spinal cord disorders

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SPINAL CORD DISORDRS ALI ABDULLAH ALBALUSHI OMSB EMERGENCY MEDICINE, R-4

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Page 1: Spinal cord disorders

SPINAL CORD DISORDRS

ALI ABDULLAH ALBALUSHIOMSB

EMERGENCY MEDICINE, R-4

Page 2: Spinal cord disorders

OUTLINE

• ANATOMY

• DIFFERENT SPINAL CORD DISORDERS

• CONCLUSION

• QUISTIONS

Page 3: Spinal cord disorders

ANATOMY

Spinal cord: foramen magnum 1st/2nd lumbar vertebrae .

Cervical enlargement: C5-T1: gives rise to brachial plexus, innervates UE; L2-S3: gives rise to lumbosacral plexus,

Gray matter – central (cell bodies)White matter – peripheral (ascending and descending tracts)

Page 4: Spinal cord disorders
Page 5: Spinal cord disorders

1) All are true about the anatomy of the spinal cord except :

A. It is 40 cm long

B. Supplied by a single anterior spinal artery & paired vertibral artery

C. The posterior column carry the afferent ascending fibers for properiocetion &

vibration & cross at level of medulla

D. In the spinothalamic tract, sacral fibers are represented most medially

E. In corticospinal tract, the fibers cross at level of medulla & cervical fibers are

located medially

Page 6: Spinal cord disorders

2) All are true regarding complete spinal cord syndrom except:

A. It is a total loss of sensory, autonomic & voluntary motor innervation distal to the

level of the spinal cord injury

B. Deep tendon reflexes my persist

C. The most common cause is trauma

D. 99% of patients with persistent symptoms beyond 24 hrs do not have a functional

recovery

E. 1% of patients will have some evident of cord function below the level of injury

Page 7: Spinal cord disorders

3) All are true about spinal shock except :

A. It is the loss of muscle tone & reflexes with complete cord syndrom during

the acute phase of injury

B. The intensity of the spinal shock increases with the height of the level in the

spinal cord

C. It typically lasts less than 24 hrs

D. Bulbocavernous reflex is present

E. The termination of spinal shock phase of injury is heralded by return of

balbocavernous reflex

Page 8: Spinal cord disorders

4) Central cord syndrom, all are true except :

A. It is the post prevalent of the partial cord syndroms

B. Upper extremities are affected more & distal muscles are affected to a greater

degree

C. The most common mechanism is motor vehicle crush

D. It is caused most often by hyperextension

E. Elderly are affected more & prognosis is better in patients younger than 50 yrs

Page 9: Spinal cord disorders

5) All are true about Brown- Sequard Syndrom except:

A. Usually, it results from penetration injuries

B. Characterized by ipsilateral motor weakness & vibration / position loss &

contralateral pain/ tempreture loss

C. It can be associated with A-V malformation

D. Ipsilateral pain & tempreture loss may be noted 1 – 2 levels above the lesion

E. It has the worst prognosis of any incomplete spinal cord syndroms

Page 10: Spinal cord disorders

6) Regarding anterior cord syndrom, all of the following are

true except :

A. Posterior column is preserved

B. Most cases reposted after aortic surgeries

C. It can be caused by hypotension

D. Generally, the prognosis is good

Page 11: Spinal cord disorders

7) Regarding Conus Medullaris & Cauda Equina syndroms ,

What is false ?

A. It is very difficult to separate the two syndroms clinically

B. Conus Medullaris usually presents with overflow incontinence or sexual

dysfunction

C. Usually, Conus Medullaris presents unilaterally

D. Cauda Equina is a LMN picture with hyporeflexia

E. Saddle sensory loss is common in both syndroms

Page 12: Spinal cord disorders

Sensory Motor Sphincter involvement

Central cord Variable Upper extremity weakness> lower extremity weakness, distal > proximal

Variable

Brown-Séquard syndromeBEST SCENARIO = BS = BEST OUTCOME

Ipsilateral position and vibration loss

Motor loss ipsilateral to cord lesion Variable

Contralateral pain and temperature loss

Anterior cord syndrome Loss of pin and touch Motor loss or weakness below level Variable

Vibration, position preserved

Transverse cord/complete Total loss of sensation (as well as autonomic fc) below level of cord injury

Total loss of voluntary motor function below cord level, DTRs absent/abnl/normal

Sphincter control lostAutonomic dysfc: may cause hypotension (neurogenic shock), priapism

Conus medullaris (terminal end of the spinal cord – L1) syndrome

Saddle anesthesia may be present or sens loss may range from patchy to complete transverse pattern

Weakness may be of upper motor neuron type, increased motor tone and reflexes

Sphincter control impaired – disturbance in urination/sexual dysfc

Cauda equina syndrome Saddle anesth may be present or sens loss may range from patchy to complete transverse.

Weakness may be of lower motor neuron type

Sphincter control impaired

Page 13: Spinal cord disorders

8) All of the following result from intrinsic lesions in the spinal

cord except :

A. Multiple Sclerosis

B. Syrigomyelia

C. Myelopathy

D. Spinal epidural abscess

E. Spinal cord infarction

Page 14: Spinal cord disorders

Nontraumatic Etiologies of Spinal Cord Dysfunction

Processes Affecting the Spinal Cord or Blood Supply Directly

Demyelination

Multiple sclerosis

Transverse myelitis

Spinal Arteriovenous Malformation/Subarachnoid Hemorrhage

Syringomyelia

Traumatic

Tumor

Idiopathic Spastic Paraparesis

HIV myelopathy

Other myelopathies

Spinal cord infarction Compressive Lesions Affecting the Spinal Cord

Spinal Epidural Hematoma

Spinal epidural abscess

Diskitis

Neoplasm

Metastatic

Primary CNS

HIV, human immunodeficiency virus; CNS, central nervous system.

Page 15: Spinal cord disorders

9) All are true about MS except :

A. It is a demyelinating disease affecting CNS

B. Presents with patchy motor & sensory findings

C. Presents with UMN picture

D. Oligoclonal bands in CSF are significant only if present in the serum as well

E. Immunosuppresive therapy is the treatment of choice

Page 16: Spinal cord disorders

10) All are true about Transverse Myelitis except :

A. Present with paraplegia , sensory level & sphincter disturbance

B. It is rare & progress slowly

C. Thoracic cord is affected most often & cervical rarely

D. The most essential aspect in management is to role out treatable causes

E. Steroids are of unknown benefit

Page 17: Spinal cord disorders

11) All of the following are true about syringomyelia except ?

A. It is a condition of having a cavity lesion within the substance of the spinal cord

B. Disassociative anesthesia is the classic pattern of sensory deficit

C. CT is the diagnostic tool of choice

D. It is not necessary to perform an emergent imaging if f/u can be arranged

E. It is ass with Arnold – Chiari I Syndrom

It is treated with surgical removal If symptoms are progressive

Page 18: Spinal cord disorders

12) Which statement is true about Spinal Epidural Hematoma ?

A. It is common with incidence of 5 per 100000 pts

B. It is not associated with anticoagulation therapy

C. Pain decreases by coughing or sneezing or straining

D. Patients usually present initialy with neurological deficit rather than pain

E. Emergent decompressive laminectomy is the treatment of choice

Page 19: Spinal cord disorders

13) All statements are true about spinal epidural abscess Except :

A. It results from hematogenous spread of infection , mostly bacterial

B. Diabetics , IV drug users & HIV patients are at higher risk

C. Cervical site of infection predominate

D. Spread to subdural space & intraspinal area is uncommon

E. Urgent surgical consultation for decompression is required

Page 20: Spinal cord disorders

• Urgent MRI must be done if diagnosis is suspected

•If MRI is not available, CT Myelogram should be done

• Neurological deficit rarely improve if surgical intervention is delayed more than 12

– 36 hrs after onset of paralysis

• Antibiotics : Vancomycin & Third generation Cephalosporine IV

Rifampin oral

Page 21: Spinal cord disorders

14) All statements are true about Diskitis Except :

A. The most common causative organism is staph. Aurius

B. It is more common among pediatric age group, < 10 yrs

C. Lumbar spine is the most common site

D. Neurological deficit is common

E. Treated usually with antibiotics & surgery is often not necessary

Page 22: Spinal cord disorders

15) All are true about spinal cord neoplasm Except :

A. Neurological symptoms caused by compression, invasion & distruction of the

myelinated tracts by the tumors

B. Metastasis is the most common spinal cord tumers

C. Lumbar region is the most affected

D. Recumbency worsen the pain

E. Severe nighttime pain is charactrestic

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CONCLUSION

Page 25: Spinal cord disorders

THANKS