Diseases of the Spinal Cord & Nerve Roots (Medical)

Question 1

What are the classic UMN signs?

Answer 1

Increased tone
Hyperreflexia
Pyramidal pattern of weakness

Question 2

What are the classic LMN signs?

Answer 2

Decreased tone
Hyporeflexia
Weakness

Question 3

What sensory signs are caused by radiculopathy?

Answer 3

Dermatomal pattern of sensory loss

Question 4

Leisions to what tracts will cause ipsilateral deficit?

Answer 4

UMN - pyramidal

Dorsal column

Question 5

Leisions to which tracts will cause contralateral deficit?

Answer 5

Spinothalamic

Question 6

What is myelopathy?

Answer 6

Disease of the spinal cord

Question 7

Give some causes of myelopathy

Answer 7

Demyelination (MS)
Islamic - occlusion of blood vessel including dissection of aortic aneurysm, emboli, atherosclerosis
Transverse Myelitis
Neurodegenerative - Friedrich's ataxia, spinocerebellar ataxias
Metabolic, B12 deficiency
Malignant/infiltrative
Infective - Lyme's, AIDS
Inflammatory

Question 8

Recognise that spinal stroke/infarction causes ischaemic myelopathy and there are multiple causes

Answer 8

Ok

Question 9

What are the clinical features of spinal cord stroke?

Answer 9

May have vascular risk factors
Onset may be sudden or over several hours
Pain in the back/radicular
Weakness - usually paraparesis rather than quadraparesis given vulnerability of thoracic cord to flow related ischaemia
Numbness
Urinary symptoms - retention followed by incontinence

Question 10

What artery is most commonly affected in spinal stroke?

Answer 10

Anterior spinal

Question 11

What is Brown-Sequard syndrome?

Answer 11

Damage to one full half of the spinal cord. It results in paralysis on the ipsilateral side as well as touch and proprioception. On the contralateral side there is loss of pain and temperature

Question 12

What part of the spine does spinal stroke most commonly affect?

Answer 12

The mid thoracic area

Question 13

What is the treatment for spinal cord stroke?

Answer 13

Supportive
Reduce risk of recurrence - maintain adequate BP, bed rest, reverse hypovolaemia/arrhythmia
OT and physio
Manage vascular risk factors

Question 14

What is a good indicator in the first 24 hours of spinal stroke prognosis

Answer 14

Unless there is significant motor recovery in the first 24 hours the chance of major recovery is very low

Question 15

What is the overall prognosis in spinal shock?

Answer 15

Pain may be persistent and significantly contribute to disability
20% mortality, only 35-40% have more than minimal recovery

Question 16

What is demyelinating myelitis?

Answer 16

Usually part of MS
Common cause of medical spinal disease, can affect the young

Characterised by pathological lesions of inflammation and demyelination leading to temporary neuronal dysfunction
Affects the white matter of the CNS

Question 17

What is transverse myelitis?

Answer 17

Myelitis that affects the entire width of the spinal cord

Question 18

Give some causes of transverse myelitis

Answer 18

NB: may be the initial presentation of MS

Idiopathic
Viral - VZV, HSV, EBV, flu, HIV
Other infections - syphilis, measles, Lyme
Autoimmune - SLE, sjogre's, sarcoidosis
Post vaccination - chicken pox, rabies

Question 19

Recognise the impact of B12 deficiency on the majority of the nervous system

Answer 19

Ok

Question 20

What are the features of B12 deficient myelopathy?

Answer 20

Paraesthesia of hands and feet, areflexia
First UMN sign is increased plantars
Degeneration of corticospinal tracts leads to paraplegia
Degeneration of dorsal columns leads to sensory ataxia
Painless retention of urine

Often too late for treatment