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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

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
Describe the clinical presentation of a disc prolapse
* 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
How is a disc prolapse managed
* Rehabilitation * Nerve root inject * Lumbar/cervical discectomy
27
What is caudal equine syndrome
Prolapse or herniation of disc which compresses nerve roots within narrowed spinal canal
28
What are the red flags that would suggest caudal equine syndrome
* Bilateral sciatica * Saddle anaesthesia * Urinary dysfunction
29
How is caudal equine syndrome managed
MRI | Emergency lumbar disectomy
30
Degenerative change in the spine can be caused by
o Disc prolapse o Ligamentum hypertrophy o Osteophyte formation
31
What is Cervical Spondylosis
* 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
How is Cervical Spondylosis managed
* Conservative if no/mild myelopathy * Surgery for progressive moderate to severe myelopathy * Anterior and posterior approaches
33
What is lumbar spinal stenosis
Narrowing of the spinal canal
34
What are the clinical presentations of lumbar stenosis
* Pain down both legs ‘spinal claudication’ | * Worse on walking/standing and relieved by sitting or bending forward
35
How is lumbar stenosis managed
• Management with lumbar laminectomy
36
Name intramural spinal tumours
* Meningioma * Neurofibroma * Lipoma
37
Name Intramedullary tumours
* Astrocytoma * Ependymoma * Teratoma * Haemangioblastoa
38
Name extradural spinal tumours
* Metastases (lung, breast, prostate) | * Primary bone tumours (chrodomas, osetoblastomas, osteoid osteoma)
39
Describe the clinical presentation of malignant cord compression
* 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
Name types of spinal infections
* Osteomyelitis: infection within vertebral body * Discitis: infection of intervertebral disc * Epidural abscess: infection in the epidural space
41
What are the clinical features of an epidural abscess
Back pain Pyrexia Focal neurology
42
Name risk factors for epidural abscess
IV drug abuse, diabetes, chronic renal failure, alcoholism
43
Main causative organisms of epidural abscess
Staph aureus Streptococcus E coli
44
How is an epidural abscess managed
Surgical decompression and long term IV antibiotics
45
Name risk factors for Osteomyelitis
IV drug abuse, diabetes, chronic renal failure, alcoholism, AIDS
46
How is Osteomyelitis managed
Antibiotics and surgery is evidence of neurology
47
• 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
* Cauda Equina Syndrome * Requires urgent MRI * Emergency lumbar discectomy
48
• 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
• UMN lesion (metastases)- Cervical Myelopathy • MRI Surgery and Radiotherapy
49
• 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
* Epidural abscess | * Managed with urgent surgical decompression and long-term IV antibiotics
50
What reflex does C5 test
Biceps
51
What reflex does C6 test
Brachioradialis
52
What reflex does C7 test
Triceps

Neurology (44 decks)

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