Spinalcord pathologies

Question 1

How are spinal corth patholgies classed?

Answer 1

Involvement of C1-L1/L2 : Spinal cord - Myelopathy
L3 and sacral nerve roots: cauda equina

Question 2

What paralysis is seen with different spinal cord pathologies

Answer 2

Brain lesion will express hemiplegia
Spinal cord lesions will express paraplegia

Question 3

Spinal cord compression (myelopathy) causes

Answer 3

Most commonly due to trauma
vertebral compression fractures
disc ehrniation /protrusion
tumours - vertebral body neoplasm (mets from lungs, breast RCC)
infections

Question 4

How would spinal cord compression present?

Answer 4

Progressive leg weakness with UMN signs
(increased tone, spacticity)
sensory loss below lesion (pinprick, finetouch, vibration, temperture)
motor paralysis below level of injury

Question 5

How to investigate spinal cord lesions? and tx

Answer 5

Full neurological examination; tone, power, sensation, reflex, propioception
MRI spinal cord asap
CT thorax, abdo and pelvis - if suspecting malignancy

TX - dependant on cause

Question 6

What is cauda equina syndrome

Answer 6

comprlession below conus medullaris (L1/L2)
most commonly due to lumbar herniation L4/5 or L5/S1

Question 7

How would cauda equina present?

Answer 7

leg weakness w/LMN signs (hypotonia, hyporeflexia, fasculitis
Saddle anaesthesia
bladder and bowel dysfunction

Question 8

Cauda equina syndrome - DX

Answer 8

Full neurological examination
MRI spine - IMMEDIATE

Question 9

TX cauda equina

Answer 9

refer to neurosurgert immediatly to reduce risk of permenant neruological damage.

Emergency decompressive laminectomy: surgery should be performed within 24-48 hours of symptom onset