Neuro - Spinal Disease - Only Myelopathies

Front 1

Myelopathy definition. Usually bilateral signs/sx.

Back 1

Damage to spinal cord from any cause

Front 2

Radiculopathy definition

Back 2

Damage to nerve roots from any cause.

Front 3

Sx of myelopathy

Back 3

Spastic weakness below level of damage (Babinski and loss of other superficial reflexes)
Spinal shock is an exception

Sensory loss below lesion

Bladder/bowel control issues (severe urgency then frequent incontinence of small volumes)

Radicular sx at level of injury. Or anterior horn cell damage or lower motor neuron weakness (flaccid then atrophy)

No cranial symptoms except maybe less face pin and temp sensation from craniocervical junction problems.
CNXI is another exception.

Front 4

If pt has bilateral lower limb sx, what to think of first?

Back 4

Myelopathy or polyneuropathy!

Front 5

Poor localizers of myelopathy

Back 5

Long tracts don't localize well (corticospinal, spinothalamic, dorsal columns)
If only long ones are affected, lesion is btwn lowest normal level and highest abnormal level.

Front 6

Best localizers of myelopathy

Back 6

Back pain, percussive tenderness


And in general, sensory levels tell you the LOWEST a lesion can be.

Front 7

Second best localizer of myelopathy

Back 7

Radicular pain or loewr motor neuron weakness.

Front 8

Etiologies of myelopathy

Back 8

Degeneration of the spine

Trauma

tumor

infection

hematoma

metabolic disorders

demyelination

degenerative conditions

syrinx

infarction

radiation

transverse myelitis

Front 9

Degeneration of the spine

Back 9

Can cause myelopathy

Spondylosis (vertebral arthritis) is often with spinal stenosis and disk protrusion. Only produces myelopathy if above the conus (usually cervical or thoracic)

Slowly progressive

Most common cause of myelopathy in the elderly.

Front 10

Trauma

Back 10

Can cause myelopathy

Doesn't have to be a fracture or dislocation

Spinal shock - Flaccid without LMN weakness - makes prognosis of trauma difficult to predict.

Steroids - controversial if they are helpful.

Main tx - support, prevention of further inj/complications

Front 11

Tumor - common causes

Back 11

Spinal metastasis. From lung, breast, prostate, kidney, lymphoma, then others.

20% cervical. 60% thoracic. 20% lumbar (can effect cauda equina)

Vertebrae commonly get mets because lots of blood flow and the veins have no valves (so mets can come from both directions)

Multiple myeloma can start in the spinal cord.

Front 12

Tumor sx

Back 12

Pain, weakness, numbness/parasthesia, bowel/bladder.

Front 13

Tumor signs

Back 13

Weakness, sensory level, abnormal reflex, Babinski, local tenderness,decreased rectal tone.

Front 14

Tumor tx

Back 14

Must catch it early.
XRT and steroids can preserve function.

Surgical decompression also useful if no primary is found, pt continues to do worse with tx, or if spine is unstable.

Front 15

Infection

Back 15

Epidural abscess usually
Acute severe and focal back pain with elevated sed rate. May be from an adjacent vertebral osteomylelitis or discitis (maybe after a procedure). THIS IS A MEDICAL EMERGENCY!!!

Lyme disease, syphilis, CMV (AIDS pts usually) and HTLV-1 can directly attack the spinal cord too.

Front 16

Hematoma

Back 16

In the epidural space to push on cord.

Common in pts on anticoagulants, with bleeding disorders, or with trauma

Front 17

Metabolic disorders

Back 17

Most common with B12 def.
Loss of vibratory and position sense with preserved pin sensitivity.
Bladder function is preserved.
Usually due to less absorption, not decreased intake (intrinsic factor needed)

Front 18

Subacute combined degenerativity

Back 18

B12 deficiency causing myelopathy

Front 19

Demyelination

Back 19

Myelopathies are common in pts with MS

Front 20

Lhermitte's sign

Back 20

Common in pts with MS

Electrical tingling sensation down the back and out the legs with forced neck flexion.

It indicates dorsal column irritation--so it is pretty non-specific.

Front 21

Degenerative conditions

Back 21

Myelopathy common in pts with ALS

Hereditary spinocerebellar degenerations (e.g. Friedreich's ataxia)

These conditions don't affect the bladder.

Front 22

Syrinx

Back 22

A cavity in the region of the central canal. (often cervical)

Expansion impairs crossing fibers going to spinothalamic tract at the level of the lesion.

Produces a suspended pain/temp sensation loss.

Front 23

Infarction

Back 23

RARE. Usually in pts with severe vascular disease, aortic diseases or aortic procedures.
AV malformation
Usually painless myelopathy unless it ruptures to produce subarachnoid hemorrhage.

Front 24

Radiation

Back 24

Myelopathy occurs months to years later.

Front 25

Transverse myelitis

Back 25

Post-viral-infection and has a good prognosis.

Unknown cause

An acute myelopathy. Typically painful.