Diseases of the Spinal Cord and Nerve Roots

Question 1

Does damage to the spinal cord damage upper or lower motor neurons?

Answer 1

Upper

Question 2

RECAP- where is the motor cortex?

Answer 2

Precentral gyrus

Question 3

Myelopathy?

Answer 3

Anything that causes damage to the spinal cord

Question 4

Myelitis?

Answer 4

Inflammation causing damage of spinal cord

Question 5

What are some of the motor signs seen in spinal cord damage?

->remember, upper motor signs as UMN affected

Answer 5

No muscle wasting
Increased muscle tone
Increased reflexes
Extensor plantar response

Question 6

In an upper motor neuron weakness, which muscles of the upper limb are stronger, the extensors or flexors?

Answer 6

Flexors

Question 7

In an upper motor neuron weakness, which muscles of the lower limb are stronger, the extensors or flexors?

Answer 7

Extensors

Question 8

Where do you find upper motor neuron signs?

Answer 8

Below the level of the lesion

Question 9

Is damage to spinal cord usually unilateral or bilateral?

Answer 9

Bilateral as quite thin

Question 10

If there is spastic tetraparesis, which part of the spinal cord is damaged?

Answer 10

Cervical

->tetra=four, if lesion is here, all four limbs affected

Question 11

If there is spastic paraparesis, which part of the spinal cord is damaged?

Answer 11

Thoracic

Question 12

If the lesion was in the thoracic cord, which limbs would be affected?

Answer 12

Lower limbs

Question 13

If the lesion was in the cervical section of the spinal cord, which limbs would be affected?

Answer 13

Upper and lower limbs

Question 14

If you damaged the spine at the level of T9/10, where would there be abnormal sensation?

Answer 14

Below the level of the damage, in this case, below the umbilicus

Question 15

Sometimes lesions only affect half of the spinal cord. This gives rise to what?

Answer 15

Brown-Sequard syndrome

Question 16

When a lesion only damages half of the spinal cord, pain and temperature are lost on the same side as the lesion in body parts below that level.

True or false?

Answer 16

False

Question 17

When a lesion only affects half of the spinal cord, joint position and vibration are abnormal on the same side as the lesion below that level.

True or false?

Answer 17

True

Question 18

When a lesion only affects half of the spinal cord, any weakness would usually be on the same side as the loss of joint position and vibration sensation.

True or false?

Answer 18

True

Question 19

Therefore, in Brown-Seqaurd, what happens on the ipsilateral side to the lesion?

Answer 19

Loss of vibration and sense of joint sense.
Weakness

Question 20

Therefore, in Brown-Seqaurd, what happens on the contralateral side to the lesion?

Answer 20

Loss of pain or temperature sensation

Question 21

What is a syrinx?

Answer 21

Fluid filled cavity within the spinal cord, usually the grey matter

Question 22

What do syrinx’s (a type of lesion) result in?

Answer 22

Loss of pain and temperature on same side.
Often joint position and vibration sense are not affected.

->this is because they come into the spinal cord more posteriorly

Question 23

Syringomyelia?

Answer 23

Syrinxes in the cervical cord in which people lose pain and temperature sensation on same side.

Question 24

Multiple sclerosis affects the dorsal columns. Therefore, which sensations will be lost?

Answer 24

Joint position and vibration.
Pain and temperature remain unchanged.

Question 25

What would happen if there was a lesion of the anterior spinal cord?

Answer 25

Loss of pain and temperature as damaged spinothalamic trunk where they cross over.

Question 26

If there is damage of the spinal cord, as well as motor and sensory damage, what other function can be altered?

Answer 26

Bladder and bowel function ->there are autonomic tracts going down to these

Question 27

Describe the potential changes in bladder function if the spinal cord is damaged.

Answer 27

Retention of urine without pain Irritable bladder with frequency and incontinency.

Question 28

Describe the potential changes in bowel function if the spinal cord is damaged.

Answer 28

Bowel disturbance- constipation or incontinence

Question 29

Causes of myelopathy (damage to spinal cord) are usually described as being intrinsic or extrinsic. What is meant by these terms?

Answer 29

Intrinsic cause is one which affects the spinal cord directly. Extrinsic cause is one which damages the spinal cord from outside the spinal cord.

Question 30

Give an example of an extrinsic cause of myelopathy.

Answer 30

Prolapsed IV disc Tumour of meninges pressing on spinal cord.

Question 31

Are extrinsic causes usually treated by surgery or medicine?

Answer 31

Surgery

Question 32

In general, if someone is presenting with spinal cord symptoms, which investigations would be carried out?

Answer 32

Localise using MRI Investigate cause using bloods. CSF

Question 33

What is one thing you would need to look at in bloods of someone presenting with spinal cord symptoms?

Answer 33

Vitamin B12 levels

Question 34

Spinal strokes or infarction are due to damage of what?

Answer 34

Damage to vascular supply

Question 35

Which arteries supply the anterior and posterior spinal cord?

Answer 35

Anterior spinal artery Posterior spinal artery

Question 36

What is the anterior spinal cord a branch of?

Answer 36

Vertebral artery

Question 37

Which thromboembolic diseases could cause spinal cord infarction?

Answer 37

Endocarditis Atrial fibrillation

Question 38

How would a spinal cord stroke present?

Answer 38

-Could be sudden or over several hours, but fairly sudden -Back pain/ radicular pain -Weakness -Numbness and paraesthesia -Urinary symptoms

Question 39

What is meant by radicular pain?

Answer 39

Pain which started in posterior spine and radiates to anterior abdomen or thorax

Question 40

Which part of the spinal cord are usually affected in someone with a spinal cord stroke?

Answer 40

Most damage or infarction occurs in anterior spinal artery- this damages spinothalamic but spares dorsal column.

Question 41

What happens in initial spinal shock?

Answer 41

Rapid shutdown of spinal cord. Low tone, absent reflexes.

Question 42

What is the acute treatment for spinal cord strokes?

Answer 42

No acute treatment- cannot thrombolyse spinal cord strokes. Manage risk factors e.g. maintain adequate BP, antiplatelet therapy, reverse hypovolaemia/arrhythmia

Question 43

What is the management for a spinal cord stroke?

Answer 43

OT and physio Continue to manage vascular risk factors

Question 44

Which vitamin deficiency can lead to spinal cord degeneration?

Answer 44

Vitamin B12

Question 45

How do we get vitamin B12?

Answer 45

In the diet, in animal products :))

Question 46

How is vitamin B12 absorbed?

Answer 46

Gut absorbs but requires intrinsic factor in order to do so.

Question 47

What can cause a vitamin B12 deficiency

Answer 47

-Diet, especially in vegans -Pernicious anaemia -Total gastrectomy -Crohn's -Tapeworms ->in terms of gastrectomy, stomach removed so cannot produce intrinsic factor

Question 48

How does pernicious anaemia lead to B12 deficiency?

Answer 48

Antibody produced to intrinsic factor which prevents vitamin B12 absorption

Question 49

Vitamin B12 deficiency does not just affect the spinal cord, which other parts of the nervous system may it affect?

Answer 49

Brain Eyes Brainstem Cerebellum Peripheral nerves

Question 50

Which parts of the nervous system are affected more quickly by a vitamin B12 deficiency?

Answer 50

Spinal cord Peripheral nerves ->spreads to brain if long-term deficiency

Question 51

What are the symptoms of vitamin B12 deficient myelopathy?

Answer 51

Paraesthesia of hands and feet Painless retention of urine Degeneration of corticospinal tracts and dorsal column May have extensor plantar

Question 52

Which investigations are used in the diagnosis of B12 deficient myelopathy?

Answer 52

FBC/blood film Vitamin B12 measured

Question 53

What is the treatment for B12 deficient myelopathy?

Answer 53

Intramuscular B12