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Year 2- CNS > Diseases of the Spinal Cord and Nerve Roots > Flashcards

Diseases of the Spinal Cord and Nerve Roots Flashcards

1
Q

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

A

Upper

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2
Q

RECAP- where is the motor cortex?

A

Precentral gyrus

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3
Q

Myelopathy?

A

Anything that causes damage to the spinal cord

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4
Q

Myelitis?

A

Inflammation causing damage of spinal cord

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5
Q

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

->remember, upper motor signs as UMN affected

A

No muscle wasting
Increased muscle tone
Increased reflexes
Extensor plantar response

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6
Q

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

A

Flexors

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7
Q

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

A

Extensors

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8
Q

Where do you find upper motor neuron signs?

A

Below the level of the lesion

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9
Q

Is damage to spinal cord usually unilateral or bilateral?

A

Bilateral as quite thin

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10
Q

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

A

Cervical

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

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11
Q

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

A

Thoracic

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12
Q

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

A

Lower limbs

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13
Q

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

A

Upper and lower limbs

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14
Q

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

A

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

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15
Q

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

A

Brown-Sequard syndrome

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16
Q

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?

A

False

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17
Q

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?

A

True

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18
Q

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?

A

True

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19
Q

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

A

Loss of vibration and sense of joint sense.
Weakness

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20
Q

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

A

Loss of pain or temperature sensation

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21
Q

What is a syrinx?

A

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

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22
Q

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

A

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

23
Q

Syringomyelia?

A

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

24
Q

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

A

Joint position and vibration.
Pain and temperature remain unchanged.

25
Q

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

A

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

26
Q

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

A

Bladder and bowel function

->there are autonomic tracts going down to these

27
Q

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

A

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

28
Q

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

A

Bowel disturbance- constipation or incontinence

29
Q

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

A

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

30
Q

Give an example of an extrinsic cause of myelopathy.

A

Prolapsed IV disc
Tumour of meninges pressing on spinal cord.

31
Q

Are extrinsic causes usually treated by surgery or medicine?

A

Surgery

32
Q

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

A

Localise using MRI
Investigate cause using bloods. CSF

33
Q

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

A

Vitamin B12 levels

34
Q

Spinal strokes or infarction are due to damage of what?

A

Damage to vascular supply

35
Q

Which arteries supply the anterior and posterior spinal cord?

A

Anterior spinal artery
Posterior spinal artery

36
Q

What is the anterior spinal cord a branch of?

A

Vertebral artery

37
Q

Which thromboembolic diseases could cause spinal cord infarction?

A

Endocarditis
Atrial fibrillation

38
Q

How would a spinal cord stroke present?

A

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

39
Q

What is meant by radicular pain?

A

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

40
Q

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

A

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

41
Q

What happens in initial spinal shock?

A

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

42
Q

What is the acute treatment for spinal cord strokes?

A

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

43
Q

What is the management for a spinal cord stroke?

A

OT and physio
Continue to manage vascular risk factors

44
Q

Which vitamin deficiency can lead to spinal cord degeneration?

A

Vitamin B12

45
Q

How do we get vitamin B12?

A

In the diet, in animal products

:))

46
Q

How is vitamin B12 absorbed?

A

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

47
Q

What can cause a vitamin B12 deficiency

A

-Diet, especially in vegans
-Pernicious anaemia
-Total gastrectomy
-Crohn’s
-Tapeworms

->in terms of gastrectomy, stomach removed so cannot produce intrinsic factor

48
Q

How does pernicious anaemia lead to B12 deficiency?

A

Antibody produced to intrinsic factor which prevents vitamin B12 absorption

49
Q

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

A

Brain
Eyes
Brainstem
Cerebellum
Peripheral nerves

50
Q

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

A

Spinal cord
Peripheral nerves

->spreads to brain if long-term deficiency

51
Q

What are the symptoms of vitamin B12 deficient myelopathy?

A

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

52
Q

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

A

FBC/blood film
Vitamin B12 measured

53
Q

What is the treatment for B12 deficient myelopathy?

A

Intramuscular B12

54
Q
A

Year 2- CNS (49 decks)

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