Myelopathy
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Introduction
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis. To get students thinking.
Pathophysiology
The thoracic spine is smaller, so is more susceptible to compression
Problems with the spine will likely affect all body systems
- bilateral weakness UMN - legs +/- arms
- bilateral sensory impairment + level
- sphincter dysfunction
- Lhermitte's sign
- clonus
- typical pattern (Brown-Sequard, central cord, anterior cord)
| UMN | LMN | |
| Babinski | yes | no |
| atrophy | no | yes |
| fasciculations | no | yes |
| reflexes | hyper | absent |
| tone | spasticity | flaccidity |
Mechanisms of COrd Damage
Is it outside or inside the dura?
Brown-Sequard Syndrome
hemicord lesion
- ipsilateral motor loss
- ipsilateral proprioreception and vibration loss
- contralateral pain and temperature loss
Central Lesions
- larger effects on arms that legs
- allodynia is common due to crossing of signals
Foramen Magnum Syndrome
- occipital pain and lhermitte's syndrome
- lower cranial nerve lesions
- +/- trigeminal loss
- marching paralysis
- dorsal column loss
Conus Medullaris Syndrome
Cauda Equina Syndrome
- will present with lower extremity pain first, before bladder dysfunction
- more assymetrical findings
Signs and Symptoms
- history
- physical exam
History
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Treatments
Consequences and Course
Resources and References
Topic Development
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