Spinal Cord Compression/Paraplegia

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Clinical DescriptionLower limbs weakness

Clinical FeaturesSIGNS AND SYMPTOMS

  • Deep, local spinal pain
  • Stabbing, radicular pain in a dermatomal distribution and LMN weakness at lesion level
  • Progressive UMN weakness and sensory loss below lesion
  • Bladder hesitancy, frequency → painless retention
  • Faecal incontinence or constipation
  • Look for motor, reflex and sensory level
  • Shooting, radicular pain at level, anaesthesia below
  • LMN signs at level, UMN signs below level
  • Tone and reflexes are usually reduced in acute cord compression

Causes

Compressive

  • Spinal cord tuberculosis (Pott‘s disease)
  • Spinal cord metastases and neoplasms
  • Degenerative spinal disease (e.g. slipped disc)
  • Schistosomiasis
  • Bacterial abscesses

Non-Compressive

  • Autoimmune transverse myelitis
  • HIV-associated vacuolar myelopathy
  • Neuroschistosomiasis
  • Neurocysticercosis
  • Syphilis (meningomyelitis, meningovascular myelitis, Tabes dorsalis)
  • Vitamin B12 deficiency (subacute combined cord degeneration)
  • Viral (Herpes, Varicella)

INVESTIGATIONS

  • HIV test, VDRL (Syphilis test), FBC, Blood sugar, ESR (erythrocyte sedimentation rate), Ova of Schistosoma in urine and stool; If available, serology
  • X-ray: spine (level depending on clinical findings) and chest (signs of TB?)
  • Ultrasound abdomen (signs of TB?), Lumbar Puncture
  • CT-guided percutaneous vertebral or paravertebral biopsy and aspiration would be the gold standard for spinal TB, Neuroimaging: MRI (level depending on clinical findings)
  • MRI is definitive modality
  • CXR for primaries

Treatment

 This is a neurosurgical emergency