131 Neuro: Spinal Cord issues

Cauda Equina Syndrome • Neurosurgical emergency due to compression of cauda equina nerve roots, usually from disc herniation, tumor, or trauma Clinical Presentation Severe low back pain with bilateral leg radiation, saddle anesthesia, bowel/bladder dysfunction (urinary retention, overflow incontinence), decreased rectal tone, lower extremity weakness Labs, Studies, and Physical Exam Findings Immediate MRI lumbar spine (gold standard) showing nerve root compression Rectal exam showing decreased sphincter tone Treatment Emergent surgical decompression within 24-48 hours Supportive care: Pain management, bladder catheterization Key Differentiators Rapid onset of bilateral symptoms with bowel/bladder dysfunction differentiates it from typical lumbar radiculopathy or sciatica     Epidural Abscess • • Spinal epidural infection commonly caused by Staphylococcus aureus Risk factors: IV drug use, recent spinal procedures, immunosuppression Clinical Presentation Classic triad: Fever, localized spinal tenderness, progressive neurological deficits Insidious onset of worsening back pain, fever, neurological symptoms over days to weeks Labs, Studies, and Physical Exam Findings Elevated ESR, CRP, leukocytosis MRI with gadolinium (gold standard): Ring-enhancing lesion with surrounding inflammation Treatment First-line: Immediate empiric IV antibiotics (Vancomycin + Ceftriaxone or Cefepime) Surgical drainage for progressive neurologic deficit, large abscess, or failed medical management Key Differentiators Progressive fever and neurological deficits distinguish from mechanical back pain; confirmed by MRI and inflammatory markers   Spinal Cord Injuries • • Traumatic injury causing varying neurological deficits based on level and completeness Clinical Presentation Acute trauma history, spinal shock (temporary loss of reflexes, motor/sensory function) Neurological deficits depend on injury level: Cervical injuries: Tetraplegia/quadriplegia Thoracic/lumbar injuries: Paraplegia Neurogenic shock (hypotension, bradycardia) seen with injuries above T6 due to disrupted autonomic pathways Labs, Studies, and Physical Exam Findings CT scan for initial assessment of bony injuries/fractures MRI to evaluate soft tissue and spinal cord involvement Treatment Initial management: Spinal stabilization (cervical collar, spine immobilization), airway control, neurogenic shock treatment (IV fluids, vasopressors) Surgical decompression/stabilization for unstable injuries or ongoing compression High-dose corticosteroids controversial but considered if initiated within 8 hours post-injury Key Differentiators Neurogenic shock (bradycardia + hypotension) distinguishes cervical spinal injuries from hemorrhagic shock (tachycardia + hypotension)