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Lucy Knox - Year 1 > 129 - Spinal Cord Compression > Flashcards

129 - Spinal Cord Compression Flashcards

1
Q

What signs might you expect in Brown-Sequard Syndrome at T5 (legs spinal level) - where the L side of the spinal cord is lesioned?

A

Arms fine

R leg motor, reflexes and autonomic fine

R leg pain and soft touch imparied (as this crosses and travels up contralateral side)

Left leg motor weakness/paralysis, abnormal reflexes (brisk as no dampenign down)

L leg pain and temp fine (as already crossed and so spared)

L leg soft touch impaired (as travels up ipsilateral side)

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2
Q

What observations might you expect after an anterior spinal artery infarction (at T5)?

A

Affects decending tracts on both sides - paraplegia

Reflexes abnormal and brisk

Autonomic issues - as travels up middle

But soft touch and proprioception sensation is preserved (as it travels up in dorsal column)

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3
Q

What observations would you expect from a cavity forming in the central canal of the spinal cord (C3-8) (Syringomyelia)?

A

Motor and reflexes probably have no effect if not too expanded

Sensation of pain and temp of the arms at the levels while they are decussating will be affected.

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4
Q

Case:

20 year old, Pain in ribs, clumsy legs -> legs giving way.

Difficulty climbing stairs

develops numbness from the nipples down

Develops constapation

A

Compression of the spinal cord at T3

Sensory level at T4 (nipples)

Cause? Tumour eg. Neurofibroma

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5
Q

Case:

67 year old

Dragging left leg. Can’t use L arm

Numbness L arm

Develops paraesthesia of R hand

Examination - clonnus, wasting hands, spastic gait, positive babinski

A

Cervical spondylotic myolopathy

eg. disk prolapse - pushing on spinal cord

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6
Q

Case:

Progressive weakness L arm and leg

Apathetic and disinterested in hobbies

Headaches

Papilloedema - swelling of eyes

A

Subacute motor cortex tumour

Cortex lesion

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7
Q

Case:

R sided foot drop, difficulty voiding, poor stream

Bilateral sciatica

Pain on straght leg raise

Bilateral loss of ankle reflexes (S1)

Loss of anal tone

Sensory loss over genitalia region

A

Cauda equina!

saddle anaesthesia

URGENT treatment - surgical correction of ?slipped disk in lower spine

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8
Q

Case:

6 months progressive stiffness in both legs

Catches toe on step

Pain down outer arm

4 weeks of consapation and bladder urgency

Absent biceps reflex (C5)

Brisk other reflexes

A

Cervical myelopathy

(spinal cord damage in cervical region)

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9
Q

Case:

3 months increasing difficulty climbing stairs

Pain and tender muscles

Rash over face

Preserved reflexes

No eye weakness

A

Muscle disease! (polymyositis?)

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10
Q

Case:

6 months: progressive weakness in R hand

3 months: choking on food, lost weight

Speech harder to understand

Examination:

UMN - dysarthuric, slow tongue movements, brisk jaw jerk, brisk arm reflexes

LMN - weakness, wasting, fasiculations

A

Motor Neurone Disease

Has both UMN and LMN signs

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11
Q

Case:

2 months: mid-thoracic back pain

Difficulty walking

Weak legs, trips over

Constipated, urgency to wee

Arms, speech, swallowing normal

Examination: CN ok, upper limbs ok

Tenderness on spine T7

Increased tone bilaterally to legs

Weakness in flexors

Ankle clonus, brisk reflexes to leg, positve babinski

Sensory pin prick level to T8, impaired proprioception

A

Spastic paraparysis

Due to myelopathy (spinal cord injury) with a sensory level of T8

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12
Q

Case:

25 year old

Severe lower back pain, radiates down R leg

After picking up bricks

Can’t straighten up, cant pick R foot up properly

Examination:

CN and upper limbs normal

Limited R straight leg raise

Weakness to dorsiflexion (L5)

Sensation reduced over anterior aspect of right calf to foot

Reflexes present

A

Foot drop with radiculopathy

Damage to nerve root

Cause? Slipped disk, fracture, tumour?

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13
Q

Case:

63 yr old

Sudden loss of power in both legs

No pain

Has diabetes and had coronary artery bypass

Examination:

CN normal

Upper limbs normal

Increased tone bilaterally of legs, severe weakness (flexion weaker than extension muscles)

Brisk reflexes, positive babinski

Sensory level to pain at umbilicus

BUT soft touch and proprioception normal

A

Anterior spinal artery infarction

Stroke in the anterior part of spinal cord

Sudden, effects pain and temp but spares proprioception and soft touch

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14
Q

Case:

23 yr old

Emergency admission, fell from horse

on O2, stable from resp point of view

Cant feel arms or legs properly

Hasn’t moved them since accident

Not passed water

Examination:

No sensation below collar

Limbs are flaccid and areflexic

A

Spinal shock - straight after acute trauma of spinal cord they act differently to you would expect (ie. hyperreflexive and spastic)

= Flaccid tetraparesis in spinal shock

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15
Q

Define monoparesis

A

Weakness in 1 limb

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16
Q

Define paraparaesis

A

Weakness in 2 legs

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17
Q

Define hemiparaesis

A

weakness to 1 side

18
Q

Define quadraparaesis

A

Weakenss to all limbs

19
Q

Define Hemiplegia

A

1 side paralysed

20
Q

Define Paraplegia

A

Both legs paralysed

21
Q

What would you call a conditon of the spinal cord?

A

Myelopathy

22
Q

What would you call a condition of the nerve root?

A

Radiculopathy

23
Q

What would you call a condition of the peripheral nerves?

A

Neuropathy

24
Q

What would you call a condition of the muscles?

A

Myopathy

25
Q

What are the key features of UMN damage?

A

Increased tone

Hyper-reflexia

Weakness/paralysis of affected muscles

Positive Babinski

26
Q

What are common causes of UMN damage?

A

Stroke, slipped disk, tumour, MS, infection

27
Q

What are the characteristic features of LMN damage?

A

Weakness/paralysis to the muscle that that nerve innervates

Hyporeflexia

Wasting/atrophy

Fasiculations

28
Q

What are the common causes of LMN damage?

A

Trauma, viral infection, compression

29
Q

What are features of muscle disease?

A

Wasting or hypertrophied

Reflexes preserved

Pain

Proximal weakness

? Rash

30
Q

What are the features of damage to the cortex?

A

Seizures

Dementia

Agnosias (inability to recognise objects)

Apraxias (can’t coordinate movements)

Visual field defects

Dysphagia (difficulty swollowing)

31
Q

What are the featurss of damage to the Brainstem/Cerebellum?

A

CN palsies, dysphagia, dysarthria, vertigo, ataxia, horners syndromes

32
Q

What is a myotactic reflex? Describe its process.

A

Reflex involving one joint

Hit tendon (ie. patella)

Muscle spindles detect stretch

1a Afferent nerve travels into spinal cord

Synapses with efferent alpha motor neurone

This constricts homonymous muscle (Quad - leg kicks out)

Afferent also synapses with an inhibatory interneurone, this inhibits the alpha motor neurone of the heteronymous muscle to ensure it stays relaxed, allowing reflex to occur.

33
Q

What do muscle spindle musculoskeletal receptors do?

A

Detect changes in muscle length

Stretch them - action potential fired

Sit parallel to muscle fibres

34
Q

Describe alpha and gamma coactivation of muscle spindles

A

Ensures that the msucle spindle is always at the right tension to detect changes

Asjusts sensitivity

alpha motor neurone causes muscle contraction

so the spindle is flaccid

Gamma motor neurone contacts the spindle - respiring tension

35
Q

What are golgi tendon organs?

A

Respond to tension in isometric contractions

Act at muscle-tendon junctions

Activated by prolonged stretch, so then inhibits the muscles, relaxation - drops heavy object

protective mechanism

36
Q

What is the biggest descending motor tract?

A

Corticospinal

37
Q

What is the route of the corticospinal tract?

A

Originates in the cortex (various parts)

descends through the internal capsule

Crosses at the pyramids of decussation in the medulla

Decends in a lateral tract in the spinal cord and an anterior/medial tract

38
Q

What ascending tract carries pain and temperature sensation?

A

Spinothalamic

On Anterior side of spinal cord

Enters spinal cord and crosses within a few levels of entering and travels up the contralateral side

39
Q

What tract carried soft touch and proprioception sensation?

A

Dorsal columns

enters spinal cord, travels up on ipsilateral side (same), then crosses in the brainstem/medulla

40
Q

What is the 3rd ascending spinal tract that just carried proprioception?

A

Spinocerebellar tract

Lucy Knox - Year 1 (36 decks)

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