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Neuro > Diseases of Spinal Cord > Flashcards

Diseases of Spinal Cord Flashcards

1
Q

Motor signs of cord/root pathology

A

UMN - no wasting, increased tone, increased reflexes, extensor plantar. Pyramidal pattern of weakness

LMN (root) - reduced tone, absent reflexes, flexor platar, weakness

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2
Q

Sensory signs of cord pathology

A

Myelopathy - sensory level
Hemicord lesion - Brown Sequard syndrome
- ipsilateral; reduced vibration, reduced joint position sense, weakness
- contralateral - reduced pain, reduced temperature

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3
Q

Sensory signs of root pathology

A

Radiculopathy –> dermatomal sensory loss

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4
Q

Autonomic signs of cord/root pathology

A

Bladder/bowel involvement

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5
Q

Signs of C5 cord lesion

A 
Wasting of C5 innervated muscle
Increased tone in legs more than arms
Reduced reflexes in biceps, increased all lower reflexes
Power reduced in C5 innervated muscles
Pyramidal pattern below
Sensory level
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6
Q

Extrinsic Causes of myelopathy or radiculopathy

A

Surgical

  • Tumour: extradural, intradural, extramedullary, intramedullary
  • Vascular abnormlities - haemorrhage, AVVM, dural fistula
  • Degenerative
  • Trauma
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7
Q

Intrinsic causes of myelopathy or radiculopathy

A

Congenital/genetic
- Friedrich’s ataxia, spinocerebellar ataxias, hereditary paraparesis

Acquired
-Inflammation - Demyelination;MS, Autoimmune (Ab mediated), Sarcoid
Vascular - Ischaemic v Haemorrhage
-Infective - Viral; Herpes, EBV, CMV, measles, HIV
- Bacterial; TB, borrelia, syphylis, brucella
- Other; schistosomiasis
-Metabolic - B12 deficiency
-Malignant/infiltrative
Idiopathic

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8
Q

Causes of spinal cord ischaemia

A 
Atheromatous disease
Thromboembolic disease
Arterial dissection
Systemic hypotension
Thrombotic haematological disease
Hyperviscosity syndromes
Vasculitis
Venous occlusion
Endovascular procedures
Decompression sickenss
Meningovascular syphylis
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9
Q

Spinal cord stroke - presentaion

A

Vascular risk factors
Onset may be sudden or several hours
Pain - back pain/radicular, visceral referred pain
Weakness - usually paraparesis than quadriparesis (vulnerability of thoracic cord to flow-related ischaemia)
Numbness and paraesthesia
Urinary symptoms - Retnetion followed by bladder and bowel incontinence as aspinal shock settles

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10
Q

Spinal cord stroke on examination

A

Usually anterior, rarely posterior spinal artery - dorsal columns spared
Occlusion of central sulcal artery - partial Brown Sequard
Mid thoracic
May be spinal shock

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11
Q

Treatment of spinal cord stroke

A 
Maintain adequate BP
Reverse hypovolaemia/arrhythmia
Antiplatelet therapy
OT and physio
Manage vascular risk factors
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12
Q

Prognosis for spinal cord stroke

A

Return of function depends on parenchymal damage
Chance of major recovery low if motor recovery poor within first 24 hours
Pain may be persistent and contribute to disability
20% mortality

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13
Q

Demyelinating myelitis affects which part of the CNS?

A

White matter

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14
Q

What is required for B12 absorption from the gut?

A

Intrinsic factor- secreted by gut parietal cells

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15
Q

How is B12 absorption prevented in pernicious anaemia?

A

Autoimmune - antibodies to intrinsic factor

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16
Q

How does B12 deficiency affect the nervous system?

A 
Myelopathy - L'hermitte's
Peripheral neuropathy
Brain
Eye/optic nerve
Brainstem
Cerebellum
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17
Q

Signs of B12 deficient myelopathy

A

Paraesthesia of hands and feet, areflexia
Extensor plantars
Degen of corticospinal tract - paraplegia
Degen of dorsal columns - sensory ataxia
Painless retention of urine

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18
Q

Invesitgation of B12 deficient myelopathy

A

FBC, blood film, B12

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19
Q

Treatment for B12 deficient myelopathy

A

Intramuscular B12

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20
Q

Vertebra, number in each region

A 
Cervical - 7
Thoracic - 12
Lumbar - 5
Sacral -3
Coccyx-4
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21
Q

Spinal cord extends from which spinal levels

A

C1 to L2

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22
Q

Spinal cord progresses to…

A

Conus medularis

Cauda equina

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23
Q

What is the transition point between UMN and LMN

A

Anterior horn

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24
Q

C5 innervates…

A

Elbow flexors

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25
Q

C6 innervates

A

Wrist extensors

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26
Q

C7 innervates

A

Elbow extensors

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27
Q

C8 innervates

A

Finger extensors

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28
Q

T1 innervates

A

Intrinsic hand muscles

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29
Q

L2 innervates

A

Hip flexors

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30
Q

L3 innervates

A

Knee extensors

31
Q

L4 innervates

A

Anke dorsiflexors

32
Q

L5 myotome

A

Long toe extensors

33
Q

S1 myotome

A

Ankle plantar flexors

34
Q

Signs of C5 spinal cord lesion

A 
Weakness in shoulder and below
Sensory level at C5
Increased tone in legs
Brisk reflexes
Babinski positive

Myelopathy - UMN - neurological deficit due to compression of spinal cord

35
Q

L4 Nerve root lesion sign

A

Pain down ipsilateral leg
Numbness in L4 dermatome
Weakness in abkle dorsiflexion
Reduced knee jerk

Radiculopathy - compression of nerve root leading to dermatomal and myotomal deficits

36
Q

5 Causes of surgical spine

A 
Degenerative
Tumour
Infection
Trauma
Congenital
37
Q

History for surgical spine

A

Pain
Onset - speed
PMH

38
Q

Investigation for surgical spine

A

Blood
Xray
CT
MRI

39
Q

What is a disc prolapse?

A

Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord

40
Q

Onset of pain in disc prolapse

A

Acute

41
Q

Group of patients disc prolapse is common in

A

Younger

42
Q

Central cervical disc prolapse causes which condition

A

Cervial myelopathy

43
Q

Lateral cervical disc prolapse causes which condition

A

Cervical radiculopathy

44
Q

Central lumbar disc prolapse causes which condition

A

Cauda equina syndrome

45
Q

Lateral lumbar disc prolapse causes which condition

A

Lumbar radiculopathy

46
Q

Is disc prolapse common in thoracic spine?

A

No

less mobile

47
Q

Symptoms of disc prolapse

A

Acute pain down leg/arm

Numbness and weakness in distribution of nerve involved

48
Q

Investigation of disc prolapse

A

MRI

49
Q

Treatment of disc prolapse

A

Rehabilitation
Nerve root injection
Lumbar/cervical discectomy

50
Q

Red flags for Cauda Equina Syndrome

A

Bilateral Sciatica
Saddle anaesthesia
Urinary dysfunction

51
Q

Investigation Cauda Equina

A

Emergency MRI

52
Q

Treatment Cauda Equina

A

Emergency lumbar discectomy

53
Q

3 causes of degenerative spinal issues

A

Disc prolapse
Ligamentum hypertrophy
Osteophyte formation

54
Q

2 conditions of degenerative changes in spine

A

Cervical spondylosis

Lumbar spinal stenosis

55
Q

Presentation of cervical spondylosis

A

Can present with myelopathy or radiculopathy or both

Speed of onset varies months to years

56
Q

Management of cervical spondylosis

A

Conservative if no/mild myelopathy

Surgery if progressive

57
Q

Presentation of lumbar spinal stenosis

A

Pain down both legs - spinal claudication

Worse on walking/standing - relieve by sitting or bending forwards

58
Q

Management of lumbar spinal stenosis

A

Lumbar laminectomy

59
Q

3 types of spinal tumours

A

Extradural
Intradural
Intramedullary

60
Q

Examples of extradural spinal tumours

A 
Metastases (breast, lung, prostate)
Primary bone (chondroma, osteroblastoma)
61
Q

Examples of intradural spinal tumours

A

Meningioma, Neurofibroma, Lipoma

62
Q

Examples of intramedullary spina tumour

A

Astrocytoma
Ependymoma
Teratoma
Haemangioblastoma

63
Q

Malignant cord compression symptoms

A

Pain
Weakness
Sphincter disturbance

64
Q

Investigation of malignant cord compression

A

Urgent MRI

- known cancer and develops back pain

65
Q

Management of malignant cord compression

A

Cord decompression and radiotherapy

66
Q

Two conditions arising from spinal infection

A

Epidural abscess

Osteomyelitis

67
Q

Triad for urgent MRI

A

Back pain
Pyrexia
Focal neurology

68
Q

Risk factors for Epidural abscess

A

IVDU
diabetes
Chronic renal failure
Alcoholism

69
Q

Organisms common to epidural abscess

A

S.aureus
Streptococci
E.coli

70
Q

Treatment for epidural abscess

A

Urgent surgical decompression

Long term IV antibiotics

71
Q

Risk factors for Osteomyelitis

A 
IV drug abuse
Diabetes
Chronic renal failure
Alcoholism
AIDS
72
Q

Management of osteomyelitis

A

Antibiotics

Surgery if evidence of neurology

73
Q

Contraindications to CT

A

Minor head trauma

Seizure

74
Q

Contraindications to MRI

A 
Cardiac pacemaker, cochlear implants
Metallic implants - aneurysm clip, heart valve
Claustrophobia
Pregnancy
Tattoos

Neuro (9 decks)

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