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Neurology > 15 Jan 24 > Flashcards

15 Jan 24 Flashcards

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
Q

Syringomyelia dx and ttt

A

MRI

Surgery (shunt)

26
Q

Cervical radiculopathy dx

A

MRI

27
Q

Cervical radiculopathy ttt

A

Myelogram showing conpressive feature s

28
Q

Cervical spondylosis

A

Radiculopathy :
Nerve root compression

Myelopathy. : Spinal cord narrowing and compression

   UMN in lower limbs 
   LMN. In upper limbs 
   Bowel bladder dysfunction
29
Q

Spondylosis

A

Degenerative condition marked by osteophyte formation in facet and uncovertebral joints causing neural foramina narrowing.

30
Q

Define radiculopathy

A

➡️Pain radiating to shoulder/arm
➡️Dermatomal sensory /motor/reflex findings
➡️ positive spurling test

31
Q

Facet osteoarthritis

A

Older patient
Pain/stiffness worse with movement
Relived with rest
Progresses to radiculopathy

32
Q

Cause of myelopathy in older pts

A

Spondylosis
A degenerative spine dx causing canal narrowing with sp cd compression

33
Q

Cervical myeloapthy SS

A

➡️Gait dysfunction (first)
➡️ extremity weakness and numbness
➡️LMN signs in arms
Muscle atrophy, hyporeflexia
➡️ UMn in legs : babinski, hyperreflexia
➡️ dec proprioception /vib/pain

34
Q

Dx of myelopathy

A

MRI cervical spine
CT myelogram

35
Q

Ttt of myelopathy

A

Non surgical: Immobilization
Surgical. : Decompression

36
Q

Thoracid spinal cord ischemia cause

A

Descending aortic dissection type B

37
Q

Most prone to ischemia area of spinal cord

A

T10-T12 blood flow is lowest

38
Q

Anterior spinal cord ischemia CF

A
  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
Q

Type B dissection ?

A

Involves aorta distal to subclavian arteries

40
Q

Posterior spinal cord ischemia

A

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
Q

Central cord syndrome CF

A

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
Q

Spinal focal tenderness , low back pain , neurologic deficits , fluid collection affecting multiple adj spinal levels on MRI

A

Spinal epidural abscess

43
Q

Prehospital management of cervical spinal trauma

A

🦬Spinal immobilization

     Cervical collar, lateral head supports, backboard

🦬Careful helmet removal (motorcycle helmet)

🦬Supplemental oxygen

44
Q

ER management of cervical trauma

A

🚨 orotracheal intubation (unless sig facial trauma present)
🚨in line cervical stabilization suggested unless it interferes with intubation
🚨 CT cervical spine

45
Q

Spinal cord compression SS

A

🛞Gradually worsening severe back pain
🛞Pain worse with recumbent position at night

46
Q

Spinal cord compression Neurologic features

A

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
Q

Cord compression management

A

🛴Emergency MRI
🛴Emergency surgical consult
🛴IV glucocorticoids (malignancy)
🛴Antibiotics (infection)

48
Q

Cancers that cause Sp Cd compression

A

Breast
Lung
Renal
Prostate
Multiple myeloma

Most common thoracic spine
2nd common
Lumbar spine

49
Q

Classic signs of cord compression

A

Pain in recumbency ; distension of epidural venous plexus

(Pain due to degenerative dx improves on recumbency)

50
Q

Cervical fracture / trauma
Next best step

A

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
Q

Autonomic dysreflexia cause

A

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
Q

Management of autonomic dysreflexia

A

🚓Remove noxious stimuli
Urinary retention
Tight fitting clothes

🚑Treat hypertension

Neurology (19 decks)

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