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spinal cord patholog
CNS spinal cord
| Question | Answer |
|---|---|
| a localized tubercular abscess in L3 vertebral body can cause what? | cauda equina areflexia of LE numbness of BLE flaccid weakness of both legs |
| which spinal cord tract runs contralateral to the body half it serves? | spinothalamic tract |
| where does the spinal cord end? | L1-L2 |
| what can a cervical cord transection cause? | ventilator dependence autonomic instability sex dysfunction brisk reflexes bilateral involvement sensory "level" spasticity/UMN signs |
| how does a cauda compression present? | pain flaccid bilat LE weakness/sensory loss areflexia bladder/bowel/sex dysfunction |
| what's the ddx of myelopathy? | trauma spondylotic cord compression transverse myelitis neoplasm infectious vascular hereditary metabolic syringomyelia |
| why should you do a stat spinal cord MRI emergently in pt w/ acute myelopathy? | r/o cord compression |
| what is consistent w/ transverse myelitis due to MS? | band like sensation around abdomen asymmetric cross sectional inflammation only 1 ovoid periventricular brain lesion loss of pin in R leg w/ loss o vibratory sense in L leg |
| do you give glucocorticoids in spinal cord trauma? | no |
| what happens if you have a complete injury above C4? | vent dependent |
| what are the most common causes of epidural cord compression? | cancer: vert metastasis, path features hematoma: anticoag, bleeding d/o, instrumentation abscess: bacterial, TB, fungal |
| how does transverse myelitis develop? | evolves over hours - days no apparent trigger or trauma |
| what demographic does transverse myelitis present in? | young ppl |
| how does transverse myelitis present? | LE +/- UE weakness band like sensation pain sensory loss/level bladder & autonomic |
| how do you dx transverse myelitis? | inflammation by imaging (+gad < 2 segments) CSF (protein, WBC) |
| if transverse myelitis is due to MS, what does it look like? | 2 vert segments or less and often asymmetric |
| if there are brain lesions w/ transverse myelitis, what becomes more likely? | MS |
| what's the treatment for transverse myelitis? | high dose IV steroids |
| how does TM recovery look like? | happens over many weeks at least partial |
| what infections can cause anterior horn neuronitis? | Polio West Nile Coxsackie Enterovirus 71 |
| how do you dx acute viral myelitis? | CSF pleocytosis or MRI findings |
| which viruses can present like Transverse Myelitis? | HSV VZV CMV EBV Hep C |
| what usually causes a cord infarct? | aortic pathology surgery |
| what's the exam in cord infarct? | pinprick diminished weak vibration preserved |
| what are other causes for cord infarcts? | systemic hypotension conventional athero/embolism |
| what a is involved in a cord infarct? | anterior spinal a. |
| which chronic myelopathy is the most likely to fluctuate? | spinal dural AV fistula |
| how does lumbar spinal stenosis present? | gluteal/LE pain relieved by sitting/bending. worse w/ walking |
| what's the tx for lumbar spinal stenosis? | sx |
| how does cervical spondylotic myelopathy present? | LMN UE signs + UMN LE signs |
| what metabolic deficiencies can cause chronic myelopathies? | vit B12 copper deficiency |
| which infections can cause chronic myelopathies? | HIV myelitis HTLV-1 (tropical spastic paraparesis) tertiary neurosyphilis |
| what's the most common AVM of the spine? | dural AV fistula |
| how do dural AV fisulas present? | myelo-radicular symptoms that may initially fluctuate |
| how ddx AV fistula? | spinal angiogram |
| what intramedullary tumors cause chronic myelopathies? | primary CNS (ependymoma, astrocytoma) systemic cancer mets |
| what are the types of hereditary spastic paraplegia? | uncomplicated: LE spasticity/weakness, mild bladder dysfunction, vibration loss complicated: cognitive, visual, auditory, speech, extrapyramidal |
| what are the inherited myelopathies? | hereditary spastic paraplegia adrenomyeloneuropathy friedreich ataxia |
| what's the problem in adrenomyeloneuropathy? | very long chain fatty acid deficiency |
| how is adrenomyeloneuropathy inherited? what are ass illnesses? | X linked leukodystrophy associated: adrenal dz, peripheral neuropathy |
| how does Friedreich ataxia present? | areflexic w/ upgoing toes sensory degeneration w/i cord |
| what are the associated diseases w/ Friedreich ataxia? | diabetes cardiomyopathy scoliosis |
| what is a syringomyelia? | fluid-filled longitudinal cavity, in cervical or upper thoracic cord may involve brainstem |
| what is ass pathology w/ syringomyelia? | Chiari 1 (most common) prior infection inflammation trauma tumor |
| what are symptoms of syringomyelia? | central cord syndrome: suspended pain/sensory at that level |
| what are other myelopathies not covered? | tethered cord syndrome paraneoplastic radiation-induced hepatic cirrhosis electrocution lathyrism (overeating certain legumes- Fava) |
Created by:
Syndenham
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