Diseases of the Spinal Cord.ppt

Diseases of the Spinal Cord Stacy Rudnicki, MD Department of Neurology Upper vs. Lower Motor Neuron Upper motor neuron lesion Motor cortex internal capsule brainstem spinal cord Lower motor neuron lesion Anterior horn cell nerve root plexus peripheral nerve neuromuscular junction muscle Basic Features of Spinal Cord Disease UMN findings below the lesion Hyperreflexia and Babinski’s Sensory and motor involvement that localizes to a spinal cord level Bowel and Bladder dysfunction common Remember that the spinal cord ends at about T12-L1 History Onset Acute, subacute, chronic Symptoms Pain Weakness Sensory Autonomic Past history Family history Tempo of Spinal Cord Disease Motor Exam Strength - helps to localize the lesion Upper cervical Quadriplegia with impaired respiration Lower cervical Proximal arm strength preserved Hand weakness and leg weakness Thoracic Paraplegia Can also see paraplegia with a midline lesion in the brain Tone Increased distal to the lesion Sensory Exam Establish a sensory level Dermatomes Nipples: T4-5 Umbilicus: T8-9 Posterior columns Vibration Joint position sense (proprioception) Spinothalamic tracts Pain Temperature Autonomic disturbances Neurogenic bladder Urgency, incontinence, retention Bowel dysfunction Constipation more frequent than incontinence With a high cord lesion, loss of blood pressure control Alteration in sweating Investigation of Spinal Cord Disease Radiographic exams Plain films Myelography CT scan with myelography MRI Spinal tap If you suspect: inflammation, MS, rupture of a vascular malformation Etiology of Spinal Cord Disease Traumatic Spinal Cord Disease 10,000 new spinal cord injuries per year MVA, sports injuries the most common Victims under 30 yrs old, malefemales Fx/dislocation of vertabrae most likely to occur at: C5,6 T12, L1 C1,2 Tumors Metastatic or primary Extramedullary Extradural - most common Bony - breast, pro