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Neurology > Back and Spine Pathology > Flashcards

Back and Spine Pathology Flashcards

1
Q

Where does the corticospinal tract decussate

A

Medullary level

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2
Q

How does an upper motor neuron lesion present

A

Increased tone
Hyperreflexia
No fasciculation
No marked muscle wasting

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3
Q

How does a lower motor neuron lesion present

A

Decreased tone
Muscle wasting
Fasciculation
Decreased reflexes

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4
Q

What can cause a lower motor neuron lesion

A

Spinal nerve root injury
Nerve root injury
Or injury to a peripheral nerve

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5
Q

Where do the spinothalamic tracts decussate

A

Spinal level

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6
Q

What type of sensation does the spinothalamic tract carry

A

Pain, temperature and crude touch

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7
Q

What type of sensation does the dorsal column carry

A

Fine touch, proprioception and vibration

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8
Q

Where does the dorsal column decussate

A

Medullary level

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9
Q

What can lead to acute cord compression

A

Trauma
Tumours - either haemorrhage or collapse the vertebrae
Infection
Spontaneous haemorrhage

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10
Q

What conditions can lead to chronic cord compression

A

Degenerative diseases like spondylosis
Tumours
RA

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11
Q

How does a cord transection present

A

Complete loss of sensation and motor action below the affected level
Initially go into spinal shock - go very floppy
UMN signs appear later
Loss of vasomotor tone below level of damage if the sympathetic chain is interrupted – leads to hypotension

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12
Q

What is the name for a cord hemi section

A

Brown-Sequard Syndrome

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13
Q

How does Brown-Sequard Syndrome present

A

Lose dorsal column sensation (fine touch) on the same side as injury but lose spinothalamic sensation (pain/temp) for the opposite side

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14
Q

What causes central cord syndrome

A

Hyperflexion or extension injury to already stenotic neck
This pinches the cord and the
blood supply which leads to ischaemia in the central portion

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15
Q

How does central cord syndrome present

A

Predominantly distal upper limb weakness
Very weak hands – strength progressively comes back as you go up the arms

“Cape-like” spinothalamic sensory loss (pain/temp)
Lower limb power and dorsal column sensation preserved

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16
Q

How does chronic cord compression present

A

Very similar to the acute syndromes

UMN signs predominate

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17
Q

What type of trauma commonly leads to cord compression

A

High energy injury - car accidents
Falls from height
Mobile portions of spine like the cervical region are most at risk

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18
Q

Which extradural tumours commonly affect the spine and lead to compression

A

Mets from lung, breast, kidney and prostate
Lymphoma or myeloma
Eat away at the bones of the spine and weaken it
Can present acutely if the vertebrae collapse and suddenly compress the cord

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19
Q

Which intradural tumours commonly affect the spine and lead to compression

A

extramedullary - meningioma or schwannoma

Intramedullary (in cord itself) - astrocytoma or ependymoma

20
Q

How can tumours lead to spinal cord compression

A

Can slowly press on the cord and lead to chronic compression
Can cause acute compression by collapse or haemorrhage
Eat away at the bones leading to a collapse

21
Q

What can cause spinal canal stenosis

A

Formation of osteophytes
Disc bulging or prolapse
Facet joint hypertrophy
Subluxation

22
Q

Which infections commonly cause cord compression

A

Bloodborne staph - occurs after surgery or sepsis
TB
Both are very rare in the UK

23
Q

How do you manage a cord compression

A

Immobilise the patient
Investigate - XR/CT/MRI
Decompress and stabilise - surgery, traction or external fixation

24
Q

What type of imaging is best if you suspect a spine tumour

A

MRI

25
Q

In acute cases what type of imaging is most common

A

CT

26
Q

How does spinal traction work

A

Pulls the spine back into place
Can use a halo with weights
Good for subluxations

27
Q

How do you treat a spinal tumour

A

Depends on the patient and tumour
Usually radiotherapy
Mets are usually a sign that the disease is very far gone so often just palliate with radiotherapy
Benign tumours are often excised

28
Q

How do you treat spinal infection

A

Antimicrobial therapy
Surgical drainage
Stabilisation where required

29
Q

How do you treat a haemorrhage that is causing a cord compression

A

Reverse anticoagulation

Surgical decompression

30
Q

What is considered chronic back pain

A

Lasting over 3 months

31
Q

What is considered sub-acute back pain

A

lasts 6weeks to 3months

32
Q

List some degenerative conditions that can lead to back pain

A 
Disc disease 
Spondylolisthesis 
Spinal stenosis 
Facet joint arthritis 
Scoliosis and other structural issues
33
Q

List some infections that can lead to back pain

A

Discitis
Vertebral osteomyelitis
Epidural abscess
Paraspinal abscess

34
Q

What inflammatory conditions can lead to back pain

A

Sacroiliitis
Ankylosing spondylitis
Rheumatological conditions affecting the spine

35
Q

What conditions can refer pain to the back

A

Aortic dissection
Retroperitoneal disease - pancreatitis
Tumours and abscess
Ovarian disease

36
Q

List some non-organic causes of back pain

A

Psychiatric conditions

Malingering - financial or emotional

37
Q

What other symptoms should you ask about in a back pain history

A 
Weight loss 
Fever 
Symptoms in the neck, arms or legs 
Bladder or bowel problems 
Cold extremities 
Non-healing ulcers
38
Q

What are the red flags for back pain

A 
Acute, rapidly progressive worsening
Constitutional symptoms
History of malignancy/family history
Bladder / bowel
Bilateral pain / weakness
Pain on lying flat
39
Q

How does sciatica present

A 
Pain is worse in the legs 
Sharp and shooting 
Worse on stretching or standing 
Better when lying down or knees are bent 
Painful retention
40
Q

How does spinal stenosis present

A 
Back pain >> leg pain
Brought about by walking
Claudication distance
Chronic bladder/bowel
Gradual bilateral leg weakness
41
Q

How does cauda equina syndrome present

A

Back and/or leg pain
Bilateral sciatica
Bilateral leg weakness
Acute bladder/bowel - including incontinence
Painless urinary retention
Perineal/perianal numbness - saddle anesthesia
Impotence

42
Q

Which drugs can be used for back pain

A

Paracetamol can be effective
Anti-inflammatory for inflammatory conditions
Muscle relaxants
Amitriptyline or gabapentin for nerve pain
Opiates and derivatives good for acute lower pain

43
Q

How can you treat back pain

A 
Surgical stabilisation if necessary 
Keep active - physio and exercise 
Analgesia 
Injections - anaesthetic or steroid 
Proper sitting and lifting advice
44
Q

How do you manage cauda equina

A

Must be sent to A&E immediately for assessment
MUST do a PR
Urgent spine MRI
Surgery within 48 hours

45
Q

Most disc prolapses require surgery - true or false

A

False
Most get better on their own
This is why patient’s are referred for 6 weeks of physio first
If this doesn’t work then they get an MRI and go on the surgical waiting list

46
Q

Why is a disc more likely to prolapse to one side rather than centrally

A

In the centre there is a thicker section of the posterior longitudnal ligament which stops it

Neurology (18 decks)

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