[Neuro] Spinal Cord Injury

Question 1

what can acute spinal cord pathology be classified into?

Answer 1

• traumatic

- non-traumatic

Question 2

what do you do first if there is a traumatic suspected acute spinal cord pathology?

Answer 2

if C-spine injury: full in-line mobilisation (incl. C-spine)

in no C-spine injury: lie flat, spinal immobilisation

Question 3

what should be done next if there is a multi-injury trauma in a pt with suspected acute spinal cord pathology?

Answer 3

whole body CT

if not: CT spine

Question 4

what do you do first if there is a non-traumatic suspected acute spinal cord pathology?

Answer 4

lie flat, spinal immobilisation

Question 5

what should be done next if there is abnormal neurology in in a pt with non-traumatic suspected acute spinal cord pathology?

Answer 5

MRI spine

if not: consider alternative dx

Question 6

what is anterior spinal artery syndrome caused by?

Answer 6

occlusion of the anterior spinal artery which supplies blood to the anterior 2/3rds of the spinal cord

Question 7

what are the features of spinal artery syndrome?

Answer 7

• bilateral lower limb paresis (corticospinal tracts)
• bilateral loss of pain and temperature (spinothalamic tracts)
• sparing of dorsal columns

Question 8

what are the risk factors for spinal artery syndrome?

Answer 8

• atherosclerosis
• hypotension
• aortic dissection
• aortic aneurysm

Question 9

what are the clinical features of syringomyelia?

Answer 9

• “cape-like” distribution of pain/temperature loss in upper limbs
• spastic weakness lower limbs
• bilateral up-going plantars in lower limbs

Question 10

what is the neuroanatomy affected in synringomyelia?

Answer 10

• spinothalamic tracts (crossing anteriorly at spinal cord level)
• ventral horns

Question 11

what are the clinical features of Brown-Sequard?

Answer 11

• ipsilateral loss of vibration and proprioception
• ipsilateral weakness (spastic paresis)
• contralateral loss of pain and temperature
• sensory level

Question 12

what is the the neuroanatomy affected in Brown-Sequard?

Answer 12

one entire hemisection of the cord

Question 13

what are the clinical features of Anterior Spinal Artery Syndrome?

Answer 13

• bilateral loss of pain and temperature
• bilateral weakness (spastic paresis)
• preserved vibration and proprioception
• autonomic features

Question 14

what is the the neuroanatomy affected in Anterior Spinal Artery Syndrome?

Answer 14

• lateral corticospinal tracts

- lateral spinothalamic tracts

Question 15

what are the clinical features of Cauda Equina Syndrome?

Answer 15

• saddle anaesthesia
• autonomic features
• down-going plantars
• bilateral lower limb weakness

Question 16

what is the the neuroanatomy affected in Cauda Equina Syndrome?

Answer 16

Cauda equina (base of spinal cord)

Question 17

“cape-like” distribution of pain/temperature loss. dx?

Answer 17

syringomyelia

Question 18

sensory level L1-2, up-going plantars, absent knee reflexes. dx?

Answer 18

conus medullaris lesion

Question 19

VDRL +ve, loss of vibration/proprioception. dx?

Answer 19

Tabes dorsalis (3˚ neurosyphillis)

Question 20

ix for traumatic spinal cord injury?

Answer 20

CT spine (bony lesion / fracture)

Question 21

ix for non-traumatic spinal cord injury?

Answer 21

MRI spine (soft tissue injury)

Question 22

where should all spinal cord injuries be managed?

Answer 22

3˚ neurosurgical centres