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Neurology > Diseases of the spinal cord and nerve roots > Flashcards

Diseases of the spinal cord and nerve roots Flashcards

1
Q

Which neurons does myelopathy/myelitis affect?

A

UMN’s - disease of the spinal cord

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2
Q

Which neurons does radiculopathy/radiculitis affect?

A

LMN’s - disease of the nerve roots

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3
Q

Name a tick-borne infection that can cause radiculitis?

A

Lyme.

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4
Q

What is myeloradiculitis?

A

Compression of the cord which causes both UMN and LMN signs.

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5
Q

What are the medical causes of myelopathy/radiculopathy?

A
  • inflammation
  • infarction
  • infection
  • infiltration
  • degenerative (neurons)
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6
Q

What are the surgical causes of myelopathy/radiculopathy?

A
  • tumour
  • vascular abnormalities
  • degenerative (spine)
  • trauma
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7
Q

What are the signs of an UMN lesion?

A
  • no muscle wasting
  • increased tone
  • increased reflexes
  • pyramidal pattern of weakness (weakness in extensors of upper limbs and flexors of lower limbs)
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8
Q

What are the signs of an UMN lesion?

A
  • wasting (only the muscle innervated by the affected nerve will be wasted)
  • decreased tone
  • decreased reflexes
  • weakness
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9
Q

Which nerve roots supply reflexes?

A

Biceps: C5/C6

Triceps: C7

Knee jerk: L3/L4

Ankle jerk: S1

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10
Q

What would be caused by a left-sided hemisection of the cord?

A

Brown-Sequard syndrome:

  • left sided paralysis
  • left sided loss of proprioception and vibration sense
  • right sided loss of pain and temperature
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11
Q

What would the signs of a C5 cord lesion be?

A

UMN lesion:

  • wasting of C5 innervated muscles
  • increased tone
  • reflexes decreased in biceps and increased in all other reflexes
  • power decreased in all C5 innervated muscles and pyramidal pattern below
  • sensory level - all dermatomes below C5 are impaired
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12
Q

What are the medical causes of myelopathy?

A
  • demyelination (MS)
  • ischaemic (due to occlusion of blood vessels eg dissection of an aortic aneurysm)
  • transverse myelitis
  • metabolic (B12 deficiency)
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13
Q

What can cause ischaemic myelopathy?

A

Spinal stroke.

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14
Q

Which parts of the spinal cord are most at risk of a spinal stroke?

A
  • Most likely to get a stroke in thoracic cord or lower down

- Anterior spinal artery most commonly affected

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15
Q

Give a few examples of causes of spinal cord ischaemia.

A
  • atheromatous disease
  • thromboembolic disease
  • arterial dissection (aortic)
  • decompression sickness (common in Aberdeen divers due to air emboli)
  • venous occlusion
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16
Q

What is the presentation of a spinal cord stroke?

A
  • back pain
  • visceral referred pain (diffuse)
  • paraparesis (usually in legs as thoracic cord is most vulnerable)
  • urinary retention followed by bladder and bowel incontinence
17
Q

Which investigation is used for a spinal cord stroke?

A

MRI

18
Q

How is a spinal cord stroke treated?

A
  • reduce risk of recurrence (maintain BP, reverse hypovolemia etc)
  • manage vascular risk factors
19
Q

What is the prognosis for a spinal cord stroke?

A
  • return on function depends on degree of damage

- only 25-40% have more than a minimal recovery

20
Q

Which features characterise demyelinating myelitis?

A

Lesions of inflammation and demyelination which leads to temporary neuronal dysfunction.

Commonly part of MS disease presentation.

Only affects 1 half of the cord eg 1/2 of C5 - partial myelitis.

21
Q

How is demyelinating myelitis investigated and treated?

A

LP - looking for CSF-specific inflammation (ie inflammation that is in the CSF but not in the blood).

Supportive or methylprednisolone.

22
Q

What is MS?

A

Patchy myelitis.

23
Q

What are the causes of transverse myelitis?

A
  • idiopathic
  • Lyme
  • autoimmune
  • viral
  • post-vaccination
24
Q

What is pernicious anaemia?

A

Autoimmune condition in which autoantibodies against intrinsic factor in the gut prevent vitamin B12 absorption.

25
Q

What is the first presentation of vitamin B12 deficiency?

A

Peripheral neuropathy - reversible at this stage. When it then starts to affect the spinal cord it is no longer reversible.

26
Q

What are the signs of B12 deficient myelopathy?

A
  • paraesthesia of hands/feet
  • areflexia
  • degeneration of corticospinal tracts (paraplegia) and dorsal columns (sensory ataxia)
  • first UMN sign is upgoing plantars
  • painless retention of urine

Neurology (23 decks)

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