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SPINAL CORD ,[object Object],DISORDRS,[object Object],ALI ABDULLAH ALBALUSHI,[object Object],OMSB,[object Object],EMERGENCY MEDICINE, R-4,[object Object]
OUTLINE,[object Object],ANATOMY,[object Object],DIFFERENT SPINAL CORD DISORDERS,[object Object],CONCLUSION,[object Object],QUISTIONS,[object Object]
ANATOMY,[object Object],Spinal cord: foramen magnum  1st/2nd lumbar vertebrae. ,[object Object],Cervical enlargement:,[object Object],C5-T1: gives rise to brachial plexus, innervates UE;,[object Object],L2-S3: gives rise to lumbosacral plexus, ,[object Object],Gray matter – central (cell bodies),[object Object],White matter – peripheral (ascending and descending tracts),[object Object]
Spinal cord disorders
All are true about the anatomy of the spinal cord except :,[object Object],It is 40 cm long,[object Object],Supplied by a single anterior spinal artery & paired vertibral artery,[object Object],The posterior column carry the afferent ascending fibers for properiocetion & vibration & cross at  level of medulla,[object Object],In the spinothalamic tract, sacral fibers are represented most medially,[object Object],In corticospinal tract, the fibers cross at level of medulla & cervical fibers are located medially,[object Object]
2) All are true regarding complete spinal cord syndrom except:,[object Object],It is a total loss of sensory, autonomic & voluntary motor innervation distal to the level of the spinal cord injury,[object Object],Deep tendon reflexes my persist,[object Object],The most common cause is trauma,[object Object],99% of patients with persistent symptoms beyond 24 hrs do not have a functional recovery,[object Object],1% of patients will have some evident of cord function below the level of injury,[object Object]
3) All are true about spinal shock except :,[object Object],It is the loss of muscle tone & reflexes with complete cord syndrom during the acute phase of injury,[object Object],The intensity of the spinal shock increases with the height of the level in the spinal cord,[object Object],It typically lasts less than 24 hrs,[object Object],Bulbocavernous reflex is present,[object Object],The termination of spinal shock phase of injury is heralded by return of balbocavernous reflex,[object Object]
4) Central cord syndrom, all are true except :,[object Object],It is the post prevalent of the partial cord syndroms,[object Object],Upper extremities are affected more & distal muscles are affected to  a greater  degree,[object Object],The most common mechanism is  motor vehicle crush,[object Object],It is caused  most often by hyperextension,[object Object],Elderly are affected more & prognosis is better in patients younger than 50 yrs,[object Object]
5) All are true about Brown- Sequard Syndrom except:,[object Object],Usually, it results from penetration injuries,[object Object],Characterized by ipsilateral motor weakness & vibration / position loss & contralateral pain/ tempreture loss,[object Object],It can be associated with A-V malformation,[object Object],Ipsilateral pain & tempreture loss may be noted 1 – 2 levels above the lesion,[object Object],It has the worst prognosis of any incomplete spinal cord syndroms,[object Object]
6) Regarding anterior cord syndrom, all of the following are true except :,[object Object],Posterior column  is preserved,[object Object],Most cases reposted after aortic surgeries,[object Object],It can be caused by hypotension,[object Object],Generally, the prognosis is good,[object Object]
7)  Regarding Conus Medullaris & Cauda Equina syndroms , What is false ?,[object Object],It is very difficult to separate the two syndroms clinically,[object Object],Conus Medullaris usually presents with overflow incontinence or sexual dysfunction,[object Object],Usually, Conus Medullaris presents unilaterally,[object Object],Cauda Equina is a LMN picture with hyporeflexia ,[object Object],Saddle sensory loss is common in both syndroms,[object Object]
Spinal cord disorders
8) All of the following result from intrinsic lesions in the spinal cord except :,[object Object],Multiple Sclerosis,[object Object],Syrigomyelia,[object Object],Myelopathy,[object Object],Spinal epidural abscess,[object Object],Spinal cord infarction,[object Object]
Spinal cord disorders
All are true about MS except :,[object Object],It is a demyelinating disease affecting CNS,[object Object],Presents with patchy motor & sensory findings,[object Object],Presents with UMN picture,[object Object],Oligoclonal bands in CSF are significant only if present in the serum as well,[object Object],Immunosuppresive therapy is the treatment of choice,[object Object]
10) All are true about Transverse Myelitis except :,[object Object],Present with paraplegia , sensory level & sphincter disturbance,[object Object],It is rare & progress slowly,[object Object],Thoracic cord is affected most often & cervical rarely,[object Object],The most  essential aspect in management is to role out treatable causes,[object Object],Steroids are of unknown benefit,[object Object]
11) All of the following are true about syringomyelia except ?,[object Object],It is a condition of having a cavity lesion within the substance of the spinal cord,[object Object],Disassociative anesthesia is the classic pattern of sensory deficit,[object Object],CT is the diagnostic tool of  choice,[object Object],It is not necessary to perform an emergent imaging if f/u can be arranged,[object Object],It is ass with Arnold – Chiari I Syndrom,[object Object],It is treated with surgical removal If symptoms are progressive,[object Object]
12) Which statement is true about Spinal Epidural Hematoma ?,[object Object],It is common with incidence of 5 per 100000 pts,[object Object],It is not associated with anticoagulation therapy,[object Object],Pain decreases by coughing or sneezing or straining,[object Object],Patients usually present initialy with neurological deficit rather than pain,[object Object],Emergent decompressive laminectomy is the treatment of choice ,[object Object]
13) All statements are true about spinal epidural abscess Except :,[object Object],It results from hematogenous spread of infection , mostly bacterial,[object Object],Diabetics , IV drug users & HIV patients are at higher risk,[object Object],Cervical site of infection predominate ,[object Object],Spread to subdural space & intraspinal area is uncommon,[object Object],Urgent surgical consultation for decompression is required,[object Object]
[object Object]
If MRI is not available, CT Myelogram should be done
Neurological deficit rarely improve if surgical intervention is delayed more than 12 – 36 hrs after onset of paralysis
 Antibiotics : Vancomycin & Third generation Cephalosporine IVRifampin oral,[object Object]
14) All statements are true about Diskitis Except :,[object Object],The most common causative organism is staph. Aurius,[object Object],It is more common among pediatric age group, < 10 yrs,[object Object],Lumbar spine is the most common site,[object Object],Neurological deficit is common,[object Object],Treated usually with antibiotics & surgery is often not necessary,[object Object]
15) All are true about spinal cord neoplasm Except :,[object Object],Neurological symptoms caused by compression, invasion & distruction of the myelinated tracts by the tumors,[object Object],Metastasis is the most common spinal cord tumers,[object Object],Lumbar region is the most affected,[object Object],Recumbency worsen the pain,[object Object],Severe nighttime pain is charactrestic,[object Object]

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Spinal cord disorders

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  • 21. If MRI is not available, CT Myelogram should be done
  • 22. Neurological deficit rarely improve if surgical intervention is delayed more than 12 – 36 hrs after onset of paralysis
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