Cord compression

Question 1

Name of the main spinal motor tract

Answer 1

Corticospinal tracts (anterior and lateral)

Question 2

Where does the corticospinal tract decussate?

Answer 2

At the medulla- tract is ipsilateral

Question 3

Signs of upper motor neurone lesion (4)

Answer 3

Increased tone
Muscle wasting not marked
No fasciculation
Hyper-reflexia

Question 4

Signs of lower motor neurone lesion (4)

Answer 4

Decreased tone
Muscle wasting
Fasciculation
Absent or reduced reflexes

Question 5

Name of the sensory pathway carrying information relating to pain, temperature and crude touch

Answer 5

Spinothalamic tracts

Question 6

Where does the spinothalamic tract decussate?

Answer 6

At the spinal level

Question 7

Name of the sensory pathway carrying information relating to proprioception, pressure and light touch

Answer 7

Dorsal column/medial lemniscus

Question 8

Where does the dorsal column decussate?

Answer 8

Medulla

Question 9

Four causes of acute spinal cord compression (4)

Answer 9

Trauma
Tumours (collapse or haemorrhage)
Infection
Haemorrhage

Question 10

Three causes of chronic spinal cord compression (3)

Answer 10

Spondylosis
Tumours
Rheumatoid arthritis

Question 11

Initial signs in acute cord transection

Answer 11

Spinal shock- flaccid arreflexic paralysis

Question 12

Describe the symptoms of Brown-Sequard syndrome (3)

Answer 12

Ipsilateral motor level (UMN weakness)
Ipsilateral dorsal column level (proprioception, pressure, light touch)
Contralateral spinothalamic level (pain, temperature, crude touch)

Question 13

How is sensory loss classically experienced in central cord syndrome?

Answer 13

“Cape-like” spinothalamic sensory loss, with preservation of the dorsal columns

Question 14

What usually causes central cord syndrome?

Answer 14

Hyperflexion or extension injury to an already stenotic neck

Question 15

How does central cord syndrome usually present?

Answer 15

Distal upper limb weakness

Question 16

How is traumatic spinal cord damage treated? (4)

Answer 16

Immobilise
Investigate (imaging)
Methylprednisolone
Decompress and stabilise

Question 17

Commonest cause of cord compression

Answer 17

Secondary malignancy

Question 18

Management of spinal cord compression due to malignancy

Answer 18

Dexamethasone whilst considering further treatment e.g. radio, chemo, surgical decompression

Question 19

What is syringomyelia?

Answer 19

Expansion of the central cord canal due to CSF blockage, causing slowly progressive sensory and motor symptoms

Question 20

Symptoms of syringomyelia

Answer 20

Cape-like distribution of pain/temperature sensation loss
LMN signs in upper limbs
Spastic paraparesis of low limbs

Question 21

What is a malformation commonly underlying syringomyelia?

Answer 21

Chiari malformation- extension of the lower part of the brain into the spinal cord

Question 22

Signs suggestive of a root compression (radiculopathy)

Answer 22

Dermatomal distribution of sensory disturbance (pain/tingling/numbness)
LMN pattern of weakness for muscles innervated by the root

Question 23

Below the level of a compressed root, what signs might there be? (2) What do these suggest?

Answer 23

UMN signs (spastic weakness, hyperreflexia, upgoing plantars)
Sensory level
These suggest cord compression starting below the radiculopathy

Question 24

Lhermitte’s symptom

Answer 24

Neck flexion producing tingling down the spine- suggestive of cervical spondylosis

Question 25

Worrying symptoms in suspected cord compression (3)

Answer 25

Nocturnal pain
Weight loss
Fever

Question 26

What is radiculopathy?

Answer 26

Compression of the nerve root as it leaves the spinal cord