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ENT > Acute Bilateral Leg Weakness **** > Flashcards

Acute Bilateral Leg Weakness **** Flashcards

1
Q

Spinal cord lesion - intrinsic causes

  • Infection
  • Inflammation
  • Metabolic
  • Others - 2
A

EBV, syphilis

Transverse myelitis, MS

B12 deficiency - myelin sheath is damaged

Primary tumour
Spinal stroke

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2
Q

Spinal cord lesion - extrinsic causes - think about what could compress the cord

A

Tumour - local or mets
Haematoma
Abscess
Trauma

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3
Q

Key levels and impairments:

Where is the phrenic nerve and what happens if there is a lesion at or above this?

Above what level are intercostal muscles affected?

A

C3-5

Impaired ventilation

Above T8

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4
Q

Spinal cord compression:

Causes - non-neoplastic

Causes - neoplastic

A

Trauma
Vertebral crush fracture due to osteoporosis
Slipped disc
Infection - epidural abscess, TB

Extradural mets from breasts, lungs etc.
CNS cancer

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5
Q

Spinal cord compression - Presentation

How does it start?
What makes the above worse?

Then Sensory loss - symmetry? where?

Then motor weakness - where?
What happens to the reflexes, tone, sphincter function?

In what patient should alarm bells start ringing if they have back pain or impaired mobility or sensation?

A

Back pain

Lying and coughing

Symmetrical sensory loss - 1-2 dermatomes below lesion

Legs
Hyperreflexia
Hypertonia (spastic paraparesis)
Sphincter dysfunction (hesitancy, frequency and later retention)

Cancer patients - mets

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6
Q

Spinal cord compression - Management

What med is given first? route? how long for?

Imaging - 2 types

Definitive Rx

A

Dexamethasone PO/IV loading dose then daily - reduces oedema therefore reduces pain

MRI whole spine
X-ray in trauma

Neurosurgery or radiotherapy
Chemo

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7
Q

Spinal stenosis:

What is it?

How is it different from other types?

A

An abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots.

Affects both cords and roots

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8
Q

Spinal stenosis - Presentation

Main symptom
What about the legs? - 2
Where is the pain? - 2

When are symptoms worsened and relieved?

A

Neurogenic intermittent claudication

Leg weakness and numbness (motor and sensory)

Back and buttocks

Lumbar lordosis - standing up and arching back

Flexion

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9
Q

Spinal stenosis - Management:

What type of exercises can be done?
Meds - 1 orally and 1 epidurally?

Surgical intervention and in who? Risks of spinal surgery?

A

Bracing and strengthening exercises

NSAID’s
Corticosteroids

Decompression in this with debilitating pain

Nerve damage
Continued pain
Infection
CSF leak

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10
Q

Conus medullaris syndrome:

What presentation do you have - UMN/LMN?

S+S:

  • Onset
  • Bi/unilateral
  • The actual symptoms

What about the reflexes?

What might happen in men?

A

Both - you get a mixed presentation

Sudden onset
Bilateral leg symptoms

Weakness
Perineal numbness
Urinary retention and faecal incontinence
Fasciculations

Hyperreflexic knee but hypo in others

Erectile dysfunction (ED)

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11
Q

Conus medullaris syndrome vs cauda equina syndrome:

  • Which one tends to have less back pain but more radicular (dermatomal) pain?
  • Which one has more ED, with sooner urinary retention?
  • Which one has less fasciculations but more atrophy?
A

Cauda equina syndrome

Conus medullais syndrome

Cauda equina syndrome

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12
Q

Cauda equina syndrome:

Where is the lesion?

Presentation of symptoms:

  • Sudden/gradual
  • bi/unilateral
  • sym/asymmetrical

Where is the numbness - 2
What about bowels and waterworks - 2
Reflexes?

Management - 1

A

Intradural roots and nerves below the spinal cord

Sudden or gradual onset
Bilateral
Asymmetrical leg symptoms

Saddle (upper inner thigh) and perineal numbness

Urinary retention and faecal incontinence

Hyporeflexia

Urgent neurosurgical decompression

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13
Q

Spine and nerve root anatomy:

Grey matter has a butterfly shape.
> What is in the dorsal horns and the ventral horns?

Surrounding white matter:

> What travels in the ascending tracts in the dorsal and external lateral cord?

> What travels in the descending tracts in the ventral and internal lateral cord?

A

D - sensory nuclei
V - motor nuclei

Sensory (afferent) info to the brain

Motor (efferent) info from the brain

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14
Q

Route of Spinal nerve:

What does the dorsal (back) root carry?

What does the ventral (front) root carry?

What does the anterior ramus innervate?

What does the posterior ramus innervate?

Why is it never wrong to scan too high in a suspected spinal cord lesion?

A

Sensory (afferent) information

Motor (efferent) information

Innervates most of the body

Innervates the back

Nerve roots move down alongside the spine before exiting the spinal cord - E.g T12 sensory level is at the level of the ASIS. even though it is far below the thoracic spine.

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15
Q

Radiculopathy:

This is nerve root compression.

Causes:

  • Main causes
  • Another 2 causes are spondylosis and spondylolisthesis?
A

Disc degeneration and herniation
Trauma

Veterbral degeneration

Veterbral displacement

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16
Q

Radiculopathy:

Sensory features:

Pain:
- Character - 4

  • Other sensory symptoms
  • What distribution does it occur in?

Motor features:

  • Where you get weakness?

Are the symptoms bi/unilateral?

A

Sharp
Stabbing
Electrical
Hot

Numbness
Parasthesia

Dermatomal

Weak in a myotome

Unilateral

17
Q

Radiculopathy:

If the lesion compresses the spinal cord, what signs do you get below that level - UMN/LMN?

Where do you get issues with cervical radiculopathy?

A

UMN signs

Neck and upper limb pain symptoms

18
Q

Radiculopathy:

What is classed as a lumbar spine?

What does lumbar radiculopathy cause 90% of..?

Lumbar radiculopathy:

  • Where is the pain? - 2
  • Uni/bi?
  • Where does it radiate to?
  • Other symptoms
  • Reflexes?
  • Why do you get foot drop?
A

L4-S3

Buttock and leg pain

Unilateral

Foot/toes

Numbness and parasthesia

Hyporeflexia

Muscle weakness

19
Q

Radiculopathy:

How should it be managed?

How long does it take to self-resolve?

Do you need imaging? When do you need to do it?

Analgesia:

  • First line
  • Second line
A

Like mechanical back pain:

  • Continue ADLs
  • Patient education
  • Physiotherapy
  • Psychological support

4-6 wks

Simple - para, NSAIDs
Weak opioids or neuropathic (amitriptyline, gabapentin)

20
Q

Radiculopathy:

Refractory sciatica:

What can be done if severe, acute and persists for:
>1-2 wks
>6-8 wks

What should be done for rafractory cervical radiculopathy (>6 wks) or with objective neurological signs

A

Epidural steroid or local anesthetic injections

MRI and spinal cord decompression surgery

MRI and possible epidural injection or surgery

ENT (29 decks)

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