Podcast
Questions and Answers
What is the most common cause of spinal cord compression?
What is the most common cause of spinal cord compression?
Which of the following is the most frequent cause of transverse myelitis?
Which of the following is the most frequent cause of transverse myelitis?
What is the percentage of cases of transverse myelitis attributed to vascular origin?
What is the percentage of cases of transverse myelitis attributed to vascular origin?
Which of the following is NOT a cause of spinal cord compression listed in the content?
Which of the following is NOT a cause of spinal cord compression listed in the content?
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What is the percentage of spinal cord compression cases attributed to intramedullary causes?
What is the percentage of spinal cord compression cases attributed to intramedullary causes?
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Which of the following conditions is NOT a possible cause of transverse myelitis as listed in the content?
Which of the following conditions is NOT a possible cause of transverse myelitis as listed in the content?
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What is the approximate percentage of transverse myelitis cases attributed to tumors?
What is the approximate percentage of transverse myelitis cases attributed to tumors?
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Which of the following is the most common cause of spinal cord compression attributed to vertebral causes?
Which of the following is the most common cause of spinal cord compression attributed to vertebral causes?
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Which of these conditions is primarily associated with an abrupt onset of weakness and sensory loss, often with pain, developing over hours to days?
Which of these conditions is primarily associated with an abrupt onset of weakness and sensory loss, often with pain, developing over hours to days?
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What is the typical pattern of motor loss in a thoracic cord lesion?
What is the typical pattern of motor loss in a thoracic cord lesion?
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Which condition is associated with slowly progressive upper motor neuron features affecting the legs more than the arms, with minimal sensory loss?
Which condition is associated with slowly progressive upper motor neuron features affecting the legs more than the arms, with minimal sensory loss?
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Which of these conditions is NOT typically associated with impaired sphincter function?
Which of these conditions is NOT typically associated with impaired sphincter function?
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What can be done to reduce the incidence of diastematomyelia?
What can be done to reduce the incidence of diastematomyelia?
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Which of these conditions is most likely to be associated with an elevated white blood cell count in the cerebrospinal fluid?
Which of these conditions is most likely to be associated with an elevated white blood cell count in the cerebrospinal fluid?
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Which condition is characterized by relentless progressive lower motor neuron and upper motor neuron features, associated with bulbar weakness?
Which condition is characterized by relentless progressive lower motor neuron and upper motor neuron features, associated with bulbar weakness?
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What is the typical pattern of sensory loss in syringomyelia?
What is the typical pattern of sensory loss in syringomyelia?
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Which of these conditions is most likely to be associated with a history of cancer?
Which of these conditions is most likely to be associated with a history of cancer?
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Which condition is potentially treatable with folate supplementation?
Which condition is potentially treatable with folate supplementation?
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Which of these conditions is most likely to be associated with a history of excessive dietary zinc intake?
Which of these conditions is most likely to be associated with a history of excessive dietary zinc intake?
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Which of these conditions is associated with a gradual onset of motor loss over months or years, often with pain in the cervical segments?
Which of these conditions is associated with a gradual onset of motor loss over months or years, often with pain in the cervical segments?
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Which of these conditions is most likely to be diagnosed based on a characteristic "suspended" sensory loss?
Which of these conditions is most likely to be diagnosed based on a characteristic "suspended" sensory loss?
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Which of these conditions is most likely to be associated with a history of nitrous oxide abuse?
Which of these conditions is most likely to be associated with a history of nitrous oxide abuse?
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Which of these conditions is most likely to be treated with surgery?
Which of these conditions is most likely to be treated with surgery?
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Which of the following conditions is most likely to cause spastic paraplegia with a sensory level on the trunk?
Which of the following conditions is most likely to cause spastic paraplegia with a sensory level on the trunk?
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What type of weakness is exhibited in the ipsilateral motor function below the level of the lesion in Brown-Sequard syndrome?
What type of weakness is exhibited in the ipsilateral motor function below the level of the lesion in Brown-Sequard syndrome?
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Which sensory modalities are typically lost ipsilaterally below the level of the lesion in Brown-Sequard syndrome?
Which sensory modalities are typically lost ipsilaterally below the level of the lesion in Brown-Sequard syndrome?
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What causes the increased deep tendon reflexes observed in Brown-Sequard syndrome?
What causes the increased deep tendon reflexes observed in Brown-Sequard syndrome?
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Which side experiences loss of pain and temperature sensation in Brown-Sequard syndrome?
Which side experiences loss of pain and temperature sensation in Brown-Sequard syndrome?
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What is the mechanism behind the band of weakness and atrophy noted at the ipsilateral level of the lesion?
What is the mechanism behind the band of weakness and atrophy noted at the ipsilateral level of the lesion?
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What happens to deep tendon stretch reflexes in Brown-Sequard syndrome?
What happens to deep tendon stretch reflexes in Brown-Sequard syndrome?
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Which clinical feature is associated with damage to the dorsal root and dorsal horn in Brown-Sequard syndrome?
Which clinical feature is associated with damage to the dorsal root and dorsal horn in Brown-Sequard syndrome?
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The loss of pain and temperature sensation begins how far below the level of the transaction or compression in Brown-Sequard syndrome?
The loss of pain and temperature sensation begins how far below the level of the transaction or compression in Brown-Sequard syndrome?
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What is the primary investigation method for evaluating spinal cord compression?
What is the primary investigation method for evaluating spinal cord compression?
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What characteristic finding is associated with Froin syndrome during cerebrospinal fluid analysis?
What characteristic finding is associated with Froin syndrome during cerebrospinal fluid analysis?
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In the management of spinal cord compression, what should be considered for benign tumors?
In the management of spinal cord compression, what should be considered for benign tumors?
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What does MRI primarily assess in the case of spinal cord conditions?
What does MRI primarily assess in the case of spinal cord conditions?
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What may indicate the need for a needle biopsy when evaluating spinal cord compression?
What may indicate the need for a needle biopsy when evaluating spinal cord compression?
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What systemic investigation might be warranted in patients with spinal cord syndrome?
What systemic investigation might be warranted in patients with spinal cord syndrome?
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During an investigation for intrinsic spinal cord diseases, which diagnostic step is taken first?
During an investigation for intrinsic spinal cord diseases, which diagnostic step is taken first?
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Which of the following conditions might show non-specific signal changes on MRI?
Which of the following conditions might show non-specific signal changes on MRI?
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What is necessary for regaining useful function in cases of extradural compression due to malignancy?
What is necessary for regaining useful function in cases of extradural compression due to malignancy?
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Which management strategy is crucial for dealing with spinal cord compression due to malignancy?
Which management strategy is crucial for dealing with spinal cord compression due to malignancy?
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What must be avoided in patients with severe spasticity?
What must be avoided in patients with severe spasticity?
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After acute paraplegia, what is an immediate management technique for bladder issues?
After acute paraplegia, what is an immediate management technique for bladder issues?
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What should follow surgical treatment for spinal cord compression due to tuberculosis?
What should follow surgical treatment for spinal cord compression due to tuberculosis?
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What can chronic kidney disease in patients with spinal cord compression be attributed to?
What can chronic kidney disease in patients with spinal cord compression be attributed to?
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Which treatment is suggested for managing severe spasticity?
Which treatment is suggested for managing severe spasticity?
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What is critical to prevent in patients at risk of pressure ulcers?
What is critical to prevent in patients at risk of pressure ulcers?
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Which of the following is NOT a potential complication that may arise in a patient with paraplegia?
Which of the following is NOT a potential complication that may arise in a patient with paraplegia?
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Which of the following describes the most common method of bladder management in paraplegia patients?
Which of the following describes the most common method of bladder management in paraplegia patients?
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Which of the following strategies is primarily used to manage the potential development of pressure ulcers in patients with paraplegia?
Which of the following strategies is primarily used to manage the potential development of pressure ulcers in patients with paraplegia?
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Which statement accurately reflects the role of tendon transfers in patients with paraplegia?
Which statement accurately reflects the role of tendon transfers in patients with paraplegia?
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In the context of managing bowel function in paraplegia patients, what is the primary strategy during the initial phase immediately following the injury?
In the context of managing bowel function in paraplegia patients, what is the primary strategy during the initial phase immediately following the injury?
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Which of the following is NOT a common site for pressure ulcer development in individuals with paraplegia?
Which of the following is NOT a common site for pressure ulcer development in individuals with paraplegia?
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Which type of rehabilitation is specifically designed to address the potential for contractures in paraplegia patients?
Which type of rehabilitation is specifically designed to address the potential for contractures in paraplegia patients?
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What is the significance of the C7 level in the context of self-sufficiency for individuals with paraplegia or tetraplegia?
What is the significance of the C7 level in the context of self-sufficiency for individuals with paraplegia or tetraplegia?
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Study Notes
Paraplegia Overview
- Paraplegia is weakness or paralysis affecting both legs, caused by spinal cord damage.
- It can manifest as spastic (increased muscle tone) or flaccid (decreased muscle tone) paraplegia.
- Sensory and autonomic dysfunction may also be involved.
- Severity, course, and associated symptoms depend on the spinal cord damage level and type.
Learning Outcomes
- Describe clinical features of Brown-Séquard syndrome.
- Describe the aetiology, clinical characteristics, investigations, and management of paraplegia.
Brown-Séquard Syndrome - Clinical Features
- Ipsilateral (same side as lesion):
- Spastic weakness
- Increased deep tendon reflexes
- Babinski sign
- Loss of vibration, proprioception, and other sensory modalities below the lesion level
- Contralateral (opposite side to lesion):
- Loss of pain and temperature sensation below the lesion level
Brown-Séquard Syndrome - Clinical Signs
- Ipsilateral below lesion level:
- Motor deficit
- Spastic weakness
- Deep tendon reflexes increased
- Babinski sign
- Loss of Vibration, Position, Proprioceptive sensation.
- Contralateral below lesion level:
- Sensory deficit
- Loss of Pain and Temperature Sensation.
- Ipsilateral at lesion level:
- Motor/Sensory deficit.
- Spastic weakness
- Depression of deep tendon stretch reflexes.
- Loss of all sensory modalities.
Paraplegia Etiology
-
Traumatic (73%):
- Motor vehicle accidents (55%)
- Falls (34%)
- Gunshot wounds (8%)
- Diving accidents (2%)
- Sports injuries (1%)
-
Non-traumatic (27%):
- Spinal tumors (29%)
- Spinal stenosis (29%)
- Transverse myelitis (18%)
- Vascular origin (16%)
- Spinal arachnoiditis (5%)
- Meninges (intradural) (extramedullary) (15%)
Paraplegia Etiology (Compressive)
-
Non-compressive (12%):
- Multiple sclerosis
- Idiopathic myelitis
- Sarcoidosis
- Spinal cord infarction
- HTLV myelopathy
- Radiation myelopathy
- NMOSD
- HIV-associated vacuolar myelopathy
- Vitamin B12 deficiency myelopathy
- Other causes of spinal cord compression:
- Trauma, extradural
- Intervertebral disc prolapse
- Metastatic carcinoma (breast, prostate, bronchus)
- Myeloma
- Tuberculosis
- Tumors (meningioma, neurofibroma, ependymoma, metastasis, lymphoma, leukaemia)
- Epidural abscess
Investigation of Acute Spinal Cord Syndrome
- Magnetic resonance imaging (MRI) of the spine or myelography
- Plain X-rays of the spine
- Chest X-ray
- Cerebrospinal fluid (CSF) analysis
- Serum vitamin B12 levels
Spinal Cord Compression
- MRI is the investigation of choice to define the extent of compression and associated soft tissue abnormalities.
- Plain X-rays reveal bony destruction and soft-tissue abnormalities.
- Myelography shows:
- Normal cell count with very elevated protein (Froin syndrome) in complete spinal block.
- Needle biopsy may be needed to diagnose a secondary tumor.
Paraplegia Management - General Care
- Bladder management
- Urinary retention can result
- Patients may self-catheterize
- Reflex bladder emptying may be helped by abdominal pressure
- Early treatment of urinary tract infections (UTIs) is crucial.
- Bowel management
- Constipation and impaction must be avoided.
- Skin care
- Inspection for pressure ulcers, especially in high-risk areas (sacrum, iliac crests, heels).
- Meticulous skin care and regular turning/positioning.
- Lower Limbs
- Passive physiotherapy to prevent contractures, and treat spasms.
- Muscle relaxants (baclofen, botulinum toxin injections) for severe spasticity (flexors or extensors).
Paraplegia Management - Specific
- Benign tumors should be surgically removed for better chances of recover
- Extradural compression due to malignancy has a poor prognosis.
- Function can be restored through radio-therapy if treatment is administered within 24 hours of onset of weakness or sphincter dysfunction.
- Spinal Cord Compression due to tuberculosis requires surgical treatment followed by anti-tuberculosis chemotherapy for an extended period.
Paraplegia Management - Specific Conditions
- Inflammatory causes: Inflammatory-steroids
- Subacute combined degeneration: Vitamin B12
- Multiple sclerosis: Disease-Modifying Therapies
Paraplegia Management - Rehabilitation
- Many patients recover self-sufficiency, especially if the injury level is at C7 or below
- Specialists spinal rehabilitation units are often needed.
- Support from a specialist team is needed to include psychological and sexual needs
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Description
Test your knowledge on causes and statistics related to spinal cord compression and transverse myelitis. This quiz covers common causes, associated percentages, and clinical features. Perfect for students and professionals in neurology and medical fields.
