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NEURO > Disease of spinal cord and nerve root > Flashcards

Disease of spinal cord and nerve root Flashcards

1
Q

What is damage to the upper motor neurone

A

damage to the brainstem, spinal cord - myelopathy/myelitis

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2
Q

what is damage to the lower motor neurone

A

damage to the nerve root - radiculopathy/radiculitis

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3
Q

what are motor signs in upper motor neuron lesions

A

No wasting
↑tone
↑reflexes
Pyramidal pattern of weakness

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4
Q

what is seen in a pyramidal pattern of weakness

A

weakness in the extensors of the upper limb or flexors of the lower limb

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5
Q

what are the motor signs of lower motor neuron lesions

A

↓tone
↓reflexes, flexor plantar
weakness

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6
Q

what are the sensory signs of UMN lesions

A

myelopathy at the sensory level

hemicord lesion = brown squared syndrome

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7
Q

what is seen in brown-sequard syndrome

A 
ipsilateral:
↓ vibration 
↓ joint position sense
Weakness
(because they cross above the lesion)

contralateral:
↓ pain
↓ temperature
(because they cross below th lesion)

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8
Q

what are the sensory signs of LMN lesions

A

radiculopathy - dermatomal sensory loss

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9
Q

what is an autonomic sign of cord/root pathology

A

bladder/bowel problems

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10
Q

EXAMPLE: what would the signs be for a C5 cord lesion

A

wasting of C5 innervated muscles

↑ tone in LL>UL

reflexes ↓biceps, ↑all lower reflexes

power ↓C5 innervated muscles, pyramidal pattern below

sensory level

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11
Q

what are the groups of causes of myelopathy or radiculopathy

A

intrinsic or extrinsic

can be medical or surgical

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12
Q

what are some surgical causes of myelopathy or radiculopathy

A

tumour
- extradural, intradural/extramedullary, intramedullary

vascular abnormalities

  • haemorrhage
  • AVM, dural fistula

degenerative (spine)

trauma

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13
Q

what are the medical causes of myelopathy

A

Inflammation

vascular - ischaemic vs haemorrhage

infective

metabolic

malignant/infiltrative

congenital/genetic

idiopathic

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14
Q

give examples of inflammatory causes of myelopathy

A

demyelination (MS)

autoimmune (antibody mediated eg aquporin 4, lupus)

sarcoid

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15
Q

give some examples of infective causes of myelopathy

A

Viral: herpes simplex/zoster, EBV, CMV, measles, HIV etc

Bacterial: TB, borrelia (Lyme), syphilis, brucella

Other: schistosomiasis

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16
Q

what is a metabolic cause of myelopathy

A

B12 deficiency

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17
Q

give examples of congenital/genetic causes of myelopathy

A

friedrichs ataxia

spinocerebellar ataxias

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18
Q

what are ischameic myelopathy

A

spinal stroke/infarction

19
Q

what can cause spinal cord ischaemia

A

Atheromatous disease (aortic aneurysm)

Thromboembolic disease (endocarditis, AF)

Arterial dissection (aortic)

Systemic hypotension

Thrombotic haematological disease

Hyperviscosity syndromes

Vasculitis

Venous occlusion

Endovascular procedures

Decompression sickness

Meningovascular syphilis

20
Q

how may a spinal cord stroke present

A

vascular risk factors

onset - sudden or over several hours

pain

  • back pain/radicular
  • visceral referred pain

weakness

numbness and paraesthesia

urinary symtoms - retention followed by bladder and bowel incontinence as spinal shock settles

21
Q

what kind of weakness is seen in spinal cord stroke and why

A

usually paraparesis (lower limbs affected) rather than quadraparesis

due to vulnerability of thoracic cord to flow related ischamia

22
Q

what artery is usually occluded in spinal cord stroke

A

anterior spinal artery

very rarely posterior spinal artery - dorsal columns spared

23
Q

what can occlusion of the central soulful artery cause

A

partial brown-sequard syndrome

24
Q

at what level does spinal cord stroke usually occur

A

mid thoracic

25
Q

what might you also have for a while in spinal cord stroke

A

spinal shock

26
Q

what investigation can be done for spinal cord stroke

A

MRI

27
Q

what is the treatment for spinal cord stroke

A

reduce risk of recurrence

  • maintain adequate BP
  • reverse hypovolaemia/arrhythmia
  • antiplatelet therapy

OT and physio

manage vascular risk factors

28
Q

what does the returns of function after spinal cord stroke depend on

A

degree of parenchymal damage

29
Q

what is the prognosis for spinal cord stroke

A

unless significant motor recovery in first 24 hrs - chance of major recovery low

pain may be persistent and significantly contribute to disability

only 30-40% have more than minimal recovery

30
Q

what is the mortality rate for spinal cord stroke

A

20%

31
Q

what is demyelinating myelitis

A

usually part of MS

common cause of medical spinal cord disease

can affect the young

32
Q

what characterises demyelinating myelitis

A

pathological lesions leading to inflammation and demyelination - this leads to temporary neuronal dysfunction

affects the white matter of the CNS

one or more lesions anywhere

33
Q

how does myelitis present in MS

A

partial or incomplete myelitis
transverse or complete myelitis

can be the initial presentation of MS

subacute onset (slower than ischaemia)

may have a chronic progressive myelopathy - secondary or primary

may be a history of previous neurological or ophthalmological episodes

34
Q

what investigations can be done for MS

A

MRI - spinal cord, brain

lumbar puncture - examine CSF

35
Q

what is the treatment for MS

A

supportive

methylprednisolone

36
Q

where is vitamin B12 found in the diet

A

meat, fish, animal by-productsm, legumes

37
Q

what is need for absorption of B12

A

absorption from the gut needs INTRINSIC FACTOR

- binding protein secreted by gastric parietal cells

38
Q

what is pernicious anaemia

A

autoimmune condition in which antibodies to IF prevent B12 absorption

39
Q

what can pernicious anaemia complicate

A

total gastrectomy, crohns, tape worms

40
Q

what parts of the nervous system can B12 deficiency affect

A

most of it

can cause myelopathy 
peripheral neuropathy
brain
eye/optic nerve
brainstem
cerebellum
41
Q

what symptoms can B12 deficiency myelopathy cause

A

paraesthesia of hands and feet

areflexia

first UMN sign - extensor plantars

paraplegia (degeneration of corticospinal tract)

sensory ataxia (degeneration of dorsal columns)

painless retention of urine

42
Q

what investigations can be done for B12 deficiency myelopathy

A

FBC, blood film, B12

43
Q

what is the treatment for B12 deficiency myelopathy

A

intramuscular B12 (the quick the better)

NEURO (51 decks)

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