Info
🌱 來自: Huppert’s Notes
Myelopathy and Radiculopathy🚧 施工中
Myelopathy and Radiculopathy
• Description: Neurologic deficit related to the spinal cord
• Physical exam:
- Myelopathy: Pyramidal weakness in the arms/legs, bowel or bladder dysfunction, numbness including saddle anesthesia, hyperreflexia below the level of the lesion (may be hyporeflexive at the level of the lesion or if hyperacute), spasticity, +Babinski sign
- Radiculopathy: Sensory and motor symptoms referable to an individual nerve root
• Key clinical syndromes:
- Conus medullaris syndrome: Diseases affecting spinal cord levels S2–S5 resulting in back pain, bowel/bladder dysfunction, bilateral sensory loss, and spastic or flaccid weakness.
- Cauda equina syndrome: Diseases affecting the lumbosacral nerve roots resulting in leg weakness, saddle anesthesia, urinary retention/incontinence, fecal incontinence, impotence, reduced patellar and ankle reflexes
• Etiologies:
- Compressive: Spondylotic (degenerative/arthritic), tumor, infection (abscess), trauma/hemorrhage
- Non-compressive:
• Non-inflammatory (CSF with normal WBC, normal IgG index, no oligoclonal bands)
- Vascular: Cord ischemia (e.g., during aortic surgery), dural arteriovenous fistula (slowly progressive myelopathy, common in older men), arteriovenous malformation (often presents with subarachnoid hemorrhage, common in patients 20–30 yr)
- Infectious: HIV vacuolar myelopathy
- Toxic/metabolic: B12 deficiency (can be due to pernicious anemia, gastrectomy, Crohn’s, malnutrition, medication effect), nitrous oxide toxicity (functional B12 deficiency), vitamin E deficiency, copper deficiency (can be due to zinc excess [denture cream!])
- Inherited: Friedreich ataxia, adrenoleukodystrophy
- Structural: Syringomyelia (post-traumatic or associated with Chiari malformation; areflexia at level of lesion, “cape-like” distribution of sensory loss to pain and temperature)
• Inflammatory (CSF with abnormal WBC or abnormal IgG index/oligoclonal bands)
- Autoimmune: Multiple sclerosis, neuromyelitis optica (NMO), SLE, Sjogren’s, sarcoid, ADEM
- Infectious: HSV, CMV, VZV, HIV, HTLV-1, enterovirus, fungal infections, tuberculosis, Lyme, syphilis (tabes dorsalis, affects dorsal columns)
- Neoplastic: Lymphoma, paraneoplastic, solid tumor malignancies (may also have bland CSF)