B4-5. Cervical Diseases Flashcards
(57 cards)
What are some red flag for disease when a patient presents with neck and/or arm pain?
- prior CA history
- unexplained weight loss
- unvarying symptoms
- sharp, sever, intolerable pain
- fever/chills
- recent bacterial infection
- pain unimproved with months of treatment
- multiple joints involved
- smoker over the age of 50
- recent infection + fever + neck stiffness
- nuchal rigidity
- palpable mass
- horner’s syndrome
What is the triad of Horner’s syndrome?
- ptosis
- meiosis
- anhidrosis
Acute onset of painful Horner’s syndrome with ipsilateral eye, face or neck pain should be treated as what?
should be treated as internal carotid artery dissection until proven otherwise!
What are the most common causes of Horner’s syndrome?
- most are idiopathic
- if they are cause by disease, most common are Tumor, cluster headache, head/nick procedures
What percentage of neck masses in patients > 40 are caused by malignant tumors?
75%
In the absence of overt signs of infection, a lateral neck mass should be considered what?
metastatic squamous cell carcinoma or lymphoma until proven
others.
What are the follow up testing for suspected disease with neck/arm pain?
- radiograph (MRI/CT as needed)
- CRP/ESR
- CBC
- Blood chemistry
What is the typical presentation of a pancoast tumor?
Chronic shoulder pain in a smoker over 50
Describe the pain associated with a pancoast tumor?
- initially occurs in shoulder, medial border of scapula
- may later radiate along ulnar nerve (C8)
- often relentless and unremitting
- supporting elbow can ease tension on shoulder and upper arm
What is a pancoast tumor?
Tumor of the pulmonary apex that can spread to neighboring tissues such as ribs and vertebrae.
What are some neurological signs that may be present with a pancoast tumor?
- ipsilateral Horner’s syndrome
- weak and strophic hand muscles
- absent triceps reflex
- if spinal cord or NR is invaded, will have symptoms of myelopathy/radiculopathy
What are three possible presentations of cervical instability in a patient with RA?
- C1-C2 instability causing subluxation (usually anterior, 50% of RA patients)
- proximal migration of the odontoid (40% of RA patients)
- subaxial instability (very common but rarely occurs alone, only 10-20%)
What is the most common cause of inflammatory arthritis?
RA
What is the estimated prevalence of RA in the general population?
1-2%
Neck pain, suboccipital pain, radiculopathy and myelopathy are common in RA patients. Those without neck pain are typically _______.
Younger (34 years)
Lesser duration of disease (3.5 years)
The degree of cervical involvement in RA patients often correlates with the degree of erosion in what other joints?
Hand a wrist
What are the two blood tests/markers that are usually positive in RA/
- RF
- anti-CCP antibody
Neurological symptoms in RA may include:
- weakness
- gait changes
- paresthesia in hands
- loss of fine dexterity and endurance
- incontinence
- rarely, deficits
How common are neurological symptoms in RA?
Fairly common (5-67%), but neurological deficits are more rare (7-34%)
RA patients, particularly those with Atlanto-axial instability (AAI) can also have what vascular presentation?
Vertebrobasilar artery insufficiency
What are common complaints associated with vertebrobasilar artery insufficiency?
- vertigo
- loss of equilibrium
- visual disturbance
- tinnitus
- dysphagia
NOTE: similar symptomatology can also be caused by mechanical compression of the brainstem
What is Lhermitte sign?
neck motion elicits shock-like sensations through
the torso or into the extremities
What is the most common radiographic finding in RA?
Multiple subluxations
Instability on flexion-extension views of radiograph are indicated by what?
An ADI(atlantodental index) more than 3-4mm in adults and 4mm in children
