Lecture 22 Medical Diseases of the Spinal Cord

Question 1

Myelopathy describes disease of the __

Answer 1

Spinal cord

Question 2

Radiculopathy describes diseases of the __

Answer 2

Spinal Roots

Question 3

UMN- cord motor signs

Answer 3

• No wasting
• ↑tone
• ↑reflexes, extensor plantar
• Pyramidal pattern of weakness

Question 4

LMN- root motor signs

Answer 4

• wasting
• ↓tone
• ↓reflexes, flexor plantar
• Weakness

Question 5

What is Brown Squared Syndrome

Answer 5

is 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.

Question 6

A hemi-section on the left side of the spinal cord would result in what

Answer 6

•	Ipsilateral Side-left:
o	↓ vibration 
o	↓ joint position sense
o	Weakness
•	Contralateral Side- right
o	↓ pain 
o	↓ temperature

Question 7

What would you see in a C5 cord lesion

Answer 7

• Wasting of C5 innervated muscles
• ↑ tone in legs > arms
• Power ↓C5 innervated muscles, pyramidal pattern below
• Reflexes ↓biceps, ↑all lower reflexes

Question 8

Name causes of Myelopathy or Radiculopathy

Answer 8

o	Tumour
o	Extradural, intradural/extramedullary, intramedullary
o	Vascular abnormalities
o	Haemorrhage
o	AVM, dural fistula
o	Degenerative (spine)
o	Trauma

Question 9

Congenital causes of Myelopathy

Answer 9

– Friedrich’s ataxia, spinocerebellar ataxias, hereditary paraparesis

Question 10

Acquired cause of Myelopathy

Answer 10

Demyelination (MS)
Ischaemic- Stroke
B12 deficiency

Question 11

Name Causes of Spinal Cord Ischaemia

Answer 11

• Atheromatous disease (aortic aneurysm)
• Thromboembolic disease (endocarditis, AF)
• Arterial dissection (aortic)
• Systemic hypotension
• Hyperviscosity syndromes / prothombotic disease
• Vasculitis
• Arteriovenous abnormalities
• Endovascular procedures
• Meningovascular syphilis
• Decompression sickness

Question 12

Clinical Presentation of Spinal Cord Stroke

Answer 12

Vascular Risk Factors
Onset sudden or over a period of several hours
Back pain/radicular
Visceral referred pain
Weakness- parapesis
Numbness and paraethesia – Retention followed by bladder and bowel incontinence as spinal shock settles

Question 13

What are of the CNS does MS affect

Answer 13

White matter

One or more lesions

Question 14

Treatment of Demyelinating MS

Answer 14

• Supportive

* Methylprednisolone

Question 15

What are some of the causes of B12 deficiency

Answer 15

• Diet (vegans)
• Pernicious anaemia: autoimmune condition in which antibodies to IF prevent B12 absorption
• Total gastrectomy, Crohn’s, tape worms

Question 16

Symptoms of B12 Deficient Myelopathy

Answer 16

•	Paraesthesia hands and feet, areflexia
•	First UMN sign extensor plantars
•	Degeneration of: 
–	Corticospinal tracts → paraplegia
–	Dorsal columns → sensory ataxia
•	Painless retention of urine

Question 17

Investigation for B12 deficient myelopathy

Answer 17

FBC/blood film (can be N), B12

Question 18

Treatment for B12 deficient myelopathy

Answer 18

Intramuscular B12