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Myelopathy
Neuro Assessment 8
53
Anatomy
Graduate
10/26/2011

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Cards

Term
A lesion in the Corticospinal tract will cause what?
Definition
Hyper-reflexia
Spasticity
Babinski Sign
weakness
Term
A lesion to the Posterior columns will cause what?
Definition
Loss of vibration sense
Loss of position sense
Romberg sign
Term
A lesion in the spinothalamic tract will cause what?
Definition
Loss of Pain and Temperature, sensory level
Term
A lesion in the Anterior Horn cells will cause what?
Definition
Flaccid weakness
hypo-reflexia
fasciculations
Term
A lesion to the Root will cause what?
Definition

Irritation -Lancinating pain

Damage - Numbness and hypo-reflexia

Term
What is the anatomy of the Spinal cord from inside->out?
Definition
Spinal cord parenchyma
Pia Matter
subarachnoid space
subdural space
dura
epidural space
bone
Term
Leptomeninges
Definition
pia and subarachnoid space
Term
Where is the T4 sensory level?
Definition
nipple line
Term
Where is the T10 sensory level?
Definition
umbilicus
Term
What is the bladder mostly controlled by?
Definition
CNS
Term
What bladder symptoms are involved in an acute lesion?
Definition
urinary retention with some overflow incontinence
Term
What type of bladder symptoms occur in chronic spinal cord lesions?
Definition
small spastic bladder, does not completely empty with spasms and urge incontinence
Term
What is the approach for a patient with myelopathy?
Definition
Recognize signs and symptoms
Immediate neuro-radiologic testing
Lumbar puncture if neuro-rad testing negative
Therapy usually IV steroids
Term
Approach to Chronic Myelopathy
Definition
Recognize signs and symptoms
Neuro-radiologic testing
Lumbar puncture
Therapy related to cause of myelopathy
Term
What are the symptoms early in an epidural lesion?
Definition
Motor:
hyperreflexia
Babiski signs
Difficulty walking
Sensory:
hypersensitive to touch
Band/Girdle-like sensation in abdomen
*Urinary Urgency
Term
What are the symptoms of an epidural lesion as it worsens?
Definition
Motor:
Legs are spastic and weak
Brisk reflexes
Babinski signs
Sensory:
Root area - numb ipsilateral
decreased Pain contralateral (spinothalamic)
Partial Brown-Sequard
Definite sphincter dysfunction
Term
What is the final stage of an epidural lesion?
Definition
Motor:
Flaccid Paraplegia, areflexic (acute)
spastic paraparesis (subacute/chronic)
Sensory:
Complete sensory level to all modalities
Term
What is the treatment for severe disc disease?
Definition
Steroids and surgery
Term
What is the treatment protocol for spinal cord injury?
Definition
Methylprednisolone 30mg/kg over 1 hr
Followed by 5.4mg/kg/hr over next 23 hrs
Term
What are some causes of spinal cord dysfunction in patients with cancer?
Definition
Epidural cord compression
-Tumor, abcess, hematoma
Intramedullary processes
-metastases, abscess, hematoma, syrinx
Other myelopathies
-radiation, chemotherapy, paraneoplastic
Neoplastic meningitis
Spinal arachnoiditis
Term
What are the most common cancers that metastesis to the spinal column?
Definition
Lung
Breast
Prostate
Term
What diagnostic approach should be taken with a cancer patient with back pain?
Definition
Treat with Steroids
MRI with gadolinium
Neurosurgical consult
Spinal tap if NO compression
Term
Why is a spinal tap required if there is no evidence of cord compression in a cancer patient with back pain?
Definition
cancer cells can enter subarachnoid space and cause meningitis and spinal cord injury
Term
Where do most metastatc cancers begin?
Definition
Vertebral Body
Term
Where do most spinal abscesses begin?
Definition
Disc Space
Term
What bug is the most common in spinal abcessess?
Definition
Staph aureau
Term
Who is at highest risk for spine infections?
Definition
IV drug abusers
immunocompromised
Term
What are the symptoms of an Epidural abscess?
Definition
Fever
Pain on percussion
elevated WBC
elevated ESR
Term
Osteomyelitis
Definition
infection of the vertebral bodies.
causes weakness of bones, collapse of vertebral body and subsequent cord compression
Term
What neurologic syndrome of osteomyelitis results from TB?
Definition
Pott's disease
Term
What is the 2nd most common cause of spinal tumor?
Definition
Spinal meningioma
Term
Where are spinal meningiomas located?
Definition
Thoracic Spine
intradural, extramedullary
Term
Who classically gets spinal meningiomas?
Definition
middle-aged women
Term
What are the most common intradural extramedullary mass?
Definition
Nerve Sheath tumors
Term
What are the types of Nerve Sheath Tumors?
Definition
Schwannoma
neurofigroma
ganglioneuroma
neurofibrosarcoma(rare)
Term
What type of tumor has a classic Dumbell shape?
Definition
Nerve sheath tumor
Term
What are the beginning symptoms of a central cord lesion?
Definition
Pain in Shoulders
Loss of pain and temperature
Crossing spinothalamic tracts
Term
How does a central cord lesion progress?
Definition
Lesion extends to Dorsal Root Entry Zone - Loss of Reflexes in arms
Continued loss of pain and temperature
Horner's syndrome - loss of sympathetic
Vibration and Joint position sense preserved (posterior columns late)
Legs spastic paraparesis, babinski signs and hyper-reflexia
Term
What is dissociated sensory level?
Definition
Vibration and joint position sense are preserved compared to pain and temperature.
Term
What is the final progression of a central cord lesion?
Definition
Worsening symptoms
Sacral Sparing
May involve face due to sensory nucleus of the trigeminal nerve
Term
What kind of central cord syndrome is a large espanding space in the spinal cord?
Definition
Syrinx
Term
What is the second most common spinal cord tumor overall and the most common cord tumor in children?
Definition
Astrocytoma
Term
What are the symptoms of Anterior apinal aretey syndrome (Artery of Adamkiewicz?
Definition
Loss of pain and temp - spinothalamic
Weakness - corticospinal function
(Intact Posterior Column)
Term
What can Arterial-venous malformations cause?
Definition
Anterior spinal artery syndrome
Term
What is Transverse myelitis?
Definition
Acute neurologic conditions
Acute or subacute motor, sensory and sphincter disturbance
Spinal segmental sensory disturbance with defined upper limit
No evidence of compression
Absence of neurlogic disease
Term
What are the symptoms of Brown-Sequard hemi-section syndrome?
Definition
Ipsilateral:
spastic paralysis below level of lesion
Hyperreflexia, Babinski signs
Loss of vibration and joint position sense
Contralateral:
Loss of pain and Temperature
Term
How does B12 deficiency present in the spinal cord?
Definition
Subacute combined degeneration
Term
What are the symptoms of Subacute combined degeneration of the spinal cord?
Definition
Spastic weakness of lower extremities
Decreased sensation to vibration and position
Romberg's sign
Ataxia
Babinski signs and hyperreflexia
Peripheral neuropathy
Term
What is a neurologic complication of HIV?
Definition
Vacuolar Myelopathy
Term
What are the symptoms of Vacuolar myelopathy?
Definition
Progressive spastic paraparesis
Sensory ataxia and incontinence
Vacuolation and myelin pallor
Term
What is a complication of neurosyphilis?
Definition
Tabes Dorsalis
Term
What is Tabes Dorsalis?
Definition

Posterior column dysfunction Loss of vibration and joint position sense Romberg sign

(due to Syphilis)

Term
What are the Top 10 Things to remember about myelopathy?
Definition
1. Acute myelopathies are neurologic emergencies
2. Spinal cord ends at L1/L2
3. Back pain in cancer patients is an emergency until proven otherwise
4. Myelopathies can progress quickly
5. Don not dely neuroradiologic testing
6. Ask patients where it hurs
7. Percuss the vertebral column
8. Steroids almost always in acute
9. Make Patient Walk
10. Remember basic neuroanatomy
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