Diseases of spinal cord and nerve roots

Question 1

Where is every UMN nuclei found?

Answer 1

precentral gyrus

Question 2

What can hemicord lesions lead to?

Answer 2

loss on ipsilateral side of vibration, joint position sense and weakness
on opposite side loss of temperature and pain

Question 3

Autonomic signs of cord pathology

Answer 3

bladder retention leading to kidney failure and constipation

Question 4

Surgical causes of myelopathy

Answer 4

trauma, vascular abnormalities, trauma, degenerative

Question 5

Inflammatory causes of myelopathy

Answer 5

demyelination - MS
autoimmune - lupus
systemic - sarcoidosis

Question 6

Infective causes of myelopathy

Answer 6

viral = HIV, bacterial = TB, other

Question 7

Other causes of myelopathy

Answer 7

malignant, congenital, idiopathic

Question 8

Vascular causes of myelopathy

Answer 8

ischaemic or haemorrhagic

Question 9

What vitamin deficiency can lead to myelopathy?

Answer 9

B12

Question 10

Main arterial blood supply to spinal cord?

Answer 10

anterior and posterior spinal arteries

Question 11

Causes of ischaemic myelopathy

Answer 11

thromboembolism, dissected aneurysm, atheroma, vasculitis

Question 12

Clinical presentation of ischaemic myelopathy

Answer 12

variable onset
pain - back, intercostals, referred visceral
vascular risk factors
weak, numb, incontinence, paraesthesia

Question 13

What is paraesthesia?

Answer 13

numb/tingling sensation

Question 14

What artery is mostly affected in ischaemic myelopathy?

Answer 14

anterior spinal

Question 15

Investigations and treatment of ischaemic myelopathy

Answer 15

MRI

manage risk factors, blood pressure, antiplatelets etc

Question 16

Prognosis of ischaemic myelopathy

Answer 16

depends on parenchymal damage
first 24 hours motor recovery gives indication
20% die

Question 17

What food is B12 found in?

Answer 17

meat, fish, animal products, legumes

Question 18

What conditions can affect B12 absorption?

Answer 18

gastrectomy, crohns

Question 19

Where is intrinsic factor produced?

Answer 19

parietal cells in stomach

Question 20

What does B12 - pernicious anaemia - affect?

Answer 20

nervous system eg brain, eyes, optic nerve, cerebellum, brain stem

Question 21

B12 deficiency symptoms

Answer 21

paraesthesia in hands and feet, extensor plantar, urine retention which is painless, paraplegia

Question 22

Investigation and treatment of B12 deficiency

Answer 22

FBC, B12

intramuscular B12 injection ASAP

Question 23

Investigation of MS

Answer 23

CSF - oligoclonal bands in lumbar puncture

Question 24

Does MS affect white or grey matter?

Answer 24

white

Question 25

Treatment of MS

Answer 25

supportive, steroids