Acute limb and back problems

Question 1

Causes of intracranial haemorrhages

Answer 1

• Hypertension
• Illicit drug use (cocaine, amphetamines)
• Trauma
• Vascular malformations
• Coagulopathies

Question 2

Major cause of subarachnoid haemorrhage is…

Answer 2

Rupture of arterial aneursym

Question 3

Late sign of cauda equina

Answer 3

Urinary incontinence

Question 4

Features of cauda equina

Answer 4

Lower back pain/ sciatica

Leg/ perianal weakness/ altered sensation

Urinary/ bowel: retention, incontinence

Reduced anal tone

Question 5

Causes of cauda equina

Answer 5

Herniation
- Disc

Tumour

Vertebral fracture

Infection (abscess, discitis)

Question 6

Red flags for back pain

Answer 6

Leg weakness/ sensory disturbance (cord compression)

Brisk/ flaccid reflexes (spinal cord compression)

Background of cancer (metastasis)

Central back pain relieved by laying (spinal fracture)

Cauda equina: loss of anal tone, saddle anaesthesia, fecal incontinence

Fever, weight loss, night sweats (malignancy)

Immunosuppression (Infection risk)

Leg claudication (stenosis)

Question 7

Indications for urgent MRI spine in back pain

Answer 7

Cauda equina/ cord compression features (neurological signs)

Indications of malignancy (i.e. raised ALP, calcium)

Suspicion of cervical spine injury

Question 8

Describe canadian c-spine rule

Answer 8

Helps to decide if imaging is needed for suspected spinal injury in traumatic cases.
- Not used in children

Imaging indicated if high risk
- >65
- Dangerous mechanism
- Paraesthesia of extremities

Indicated if low risk + cannot rotate head 45 degrees right AND left.