spinal cord dysfunction. stuff I forget Flashcards
causes of spinal cord dysfunction in pts w/ cancer:
- epidural cord compression? (3 HAT)
- intramedullary? (4 HAMS)
- other myelopathies: (3- CPR)
- 2 more causes(AM itis)
- epidural: H-hematoma, A- abscess, T-tumor
- intramedullary- HAMS- H- hematoma, A-absces, M-mets, S-syrinx
- other: CPR- chemotherapy, paraneoplastic, radiation
- AM itis - spinal arachnoiditi, neoplastic meningitis.
epidural myelopathy often due to ______.
what are the 3 most common etiologies?
what happens w/cancer?
metastatic cancer
: lung, breat, prostate
cancer enters vertebral bodies –> weakens it–> expands–> compresses cord
what to do if suspicious of spinal cord compression?(3 steps here)
- tx w/steroids first (dexamethasone)
- spinal MRI w/gadolinium
- follow pt slowly
- neurosurgery consult.
when is a spinal tap required in a cancer pt w/back pain(esp in thoracic region)?
- spinal tap reuired if NO EVIDENCE of cord compression by imaging techniques
infections of spinal cord can –>spinal cord compresssion.
order.
MC cause of infectious spondylitis?
S. Aureus (usually hematogenous)
diff in kids: disc space –> vertebrae
adults: subchondral vertebral body –> disc space
most metastastic cancer begins in _______
most spinal abscess begin in_________
MC patient with spnal abscess?
cancer: vertebral body
abscess: disc space
MC pt = IV drug user w/staph aureus infection. MRI = choice test.
fever, pain on percussion, elevated white count, elevated ESR with risk factors of: IV drug use, HIV immunosuppression are indiciative of?
epidural abscess
what is an infection of the vertebral bodies that causes following:
weakness fo bones —> collapse of vertebral body–> subsequent cord compression
osteomyelitis
what presetns as
X-ray: destruction of disc space and adjacent end plates of vertebrae
CT scan: paraspinous abscess in addition to bony destruction
kyphposis
_red rods of CSF (Ziehl-Neelsen stain) _
TB- Pott’s disease
what presents as:
2nd most cancer of spinal tumor
middle-aged woman w/thoracic spine tumor that is intramedullary and extramedullary bone ersion, lesion that is isointencse w/cord on T1 and T2WI, moderate contrast enchancement +/- dural tail.
spinal meningioma
dumbell shaped extramedullary + intramedullary tumor in middle aged adult
schwannnoma and neurofibroma
lesion that MC presents as central cord syndrome?
syrninx
tumor of spinal cord w/multisegmental enlargement.
spinal cord astrocytoma
3 vascular disease of spinal cord?
Aneurysm
AVM
infarct much less common in brain
vascular supply of spinal cord?
how may arteries?
which arteries supplies 70% of cord?
where is water shed zone?
one anterior, two posterior arteries
Anterior spinal artery of ADAMKIEWITZ supplies 70% of cord
“water shed zone” at peripheray of central gray matter
describe how lesion to artery of Adamkiewicz(great radicular artery presents)
provides blood to ant 2/3 of cord. lesion = xSpinothalamic tract(lost pain and temp), xCST (weakness), but INTACT posterior column function(vibration and position sense)
what are two acute non-compressive myelopathies
transverse myelitis
Nueromyelitis optica
what are the acute(4) and chronic symptoms of spinal cord transection
ACUTE = SPINAL SHOCK
ACUTE = 1. flaccid paralysis
- complete sensory level to ALL MODALITIES
- loss of bladder, bowel, and sexual function
- Autonomic malfunction.
CHRONIC = NO SHOCK; spastic paralysis w/symp of acute.
what is described by following:
- rare-stab wound: sometimes seen in myelitis
- on side of lesion: ipislateral spastic paralysis(after spinal shock) below level of lesion
- HYPER-reflexia and Babinski signs (xCST)
- Ispilateral loss of vibration and position sense (xposterior columns)
- _contralateral loss of pain and temp _
Brown-sequard hemi-section syndrome.
Spastic weakness of lower extremeities
decreased sensation to vibration and positiion
ROMBERG SIGN
non-cerebellar ataxia
BABINSKI and HYPERREFLEXIA
May also cause peripheral neurpathy (mixed signs)
subacute cominbed degeneration of spinal cord (eg due to B12 def- pernicious anemia)
B12 def will present as subacute cominbed with invovlement of CORTICOTSPINAL and POSTERIOR COLUMN + dementia and peripheral neuropathy
how do you tx B12 def?
IM vit B12 injection
what presents as following:
- develop parapersis
- CNS infiltrated by monocytes
- CNS demyelination and axonal degeneration (CST>>>POSTERIOR COLUMN)
- CSF shows oligoclonal bands and IgG
HTLV-1 associated myelopathy/tropical spastic paraparesis
CD4+ T lymphocytes reserviour
what presents as following:
neurologic complication of late AIDs
progressive spastic parapareis - hyperreflexia, extensor plantar responses
sensory ataxia and incontinence
resembles B12 def
vacuolar myelopathy associated with late AIDS
get vacuolation and myelin pallor (post and lateral columns)
- what causes tabes dorsalis?
- what part of spina cord affected?
- what sign is positive
- complication of neurosyphillis
- posterior column dysfunction
- loss of vibration and joint position sense
- ROMBERG sign
top ten things:
- _______ = neurologic emergency
- spinal cords ends at ______
- back pain in whom is emergency?
- what can progress quickly?
- do not delay what type of testing?
- ask pt what?
- what do you need to percuss?
- what tx is ndicated in acute myelopathies?
- what should you make pt do?
- remember basic neuro anatomy
- acute myelopathy = emergency
- L1/L2
- cancer pt.
- myelopathies
- neuroradiologic
- where it hurts
- vertebral column
- STEROIDS
- WALK
