Diseases of the Spinal Cord and Nerve Roots

Question 1

Where do injuries causing myelopathy/myelitis tend to occur? Radiculopathy/radiculitis?

Answer 1

Myelopathy/myelitis - tends to affect the spinal cord (UMNs)

Radiculopathy/radiculitis - affects the spinal nerve roots (LMNs)

Question 2

Signs of upper motor neuron pathology?

Answer 2

• Delayed muscle wasting (disuse)
• Increased tone
• Increased reflexes
• Extensor plantar / + Babinski (toes up)
• Pyramidal pattern of weakness

Question 3

Signs of lower motor neuron pathology?

Answer 3

• Muscle wasting (denervation)
• Decreased tone
• Decreased reflexes
• Flexor plantar (- Babinski)
• Weakness

Question 4

What is Brown-Sequard Syndrome? What are the characteristic sensory signs?

Answer 4

• Hemicord (half-cord) lesion of SC at certain level
• Loss of mechanoreceptors/proprioception on ipsilateral side of lesion. Weakness on this side also
• Loss of pain and temperature sense on contralateral side of lesion

Question 5

sensory signs of nerve root damage?

Answer 5

Dermatomal sensory loss

Question 6

What is Myelopathy?

Answer 6

Injury to the nerves located in the spinal cord (UMNs)

Question 7

What is radiculopathy?

Answer 7

Injury to specific nerve roots (LMNs)

Question 8

Autonomic nervous signs of radiculopathy?

Answer 8

Bladder/bowel incontinence

Question 9

What is pyramidal pattern weakness?

Answer 9

• UMN lesion weakness

Question 10

Causes of myelopathy/radiculopathy?

Answer 10

• Congenital disease
• Inflammation (MS/Sarcoid)
• Infection
• Tumours
• Vascular abnormalities (haemorrhage/dural fistula)
• Degeneration (spine)
• Metabolic (B12 deficiency)
• Trauma

Question 11

Most common causes of acquired myelopathy?

Answer 11

• MS (demyelination)
• Ischaemia (vascular cause)
• B12 Deficiency

Question 12

Look at arterial supply to the spinal cord

Answer 12

Print a diagram

Question 13

Causes of spinal cord ischaemia?

Answer 13

Vascular pathology

• Atheroma
• Thromboembolism
• Arterial dissection
• Hypotension
• etc.

Question 14

Clinical presentation of spinal cord stroke?

Answer 14

• Pain (flank/visceral referred)
• Weakness (usually in lower limbs more than upper)
• Numbness and paraesthesia
• Urinary symptoms (retention followed by incontinence)

Question 15

Which artery is usually occluded during spinal cord stroke? Where along the spine does occlusion usually occur?

Answer 15

• Usually anterior spinal artery (dorsal columns spared)

- Usually in mid-thoracic region

Question 16

Treatment of spinal cord stroke?

Answer 16

Reduce risk of recurrence:

• Maintain adequate BP
• Reverse hypovolaemia/arrhythmia
• Antiplatelets

Question 17

What’s the prognosis like for spinal cord stroke?

Answer 17

• Unless significant motor function is recovered within first 24 hours chance of major recovery is low
• 20% mortality, 35-40% have more than minimal recovery

Question 18

What is often the initial presentation of MS?

Answer 18

Demyelinating myelitis

Can occur without MS, subacute onset and spontaneous recovery

Question 19

How to determine if demyelinating myelitis is MS related or not?

Answer 19

• CSF has few white cells (<50) in MS

Question 20

Nervous system effects of vitamin B12 deficiency?

Answer 20

• Myelopathy
• Peripheral neuropathy
• Eye/optic nerve issues
• Brain/brainstem pathology

Question 21

Signs of B12 deficiency myelopathy?

Answer 21

• Paraesthesia
• Areflexia
• Positive Babinsky
• Painless retention of urine

Question 22

Investigations and treatment for B12 deficient myelopathy?

Answer 22

Investigations:
- FBC/blood film (check B12)

Treat with intramuscular B12