HVLA LECTURE 3 FINISHED

Question 1

HORNER’S SYNDROME
Definition
Classic signs
Causes

Answer 1

Is the result of disruption to the sympathetic nervous system that supplies the eye and face.

CLASSIC SIGNS:
Miosis
Enopthalmus (eyeballs sink back into the sockets)
Upper lid Ptosis (eye lid droop)
Facial anhidrosis (lack of sweating on one side of the face)
Pupillary miosis

CAUSES:
VBI
Pancoast tumour
Lesion to the brainstem (tumour, stroke, syrinx)
Trauma to the brachial plexus 
Migrane
Tumour to the other parts of the brain

Question 2

What is a pancoast tumour?

Answer 2

A tumour in the apex of the lung (upper part of the lung under the clavicle)

Question 3

What other SSX could a pan coast tumour also present with?

Answer 3

SOB
Sputum
Coughing
Numbness and tingling in C8-T1 dermatomes and radial nerve pathway.

Question 4

CERVICAL MYELOPATHY
Definition
SSX
Causes

Answer 4

DEFINITION
Is the compression of the spinal cord in the cervical region, as a result of compression or ischaemia.

SSX:
Heavy feelings in the arms and legs, numbness and tingling in the limbs, lack of ability to do fine motor tasks, increased reflexes and muscular tone, issues with gait, pain

CAUSES:
Degeneration of the spinal elements e.g. discs, vertebra, joints
Disc bulge, prolapse
Pathology in the vertebral canal

Question 5

CERVICAL ARTERY DISSECTION
Definition
SSX

Answer 5

DEFINITION
A tear in the layer of the artery which results in arterial blood to move into the walls and split the layers, causing an intramural haematoma or aneurysmal dissection which can cause an emboli.

SSX:
Minor mechanical trauma to the neck
Occipital headaches
Cervical spine pain
Dizziness
Ataxia (lack of voluntary coordination of muscle movements) or unsteadiness

Question 6

What are the 4 recommendations for Cervical Artery Dissection:

Answer 6

1) Recognise that a CAD can present as acute onset cervical spinal pain and headache
2) CAD should be considered as a DD for cervical spine pain of less than one weeks duration.
3) Factors that could indicate a a dissection in progress should be followed up with the appropriate neurological and/or cardiovascular examination and referred for further investigation if necessary.
4) Cervical pre-manipulative screening tests should not be performed due to their lack of validity and clinical utility.

Question 7

What are some historical factors that could be linked to cervical artery dissection?

Answer 7

Acute onset unilateral cervical spinal pain
Acute onset occipital, frontal, temporal or supraorbital pain
Current history of migraine
History of cervical trauma
Onset of pain related to sudden cervical movement
Tinnitus
History of hypertension and risk factors for cardiovascular disease
Recent upper/lower respiratory infection (within the last week)
Upper/lower extremity neurological symptoms

Question 8

UPPER CERVICAL INSTABILITY
Definition
Causes
SSX

Answer 8

DEFINITION:
Instability of the upper cervical segments due to compromise in alar and/or transverse atlantal ligament (TAL) causing clinical signs and symptoms.

CAUSES:
Congenital
Inflammatory
Neoplastic 
Trauma

SSX
Neck pain
Limitations of neck movements
Torticollis
HA
Dizziness
Tinnitus
Dysphagia
Spasticity
Pareses

Question 9

What are some congenital causes of upper cervical instability?

Answer 9

• Incompetence of the odontoid process
  e.g. separate odontoid
  Free apical segment
  Agenesis of the odontoid base or process etc.
• Incompetence of the transverse atlantal ligament e.g. downs syndrome

Question 10

What are some inflammatory causes of upper cervical instability:

Answer 10

• Incompetence of the odontoid process e.g. osteomyelitis
• Incompetence of the TAL
  e.g. bacterial/ viral infection
  Granulomatous change
  RA
  Ankylosing spondylitis

Question 11

What are some neoplastic causes of upper cervical instability?

Answer 11

• Incompetence of the odontoid process

e. g. Primary or metastatic bone tumour

Question 12

What are some traumatic causes of upper cervical instability?

Answer 12

• Incompetence of the odontoid process
  e.g. acute bony injury
  chronic bony change

Incompetence of the TAL
e.g. acute ligamentous damage associated with trauma and fracture
chronic ligamentous damage

Question 13

Cardinal SSX of upper cervical instability:

Answer 13

1) Overt loss of balance in relation to head movements
2) Fascial lip paraesthesia, reproduced by active or passive cervical neck movements
3) Bilateral or quadrilateral limb paraesthesia either constant or reproduced by neck movement.
4) Nystagmus produced by active or passive movements