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Y2 Neurology > Disease of Spinal Cord > Flashcards

Disease of Spinal Cord Flashcards

1
Q

what is a myelopathy ?

A

upper motor neuron disorder

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2
Q

what is radicuopathy?

A

lower motor neurone disorder

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3
Q

where abouts is the corticospinal tract in the spinal cord?

A

lateral column

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4
Q

what is myelitis ?

A

inflammation of the upper motor neurones

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5
Q

what is radiculopathy ?

A

disease of the spinal roots

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6
Q

what is Myeloradiculopathy ?

A

when the upper motor neurones and the spinal roots are diseases ?

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7
Q

what are the two main categories of myelopathy and radiculopathy?

A
  1. medical (intrinsic)

2. surgical (extrinsic)

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8
Q

give some examples of medical causes of myelopathy and radiculopathy

A
  1. Inflammation
  2. Infarction
  3. Infiltration
  4. Infection
  5. Degenerative
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9
Q

give some examples of surgical causes of myelopathy and radiculopathy

A
  1. tumour
  2. vascular abnormalities
  3. degenerative
  4. trauma
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10
Q

state some causes of vascular abnormalities which can cause spinal cord and spinal root disorders?

A

haemorrhage
dural fistula
AVM (arteriovenous malformation)

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11
Q

what are some upper motor neurone disease signs ?

A
  1. no wasting
  2. increased tone
  3. increased reflexes
  4. Pyramidal pattern of weakness
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12
Q

what is Pyramidal pattern of weakness?

A

A pattern of weakness in the extensors (upper limbs) or flexors (lower limbs)

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13
Q

what are some lower motor neurone disease signs?

A
  1. decreased tone
  2. decreased reflexes
  3. muscle weakness
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14
Q

what is the pattern of the sensory loss due to radicuopathy?

A

dermatomal pattern

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15
Q

what is brown-Sequard Syndrome?

A

ipsilateral upper motor neuron paralysis and loss of proprioception, as well as contralateral loss of pain and temperature sensation

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16
Q

state some causes of myelopathy ?

A
  1. demyelination
  2. ischaemia
  3. transverse myelitis
  4. neurodegenerative
  5. B12 deficiency
  6. infective
  7. inflammatory
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17
Q

are spinal tracts laminated ?

A

yes

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18
Q

what does it mean that spinal tracts are laminated?

A

that the spinal tracts are in different layers of the different spinal root groups

  • cervical
  • thoracic
  • lumbar
  • sacral
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19
Q

what fibres travel up the spinothalamic tract ?

A

nociception

temperature

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20
Q

what fibres travel up the dorsal columns ?

A

proprioception and vibrations

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21
Q 
What would occur to the
- C5 innervated muscles
- tone
- reflexes
- power
- sensation 
if there was a C5 cord lesion?
A

C5 innervated muscles = wasted

tone = increased in lower limbs

reflexes = decreased in biceps, increased in lower limbs

power = decreased in C5 muscles, pyramidal pattern below

sensation = below C5

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22
Q

is the anterior or posterior part of the spinal cord more affected by strokes?

A

anterior

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23
Q

how many arteries supply the anterior 2/3rds of the spinal cord?

A

one artery

- the anterior spinal artery

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24
Q

how many arteries supply the posterior 1/3rd of the spinal cord?

A

2 arteries

- posterior spinal arteries

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25
Q

why is the anterior of the spinal cord more prone to strokes?

A

because only one artery supplies that area so there is less blood supply compared to the posterior so ischaemia is more likely

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26
Q

what two areas of the spinal cord have high blood supply?

A

the top and bottom of the spinal cord

27
Q

what artery supplies the bottom of the spinal cord ?

A

artery of Adamkiewicz

28
Q

what artery supplies the middle section of the spinal cord?

A

branches of the aorta

29
Q

is a stroke likely at the top of the spinal cord?

A

no

-because there is rich blood supply at the top of the spinal cord

30
Q

where is the most likely area of the spinal cord to have a stroke?

A

middle part anteriorly

31
Q

state some causes of spinal cord ischaemia

A
  • atheromatous disease
  • thromboembolic disease
  • arterial dissection
  • hypotension
  • composition of blood
  • vasculitis
  • venous occlusion
  • depression sickness
32
Q

state some risk factors of spinal cord strokes?

A
  • diet
  • smoking
  • lack of exercise
  • alcohol
  • diabetes
33
Q

does the patient experience pain with a spinal cord stroke ?

A

yes

34
Q

where does a spinal cord stroke patient experience pain?

A

back (radiating) pain

visceral referred pain

35
Q

what is the clinical significance of the referred pain with spinal cord stroke patients ?

A

the referred pain can be misleading for the doctor as the neurological signs don’t come till later

36
Q

what symptoms would a spinal cord stroke patient experience ?

A 
back pain 
weakness 
- paraparesis 
numbness
paraesthesia 
urinary symptoms
37
Q

what is paraparesis ?

A

partial paralysis in lower limbs

38
Q

what are three management options ?

A
  • Supportive
  • Reduce risk of recurrence
  • Physiotherapy for functional recovery
  • Manage risk factors
39
Q

what does the time of recovery depend on ?

A

The degree of parenchymal damage

- more damage = longer recovery time

40
Q

what is the mortality rate for spinal cord strokes?

A

20%

41
Q

what is the most common demyelination myelitis disease?

A

multiple sclerosis

42
Q

what age is MS commonly diagnosed at?

A

young people

>20 yrs

43
Q

what matter does multiple sclerosis affect?

A

white matter in the CNS

44
Q

what causes temporary neuronal dysfunction during multiple sclerosis ?

A

inflammation and demyelination which means conduction isn’t as good

45
Q

what symptoms does MS have?

A

weakness in muscles over a period of a few days

46
Q

what are the two types of MRI scans?

A

T1

T2

47
Q

what is the difference between MRI T1 and T2 scans ?

A

White matter is brighter than grey matter in T1-weighted images

White matter is darker than grey matter in T2-weighted images.

48
Q

what two investigation should be done for MS ?

A

MRI scan

Lumbar scan

49
Q

what drugs can be given to MS to stop the relapse being so bad?

A

methylprednisolone

- steroids

50
Q

what foods do you get B12 from?

A

meat
fish
legumes

51
Q

what does B12 require to be absorbed?

A

intrinsic factor

52
Q

what does pernicious anaemia result in ?

A

B12 deficiency

53
Q

what areas of the brain does a B12 deficiency affect?

A 
peripheral neuropathy 
cerebrum
eyes
brain stem 
cerebellum
54
Q

if there was degeneration of the dorsal column what would the effects be?

A

sensory ataxia

- loss of sensory input of muscle coordination

55
Q

if there was degeneration of the corticospinal tracts what would the effects be?

A

impairment in motor or sensory function of the lower extremities.

56
Q

what are the symptoms of B12 deficiency ?

A

paresthesia in hands and feet
areflexia - absent reflexes
painless retention of urine

57
Q

what is a good way to test for sensory ataxia during neurology examination ?

A

get patient to stand and close their eyes

- they may sway and lose balance due to proprioception not working

58
Q

when would treatment be too late for B12 deficiency ?

A

if the disease affected the spinal cord and not just the peripheral nerves

59
Q

what is a very rare type of demyelination ?

A

transverse myelitis

60
Q

state some causes of transverse myelitis ?

A 
idiopathic 
viral 
infections 
autoimmune 
malignancies 
post vaccinations
61
Q

how would demyelination be described during MS?

A

patchy

62
Q

why is a lumbar puncture used for MS?

A

antibodies showing immune response to inflammation

63
Q

why is lumbar puncture used for sub arachnoid haemorrhage ?

A

blood for subarachnoid bleed would mean there would be blood in the CSF
a lumbar puncture is done 12 hours after the onset of symptoms to give the blood time to breakdown to bilirubin

Y2 Neurology (52 decks)

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