Spinal Cord Syndromes Flashcards
Where do the sensory fibres of the dorsal columns decussate?
Medulla
Where do the spinothalamic tracts decussate?
In the spinal cord, at the level of the nerve root (+ or - 1 level).
At what level does the spinal cord need to be affected to cause autonomic dysreflexia?
Above T6
What are the key symptoms of spinal cord syndromes (4)?
(1) Bilateral loss of all sensation below level of the lesion
(2) Bilateral weakness (LMN pattern at the level of the injury, UMN pattern below the level of the injury).
(3) Bowel/Bladder dysfunction
(4) Hyperreflexia and spasticity below the level of the lesion (initially can be flaccid with absent reflexes after acute injury)
What are the causes of a central cord syndrome (2)?
(1) Syringomyelia
(2) Intramedullary Tumor
What are the symptoms of a central cord syndrome?
Typically just loss of pain and temperature bilaterally, below the level of the lesion. No weakness or loss of proprioception, vibration and discriminatory touch.
What are the common etiologies of an anterior cord syndrome (2)?
(1) Spinal Cord Infarction (anterior spinal artery)
(2) Disc Herniation
What are the symptoms and signs of an anterior cord syndrome (4)?
(1) Bilateral loss of pain & temperature
(2) Bilateral weakness
(3) Bowel & bladder dysfunction
(4) INTACT proprioception & vibration sense
What are the common etiologies of a posterior cord syndrome?
(1) Syphilis
(2) B12 Deficiency
What are the features of that can help you differentiate syphilis from subacute combined degeneration of the spinal cord in a posterior cord syndrome (3)?
(1) Pupils - Argyl-Robertson pupils in syphilis
(2) Reflexes - Loss of reflexes in syphilis, hyperreflexia in B12 deficiency.
(3) Strength - Normal strength in syphilis, weakness in B12
What are the common etiologies of a hemi-cord syndrome?
AKA Brown Sequard Syndrome
1) Trauma (knife, bullet
(2) Demyelination (MS)
What are the clinical features of a hemi-cord syndrome (3)?
(1) Ipsilateral weakness
(2) Ipsilateral loss of vibration & proprioception.
(3) Contralateral loss of pain & temperature.
What is affected in the spina cord if there are pure upper motor neuron features? What are 2 possible etiologies?
Corticospinal Tract
(1) Hereditary Spastic Paraperesis
(2) HTLV-1
What is affected in the spinal cord if there are only pure LMN findings? What are 2 possible causes?
Anterior horn cells.
(1) West Nile
(2) Polio
What pure motor spinal cord pathology would cause both UMN & LMN patterned weakness?
ALS
