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Systems Nervous System > Diseases of the Spinal Cord and Nerve Roots (Medical) > Flashcards

Diseases of the Spinal Cord and Nerve Roots (Medical) Flashcards

1
Q

What are the motor signs of upper mtor neurone root pathology?

A
  • No wasting
  • ↑tone

Increased tone in terms of spasticity – tone is not the same over the whole range of the joint

  • ↑reflexes - Babinski sign
  • Pyramidal pattern of weakness

Pattern of weakness – flexors are stronger than extensors in the arm – drives the arm into flexion, in the leg it is the opposite – legs get driven into extension

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2
Q

What are lower motor neurone signs?

A
  • ↓tone
  • ↓reflexes, flexor plantar
  • weakness
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3
Q

What are sensory signs of root pathology?

A

Myelopathy

Hemicord lesion: Brown-Sequard syndrome (BSS) is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.

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4
Q

In Brown sequard syndrome, what function is lost on the ipsilateral side and what function is lost on the contralateral side?

A

Ipsilateral: Decreased vibration

Decrease in joint position sense

Weakness

Contralateral: Pain and temperature

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5
Q

What tracts are motor tracts?

A

Lateral corticospinal

Ventral corticospinal

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6
Q

What tract does pain travel in ?

A

Lateral spinothalamic tract

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7
Q

What tract does light touch travel in?

A

Ventral spinothalamic

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8
Q

What travels in the dorsal column?

A

Deep touch, proprioception and vibration

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9
Q

Overview

A
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10
Q

Define radiculopathy?

A

Pain, numbness or weakness to part of the body as a result of injury to a nerve root (such as compression)

Results in dermatomal sensory loss

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11
Q

What is autonomic effect of root pathology?

A

Bladder / Bowel dysfunction

Incontinence?

Constipation?

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12
Q

What are the signs of a C5 cord lesion?

A

•Wasting of C5 innervated muscles

LMN features in C5 - los of biceps jerk and weakness

UMN features below C5 - tone in legs is greater than tone in the arms

  • Reflexes ↓biceps, ↑all lower reflexes
  • Power ↓C5 innervated muscles, pyramidal pattern below
  • Sensory level

Sensation all the way down may be lost because of ascending pathways

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13
Q

What are intrinsic causes of myelopathy / radiculopathy?

A

Medical

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14
Q

What are extrinsic causes of radiculopathy / myelopathy?

A

Surgical:

Tumour (Extradural, intradural/extramedullary, intramedullary)

Vascular abnormalities

  • Haemorrhage
  • AVM, dural fistula

Degenerative (spine)

Trauma

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15
Q

What are the medical causes of myelopathy?

A

•Inflammation

–Demyelination (Multiple Sclerosis)

–Autoimmune (antibody mediated eg aquaporin 4, lupus)

–Sarcoid

  • Vascular: ischaemic vs haemorrhage
  • Infective

–Viral: herpes simplex/zoster, EBV, CMV, measles, HIV etc

–Bacterial: TB, borrelia (Lyme), syphilis, brucella

–Other: schistosomiasis

•Metabolic

–B12 deficiency

  • Malignant / infiltrative
  • Congenital / genetic

–Friedrich’s ataxia, spinocerebellar ataxias

•Idiopathic

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16
Q

In the case of ischaemic myelopathy (spinal stroke) - what function is most likely to be lost if there is anterior spinal artery occlusion?

A

Motor function

17
Q

What are the causes of 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
18
Q

What is the clinical presentaion of spial cord stroke?

A
  • May have vascular risk factors
  • Onset may be sudden or over several hours
  • Pain

–Back pain/radicular

–Visceral referred pain

•Weakness (everythin below the level of infarction)

–Usually paraparesis rather than quadraparesis 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

19
Q

Which artery does spinal cord stroke normally affect?

A

Anterior spinal artery

•Very rarely posterior spinal artery => dorsal columns spared

20
Q

What is the result of occlusion of a central sulcal artery?

A

Can present as a partial brown-sequard syndrome

21
Q

What is the treatment of spinal cord stroke?

A

•Reduce risk of recurrence

–Maintain adequate BP

–Reverse hypovolaemia/arrhythmia

–Antiplatelet therapy

  • OT and physiotherapy
  • Manage vascular risk factors
22
Q

What is prognosis for spinal shock?

A

Depends on degree of parenchymal damage

•Unless significant motor recovery in first 24 hours chance of major recovery is low

Pain may be consistent

20% mortality, only 35-40% have more than minimal recovery

23
Q

What is demyelating myelitis often part of?

A

MS

  • Common cause of medical spinal cord disease
  • Can affect the young
24
Q

What part of the nervous system does MS attack?

A

All central nervous system - UMN

25
Q

What causes the temporary neuronal dysfunction in MS?

A

Pathological lesions of inflammation and demyelination

One or more lesions anywhere

26
Q

Where do we get vitamin B12?

A
  • Abundant in meat, fish and most animal by-products
  • Legumes
27
Q

How do we absorb vitamin B12?

A

Intrinsic factor - produced by gastric parietal cells

28
Q

What causes pernicious anaemia?

A

Antibodies to intrinsic factor prevent vitamin B12 absorption

29
Q

Vitamin B12 affects most of the nervous system

A

•Myelopathy

–L’hermitte’s

  • Peripheral neuropathy
  • Brain
  • Eye/optic nerves
  • Brainstem
  • cerebellum
30
Q

What are the features of B12 deficient myelopathy?

A
  • Paraesthesia hands and feet, areflexia
  • First UMN sign extensor plantars
  • Degeneration of:

– corticospinal tracts → paraplegia

–Dorsal columns → sensory ataxia

•Painless retention of urine

Systems Nervous System (48 decks)

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