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Neurology > Diseases of the Spinal Cord > Flashcards

Diseases of the Spinal Cord Flashcards

1
Q

What are the different parts of the spinal column?

A
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2
Q

How many vertebrae are there for each part of the spinal column?

A
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3
Q

Where does the spinal cord terminate in adults and children?

A

Adults - L2

Children - L3

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4
Q

Compare and contrast the following signs for UMN lesions and LMN lesions:

  • weakness
  • atrophy
  • reflexes
  • tone
  • fasciculations
  • babinki
A
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5
Q

What are fasciculations?

A

Involuntary muscle contraction and relaxation which may be visible under the skin

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6
Q

How do you localise a lesion?

A
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7
Q

How are dermatomes distributed?

A
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8
Q

What is a myotome?

A

Group of muscles that a single spinal nerve innervates

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9
Q

What is the myotome of C5, C6, C7, C8 and T1?

A
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10
Q

What is the myotome of L2, L3, L4, L5 and S1?

A
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11
Q

What is the clinical presentation of a C5 spinal cord lesion?

A
  • Weakness in shoulder and below
  • Sensory level at C5
  • Increased tone in legs
  • Brisk reflexes
  • Babinski (one of the normal reflexes in infants, firmly stroke sole of foot and big toe moves upwards and other toes fan out) positive, should not happen in people over 2

This is myelopathy (UMN), which is a neurological deficit due to compression of the spinal cord

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12
Q

What is the clinical presentation of L4 nerve root lesion?

A

Signs and symptoms:

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

This is radiculopathy (LMN), which is compression of nerve root leading to dermatomal and myotomal deficits

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13
Q

What is radioculopathy?

A

Compression of nerve root leading to dermatomal and myotomal deficits

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14
Q

What is myelopathy?

A

Neurological deficit due to compression of the spinal cord

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15
Q

Is myelopathy UMN or LMN?

A

UMN

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16
Q

Is radioculopathy UMN or LMN?

A

LMN

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17
Q

What are the different types of spinal diseases?

A
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18
Q

What is a disc prolapse?

A

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

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19
Q

If a disc prolapse occurs centrally does it cause myelopathy or radiculopathy?

A

Myelopathy

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20
Q

If a disc prolapse occurs lateral does it cause myelopathy or radiculopathy?

A

Radiculopathy

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21
Q

What is the clinical presentation of disc prolapse?

A
  • Acute pain down leg/arm
  • Numbness and weakness in distribution of nerve root involved
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22
Q

What investigation is done for disc prolapse?

A

MRI

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23
Q

What is the management of a disc prolapse?

A
  • Rehabilitation
  • Nerve root injection
  • Lumbar/cervical discectomy
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24
Q

What red-flages for cauda equina syndrome?

A
  • Bilateral sciatica (pain in buttocks or legs caused by sciatic nerve becoming compressed)
  • Saddle anaesthesia (loss of sensation restricted to the area of the buttocks)
  • Urinary dysfunction
25
Q

What is bilateral sciatica?

A

Pain in buttocks or legs caused by sciatic nerve becoming compressed

26
Q

What is saddle anaesthesia?

A

Loss of sensation restricted to the area of the buttocks

27
Q

What is the investigation for cauda equina syndrome?

A

Urgent MRI

28
Q

What is the treatment of cauda equina syndrome?

A

Treatment is emergency lumbar discectomy (surgery to remove herniated or degenerative disk in lower spine)

29
Q

What is cauda equina syndrome?

A

Condition that occurs when the nerves that form the cauda equina are damaged

30
Q

Is disc herniation seen in older or younger patients?

A

Younger patients

31
Q

Are degenerative spinal disorders seen in older or younger patients?

A

Older patients

32
Q

What are degenerative spinal conditions the result of?

A
  • Disc prolapse
  • Ligamentum hypertrophy (thickening of ligamentum flavum)
  • Osteophyte formation (newly formed fibrocartilage and bone)
33
Q

What can degenerative spinal conditions lead to?

A

Myelopathy or radiculopathy

34
Q

What is cervical spondylosis?

A

Umbrella term for degenerative change in cervical spine leading to spine and nerve root compression

35
Q

What is the clinical presentation of cervical spondylosis?

A

Patient can present with either myelopathy or radiculopathy (or both)

Speed of onset is usually months to years

36
Q

What is the management of cervical spondylosis?

A
  • Conservative if no/mild myelopathy
  • Surgery for progressive moderate to severe myelopathy
  • Anterior and posterior approaches
37
Q

What is lumbar spinal stenosis?

A

Is the narrowing of the spinal canal, compassing the nerves travelling through the lower back into the legs

38
Q

What is the clinical presentation of lumbar spinal stenosis?

A
  • Pain down both legs ‘spinal claudication’
  • Worse on walking/standing and relieved by sitting or bending forwards
39
Q

What is the management of lumbar spinal stenosis?

A

Lumbar laminectomy

40
Q

What is a lumbar laminectomy?

A

Surgery that creates space by removing the lamina

41
Q

What are the different classes of spinal tumours?

A

Extradural

Intradural

Intramedullary

42
Q

What are examples of intradural spinal tumours?

A

Meningioma

Neurofibroma

Lipoma

43
Q

What are examples of intramedullary spinal tumours?

A

Astrocytoma

Ependymoma

Teratoma

Haemangioblastoma

44
Q

What are examples of extradural spinal tumours?

A

Metastases (lung, breast, prostate)

Primary bone tumours (chrodomas, osteoblastomas, ostelud osteoma)

45
Q

What cancers commonly metastasis to the spinal cord and become extradural spinal tumours?

A

Lung

Breast

Prostate

46
Q

Patients with malignant cord compression present with what?

A
  • Pain
  • Weakness
  • Sphincter disturbance
47
Q

What is the mangement of patients with malignant cord compression?

A

Management involves surgical decompression and radiotherapy

48
Q

What are examples of spinal infections?

A

Osteomyelitis

Discitis

Epidural abscess

49
Q

What is osteomyelitis?

A

Infections within vertebral body

50
Q

What are risk factors for osteomyelitis?

A
  • IV drug abuse
  • Diabetes
  • Chronic renal failure
  • Alcoholism
  • AIDS
51
Q

What is the management of osteomyelitis?

A
  • With antibiotics
  • Surgery if evidence of neurology
52
Q

What is discitis?

A
  • Infection of intervertebral disc
53
Q

What is an epidural abscess?

A
  • Infection in epidural space
54
Q

What do patients with an epidural abscess present with?

A
  • Presents with the following triad
    • Back pain
    • Pyrexia
    • Focal neurology (impairments of nerve, spinal cord or brain function that affects a specific region of the body)
55
Q

What is focal neuropathy?

A

Impairments of nerve, spinal cord or brain function that affects a specific region of the body

56
Q

What investigation should be done for epidural abscess?

A

Urgent MRI

57
Q

What are risk factors for epidural abscess?

A
  • IV drug abuse
  • Diabetes
  • Chronic renal failure
  • Alcoholism
58
Q

What organisms typically cause epidural abscess?

A
  • Staph Aureus
  • Streptococcus
  • E-coli
59
Q

What is the mangement of epidural abscess?

A
  • Urgent surgical decompression and long-term IV antibiotics

Neurology (5 decks)

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