| SPINAL DISORDERS: Points in differential diagnosis | |||
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MNEMONIC Vascular Infectious B12 Deficiency Radiation ALS Tumor, Trauma & Toxic Epidural Abscess & Electricity Developmental & Hereditary Spondylosis & Spine Paraneoplastic & Parasagittal Arachnoiditis Syringomyelia Multiple Sclerosis & Myelitis Systemic Disorders
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FOCAL LESIONS AVM Fluctuating signs Slow progression Radiation Partial Brown-Séquard Epidural abscess: Pain Parasagittal lesion: Leg Spine: Disk; Stenosis Spondyolsis Mass: Neoplasm; Hematoma; Cyst ↑ spinal root or vessel Arachnoiditis: Sarcoid; Mpl surgery; Infection Trauma Toxic: Contrast agents; Chymopapain; Methotrexate; Cytosine arabinoside 1° CNS DISEASE Multiple sclerosis ALS: Pure motor Syringomyelia Transverse myelitis: Parainfectious; Vaccine; Immune |
SYSTEMIC CAUSES OF MYELOPATHY | |
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Spinal Cord lesions Connective Tissue Disease Lupus Erythematosis Sjögren's Mixed Connective Tissue Systemic Sclerosis (PSS) Behçet's Embolism Decompression Sickness Ischemic Atherosclerosis Liver disease: Portosystemic shunt Aortic Aneurysm Anemia Hyperviscosity: Waldenström's Paraneoplastic Infectious HIV: Posterior columns HTLV 1: Spastic Syphilis Vitamin ↓: E; B12 Toxic: Organophosphate N2O; Heroin Electricity |
Skeletal lesions Atlanto (C1)-Axial (C2) Arthritis: RA; Psoriasis Trisomy 21 Morquio A & B Skeletal dysplasias Klippel-Feil: Cervical vertebral fusion Ochronosis von Recklinghausen Ankylosing spondylitis Spinal canal stenosis Achondroplasia Coffin Lowry Stickler dysplasia Acrodysostosis (lumbar) Familial Lumbar Stenosis Hypophosphatemia, Vit D resistant rickets Spondyloarthropathy & chronic renal failure Other Epidural Masses: Gout; Xanthoma; Large nerves; Amyloid; Hematopoesis; Lipomatosis (Steroids) Acromegaly Myelomeningocoele Metastasis |
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| ANATOMICAL SYNDROMES | FAMILIAL MYELOPATHIES | |||
| Cord Region | Clinical features | Related lesion | Spastic Paraplegias | Other syndromes |
| Central |
Sensory loss: Pain & temperature Sacral sparing Weakness: Arms > legs |
Trauma Syringomyelia Cervical arthritis Spondylosis Neoplasm: Glial; Metastatic Lymphoma |
Dominant (Strumpell) SPG3 (FSP1): Atlastin; 14q SPG4 (FSP2): Spastin; 2p22 SPG6 (FSP3): 15q11.1 SPG8: 8q23 SPG9: 10q23 SPG10: KIF5A; 12q13 SPG12: 19q13 SPG13: HSPD1; 2q24 SPG17: 11q12 SPG19: 9q33 Multiple exostoses Recessive SPG5A: 8q SPG5B: ? SPG7 (5C): Paraplegin; 16q24 SPG11: 15q13 SPG14: 3q27-q28 SPG15: 14q22-q24 SPG20 (Troyer): Spartin; 13q12.3 Sjögren-Larsson: FALDH; 17p11 DRPLA: 12p13 Homozygotes Intermediate # repeats Spastic paraplegia +: Dementia & Extrapyramidal Δ Retinal degeneration Evans syndrome Leukodystrophies: Late-onset MLD & Krabbé X-linked SPG1: L1CAM; Xq28 SPG2: Proteolipid protein; Xq21 SPG16: Xq11 AMN: ALDP protein; Xq28 Adult onset: 5q31 Retardation, psychosis, macroorchidism Woods-Black-Norbury |
Syringomyelia + Arnold-Chiari & Scoliosis Cleidocranial dysplasia Acromesomelic dysplasia Spine Disorders & Myelopathy Coffin-Lowry Syndrome: Ribosomal Protein S6 kinase Morquio's Syndromes: A: Galactosamine sulfatase B: β-galactosidase Achondroplasia: FGF Receptor-3 Type II Collagenopathies Spine dysplasias; Spina bifida Trisomy 21 Ankylosing spondylitis Lumbar Stenosis Hypophosphatemia: Vitamin D resistant rickets Other familial syndromes Arnold-Chiari Malformation Spastic Ataxias: DRPLA Charlevoix-Saguenay Paroxysmal Choreoathetosis/Spasticity Hereditary Motor Syndromes Spastic dystonia syndromes: DOPA-responsive dystonias: GTP cyclohydrolase I; Tyrosine hydroxylase; Mitochondrial & Leber's optic atrophy Infections: HTLV-1 Mass lesion: Meningioma von Hippel-Lindau Hemangioblastoma Neurofibroma |
| Anterior |
Sensory loss: Pain & temperature Weakness: Legs ± arms |
Ant spinal artery Δ Disk; Osteophyte |
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| Posterior |
Sensory loss: Position sense Relative preservation: Motor Pain & temperature |
Post spinal artery Δ ↓ collateral perfusion: Atherosclerosis Vitamin ↓: B12; E Lipoma; Lig flavum |
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Hemicord (Brown- Séquard) |
Ipsilateral loss: Position sense; Motor Contralateral loss: Pain & temperature |
Trauma: Penetrating Radiation Decompression Tumor: Dumbbell Facet; Luschka joint |
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Inferior (Conus) |
Onset: Rapid; Symmetric Pain: ± Perineum & thighs Sensory: Saddle; Pain, Temp Weakness: Sacral Reflex ↓: Ankle > Knee Bladder Δ; Impotence |
Tumor Compression Ischemia |
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| Cauda equina |
Onset: Progressive; Asymmet Pain: Severe; Radicular Fatigue; Fasciculations Sensory: All modalities; Lumbar > sacral Weakness: Lumbar > Sacral Reflex loss: Knee > Ankle ± Bladder involvement |
Compression Tumor Arachnoiditis |
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