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Systems: Neurology AB > Diseases of the Spinal Cord and Nerve Roots > Flashcards

Diseases of the Spinal Cord and Nerve Roots Flashcards

1
Q

What motor signs would you expect to see with an UMN pathology?

A
  • Increased tone (spasticity)
  • Increased reflexes, extensor plantar
  • Pyramidal pattern of weakness
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2
Q

What motor signs would you expect to seen with a LMN pathology?

A
  • Decreased tone
  • Decreased reflexes, flexor plantar
  • Weakness
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3
Q

What sensory sign would you expect to see in a myelopathy?

A

Sensory level

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4
Q

What sensory sign would you expect to see with a hemicord lesion?

A

Brown-Sequard syndrome

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5
Q

What are the features of Brown-Sequard syndrome?

A

Ipsilateral
-Decreased vibration
-Decreased joint position sense
Weakness

Contralateral

  • Decreased pain
  • Decreased temperature
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6
Q

What are the dorsal columns responsible for?

A
  • Deep touch
  • Joint position sense (proprioception)
  • Vibration
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7
Q

What is the ventral corticospinal tract responsible for?

A

Motor

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8
Q

What is the ventral spinothalamic tract responsible for?

A

Light touch

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9
Q

What is the lateral spinothalamic tract responsible for?

A
  • Pain

- Temperature

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10
Q

What is the lateral corticospinal tract responsible for?

A

Motor

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11
Q

What sensory sign would you expect to see in a radiculopathy?

A

Dermatomal sensory loss

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12
Q

What autonomic signs may be present with a cord/root pathology?

A

Bladder/bowel dysfunction

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13
Q

What signs would be present in a C5 cord lesion?

A
  • Wasting of C5 innervated muscles
  • Increased tone in lower limbs > more upper limbs
  • Reflexes decreased in biceps, increased in all lower reflexes
  • Power decreased in C5 innervated muscles, pyramidal pattern below
  • Sensory level
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14
Q

What surgical causes of myeleopathy/radiculopathy are there?

A
  • Tumour (extradural, intradural/extramedullary, intramedullary
  • Vascular abnormalities (haemorrhage, AVM, dural fistula
  • Degenerative (spine)
  • Trauma
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15
Q

What medical causes of myelopathy are there?

A
  • Inflammation
  • Vascular (ischaemic vs haemorrhage)
  • Infective
  • Metabolic (B12 deficiency)
  • Malignant/infiltrative
  • Congenital/genetic
  • Idiopathic
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16
Q

What inflammatory causes of myelopathy are there?

A
  • Demyelination (Multiple sclerosis)
  • Autoimmune (antibody mediated e.g. aquaporin 4, lupus)
  • Sarcoid
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17
Q

What infective causes of myelopathy are there?

A
  • Viral: herpes simplex/zoster, EBV, CMV, measles, HIV et.
  • Bacterial: TB, borrelia (Lyme), syphilis, brucella
  • Other: schistosomiasis
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18
Q

What congenital/genetic causes of myelopathy are there?

A
  • Friedrich’s ataxia

- Spinocerebellar ataxias

19
Q

What can cause spinal cord ischaemia?

A
  • Atheromatous disease (aortic aneurysm)
  • Thromboembolic disease (endocarditis, AF)
  • Arterial dissection (aortic )
  • Systemic hypotension
  • Thrombotic haematological disease
  • Hyperviscosity syndromes
  • Vasculitis
  • Venous occlusion
  • Endovascular procedures
  • Decompression sickness
  • Meningovascular syphilis
20
Q

How does a spinal cord stroke present clinically?

A
  • Onset: sudden or over several hours
  • Pain (back pain/radicular which radiates to the front, visceral referred pain)
  • Weakness (usually paraperesis rather than Quadra paresis given vulnerability of thoracic cord to flow related ischaemia)
  • Numbness and paraesthesia
  • Urinary symptoms (retention followed by bladder and bowel incontinence as spinal shock settles)
  • May have vascular risk factors
21
Q

What are the general examination points of spinal cord?

A
  • Very rarely posterior spinal artery => dorsal columns spared
  • Usually anterior spinal artery
  • Occlusion of a central sulcal artery can present as a partial Brown-Séquard syndrome
  • Usually mid thoracic
  • May be spinal shock
22
Q

What investigation is key in spinal cord stroke?

A

MRI

23
Q

What is the treatment for spinal cord stroke?

A
  • Reduce risk of recurrence (Maintain adequate BP, reverse hypovolaemia/arrhythmia, antiplatelet therapy)
  • OT and physiotherapy
  • Manage vascular risk factors
24
Q

What is the prognosis of spinal cord stroke?

A
  • Return of function depends on degree of parenchymal damage
  • Unless significant motor recovery in first 24 hours chance of major recovery is low
  • Pain may be persistent and significantly contribute to disability
  • 20% mortality, only 35-40% have more than minimal recovery
25
Q

What is demyelinating myelitis usually part of?

A

Multiple sclerosis

26
Q

What is demyelinating myelitis a common cause of?

A

Medical spinal cord disease

27
Q

Who can demyelinating myelitis affect?

A

The young

28
Q

What is demyelinating myelitis in MS characterised by?

A
  • Characterised by pathological lesions of inflammation and demyelination leading to temporary neuronal dysfunction
  • One or more lesions anywhere
29
Q

What type of matter does demyelinating myelitis in MS affect?

A

Only the white matter of the CNS

30
Q

What may be the initial presentation of MS?

A

Demyelinating myelitis

60-70% have MRI brains typical of MS

31
Q

How can demyelination myelitis of MS present

A
  • Partial or incomplete transvers myelitis

- Subacute onset (slower than ischaemia)

32
Q

What may there be a history of in demyelination myelitis?

A

There may be a history of previous neurological or ophthalmological episodes

33
Q

How is myelitis investigated in MS?

A

MRI

34
Q

How is MS myelitis treated?

A
  • Supportive

- Methylprednisolone

35
Q

What can MS myelitis result in?

A

Mya have chronic progressive myelopathy (secondary or primary progressive)

36
Q

What are some sources of B12?

A
  • Abundant in meat, fish and most animal by-products

- Legumes

37
Q

What does absorption of B12 form the gut require?

A

Intrinsic factor: a binding protein secreted by gastric parietal cells

38
Q

What is pernicious anaemia?

A

Autoimmune condition in which antibodies to IF prevent B12 absorption

39
Q

What does B12 deficiency complicate?

A

Complicates total gastrectomy, Crohns, tape worms

40
Q

What parts of the nervous system are affected by B12 deficiency?

A

B12 deficiency affects most of the nervous system

  • Myelopathy (L’hermitte’s)
  • Peripheral neuropathy
  • Brain
  • Eye/optic nerves
  • Brainstem
  • Cerebellum
41
Q

How does B12 deficiency myelopathy?

A
  • Paraesthesia hand and feet, areflexia
  • First UMN signs extensor plantars
  • Painless retention of urine
  • Paraplegia
  • Sensory ataxia
42
Q

What is there degeneration of the B12 deficiency myelopathy?

A

Corticospinal tracts leading to paraplegia

-Dorsal columns leading to sensory ataxia

43
Q

What investigations should be carried out for B12 deficient myelopathy?

A
  • FBC/ blood film (may be negative

- B12 levels

44
Q

What is the treatment for B12 deficient myelopathy?

A

IM B12 (the quicker the better)

Systems: Neurology AB (51 decks)

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