Cord disease

Question 1

Features of cord compression

Answer 1

Pain: local and deep or radicular
Weakness: LMN (root) - at level, UMN - below level
Sensory level
Sphincter disturbance

Question 2

Causes of cord compression

Answer 2

Trauma: vertebral #
Infection: epidural abscess, TB
Malignancy: breast, thyroid, bronchus, kidney, prostate
Disc prolapse: above L1/2 (below this - cauda equine syndrome)

Question 3

Investigations for cord compression

Answer 3

MRI is definitive modality

CXR for primaries

Question 4

Treatment of cord compression

Answer 4

This is a neurosurgical emergency
Malignancy: dexamethasone IV, consider chemo, radiation, and decompressive laminectomy.
Abscess: antibiotics and surgical decompression.

Question 5

Features of cauda equina lesions

Answer 5

Pain: back pain, radicular pain down legs.
Weakness: bilateral flaccid, areflexic lower limb weakness.
Sensation: saddle anaesthesia.
Sphincters: incontinence or retention of faeces and urine, poor anal tone.

Question 6

Causes of cauda equina lesions

Answer 6

Same as for cord compression.
Trauma: vertebral #
Infection: epidural abscess, TB
Malignancy: breast, thyroid, bronchus, kidney, prostate
Disc prolapse: below L1/2 (above this - cord compression)

Question 7

Treatment of cauda equina lesions

Answer 7

Same as for cord compression.
Neurosurgical emergency.
Malignancy: dexamethasone IV, consider chemo, radiation, and decompressive laminectomy.
Abscess: antibiotics and surgical decompression.

Question 8

Lesion in Anterior Spinal Artery Syndrome AKA Beck’s Syndrome

Answer 8

Infarction of spinal cord in distribution of anterior spinal artery: ventral two-thirds of spinal cord.

Question 9

Causes of Anterior Spinal Artery syndrome

Answer 9

Aortic aneurysm dissection or repair

Question 10

Features of Anterior Spinal Artery syndrome

Answer 10

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

Question 11

Pathophysiology of syringomyelia

Answer 11

A cyst forms within the central canal of the cord (syrinx), commonly located in the cervical cord. Symptoms may be static for years but then rapidly worsen, e.g. on coughing, sneezing as pressure causes extension of syrinx. Syrinx expands ventrally affecting: decussating spinothalamic neurones, anterior horn cells, and corticospinal tracts.

Question 12

Causes of syringomyelia

Answer 12

1. Blocked CSF circulation, with reduced flow from posterior fossa: Arnold-Chiari malformation (cerebellum herniates through foramen magnum), SOL.
2. Spina bifida.
3. Secondary to trauma, myelitis, cord tumours, AVMs.

Question 13

Cardinal signs of syringomyelia

Answer 13

1. Dissociated sensory loss: loss of pain and temperature (scars from burns), but preserved touch, proprioception and vibration. Root distribution reflects syrinx location - usually upper limbs and chest (“cape”).
2. Wasting/weakness of hands ± Claw hand.
3. Loss of reflexes in upper limb.
4. Charcot joints in shoulder and elbow.

Question 14

Investigations for syringomyelia

Answer 14

MRI spine

Question 15

Surgery for syringomyelia

Answer 15

Decompression at the foramen magnum for Arnold-Chiari malformation

Question 16

Geographical distribution of HTLV-1

Answer 16

Prevalent in Japan and Caribbean

Question 17

Features of HTLV-1 infection

Answer 17

Adult T cell leukaemia/lymphoma
Tropical spastic paraplegia AKA HTLV myelopathy:
Slowly progressing spastic paraplegia, sensory loss and parasthesia, bladder dysfunction