Spinal emergencies Flashcards
Types of compressive myelopathies
SC compression
Conus medullaris syndrome
Cauda equina syndrome
Causes of cauda equina syndrome
Damage below L2
Large posteromedical disc herniation, trauma, tunmors
Cauda equina syndrome is a ….
radiculopathy therefore LMN lesion
Onset of clin f for cauda quina syndrome
Gradual, unilateral
Where is the pain located in cauda equina syndrome
LBP
Severe radicular pain
Motor symptoms in cauda equina syndrome
asymmetric, areflexia, flaccid paresis of legs
Muscle atrophy
Sensory symptoms of cauda equina syndrome
Saddle anesthesia: lack of sensitivity in the dermatomes S3–S5, affecting the areas around the anus, genitalia, and inner thighs (may be asymmetric)
Asymmetric unilateral numbness and/or paresthesia in lower limb dermatomes
Urogenital symptoms in cauda equina syndrome
Late onset of urinary retention
Change in bowel habits due to loss of anal sphincter control
Decreased rectal tone or bulbocavernosus reflex
Erectile dysfunction
Causes of conus medullaris syndrome
Damage to or compression of the spinal cord at the vertebral level T12–L2, resulting in injury to the conus medullaris (sacral and coccygeal spinal segments) [29][30]
Common causes include spondylolisthesis, tumors, and trauma (e.g., vertebral fracture).
Transverse myelitis and is at termianl end of SC therefore UMN signs
Onset of conus medullaris syndrome
Sudden, bilateral
Pain in conus medullaris syndrome
LBP
Less severe radicular pain
Motor symptoms of conus medullaris syndrome
Symmetric, hyperreflexic distal paresis of lower limbs, possibly fasciculations
Achilles reflex may be absent.
Sensory symptoms of conus medullaris syndrome
Symmetric bilateral perianal numbness
Sensory dissociation
Urogenital and rectal symptoms in conus medullaris syndrome
early onset of bladder and fecal incontinence
Erectile dysfunction
Causes of SC compression
Damage to or compression of the spinal cord at any level due to:
Degenerative disc disease
Neoplasms
Vertebral metastases
Trauma (epidural hematoma, vertebral fracture)
Epidural abscess
Onset of symptoms associated with SC compression
Variable, bilateral
Pain in spinal cord compression
Localised neck or back pain
Motor symptoms in spinal cord compression
Bilateral paralysis below the affected level of the spinal cord
Hyperreflexia
Positive Babinski sign
Ataxia
Sensory symptoms in spinal compression
Loss or reduction of all sensation below the affected level of the spinal cord
Urogenital and rectal symptoms in spinal cord compression
Sphincter dysfunction with urinary or bowel urgency, retention, or incontinence
Management of compressive spinal emergencies
Urgent MRI spine without contrast, CT scan and contrast for emergency
Consult neurosurg for urgent surgical decompression
Analgesia
Tx underlying
