Spinal cord disorders Flashcards
How is the spinal cord arranged?
More than 19 different tracts
Ends in the cauda equina
What is the most important descending motor tract?
Lateral corticospinal tract
What is that pathway of the lateral corticospinal tract?
Begins in cerebral cortex, decussates in pyramids of lower medulla (medulla oblongata) and travels down contralateral side of spinal cord
What are the most important ascending sensory tracts?
Fasciculus gracilis
Fasciculus cuneatus
Lateral spinothalamic
Anterior spinothalamic
What is the function of the fasciculus gracilis?
Transmits vibration, conscious proprioception, and fine touch sensations from lower body
What is the function of the fasciculus cuneatus?
Carries tactile and proprioceptive information for upper limbs and torso
What is the function of the lateral spinothalamic tract?
Carries information about pain and temperature
What is the function of the anterior spinothalamic tract?
Carries information about touch and pressure
What makes up the dorsal column?
Fasciculus gracilis and fasciculus cuneatus
Where does the dorsal column decussate?
In the medulla
Where does the anterior spinothalamic tract decussate?
Crosses over at level of the spinal cord
Where does the lateral spinothalamic tract decussate?
At the level of the spinal cord
What artery is the biggest source of blood supply in the spinal cord?
Anterior spinal artery
Supplies 2/3
What are the 11 ways of classifying spinal cord disorders?
- Traumatic - whiplash, gunshot, stab, haematoma
- Degenerative disc disease - cervical/lumbar spondylosis, spinal canal stenosis
- Inflammatory - MS, transverse myelitis, NMO
- Neoplastic - intrinsic/extrinsic
- Infective, HIV, HTLV, abscess, empyema
- Vascular - ASA occlusion, spinal dural fistula, vasculitis
- Granulomatous - sarcoidosis
- Metabolic - vit B12 deficiency
- Hereditary - hereditary spastic paraplegia, Fredrich’s ataxia
- Other neurodegenerative - ALS
- Other - syringomyelia
Give an example of an intrinsic spinal cord tumour
Ependymoma
Give an example of an extrinsic spinal cord tumour
Meningioma
Metastatic lymphoma
What acute/subacute conditions are spinal cord emergencies?
Bladder/bowel weakness Saddle anaesthesia Leg weakness Constant sensory deficit Significant pain
How do you assess spinal cord problems?
Acute imagine of spine
MRI
What investigations do you do in a traumatic spinal cord issue?
MRI
What investigations do you do in degenerative disc disease?
MRI
CT
What investigations do you do in inflammatory spinal problems?
MRI spine and brain with contrast
LP - OCB and cells
What investigations do you do in neoplastic spinal problems?
MRI with contrast
What investigations do you do in vascular spinal problems?
MRI
Angiography
Vasculitis screen
What investigations do you do in granulomatous spinal problems?
Serum ACE level
MRI
CXR
What investigations do you do in metabolic spinal problems?
B12/folate
MMA
Fasting homocysteine levels
What investigations do you do in hereditary spinal problems?
Genetic panel
What investigations do you do in neurodegenerative conditions?
EMG
Genetics
What are the common causes of a dorsal column lesion?
MS
Penetrating injuries
Compression from tumours
What will you lose in a dorsal column lesion?
Ipsilateral loss of light touch, vibration, proprioception generalised below level of lesion
What are the common causes of a fasciculus cuneatus lesion?
MS
Penetrating injuries
Compression from tumours
What will you lose in a fasciculus cuneatus lesion?
Ipsilateral loss of light touch, vibration and proprioception below lesion
What are the common causes of lateral corticospinal tract lesions?
Penetrating injuries
Lateral compression from tumours
MS
What will you lose in a lateral corticospinal tract lesion?
Ipsilateral UMN signs - spastic paralysis, hyperreflexia, babinski, clonus, hypertonia generalised below lesion
What are the common causes of lateral spinothalamic tract lesions?
MS
Penetrating injuries
Compression from tumours
What will you lose in a lateral spinothalamic tract lesion?
Contralateral loss of pain and temperature
What are the common causes of a lesion of the anterior grey and white commissures?
Post-traumatic contusion
Syringomyelia
Intrinsic spinal cord tumours
What will you lose in a lesion of the anterior grey and white commisures?
Pain and temperature sensation impaired bilaterally
What is central cord syndrome?
Lesion of anterior grey and white matter commisures
What are the common causes of brown sequard syndrome?
Penetrating injuries
Lateral compression from tumours
MS
What lesions will you get in Brown-Sequard syndrome?
Dorsal column
Lateral corticospinal tracts
Lateral spinothalamic tracts
What will you lose in Brown-Sequard syndrome?
Ipilateral loss of light touch, vibration, proprioception, UMN signs
Contralateral loss of pain and temperature
What lesions will you get in a transverse cord lesion?
Doral column
Lateral corticospinal
Lateral spinothalamic
What will you lose in a transverse cord lesion?
Bilateral loss of light touch, vibration, proprioception
Bilateral UMN signs
Bilateral loss of pain and temperature
What are the common causes of transverse cord lesions?
Trauma
Tumours
Transverse myelitis
MS
What is posterior cord syndrome?
Complete transection of dorsal columns
What are the common causes of posterior cord syndrome?
Trauma
Compression from posteriorly located tumours
MS
Vit B12 deficiency
What will you lose in posterior cord syndrome?
Bilateral loss of light touch, vibration and proprioception
What is anterior cord syndrome?
Complete transection of lateral corticospinal and spinothalamic tracts
What will be the symptoms of anterior cord syndrome?
Bilateral UMN signs and LMN signs
Absence of pain and temperature sensation bilaterally
What are the common causes of anterior cord syndrome?
Anterior spinal artery infarct
Trauma
MS
What can cause a hemi-section of the cord by extra-medullary compression?
Intervertebral disc protrusion Spinal cord tumours - meningiomas Metastatic deposits Abscess Transverse myelitis MS Sarcoidosis
What can cause cauda equina?
Compressive - discs, tumours (primary and secondary)
Non-compressive - inflammatory, infiltrative, granulomatous
Vascular - spinal dural fistula
What are the signs of cauda equina?
SPINE
- Saddle anaesthesia
- Pain/paralysis
- Incontinence of bladder/bowel
- Numbness
- Emergency
How do you manage spinal cord disorders?
Manage cause - exclude emergencies Some are untreatable Manage complications - Weakness - B/B dysfunction - Spasticity - Pain - Pressure areas - Mobility
