Spinal cord compression

Question 1

where is the DCML located in the spinal cord

Answer 1

posteriorly/dorsal

Question 2

functions of DCML

Answer 2

fine touch
proprioception
vibration

Question 3

where do fibres of the DCML cross over

Answer 3

cross over to the contralateral side at the medulla

Question 4

where is the STT located in the spinal cord

Answer 4

anterolateral

Question 5

functions of STT

Answer 5

pain
temperature
deep pressure

Question 6

where do fibres of the STT cross over

Answer 6

segmentally at the spinal level it enters

Question 7

where is the CST located in the spinal cord

Answer 7

laterally

Question 8

function of CST

Answer 8

fine movement

Question 9

where do fibres of the CST cross over

Answer 9

cross over at the medullary pyramids

Question 10

where is the UMN found

Answer 10

motor cortex to anterior grey horn

Question 11

where is the LMN found

Answer 11

anterior horn cell to muscle

Question 12

how can spinal cord compression be classified

Answer 12

acute vs chronic

complete vs incomplete

Question 13

causes of acute SCC

Answer 13

trauma
tumour
haemorrhage
infection

Question 14

causes of chronic SCC

Answer 14

degenerative
tumour
rheumatoid arthritis

Question 15

at what vertebral levels can rheumatoid arthritis cause SCC

Answer 15

C1/2 synovial joint

Question 16

how does a complete acute SCC present

Answer 16

all motor and sensory modalities are affected

Question 17

how does an incomplete acute SCC present

Answer 17

partial preservation of power and sensation

Question 18

what is spinal shock

Answer 18

temporary hypo/areflexia, flaccid paralysis and autonomic dysfunction

Question 19

hypo/hypertension occurs in spinal shock

Answer 19

hypotension from lost vasomotor tone in blood vessels

Question 20

what is Brown Séquard syndrome

Answer 20

hemisection of the spinal cord

Question 21

features of Brown Séquard syndrome

Answer 21

ipsilateral DCML and CST loss

contralateral STT loss

Question 22

causes of cord hemisection

Answer 22

knife injury

demyelination

Question 23

what causes central cord syndrome

Answer 23

hyperflexion or extension injury to an already stenotic neck

Question 24

presentation of central cord syndrome

Answer 24

distal upper limb weakness

cape like STT sensory loss

Question 25

what is preserved in central cord syndrome

Answer 25

DCML | lower limb power

Question 26

how does chronic SCC present

Answer 26

same as acute SCC but with UMN signs predominating

Question 27

tumour causes of SCC

Answer 27

meningioma metastases astrocytoma schwannoma

Question 28

degenerative causes of SCC

Answer 28

osteophytes bulging discs facet joint hypertrophy subluxation

Question 29

haemorrhagic causes of SCC

Answer 29

epidural subdural intramedullary

Question 30

infectious causes of SCC

Answer 30

epidural abscess | TB

Question 31

management of trauma to the spine

Answer 31

immobilise spinal column with blocks Imaging - Xray, CT, MRI decompress and stabilise steroids sometimes used

Question 32

management of malignant SCC

Answer 32

dexamethasone IV radiotherapy chemo is appropriate rarely operate

Question 33

management of infectious SCC

Answer 33

antimicrobial therapy | surgical drainage

Question 34

management of haemorrhagic causes of SCC

Answer 34

reverse anticoagulation | surgical decompression

Question 35

management of degenerative causes of SCC

Answer 35

surgical decompression +- stabilisation

Question 36

what is syringomyelia

Answer 36

fluid filled cavity/cyst in the spinal cord associated with Chiari malformation

Question 37

what is acute degenerative cervical myelopathy

Answer 37

degenerative condition with compression of the spinal cord

Question 38

what kind of SCC does syringomyelia cause

Answer 38

central cord syndrome

Question 39

pathology/causes of degenerative cervical myelopathy

Answer 39

``` osteophytes degenerative cervical spondylosis ligament hypertophy stenosis tumour epidural abscess ```

Question 40

symptoms of degenerative cervical myelopathy

Answer 40

``` neck pain and stiffness clumsiness and weakness occipital headaches gait instability paraesthesias of extremities ```

Question 41

management of degenerative cervical myelopathy

Answer 41

surgical decompression

Question 42

what is Hoffman's sign

Answer 42

presence of UMN lesion from spinal cord compression | flicking of middle distal phalynx causes overflexion of index finger and thumb

Question 43

what is subacute combined degeneration of the cord

Answer 43

degeneration of the posterior and lateral columns of the spinal cord due to a B12 deficiency