Spinal cord compression history and symptoms: Difference between revisions
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{{CMG}} ; {{AE}} {{ADG}} | {{CMG}} ; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
Back pain is the most common presenting symptom in almost all acute cases of spinal cord compression. Symptoms of spinal cord compression depends upon the anatomic level involved. All cases of spinal cord compression presents with sensory, motor and autonomic dysfunction. Sensory symptoms include altered sensation below a certain level (e.g., pin, touch, vibration, temperature) | [[Back pain]] is the most common presenting symptom in almost all acute cases of [[spinal cord compression]]. Symptoms of [[spinal cord compression]] depends upon the anatomic level involved. All cases of spinal cord compression presents with [[Sensory system|sensory]], [[Motor control|motor]] and [[autonomic dysfunction]]. Sensory symptoms include altered sensation below a certain level (e.g., pin, touch, vibration, temperature). Motor symptoms include [[hemiplegia]] or [[hemiparesis]] (sparing the face), [[paraplegia]] or [[Paraplegia|paraparesis]], [[Quadriplegia|tetraplegia]] or [[Quadriplegia|tetraparesis]]. Autonomic symptoms include [[constipation]], [[urinary retention]], [[dizziness]] (due to [[hypotension]]), cold, shivering, and [[drowsiness]] (due to [[hypothermia]]), [[erectile dysfunction]], [[abdominal pain]] and [[distension]] (due to [[ileus]]), [[syncope]] (due to [[bradycardia]]).<ref name="pmid18420159">{{cite journal |vauthors=Cole JS, Patchell RA |title=Metastatic epidural spinal cord compression |journal=Lancet Neurol |volume=7 |issue=5 |pages=459–66 |year=2008 |pmid=18420159 |doi=10.1016/S1474-4422(08)70089-9 |url=}}</ref><ref name="pmid28187806">{{cite journal |vauthors=Flanagan EP, Pittock SJ |title=Diagnosis and management of spinal cord emergencies |journal=Handb Clin Neurol |volume=140 |issue= |pages=319–335 |year=2017 |pmid=28187806 |doi=10.1016/B978-0-444-63600-3.00017-9 |url=}}</ref><ref name="RopperLongo2017">{{cite journal|last1=Ropper|first1=Alexander E.|last2=Longo|first2=Dan L.|last3=Ropper|first3=Allan H.|title=Acute Spinal Cord Compression|journal=New England Journal of Medicine|volume=376|issue=14|year=2017|pages=1358–1369|issn=0028-4793|doi=10.1056/NEJMra1516539}}</ref> | ||
==History== | ==History== | ||
The significant information that needs to | The significant information that needs to focus on the history of the patient includes | ||
*History of cancer | *History of [[cancer]] | ||
*History of IV drug abuse | *History of [[Intravenous drug use (recreational)|IV drug abuse]] | ||
*Menopause | *[[Menopause]] | ||
==Common Symptoms== | ==Common Symptoms== | ||
*Back pain is the most common presenting symptom in almost all acute cases of spinal cord compression.<ref name="pmid18420159">{{cite journal |vauthors=Cole JS, Patchell RA |title=Metastatic epidural spinal cord compression |journal=Lancet Neurol |volume=7 |issue=5 |pages=459–66 |year=2008 |pmid=18420159 |doi=10.1016/S1474-4422(08)70089-9 |url=}}</ref><ref name="pmid28187806">{{cite journal |vauthors=Flanagan EP, Pittock SJ |title=Diagnosis and management of spinal cord emergencies |journal=Handb Clin Neurol |volume=140 |issue= |pages=319–335 |year=2017 |pmid=28187806 |doi=10.1016/B978-0-444-63600-3.00017-9 |url=}}</ref><ref name="RopperLongo2017">{{cite journal|last1=Ropper|first1=Alexander E.|last2=Longo|first2=Dan L.|last3=Ropper|first3=Allan H.|title=Acute Spinal Cord Compression|journal=New England Journal of Medicine|volume=376|issue=14|year=2017|pages=1358–1369|issn=0028-4793|doi=10.1056/NEJMra1516539}}</ref> | *[[Back pain]] is the most common presenting symptom in almost all acute cases of [[spinal cord compression]].<ref name="pmid18420159">{{cite journal |vauthors=Cole JS, Patchell RA |title=Metastatic epidural spinal cord compression |journal=Lancet Neurol |volume=7 |issue=5 |pages=459–66 |year=2008 |pmid=18420159 |doi=10.1016/S1474-4422(08)70089-9 |url=}}</ref><ref name="pmid28187806">{{cite journal |vauthors=Flanagan EP, Pittock SJ |title=Diagnosis and management of spinal cord emergencies |journal=Handb Clin Neurol |volume=140 |issue= |pages=319–335 |year=2017 |pmid=28187806 |doi=10.1016/B978-0-444-63600-3.00017-9 |url=}}</ref><ref name="RopperLongo2017">{{cite journal|last1=Ropper|first1=Alexander E.|last2=Longo|first2=Dan L.|last3=Ropper|first3=Allan H.|title=Acute Spinal Cord Compression|journal=New England Journal of Medicine|volume=376|issue=14|year=2017|pages=1358–1369|issn=0028-4793|doi=10.1056/NEJMra1516539}}</ref> | ||
*All cases of spinal cord compression presents with sensory, motor and autonomic dysfunction. | *All cases of spinal cord compression presents with [[Sensory system|sensory]], [[Motor control|motor]] and [[autonomic dysfunction]]. | ||
*Sensory symptoms include altered sensation below a certain level (e.g. | *Sensory symptoms include altered sensation below a certain level (e.g. pin, touch, vibration, temperature). | ||
*Motor symptoms include hemiplegia or hemiparesis (sparing the face), paraplegia or paraparesis, tetraplegia or tetraparesis. | *Motor symptoms include [[hemiplegia]] or [[hemiparesis]] (sparing the face), [[paraplegia]] or [[paraparesis]], [[tetraplegia]] or [[tetraparesis]]. | ||
*Autonomic symptoms include constipation, urinary retention, dizziness (due to hypotension), cold, shivering, and drowsiness (due to hypothermia), erectile dysfunction, abdominal pain and distension (due to ileus), syncope (due to bradycardia). | *Autonomic symptoms include [[constipation]], [[urinary retention]], [[dizziness]] (due to [[hypotension]]), cold, shivering, and drowsiness (due to [[hypothermia]]), [[erectile dysfunction]], [[abdominal pain]] and [[distension]] (due to [[ileus]]), and [[syncope]] (due to [[bradycardia]]). | ||
*The following table describes the most common symptoms of spinal cord compression depending upon the anatomic level | *The following table describes the most common symptoms of spinal cord compression depending upon the anatomic level of involvement. | ||
{| class="wikitable" | {| class="wikitable" | ||
!Type of spinal | !Type of spinal | ||
| Line 23: | Line 23: | ||
!Symptoms | !Symptoms | ||
|- | |- | ||
|Cervical | |[[Cervical vertebrae|Cervical]] | ||
|Headache | |[[Headache]] | ||
Neck, shoulder or arm pain | [[Neck stiffness/pain|Neck]], [[Shoulder pain|shoulder or arm pain]] | ||
Loss of sensation over the upper extremities | Loss of sensation over the upper extremities | ||
Motor weakness of neck, shoulder, and arm | [[Muscle weakness|Motor weakness]] of neck, shoulder, and arm | ||
|- | |- | ||
|Thoracic | |[[Thoracic vertebrae|Thoracic]] | ||
|Pain in the chest and/or back | |Pain in the chest and/or back | ||
Loss of sensation below the level of the compression | Loss of sensation below the level of the compression | ||
| Line 37: | Line 37: | ||
Paralysis of respiratory muscles | Paralysis of respiratory muscles | ||
|- | |- | ||
|Lumbosacral | |[[Lumbar vertebrae|Lumbosacral]] | ||
|Low back pain that may radiate down the legs | |[[Low back pain]] that may radiate down the legs | ||
Weakness in the legs and feet | [[Muscle weakness|Weakness]] in the legs and feet | ||
Loss of sensation in the legs and feet | Loss of sensation in the legs and feet | ||
| Line 60: | Line 60: | ||
!Sphincter dysfunction | !Sphincter dysfunction | ||
|- | |- | ||
|Central cord syndrome | |[[Central cord syndrome]] | ||
|Sensory loss is very rare | |Sensory loss is very rare | ||
| | | | ||
* Upper extremity weakness | |||
* Distal muscles are involved more than proximal | |||
|<nowiki>-</nowiki> | |||
|- | |- | ||
|Brown-Séquard syndrome | |[[Brown-Sequard syndrome|Brown-Séquard syndrome]] | ||
|Ipsilateral position and vibration sense loss | | | ||
Contralateral pain and temperature sensation loss | * Ipsilateral position and vibration sense loss | ||
* Contralateral pain and temperature sensation loss | |||
|Motor loss ipsilateral to cord lesion | |Motor loss ipsilateral to cord lesion | ||
|<nowiki>-</nowiki> | |||
|- | |||
|[[Anterior cord syndrome]] | |||
| | | | ||
* Loss of pin and touch sensation | |||
Vibration, position sense preserved | * Vibration, position sense preserved | ||
|Motor loss or weakness below the level of compression | |Motor loss or weakness below the level of compression | ||
| | |<nowiki>-</nowiki> | ||
|- | |- | ||
|Transverse cord syndrome | |Transverse cord syndrome | ||
|Loss of sensation below level of compression | |Loss of sensation below level of compression | ||
|Loss of voluntary motor function below the level of compression | |Loss of voluntary motor function below the level of compression | ||
| | |Loss of urinary sphincter control | ||
|- | |- | ||
|Conus medullaris syndrome | |Conus medullaris syndrome | ||
| rowspan="2" |Saddle anesthesia | | rowspan="2" | | ||
* [[Saddle anesthesia]] in cauda equina syndrome | |||
Sensory loss may range from patchy to complete transverse pattern | * Sensory loss may range from patchy to complete transverse pattern | ||
| rowspan="2" |Weakness may be of upper motor neuron type | * Peri-anal anaesthesia in conus medullaris syndrome | ||
| rowspan="2" | | | rowspan="2" | | ||
* Weakness may be of upper motor neuron type in conus medullaris syndrome. | |||
* Lower motor neuron symptoms in cauda equina syndrome | |||
| rowspan="2" |Impaired sphincter control | |||
|- | |- | ||
|Cauda equina syndrome | |[[Cauda equina syndrome]] | ||
|} | |} | ||
[[Image:Grant 1962 663.png|center| | |||
Dermatomes | |||
|frame]] | |||
[[Image:Referred_Pain_Chart.jpg|center| | [[Image:Referred_Pain_Chart.jpg|center| | ||
Referred pain | Referred pain | ||
|frame]] | |frame]] | ||
Latest revision as of 12:45, 25 April 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Back pain is the most common presenting symptom in almost all acute cases of spinal cord compression. Symptoms of spinal cord compression depends upon the anatomic level involved. All cases of spinal cord compression presents with sensory, motor and autonomic dysfunction. Sensory symptoms include altered sensation below a certain level (e.g., pin, touch, vibration, temperature). Motor symptoms include hemiplegia or hemiparesis (sparing the face), paraplegia or paraparesis, tetraplegia or tetraparesis. Autonomic symptoms include constipation, urinary retention, dizziness (due to hypotension), cold, shivering, and drowsiness (due to hypothermia), erectile dysfunction, abdominal pain and distension (due to ileus), syncope (due to bradycardia).[1][2][3]
History
The significant information that needs to focus on the history of the patient includes
- History of cancer
- History of IV drug abuse
- Menopause
Common Symptoms
- Back pain is the most common presenting symptom in almost all acute cases of spinal cord compression.[1][2][3]
- All cases of spinal cord compression presents with sensory, motor and autonomic dysfunction.
- Sensory symptoms include altered sensation below a certain level (e.g. pin, touch, vibration, temperature).
- Motor symptoms include hemiplegia or hemiparesis (sparing the face), paraplegia or paraparesis, tetraplegia or tetraparesis.
- Autonomic symptoms include constipation, urinary retention, dizziness (due to hypotension), cold, shivering, and drowsiness (due to hypothermia), erectile dysfunction, abdominal pain and distension (due to ileus), and syncope (due to bradycardia).
- The following table describes the most common symptoms of spinal cord compression depending upon the anatomic level of involvement.
| Type of spinal
involvement |
Symptoms |
|---|---|
| Cervical | Headache
Loss of sensation over the upper extremities Motor weakness of neck, shoulder, and arm |
| Thoracic | Pain in the chest and/or back
Loss of sensation below the level of the compression Paralysis of respiratory muscles |
| Lumbosacral | Low back pain that may radiate down the legs
Weakness in the legs and feet Loss of sensation in the legs and feet Bladder and bowel problems Sexual dysfunction Foot drop Decreased or absent reflexes in the legs |
Syndromes Associated with Spinal cord compression
Lesions may develop gradually or acutely and be complete or incomplete. Incomplete lesions often present as distinct syndromes as follows:
| Sensory dysfunction | Motor dysfunction | Sphincter dysfunction | |
|---|---|---|---|
| Central cord syndrome | Sensory loss is very rare |
|
- |
| Brown-Séquard syndrome |
|
Motor loss ipsilateral to cord lesion | - |
| Anterior cord syndrome |
|
Motor loss or weakness below the level of compression | - |
| Transverse cord syndrome | Loss of sensation below level of compression | Loss of voluntary motor function below the level of compression | Loss of urinary sphincter control |
| Conus medullaris syndrome |
|
|
Impaired sphincter control |
| Cauda equina syndrome |
References
- ↑ 1.0 1.1 Cole JS, Patchell RA (2008). "Metastatic epidural spinal cord compression". Lancet Neurol. 7 (5): 459–66. doi:10.1016/S1474-4422(08)70089-9. PMID 18420159.
- ↑ 2.0 2.1 Flanagan EP, Pittock SJ (2017). "Diagnosis and management of spinal cord emergencies". Handb Clin Neurol. 140: 319–335. doi:10.1016/B978-0-444-63600-3.00017-9. PMID 28187806.
- ↑ 3.0 3.1 Ropper, Alexander E.; Longo, Dan L.; Ropper, Allan H. (2017). "Acute Spinal Cord Compression". New England Journal of Medicine. 376 (14): 1358–1369. doi:10.1056/NEJMra1516539. ISSN 0028-4793.