Spinal Cord Lesions Flashcards
What are motor descending pyramidal tract
- Pass through pyramid of medulla
What is pattern of weakness
Anterior and Lateral corticospinal = 90%
Also corticobulbar
Extensor weaker in arms and flexor in legs
UMN originate at either motor cortex or brain stem nuclei
Travel to anterior horn cell in spinal cord at target level
What are extra pyramidal motor tracks
- Don’t pass through pyramid
Rubrospinal
Reticulospinal
Vestibulospinal
What are sensory descending tracts in dorsal column
Gracile fasiculus
Cuneate fasicullus
Sensory spinocerebelllar
Anterior
Posterior
Sensory spinothalamic
Anterolteral tract
Lateral
Anterior
What causes pure motor signs
MND
Poliomyelitis
How does motor neurone present
Corticospinal tracts
UMN and LMN signs
What does poliomyelitis affect
Anterior horn cell
LMN signs
How can sensory present
Dorsal column
Spinothalamic
If spinothalamic affected what are the signs
Loss of pain, temp and sensation
If dorsal column affected what are the signs
Loss of proprioception and vibration
What affects dorsal
Tabes dorsalis - late consequence of syphillis
SACD
Spinal cord infarction
What happens if spinothalamic lesion
Loss of pain, temp and sensation
What causes combined UMN and LMN signs
Fred Tabby Cat Seeks Mice
Fredreich ataxia Tabes dorsalis (syphillis) Cervical + lumbar spondylosis SACD- B12 Motor neurone disease
Alnord chiari malformato / syndomyelia
What is Brown Squared
Spinal cord hemisection
What tracts are affected
Lateral corticospinal
Dorsal
Lateral Spinothalamic
What does it lead too
Ipsilateral spastic paralysis below lesion (corticospinal) + UMN signs
Ipsilateral loss of proprioception and vibration (dorsal)
Ipsilateral sensory loss
Contralateral loss of pain and temp (spinothalamic)
What does cord compression lead too
UMN signs
What can cause
Malignancy
Haematoma
Fracture
What causes subacute combined degeneration of spinal cord (SCAD)
B12 / thiamine deficiency
- Pernicious - Ab against intrinsic factor
- Chron’s
- Gastrectomy
What tracts are affected
Lateral corticospinal
Dorsal
Spinocerebellar
What does it cause
Bilateral spastic paralysis
Bilateral loss of proprioception and vibration - usually first
Distal paraesthesia after
Bilateral limb ataxia
UMN and LMN signs in leg - extensor plantar / absent knee / absent ankle reflex (hyporeflexia)
Painess urine retention
Pain and temp often remain intact
What does Fredreich’s ataxia cause
Same as above
Also cerebellar ataxia signs
What is syringomyelia
Collection of cerebrospinal fluid in spinal cord
Symptoms may be static for years but worsen fast e.g. on coughing or sneezing
What can cause
Tumour
Trauma
Arnold Chiari malformation
What tracts are affected
Antero-Lateral spinothalamic as fluid in middle of cor where this tract passes
What does it cause
Progressive slow neuro signs Flaccid paralysis (typically hand) Loss of pain and temp but preserved touch / vibration Wasting and weakness of hands Cape like distribution Paraesthesia Hyporeflexia Neuropathic pain Upgoing plantar Bladder. / bowel Horner due to compression of sympathetic but rare
What is classic presentation
Burning hand without realising
What happens if not Rx
Scoliosis
How do you Dx
Spine MRI for tumour
Brain MRI for CHairi
How do you Rx
Treat cause
Shunt
How does MS present
Asymmetrical combination of motor, sensory and ataxia signs
What tracts affecting in anterior spinal artery occlusion
Lateral corticospinal
Lateral spinothalamic
What does it cause
Bilateral spastic paresis
Bilateral loss of pain and temp
What is Alnord Chiari malformation
Downward displacement of cerebral tonsil through foramen magnum
Congenital
Trauam
What does it cause
Synrigmyelia
Non-communicating hydrocephalus
Headache
What is Fredreich’s ataxia
AR trinucleotide disorder that causes spinocerebellar degeneration
Anticipation
How does it present
Present teens
UMN and LMN signs e.g. absent ankle jerk + extensor plantar
+ Ataxia
Other Kyphoscolisosis Optic atrophy HOCM DM Associated with WPW
What is Telangiectasia ataxia
AR defect in gene for DNA repair + immunodeficiency
What does it cause
Early childhood Abnormal movement Ataxia Telangiectasia IgA deficient so recurrent infection
What is Leg term risk
Leukaemia
