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Neurology Week 4 2018/19 > 10: Spinal cord and root dysfunction > Flashcards

10: Spinal cord and root dysfunction Flashcards

1
Q

Which symptoms do patients with spinal cord problems present with?

A

Sensory - pain, abnormal sensations

Motor - weakness, sphincter and sexual dysfunction

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2
Q

If the arms are involved, which segment of the spine is likely to be involved?

A

Cervical

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3
Q

If a spinal cord prolapse is central, ___ motor neurons are more likely to be involved.

A

upper

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4
Q

If a spinal cord problem is lumbar in origin, which limbs will be involved?

A

Lower limbs

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5
Q

Which chart can be used to diagnose the level of a spinal cord injury?

A

ASIA chart

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6
Q

Which motor neurons are affected by a lateral prolapse?

A

Lower motor neurons (LMNs)

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7
Q

Where does pain occur in cervical disc prolapses?

A

Arms (tends to be)

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8
Q

Which section of the spine does disc prolapse most often occur in?

A

Lumbar

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9
Q

Are upper motor neurons found in the lumbar spine?

A

No, so if a patient has problems in the lower limbs but they’re typical of UMN lesions (see table), the problem is higher up

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10
Q

What is spinal / neurogenic claudicstion?

A

Pain caused by a narrowing of spine, putting pressure on nerve roots

often compared to vascular but v different

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11
Q

Spinal claudication must not be mistaken for ___ claudication.

A

vascular

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12
Q

What can be checked to differentiate spinal claudication from vascular claudication?

A

Peripheral pulses

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13
Q

What is the triad of symptoms in cauda equina syndrome?

A

Saddle anaesthesia

Leg pain

Bowel/bladder dysfunction (painless retention and loss of anal tone)

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14
Q

What type of incontinence do patients with advanced cauda equina get?

A

Overflow incontinence

too late to treat

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15
Q

Which types of sensation should you test for in suspected cauda equina syndrome?

A

Light touch

Pin prick

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16
Q

Which spinal nerves are compressed in cauda equina syndrome?

A

S2 - 4

Pudendal nerve roots

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17
Q

How are patients with suspected cauda equina investigated?

A

Urgent MRI scan

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18
Q

Pain in which spinal region is a red flag?

A

Thoracic region

19
Q

What are general red flag cancer symptoms?

A

Weight loss

Fever

Night sweats

20
Q

Pain which patients notice at ___ is a red flag.

A

night

21
Q

What is cervical myelopathy?

A

Progressive compression of the spinal cord in the cervical spine due to disc prolapse

22
Q

Are the symptoms of cervical myelopathy unilateral or bilateral?

A

Bilateral

23
Q

Which motor neurons are affected in cervical myelopathy?

A

UMNs

24
Q

Which group of patients tend to develop cervical myelopathy?

A

Elderly

25
Q

What are the symptoms of cervical myelopathy?

A

‘Numb, clumsy hands’ -> bilateral, difficulty performing ADLs

Gait problems -> falls

26
Q

Describe

a) Babinski’s

b) Hoffman’s

c) Lhermitte’s

signs, which can all be seen in cervical myelopathy.

A

a) Toes extend on stroking the plantar surface of the foot

b) Thumb, index and middle fingers flex when the nail of middle finger is tapped

c) Patient experiences ‘electric shock’ sensation on neck flexion

27
Q

Does surgery for cervical myelopathy reverse the symptoms?

A

No, only halts progress

28
Q

What is the conservative treatment for a disc prolapse?

A

Analgesia

Physiotherapy

29
Q

Does surgery make any difference to the final outcome of most disc prolapses?

A

No

Tends to speed up recovery, but most patients end up in the same place two years later

30
Q

Surgery for back pain has a lot of potential ___.

A

complications

31
Q

What is failed back syndrome?

A

Chronic back pain following surgery

32
Q

What is an upper motor neuron?

What is its path?

A

Motor neuron connecting the brain (motor cortex) to the spinal cord (at the level of the muscle the next neuron will supply)

33
Q

What is a lower motor neuron?

What is its path?

A

Motor neuron connecting the spinal cord (anterior horn) to the muscle itself

34
Q

How is muscle tone affected in upper motor neuron disease?

A

Muscle tone increases

(Hypertonia)

35
Q

How is muscle tone affected in lower motor neuron disease?

A

Decreased muscle tone

(Hypotonia)

36
Q

What is a consequence of decreased muscle tone in lower motor neuron disease?

A

Atrophy

37
Q

What is a fasciculation?

A

Brief muscle twitch

38
Q

In which type of motor neuron disease are fasciculations seen?

A

Lower motor neuron disease

39
Q

Describe how reflexes change in upper motor neuron disease.

A

Brisk reflexes

i.e hypersensitive reflexes due to impaired descending controls from the UMNs

40
Q

Describe how reflexes change in lower motor neuron disease.

A

Decreased / Absent reflexes

because the reflex arc relies on LMNs, which are damaged

41
Q

What is the plantar reflex?

A

When sole of the foot is stroked, toes should FLEX

42
Q

What is the Babinski reflex?

In which type of motor neuron disease is it found?

A

When sole of foot is stroked, toes EXTEND (abnormal)

Upper motor neuron disease

43
Q

What is clonus?

In which neurological disease is it sometimes seen?

A

Involuntary, rhythmic muscle contractions

Epilepsy (see: juvenile myoclonic epilepsy)

44
Q

Clonus can be a feature of (UMN / LMN) disease.

Which common neurological disease may have clonus as one of its symptoms?

A

UMN disease

Epilepsy (juvenile myoclonic epilepsy)

Neurology Week 4 2018/19 (12 decks)

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