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Neurology Clinical > Diseases Of The Spinal Cord > Flashcards

Diseases Of The Spinal Cord Flashcards

1
Q

What is radiculopathy?

A

Disease of lower motor neurone
(Out-with the spinal cord)
Damage of the motor root resulting in dermatomal damage

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2
Q

What is myelopathy?

A

Damage to the spinal cord usually due to severe compression

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3
Q

what are signs of upper motor neurone lesion?

A

no wasting
increased tone (rigidity or spasticity)
hyperreflexia , extensor plantar
pyramidal pattern of weakness

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4
Q

what are signs of lower motor neurone lesion?

A

wasting
decreased tone
decreased reflexes, flexor plantar
weakness

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5
Q

brown-sequard syndrome results from what type of lesion?

A

hemicord lesion (damage to one half of the spinal cord)

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6
Q

what is the presentation of brown-sequard syndrome?

A

causes weakness/paralysis (hemiparaplegia) on one side of the body and loss of sensation on the other side

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7
Q

what affects does Brown squared syndrome cause on the ipsilateral side?

A

decrease vibration, joint position sense and weakness

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8
Q

what affects doesn’t brown seuquard syndrome causes eon the contralateral side?

A

contralateral loss of pain and temperature

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9
Q

how can you differentiate between a spinal cord lesion and motor neurone diseasE?

A

spinal cord lesion will also cause sensory symptoms whereas motor neurone is only motor effects

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10
Q

what are congenital causes of myelopathy?

A

fredrick’s ataxia
spinocerebellar ataxia
hereditary paraparesis

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11
Q

what are the 3 most common causes of myelopathy?

A 
demyelination ie. in MS
ischaemic myelopathy (spinal cord infarction)
Vitamin B12 deficiency
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12
Q

what is the main blood supply to the spinal cord?

A

anterior and posterior spinal arteries
anterior S.A branch of the vertebral artery
posterior S.A branch of the inferior cerebellar artery

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13
Q

what artery is the most common culprit for ischameic myelopathy and at what point int he spinal cord this most common?

A

the anterior spinal artery

most commonly in the mid thoracic

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14
Q

what is the clinical presentation of ischaemic myelopathy/spinal cord infarction?

A

onset may be sudden or over several hours
back pain , radicular pain
visceral referred pain
weakness - paraparesis (usually only weakness of the legs)
numbness and paraesthesia
urinary symptoms

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15
Q

how would you investigate a suspected spinal cord infarction?

A

MRI

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16
Q

what is the treatment/management of a spinal cord infarction/ ishcameic myelopathy?

A 
reduce risk of recurrence;
- maintain BP
- reverse hypokalaemia/arrhythmia
- anti platelet therapy 
manage vascular risk factors
- physiotherapy , OT
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17
Q

what does the recovery of spinal cord infarction depend on?

A

the extent of parenchymal damage

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18
Q

what is the prognosis of spinal cord infarction?

A

20% mortality, with only 35-40% have more than minimal recovery

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19
Q

what is the treatment for demyelinating myelitis?

A

supportive

methylpredinosolone (speeds up recovery from myelitis but not progression of MS)

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20
Q

what are the main causes of vitamin B 12 deficiency?

A

gastrectomy - vit B 12 is absorbed in the small intestine by intrinsic factor
pernicious anaemia
veganism

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21
Q

what affects on the CNS does vitamin B12 cause?

A 
myelopathy - L'hermitte's 
peripheral neuropathy
brain
eyes/optic nerves 
brainstem 
cerebellum
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22
Q

vitamin B12 can cause degeneration of the corticospinal tract, what symptom would this cause?

A

paraplegia

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23
Q

vitamin B12 can cause degeneration of the dorsal columns, what symptom would this cause?

A

sensory ataxia

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24
Q

what are the investigations and treatment for vitamin B 12 deficiency?

A

investigations: FBC, blood film, B12

treatment = intramuscular B12

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25
Q

how can a gastrectomy cause vitamin B12 deficiency?

A

Vitamin B12 absorption from the ileum requires intrinsic factor - produced from gastric parietal cells.
therefore if someone has a gastrectomy, then Vitamin B12 won’t be absorbed to be taken and stored in the liver

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26
Q

if there radiculopathy of C5 what symptoms would this cause?

A 
= damage to the C5 spinal root
decreased power in C5 innervated muscles
wasting of the C5 innervates muscle
decreased reflex of bicep muscle but increased reflexes below C5
increased tone in legs > arms
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27
Q

is muscle wasting a symptom of upper motor neurone or lower motor neurone lesion?

A

lower motor neurone

28
Q

in which spinal cord/root pathology causes back pain and what is its pattern like?

A

ischaemic spinal cord / spinal cord infarction

radicular pain - radiates out along the course of the spinal nerve

29
Q

what does paraparesis mean?

A

partial paralysis of the lower limbs

30
Q

what does paraesthesia mean?

A

burning/tingling sensation

31
Q

what does paraplegia mean?

A

impairment of the motor or sensory function of the lower limbs

32
Q

would u find extensor plantar in an UMN or LMN lesion?

A

extensor plantar = UMN

33
Q

would you find flexor plantar in UMN or LMN lesion?

A

flexor plantar = LMN

34
Q

What is radiculopathy and what is the presentation like?

A

Damage of the nerve root

  • unilateral
  • single myotome
  • single dermatome
  • decreased reflexes
  • LMN
35
Q

What is myelopathy and what does it present like?

A

Damage to the spinal cord

  • bilateral
  • motor and sensory level
  • UMN
36
Q

Would damage to a peripheral nerve cause unilateral or bilateral symptoms?
Would this be motor, sensory or both?

A

Unilateral

Motor and sensory deficit

37
Q

If a patient presents with signs such as clonus, up going plantars and brisk reflexes, what type of lesion would you suspect ?

A

Spinal cord lesion / myelopathy / UMN

38
Q

What are the long tract signs of myelopathy?

A 
Brisk reflexes
Increased tone 
Up going plantars
Clonus
Hoffmans signs 
Proprioception impairement
39
Q

Does myelopathy cause a possitive Babinski’s sign?

A

Yes

UMN show possitive sign whereas LMN doesn

40
Q

Does radiculopathy cause fasciculations

A

No, nerve root compression doesnt cause fasciculations

UMN (myelopathy) causes fasciculations

41
Q

What are the 5 main ligaments in the vertebral column?

A 
Anterior longitudinal
Posterior longitudinal
Ligamentum flavum 
Interspinal ligament
Supraspinous ligament
42
Q

Would upper or lower motor neurone cause brisk reflexes?

A

UMN

43
Q

Disc prolapse tends to occur in what age group?

A

Younger patients

44
Q

What is the main feature of a disc prolapse?

A

Acute onset pain

45
Q

Does a disc prolapse cause myelopathy or radiculopathy?

A

If central herniation = myelopathy

If lateral herniation = radiculopathy

46
Q

What is the presentation of a lateral disc herniation ?

A

Acute onset pain down leg/arm of side affected

Weakness and numbness in distrubution of nerve root involved

47
Q

What is the management of a disc prolapse?

A

Rehabillitation
Nerve root injection
Lumbar/cervical discectomy

48
Q

What are the red flag symptoms of causes equina syndrome?

A

Bilateral sciatica
Saddle anaesthesia
Urinary dysfunction

49
Q

What is the treatment for cauda equina syndrome?

A

Emergency lumbar discectomy

50
Q

What age group are degenerative spinal diseases commonly found in?

A

Older patients

51
Q

What is cervical spondylosis?

A

Umbrella term for degenerative change in the cervical spine that leads to spine and nerve root compression

52
Q

What is the presentation of cervical spondylosis?

A

Can presentwith either radiculopathy or myelopathy

Speed of onset if usually months to years

53
Q

What is the management of cervical spondylosis?

A

Conservative if no/mild myelopathy

Surgery for progressive moderate/severe myelopathy

54
Q

What is lumbar spinal stenosis?

A

Spinal canal narrows and compresses the nerves at the lumbar vertebrae

55
Q

What is the presentation of lumbar stenosis?

A

Pain down both legs ‘spinal claudication’
Pain eases with sitting down or bending forwards
Worse on walking / standing

56
Q

What is the treatment for lumbar stenosis?

A

Lumbar laminectomy

57
Q

Metastases to the spinal cord are usually ;

Extra dural ? Intramural ? Intramedullary ?

A

Extra dural

58
Q

What is the triad presentation of a malignant cord compression?

A

Pain
Weakness
Sphincter dysfunction.

59
Q

What is the management for a malignant spinal cord compression?

A

Surgical decompression

Radiotherapy

60
Q

What are the 3 main spinal infections?

A

Osteomyelitis
Discitis
Epidural abscess

61
Q

What are the risk factors for osteomyelitis?

A

IV drug abusers
Alcoholics
Diabetic
Chronic renal failure

62
Q

What are the causative organisms of osteomyelitis?

A

Staph aureus
Streptococcus
E. coli

63
Q

What is the triad presentation of osteomyelitis?

A

Pain
Pyrexia
Focal neurology

64
Q

What is the management of osteomyelitis?

A

Urgent surgical decompression

Long term IV antibiotics

65
Q

What is discitis?

A

Infection of the intervertebral disc

66
Q

Describe the clinical presentation of vitamin a B12 deficient myelopathy

A

Paraesthesia of hands and feet
Hyporeflexia
Extensor plantar (first UMN sign)
Degeneration of the corticospinal tract causing paraplegia
Degeneration of the dorsal columns causing sensory ataxia
Painless retention of urine

67
Q

What sign suggests myelopathy caused by vitamin B12 deficiency?

A

L’hermittes

Flex your neck and you get a rush of electricity down your back

Neurology Clinical (21 decks)

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