Spinal Cord Disorders Overview

Study Notes

Overview of Spinal Cord Disorders

Spinal cord disorders can cause permanent severe problems, such as paralysis or impaired bladder and bowel control (urinary incontinence and fecal incontinence).
Quick evaluation and treatment can help avoid or minimize these problems.
Causes of spinal cord disorders include injuries, infections, a blocked blood supply, and compression by a fractured bone or a tumor.
Symptoms of spinal cord disorders include weak or paralyzed muscles, abnormal or lost sensation, and difficulty controlling bladder and bowel function.
Diagnosis is based on symptoms and results of a physical examination and imaging tests, such as magnetic resonance imaging (MRI).
Treatment involves correcting the underlying condition causing the disorder, and often requires rehabilitation to recover as much function as possible.

Causes of Spinal Cord Disorders

Outside the spinal cord:
- Injuries
- Compression of the spinal cord (e.g., by bone, blood, tumor, or disk)
- Blockage of the blood supply
Inside the spinal cord:
- Fluid-filled cavities (syrinxes)
- Blockage of the blood supply
- Inflammation (e.g., acute transverse myelitis)
- Tumors, abscesses, bleeding (hemorrhage)
- Vitamin B12 deficiency, copper deficiency
- Infection with human immunodeficiency virus (HIV), COVID-19, multiple sclerosis, or syphilis
- Radiation therapy

Cauda Equina Syndrome

Caused by severe compression of the nerve roots in the lumbar spine, often due to an acute lumbar disc herniation.
Symptoms include:
- Low back pain
- Pain radiating down the leg
- Numbness around the anus
- Loss of bowel or bladder control
- Saddle-like paresthesias (abnormal sensations)
Diagnosis is made clinically, with urgent MRI to confirm the cause.
Treatment involves prompt surgical decompression, ideally within 24 hours, or absolutely within 48 hours.

Symptoms of Cauda Equina Syndrome

Motor:
- Muscle weakness or paralysis in one or both legs
- Weakness of the muscles of the lower legs (often paraplegia)
- Achilles (ankle) reflex absent on both sides
- Absent superficial reflexes
- Gait disturbance
Sensory:
- Severe low back pain
- Pain, numbness, or weakness in one or both legs
- Later hypoesthesia or anaesthesia in affected dermatome
- Loss or altered sensations in the legs, buttocks, inner thighs, backs of legs, or feet
- Saddle anaesthesia (numbness or "pins-and-needles" sensations)
Autonomic:
- Sphincteric dysfunction
- Sensory atonic bladder or motor atonic bladder
- Vasomotor and trophic changes
- Recent problem with bladder or bowel function (retention or incontinence)
- Sexual dysfunction

Neurogenic Bladder

A condition in which problems with the nervous system affect the bladder and urination
Types:
- A.UMNL (Upper Motor Neuron Lesion):
  - Acute: retention of urine with overflow
  - Gradual: partial lesion causing precipitancy of micturition or complete lesion causing automatic bladder
- B.LMNL (Lower Motor Neuron Lesion):
  - Sensory atonic bladder: absence of sense of fullness of bladder, overflow retention of urine
  - Motor atonic bladder: preservation of sense of fullness of bladder, retention of urine with moderate size of bladder, inability to evacuate bladder voluntarily
  - Autonomic or autonomous bladder: incomplete, irregular, and involuntary evacuation of the bladder

Transverse Myelitis

Definition: An inflammation of both sides of one section of the spinal cord, often damaging the insulating material covering nerve cell fibers (myelin)
Signs and symptoms:
- Pain, often beginning suddenly in the lower back, with sharp pain shooting down to the legs or arms
- Abnormal sensations, such as numbness, tingling, coldness, or burning
- Weakness in arms or legs, sometimes with severe weakness or total paralysis
- Bladder and bowel problems, such as urinary incontinence, difficulty urinating, and constipation
Causes:
- Viral and other infections, including herpes viruses, which can infect the spinal cord directly
- Multiple sclerosis
- Neuromyelitis Optica (Devic's disease)
- Rarely, parasites or bacteria, such as Lyme disease, can cause a painful inflammation of nerve roots of the spinal cord

Description

This quiz covers the causes and effects of spinal cord disorders, including paralysis and impaired bladder and bowel control. It highlights the importance of quick evaluation and treatment to minimize or avoid severe problems.