Disease of spinal cord and nerve root Flashcards by J Murray

What is damage to the upper motor neurone

damage to the brainstem, spinal cord - myelopathy/myelitis

How well did you know this?

Not at all

Perfectly

what is damage to the lower motor neurone

damage to the nerve root - radiculopathy/radiculitis

How well did you know this?

Not at all

Perfectly

what are motor signs in upper motor neuron lesions

No wasting
↑tone
↑reflexes
Pyramidal pattern of weakness

How well did you know this?

Not at all

Perfectly

what is seen in a pyramidal pattern of weakness

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

How well did you know this?

Not at all

Perfectly

what are the motor signs of lower motor neuron lesions

↓tone
↓reflexes, flexor plantar
weakness

How well did you know this?

Not at all

Perfectly

what are the sensory signs of UMN lesions

myelopathy at the sensory level

hemicord lesion = brown squared syndrome

How well did you know this?

Not at all

Perfectly

what is seen in brown-sequard syndrome

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

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

How well did you know this?

Not at all

Perfectly

what are the sensory signs of LMN lesions

radiculopathy - dermatomal sensory loss

How well did you know this?

Not at all

Perfectly

what is an autonomic sign of cord/root pathology

bladder/bowel problems

How well did you know this?

Not at all

Perfectly

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

wasting of C5 innervated muscles

↑ tone in LL>UL

reflexes ↓biceps, ↑all lower reflexes

power ↓C5 innervated muscles, pyramidal pattern below

sensory level

How well did you know this?

Not at all

Perfectly

what are the groups of causes of myelopathy or radiculopathy

intrinsic or extrinsic

can be medical or surgical

How well did you know this?

Not at all

Perfectly

what are some surgical causes of myelopathy or radiculopathy

tumour
- extradural, intradural/extramedullary, intramedullary

vascular abnormalities

haemorrhage
AVM, dural fistula

degenerative (spine)

trauma

How well did you know this?

Not at all

Perfectly

what are the medical causes of myelopathy

Inflammation

vascular - ischaemic vs haemorrhage

infective

metabolic

malignant/infiltrative

congenital/genetic

idiopathic

How well did you know this?

Not at all

Perfectly

give examples of inflammatory causes of myelopathy

demyelination (MS)

autoimmune (antibody mediated eg aquporin 4, lupus)

sarcoid

How well did you know this?

Not at all

Perfectly

give some examples of infective causes of myelopathy

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

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

Other: schistosomiasis

How well did you know this?

Not at all

Perfectly

what is a metabolic cause of myelopathy

B12 deficiency

How well did you know this?

Not at all

Perfectly

give examples of congenital/genetic causes of myelopathy

friedrichs ataxia

spinocerebellar ataxias

How well did you know this?

Not at all

Perfectly

what are ischameic myelopathy

spinal stroke/infarction

what can cause spinal cord ischaemia

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

how may a spinal cord stroke present

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

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

usually paraparesis (lower limbs affected) rather than quadraparesis

due to vulnerability of thoracic cord to flow related ischamia

what artery is usually occluded in spinal cord stroke

anterior spinal artery

very rarely posterior spinal artery - dorsal columns spared

what can occlusion of the central soulful artery cause

partial brown-sequard syndrome

at what level does spinal cord stroke usually occur

mid thoracic

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

spinal shock

what investigation can be done for spinal cord stroke

MRI

what is the treatment for spinal cord stroke

reduce risk of recurrence - maintain adequate BP - reverse hypovolaemia/arrhythmia - antiplatelet therapy OT and physio manage vascular risk factors

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

degree of parenchymal damage

what is the prognosis for spinal cord stroke

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

what is the mortality rate for spinal cord stroke

20%

what is demyelinating myelitis

usually part of MS common cause of medical spinal cord disease can affect the young

what characterises demyelinating myelitis

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

how does myelitis present in MS

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

what investigations can be done for MS

MRI - spinal cord, brain lumbar puncture - examine CSF

what is the treatment for MS

supportive methylprednisolone

where is vitamin B12 found in the diet

meat, fish, animal by-productsm, legumes

what is need for absorption of B12

absorption from the gut needs INTRINSIC FACTOR | - binding protein secreted by gastric parietal cells

what is pernicious anaemia

autoimmune condition in which antibodies to IF prevent B12 absorption

what can pernicious anaemia complicate

total gastrectomy, crohns, tape worms

what parts of the nervous system can B12 deficiency affect

most of it ``` can cause myelopathy peripheral neuropathy brain eye/optic nerve brainstem cerebellum ```

what symptoms can B12 deficiency myelopathy cause

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

what investigations can be done for B12 deficiency myelopathy

FBC, blood film, B12

what is the treatment for B12 deficiency myelopathy

intramuscular B12 (the quick the better)