Diseases of the spinal cord

Question 1

What does the prefix “myelo” refer to?

Answer 1

The cord

Question 2

What does the prefix “radiculo” refer to?

Answer 2

Nerve roots

Question 3

What are some signs of UMN damage?

Answer 3

Hypertonia
Hyperreflexia
Pyramidal pattern of weakness (extensors in the arms, flexors in the legs)

Question 4

Would UMN damage show wasting?

Answer 4

No

Question 5

What are some signs of LMN damage?

Answer 5

Wasting
Hypotonia
Hyporeflexia
Weakness

Question 6

Why would you not do a lumbo-sacral MRI for UMN signs in the legs?

Answer 6

Spinal cord is already done at L1 for that area

Question 7

How will a cord lesion affect senses?

Answer 7

Abnormal sensation up to the level of the lesion from inferior

Question 8

Which side will show weakness in a lesion of the cord?

Answer 8

The side the lesion affects

Question 9

Will a cord lesion affect pain/temperature sensation?

Answer 9

Yes, there will be a loss

Question 10

Will a lesion of the dorsal column affect pain/temperature sensation?

Answer 10

No

Question 11

How will a lesion of the dorsal column affect senses?

Answer 11

Loss of vibration sense below lesion

Question 12

What is a congenital cause of myelopathy?

Answer 12

Friedrich’s ataxia

Question 13

What are some inflammatory causes of myelopathy?

Answer 13

MS
Sarcoidosis
Autoimmune

Question 14

What are some metabolic causes of myelopathy?

Answer 14

B12 deficiency

Question 15

What are some acquired causes of myelopathy?

Answer 15

Inflammation
Vascular
Infection
Metabolic
Malignant 
Idiopathic

Question 16

Why do spinal strokes tend not to affect the arms?

Answer 16

Innervation of the arms branches off T1 and above

Question 17

How may a spinal stroke present?

Answer 17

Back pain
Visceral referred pain
Weakness
Numbness
Paraesthesia

Question 18

What is Brown-Séquard syndrome?

Answer 18

Damage to one half of the spinal cord (i.e. hemisection of spinal cord) resulting in paralysis and loss of proprioception on the side of the injury

Question 19

What are some useful investigations for spinal stroke?

Answer 19

CT

MRI

Question 20

How would we treat a spinal stroke?

Answer 20

OT and physio
Manage vascular risk factors
Reduce risk of recurrence (Maintain BP, reverse arrhythmia, antiplatelet therapy)

Question 21

How would we treat demyelinating myelitis?

Answer 21

Methylprednisolone

Question 22

What investigation may be useful for disc prolapse?

Answer 22

MRI

Question 23

How is disc prolapse managed?

Answer 23

Rehab
Nerve root inject
Lumbar/cervical disectomy

Question 24

What are some red flags for cauda equina syndrome?

Answer 24

Bilateral sciatica
Saddle anaesthesia
Urinary dysfunction

Question 25

How is cauda equina syndrome managed?

Answer 25

Urgent MRI

Emergency lumbar disectomy

Question 26

Describe the pain experienced as a result of lumbar spinal stenosis.

Answer 26

Pain down both legs “spinal claudication”
Worse on standing/walking
Relieved by sitting or bending forward

Question 27

How is lumbar spinal stenosis managed?

Answer 27

Lumbar laminectomy

Question 28

What triad for epidural abscess would warrant an urgent MRI?

Answer 28

Back pain
Pyrexia
Focal neurology

Question 29

What organisms may cause epidural abscess?

Answer 29

Staph Aureus
Streptococcus
E. Coli