Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*Nervous System - Pathology > Diseases of the Spinal Cord & Nerve Roots (Medical) > Flashcards

Diseases of the Spinal Cord & Nerve Roots (Medical) Flashcards

1
Q

What is the difference between a myelopathy and radiculopathy?

A

Myelopathy is a disorder of the spinal cord - UMN; from pressure on the cord
Radiculopathy is a disorder of the spinal roots - LMN; compression of nerve root

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the motor signs of an upper motor neuron lesion - myelopathy?

A

Increased tone
Increased reflexes, extensor plantar
Pyramidal pattern of weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the motor signs of a lower motor neuron lesion - radiculopathy?

A

Decreased tone
Decreased reflexes, flexor plantar
Weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is the plantar reflex significant?

A

The abnormal extensor plantar response reliably indicates metabolic or structural abnormality in the corticospinal system upstream from the segmental reflex (has been observed in structural lesions e.g. haemorrhage, brain and spinal cord tumors, and multiple sclerosis, and in abnormal metabolic states e.g. hypoglycemia, hypoxia, and anesthesia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the sensory signs for a spinal cord pathology?

A

Myelopathy - sensory level

Hemicord lesion - Brown-Sequard syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Brown-Sequard syndrome?

A

A rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side (results from hemisection of spinal cord due to injury or pathology)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the sensory loss in (complete) Brown-Sequard?

A 
On ipsilateral side: 
Reduced vibration 
Reduced joint position sense +WEAKNESS 
[Dorsal Column] 
On contralateral side: 
Reduced pain 
Reduced temperature [Spinothalamic]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the sensory signs of a root pathology?

A

Radiculopathy - dermatomal sensory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the autonomic signs of a cord/root pathology?

A

Bladder/bowel problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some congenital causes of myelopathy?

A

Friedrich’s ataxia
Spinocerebellar ataxias
Hereditary paraparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the categories of acquired medical causes of myelopathy?

A 
Inflammation (demyelination, autoimmune, sarcoid)
Vascular
Infective (viral bacterial, other)
Metabolic 
Malignant/infiltrative
Idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the inflammatory causes of myelopathy?

A

Demyelination - MS
Autoimmune - antibody mediated e.g. aquaporin 4, lupus
Sarcoid (inflammatory cells forming granulomas)

(treated via immunosuppression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the vascular causes for myelopathy?

A

Ischaemic v haemhorrage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are viral infective causes of myelopathy?

A

Herpes simplex/zoster, EBV, CMV, measles, HIV etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are bacterial infective causes of myelopathy?

A

TB, borrelia (Lyme), syphilis, brucella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is another infective cause of myelopathy?

A

Schistomiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a metabolic cause of myelopathy?

A

B12 deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are causes of spinal cord ischaemia?

A, A, T, T, V, V, S, H, E, D, M

A 
Atheromatous disease (aortic aneurysm)
Arterial dissection (aortic)
Thromboembolic disease (endocarditis, AF)
Thrombotic haematological disease
Vaculitis 
Venous occlusion 
Systemic hypotension 
Hyperviscosity syndromes 
Endovascular procedures 
Decompression sickness
Meningovascular syphillis
19
Q

What are some of the features of the clinical presentation of spinal cord stroke?

A
  • may have vascular risk factors
  • onset sudden or over few hours
  • pain
  • weakness
  • numbness + parasthesia
  • urinary symptoms
20
Q

What type of pain is found in spinal cord stroke?

A

Back pain/radicular

Visceral referred pain

21
Q

What type of weakness is found in spinal cord stroke?

A

Usually paraparesis rather than quadraparesis given vulnerability of thoracic cord to flow related ischaemia

22
Q

What urinary symptoms are found in spinal cord stroke?

A

Retention followed by bladder and bowel incontinence as spinal shock settles

23
Q

What artery is usually affected in spinal cord stroke?

A

Anterior spinal artery

24
Q

Occlusion of which artery can present as a partial Brown-Sequard syndrome?

A

Central sulcal artery

25
Q

What investigation should be used for suspected spinal cord stroke?

A

MRI

26
Q

What is the treatment for spinal cord stroke?

A
  • Reduce risk of recurrence (maintain adequate BP, reverse hypovolaemia/arrhythmia, antiplatelet therapy)
  • OT and physio
  • Manage vascular risk factors
27
Q

What is the prognosis for spinal cord stroke?

A
  • return of function depends on degree of parenchymal damage
  • unless sig recovery in first 24 hrs, chance of major recovery is low
  • pain may be persistent + contribute to disability
  • 20% mortality, 35-40% have more than min recovery
28
Q

What is demyelinating myelitis?

A

Inflammation causing damage to myelin sheath of nerve fibres

29
Q

What condition is DM usually a part of?

A

Multiple sclerosis

30
Q

What is demyelinating myelitis in MS characterised by?

A

Pathological lesions of inflammation and demyelination leading to temp neuronal dysfunction; affects white matter of CNS; one or more lesions anywhere

31
Q

Demyelination myelitis of MS

A
  • partial or complete transverse myelitis
  • may be initial presentation of MS (60-70% have MRI brain typical of MS)
  • subacute onset (slower than ischaemia)
  • may be history of neuro/opthalmo episodes
32
Q

What is the treatment for MS myelitis?

A
  • supportive

- Methylpredisnolone

33
Q

What is vitamin B12 found in?

A

Meat, fish and most animal byproducts

34
Q

What does absorption of B12 from the gut require?

A

Intrinsic factor, a binding protein secreted by gastric parietal cells

35
Q

What is pernicious anaemia?

A

An autoimmune condition in which antibodies to intrinsic factor prevent B12 absorption

36
Q

What are the commonest causes of pernicious anaemia?

A

Inability to absorb B12 at the terminal ileum

Failure to produce intrinsic factor in the stomach

37
Q

What does B12 deficiency cause complications in?

A

Total gastrectomy
Crohns
Tape worms

38
Q

How much of the nervous system does B12 deficiency affect?

A

Most of it

39
Q

What parts of the nervous system does B12 def affect?

A
  • Myelopathy (L’Hermitte’s sign - sudden sensation resembling electric shock that passes down back of neck and into spine; may radiate out into arms and legs)
  • Peripheral neuropathy
  • Brain
  • Eye/optic nerves
  • Brainstem
  • Cerebellum
40
Q

How does B12 def present?

A
  • Paraesthesia hands + feet, areflexia
  • First UMN sign extensor plantars
  • Degeneration of: corticospinal tracts -> paraplegia; dorsal columns -> sensory ataxia
  • Painless retention of urine
41
Q

How is B12 def investigated?

A

FBC/blood film, B12

42
Q

How is B12 def treated?

A

Intramuscular B12 injections

Given daily, then once every 3 months

43
Q

Why does treatment for B12 def need to be given quickly?

A

Untreated it can become permanent

*Nervous System - Pathology (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions