5.4 Syndromes of the spinal cord and PNS

Question 1

What nerves are you testing with 
Biceps jerk 
Brachioradialis 
Triceps 
Finger 
Knee 
Ankle

Answer 1

Biceps jerk C5 (6)
Brachioradialis  C6
Triceps C7
Finger C8
Knee L4
Ankle S1

Question 2

What are upper and lower motor neurons?

Answer 2

Upper = brain and spinal cord 
Lower = nerves, nerve roots and plexus

Question 3

What typically is the difference between UMN and LMN lesions?

Answer 3

UMN: descending inhibition is usually lost so stretch reflexes are overactive
LMN: reflexes will be reduced

Question 4

What are the signs of UMN lesions?

Answer 4

Spastic weakness, increased tone, pyramidal pattern of weakness, increased reflexes, positive babinski and hoffmans, minimal atrophy

Question 5

What are the signs of LMN lesions?

Answer 5

Flaccid weakness, decreaed tone, non pyramidal weakness, negative babinski and hoffmans, marked atrophy, fasiculations

Question 6

What effect does a complete cord lesion have

Answer 6

Everything above fine and below not

Question 7

What effect does a brown-sequard lesion have?

Answer 7

Affects one half of the spinal cord so pain and temperature will be affected on the opposite side to proprioception and motor

Question 8

What effect will a central cord lesion have?

Answer 8

Pain and temperature loss

Question 9

What effect with a posterior cord lesion have?

Answer 9

Loss of proprioception and vibration sense due to damage of the dorsal column pathways

Question 10

What tracts does an anterior lesion affect?

Answer 10

corticospinal and spinothalamic

Question 11

What are the causes of cord compression?

Answer 11

Cervical spondylosis
Thoracic disc prolapse
Tumours
Haematoma and abscesses (rare)

Question 12

What levels does cervical spondylosis commonly occur and why

Answer 12

C4/5 5/6 6/7 due to the increased mobility of the spine at these levels

Question 13

What happens in cervical spondylosis?

Answer 13

The cord gets stretched over the spondylitic bar in extension, this can cause the ligamentum flavum to be buckled in extension

Question 14

What is the presentation of cervical spondylosis

Answer 14

Predominantly motor presentation in legs with motor neuron and sensory signs in the arms

Question 15

When you have cord compression will you have UMN or LMN symptoms?

Answer 15

UMN below the level of the lesion and LMN at the level of the lesion

Question 16

What is cauda equina syndrome?

Answer 16

Where you have dysfunction of most of the descending nerve roots within the lumbar spinal canal (lesion taking these out)

no UMN signs as this is below the spinal cord

Question 17

What are the symptoms of cauda equina syndrome?

Answer 17

Saddle sensory loss 
Distended atonic bladder 
Constipation, decreased anal/rectal tone, fecal incontinence 
Loss of erectile function 
Weakness in sacral mytomes

Question 18

What are the common causes of cauda equina syndrome?

Answer 18

Central lumbar disc prolapse 
Epidural metastases 
Benign tumour 
Neoplastic meningitis 
Trauma

Question 19

What is a radiculopathy?

Answer 19

Nerve root pathology

Question 20

What are the two common causes of radiculopathy?

Answer 20

Compression at the neural exit foramen

Compression of the descending root within the central canal (lumbar > sacral)

Question 21

What are the symptoms of a radiculopathy?

Answer 21

Pain and sensory loss in the dermatome
LMN weakness in affected myotome

Back pain, lumbar/cervical muscle spasm, postural changes, intolerance of head movements

Question 22

How are the nerves named in the spine?

Answer 22

In the neck = named after the vertebrae below

Elsewhere = named after one above

Question 23

If you have an L5 nerve issue which disc is most likely to be involved?

Answer 23

L4/5

Question 24

How do you differentiate a common peroneal and L5 lesion?

Answer 24

Peroneal will spare the tibialis posterior and hamstrings

Question 25

What nerve is affected in carpal tunnel?

Answer 25

Median

Question 26

What is the typical presentation of carpal tunnel?

Answer 26

Parasthesia or hypothesia in the thumb and adjacent 2.5 digits, sparing sensation over the thenar eminence

Question 27

What is the motor loss in carpal tunnel?

Answer 27

LOAF muscles

1,2 lumbricals, opponens pollicus, ABP and FBP

Question 28

What do you get in compression of the ulnar nerve?

Answer 28

Ulna claw - weakness of FDP, all intrinsic muscles apart from median LOAF muscles
- hyperextension at MCP joints and flexion at DIP and PIP on ulna side of hand

Sensory: loss in lateral 1.5 digits and adjacent palm

Question 29

What nerve is affected in wrist drop?

Answer 29

Radial