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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
What is the specific signs of a root lesion
Restricted deficit: Dermatonal loss of sensory and motor sensation
26
What is the commonest cause of root lesion
Herniated disc
27
What are the extrinsic causes o myelopathy
Tumour Vascular abnormalities (Haemorrhage, dural fistula) Degenerative (spine) Trauma
28
What are the tumours that can occur in and around the spine
Extradural, intradural/extramedullary, intramedullary
29
What are the medical causes of myelopathy
De-myelination Auto-immune Sarcoid Ischaemic Heamorrhage Infection B12 deficiency Malignant/infiltrative Congenital/genetic Idiopathic
30
What are antibody mediated autoimmune cause of myelopathy
aquaporin 4 | Lupus
31
What Viral and bacterial infections can cause myelopathy
Viral: herpes simplex/zoster, EBV, CMV, measles, HIV Bacterial: TB, borrelia (Lyme), syphilis, brucella Schistosomiasis
32
What is a congenital /genetic cause of myelopathy
Friedrich’s ataxia, Spinocerebellar ataxias
33
What is an example of a malignant/infiltrative cause of myelopathy
Glioma | a malignant tumour of the glial tissue of the nervous system
34
What is the causes of spinal cord ischaemia
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
What is the clinical presentation of spinal cord stroke
Onset may be sudden or over several hours Back pain +- radiates Visceral referred pain Weakness/numbness Paraparesis - paralysis waist down Urinary symptoms (retention)
36
Why does paraparesis occur rather than quadraparesis
due to vulnerability of thoracic cord to flow related ischaemia
37
What is a follow up symptom as spinal cord shock settles
Bladder and bowel incontinence
38
The arteries of the spinal cord is anterior and posterior spinal arteries What does the anterior spinal artery supply
The central area of the spinal cord which is pre-dominatly a motor area
39
What is usually the spinal artery affected that causes spinal cord stroke (what area does this affect)
Anterior spinal artery - the ventral/motor area
40
Where would an occlusion to occur for partial Brown-sequard syndrome
Central sulcal artery
41
What area in the spine would spinal cord stroke usually occur
Mid thoracic
42
What investigation occurs in spinal cord stroke
MRI
43
What treatment is used to reduce the risk of a recurrent spinal cord stroke
Maintain adequate BP Reverse hypovolaemia/arrhythmia Antiplatelet therapy
44
What needs to be managed in a spinal cord stroke
Vascular risk factors
45
What healthcare professionals are involved in the treatment of spinal cord stroke
Occupational therapist | Physiotherapist
46
What sign usually suggests major recovery is low
No significant motor recovery in first 24 hours
47
What is the commonest cause of medical spinal cord disease
demyelinating myelitis - part of MS
48
What is the characteristic pathology of demyelinating myelitis MS
Lesions of inflammation and demyelination in the white matter of the CNS leading to temporary neuronal dysfunction
49
What is causes of B12 definceny
Percinous anaemia Total gastrectomy Crohns Tape worms
50
What parts of the nervous system does B12 deficiency affect
Myelopathy Peripheral neuropathy Brain Eye/optic nerves Brainstem cerebellum
51
What is the presentation of B12 deficient myelopathy
Paraesthesia hands and feet, (absent reflexes) Extensor plantar paraplegia Sensory ataxia Painless retention of urine
52
What sign occurs when B12 deficient myelopathy cause degeneration of corticospinal tracts
paraplegia
53
What sign occurs when B12 deficient myelopathy cause degeneration of dorsal columns
Sensory ataxia
54
What is the investigations for vitamins B12 deficient myelopathy
FBC/ Blood film | B12 test
55
What is the treatment of B12 deficient myelopathy
Intramuscular B12

The Nervous System: Pathology (25 decks)

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