Spinal Cord Syndromes

What is Brown-Sequard syndrome? What causes it? What are the sx?

Hemicord spinal cord lesion -Causes loss of vibration & proprioception and motor loss IPSILATERAL to the lesion -Causes loss of pain and temperature CONTRALATERAL to lesion.

What are 5 contraindications of LP?

1. evidence of inc ICP 2. unstable pt with cardiovascular or respiratory issue 3. infection near puncture site 4. bleeding disorders 5. chiari malformation

How many posterior spinal arteries are there? anterior? What does the anterior spinal artery arise from?

2 poster, 1 anterior - anterior SA arises from the great Radicular Artery of Adamkiewicz.

Pt presents with loss of vibration and proprioception in his trunk and legs. His pain & temp sense and motor function are intact. Diagnosis?

posterior cord syndrome affecting the dorsal columns

What kind of pt's can vitamin B12 neuropathy be found in? What is the tx?

pt's with vegan diets, gastrectomy, impaired absorption - tx: replace B12

How will spinal cord ischemia look on T2 MRI?

ischemic spinal cord will be brighter than the surrounding gray spinal cord.

What position should a pt be in for an LP?

lateral decubitus position

Where does the dorsal column decussate?

medulla

Will tertiary syphillis (tabes dorsalis) be early onset after infection or later?

much later - years after infection

How does vitamin B12 deficiency affect the spinal cord? What sx?

- causes loss of myelin in the lateral and dorsal columns - causes weakness and "patchy" sensory loss

What antibodies are present in NMO (neuro-myelitis optica)?

Aquaporin-4 channel

Where should an LP be performed?

Between L3-L4 or L4-L5

Pt presents with progressively worsening gait disturbance, right leg numbness and urinary problems. Exam: - Left leg weakness and inc tone - Left leg dec vibration and proprioception - Right leg dec pinprick and temperature sense. diagnosis?

Brown-Sequard syndrome as a result of hemicord lesion

Is MS an autoimmune or neuroinflammatory dz? Where will lesions be found? What 2 sx do pt's present with ?

neuroinflammatory - lesions thruout CNS - sx: - optic neuritis - transverse myelitis

What are the 2 major ways to tell apart MS and NMO? Why are these diseases easily confused?

Easily confused b/c present with two same sx: - optic neuritis - transverse myelitis NMO will have antibodies against aquaporin 4, and lesions in optic nerve and spinal cord MS will have no antibodies and lesions throughout CNS.

What causes posterior cord syndrome? What are the sx?

Interruption of the posterior spinal arteries (x2) Sx: loss of vibration and proprioception (interruption of dorsal columns) below the lesion.

What will be the symptoms of a transverse cord lesion?

Loss of: - vibration and proprioception - pain and temperature - motor loss Below the level of the lesion

What will the CSF of a person with MS show?

oligoclonal bands

What are two potential causes of a central cord lesion?

Syrinx Transverse Myelitis

Case: 24 y/o man fell from roof. Landed on his back and immediately afterward had loss of movement and sensation in his legs. - bilateral flaccid leg paralysis - dec. rectal tone - absent bulbocavernosus reflex - T10 sensory level Diagnosis?

Transverse cord lesion

What is ALS?

UMN and LMN disease, caused by neuron apoptosis

Describe what a lumbar spinal cord section looks like.

Very circular shape - pretty equal gray/white matter ratio

Describe what a thoracic spinal cord section looks like.

Very small amount of gray matter compared to cervical.

What sensation do the dorsal columns project?

Vibration and proprioception

What is a possible metabolic cause of spinal cord syndrome?

Vitamin B12 deficiency

Which two needles are most used for LP?

Whitacre and Quinke

Pt's with what condition are more likely to suffer herniation during LP?

brain tumors

If a pt fell on their back and suffered a spinal cord transection, what kind of bone injury could cause this?

burst fracture of the vertebral body

How does tertiary syphillis (tabes dorsalis) affect the spinal cord? What sx?

affects dorsal columns - causing unsteadiness and loss of proprioception. - reflexes are diminished - Tabetic gait - high steppage with feet falling flat and hard.

54 y/o man awoke from surgery with weakness of the lower extremities. He has loss of pain and temperature in the same distribution of the weakness. During surgery his blood pressure dropped significantly. Diagnosis?

anterior cord syndrome -> caused by interruption of the anterior spinal artery from hypotension during surgery.

What will be present in the CSF of a person with NMO?

aquaporin 4 antibodies

Where does the anterolateral pathway decussate?

at the spinal cord level that they exit.

Is neuro-myelitis optica an autoimmune or neuroinflammatory dz? Where will lesions be found? What 2 sx do pt's present with ?

autoimmune - lesions in optic nerves and spinal cord - sx: -- - optic neuritis - transverse myelitis

What is the difference between an autoimmune and neuroinflammatory disease?

autoimmune - has known antibodies neuroinflammatory - no known antibody found

Describe what a cervical spinal cord section looks like.

butterfly shaped gray matter - prominent dorsal columns

What sensation do the anterolateral columns project?

pain and temperature

Pt presents with loss of vibration & proprioception, pain & temp, and motor loss in every area aside from the head and genital region. Diagnosis?

central cord syndrome - large lesion

What are some possible complications of LP?

headache - bleeding or fluid leaking - infection, pain - nerve trauma

Describe what a sacral spinal cord section looks like.

huge amount of gray matter, very little white.

Where does the lateral corticospinal tract decussate?

in the medulla

What is transverse myelitis? what is the tx?

inflammation of the spinal cord secondary to: . Idiopathic . Post-infectious . MS . NMO . Sarcoidosis - onset evolves over hours with no obvious trigger tx: steroids

What are the initial sx of ALS? How will the pt progress?

initially presents with stiff muscles and muscle wasting leading to atrophy and fasciculations. - over time progresses to difficulty speaking, swallowing and breathing.

What 7 structures/spaces will be traversed during an LP?

skin subq layer back muscles supraspinous ligament interspinous ligament ligamentum flavum epidural space

Pt presents with numbness and tingling along the shoulders and dorsum of the arms for the past couple months. Diagnosis?

small lesion in the central cord - this lesion would cause pain and temp loss it would affect where the anterolateral fibers cross over at the anterior commissure.

What infectious can cause spinal cord syndrome?

tertiary syphillis (tabes dorsalis)

Occlusion of what artery besides the anterior spinal artery can cause anterior cord syndrome?

the great Radicular Artery of Adamkiewicz.