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Neurology > Diseases of Spinal Cord/Nerve Roots (Surgical) > Flashcards

Diseases of Spinal Cord/Nerve Roots (Surgical) Flashcards

1
Q

What are the specific upper and lower motor neuron signs?

A

UMN:

  • Hypereflexia
  • Spastic Weakness
  • Increased Tone
  • Babinski’s sign (Plantar extension)
  • Clonus

LMN:

  • Hyporeflexia
  • Weakness
  • Fasciculations
  • Decreased Tone
  • Atrophy
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2
Q

If someone has the following symptoms where is the lesion?

  • Weakness in elbow & below
  • Sensory level at C6
  • Increased tone in legs
  • Brisk reflexes
  • Babinski & Hoffmans +ve
  • Clonus
A

Lesion in the spinal cord at C6

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3
Q

If someone has the following symptoms where is the lesion?

  • Pain in right leg
  • Numbess in the right L4 dermatome
  • Weakness in right ankle dorsiflexion
  • Reduced right Knee Jerk Reflex
A

Radiculopathy at L4

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4
Q

What conditions are in this deck?

A
  • Cauda Equina Syndrome
  • Herniated Disc
  • Spinal Cord Tumours
  • Degenerative (Cervical Spondylosis & Lumbar spinal stenosis)
  • Spinal Infections (Osteomyelitis, Discitis & Epidural abscess)
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5
Q

What is a herniated disc?

A

The nucleus pulposes of the disc herniates out through the annulos fibrosus medially (compressing the cord) or laterally (compressing the nerve roots)

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6
Q

How do we manage a herniated disc?

A

Conservatively with analgesia and rehabilitation

Or invasively with anaesthetic nerve root injection or a discectomy

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7
Q

What would a centrally herniated lumbar disc cause?

A

Cauda equina syndrome

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8
Q

How do we diagnose cauda equina syndrome?

A

By its specific clinical presentation AND radiology

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9
Q

Whats the typical presentation of Cauda Equina Syndrome?

A
  • Bilateral Sciatica
  • Saddle Anaesthesia (No feeling in their but)
  • Urinary Dysfunction (Retention, incontinence or altered urge)
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10
Q

How do we manage Cauda Equina Syndrome?

A

Since its due to a prolapsed disc:

- Emergency Lumbar Discectomy

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11
Q

What age get prolapsed discs vs degerenative disorders?

A

Prolapsed discs affect young males most and are acute onset

Degenerative spinal disorders generally affect the elderly and are slow onset

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12
Q

How does a degenerative spinal disorder develop?

A

Through osteophyte formation
Ligament hypertrophy
Disc Prolapse

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13
Q

What are the two main types of degenerative spinal disorders?

A

Cervical Spondylosis:
Degenerative changes in the cervical spinal cord leading to cord/nerve root compression

Lumbar spinal stenosis:
Stenosis leading to compression of the spinal cord/cauda equina

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14
Q

How does lumbar spinal stenosis present?

A

Pain down both legs which worsens when walking/standing (spinal Claudication)
Its relieved when sitting/bending forward as it opens up the spine

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15
Q

How do we treat cervical spondylosis?

A

A radiculopathy can be managed conservatively or with elective surgery

A progressive or severe myelopathy requires urgent surgery

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16
Q

How do we manages Lumbar spinal stenosis?

A

Lumbar laminectomy

Cuts open the lamina of the vertebrae to open up the column reducing the effects of stenosis

17
Q

What types of tumour commonly metastasise to the spinal cord?

A

Lung breast and prostate

18
Q

What are the types of spinal cord tumour?

A

Extradural (primary and metastatic)

Intradural (meningioma, lipoma & neurofibroma)

Intramedullary (Astrocytoma, ependymoma, teratoma & haemangioblastoma)

19
Q

How do you spot a malignant cord compression?

A

Back pain (particularly thoracic), weakness and sphincter disturbance

Should look out for these things in anyone with lung, breast or prostate cancer.

20
Q

How do approach a malignant cord compression?

A

If you spot the symptoms and you know they have cancer do an urgent MRI

Then surgical decompression and radiotherapy

21
Q

What are the risk factors for spinal cord infections?

A
  • IV drug abuse
  • Diabetes
  • chronic renal failure
  • Alcoholism
  • AIDs (osteomyelitis)
22
Q

How do we manage osteomyelitis

A

Its an infection in the vertebral body so antibiotics

If its causing neuro symptoms then surgical intervention

23
Q

How would an epidural abscess present?

A
  • Back pain from compression of the cord
  • Focal neuro symptoms
  • Pyrexia
24
Q

What organisms cause epidural abscesses?

A

Staph aureus
Streptococcus
E. Coli

25
Q

How do manage an epidural abscess?

A

Emergency MRI when someone presents with that combo of symptoms

Urgent surgical decompression and long-term IV Abx

Neurology (50 decks)

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