|Clinical Features||lower motor neuron findings the level of the lesion and upper motor neuron findings below the level of the lesion|
Myelopathy is term that describes a spinal cord lesion that is confined to a discrete level, for example from trauma, tumour, or central disc protrusion. Symptoms and signs of myelopathy occur in the upper limbs, trunk, and lower limbs. The examination is used to determine whether long tract signs are present such as hyperreflexia, spasticity, and a positive Hoffman's sign. Patients may present with signs only in the upper limbs. There is the absence of lower motor neurone signs
The lesion causes motor, sensory, and reflex abnormalities at the level of the lesion and below it. The weakness is of the lower motor neuron type at the level of the lesion (from damage to anterior horn cells and spinal roots), and of the upper motor neuron type below the level of the lesion (from damage to the descending upper motor neuron paths). An exception is that lesions at the foramen magnum and C3 to C4 can sometimes produce atrophy in the hands.
One needs to be familiar with the spinal innervation of the muscles. For example, in someone with a C7 segment spinal cord lesion, there is lower motor neuron weakness in the C7 muscles, but upper motor neuron weakness of the muscles below this level (e.g. in the lower limbs). The muscles from the segments above C7 are normal.
Gait may be disturbed with sensory ataxia due to a combination of proprioceptive defects, hypertonicity, and weakness.
There may be deep sensation defects in severe disease involving proprioception and vibration sense, due to posterior column compression.
Urinary incontinence can occur in long standing disease
Neck pain may be a feature but is not normally prominent, and does not tend to occur early unlike cervical radiculopathy
- Lhermittes sign (electric shock down torso on neck flexion)
- Foot tapping test
- Hand clenching test
- With back against the wall, unable to extend head back to touch the wall.
- Hoffman test, facilitated by cervical extension
MRI is best. Severe cord atrophy suggests a poor prognosis.
- Amyotrophic lateral sclerosis
- Multifocal motor neuropathy
- Multiple sclerosis
- Peripheral neuropathy
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