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Year 4 > Neuro (spinal cord) > Flashcards

Neuro (spinal cord) Flashcards

1
Q

Why are lumbar punctures aimed below L2?

A
  • Spinal cord end at L1-L2 with conus medullaris
  • Aim below L2 to miss spinal cord
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2
Q

What are the important sensory (ascending) tracts?

A
  • DCML
  • Spinothalamic
  • Dorsal horn
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3
Q

What is the DCML tract responsible for?

A

Vibration, soft touch, proprioception

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4
Q

What its the DCML cutaneous pathway responsible for?

A
  • Vibration, soft touch and proprioception of the upper limbs
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5
Q

What is the DCML gracilis pathway responsible for and where is it in relation to the cutaneous pathway?

A
  • Vibration, soft touch, proprioception of lower limbs
  • Medial to DCML cutaneous
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6
Q

Where does the DCML decussate?

A

In the medulla

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7
Q

What is the ventral spinothalamic tract responsible for?

A

Crude touch

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8
Q

What is the dorsal spinothalamic tract responsible for?

A

Pain and temperature sensation

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9
Q

Where does the spinothalamic tract decussate?

A

White anterior commissure of spinal cord

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10
Q

What are the important motor (descending) tracts?

A

Corticospinal tract

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11
Q

What is the ventral corticospinal tract responsible for?

A

Trunk, neck and shoulders movement

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12
Q

What is the lateral corticospinal tract responsible for?

A

Limb movement

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13
Q

An acute onset spinal cord lesion suggest what aetiology?

A
  • Trauma (e.g. knife wound, Brown sequard)
  • Vascular (spinal cord stroke)
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14
Q

A subacute onset spinal cord lesion suggests what aetiology?

A
  • Inflammation (e.g. MS, devics)
  • Infection (e.g. asbcesss, Lyme)
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15
Q

A chronic onset spinal lesion suggests what aetiology?

A
  • Cervical spondylosis
  • Tumour
  • Syringomyelia
  • B12 deficiency
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16
Q

What are some intrinsic causes of spinal cord lesions?

A
  • Transverse myelitis
  • B12 deficiency (SADC)
  • Spinal ischaemia
  • Intraspinal neoplasm
  • Hereditary spastic paraplegia
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17
Q

What is transverse myelitis and what are some examples?

A
  • Inflammation of spinal cord
  • MS
  • Neuromyelitis optica (devics)
  • Infection (viral, bacterial, Lyme)
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18
Q

What must be assumed in any force that results in loss of consciousness?

A

Cervical spine injury until proven otherwise

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19
Q

What are the 2 most common sites of spinal cord injury?

A

Cervical spine followed by thoracolumbar junction

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20
Q

What are some A-E considerations in spinal cord injury relating to airway?

A
  • Can’t do head tilt, chin lift
  • Laryngeal stimulation can cause massive vagal response (e.g. when intubating)
  • This can cause cardiac arrest
  • Give atropine before securing airway to prevent
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21
Q

What are some A-E considerations in spinal cord injury relating to breathing?

A
  • Intercostal muscle paralysis or phrenic nerve paralysis can occur
  • More proximal = worse
  • C3, 4, 5 are phrenic nerve roots (C3, 4, 5 keep the diaphragm alive)
  • Intercostals = t1 ro 11
22
Q

What are some A-E considerations in spinal cord injury relating to circulation?

A
  • Neurogenic shock can occur at level above T6
  • Careful with resus as can cause acute pulmonary oedema
  • Can diet and get hypothermia
23
Q

What is the gold standard investigation for cervical spinal cord injury?

A

CT cervical spine

24
Q

What are the features of complete spinal cord section?

A
  • Complete sensorimotor loss below the level
  • UMN signs and radicular pain at the level
25
Q

What are the features of spinal cord hemisection (Brown-Sequard)?

A

Ipsilateral:
- UMN signs at level
- LMN signs, dorsal column loss (vibration, soft touch, proprioception) and spinothalamic (pain, temperature, crude touch) loss below the level
Contralateral:
- Spinothalamic (pain, temperature, crude touch) loss 2 levels below

26
Q

What is a syringomyelia?

A
  • CSF buildup in anterior commissure of spinal canal (syrinx)
  • Most commonly between C3-C7
27
Q

What are the features of syringomyelia?

A
  • Cape-like distribution of loss of pain and temperature sensation (dorsal spinothalamic compression)
  • Patients classically burn themselves and don’t notice
  • Chronic onset
  • UL weakness > LL weakness
28
Q

What anatomical malformation is associated with syringomyelia?

A

Chiari malformation

29
Q

What is an Chiari malformation?

A

Where the lower part of the brain pushes down into the spinal canal

30
Q

What is a syrinx in the medulla called?

A

Syringobulbar

31
Q

What investigation is used to investigate Chiari malformation?

A

MRI brain

32
Q

What are the features of spinal cord infarct?

A

Acute onset back of neurological signs and back pain

33
Q

At what level is a spinal cord infarct most likely to occur and why?

A
  • T8
  • Presence of artery of adamkiewicz
34
Q

What are some causes of spinal cord infarct?

A
  • Thromboembolic event
  • Trauma
  • Spinal surgery
  • Cross clamping in non-spinal surgery
  • Vasculitis
  • Aortic dissection
35
Q

What are the features of anterior spinal cord infarct?

A

Acute onset back pain and:
- Motor loss
- Spinothalamic (pain, temperature, crude touch) loss

36
Q

What are the features of a posterior spinal infarct?

A

Acute onset back pain and DCML (soft touch, vibration, proprioception) loss

37
Q

What investigations might help in diagnosing a spinal cord infarct?

A
  • MRI spine
  • Nerve conduction studies (rule out GBS)
  • Look for cause (echo, coagulation, vasculitis and angiography)
38
Q

How are spinal cord infarct treated?

A

As stroke

39
Q

What is hereditary spastic paraplegia?

A
  • An autosomal dominant cause of spastic paraparesis
  • Results in bilateral lower limb UMN signs
40
Q

What are the 2 types of HSP and what is the difference?

A
  • Simple: just lower limb UMN signs
  • Complex: LL UMN signs + ataxia + dementia
41
Q

What are the typical ages of one for hereditary spastic paraplegia?

A

2 and 40 (i.e. young and middle age)

42
Q

What is the management of hereditary spastic paraplegia?

A

Physio and baclofen

43
Q

What are some causes of myelitis?

A
  • MS or devics
  • Systemic disease (e.g. Sjorgens, SLE, sarcoid, Behcets)
  • Infection (viral, mycoplasma, syphilis and Lyme)
  • Post vaccine immune response
44
Q

What are features of myelitis?

A
  • Subacute onset myopathy and radicular pain
  • Takes months to settle
  • Often only settles partially
  • MRI shows SC swelling and oedema
45
Q

What is the treatment for transverse myelitis?

A
  • Dexamethasone for swelling
  • Treat cause
46
Q

What are the features of subacute degeneration of the cord?

A
  • Distal sensory loss (mainly DCML)
  • Proprioception and vibration loss can lead to ataxia
  • Cord involvement cause MND features
  • Dementia and widespread weakness in late disease
47
Q

What are some causes of SADC?

A
  • Anything that causes B12 loss
  • Pernicious anaemia
  • Ileal resection
  • Tropical sprie
  • IBD/coeliac
48
Q

What is the management of SADC?

A
  • B12 supplementation
  • PN damage is curable
  • SC damage is irreversible
49
Q

What are some intramedullary spinal cord tumours?

A
  • Glioma
  • Astrocytoma
  • Ependyoma
50
Q

What are some extra medullary spinal cord tumour?

A
  • Meningioma
  • Neurofibroma
  • Schwannoma
  • Nerve sheath tumor

Year 4 (16 decks)

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