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Review of Myelopathy

Review of Myelopathy

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Published by Pranay Sinha
A case based review of myelopathy
A case based review of myelopathy

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Published by: Pranay Sinha on Jun 18, 2012
Copyright:Attribution Non-commercial

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02/01/2013

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Learning Objectives:
 
Describe the 5 main signs & symptoms of myelopathy: – 
 
Para-/quadriparesis, sensory level, urinary incontinence, constipation,sexual dysfunction
 
Identify & distinguish the different causes of myelopathy by their clinical presentations
 
Describe the evaluation & management of spinal cord compression
 
When approaching a patient with a neurologic complaint, it is important to“think like a neurologist.” The initial most important aspect of the neurologicevaluation is to anatomically localize the site of the lesion.Example: Is the lesion in the central or peripheral nervous system?
 
If central, is it in the brain or spinal cord? Within the brain, is the lesioncortical or subcortical?
 
If peripheral, is it in the nerve root, peripheral nerve, neuromuscular  junction, or muscle?The process of "localizing the lesion" from the onset of the evaluation willserve as a guide to focus the neurologic assessment.Localizing the lesion ultimately lays the foundation for forming a differentialdiagnosis and developing a plan for evaluation, management, andcounseling of the patient.
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“Numbness” requires clarification to determine whether the patient isdescribing a loss of sensation, or a positive phenomena, such asparesthesias (abnormal spontaneous sensation) or dysesthesias (abnormalsensation to stimulus). Destructive or compressive lesions of the CNS moreoften cause sensory loss whereas inflammatory or irritative lesions oftenresult in positive phenomena.Cold feeling in the legs can be neurologic in nature but can also be due toperipheral vascular disease.Hemibody symptoms can result from a contralateral cerebral hemisphere or brainstem lesion, or from a spinal cord lesion. However, bilateral symptomsare more likely due to spinal cord or peripheral nerve disorders. A complaint of “tightness” in a band around the chest or abdomen ischaracteristic of a spinal cord lesion. This usually correlates with findings of a sensory level on neurologic examination.
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