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Nervous System > Diseases of the Spinal Cord and Nerve Roots > Flashcards

Diseases of the Spinal Cord and Nerve Roots Flashcards

1
Q

What are the five vertebral ligaments?

A
  • Anterior longitudinal ligament
  • Posterior longitudinal ligament
  • Ligamentum flavum
  • Interspinal ligament
  • Supraspinous ligament
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2
Q

What are the two parts to the vertebral disc?

A

Nucleus pulposus and anulus fibrosis

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3
Q

What are the boundaries of the spinal cord

A

C1-L2

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4
Q

Where does the spinal cord end?

A

At the conus medularis and become cauda equina (contain film terminale)

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5
Q

What myotome does C5 supply?

A

Elbow flexors

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6
Q

What myotome does C6 supply?

A

Wrist extensors

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7
Q

What myotome does C7 supply?

A

Elbow extensors

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8
Q

What myotome does C8 supply?

A

Finger extensors

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9
Q

What myotome does T1 supply?

A

Intrinsic hand muscles

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10
Q

What myotome does L2 supply?

A

Hip flexors

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11
Q

What myotome does L3 supply?

A

Knee extensors

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12
Q

What myotome does L4 supply?

A

Ankle dorsiflexors

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13
Q

What myotome does L5 supply?

A

Long toe extensors

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14
Q

What myotome does S1 supply?

A

Ankle plantar flexors

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15
Q

Describe the signs of an UMN lesion

A
  • Weakness
  • No atrophy
  • Increased reflexes
  • Increased tone
  • No fasiculations
  • Babinski sign present
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16
Q

Describe the signs of LMN lesion

A
  • Weakness
  • Atrophy present
  • Decreased reflexes
  • Decreased tone
  • Fasiculations present
  • No babinski sign
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17
Q

How to localise lesion?

A

Pain?
Sensory?
Weakness?
UMN vs LMN

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18
Q

Define myelopathy

A

Neurological deficit due to compression of spinal cord

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19
Q 
What is the cause of:
Weakness in elbow below
Sensory level at C6
Increased tone in legs
Brisk reflexes
Babinski +ve
A

Myelopathy (UMN)

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20
Q

Define radiculopathy

A

Compression of nerve root leading to dermatomal and myotomal deficits

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21
Q 
What is the cause of;
Pain down ipsilateral leg
Numbness in L4 dermatome
Weakness in ankle dorsiflexion
Reduced knee jerk
A

Radiculopathy

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22
Q

Name five causes of spine disease

A
  • Degenerative
  • Tumour
  • Infection
  • Trauma
  • Congenital
23
Q

What is a disc prolapse?

A

Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord

24
Q

What are two common parts of the spine for disc prolapse to occur?

A

Cervical and lumbar

25
Q

What are the the effects of cervical disc prolapse?

A

Central –> cervical myelopathy

Lateral –> cervical radiculopathy

26
Q

What are the effects of lumbar disc prolapse?

A

Central –> cauda equina syndome (CES)

Lateral –> lumbar radiculopathy

27
Q

What are the symptoms of disc prolapse?

A
  • Acute pain down leg/arm

* Numbness and weakness in distribution of nerve root involved

28
Q

What is used to investigate disc prolapse?

A

MRI

29
Q

What is the management of disc prolapse?

A
  • Rehabilitation
  • Nerve root inject
  • Lumbar/cervical discectomy
30
Q

What are red flags of cauda equina syndrome?

A
  • Bilateral sciatica
  • Saddle anaesthesia
  • Urinary dysfunction
31
Q

What is the investigation and management of CES?

A
  • Medical emergency
  • Clinico-radiological diagnosis
  • Requires urgent MRI
  • Emergency lumbar discectomy
32
Q

What are degenerative spinal diseases?

A

Loss of normal spinal structure

33
Q

What are causes of degenerative spinal disease?

A
  • Disc prolapse
  • Ligamentum hypertrophy
  • Osteophyte formation
34
Q

What are cervical spondylosis?

A

Umbrella term for degenerative change in cervical spine leading to spine and nerve root compression

Patient can present with either myelopathy or radiculopathy (or both)

Speed of onset is usually months to years

35
Q

How do you manage cervical spondylosis?

A
  • Conservative if no/mild myelopathy
  • Surgery for progressive moderate to severe myelopathy
  • Anterior and posterior approaches
36
Q

What is the clinical presentation of lumbar spinal stenosis?

A
  • Pain down both legs ‘spinal claudication’

* Worse on walking/standing and relieved by sitting or bending forward

37
Q

What is the management of lumbar spinal stenosis?

A

Lumbar laminectomy

38
Q

Name three intradural, extramedullary spinal tumours

A
  • Meningioma
  • Neurofibroma
  • Lipoma
39
Q

Name four intramedullary tumours

A
  • Astrocytome
  • Ependymoma
  • Teratoma
  • Haemangioblastoma
40
Q

Name types of extradural tumours

A
  • Metastases (lung, breast, prostate)

* Primary bone tumours (chrodomas, osteoblastomas, osteiud osteoma)

41
Q

What is the clinical presentation of malignant cord compression?

A

Patient present with pain, weakness, sphincter disturbance

42
Q

How should you investigate malignant cord compression?

A

If known cancer, should get urgent MRI if develops back pain

43
Q

How do you manage malignant cord compression?

A

Surgical decompression and radiotherapy

44
Q

Name three types of spinal infections

A
  • Osteomyelitis
  • Discitis
  • Epidural abscess
45
Q

What is osteomyelitis?

A

Infection within vertebral body

46
Q

What is discitis?

A

Infection of intervertebral disc

47
Q

What is epidural abscess?

A

Infection in the epidural space

48
Q

What is the triad of symptoms of an epidural abscess?

A
  • Back pain
  • Pyrexia
  • Focal neurology
49
Q

What are the risk factors for epidural abscess?

A

IV drug abuse, diabetes, chronic renal failure, alcoholism

50
Q

What are the causative organisms of epidural abscesses?

A

Staph aureus, streptococcus, E. coli

51
Q

What is the investigation and management of epidural abscesses?

A
  • Urgent MRI

* Managed with urgent surgical decompression and longterm IV antibiotic

52
Q

What are risk factors for osteomyelitis?

A

IV drug abuse, diabetes, chronic renal failure, alcoholism, AIDS

53
Q

What is the management of osteomyelitis?

A
  • Antibiotics

* Surgery if evidence of neurology

Nervous System (47 decks)

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