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3a neurology > Myelopathy and radiculopathy > Flashcards

Myelopathy and radiculopathy Flashcards

1
Q

Give 2 causes of spinal cord compression

A
  • Vertebral body neoplasms - metastases
  • Disc prolapse/ herniation
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2
Q

Spinal tumours can be secondary to metastatic disease such as…

A

Lung cancer
Breast
Prostate
Kidney
Thyroid

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3
Q

Give 6 features of spinal cord compression

A
  • Back pain (mc)
  • Progressive lower limb weakness - unsteady gait
  • Lesions above L1: UMN signs in legs
  • Lesions below L1: LMN signs in legs and perianal numbess
  • Bladder/ bowel incontinence - late Sx
  • Numbness/ tingling of toes/ fingers
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4
Q

What is normally the first symptom that presents in spinal cord compression

A

Back pain

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5
Q

State 3 things that could exacerbate the back pain in a spinal cord compression

A
  • Lying down
  • Coughing
  • Straining
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6
Q

Give 2 RFs for malignant spinal cord compression

A
  • Known cancer
  • > 40
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7
Q

What is the gold standard investigation for a spinal cord compression

A

urgent Gadolinium enhanced MRI of the whole spine within 24hrs of presentation

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8
Q

When is the gold standard investigation for a spinal cord compression contraindicated and what is the alternative imaging offered

A
  • CI - Px with implanted pacemaker or claustrophobia etc
  • CT myelography is alternative
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9
Q

How is malignant spinal cord compression managed

A
  • oral dexamethasone ASAP
  • Urgent oncological assessment for consideration of radiotherapy or surgical decompression
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10
Q

When are corticosteroids contraindicated in treatment of spinal cord compression

A

Confirmed or significant suspicion of lymphoma

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11
Q

Why is malignant spinal cord compression considered a medical emergency

A

Can lead to paralysis

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12
Q

What spinal nerves combine to form the sciatic nerve?

A

L4-S3

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13
Q

What does the sciatic nerve supply sensory innervation to?

A

Lateral lower leg and foot

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14
Q

Which muscle groups receive motor function from the sciatic nerve?

A

Posterior thigh, lower leg, and foot.

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15
Q

What are 2 causes of sciatica

A
  • Disc herniation/ prolapse at L4/5 or L5/S1
  • Spinal stenosis
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16
Q

What type of pain characterises sciatica

A

Unilateral pain from the buttock radiating down the back of the thigh to below the knee or feet, often described as “electric” or “shooting” pain.

17
Q

State the features of an L3 nerve root compression

A
  • Sensory loss over anterior thigh
  • Weak hip flexion, knee extension and hip adduction
  • Reduced knee reflex
  • Positive femoral stretch test
18
Q

State the features of an L4 nerve root compression

A
  • Sensory loss - anterior aspect of knee and medial malleolus
  • Weak knee extension and hip adduction
  • Reduced knee reflex
  • Positive femoral stretch test
19
Q

State the features of an L5 nerve root compression

A
  • Sensory loss dorsum of foot
  • Weakness dorsiflexion, inversion and eversion of the ankle
  • Reflexes intact
  • Positive sciatic nerve stretch test
20
Q

State the features of an S1 nerve root compression

A
  • Sensory loss in posterolateral aspect of leg and lateral aspect of foot
  • Weakness in plantar flexion of foot
  • Reduced ankle reflex
  • Positive sciatic nerve stretch test
21
Q

How is sciatica diagnosed

A
  • Clinical exam
  • MRI spine (GS) - referral if 4-6w of conservative management has failed
22
Q

How is sciatica managed

A
  • Physio
  • Analgesia - NSAIDs
  • PPi
  • Amitriptyline or duloxetine
  • Spinal decompression if chronic
23
Q

What is cauda equina syndrome (CES)?

A

A surgical emergency in which the lumbosacral nerve roots that extend below the spinal cord are compressed

24
Q

What are the primary causes of cauda equina syndrome

A
  • MC - central disc prolapse at the L4/5 or L5/S1 level and spinal canal stenosis
  • Less commonly: tumours, infections (abscess), haematoma or trauma
25
Q

What are some typical symptoms and signs of Cauda Equina Syndrome

A
  • low back pain
  • bilateral sciatica
  • lower limb weakness
  • Saddle anaesthesia (reduced perianal sensation)
  • urinary incontinence (late sign)
26
Q

What functions are supplied by the nerves of the cauda equina?

A

*Sensation - lower limbs, perineum, bladder, and rectum.
* Motor - lower limbs, anal and urethral sphincters.
* Parasympathetic innervation of the bladder and rectum.

27
Q

How is cauda equina investigated

A
  • urgent MRI lumbar spine (CT if CI)
    Post op:
  • DRE - reduced tone
28
Q

How is cauda equina syndrome managed

A
  • urgent surgical decompression
  • Bladder and bowel management
29
Q

What is spinal stenosis

A

Refers to narrowing of part of the spinal canal that results in compression of the spinal cord and nerve roots

30
Q

What part of the spine does spinal stenosis typically affect

A
  • Lumbar (mc)
  • cervical
31
Q

State 3 types of spinal stenosis

A
  • Central stenosis - narrowing of central spinal cord
  • Lateral - narrowing of nerve roots canals
  • Foramina stenosis - narrowing of intervertebral foramina
32
Q

Give 5 causes of spinal stenosis

A
  • Congenital
  • Degenerative changes (mc)
  • Herniated discs
  • Spondylolisthesis
  • Trauma e.g. fractures
33
Q

Define spondylolisthesis

A

Anterior displacement of a vertebra out of line with the one below

34
Q

Give 3 RFs for spinal stenosis

A
  • Age >40
  • Acromegaly
  • Previous back injury
35
Q

Give 4 symptoms of lumbar spinal stenosis

A
  • Intermittent neurogenic claudication
  • Back pain
  • Pain radiating down leg
  • Stooped posture when walking
36
Q

Describe the onset of symptoms in lumbar spinal stenosis

A

Gradual

37
Q

What is the impact of position on lumbar spinal stenosis symptoms

A
  • Worsens with standing
  • relieved by sitting down or leaning forward (e.g. walking uphill)
38
Q

What is the gold standard imaging investigation for diagnosing spinal stenosis and what would a positive finding be

A
  • MRI (T2 weighted)
  • demonstrates canal narrowing
39
Q

How is spinal stenosis treated

A
  • Analgesia - NSAIDs
  • Prednisolone 1 week
  • Decompressive laminectomy ( if Sx persist over 3m)

3a neurology (16 decks)

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