptococcus, E coli are common
Anyone presenting with back pain, pyrexia, focal neurology needs urgent MRI
Managed with surgical decompression, long term IV antibiotics
