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The Nervous System: Pathology > Diseases of the Spinal Cord and Nerve Roots (Medical) > Flashcards

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

1
Q

Define Myelopathy

A

Disease that affects from the spinal cord down to the anterior horn cell

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2
Q

Define Radiculopathy

A

Disease that affects from the anterior horn cell to proximal nerve

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3
Q

What motor neurones are involved in myelopathy

A

Upper motor neurone

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4
Q

What motor neurones are involved in radiculopathy

A

Lower motor neurones

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5
Q

What is expected signs of upper motor neurone disorder

A

No Muscle wasting (in early stage, but with weakness can develop later)

Increased tone

Increased reflexes

Pyramidal pattern of weakness s

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6
Q

What kind of increased tone is seen in an Upper motor neurone disorder

A

Spasticity - normal tone then a build up cause tone to heighten

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7
Q

What is a sign on increased reflexes in Upper motor neurone disease

A

Extensor plantar - Toe extend due to withdraw

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8
Q

Why are reflexes increased in Upper motor neurone disorder

A

Damage to upper motor neurone means they no longer have control over suppressing primitive reflexes

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9
Q

What are primitive reflexes

A

Generated by the spinal cord reflex arch, these are reflexes that are exhibited by normal infants that you don’t not require as you grow older e.g. how we can walk without a reflex occurring

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10
Q

What are the causes and signs of a pyramidal pattern of weakness

A

Flexors stronger than extensors in the arm - drives arm into the body

Extensors stronger than flexors in the leg - leg extended at hip and knee

Circumduction when walking

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11
Q

What is the upper motor neurones affect on the reflex arc

A 
Suppresses it
(so when damaged = hyperflexia)
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12
Q

What generates the reflex arc

A

Lower motor neurone and sensory system

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13
Q

What are the signs of a lower motor neurone disorder

A

Decreased tone

Decreased reflexes

Weakness

Wasting

Fasciculation

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14
Q

How is decreased tone shown in lower motor neurone disorder

A

Floppiness

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15
Q

Why are reflexes decreased in lower motor neurone

A

As reflex arc not working - cant produce reflex

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16
Q

How does weakness, wasting and fasciculation occur in lower motor neurone disorder

A

Due to degeneration of nerve fibres (weakness) causing shrinkage (wasting) and therefore you can see nerve fibres flickering under the skin (fasciculation)

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17
Q

What is a sensory level

A

What level the lesion/damage occurs in the spinal cord as no sensory sensation is felt below that level

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18
Q

What is Brown squared syndrome

A

A hemicord/half cord lesion that results in a cross sensory deficit

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19
Q

How does a cross sensory deficit occur in a hemicord lesion

A

As different sensory signals go up different pathways in the body

Spinothalmic crosses at entry of spinal cord and Dorsal column doesn’t cross over in the spinal cord but the medulla

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20
Q

What tract is responsible for the ipsilateral symptoms of a hemicord lesion

A

Dorsal column

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21
Q

What tract is responsible for the contralateral symptoms of a hemicord lesion

A

Spinothalmic

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22
Q

What is the ipsilateral symptoms of a hemicord lesion

A

Decreased vibration
Decreased joint position sense
Weakness

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23
Q

What is the contralateral symptoms of a hemicord lesion

A

Decreased pain

Decreased temperature

24
Q

What are other signs noted on a spinal cord lesion

A

Autonomic signs - e.g. bladder and bowel

25
Q

What is the specific signs of a root lesion

A

Restricted deficit: Dermatonal loss of sensory and motor sensation

26
Q

What is the commonest cause of root lesion

A

Herniated disc

27
Q

What are the extrinsic causes o myelopathy

A

Tumour

Vascular abnormalities
(Haemorrhage, dural fistula)

Degenerative (spine)

Trauma

28
Q

What are the tumours that can occur in and around the spine

A

Extradural,

intradural/extramedullary,

intramedullary

29
Q

What are the medical causes of myelopathy

A

De-myelination

Auto-immune

Sarcoid

Ischaemic

Heamorrhage

Infection

B12 deficiency

Malignant/infiltrative

Congenital/genetic

Idiopathic

30
Q

What are antibody mediated autoimmune cause of myelopathy

A

aquaporin 4

Lupus

31
Q

What Viral and bacterial infections can cause myelopathy

A

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

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

Schistosomiasis

32
Q

What is a congenital /genetic cause of myelopathy

A

Friedrich’s ataxia,

Spinocerebellar ataxias

33
Q

What is an example of a malignant/infiltrative cause of myelopathy

A

Glioma

a malignant tumour of the glial tissue of the nervous system

34
Q

What is the causes of spinal cord ischaemia

A

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

35
Q

What is the clinical presentation of spinal cord stroke

A

Onset may be sudden or over several hours

Back pain +- radiates
Visceral referred pain

Weakness/numbness

Paraparesis - paralysis waist down

Urinary symptoms (retention)

36
Q

Why does paraparesis occur rather than quadraparesis

A

due to vulnerability of thoracic cord to flow related ischaemia

37
Q

What is a follow up symptom as spinal cord shock settles

A

Bladder and bowel incontinence

38
Q

The arteries of the spinal cord is anterior and posterior spinal arteries

What does the anterior spinal artery supply

A

The central area of the spinal cord which is pre-dominatly a motor area

39
Q

What is usually the spinal artery affected that causes spinal cord stroke (what area does this affect)

A

Anterior spinal artery - the ventral/motor area

40
Q

Where would an occlusion to occur for partial Brown-sequard syndrome

A

Central sulcal artery

41
Q

What area in the spine would spinal cord stroke usually occur

A

Mid thoracic

42
Q

What investigation occurs in spinal cord stroke

A

MRI

43
Q

What treatment is used to reduce the risk of a recurrent spinal cord stroke

A

Maintain adequate BP

Reverse hypovolaemia/arrhythmia

Antiplatelet therapy

44
Q

What needs to be managed in a spinal cord stroke

A

Vascular risk factors

45
Q

What healthcare professionals are involved in the treatment of spinal cord stroke

A

Occupational therapist

Physiotherapist

46
Q

What sign usually suggests major recovery is low

A

No significant motor recovery in first 24 hours

47
Q

What is the commonest cause of medical spinal cord disease

A

demyelinating myelitis - part of MS

48
Q

What is the characteristic pathology of demyelinating myelitis MS

A

Lesions of inflammation and demyelination in the white matter of the CNS leading to temporary neuronal dysfunction

49
Q

What is causes of B12 definceny

A

Percinous anaemia
Total gastrectomy
Crohns
Tape worms

50
Q

What parts of the nervous system does B12 deficiency affect

A

Myelopathy

Peripheral neuropathy

Brain

Eye/optic nerves

Brainstem

cerebellum

51
Q

What is the presentation of B12 deficient myelopathy

A

Paraesthesia hands and feet, (absent reflexes)

Extensor plantar

paraplegia

Sensory ataxia

Painless retention of urine

52
Q

What sign occurs when B12 deficient myelopathy cause degeneration of corticospinal tracts

A

paraplegia

53
Q

What sign occurs when B12 deficient myelopathy cause degeneration of dorsal columns

A

Sensory ataxia

54
Q

What is the investigations for vitamins B12 deficient myelopathy

A

FBC/ Blood film

B12 test

55
Q

What is the treatment of B12 deficient myelopathy

A

Intramuscular B12

The Nervous System: Pathology (25 decks)

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