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Flashcards in Spinal cord compression Deck (38):
1

summarise the corticospinal tracts

upper motor neurone- motor cortex
to anterior grey horn
decussates at medullary level
tract is ipsilateral
lower motor neurone (anterior horn cell)

descending motor pathway

2

what are upper motor neurone lesions features

increased tone
muscle wasting NOT marked
no fasciculation
hyper-reflexia

3

what are the lower motor neurone lesion features

decreased tone
muscle wasting - marked over time
fasciculation
diminished reflexes

4

summarise the spinothalamic tracts

pain, temp and crude touch
contralateral
decussates at spinal level (segmentally)

5

summarise the dorsal column

fine touch, proprioception, vibration
tract is ipsilateral
decussate at medullary level

6

what does complete/ incomplete cord injury mean

complete- loss of power/ sensation
incomplete- some preservation of motor/ sensory function

7

what can cause acute spinal cord compression

trauma
tumours (haemorrhage or collapse)
infection
spontaneous haemorrhage

8

what can cause chronic spinal cord compression

degenerative disease (spondylosis)
tumours
rheumatoid arthritis (erosive synovitis in synovial joints esp C1/2)

9

what will result from a complete cord transection lesion

all motor and sensory modalities affected

10

what does a sensory/ motor level mean

after a cord transection a motor/ sensory level means below this there is complete/ partial loss of sensation or power

11

what type of motor symptoms in a cord transection

initially a flaccd areflexic paralysis 'spinal shock'
upper motor neurones signs appear later s

12

what are the features of brown sequard syndrome

(cord hemisection)
-ipsilateral motor level
-ipsilateral dorsal column sensory (fine touch, vibration etc)
-contralateral spinothalamic sensory level

13

what causes central cord syndrome

hyperflexion or extension injury to already stenotic neck

14

what are the symptoms of central cord syndrome

predominantly distal upper limb weakness
cape like spinothalamic sensory loss
lower limb power preserved
dorsal columns preserved

15

why are the hands affected in central cord syndrome

affects central bit of spinal cord as most vulnerable to ischaemia (furthest away from the blood supply)
Most medial part of corticospinal tract carry innervation to hands- why hands get weakness

16

why do you get spinothalamic symptoms (parasethesia) in central cord syndrome when tracts are lateral in cord

as spinothalamic neurons cross over at the anterior white matter commissure- tract not affected but the area of decussation is- means there is paresthesia only at the level of injury as this tract crosses segmentally = suspended sensory level

17

what is the presentation of chronic spinal cord compression

same as acute except UMN signs predominate
(progressively worsening spastic paralysis)

18

what part of spine is most vulnerable to trauma

cervical

19

what are the common extradural tumours that compress the cord

usually mets
-lung
-breast
-kidney
-prostate

20

what are extradural cord tumours

outside dura (within vertebral bones)

21

what are intradural tumours

within dura
can be extramedullay (outside cord) or intramedullary (within cord)

22

what types of intradural tumours cause cord compression

extramedullary - meningioma, schwannoma

intramedullary- astrocytoma, ependymoma

23

how do tumours compress the cord

mass
expand bone
weaken bone- vertebral collapse
heamorrhage

24

what are the degenerative diseases that can cause spinal cord compression

osteophyte formation
bulging of intervertebral discs
facet joint hypertrophy
subluxation

25

what infections common cause cord compression and how

cause epidural abscess
usually blood borne staphylococcal
TB in other countries

26

what is the main symptom of infection causing spinal cord compression

extreme back pain

27

what is at risk when there is compression at C1/2 level

resp arrest- phrenic nerves

28

what haemorrhages can cause cord compression

epidural
subdural
intramedullary

29

what is the treatment for cord compression

immobilise
investigate:
-CT for trauma
-x ray
-MRI for tumours

decompress + stabilise:
-surgery
-traction
-external fixation

methylprednisolone (controversial, for trauma)

30

what drug can you give for mets causing cord compression

IV dexamethasone high dose

31

what treatment for mets causing cord compression

Depends on Patient and Tumour
Dexamethasone IV
MR imagine
Radiotherapy
Chemotherapy
Surgical decompression and stabilisation

32

what treatment for primary tumours causing cord compression

surgical excision

33

what is the commonest cause of acute spinal cord compression

mets

34

what treatment for infection cause cord compression

antimicrobials
surgical drainage
stabilisation where required

35

what treatment for haemorrhage causing cord compression

reverse anticoagulation
surgical decompression

36

what treatment for degenerative diseases causing cord compression

surgical decompression +/- stabilisation

37

is acute cord compression an emergency

YES

38

does chronic cord compression need rapid treatment

yes- prevents further deterioration- important to do while patient is still ambulant and independent