Spinal Cord Lesions - Pathoma

Synringomyelia
  • Cystic degeneration of spinal cord
  • Causes
    • Truama
    • Arnold-Chiari Malformation
    • ..
  •  Usually @ C8-T1 - so in upper extremity mostly
  • Presents
    • Disrupt lateral spinothalamic tract bilaterally
      • Loss of nociception
      • Loss of temperature sense
    • Intact tactile sensation, proprioception - as decussate in medulla = dorsal column-medial lemniscus pathway
    • in upper extremity (most often)
    • If keeps expanding, may damage α Motor Neuron in anterior horn - get Lower Motor Neuron Signs
      • Muscle weakness, atrophy
      • Dec tone
      • Dec reflexes
    • If keeps expanding again (!) may even damage spinothalamic tract in lateral horn
      • Lose proprioception, tactile
      • If @ C8-T1, lose sympathetic input to face as carried by this tract 
        • Horner's syndrome
        • Partial ptosis
        • Myosis
        • Anhidrosis
Poliomyelitis
  • Damage to anterior horn by poliovirus
  • Enterofoecal
  • Presents
    • Initially
      • Nauses
      • Vomiting
      • Abdo pain
      • Fever
    • Then
      • Spreads to CNS haematogenously
      • Lower motor neuron signs
        • Dec reflexes
        • -ve Babinksi - toes go down
        • Flaccid paralysis
        • Dec tone
        • Atrophy
        • NB may look like Werdnig-Hoffmann Disease
          • aka Spinal Muscular Atrophy type 1
          • Autosomal recessive
          • Anterior horn degenerates
          • Missing SurvivalMotorNeuron1 (SMN1) gene
          • 1/2 have both homologues of Neuronal Apoptosis Inhibitory Protein missing
          • Presents
            • Infants
            • Floppy baby
            • Death by resp failure by 2yo
              • Most common genetic caused of neonatal death - 1:25k UK live borths
              • 1:60-80 carrier freq
          • (SMA type 2, or Dubowitz syndrome, and SMA type 3, or Wohlfart-Kugelberg-Welander disease - have later onset of symptoms and a slower progression of muscle weakness and respiratory symptoms)
MND: Amyotrophic Lateral Sclerosis (see NRO notes for full detail: Motor neuron disease - MND)
Friedreich Ataxia
Robbins Basic Pathology, Robbins Pathologic Basis of Disease, Robbins Review of Pathology (MCQs - very path-y), Robbins Flash Cards, Baby Robbins, Robbins Atlas - some exact same images come up in the exam, 100 Cases in ClinicalPathology - possibly the best Qbank for the practical