Cord Disease

Question 1

What are the symptoms of cord compression?

Answer 1

Pain- localised, deep or radicular
Weakness- LMN at level, UMN below level
Sensory level
Sphincter disturbance

Question 2

What are the causes of cord compression?

Answer 2

Trauma- vertebral fracture
Infection- epidural abscess, TB
Malignancy- breast, thyroid, bronchus, kidney, prostate
Disc prolapse- above L1/2

Question 3

How do you manage cord compression?

Answer 3

Emergency- mx depends on cause
Malignancy: IV dexamethasone, consider chemo, radio and decompressive laminectomy
Abscess: abx and surgical decompression

Question 4

How do cauda equina lesions present?

Answer 4

Pain- back pain, radicular pain down legs
Weakness- Bilateral flaccid, areflexic lower limb weakness
Sensation- Saddle anaesthesia
Sphincters- incontinence, urinary/faecal retention, poor anal tone

Question 5

What are the causes of cauda equina lesions?

Answer 5

Trauma- vertebral fracture
Malignacy- breast, thyroid, bronchus, kidney, prostate
Infection- epidural abscess, TB
Disc prolapse

Question 6

How would you manage cauda equina lesions?

Answer 6

Emergency. Depends on cause
Malignancy: IV dexamethasone, consider chemo, radio and decompressive laminectomy
Abscess: Abx and surgical decompression

Question 7

What is the cause of Anterior Spinal Artery Syndrome (AKA Beck’s Syndrome)?

Answer 7

Infarction of spinal cord in distribution of anterior spinal artery- anterior 2/3rds of cord

Question 8

What are the causes of Anterior Spinal Artery Syndrome (AKA Beck’s Syndrome)?

Answer 8

Aortic aneurysm dissection or repair

Question 9

What are the symptoms of Anterior Spinal Artery Syndrome (AKA Beck’s Syndrome)?

Answer 9

Para/quadri-paresis
Impaired pain and temperature sensation
Preserved touch and proprioception

Question 10

What is a syrinx?

Answer 10

A tubular cavity in the central canal of the cord

Question 11

What are the symptoms of syringomyelia

Answer 11

May come on suddenly after e.g. coughing, sneezing (increased pressure –> extension)

Sensory symptoms: loss of pain and temperature usually in a “cape” distribution, preserved touch, proprioception and vibration.

Wasting and weakness of hands ± claw hand

Loss of upper limb reflexes

Charcot joints: Shoulder and elbow

Question 12

What are the causes of syringomyelia?

Answer 12

Blocked CSF: Due to Arnold-Chiari malformation (cerebellum) or masses
Spina bifida
Secondary to spinal cord trauma, myelitis, tumours and AVMs

Question 13

How would you ix syringomyelia?

Answer 13

MRI spine

Question 14

How would you manage syringomyelia?

Answer 14

Surgery- decompression at foramen magnum for Arnold-Chiari malformation