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Neurology > Lecture 43 Disease of the Spinal Cord and Nerve Root > Flashcards

Lecture 43 Disease of the Spinal Cord and Nerve Root Flashcards

1
Q

How many cervical vertebrae are there

A

7

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2
Q

How many thoracic vertebrae are there?

A

12

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3
Q

How many lumbar vertebrae are there

A

5

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4
Q

How many sacral vertebrae are there

A

5

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5
Q

How many coccyx vertebrae are there

A

4

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6
Q

What vertebral levels does the spinal cord extend

A

C1-L2/L3

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7
Q

Name the structures the follow after the spinal cord ends

A

Conus Medularis
Cauda equina
Filum Terminale

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8
Q

Describe the signs of an UMN lesion

A 
Weakness
No atrophy
Hyperreflexia
Hypertonia
No fasciculation
Postive Babinski sign
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9
Q

Describe the signs of a LMN lesion

A 
Weakness
Atrophy
Reduced reflexes
Reduced tone
Fasciculations
No babinski sign
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10
Q

What spinal level is responsible for elbow reflexes

A

C5

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11
Q

What is the is the spinal level for wrist extensors

A

C6

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12
Q

What is the spinal level for elbow extensor

A

C7

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13
Q

What is the spinal level for finger extensors

A

C8

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14
Q

What is the spinal level for intrinsic hand muscles

A

T1

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15
Q

What is the spinal level for hip flexors

A

L2

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16
Q

What is the spinal level for knee extensors

A

L3

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17
Q

What is the spinal level for ankle dorsiflexors

A

L4

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18
Q

What is the spinal level is long toe extensors

A

L5

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19
Q

Which spinal level is ankle plant flexors

A

S1

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20
Q

What type of lesion is Cervical Radiculopathy

A

LMN

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21
Q

Describe the features of cervical radiculopathy at L4 nerve root

A
  • Pain down ipsilateral leg
  • Numbness in L4 dermatome
  • Weakness in ankle dorsiflexion
  • Reduced knee jerk
  • Weakness, altered sensation and hyporeflexia
22
Q

What type of lesion isn Cervical Myelpathy

A

UMN

23
Q

Describe the features of Cervical myelopathy at C5

A
  • Weakness in shoulder and below
  • Sensory level at C5
  • Increased tone in legs
  • Brisk reflexes
  • Babinski +ve
  • Altered gait, weakness, hyperreflexia
  • Bowel/bladder dysfunction
  • Clonus
24
Q

What is a disc prolapse

A

• Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord

25
Q

Describe the clinical presentation of a disc prolapse

A
  • Younger patients
  • Tends be acute onset pain
  • Acute pain down leg/arm
  • Numbness and weakness in distribution of nerve root involved
  • Investigation with MRI
26
Q

How is a disc prolapse managed

A
  • Rehabilitation
  • Nerve root inject
  • Lumbar/cervical discectomy
27
Q

What is caudal equine syndrome

A

Prolapse or herniation of disc which compresses nerve roots within narrowed spinal canal

28
Q

What are the red flags that would suggest caudal equine syndrome

A
  • Bilateral sciatica
  • Saddle anaesthesia
  • Urinary dysfunction
29
Q

How is caudal equine syndrome managed

A

MRI

Emergency lumbar disectomy

30
Q

Degenerative change in the spine can be caused by

A

o Disc prolapse
o Ligamentum hypertrophy
o Osteophyte formation

31
Q

What is Cervical Spondylosis

A
  • Umbrella term for degenerative change in cervical spine leading to spine and nerve root compression
  • Patient can present with either myelopathy or radiculopathy (or both)
  • Speed of onset is usually months to years
32
Q

How is Cervical Spondylosis managed

A
  • Conservative if no/mild myelopathy
  • Surgery for progressive moderate to severe myelopathy
  • Anterior and posterior approaches
33
Q

What is lumbar spinal stenosis

A

Narrowing of the spinal canal

34
Q

What are the clinical presentations of lumbar stenosis

A
  • Pain down both legs ‘spinal claudication’

* Worse on walking/standing and relieved by sitting or bending forward

35
Q

How is lumbar stenosis managed

A

• Management with lumbar laminectomy

36
Q

Name intramural spinal tumours

A
  • Meningioma
  • Neurofibroma
  • Lipoma
37
Q

Name Intramedullary tumours

A
  • Astrocytoma
  • Ependymoma
  • Teratoma
  • Haemangioblastoa
38
Q

Name extradural spinal tumours

A
  • Metastases (lung, breast, prostate)

* Primary bone tumours (chrodomas, osetoblastomas, osteoid osteoma)

39
Q

Describe the clinical presentation of malignant cord compression

A
  • Patient present with pain, weakness, sphincter disturbance
  • If known cancer, should get urgent MRI if develops back pain
  • Management involves surgical decompression and radiotherapy
40
Q

Name types of spinal infections

A
  • Osteomyelitis: infection within vertebral body
  • Discitis: infection of intervertebral disc
  • Epidural abscess: infection in the epidural space
41
Q

What are the clinical features of an epidural abscess

A

Back pain
Pyrexia
Focal neurology

42
Q

Name risk factors for epidural abscess

A

IV drug abuse, diabetes, chronic renal failure, alcoholism

43
Q

Main causative organisms of epidural abscess

A

Staph aureus
Streptococcus
E coli

44
Q

How is an epidural abscess managed

A

Surgical decompression and long term IV antibiotics

45
Q

Name risk factors for Osteomyelitis

A

IV drug abuse, diabetes, chronic renal failure, alcoholism, AIDS

46
Q

How is Osteomyelitis managed

A

Antibiotics and surgery is evidence of neurology

47
Q

• 37 year old lady presented with sudden onset pain in both legs. She has also noticed that she has difficulty starting flow when she passes urine. She has normal power in her legs but reduced pin prick sensation around bottom. What does she have, how is it managed

A
  • Cauda Equina Syndrome
  • Requires urgent MRI
  • Emergency lumbar discectomy
48
Q

• 69 year old patient with a history of breast cancer. She sees her GP with neck pain and pain radiating down her right arm. C6 dermatomal numbness but otherwise normal neurology. What does she have? how is it managed

A

• UMN lesion (metastases)- Cervical Myelopathy
• MRI
Surgery and Radiotherapy

49
Q

• 22 year old IVDU who presented with 3 week history back pain and loss of power in his legs. He was cachectic and had 1000mls in his bladder before catheterization and was pyrexial. What do they have and how is it managed

A
  • Epidural abscess

* Managed with urgent surgical decompression and long-term IV antibiotics

50
Q

What reflex does C5 test

A

Biceps

51
Q

What reflex does C6 test

A

Brachioradialis

52
Q

What reflex does C7 test

A

Triceps

Neurology (44 decks)

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