Spinal Section Flashcards
Rules of PE for the spine
- Can take days to weeks for s/s
- Check symmetry of R vs L
- Check bladder function
- Note level of defect (e.g. T6 means abnormal below that level)
Describe spinal cord contusion
Transient dysfunction occasionally without imaging proof (MRI negative)
Order of investigation for spinal cord problem
- ABCs
- CT scan to define major structural issues (esp in short time periods under unstable conditions)
- MRI is best for most spinal structural issues BUT can only be done in stable patient
CT vs. MRI in spinal cord evaluation
- CT is good for evaluating an unstable pt quickly but radiation exposure and will only identify major structural issues
- MRI is best for spinal structural issues but can only be done in a stable patient
What is necessary to define spinal cord parenchyma?
MRI
What is necessary to define all inflammatory lesions of the spinal cord?
MRI
When in the year is West Nile infection most likely?
Late fall
Describe West Nile CNS infection
- 1 out of 150 WN pts
- Can present as any CNS/PNS problems
Infectious diseases that affect the spinal cord
- West Nile
- Zoster
- HSV1 and 2
- CMV
- HIV
What type of virus is West Nile?
Flavi virus
What vascular cord issue can arise from the cervical (vertebral) arteries?
- Acute myelopathy
- Watershed ischemia-t4
What vascular cord issue can occur in the thoracic region?
Arises from the aorta (dissection from trauma/CT disease)
Most ischemic spinal cord issues occur where?
ACA (anterior)
What is artery dissection usually a/w?
Pain - neck, radicular, HA, chest (for thoracic aorta), abdominal or belt (for abdominal aorta)
What should be tested when assessing B12 deficiency?
Methylmalonic acid
Where in the spinal cord/column does B12 deficiency cause problems?
- Optic nerve
- Dorsal columns (position, vibration, touch)
- Pyramidal tract (motor tract)
- Cognition
- Peripheral nerve
What set of criteria is used to diagnose MS?
MacDonald 10
What are the MacDonald criteria of MS?
-2 attacks 2+ lesions
-2 attacks 1 lesion w/MRI/CSF evidence
ETC ETC
What is transverse myelitis?
Monophasic cord inflammation which may be mild to complete or hemi
How is transverse myelitis diagnosed?
Diagnosis of exclusion
Difference between MS and transverse myelitis
- MS is progressive disease
- Transverse myelitis is monophasic
What is a hereditary disease that affects the spinal cord?
Familial spastic paraplegia (simple and complex types)
What are examples of vasculitis that affect the spinal cord?
- SLE (which requires 11 criteria)
- Bechet’s
- Sjogren’s
What are dysmorphic conditions of the spinal cord that will be diagnosed by MRI?
- Teathered cord (below L2)
- Arachnoid cysts (anywhere)
- Chiari malformations
- Duplication of cord
- Diastematomyelia
