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Neuro 2 > Spinal Cord Syndromes > Flashcards

Spinal Cord Syndromes Flashcards

1
Q

Myopathy

A

-any disease that affects the spinal cord

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2
Q

Spinal Cord Anatomy

A
  • ends at L1-L2
  • Spinal Taps: done b/w L4 & S1
  • most back pain is lumbar
  • bad things happen in thoracic area
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3
Q

Parts of Spinal Cord

A
    1. Corticospinal tract (hyper-reflexia, spasticity, Babinski, weakness)
      1. Post. Columns (loss of vibration, position sense, Romberg sign)
      2. Spinothalamic tract (loss of pain & temp)
      3. Anterior Horn Cells (flaccid weakness, hypo-reflexia fasiculations)
      4. Root (lancinating pain, numbness, hypo-reflexia)
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4
Q

Anatomy of Spinal Cord: Inside to Outside

A
  • cord
  • pia mater
  • subarachnoid space
  • subdural space
  • dura
  • epidural space (fat)
  • bone
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5
Q

Leptomeningeal

A

-within subarachnoid space

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6
Q

extrdural

A

-epidural

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7
Q

intradural

A

subdural

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8
Q

Intramedullary

A

-within spinal cord parenchymal

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9
Q

Conus

A
  • end of spinal cord

- L1/L2

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10
Q

Nipple Line

A

T4

-sensory level

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11
Q

Umbilicus Line

A

T10

-sensory level

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12
Q

What is common in spinal cord lesions?

A
  • sphincter dysfunction
  • micturition ultimately controlled by CNS
  • bladder symptoms

-long axons from the frontal lobe of brain synapse in the thoracic & sacral areas of the spinal cord (those tracts are vulnerable to injury)

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13
Q

2 types of bladder symptoms that occur with spinal cord lesions?

A
  1. acute lesions - urinary retention with some overflow incontinence
  2. chronic lesions - small spastic bladder that does not completely empty with spasms and urge incontinence
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14
Q

Acute & Subacute myelopathies are?

A

emergencies

  • recognize signs & symptoms, neuro-radiologic testing, lumbar puncture if neuro neg.
  • Therapy is usually IV steroids
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15
Q

Chronic Myelopathy Approach to Patient

A
  • signs & symptoms
  • neurotesting
  • lumbar if neuro neg
  • therapy directed to cause of treatment
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16
Q

History/Exam of patient with Myelopathy

A
  • other illness, fever, location of pain, neuro symptoms, pace of symptoms
  • neuro exam: motor, sensory, reflexes, gait
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17
Q

Progression of Epidural Lesion A

A

hours to days

  • motor symptoms usually early (hyperreflexia, Babinski sign, hard to walk) may NOT be weak
  • Sensory: root irritation, hypersensitive to touch, band or girdle-like sensation in abdomen
  • Urinary Urgency
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18
Q

Progression of Epidural Lesion B

A
  • Motor: legs are spastic & weak, brisk reflexes, babinski sign +
  • Sensory: root area totally numb (ipsilateral), pain in contralateral LE is dec. (spinothalamic)
  • Partial Brown-Sequard (hemi-cord syndrome)
  • Definite sphincter dysfunction
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19
Q

Progression of Epidural Lesion C

A

hours to days (may be acute)

  • Motor: flaccid, arflexic due to spinal cord shock or spastic paraparesis if more chronic or subacute
  • Sensory: complete sensory level to all modalities at level of lesion
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20
Q

Myelopathy - Disc Disease

A

-severe disc disease in the cervical or thoracic cord - can cause epidural cord compression & myelopathy
(herniated & degenerative)
Treatment: steroids & surgery

21
Q

Spinal Cord Trauma

A
  • Paraparesis/paraplegia
  • Quadriparesis/Quadriplegia
  • Vertebral body compression
  • Hematoma
  • Spinal Cord Infarct
  • Cord transection
22
Q

Spinal Cord Trauma: Injury Protocol

A

-Methyprednisolone

23
Q

Causes of Spinal Cord Dysfunction in Patients with Cancer

A
  • Epidural cord compression: tumor, abscess, hematoma
  • Intramedllary processes: metastases, abscess, hematoma, syrinx
  • Other: radiation, chemo, paraneoplastic
  • Neoplastic meningitis
  • Spinal arachnoiditis
24
Q

Epidural Myelopathy due to metastatic cancer

A
  • compression is common complication
  • cancer enters vertebral body (weakens, expands then compresses the spinal cord)
  • Lung, breast, prostate
25
Q

When to get spinal tap?

A

-when no evidence of cord compression form imaging

26
Q

Where does most metastatic cancer begin>

A

-vertebral body

27
Q

Where does most spinal abscesses begin?

A

-disc space

then expand to cause spinal cord compression

28
Q

Most common spinal cord infection?

A

-staph aureus (IV drug users)

29
Q

Test of choice for spine?

A

-MRI

30
Q

Epidural Abscess

A
  • fever, pain on percussion, elevated white count, elevated ESR
  • Risk factors: IV drug use, HIV, immunosuppression
31
Q

Osteomyelitis

A
  • infection of vertebral bodies
  • causes weakness of the bones, collapse of the vertebral body & subsequent cord compression
  • irregular vertebral body end plates
32
Q

Pott’s Disease

A

-class neurologic syndrome of osteomyelitis resulting from TB infection

33
Q

Spinal Meningioma

A
  • intradural, extramedullary
  • common in thoracic spine
  • although occasional benign herniated disc can occur in thoracic spine, most are bad
  • middle age women
34
Q

Nerve Sheath Tumors

A
  • schwannoma & neurofibroma are extramedullary, intradural
  • Classic: dumbbell shape (not common)
  • middle-age
  • symptoms mimic disc herniation
35
Q

Central Cord Lesion

A

A: begins with pain in shoulders (cervical lesion)
-loss of pain & temp, crossing spinothalamic tracts are involved early
B: as lesion involves root entry zones, reflexes are lost in arms, loss of pain & temp is sever (burn), Horner’s syndrome (involve sympathetic path), Touch & joint position are intact “dissociated sensory level”, legs develop spastic paraparesis, Babinski, hyperreflexia due to corticospinal change
C: worsening of symptoms, Sacral sparing b/c these fibers are the most lateral of the spinothalamics, may involve face due to sensory nucleus of trigeminal nerve

36
Q

Syrinx

A
  • Central Spinal Cord Syndrome
  • large expanding space in spinal cord
  • result of trauma or tumor
37
Q

Spinal Cord Astrocytoma

A
  • enhancement with gadolinium

- large amount of edema

38
Q

Vascular disease of spinal cord

A
  • Aneurysm, AVM, less common

- “watershed zone” at periphery of central gray matter

39
Q

Anterior Spinal Artery Syndrome (artery of Adamkiewicz = great radicular artery)

A
  • supplies anterior 2/3 of spinal cord (located in mid thoracic region)
  • symptoms referable to spinothalamic (loss of pain & temp., sensory level), corticospinal function (weakness), but intact posterior column function (vibration & joint position sense)
40
Q

Acute Non-compressive myelopathies

A
  • Transverse myelitis

- NMO

41
Q

Complete Transection of the Spinal Cord - Spinal Cord Shock

A
  • Transverse myelitis
  • other causes
  • acute = spinal shock
  • flaccid paralysis
  • complete sensory level to all modalities
  • loss of bladder, bowel & sexual function
  • autonomic malfunction
  • chronic - no shock (spastic paralysis with above)
42
Q

Brown-Sequard Syndrome

A
  • hemi-section
  • rare: stab wound or myelitis
  • on side of lesion: ipsilateral spastic paralysis (after spinal shock) below the level of the lesion
  • Hyper-reflexia, Babinski signs
  • Ipsilateral loss of vibration & joint position sense
  • Contralateral loss of pain & temp
43
Q

Subacute Combined Degeneration of Spinal Cord

A
  • B12 deficiency - pernicious anemia
  • spastic weakness of lower extremities
  • dec. sensation to vibration & postision
  • Romberg’s sign
  • Ataxia (non-cerebellar)
  • Babinski signs & hyperreflexia
  • peripheral neuropathy (mixed signs)
44
Q

Treatment for Subacute Combined Degeneration of Spinal Cord

A

-IM injections of vit B12

45
Q

HTLV-1

A
  • human T-lymphotropic virus type 1
  • first human retrovirus discovered
  • reservoir is CD4+ T-lymphocytes
  • associated with (HAM/TSP, ATL, uveitis, polymyositis, arthritis, ALS)
  • causes spastic paraparesis & spinal cord disease
46
Q

HAM/TSP

A
  • HTLV-1 associated myelopathy/tropical spastic paaraparesis
  • patients infected with HTLV-1
  • develop paraparesis
  • CNS is infiltrated by monocytes
  • CNS demyelination & axonal degeneration (corticospinal tract > posterior columns)
  • CFS shows ligoclonal bands & inc. IgG
47
Q

Vacuolar Myelopathy

A
  • neurologic complication of HIV infection (late with AIDS)
  • progressive spastic paraparesis (hyperreflexia, extensor plantar responses)
  • sensory ataxia & incontinence
  • vacuolation & myelin pallor (posterior & lateral columns)
  • Resembles B12 deficiency
48
Q

Tabes Dorsalis

A
  • one complication of neurosyphilis
  • posterior column dysfunction
  • loss of vibration & joint position sense
  • Romberg sign

Neuro 2 (16 decks)

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