Diseases of the Spinal Cord and Nerve Roots

Question 1

What are the upper motor neurone signs of cord/root pathologies?

Answer 1

No wasting
Increased tone
Increased reflexes, extensor plantar
Pyramidal pattern of weakness

Question 2

What are the lower motor neurone signs of cord/root pathologies?

Answer 2

Decreased tone
Decreased reflexes, flexor plantar
Weakness

Question 3

What are the signs of C5 cord lesions?

Answer 3

Wasting of C5 innervated muscles
Tone more increased in arms than in legs
Reflexes decreased in biceps but increased in all lower reflexes
Decreased power in all C5 innervated muscles

Question 4

What are the causes of myelopathy?

Answer 4

Congenital- Friedrich’s ataxia, spinocerebellar ataxias, hereditary parapresis
Acquired- inflammation, vascular, infective, metabolic (B12 deficiency), malignant, idiopathic, trauma, surgical

Question 5

What are the causes of spinal cord ischaemia?

Answer 5

Atheromatous disease
Thromboembolic disease
Arterial dissection
Systemic hypotension
Thrombotic haematological disease
Hyperviscosity syndromes
Vasculitis
Venous occlusion
Endovascular procedures
Decompression sickness
Meningovascular syphilis

Question 6

How does a spinal cord stroke present?

Answer 6

Onset can be sudden or over several hours
Pain- Back pain with possible referred visceral pain
Weakness- usually paraparesis
Numbness and paraesthesia
Urinary symptoms (retention followed by incontinence)

Question 7

Which artery is most commonly causative of a spinal cord stroke?

Answer 7

Anterior spinal artery

Question 8

Describe the management of a spinal cord stroke

Answer 8

Reduce risk of recurrence- maintain adequate BP, reverse hypovolaemia/arrhythmia, anti-platelet therapy
OTs and physiotherapy
Manage vascular risk factors

Question 9

What does the return of function after a spinal cord stroke depend on?

Answer 9

The degree of parenchymal damage

Question 10

What dietary components is vitamin B12 abundant in?

Answer 10

Meat, fish and most animal by-products

Legumes

Question 11

How does B12 deficient myelopathy present?

Answer 11

Paraesthesia and areflexia in hands and feet
First UMN sign- extensor plantars
Degeneration of corticospinal tracts causes paraplegia, dorsal columns causes sensory ataxia
Painless retention of urine

Question 12

What investigations can be useful in B12 deficient myelopathy?

Answer 12

FBC/Blood film

B12 levels

Question 13

How is B12 deficient myelopathy treated?

Answer 13

Intramuscular B12