Neurology. Spinal cord

Spinal cord

Spinal cord compression
Causes:
Metastasis (lung, breast, prostate, lymphoma)
Primary bone tumor (multiple myeloma and osteogenic sarcoma)
Thoracic spine between (60-80%)
Clinical: back pain (worse with recumbency); limb weakness; radicular pain, sensory changes; urinary and bowel dysfunction; paralysis of limbs below the level of compression
Diagnosis: MRI whole spine
Treatment: steroids (high dose dexamethasone ), radiation therapy, surgery(decompression)

Cauda equina syndrome
Extreme pressure and swelling of the nerves at the end of the spinal cord
Nerve Root levels
Lumbar(L2-L5), Sacral (S1-S5), Coccygeal(C0)
Risk factors:
Low back injury
Central dick herniation
Central spinal stenosis
Spinal fracture
Ankylosing spondylitis

Cauda equina syndrome
Signs and symptoms:
Severe low back pain, motor weakness , sensory loss , radicular pain, saddle anesthesia (S3-S5),
Bladder dysfunction, bowel incontinence, sexual dysfunction
Diagnosis: MRI of spinal cord
Treatment: surgery - decompression

Syringomyelia
A cavity formed in the brainstem or spinal cord, containing CSF
Causes:
trauma,
tumors,
abscess,
congenital (Arnold-Chiari II Malformation)

Syringomyelia
Anterior white commissure of spinothalamic tract
pain, pressure, temperature, crude touch
Lower motor neurons
corticospinal tract
Muscle atrophy
Muscle weakness
Paralysis
Dorsal column
Pressure
Vibration
Fine touch
Proprioception
Destruction of the spinothalamic tract
Bilateral loss pain and temperature
(cape-like distribution)
Lower motor neuron damage
Weakness, muscle atrophy and paralysis
Scoliosis and Charcot joints

Syringomyelia

Syringomyelia
Diagnosis: MRI
(Chiari malformation/spinal tumors)
Treatment: surgery
Chiari malformation – posterior fossa decompression
Hydrocephalus – shunt, catheter to drain syrinx

Friedreich’s ataxia
inherited condition of the nervous system characterized by the gradual loss of coordination
Impaired mitochondrial function
Symptoms:
Ataxia, Hypertrophic cardiomyopathy, Diabetes mellitus
Difficulty walking, muscle weakness, loss of proprioception, fatigue, hear failure, losing vision and hearing

Friedreich’s ataxia
Diagnosis: genetic testing
MRI of brain and spinal cord, echocardiography
Treatment: no cure
Symptom managed: physical therapy

Paraplegic patient management
The primary goals of rehabilitation are
prevention of secondary complications
maximization of physical functioning
reintegration into the community
Сoncomitant diseases
Pressure ulcer
common location of pressure injury is over the sacrum
Atelectasis and/or pneumonia
Deep vein thrombosis
Pulmonary embolus
Autonomic dysreflexia (hyperreflexia)
Urinary tract infection
Cardiometabolic syndrome (obesity, insulin resistance, hypertension, and dyslipidemia)

Paraplegic patient management
Thromboembolic Disease
Venous imaging with ultrasonography
Pneumatic compression devices for the first 2 weeks->compression hose
Unfractionated heparin (UFH; 5000 units SC every 12 hours) or a low-molecular-weight heparin (LMWH; 30 mg SC every 12 hours) for 2-3 months following injury
Placement of a caval filter
Autonomic Dysfunction
Orthostatic blood pressure changes (weakness, light-headedness, and fainting)
gradual mobilization, liberal sodium intake, use of compression hose, and an abdominal binder
Symptomatic bradycardia
intravenous (IV) atropine
Autonomic hyperreflexia
(a profound headache in the presence of elevated blood pressure)
noxious stimulus: bladder distention and bowel distention
prophylaxis with alpha-blocking agents