Neuro spine

Question 1

Subacute combined degeneration of SC:

• Definition
• Causes
• Symptoms
• Management

Answer 1

Subacute combined degeneration of SC:

• Definition: neurolog disorder of post columns of sc hence affecting dorsal, lateral corticospinal and spinocerebellar tract
• Causes : b12 deficiency, alc, pernicious anaemia, crohns, coeliac
• Symptoms:
  dorso: loss vibration/fine touch/prop so tingling and reduced sensation legs first
  corticos: umn signs e.g. spastic weakness in legs/hyperref, brisk knee reflexes, absent ankle jerk, extensor plantar responses
  spinocereb: sensory ataxia gait, + rombergs
• Management : b12 hydroxycarbamine IM

Question 2

Syringomyelia:

• Definition
• Syringobulbia definition
• Causes
• Symptoms
• Investigations
• Management

Answer 2

Syringomyelia:

• Definition: csf collection in sc
• Syringobulbia definition: when its in medulla of bstem so bulbar symptoms
• Causes : chiari malformation, trauma, tumour, idiopathic
• Symptoms : cape like c8-t1 loss of temp/pain/crude touch of upper limbs, spastic weakness lower limbs (corticospinal), neuropathic pain, upgoing planters, loss lower limbs proprio/fine touch/vib
• Investigations: mri with contrast, mri brain for chiari
• Management : treat cause

Question 3

Spondylosis:

• Definition
• Cervical spondylosis: definition, risk factors, symptoms + signs
• Lumbar spondylosis: symptoms
• Investigations
• Management

Answer 3

• intervertebral disc degen (loss height), osteophytes, facet joint OA, ligamentous hypertrophy
• neck pain especially with repetitive work, occipital headache, radiculopathy (tingling/pain/weakness upper limbs), myelopathy (clumsy hands, limb weakness, bowel dysfunction)
• xray, mri
• nsaids, physio if >4 weeks, cervical collar, epidural steroid inj, facet joint inj, pain clinic if >12 weeks

Question 4

Radiculopathies:

• Definition
• Causes
• Symptoms
• Management

Answer 4

• def: irritation to spinal nerve root
• causes: spondylosis, infection (ebv/lymes/hsv/vzv), vasculitis, neoplasm, prolapsed disc transitioning nerve, fracture
• symptoms: parasthesia + pain at level, lmn signs at level
• mx: nsaids, gabapen, physio