15 Jan 24 Flashcards

(52 cards)

1
Q

Closed spinal dysraphism CF

A

🎯A/S
🎯Cutaneous , lumbosacral anomalies (hair tuft or mass)
🎯tethered cord ;

     Back Pain
     Neurologic:  LMN signs (weakness, hyporeflexia ) below T2/L1 
     Urologic :  incontinence /retention, recurrent UTI 
     Orthopedic:   Back pain, scoliosis, foot deformities
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2
Q

Foot deformities of tethered cord ?

A

Peroneus muscle weakness (pes cavus- high arch)
Tight foot ligaments (hammer toe)

Hammer toe :
Dorsal flexion at DIP joint
Dorsal flexion at MTP
Platar flexion at PIP

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3
Q

Bladder dysfunction types

A

UMN type ;

Cerebral cortex - urge incontinence
Pons (sp cd injury) : neurogenic bladder

LMN type ;

Sacral spinal cord
( cauda equina /tethered cord)
Overflow incontinence

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4
Q

Ttt of spinal dysraphism

A

MRI

Surgical detethering of cord if symptomatic

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5
Q

Spastic diplegia vs tethered cord

A

Common features:
Urinary incontinence
Muscle atrophy
Weakness

Spastic diplegia has UMN features :
Tethered has LMN features

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6
Q

Transverse myelitus CF

A

B/L motor weakness (early flaccid later spastic). LE = UE

BL sensory dysfunction

Distinct sensory level

Autonomic dysfunction (bowel/bladder)

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7
Q

DX of TM

A

MRI. :
No compressive features
T2 hyperintensity

LP:
Pleocytosis
Inc IgG

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8
Q

Syringomyelia causes

A

Chiari type 1
Infection
Neoplasm
Trauma

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9
Q

Syringomyelia CF

A

Loss of pain / temp in a cape distribution
Due to crossing of STT in anterior white commissure.

Continued syrinx expansion encroaches the central aspect of Lateral corticospinal tract (upper extremity fibers caught first)
Hence UL> LL

Affects motor fibers in ventral horns (flaccid paralysis).

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10
Q

Dissociated sensory loss of syringomyelia

A

Loss of pain/temp sensation but not vibratory/proprioceptive (dorsal column spared

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11
Q

Neurogenic shock mechanism

A

Acute spinal cord injury ➡️ massive sympathetic stimulation ➡️ hypertension tachycardia (inc NE)
➡️ sympathetic tone plummets (descending tracts that carry sympathetic neurons to lateral horn are cut )➡️ unopposed parasympathtic stimulation ➡️hypotension hypothermia bradycardia

Lasts 1-5w

Hypothermia is due to lack of peripheral vasoconstriction

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12
Q

Cauda equina syndrome cause

A

Compression of > or equals 2 spinal nerve roots in the lumbar cistern

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13
Q

Cauda equina CF

A

CE carries nerve roots L2- sacrum
L2-L5, S1-S5 , coccygeal nerve

Radicular pain plus > 1 of the following:

MOTOR deficits - LMN signs UL or BL

Sensory loss - saddle anesthesia
(Buttock, perineum , perianal area)

Rectal sphincter , bladder :
Hesitency , dribbling , sexual dysfunction due to S3-S5 compression.

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14
Q

CE management

A

MRI

Surgical decompression in 24-48 hrs.

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15
Q

Conus medullaris CF

A

UMN deficits (L1-L2)
Symmetric
Symmetric perianal numbness

Vs CE
LMN (L2- sacrum)
Asymmetric
Asymmetric saddle numbness

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16
Q

RA cervical myelopathy S/S

A

🛞(early) Neck pain radiating to occiptal region
🛞slowly prog spastric quadriparesis
🛞Painless sensory deficits in hands and feet
🛞Resp dysfunction (vertebral artery compression)

Signs
🛞Protruding anterior arch of atlas
🛞Scoliosis with loss of cervical lordosis
🛞UMN (spastic paresis, hyperreflexia, babinski)
🛞Hoffman sign

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17
Q

RA cervical myelopathy cause

A

Neck extension during intubation results in atlantoaxial subluxation causing cord compression and cervical myelopathy.

Dx MRI

Ttt: Cervical collar
Neurosurgical intervention

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18
Q

Spinal dysraphism

A

Failure of posterior vertebral arch to close
Spinal cord anomalies lipoma ,cyst
Tethered cord

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19
Q

Brown sequard findings

A

IL hemiparesis (LST tract ) at the level if injury and below

IL proprio vib light touch : at and below level

CL pain and temp; LST tract
1-2 levels below injury and below

If injury at cervical levels ;
Horners syndrome

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20
Q

Central cord syndrome cause ;

A

Hyperextension (whiplash) injury in elderly with preexisting cervical spine degenerative changes (cervical spondylosis).
This compresses the spinal cord between hypertrophied ligamentum flavum posteriorly and bulging disc /osteophyte complex anteriorly causing damage to central spinal cord (grey matter)

Deficits same as syringomyelia:

Loss of pain and temp in upper extremity
Disproportionate upper extremity weakness.

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21
Q

Dx of central cord syndrome

A

Cervical myelogram (cord compression)

22
Q

Ttt of central cord syndorme

A

Steroids
Surgery

23
Q

L5 radiculopathy

A

Sensory loss ;
Lateral shin.
Dorsum foot

Weakness
Foot dorsiflexion
Toe extension
Foot eversion (peroneus)

24
Q

S1 radiculopathy

A

Reflex. : Achilles

Sensory: Posterior calf
Sole and lateral foot

Weakness.
Hip extension
Knee flexion

25
Syringomyelia dx and ttt
MRI Surgery (shunt)
26
Cervical radiculopathy dx
MRI
27
Cervical radiculopathy ttt
Myelogram showing conpressive feature s
28
Cervical spondylosis
Radiculopathy : Nerve root compression Myelopathy. : Spinal cord narrowing and compression UMN in lower limbs LMN. In upper limbs Bowel bladder dysfunction
29
Spondylosis
Degenerative condition marked by osteophyte formation in facet and uncovertebral joints causing neural foramina narrowing.
30
Define radiculopathy
➡️Pain radiating to shoulder/arm ➡️Dermatomal sensory /motor/reflex findings ➡️ positive spurling test
31
Facet osteoarthritis
Older patient Pain/stiffness worse with movement Relived with rest Progresses to radiculopathy
32
Cause of myelopathy in older pts
Spondylosis A degenerative spine dx causing canal narrowing with sp cd compression
33
Cervical myeloapthy SS
➡️Gait dysfunction (first) ➡️ extremity weakness and numbness ➡️LMN signs in arms Muscle atrophy, hyporeflexia ➡️ UMn in legs : babinski, hyperreflexia ➡️ dec proprioception /vib/pain
34
Dx of myelopathy
MRI cervical spine CT myelogram
35
Ttt of myelopathy
Non surgical: Immobilization Surgical. : Decompression
36
Thoracid spinal cord ischemia cause
Descending aortic dissection type B
37
Most prone to ischemia area of spinal cord
T10-T12 blood flow is lowest
38
Anterior spinal cord ischemia CF
1. Motor paresis of lower limbs 2. Loss of crude touch , pain (anterior and lateral ST tract 3. Diminished reflexes 4: bladder paresis (urinary retention) Preserved: dorsal coulmn (supplied by posterior spinal artery(vertebral /PICa) Upper extremities intact.
39
Type B dissection ?
Involves aorta distal to subclavian arteries
40
Posterior spinal cord ischemia
Causes by vertebral artery dissection from type A ascending aortic dissection. Causes loss of proprioception vib below the level of lesion and mild weakness.
41
Central cord syndrome CF
Upper extremity manifestations: 🐊 weakness (alpha motor neuron cell bodies in anterior horn cells ) 🐊 pain temp sensory loss (posterior grey column) 🐊 reflex loss (triceps reflex) - (fibers that cross from dorsal to ventral horn) Lower limbs , lateral spinal tracts running to sacrum (bowel bladder) are spared
42
Spinal focal tenderness , low back pain , neurologic deficits , fluid collection affecting multiple adj spinal levels on MRI
Spinal epidural abscess
43
Prehospital management of cervical spinal trauma
🦬Spinal immobilization Cervical collar, lateral head supports, backboard 🦬Careful helmet removal (motorcycle helmet) 🦬Supplemental oxygen
44
ER management of cervical trauma
🚨 orotracheal intubation (unless sig facial trauma present) 🚨in line cervical stabilization suggested unless it interferes with intubation 🚨 CT cervical spine
45
Spinal cord compression SS
🛞Gradually worsening severe back pain 🛞Pain worse with recumbent position at night
46
Spinal cord compression Neurologic features
Early; acute phase Symmetric leg weakness Dec DTRs Flaccid paralysis Late: Dec rectal tone Inc DTR , BL babinski reflex Paralysis Dec sensation Electric shock sensation
47
Cord compression management
🛴Emergency MRI 🛴Emergency surgical consult 🛴IV glucocorticoids (malignancy) 🛴Antibiotics (infection)
48
Cancers that cause Sp Cd compression
Breast Lung Renal Prostate Multiple myeloma Most common thoracic spine 2nd common Lumbar spine
49
Classic signs of cord compression
Pain in recumbency ; distension of epidural venous plexus (Pain due to degenerative dx improves on recumbency)
50
Cervical fracture / trauma Next best step
CT thoracic and lumbar spine The presence of a single vertebral fracture in a pt with blunt trauma is an indication to image the entire spine.
51
Autonomic dysreflexia cause
Complication of Spinal cord injury Noxious stimulus below the site of lesion (bladder distention) leading to sympathetic burst causing high BP , and widespread vspconstriction. Above lesion: severe parasympathetic response causing bradycardia and vasodilation / flushing.
52
Management of autonomic dysreflexia
🚓Remove noxious stimuli Urinary retention Tight fitting clothes 🚑Treat hypertension