Spinal cord disorders
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Spinal cord disorders

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    Spinal cord disorders Spinal cord disorders Presentation Transcript

    • SPINAL CORD
      DISORDRS
      ALI ABDULLAH ALBALUSHI
      OMSB
      EMERGENCY MEDICINE, R-4
    • OUTLINE
      ANATOMY
      DIFFERENT SPINAL CORD DISORDERS
      CONCLUSION
      QUISTIONS
    • 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)
    • All are true about the anatomy of the spinal cord except :
      It is 40 cm long
      Supplied by a single anterior spinal artery & paired vertibral artery
      The posterior column carry the afferent ascending fibers for properiocetion & vibration & cross at level of medulla
      In the spinothalamic tract, sacral fibers are represented most medially
      In corticospinal tract, the fibers cross at level of medulla & cervical fibers are located medially
    • 2) All are true regarding complete spinal cord syndrom except:
      It is a total loss of sensory, autonomic & voluntary motor innervation distal to the level of the spinal cord injury
      Deep tendon reflexes my persist
      The most common cause is trauma
      99% of patients with persistent symptoms beyond 24 hrs do not have a functional recovery
      1% of patients will have some evident of cord function below the level of injury
    • 3) All are true about spinal shock except :
      It is the loss of muscle tone & reflexes with complete cord syndrom during the acute phase of injury
      The intensity of the spinal shock increases with the height of the level in the spinal cord
      It typically lasts less than 24 hrs
      Bulbocavernous reflex is present
      The termination of spinal shock phase of injury is heralded by return of balbocavernous reflex
    • 4) Central cord syndrom, all are true except :
      It is the post prevalent of the partial cord syndroms
      Upper extremities are affected more & distal muscles are affected to a greater degree
      The most common mechanism is motor vehicle crush
      It is caused most often by hyperextension
      Elderly are affected more & prognosis is better in patients younger than 50 yrs
    • 5) All are true about Brown- Sequard Syndrom except:
      Usually, it results from penetration injuries
      Characterized by ipsilateral motor weakness & vibration / position loss & contralateral pain/ tempreture loss
      It can be associated with A-V malformation
      Ipsilateral pain & tempreture loss may be noted 1 – 2 levels above the lesion
      It has the worst prognosis of any incomplete spinal cord syndroms
    • 6) Regarding anterior cord syndrom, all of the following are true except :
      Posterior column is preserved
      Most cases reposted after aortic surgeries
      It can be caused by hypotension
      Generally, the prognosis is good
    • 7) Regarding Conus Medullaris & Cauda Equina syndroms , What is false ?
      It is very difficult to separate the two syndroms clinically
      Conus Medullaris usually presents with overflow incontinence or sexual dysfunction
      Usually, Conus Medullaris presents unilaterally
      Cauda Equina is a LMN picture with hyporeflexia
      Saddle sensory loss is common in both syndroms
    • 8) All of the following result from intrinsic lesions in the spinal cord except :
      Multiple Sclerosis
      Syrigomyelia
      Myelopathy
      Spinal epidural abscess
      Spinal cord infarction
    • All are true about MS except :
      It is a demyelinating disease affecting CNS
      Presents with patchy motor & sensory findings
      Presents with UMN picture
      Oligoclonal bands in CSF are significant only if present in the serum as well
      Immunosuppresive therapy is the treatment of choice
    • 10) All are true about Transverse Myelitis except :
      Present with paraplegia , sensory level & sphincter disturbance
      It is rare & progress slowly
      Thoracic cord is affected most often & cervical rarely
      The most essential aspect in management is to role out treatable causes
      Steroids are of unknown benefit
    • 11) All of the following are true about syringomyelia except ?
      It is a condition of having a cavity lesion within the substance of the spinal cord
      Disassociative anesthesia is the classic pattern of sensory deficit
      CT is the diagnostic tool of choice
      It is not necessary to perform an emergent imaging if f/u can be arranged
      It is ass with Arnold – Chiari I Syndrom
      It is treated with surgical removal If symptoms are progressive
    • 12) Which statement is true about Spinal Epidural Hematoma ?
      It is common with incidence of 5 per 100000 pts
      It is not associated with anticoagulation therapy
      Pain decreases by coughing or sneezing or straining
      Patients usually present initialy with neurological deficit rather than pain
      Emergent decompressive laminectomy is the treatment of choice
    • 13) All statements are true about spinal epidural abscess Except :
      It results from hematogenous spread of infection , mostly bacterial
      Diabetics , IV drug users & HIV patients are at higher risk
      Cervical site of infection predominate
      Spread to subdural space & intraspinal area is uncommon
      Urgent surgical consultation for decompression is required
      • 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
    • 14) All statements are true about Diskitis Except :
      The most common causative organism is staph. Aurius
      It is more common among pediatric age group, < 10 yrs
      Lumbar spine is the most common site
      Neurological deficit is common
      Treated usually with antibiotics & surgery is often not necessary
    • 15) All are true about spinal cord neoplasm Except :
      Neurological symptoms caused by compression, invasion & distruction of the myelinated tracts by the tumors
      Metastasis is the most common spinal cord tumers
      Lumbar region is the most affected
      Recumbency worsen the pain
      Severe nighttime pain is charactrestic
    • CONCLUSION
    • THANKS