Spinal cord disorders-classification

Non compressive

Heredo-degenerativeo MND

1. Progressive muscular atrophy PMA2. Amyotrophic lateral sclerosis (ALS)3. Progressive bulbar palsy4. Pseudobulbar palsy

o Spinal muscular atrophy Infantile Childhood Adult

o Hereditary spastic paraparesiso Spinocerebellar degenerationo Friedreich’s ataxiao Syringomyelia/bulbia

Inflammatoryo Transverse myelitiso Multiple sclerosiso Neuromyelitis optica (Devic’s Dx)o Radiation myelopathy

Infectiveo Poliomyelitiso TB-meningitis, arachnoditis, granuloma, tuberculomao Syphilis o HIVo HTLVo Schistosomiasis

Vascularo Infarction-ant spinal artery thrombosiso Haemorrhageo AV malformation

Nutritional o Deficiencies

B12-SACD E

o Toxic Lathyrism Konzo - tropical ataxic neuropathy

Compressive

Extraduralo Metastases:

Bronchus Breast Prostate Lymphoma Thyroid Melanoma

Extramedullaryo Meningiomao Neurofibromao Ependymoma

Intramedullaryo Gliomao Ependymomao Haemangioblastomao Lipomao AV malformationo Teratoma

Referance Netter_s_Neurology, Kumar & Clark - Clinical Medicine 8E

A 16-year-old boy suddenly began to walk with both knees in a flexed posture. Initially, his parents thought he was just joking. However, later that evening he began to experience knife-like pain in midback radiating around his ribs toward his epigastrium. The next morning, he awakened unable to get out of bed. He was unable to void. On neurologic examination he was paraplegic, his muscle stretch reflexes were absent, and his plantar response “ambiguous.” Sensory exam suggested a T10 level for both pain and temperature modalities.Pertinent laboratory findings included CSF findings with a protein 175 mg/dL, and 30 WBC with 90% lymphocytes. Nerve conductions demonstrated prolonged F waves but otherwise normal motor and sensory nerve conductions. The spinal cord had a focal demyelinating lesion with gadolinium enhancement involving most of its transverse diameter at T9–T11. Unfortunately a course of intravenous (IV) methylprednisolone was ineffective; he remained paraplegic, with a persistent dense sensory level and ongoing incontinence.

Spinal Cord Disorders

Epidural, intradural, or intramedullary neoplasm Epidural abscess Compressive Epidural hemorrhage Cervical spondylosis Herniated disk Posttraumatic compression by # or displaced vertebra or hemorrhage

Vascular AVM Antiphospholipid syndrome & other hypercoagulable states

Multiple sclerosis Neuromyelitis optica Transverse myelitisSpinal Cord Disorders Inflammatory Sarcoidosis Sjögren-related myelopathy SLE Vasculitis

Viral: VZV, HSV-1 & -2, CMV, HIV, HTLV-I, others Infectious Bacterial & mycobacterial: Borrelia, Listeria, syphilis, others Mycoplasma pneumoniae Parasitic: Schistosomiasis, Toxoplasmosis

Syringomyelia Developmental Meningomyelocele Tethered cord syndrome

Metabolic Vitamin B12 ↓ (subacute combined degeneration) Copper ↓

Acute transverse myelopathy (transverse myelitis)This term is used to describe a cord lesion and paraparesis (or paraplegia) occurring with Viral infections, MS,

MCTD & Other inflammatory and vascular disorders, e.g. Hiv, sarcoid, syphilis, Radiation myelopathy & Anterior spinal artery occlusion.

MRI is usually required to exclude cord compression.

Management of paraplegia

Symptomatic

1. Bladder. Catheterization is usually necessary initially. Many patients self-catheterize, or develop reflex bladder emptying, helped by

abdominal pressure. Free urinary drainage is essential to avoid stasis, subsequent infection and calculi.

2. Bowel. Constipation and impaction must be avoided. (Stool softeners) Following acute paraplegia, manual evacuation is necessary; reflex emptying develops later.

3. Lower limbs. Passive physiotherapy helps to prevent contractures. Severe spasticity, with flexor or extensor spasms, may be helped by baclofen,

diazepam, dantrolene, tizanidine or botulinum toxin injections.Supportive

1. Skin care. Risks of pressure sores and their sequelae are serious. Meticulous attention must be

paid to cleanliness and to turning every 2 hours. The sacrum, iliac crests, greater trochanters, heels and malleoli should be inspected frequently.

Ripple mattresses/water beds are useful. If pressure sores develop, plastic surgical repair may be required. Pressure palsies, e.g. of ulnar nerves, must be avoided.

2. DVT prophylaxis/ crepe bandage

3. Prevent orthostatic pneumonia: physiotherapy

4. Rehabilitation Many patients with traumatic paraplegia or tetraplegia return to self-sufficiency. Specialist advice from a skilled rehabilitation unit is necessary. Lightweight, specially adapted wheelchairs are available. Patients with paraplegia

have substantial practical, psychological and sexual needs.

General health and morale should be reviewed carefully and regularly.

Any intercurrent infection is potentially dangerous and should be treated early.

Chronic renal failure is a common cause of death. The paraplegic patient needs skilled and prolonged nursing care and training to be aware of problems.