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Flashcards in Spinal cord compression Deck (38)
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1
Q

summarise the corticospinal tracts

A
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
Q

what are upper motor neurone lesions features

A

increased tone
muscle wasting NOT marked
no fasciculation
hyper-reflexia

3
Q

what are the lower motor neurone lesion features

A

decreased tone
muscle wasting - marked over time
fasciculation
diminished reflexes

4
Q

summarise the spinothalamic tracts

A

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

5
Q

summarise the dorsal column

A

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

6
Q

what does complete/ incomplete cord injury mean

A

complete- loss of power/ sensation

incomplete- some preservation of motor/ sensory function

7
Q

what can cause acute spinal cord compression

A

trauma
tumours (haemorrhage or collapse)
infection
spontaneous haemorrhage

8
Q

what can cause chronic spinal cord compression

A
degenerative disease (spondylosis) 
tumours 
rheumatoid arthritis (erosive synovitis in synovial joints esp C1/2)
9
Q

what will result from a complete cord transection lesion

A

all motor and sensory modalities affected

10
Q

what does a sensory/ motor level mean

A

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

11
Q

what type of motor symptoms in a cord transection

A

initially a flaccd areflexic paralysis ‘spinal shock’

upper motor neurones signs appear later s

12
Q

what are the features of brown sequard syndrome

A

(cord hemisection)

  • ipsilateral motor level
  • ipsilateral dorsal column sensory (fine touch, vibration etc)
  • contralateral spinothalamic sensory level
13
Q

what causes central cord syndrome

A

hyperflexion or extension injury to already stenotic neck

14
Q

what are the symptoms of central cord syndrome

A

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

15
Q

why are the hands affected in central cord syndrome

A

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
Q

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

A

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
Q

what is the presentation of chronic spinal cord compression

A

same as acute except UMN signs predominate

progressively worsening spastic paralysis

18
Q

what part of spine is most vulnerable to trauma

A

cervical

19
Q

what are the common extradural tumours that compress the cord

A

usually mets

  • lung
  • breast
  • kidney
  • prostate
20
Q

what are extradural cord tumours

A

outside dura (within vertebral bones)

21
Q

what are intradural tumours

A

within dura

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

22
Q

what types of intradural tumours cause cord compression

A

extramedullary - meningioma, schwannoma

intramedullary- astrocytoma, ependymoma

23
Q

how do tumours compress the cord

A

mass
expand bone
weaken bone- vertebral collapse
heamorrhage

24
Q

what are the degenerative diseases that can cause spinal cord compression

A

osteophyte formation
bulging of intervertebral discs
facet joint hypertrophy
subluxation

25
Q

what infections common cause cord compression and how

A

cause epidural abscess
usually blood borne staphylococcal
TB in other countries

26
Q

what is the main symptom of infection causing spinal cord compression

A

extreme back pain

27
Q

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

A

resp arrest- phrenic nerves

28
Q

what haemorrhages can cause cord compression

A

epidural
subdural
intramedullary

29
Q

what is the treatment for cord compression

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

decompress + stabilise:

  • surgery
  • traction
  • external fixation

methylprednisolone (controversial, for trauma)

30
Q

what drug can you give for mets causing cord compression

A

IV dexamethasone high dose

31
Q

what treatment for mets causing cord compression

A
Depends on Patient and Tumour
Dexamethasone IV
MR imagine 
Radiotherapy
Chemotherapy
Surgical decompression and stabilisation
32
Q

what treatment for primary tumours causing cord compression

A

surgical excision

33
Q

what is the commonest cause of acute spinal cord compression

A

mets

34
Q

what treatment for infection cause cord compression

A

antimicrobials
surgical drainage
stabilisation where required

35
Q

what treatment for haemorrhage causing cord compression

A

reverse anticoagulation

surgical decompression

36
Q

what treatment for degenerative diseases causing cord compression

A

surgical decompression +/- stabilisation

37
Q

is acute cord compression an emergency

A

YES

38
Q

does chronic cord compression need rapid treatment

A

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