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Nervous System Flashcards

1
Q

Anatomy of dorsal columns Mode: Cell body: Decussation:

A

Anatomy of dorsal columns

Mode: fine touch, vibration, proprioception

Cell body: dorsal root ganglion

Decussation: in medulla, via medial lemniscus

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2
Q

Anatomy of lateral spinothalamic tract Mode: Cell body: Decussation:

A

Anatomy of lateral spinothalamic tract Mode: pain, temperature Cell body: dorsal root ganglion Decussation: in cord, at entry level

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3
Q

Anatomy of lateral corticospinal tract Mode: Cell body: Decussation:

A

Anatomy of lateral corticospinal tract Mode: motor (body) Cell body: primary motor cortex Decussation: ventral medulla (pyramidal)

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4
Q

Which cranial nerve nuclei (3-12) lie in each brainstem structure? Midbrain: Pons: Medulla:

A

Which cranial nerve nuclei (3-12) lie in each brainstem structure? Midbrain: 3, 4, (5) Pons: 5, 6, 7, 8 Medulla: (5), 9, 10, 11, 12

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5
Q

Cerebellar Syndrome Effects:

A

DDANISH

Dysdiadochokinesia

Dysmetria

Ataxia

Nystagmus (horizontal = ipsilateral hemisphere)

Intention tremor

Speech (slurred, stoccato, scanning dysarthria)

Hypotonia

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6
Q

Cerebellar Syndrome Causes:

A

PASTRIES

Paraneoplastic

Alcohol (B1/B12 deficiency)

Sclerosis (MS)

Tumour

Rare (Multiple System Atrophy, Friedrich’s Ataxia, Ataxia Telangiectasia)

Iatrogenic (phenytoin)

Endocrine (hypothyroidism)

Stroke (vertebrobasilar)

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7
Q

Lateral Medullary Syndrome Cause: Features:

A

Cause: occlusion of one vertebral artery or posterior inferior cerebellar artery (PICA)

Features: DANVAH

  • Dysphagia
  • Ataxia (ipsilateral)
  • Nystagmus (ipsilateral)
  • Vertigo
  • Anaesthesia (ipsilateral trigeminal, contralateral pain)
  • Horner’s Syndrome (ipsilateral)
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8
Q

6th + 7th CN palsy, contralateral hemiplegia Where is the lesion? What is the eponymous syndrome?

A

Pons

Millard-Gubler Syndrome

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9
Q

Pt aware, cognitively intact, paralysed except for eye muscles Where is the lesion? What is the syndrome? Give 2 causes

A

Ventral pons

Locked-In Syndrome

1) ventral pontine infarction (basilar artery) 2) central pontine myelinolysis (rapid correction of hyponatraemia)

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10
Q

Ipsilateral CN 5, 6, 7, 8 palsies + cerebellar signs Where is the lesion? What is the syndrome? Give 4 causes

A

Cerebellopontine angle

Cerebellopontine Angle Syndrome

1) acoustic neuroma 2) meningioma 3) cerebellar astrocytoma 4) metastasis (eg breast)

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11
Q

Anterior Spinal Artery (Beck’s) Syndrome Definition: Causes: Effects:

A

Definition: infarction of spinal cord in distribution of anterior spinal artery (ventral 2/3rds)

Causes: aortic aneurysm dissection or repair

Effects: para-/quadri-paresis, impaired pain + temperature sensation, intact touch + proprioception

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12
Q

DDx: muscle weakness

A
  • CEREBRUM / BRAINSTEM:
    • Vascular - infarct, haemorrhage
    • Inflammation - MS S.O.L
    • Infection - encephalitis, abscess
  • CORD:
    • Vascular - ant spinal artery infarct
    • Inflammation - MS
    • Trauma
  • ANTERIOR HORN: motor neuron disease, polio
  • ROOTS: spondylosis, cauda equina syndrome, carcinoma
  • MOTOR NERVES:
    • Mononeuropathy - compression, trauma
    • Polyneuropathy - GBS, CMT
  • NMJ: myasthenia gravis, Lambert-Eaton, botulism
  • MUSCLE:
    • AI - polymyositis, dermatomyositis
    • Toxins - steroids Inherited - muscular dystrophy (D/B)
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13
Q

DDx (motor): gait disturbance

A

1) Where is it. 2) Is it UMN, LMN, parkinsonian or mixed

BILATERAL

  • Parkinsonian: PD, parkinsonism (multiple system atrophy, dementia w Lewy bodies, progressive supranuclear palsy, corticobasal degeneration)
  • UMN:
    • Brain - CP, MS
    • Cord - compression, trauma, syringomyelia, transverse myelitis, hereditary spastic paraparesis
  • LMN:
    • Corda equina syndrome (emergency)
    • Polyneuropathy - CMT, GBS, DM
  • Mixed
    • MAST = MND, Ataxia (Friedrichs), Subacute combined degen of cord, Taboparesis

UNILATERAL

  • UMN :
    • Brain - MS, SOL, CVS
    • Cord - MS, tumour P
  • LMN:
    • Ant horn - polio
    • Radicular - L5 root lesion
    • Peripheral - sciatic, common peroneal nerve trauma
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14
Q

DDx (sensory): gait disturbance

A

VESTIBULAR (Romberg’s +ve): Meniere’s, viral labyrinthitis, brainstem lesion

CEREBELLAR (ataxic): EtOH, infarct

PROPRIOCEPTIVE (Romberg’s +ve): Dorsal columns - B12 deficiency Peripheral neuropathy - DM, EtOH, uraemia

VISUAL LOSS

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15
Q

Causes: blackouts

A

CARDIAC:

  • reflexes: vasovagal
  • rhythm - brady - heart block, sick sinus, longQT tachy - SVT, VT
  • structural - AS, HOCM, PE, LVF, tamponade

NEUROLOGICAL:

  • Epilepsy, drop attacks
  • CVA

SYSTEMIC: hypoglycaemia, hypoxia, hypercapnoea (anxiety)

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16
Q

Causes: vertigo

A

‘IMBALANCE’

INFECTION/INJURY: labyrinthitis, Ramsay Hunt, trauma

MENIERE’S: recurrent +/- n/v, tinnitis

BPPV

AMINOGLYCOSIDES / frusemide

LYMPH: fistula between inner and middle ears

ARTERIAL: migraine, CVA

NERVE: acoustic neuroma, vestiibular swannoma

CENTRAL: demyelination, infarct, tumour

EPILEPSY: complex partial

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17
Q

Causes: hearing loss (conductive)

A

Conductive: WIDENING

  • Wax
  • Infection (otitis media)
  • Drum perforation
  • Extra (trauma)
  • Neoplasia
  • INjury (barotrauma)
  • Granulomatous (GwP, sarcoid)
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18
Q

Causes: action / postural tremor

A

‘BEATS’

Benign essential tremor

Endocrine - thyrotoxicosis, hypoglycaemia, phaeo

Alcohol withdrawal

Toxins - beta agonists, theophylline, valproate

Sympathetic - physiological, enhanced in anxiety

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19
Q

Causes: acute confusional state

A

‘PINCH ME(^5)’

Pain

Infection (often UTI in elderly)

Neurological (stroke, subdural)

Constipation

Hydration insufficient

Medications (opioids, sedatives, L-DOPA)

Electrolytes (hyponatraemia, hyper/hypocalcaemia, uraemia)

Endocrine (hyper/hypothyroid, hypoglycaemia)

EToH

Encephelopathy (B12/folate deficiency)

Environment

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20
Q

DDx: acute headache

A

VASCULAR - haemorrhage, infarction, sinus venous thrombosis

INFECTION/INFLAMMATION - meningitis, encephalitis, abscess

RAISED ICP - tumour, glaucoma

REDUCED ICP - spontaneous intracranial hypotension (dural CSF leak)

SYSTEMIC - sinusitis, tonsillitis, HTN, toxins

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21
Q

DDx: chronic headache

A

‘MCD TINGS’

MIGRAINE

CLUSTER

DRUGS - analgesics, caffeine, vasodilators

TENSION

ICP - up (tumour aneurysm, AVM, benign intracranial HTN), down (spontanoeus intracranial hypotension)

NEURALGIA - trigeminal

GIANT CELL ARTERITIS

SYSTEMIC - HTN, uraemia

(AS)

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22
Q

Red Flags: headache

A

‘SNOOP’

  • SYSTEMIC - fever, wt loss
  • NEUROLOGICAL - confusion, impaired consciousness/speech/sensation/power
  • ONSET - sudden
  • OLDER PT - new onset, progressive (?giant cell arteritis)
  • PMH - worse than usual, unilateral eye pain

(AS)

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23
Q

Mx: migraine

A

Acute episode: 1st: paracetamol + metoclopramide

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24
Q

TIA: score for subsequent stroke risk

A

ABCD2

Age >=60

BP >=140/90

Clinical: unilateral weakness (2), speech disturbance (1)

Duration: 10-60 min (1), >60 min (2)

DM hx

Score: 0-2: outpt mx 3+: consider admission

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25
Migraine w/o aura: diagnostic criteria (International Headaches Society)
**Criteria** **A:** At least 5 attacks fulfilling criteria B-D **B:** Headache attacks lasting 4-72 hours\* (untreated or unsuccessfully treated) **C:** Headache has 2+ of: * 1. unilateral location * 2. pulsating quality (i.e., varying with the heartbeat) * 3. moderate or severe pain intensity * 4. aggravation by or causing avoidance of routine physical activity **D:** During headache 1+ of: * 1. N/V * 2. photophobia and phonophobia **E:** no alternative diagnosis is suggested in hx or O/E *(Passmedicine)*
26
Generalised tonic-clonic seizures: Long-term mx (1st line, 2nd line)
1st line: sodium valproate 2nd line: lamotrigine, carbemazepine Started after second seizure, or first if neurological deficit, abnormal imaging, epileptiform EEG, pt request. *(**NICE)*
27
Partial seizures: Long term mx (1st line, 2nd line)
1st line: lamotrigine or carbemazepine 2nd line: sodium valproate Started after second seizure, or first if neurological deficit, abnormal imaging, epileptiform EEG, pt request. *(NICE)*
28
Absence seizures: Long term mx (1st line)
1st line: sodium valproate or ethosuximide
29
Myoclonic seizures: Long term mx (1st line, 2nd line)
1st line: sodium valproate 2nd line: lamotrigine, carbemazepine
30
III nerve palsy: causes
* Medical: pupil-sparing * HTN * DM * Surgical: SOL, posterior communicating artery aneurysm (compression), trauma * pupil dilates early as parasympathetic fibres on outside more vulnerable *(Mirza)*
31
Partial ptosis: causes
* Unilateral * Horner's (small pupil) * IIIrd nerve palsy (big pupil) * Bilateral * Myasthenia gravis * Bilateral Horner's * Myotonic dystrophy (type 1) *(Mirza)*
32
VI nerve palsy: causes
* Medical * T2DM * HTN * Raised ICP * MS *(Mirza)​*
33
Raised intracranial pressure: signs (including characteristic triad)
* Cushing's triad: hypertension, bradycardia, abnormal breathing * Fundoscopy signs * Loss of retinal vein pulsation (early) * Papilloedema (late) * Focal neurology (inc III and VI nerve palsies) * Headache, reduced GCS, N/V *(Mirza)*
34
Spastic parapresis: causes
* Emergency: spinal cord compression * Non-emergency * CVA * MS * MND * Cervical spondylosis ## Footnote *(Mirza)*
35
Muscle wasting of the hands: causes
* Unilateral * Global: 'PBC' * Pancoast's * Brachial plexus injury * Cervical rib * Myotomal * Thenar: carpal tunnel * Radial/ulnar/median nerve lesion * Bilateral * RA * MND * Charcot-Marie-Tooth (early sign) * Cervical spondylosis *(Mirza)*
36
Neurofibromatosis Type 1: triad
* Neurofibromas * Cafe au lait spots (\>6 of \>15mm) * Lisch spots on iris (hamartomas of iris visible using slit lamp) *(Mirza, BMJ)*
37
What is the inheritance pattern of NF1 and NF2
Both autosomal dominant
38
NF1: incidence
1 / 3000 ## Footnote *(UpToDate)*
39
Recognise the presenting symptoms of neurofibromatosis
NF1 triad: cafe au lait spots + neurofibromas + iris Lisch nodules + axilliary freckling (= Crowe's sign) + learning difficulties, seizures
40
NF1: complications
* 'HTML': * HTN (increased risk of phaeochromocytoma and renal artery stenosis) * Thoracic kyphosis --\> respiratory compromise * Malignant change (in 10%) * Learning difficulties / behvioural problems *(Mirza)*
41
NF1: management
* Pt education (screening family members, including genetic testing in pregnancy) * MDT approach * Paediatric neurologist * Geneticist * Opthalmolgist * Screen for complications (eg monitor BP, resp function, signs of malignancy)
42
PACES: you suspect dx of Bell's palsy and have examined VII nerve, what other things should you examine for?
- localise lesion: examine CNs VI (pons lesion), V&VIII (cerebropontine angle lesion) - examine for Ramsay Hunt: look for vesicular rash in ears (herpes zoster from geniculate ganglion of VII) - ask about hyperacusis (stapedius palsy) and changes in taste - examine parotids (rule out parotid tumour) * (Mirza)*
43
# Define Bell’s palsy
Diagnosis of exclusion: acute unilateral peripheral facial nerve palsy, evolving over 72h and affecting all facial zones. *(BMJ, OHCM)*
44
Summarise the prognosis for patients with Bell’s palsy
Morbidity - complete recovery 70%, minor impairment 13%, major impairment 19% *(BMJ)*
45
Explain the aetiology / risk factors of Bell’s palsy
Idiopathic Ramsay Hunt (+ other infective eg TB, Lyme disease) Brainstem lesion (CVA, tumour) Parotid tumour Trauma *(OHCM)*
46
Identify appropriate investigations for Bell’s palsy
Bloods: VZV Abs, BM, ESR, Borrelia Abs (if ?Lyme disease) Imaging: MRI (if ? SOL) Nerve conduction studies *(OHCM)*
47
Generate a management plan for Bell’s palsy
**Conservative** - tailored facial exercises to optimise motor function (poorly evidenced) **Medical** - steroids (prednisolone), esp if present within 72h - protect eye if evidence of drying (eg dark glasses) **Surgical** - to resolve poor eye closure (eg lid loading procedure, lateral tarsorrhaphy) - augment facial symmetry (Botox) * (OHCM)*
48
Identify the possible complications of Bell’s palsy
- recurrence (7%) - eye drying and abrasion --\> corneal damage --\> blindness - deformity --\> psychological sequelae
49
O/E and UMN picture in the lower limbs and LMN picture in the upper limbs should make you think of what diagnosis?
Amyotrophic lateral sclerosis
50
Causes: hearing loss (sensorineural)
Sensorineural: DIVINITY * Developmental (Alport's, perinatal anoxia/infection) * Infection (mumps) * Vascular (stroke, eg in internal auditory artery) * INflammation (sarcoid, vasculitides) * Injury (inc noise) * Toxins (gentamicin, frusemide, aspirin) * lYmph (Meniere's, ruptured round window) *(AS)*
51
Generate a management plan for trigeminal neuralgia
Medical * 1st line: carbemazepine (100mg PO BD, titrate up until remission then lowest possible maintenance dose) * If ineffective, refer to pain/neurology *(NICE)*
52
Explain the aetiology of subarachnoid haemorrhage
* Berry anuerysm rupture (80%): RFs Ehlers-Danlos, Marfans, PCKD * AV malformation * Trauma * Tumours *(passmedicine)*
53
Generate a management plan for ischaemic stroke
* Immediate * CT head: exlude haemorrhagic stroke * Aspirin 300mg: start ASAP (w/i 24h, continue for 2w then start long-term anticoagulation) * + PPI if dyspepsia hx * \<4.5h from onset: thrombolysis (alteplase) * maintain glucose, O2, BP w/i normal limits * Secondary prevention Anticoagulation (lifelong) * 1st: Clopidogrel * 2nd: Aspirin + dipyridamole (if clopidogrel CI) * 3rd: Dipyridamole (if aspirin CI) * RF modification: * statin: if cholesterol \>3.5 mmol/L. Start \>48h after stroke (reduce risk of haemorrhagic infarct) * Carotid endarterectomy: if carotid stenosis \>70% (european criteria) ## Footnote *(NICE)*
54
What are the contraindications to thrombolysis in ?stroke (absolute and relative)
Contraindications to thrombolysis: * Absolute * Bleeding risk: ?haemorrhagic stroke, ?SAH, oesophageal varices, intracranial neoplasm, active bleeding * Previous: intracranial haemorrhage, GI bleed (previous 3w), stroke / head trauma (previous 3w), lumpar puncture (previous 1w) * Seizure at onset of stroke * Pregnancy * Uncontrolled hypertension \>200/120mmHg * Relative * ?intracardiac thrombus * INR \>1.7 * Active diabetic haemorrhagic retinopathy * Major surgery / trauma in preceding 2 weeks (Passmedicine)
55
Explain the aetiology of Horner's syndrome
Causes: central (symp chain): brainstem strokes eg lateral medullary infarct (Horner's + impaired eye movements + ipsilateral ataxia), MS, SOL, syringomyelia pre-ganglionic: Pancoast's, surgery/trauma, thoracic outlet obstruction post-ganglionic: carotid artery aneurysm / surgery = cervical ganglion (UpToDate)
56
What is Refsum's disease?
AutoR neurological disorder Peroxisomal disorder --\> accumulation of phytanic acid Retinitis pigmentosa + cerebellar ataxia + peripheral neuropathy + increased CSF protein *(AS Adam)*
57
Identify appropriate investigations for Refsum's Disease
1) serum phytanic acid: raised 2) peripheral nerve biopsy: hypertrophic onion bulb formation * (AS Adam)*
58
Generate a management plan for Refsum's Disease
* Conservative: dietary restriction of phytanic acid (fats + fish) * Medical: plasmaphoresis ## Footnote *(AS Adam)*
59
Identify appropriate investigations for subarachnoid haemorrhage
* CT: negative in 5% * lumbar puncture: done after 12 hrs if CT scan -ve (allowing time for xanthochromia to develop) * regular neuro obs: pupils, GCS, BP ## Footnote *(AS)*
60
Generate a management plan for subarachnoid haemorrhage
* Neurosurgical opinion * Medical * Regular neuro obs: pupils, BP, GCS * Intubate/ventilate: if GCS \<8 * Nimodipine: brain-specific CCB, reduces vasospasm to reduce risk of stroke/rebleeding. 3w course while risk of complications. * IV fluids: keep sBP \>160 ## Footnote *(Meeran, AS, passmedicine)*
61
Identify the possible complications of subarachnoid haemorrhage
BBSS: bleed, blockage, stroke, siadh * rebleeding (in 30%) - peaks day 10 * obstructive hydrocephalus (due to blood in ventricles) * cerebral ischaemia (due to vasospasm) - risk at days 5-14 * SIADH --\> hyponatraemia *(AS, Meeran)*
62
Summarise the prognosis for patients with subarachnoid haemorrhage
Mortality: 25% dead at 6m Morbidity: 50% survivors severely disabled at 6m *(BMJ)*
63
Generate a management plan for subdural haematoma
1st line: irrigation / evacuation via burr-hole craniotomy 2nd line: craniotomy address causes of trauma *(AS)*
64
Generate a management plan for Parkinson’s disease
* Conservative: encourage physical activity (reduces progression), Parkinson's UK, walking aids, PT/OT, depression screening * Medical * Dopaminergics: * L-DOPA (postpone for as long as possible in young pts, due to tolerance): eg levodopa, carbidopa * MAO-B Is: eg rasagiline * Da agonists (mainly in young pts) * + domperidone (to reduce DA-induced nausea) * Rescue pen: apomorphine (DA agonist) for sudden freezing * Atypical antipsychotics: for psychosis * SSRIs: for depression * Surgical * Deep brain stimulation ## Footnote *(AS)*
65
L-DOPA: side effects
'DOPAMINE' * Dyskinesia * On-off motor performance fluctuations * Psychosis * Arterial BP drop * Mouth dryness * Insomnia * N/V * Excessive daytime sleepiness *(AS)*
66
Identify appropriate investigations for multiple sclerosis
* Confirm diagnosis * MRI head + neck (T2): ring enhancing lesions show active inflammation * LP: oligoclonal bands IgG (on electrophoresis) * Bloods: anti-myelin basic protein Ab ## Footnote *(path, AS)*
67
Generate a management plan for multiple sclerosis
* Conservative: regular exercise, sleep hygiene, mindfullness, reduce stress * Medical * Acute - induce remission * High-dose steroids (methylpred 1g/24h IV/PO for 3d) * Long-term * Maintain remission (specialist) * IFN-beta (or PEG-IFN-beta) * Biologicals: alemtuzumab, natalizumab * Supportive (FED UP) * Fatigue: modafinil * Erectile dysfunction: sildenafil * Depression: SSRI * Urgency / frequency: oxybutynin * Pain: TCAs, gapapentin ## Footnote *(AS, BMJ)*
68
Identify the possible complications of multiple sclerosis
* Progression * Steroid complications: cushing's, osteoperosis, UTI * FED UP * Fatigue * Eye-problems * Depression * Urgency /frequency * Pain ## Footnote *(BMJ, AS)*
69
Summarise the prognosis for patients with multiple sclerosis
Extremely variable Multiple relapses, motor + cerebellar involvement associated with worse prognosis *(BMJ)*
70
What are the characteristics of an Argyll Robertson Pupil? Where is the lesion? One common cause
Accomodates, but does not react Pretectal region Tertiary syphilis (ie neurosyphilis)
71
What are the characteristics of a Holmes-Addie pupil? Where is the lesion? One common cause
Myotonic cause: dilated at rest, contracts slowly to light, keeps contracting after light, dilates slowly + ipsilateral reduced LL refexes Lesion in parasympathetic fibres of IIIrd nerve Post-infective (viral or bacterial) *(meeran)*
72
What is a Marcus Gunn Pupil Where is the lesion? One common cause
Relative afferent pupillary defect Optic nerve Multiple sclerosis *(Meeran)*
73
What red flags with parkinsonism may suggest Parkinson's Plus Syndrome
**'VIVAA'** * **V**ertical gaze palsy: progressive supranuclear palsy * +/- speech/swallow problems, truncal rigidity, early postural instability * **I**mpotence / incontinence: multiple system atrophy * +/- autonomic features, postural hypotension, nystagmus (lateral), cerebellar / pyramidal signs * **V**isual hallucinations: Lew-body dementia * +/- fluctuating cognition, early dementia * **A**kinetic rigidity one limb, astereognosis (can't identify object by feeling it), apraxia: Corticobasal degeneration * **A**taxia or pyramidal signs: Vascular Parkinsonism *(OHCM)*
74
Define status epilepticus
Status epilepticus = \>30 mins continusous seizure, or repeated seizures for 30 mins without intervening consciousness ## Footnote *(OHCM)*
75
Generate a management plan for status epilepticus
* ABCDE * Airway: speech (suggests pseudoseizure), check for evidence of vomiting, consider airway adjunct * Breathing: auscultate chest for evidence of aspiration, do ABG, do pulse oximetry, give high flow O2 * Circulation: get IV access, check HR, BP, cap refill, ECG * Disability: assess GCS! * Exposure: check GLUCOSE, check for evidence of PE, check temperature, if Hx of ETOH abuse then check thiamine * Immediate: call for help, warn anaesthetists * 1st line – **IV** **lorazepam** / rectal diazepam (repeat at 10 mins if no improv) * 2nd line – **IV phenytoin**/phenobarbitone (repeat half dose if no improve) * 3rd line – **IV phenobarbitone** * 4th line – Get anaesthetist. **IV propofol**/midazolam/sodium thiopentone ## Footnote *(Y3 notes)*
76
Identify appropriate investigations for epilepsy
* EEG – All pts with suspected seizure should have EEG, though not necessarily diagnostic. Usually shows spikes during seizure (generalised, myoclonic, atonic). * Grand-Mal seizures will show bilateral synchrony in the epileptiform activity * Absence seizures show activity at 3Hz. * MRI – important for diagnosis of epilepsy syndromes ## Footnote *(Y3 notes)*
77
Identify possible complications of status epilepticus
* Focal neurology * Cognitive dysfunction: esp memory problems Both improve with time *(BMJ)*
78
Identify risk factors for stroke
RFs: * Modifiable * HTN: #1 * AF (5% risk. If anticoagulated, 1% risk) * T2DM * hyperlipidaemia * smoking * Unmodifiable * Age * Male * FHx * ethnicity: Asian, black *(500SBAs, INTERSTOKE study)*
79
Give potential causes of spinal cord compression
* Trauma: vertebral # * Infection: epidural abscess, TB * Malignancy: mets from breast / thyroid / bronchus / kidney / prostate * Disc prolapse: above L1/2 ## Footnote *(AS)*
80
What are the clinical features of spinal cord compression?
* Pain: local, deep + radicular * Weakness: LMN @ level, UMN below level * Sensory level * Sphincter disturbance ## Footnote *(AS)*
81
Identify appropriate investigations for spinal cord compression
* Confirm dx: MRI definitive * Assess cause * Look for primaries: CXR, CT head abdo pelvis * Bloods: FBC, CRP, ESR, B12, UEs, LFTs, PSA ## Footnote *(AS, OHCM)*
82
Generate a management plan for spinal cord compression
Emergency * Malignancy: * dexamethasone IV * consider chemo / radio +/- decompressive laminectomy * Abscess: surgical decompression, IV Abx *(AS, OHCM)*
83
Identify the possible complications of spinal cord compression
* Autonomic dysfunction (incontinence, bradycardia, posutural hypotension, erectile dysfunction) * Sensorimotor dysfunction (--\> spastic paraparesis, pressure ulcers) * Surgical complications (infection, bleeding, DVT, PE) ## Footnote *(BMJ)*

Medicine Y6 (14 decks)

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