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Neurology > 2(E): Spinal Cord Disease > Flashcards

2(E): Spinal Cord Disease Flashcards

1
Q

What does degenerative disc disease refer to

A

Group of disorders including:

  • Disc protrusion
  • Disc herniation
  • Disc sequestration
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2
Q

What is disc protrusion

A

Where nucleus pulpous presses on annulus fibrosis

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3
Q

What is disc prolapse (herniation)

A

Tear in annulus fibrosis leading to protrusion nucleus pulposus that can compress spinal nerve

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4
Q

What is disc sequestration

A

Extrusion nucleus pulposus and seperation fragment, that enters spinal canal, may compress spinal cord

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5
Q

What age group does IV disc prolapse most commonly occur

A

30-50

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6
Q

In which gender does IV disc prolapse occur

A

Male

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7
Q

What are the most common sites of disc prolapse

A

L5/S1

L4/L5

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8
Q

What is classical history of disc prolapse

A

Individual strains back (eg. lifting) then has back pain which is worse on coughing, sneezing, lifting

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9
Q

Describe pain in IV Disc prolapse

A

Lumbago - electric shock type pain

Sciatica - bilateral shooting pain down the legs

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10
Q

Explain sensory and motor symptoms in IV Disc Prolapse

A

Pareasthesia of the nerve root affected (Nerve root affected tends to be one under disc that has prolapsed)

Muscle weakness
Loss deep tendon reflexes

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11
Q

What worsens pain in disc prolapse

A

Coughing

Sneezing

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12
Q

What improves pain in disc prolapse

A

Short walks

Change in position

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13
Q

What deficit will be present in L4-L5 disc prolapse

A

L5 radioculopathy

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14
Q

What sensation is impaired in L4-L5 disc prolapse

A

Dorsum Foot

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15
Q

What movement is lost in L4-L5 disc prolapse

A

Toe Extension

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16
Q

What test is positive in L5 radiculopathy

A

Sciatic stretch test

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17
Q

What sensation is impaired in L5-S1 disc prolapse

A

Dorsum Foot

Back of calf

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18
Q

What motor deficits are there in L5-S1 prolapse

A

Calf-pain

Weak plantar flexion

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19
Q

What test is positive in S1 radiculopathy

A

Sciatic stretch test

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20
Q

What investigaiton is ordered for possible disc prolapse

A

MRI Spine

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21
Q

If caudal equine present in disc prolapse what is done

A

Refer to neurosurgery

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22
Q

If no cauda equina in IV disc prolapse, what is done

A
  • Analgesia
  • Rest, Early Mobilisation
  • Physiotherapy
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23
Q

What is cauda equina syndrome

A

Compression cauda equina

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24
Q

What spinal level does the cauda equina start

A

L1-L2

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25
Q

Give 5 causes of cauda equina syndrome

A
  • Disc Prolapse
  • Traumatic
  • Malignancy
  • Infection (Pott’s Disease, Discitis)
  • Ankylosing spondylitis (Due to chronic inflammation)
  • Iatrogenic
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26
Q

What are three groups of cauda equina

A
  1. cauda equina syndrome with retention (CESR)
  2. cauda equina syndrome incomplete (CESI)
  3. cauda equina syndrome suspected (CESS)
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27
Q

How does cauda equina syndrome with retention (CESR) present

A
  • Back pain
  • LL weakness
  • Bilateral loss reflexes
  • Saddle anaesthesia
  • Loss anal tone
  • Loss badder control
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28
Q

Incomplete How does cauda equina syndrome

A

Same as CESR, except there is altered urinary sensation - opposed to loss of bladder control. This can cause painful then painless retention

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29
Q

How does cauda equina syndrome suspected present

A
  • Back pain
  • LL pain
  • Variable neurological symptoms
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30
Q

Will cauda equina present with UMN or LMN signs and symptoms

A

LMN

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31
Q

What are symptoms of cauda equina

A
  • Back pain
  • Bilateral sciatica
  • LL weakness
  • LL parasthesia
  • Saddle anaesthesia
  • Impotence
  • Bowel and bladder dysfunction
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32
Q

What are signs of cauda equina

A
  • Loss anal tone
  • Urinary retention: palpable bladder
  • Hypo-reflexia
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33
Q

What examination is required in cauda equina

A

PR Exam: assess anal tone

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34
Q

What imaging is ordered in cauda equina

A

Bladder USS

Whole-spine MRI (Gold-standard)

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35
Q

How is cauda equina managed

A

Neurosurgical review:

Dexamethasone
Spinal decompression

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36
Q

What is spinal cord compression

A

Compression of spinal cord

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37
Q

What is the most common cause of spinal cord compression

A

Metastatic spinal cord compression

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38
Q

What cancers cause metastatic spinal cord compression

A

BLTKETCHUP

Breast
Lung
Thyroid
Kidney
Prostate
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39
Q

Aside from metastatic spinal cord compression, what else can cause spinal cord compression

A
  • Infection (abscess)
  • Traumatic - vertebral fracture, facet joint dislocation
  • Neoplastic - myeloma
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40
Q

Why is disc herniation a rare cause of spinal cord compression

A

As disc herniation typically occurs in lumbar region which causes cauda equina, opposed to spinal cord compression

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41
Q

In general, what increases risk of spinal cord compression

A

Factors that cause stenosis of the spinal canal - these can be degenerative or inflammatory

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42
Q

What inflammatory conditions predispose to spinal cord compression

A

RA, Ankylosing spondylitis

43
Q

What degenerative conditions predispose to spinal cord stenosis

A

Osteophyte (OA)

Ligamentum Flavum Hypertrophy

44
Q

Is spinal cord compression UMN or LMN lesion and explain why

A

LMN at the level of the lesion - due to compression of anterior horn cells

UMN below the lesion - due to compression of descending corticospinal tract

45
Q

What is often first stage of spinal cord compression

A

Back pain

46
Q

When is back pain worse in spinal cord compression

A

Coughing
Sneezing
Lying Down

47
Q

Explain sensation and proprioception

A

Sensation and proprioception impaired

48
Q

Explain reflexes at level of the lesion

A

Hypo-reflexia

49
Q

Explain reflexes at levels below the lesion

A

Hyper-reflexia

50
Q

What other features will be present in spinal cord compression

A

Myoclonus

Upgoing babinski reflex

51
Q

What are late symptoms of spinal cord compression

A

Autonomic symptoms: bowel or urinary incontinence/retention = carry a poor prognosis

52
Q

How is spinal cord injury divided

A

Complete SCI

Incomplete SCI

53
Q

Define complete SCI

A

No preservation of sensory motor function more than 3 nerve roots below level of the lesion

54
Q

Why is it defined as 3 nerve roots below the lesion?

A

Less than 3 nerve roots could indicate nerve root pathology

55
Q

Define incomplete SCI

A

Residual motor or sensory function in more than 3 nerve roots below the lesion

56
Q

What is often spared in incomplete SCI

A

Sacral sparing

57
Q

Give 5 examples of incomplete SCI

A
  • Anterior Cord Syndrome
  • Posterior Cord Syndrome
  • Brown-Sequard Syndrome
  • Central cord Syndrome
  • Cauda Equina
58
Q

Who classified spinal cord injury

A

American Spinal Injury Association (AISA)

59
Q

What did AISA classify spinal cord injury into

A

A-E

60
Q

What is AISA Grade A

A

Complete SCI

61
Q

What is AISA Grade B

A

Incomplete:

Sensory, but not motor, is preserved

62
Q

What is AISA Grade C

A

Incomplete Injury:

>50% Muscles are MRC <3

63
Q

What is AISA Grade D

A

Incomplete Injury:

>50% Muscles are MRC >3

64
Q

What is AISA Grade E

A

Normal: Motor and Sensory function are normal

65
Q

What is the most common incomplete SCI

A

Central cord syndrome

66
Q

What mechanism of injury causes central cord syndrome

A

Hyperextension in presence of osteophytes (OA)

67
Q

Why is central cord syndrome more prevalent

A

Centre of the spinal cord is a watershed area - and is more susceptible to oedema

68
Q

What are symptoms of central cord syndrome

A
  • Cape-like sensory loss of pain and temperature

- Arm weakness > Leg weakness

69
Q

Why does weakness occur in arms over legs in central cord syndrome

A

As coricospical tract is organised so region representing arms is more medial to that of legs

70
Q

What causes anterior cord syndrome

A

Infarct anterior spinal artery (ASA)

71
Q

Where does anterior spinal artery arise from

A

Vertebral artery

72
Q

What typically causes anterior cord syndrome

A

Herniated disc

73
Q

What sensory loss is present in anterior cord syndrome

A

Loss of pain and temperature

74
Q

Why are proprioception, vibration and fine touch in tact in anterior cord syndrome

A

As these are transmitted by dorsal column pathway which are located in posterior cord. Spinothalamic pathway travels in anterior cord

75
Q

What motor deficit is present in anterior cord syndrome

A

Paraplegia. Unless above C7 - then quadriplegia

76
Q

What is prognosis of anterior cord syndrome

A

Poor prognosis. Only 10-20% recover motor function

77
Q

What is Brown-Sequard syndrome

A

Lateral compression of spinal cord

78
Q

What are ipsilateral symptoms in brown sequard syndrome and why does it happen

A
  • Loss vibration, proprioception, fine touch
  • Ipsilateral paralysis

= Due to damage to corticospinal tract and DCP which have already decussated in the medulla

79
Q

What are contralateral symptoms in brown sequard syndrome and why does it happen

A

Loss pain, temperature and crude touch = due to damage to spinothalamic tract that decussates at the spinal cord

80
Q

Why is light touch preserved in brown-sequard

A

As transmitted via anterior spinothalamic tract

81
Q

What is posterior cord syndrome also called

A

Contusion Cervicalis Posterior

82
Q

What causes contusion cervicalis posterior

A

Infarct PCA

83
Q

Where does PCA arise

A

Posterior inferior cerebellar artery (PICA)

84
Q

How does posterior cord syndrome present

A
  • Loss sensation and burning in neck, upper arms and torso

- Mild paresis of the upper limbs

85
Q

What is first-line if suspecting spinal cord compression

A

MRI Spine

86
Q

How is spinal cord compression managed

A

Urgent referral neurosurgery:

  • Dexamethasone
  • Decompressive laminectomy
87
Q

When is decompressive laminectomy used

A

Disease at single spinal level

88
Q

What is radiotherapy used

A

Disease at multiple levels (Malignancy)

89
Q

What is the best prognostic indicator for SCC

A

Mobility status

90
Q

What is a complication of complete spinal cord compression

A

Spinal shock

91
Q

What causes spinal shock

A

Disruption sympathetic innervation

92
Q

How does spinal shock present

A
  • Hypotension. Hypothermia
  • Quadraplegia
  • Respiratory Inusfficiency
  • Anaesthesia below the level
93
Q

How can spinal cord lesions be divided in terms of presentation

A
  1. Motor
  2. Motor and Sensory
  3. Sensory
94
Q

What are two purely motor spinal cord lesions

A
  • MND

- Poliomyelitis

95
Q

How does ALS (MND) present

A

Combination UMN and LMN signs

96
Q

How does poliomyelitis present and why

A

LMN signs - due to disrupting anterior horn cells

97
Q

What 3 conditions cause motor and sensory disruption spine

A
  • Friedrichs ataxia
  • Syringomyelia
  • Subacute combined degeneration spinal cord
98
Q

What causes subacute combined degeneration of the spinal cord

A

Vitamin B12 deficiency

99
Q

How does subacute combined degeneration of spinal cord present

A

CST: bilateral paraparesis

DCP: bilateral loss vibration and proprioception

SCT: bilateral ataxia and tremor

100
Q

What is syringomyelia

A

Collection CSF in spinal cord

101
Q

How does syringomyelia present

A
  • Cape like loss pain and temperature (due to spinothalamic tracts crossing being first affected)
  • Preservation proprioception, fine touch
  • Spastic weakness upper limbs
102
Q

What is syringomyelia associated with

A

Chiari malformato

103
Q

What is a purely sensory condition of spinal cord

A

Tabes dorsalis (Syphillis)

Neurology (26 decks)

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