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Nervous System > Diseases of Spinal Cord and Nerve Roots (Surgical) > Flashcards

Diseases of Spinal Cord and Nerve Roots (Surgical) Flashcards

1
Q

Features of upper motor neurone lesions

A

Muscle weakness – pyramidal weakness in the extensors of upper limbs or flexors of lower limbs
Decreased control of active movement
Spasticity
Clasp-knife response
Babinski sign – big toe extended rather than flexed on stimulation of sole of foot
Increased deep tendon reflex
Pronator drift

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2
Q

Features of lower motor neurone lesions

A

Muscle paresis/paralysis
Fibrillations
Fasciculations – caused by increased receptor concentration on muscles to compensate for lack of innervation
Hypotonia/atonia
Hyporeflexia
Strength not affected – weakness limited to segmental or focal pattern
Muscle wasting in end-stage

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3
Q

Upper motor features of spinal cord compression

A 
Weakness 
Increased tone 
Increased reflexes 
Upgoing plantar repsonse 
Clonus
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4
Q

Lower motor features of peripheral nerve root compression

A 
Wasting of muscle 
Fasciculation 
Weakness 
Decreased tone 
Decreased reflexes 
Plantar response decreased or absent
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5
Q

What is myelopathy?

A

Non-specific description of a pathology in the spinal cord

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6
Q

What is myelitis?

A

Inflammatory pathology in the spinal cord

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7
Q

Medical causes of myelopathy/myelitis

A 
Demyelination 
Ischaemic 
Transverse myelitis 
Metabolic e.g. B12 deficiency 
Neurodegenerative 
Malignancy/infiltration 
Infective 
Inflammatory
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8
Q

Surgical causes of myelopathy/myelitis

A

Degenerative
Tumour
Vascular abnormality
Trauma

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9
Q

What is radiculopathy?

A

Pathology in the nerve rood

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10
Q

What is radiculitis?

A

Nerve root inflammation

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11
Q

Causes of spinal cord ishchaemia

A 
Atheromatous disease 
Thromboembolic disease 
Arterial dissection 
Systemic hypotension 
Thrombotic haematological disease 
Hyperviscosity syndromes 
Vasculitis 
Venous occlusion 
Endovascular procedures
Decompression sickness 
Meningovascular syphilis
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12
Q

Presentation of spinal cord stroke

A 
Sudden or progressive onset 
Back/radicular pain 
Visceral referred pain 
Weakness - paraparesis 
Numbness and parasthesia 
Urinary retention 
Bladder and bowel incontinence
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13
Q

Spinal stroke treatment

A 
Supportive 
Reduce risk of recurrence 
Occupational therapy 
Physiotherapy 
Manage vascular risk factors
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14
Q

What is spondylosis?

A

Degenerative changes in the spine e.g. degenerative intervertebral disc disease
Can occur in cervical, thoracic or lumbar spine

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15
Q

Causes of spondylosis

A

Ageing

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16
Q

Investigation of spondylosis

A

X-rays
MRI
CT

17
Q

Treatment of spondylosis

A 
Chronic condition 
Surgical treatment controversial 
Spinal decompression surgery 
Physical therapy and analgesia 
Steroids
18
Q

Presentation of prolapsed intervertebral disc

A

Numbness, tingling, weakness
Pain in shoulder, neck, arm, hand
Pain down the back of each leg from the bottom to the knee
Pain with movement, straining and coughing
Difficulty controlling bladder and bowel

19
Q

Investigations of prolapsed disc

A 
History 
Examination 
X-ray 
CT
MRI
20
Q

Treatment of prolapsed disc

A 
Rest/limited activity 
Ice/cold packs, then heat packs 
Physical therapy 
Exercise 
Anti-inflammatories 
Steroids 
Gabapentin
21
Q

Spinal tumour presentation

A 
Dependent on site 
Back pain, sometimes radiating to other parts of the body 
Loss of sensation 
Difficulty walking 
Decreased sensitivity 
Loss of bladder/bowel function 
Muscle weakness
22
Q

Risk factors for spinal tumour

A

Neurofibromatosis type 2
Von Hippel-Lindau disease
PMH of cancer

23
Q

Investigations for spinal tumour

A

Spinal MRI
CT
Biopsy

24
Q

Treatment of spinal tumour

A 
Remove tumour completely, if possible 
Monitoring 
Surgery 
Radiation therapy 
Stereotactic radiosurgery 
Chemotherapy 
Corticosteroids
25
Q

Cause of osteomyelitis

A

Most commonly staphylococcus aureus

Chronic conditions e.g. diabetes may increase risk

26
Q

Risk factors for osteomyelitis

A 
Diabetes 
Sickle cell disease 
HIV/AIDS
Rheumatoid arthritis 
IV drug abus 
Alcoholism 
Long-term use of steroids 
Haemodialysis 
Poor blood supply 
Recent injury 
Bone surgery
27
Q

Symptoms of osteomyelitis

A 
Fever, irritability, fatigue 
Nausea 
Tenderness, redness and warmth in area of infection 
Swelling around the affected bone 
Loss of range of motion 
Severe back pain if in the vertebrae
28
Q

Treatment of osteomyelitis

A

X-ray, bloods, MRI, bone biopsy
Antibiotics
Surgery
Combination therapy

29
Q

Causes of epidural abscess

A

Direct extension of local infection e.g. vertebral osteomyelitis, psoas abscess
Haematogenous seeding
Invasive procedures/instrumentation

30
Q

Risk factors for epidural abscess

A 
Diabetes mellitus 
Spinal trauma 
Surgery 
IV drug abuse 
Alcoholism 
Renal insufficiency 
Immunosuppression 
Pregnancy 
Spinal/epidural anaesthesia or injection
31
Q

Presentation of spinal abscess

A 
Localised spinal pain 
Radicular pain 
Parasthesia 
Muscle weakness 
Sensory loss 
Sphincter dysfunction 
Paralysis 
Back strain/mild injury
32
Q

Symptoms of spinal abscess

A 
Fever
Localised back pain 
Radiculopathy with radiating/lancinating pain 
Chest/abdominal pain 
Spinal cord syndromes 
Central cord syndrome 
Paraparesis 
Paraplegia 
Sphincter dysfunction 
Headache and neck pain
33
Q

Treatment of spinal abscess

A

Surgical decompression and drainage
Antibiotics
CT-directed needle aspiration

34
Q

Causes of Cauda Equina syndrome

A

Herniation of spinal disc into lumbar area pressing on the nerves
Stenosis of spinal canal
Spinal lesion/tumour
Spinal inflammation, infection, haemorrhage or fracture
Complication from severe lumbar spine injury
Birth defect

35
Q

Symptoms of cauda equina syndrome

A

Severe lower back pain
Pain, numbness, weakness in one/both legs – causes stumbling, difficulty getting up from a chair
Loss of/altered sensations in legs, bottom, inner thighs, back of legs or feet – severe and worsening (saddle anaesthesia)
Loss of bladder/bowel control
Sexual dysfunction – come on suddenly

36
Q

Investigations for cauda equina syndrome

A

Full history and examination
MRI
Myelogram
CT

37
Q

Treatment of cauda equina syndrome

A

Relieve pressure on nerves
Surgery within 48 hours
Corticosteroids
Antibiotics if infection present

Nervous System (44 decks)

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