Peer-Teaching 3 Flashcards
Example of descending spinal tract
Corticospinal
Example of ascending sensory tracts
Dorsal column
Spinothalamic
Where do each of these tracts decussate:
Corticospinal
Dorsal column
Spinothalamic
Corticospinal - medulla
Dorsal column - medulla
Spinothalamic - almost immediately in spinal cord
What sensation is carried by dorsal column
Proprioception, vibration and 2 point discrimination
What sensation is carried by spinothalamic tract
Pain and temperature (see other cards for anterior vs lateral)
At what vertebrae do you find the spinal cord
Cord extends for C1 (junction with medulla) to L1/2 (conus medullaris)
Where do you take a lumbar puncture
L4 (around)
Below L1, the lumbar and sacral nerve roots are grouped together to form what?
Cauda equina
What is paraplegia
Paralysis of BOTH legs always caused by spinal cord lesion
What is hemiplegia
Paralysis of one side of body caused by lesion of the brain
True or False:
Sensory loss usually means spinal cord disease
True
What is myelopathy
Compression of the spinal cord resulting in upper neuron signs and specific symptoms dependent on where compression is
Causes of myelopathy/spinal cord compression
Osteophytes, Disc prolapse (slower onset), Tumour (slow onset)
Signs of spinal cord compression
UMN signs
Ix of myelopathy
urgent MRI
Tx of myelopathy
Surgical decompression and dexamethasone
*Brown-sequard syndrome:
Clinical presentation at level of and below the lesion
Below lesion
- Ipsilateral corticospinal dysfunction
- Ipsilateral dorsal column dysfunction
- Contralateral spinothalamic dysfunction
Level of lesion
-Ipsilateral spinothalamic dysfunction (localising sign)
Examples of peripheral neuropathies
Radiculopathy
Mononeuropathy
Polyneuropathy
What glial cells are found on cranial nerves
Schwann cells as they are peripheral
Describe radiculopathy
Compression of nerve root of a LMN
Risk factors of peripheral neuropathy
DAVID: Diabetes Alcohol Vitamin deficiency (B12) Infective (GB) Drugs (isoniazid)
Example of polyneuropathy
Multiple/Systemic: diabetes, MS, Guillain Barre etc
Causes of peripheral neuropathies
compression, infarction, demyelination, axonal degeneration (lead), infiltration (leprosy)
Risk factors of carpal tunnel syndrome
Pregnancy, obesity, hypothyroidism, rheumatoid arthritis, acromegaly, gout
Aetiology of carpal tunnel syndrome
NOT repetitive strain injury, idiopathic
Presentation of carpal tunnel syndrome
Pain and paresthesia in hand (wake and shake-worse at night)
Loss of sensation Median nerve distribution (palm radial 3)
Wasting of abductor pollicis brevis – wasting of thenar eminence
Investigations of carpal tunnel syndrome
PHALENS
and
TINENLS
Treatment of carpal tunnel syndrome
- conservative: pain relief, split at night
- hydrocortisone injection
- surgical decompression
What is sciatica
L5/S1 lesion = S1 NERVE ROOT COMPRESSION = SCIATICA
Presentation of sciatica
Sensory loss/pain in back of thigh/leg/lateral aspect of little toe (essentially in the sciatic nerve distribution)
Causes of sciatica
Disc prolapse, Osteoarthritis
treatment is conservative
Ix of sciatica
MRI urgent
What is cauda equina syndrome
Lesion at or below L1
Causes of cauda equina syndrome
Tumours, disc herniation, trauma can cause the compression
Signs of cauda equina syndrome
Lumbosacral pain (early), Saddle anesthesia (Do PR), areflexia, fasciculations, Loss of bowel / bladder control, urinary retention (late)
Ix of cauda equina syndrome
MRI Spine
Tx of cauda equina syndrome
Surgical decompression, high dose dexamethasone