Myelopathy Vs Radiculopathy
Myelopathy Vs Radiculopathy
Myelopathy Vs Radiculopathy
vs
Radiculopathy
Sarah Sullivan, DO
Northwest NeuroSpecialists
April 6, 2012
Spinal cord
Anatomy
Terminates at L1-2 - conus/filum terminale
Segments with dorsal/ventral rootlets, form roots, fuse to form
spinal nerve - 31 pairs
Gray matter: posterior/lateral/anterior columns
Spinal cord
Conus vs Cauda
Conus medullaris lesion
symmetric sensory/motor; bladder/bowel/sexual fxn early; sudden
and bilateral
Infectious/Inflammatory
Myelopathy
Acute/subacute sxs
MRI: intramedullary lesions without
evidence of extrinsic cord compression
Sx: fever, meningismus, encephalopathy,
known systemic infection, rash, immunocomp
Infectious: Viral/Bacterial
Infectious/Inflammatory
myelopathy
Inflammatory: most commonly demyelinating
MS, NMO, post-infections/vaccinial, ADEM,
auto-immune disease associated,
neoplastic/paraneoplastic
IV steroids, plasmapheresis, diseasemodifying medication
Hereditary Myelopathy
Spinocerebellar degeneration
Motor neuron disorders
Leukodystrophies
Distal motor-sensory axonopathy
Vascular Myelopathy
Spinal cord ischemia
Sx: sensory first, then weakness (flaccid)
Cause: physical activity, vascular manipulation, systemic hypotension
Dx/Management: MRI/prevent recurrence
Hemorrhagic
Sx: sudden, severe pain; meningeal irritation
Cause: ? spinal angioma; vascular malformations
Dx/ Management: MRI, LP/alleviate the local cause of hemorrhage
Metabolic/Toxic Myelopathy
Nutrient Deficiency
Geographic
Predilection/Toxin
Non-Geographic
Predilection/Toxin
May present as
Metabolic Myelopathy
Lathyrism
Cehmotherapy related
myelopathy
NO toxicity
Fluorosis
Organophosphate toxicity
Mitochondrial disorders
Folate deficiency
Tropical
myeloneuropathies
Hexosaminidase A
deficiency
Vitamin E deficiency
Recurrent optic
neuromyelitis with
endocrinopathy
Hepatic myelopathy
AIDS-assoc myelopathy
Biotinidase deficiency
(AR)
Copper deficiency
Compressive/Traumatic
Myelopathy
Causes:
Neoplastic - spinal mets, intradural tumors
Non-neoplastic - cervical spondylosis
Traumatic
Compressive Myelopathy
Image
Image
Radiculopathy
Leading cause of nerve root disease:
intervertebral disc disease and spondylosis
damage at the disc, uncovertebral joints,
facet joints
Risk factors: physical exertion or trauma,
male
L5/S1, C7
Localization: significant variability
Radiculopathy
Clinical diagnosis: H&P
neck/shoulder; back/buttock
exacerbation with Valsalva, Spurlings, straight-leg raise
Reconsider with Lhermittes, bowel/bladder
pain, paresthesias, weakness
Diagnostic testing
MRI/CT myelogram
EMG/NCS
Pain/Sensory
Weakness
Reflex
C5
Neck/shoulder
Shoulder abduction;
ext rotation; forearm
supination
Biceps/brachioradialis
C6
Lat arm/forearm/thumb
As with C5 and
pronation
Biceps/brachioradialis
C7
Middle finger/hand
WE/WF/forearm
pronation
Triceps
C8
Medial forearm/hand
Finger/wrist
extension/abduction/a
dduction
Triceps
L2-3-4
Back/ant thigh/medial LE
Hip
flexion/adduction/knee
extension
Patella
L5
Buttock/lat thigh/dorsum
foot/great toe (webspace)
S1
Buttock/lat-post thigh/post
calf/lat-plantar foot
Hip extension/ PF
Achilles
Radiculopathy
Image
Cervical Radiculopathy:
Management
Acute Sensory
Cervical imaging
Avoid triggers and bedrest
NSAIDs, steroid taper
Cervical traction if foraminal stenosis
Re-eval in 4 weeks
Acute Motor
Cervical imaging
Neruosx/ortho consult
Avoid triggers, avoid bedrest
NSAIDs, steroids
Cervical traction if foraminal stenosis
Subacute Chronic
PT
TENS
Neurosx/Ortho consult
Lumbar Radiculopathy:
Acute Management
Pain/Sensory Loss
Lumbar Radiculopathy:
Subacute Management
Medical/Neurologic Re-eval
Medical management: NSAIDs, prn gabapentin, Lyrica, Cymbalta, tricyclics for neuropathic pain
Polyradiculopathy
Polyradiculopathy:
Differential Diagnosis
Myelopathy
Polyradiculopathy
Polyneuropathy
Diabetes
Adrenal Insufficiency
Paraneoplastic syndrome
Lyme disease
Vasculitis
Syrinx, MS
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Questions?
http://www.adzuna.co.uk/blog/2012/01/24/graduate-competition-intensifies-how-are-you-managing/end-is-near-cartoon-9/