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Brain Power: Adam and Victor's Neurology > Spinal Cord > Flashcards

Spinal Cord Flashcards

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0
Q

What radiculomedullary artery supplies the lower 2/3 of the spinal cord?

A

Artery of Adamkiewicz, a t10 or l1 radicular artery

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1
Q 
Identify the supply to the ff
1 cervical cord
2 thoracic cord
3 lumbar cord
4 sacral cord
A

1 subclavian and vertebral
2 and 3 segmental a from aorta and internal iliac a
4 lateral sacral arteries

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2
Q

What supplies the ventral anterior 2/3 of the spinal cord?

A

Anterior median spinal artery

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3
Q

What is the network of valveless veins that extend along the vertebral column from the pelvic venous plexuses to the intracranial venous sinuses

A

Batsons plexus

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4
Q

Spinal cord infractions is what percent of all stroke?

A

1.2%

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5
Q

What diseases of the aorta causes spinal cord infarction?

A

Advanced atherosclerosis
Dissecting aneurysm
Intra operative surgical occlusion

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6
Q

Except in high cervical lesions what type of sensory loss is expected for anterior spinal artery territory infarct ions?

A

Dissociated sensory loss

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7
Q

T or F MRI of the dc after infarction is usually normal after the first hour or day

A

T

A few days later edema shows by t2

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8
Q

What percent of thoracoabdomonal aneurysm operations result in paraplegia?

A

5-10%

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9
Q

What are the 4 causes of hematomyeli?

A

Anticoagulants
Avm
Blood dyscrasia
Trauma

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10
Q

What are the 3 types of vascular malformations of the spinal cord?

A

Intra medullary
Perimedullary
Dural THE MOST COMMON

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11
Q

What are the most colon initial symptoms and dural avf?

A

Imbalance
Numbness
Paresthesia

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12
Q

Caisson disease usually affects which part of the spinal cord?

A

Upper thoracic spinal cord

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13
Q

What is the characteristic picture of the Csf of spinal subdural hemorrhage?

A

Yellow brown spinal fluid resulting motor oil

NB NO SIGNS OF MYELOPATHY APPEAR IN SPINAL SUBDURAL HEMORRHAGE

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14
Q

What form of spinal injury is most common?

A

3 fracture dislocations > 1 pure fracture > 1 pure dislocation

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15
Q

What kind of spinal injury results in damage on the laminae, pedicles, anterior longitudinal ligament usually on the midcervical vertebrae C4-C6?

A

Hyperextension injuries

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16
Q

Sometimes x-rays or CT demonstrates no apparent dislocation but spinal cord damage is apparent by PE. Why is this? Especially in hyperextension injuries. What test can show the damage?

A

Spontaneous realignment can occur. Dynamic radiologic views with gentle flexion and extension demonstrates vertebral dislocation because the ligaments are already fucked up. Or MRI can demonstrate ligamentous rupture.

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17
Q

What are the 3 most common sites of vertebral injury?

A

C1-C2
C4-C6
T11-L2

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18
Q

Why is the thoracic cord not prone to injury?

A
  1. High articular facets make dislocation difficult
  2. Thoracic cage prevents much movement
  3. Canal is spacious
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19
Q

What syndrome is characterised by segmental weakness and sensory loss in the arms with a FEW long tract signs because of traumatic lesion restricted to the anterior and posterior gray matter

A

Schneider syndrome

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20
Q

Describe the pathology of cord injury 1h 4h 8h?

A

1h hemorrhages
4h spreading edema
8h necrosis

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21
Q

What is the usual range of time at which spinal shock can occur?

A

1-6 weeks

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22
Q

Identify the location of the spinal cord region damaged in :
A. Diaphragmatic paralysis
B. Tetraplegia
C. Paraplegia with abduction and flexion of arms
D. Paraplegia AND paralysis of the hands

A

A. C1-C3
B. C4-C5
C. C5-C6
D. C6-C7

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23
Q

Abolition in autonomics during spinal shock presents with?

A

Dependent edema
Dry pale ulcerated skin
Gastric and bowel atony – paralytic ileus
CONTRACTED sphincters but detrusor of the bladder and the rectum muscles become ATONIC – overflow incontinence
Loss of genital reflexes

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24
Q

What is the purported aetiology of spinal shock?

A

Abolished reticulospinal and vesitbulospinal reflexes

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25
Q

After the stage of spinal shock, what characterises the stage of heightened reflexes– autonomic dysreflexia

A

AUTONOMIC Dysreflexia
ABOVE THE LEVEL OF THE LESION: Cutaneous flushing, pounding headache, hypertension, reflex bradycardia

Also heightened reflexes manifesting as 
Flexor spasms + triple flexion
babinski
Mass reflex movement
Reflex "spinal" sweating
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26
Q

After how long do extensor responses usually follow flexor ones?

A

6M to 2Y

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27
Q

In a patient with post traumatic spinal injury, what is the probably cause of progressive deficits years after the event?

A

Post traumatic syrinx

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28
Q

What resting state of involved extremities (flexion or extension) is favoured by a high lesion?

A

Flexion

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29
Q

What type of spinal injury is most commonly associated with the Schneider syndrome?

A

Retroflexion

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30
Q

What are the 4 biggest threats to life in the first 10 days of SCI?

A

Gastric dilatation
Ileus
Shock
Infection

After 3 months mortality rate falls rapidly

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31
Q

Early or Transient radiation myelopathy occurs when?

A

3-6 months post radiation AS OPPOSED TO Delayed progressive radiation myelopathy that occurs AFTER 6 MONTHS usually between 12-15 months

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32
Q

How to differentiate delayed progressive radiation myelopathy to spinal mets?

A

INITIALLY NO PAIN with radiation myelopathy– usually presents with sensory symptoms followed by weakness or one or both legs

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33
Q 
CSF of
A. Delayed progressive radiation myelopathy
B. Vacuolar myelopathy with AIDS
C. Spinal epidural abscess
D. Schistosomiaisis meningomyelitis
E. Transverse myelitis
F. Acute demyelinating myelitis of MS
G. Devic disease
A

A. Normal except for elevated protein
B. Few Lymphocytes, slight protein elevation, bizarre giant cells
C. Few WBC both PMN and Lympho, high protein but NORMAL glucose
D. Slight CHON elevation Slight CHO decrease Lymphocytic pleocytosis
E. Lymphocytes, slight CHON elevation but Normal CHO, NO oligoclonal bands
F. Mild lymphocytosis with oligoclonal bands (that may be absent in the first attack)
G. Like F but NO oligoclonal

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34
Q

What is considered safe radiation doses?

A

< 6000 cGy given over 30-70 days

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35
Q

What are the two most important prognostic factors in electrical injuries of the SC?

A

Duration of contact
+
Resistance offered by the skin

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36
Q

What are the top 2 causes of death after being struck by lightning?

A

Vfib
+
Fried brain– intense desiccating heat on the brain

37
Q

An OB patient after giving birth vaginally now has leg weakness and numbness on one side after waking up?

A

Spinal anaesthesia with sedation was probably used and the conus modularis was injected with aesthetic agent.

38
Q

What type of spinal tutor arises from the leptomeninges and roots?

A

Extramedullary + Intradural

39
Q

What is the most common location of spinal tumors?

A

Extramedullary + Extradural usually mets 55%
EM ID 40%
IM 5%

40
Q

Classify the most common spinal location of these tumors

  1. Neurofibroma and Meningioma
  2. Ependymoma and Astrocytoma
A
  1. Extramedullary- Intradural

2. Intramedullary

41
Q

What are the 2 most common PRIMARY EXTRAMEDULLARY TUMORS?

A

Neurofibroma and meningioma > Sarcoma > Vascular tumor > Chordoma > Epidermoid

42
Q

What are the 2 most common PRIMARY INTRAMEDULLARY TUMORS?

A

Ependymoma 60%
Astrocytoma 25%
Others: lipoma, epidermoids, hemanioma, chordoma, schwannoma, mets

43
Q

What is the Froin syndrome?

A

When intraspinal tumor blocks off a part of the lower spinal canal, fluid accumulates resulting in the Froin syndrome: xanthochromia and clotting of CSF from elevated protein

44
Q

What are the most common SECONDARY EXTRAMEDULLARY TUMORS?

A

ED is most common: CA, Lymphoma and myeloma

ID: Meningeal carcinomatosis, Lymphomatosis and primary melanoma

45
Q

What is the most common SECONDARY INTRAMEDULLARY TUMOR?

A

Bronchogenic CA

46
Q

What is the characteristic back pain of spinal cord masses?

A

Back pain that is usually worse WHEN THE PATIENT LIES DOWN AND IMPROVES AFTER GETTING UP FROM RECUMBENCY

47
Q

What are the 3 categories of spinal cord mass syndromes?

A

Sensorimotor spinal tract syndrome
Painful radicular spinal cord sydnrome
Intramedullary syringomyelic syndrome

48
Q

What are the main features of the intramedullary syringomyelic syndrome?

A

Dissociated sensory loss
Amyotrophy
Early incontinence
Late Corticospinal weakness

49
Q

A babinski sign usually indicates that the spinal cord is involved about what segment?

A

Above the 5th lumbar segment

50
Q

Differentiate cauda equina syndrome from conus medullaris syndrome

A

CES:
Bilaterally asymmetric atrophic areflexic paralysis
radicular sensory loss
Sphincteric disorder
CMS:
Early disturbances of bladder and bowel (constipatino and urinary retention)
Back pain
Anesthesia over sacral dermatomes
Lax anal sphincter with loss of anal and bulbocavernosus reflex
Impotence
Weak legs at times

51
Q

Localize in the spine

  1. Root pain early, pain and aching around the spine, motor sxs before sensory, sphincter problems late
  2. Segmental amyotrophy and dissociated type of sensory loss
A
  1. EM ED

2. IM

52
Q

Teratomatous cyst, adhesive arachnoiditis and meningomyelitic process are all differentials for a mass in what location in the spine?

A

Extradmedullary intradural

53
Q

What are the special kinds of myelitis?

  1. Confined to gray matter
  2. White matter
  3. Approximately the whole cross sectional cord in involved in multiple levels
  4. Combine inflammation of meninges and spinal cord
  5. Meningeal and root involvement
  6. Inflammation of the spinal dura
A
  1. Poliomyelitis
  2. Leukomyelitis
  3. Transverse myelitis
  4. Meningomyelitis
  5. Meningoradiculitis
  6. Pachymeningitis

NB Acute- days; Subacute- 2-6 weeks; Chronic- more than 6 weeks

54
Q

What are the two most common causes of myelitis?

A

Transverse myelitis and post infectious myelitis

55
Q

Predilection area: Myelitis virus
1 Anterior horn cells:
2 Dorsal root ganglia:

A
  1. Enteroviruses like polio

2. Herpes zoster virus

56
Q

How does dumb rabies present?

A

Sensory and motor paralysis below the level of the lesion

57
Q

What does the spinal cord of a patient with vacuolar myelopathy look like?

A

White matter is vacuolated most severely in the thoracic segments but the posterior and lateral columns are diffusely affected.

58
Q

With chronic meningeal inflammation which spinal roots become the most damaged because of their long meningeal exposure?

A

Lumbosacral

59
Q

What enzyme level in the csf can be used to distinguish multiple sclerosis and sarcoid myelitis?

A

Angiotensin converting enzyme levels

60
Q

What is the most characteristic finding in sarcoid myelitis?

A

Multifocal subpial nodular enhancement

61
Q

What is the most frequent etiologic agent of spinal epidural abscess?

A

Staphylococcus aureus followed by:

  1. Streptococci
  2. Gram negative bacilli
  3. Anaerobes
62
Q

How to differentiate a spinal subdural infection from epidural ones?

A

Subdurals have a less sharp margin and a greater vertical extent

63
Q

In tuberculous myelitis what are the causes of compressive myelopathy?

A

Epidural abscess > Spinal deformity

64
Q

What form of schistosomiasis is most commonly found in the spine?

A

Schistosoma mansoni

65
Q

T/F In stark contrast to MS post infectious and post vaccine myelitides have NO subsequent attacks and no additional lesions by MRI or evoked potentials.

A

T

Also post infectious conditions tend to evolve longer over a period of 1 to 3 weeks or even longer

66
Q

What 3 factors can be used to distinguish a myelopathy from a GBS?

A
  1. Sphincter disturbance
  2. Backache
  3. Babinski
67
Q

What viruses are the most common precedents of post infectious myelitides?

A
  1. EBV

2. CMV

68
Q

T/F Campylobacter jejuni precedes GBS but NOT myelities

A

T

69
Q

Differentiating factors that favour B
A Acute DEMYELINATING spinal MS from
B Devic’s disease (NECROTIZING MYELITIS)

A
  1. A usually painless without fever and px usually improves
    B stable THEN WORSEN with deficits profound and lasting
  2. Profound flaccidty or legs
  3. Areflexia
  4. Atonicity bladder
  5. Original bands usually absent
70
Q

What is the usual EMG finding in Necrotizing myelitis?

A

Denervation or several contiguous metopes reflecting damage to the gray matter of those segments

71
Q

What antibody is specific for Devic’s disease?

A

NMO antibody– IgG antibody directed towards aquaporin channel in capillaries of the brainstem and cerebellum

72
Q

When is necrotic myelopathy of the Foix-Alajouanine type?

A

Only when enlarged abnormal vessels involve the surface and adjacent parenchyma of the cord

73
Q

What pathology underlies subacute myoclonic spinal neuronitis?

A

SPARING of the anterior horn cells and LOSS of internuncial neurons

74
Q

Symptom: Gradual weakness of the legs give differentials based on age

  1. Late childhood to adolescence and progressing steadily
  2. Early adult life
  3. Late adult life
A
  1. Spinocerebellar degeneration
  2. MS, AIDS myelopathy, Syphilitic meningomyelitis
  3. Cervical spondylosis, Subacute combined degeneration, Spinal tumor, Spinal arachnoiditis, Tropical spastic paraplegia
75
Q

What is the most frequently observed myelopathy in general practice?

A

Cervical spondylosis

76
Q

In cervical spondylosis, what causes chronic spinal cord and nerve root compression?

A

Disc degeneration, osteophyte outgrowths

77
Q

Among the symptoms of cervical spondylosis:

  1. Pain in the neck with brachialgia
  2. Numbeness and parenthesis of hands
  3. Spastic leg weakness with babinski

Which is the most common? Earliest?

A

Common 1

Earliest 2

78
Q

What components result in narrowing of the spinal canal?

A
  1. Osteophytes of the posterior vertebral bodies
  2. Thickening of the ligamentous flavum and posterior longitudinal ligament
  3. Disc extrusion that becomes covered in fibrous tissues or becomes partially calcified
79
Q

What range of canal narrowing becomes susceptible to symptomatic cervical spondylosis?

A

7-12mm

N: 17-18

80
Q

How to distinguish ALS and cervical spondylosis in a patient with amyotrophy of the arms and spastic weakness of the legs?

A

Cervical spondylosis seldom occurs without sensory symptoms!

81
Q

How to distinguish neuropathy from myelopathy in a patient with difficulty walking?

A

Reflexes are increase in myelopathy and decreased in neuropathy

82
Q

What are the treatment options for cervical spondylosis?

A

Soft collar or surgical decompression by laminectomy

83
Q

What two conditions are associated with multiple arachnoid cysts in the thoracic or lumbar region?

A

Ankylosing spondylitis and Marfan syndrome

84
Q

What is the most hazardous complication of AS?

A

Fracture dislocation from seemingly minor trauma mainly because the rigid spine is susceptible to fracture

85
Q

What is the most common anomaly of the craniocervical jxn?

A

Fusion of the atlas and foramen magnum?

86
Q

What are the common causes of copper deficiency myelopathy (Combined system Disease of Nonpernicious anaemia type)?

A

Impaired copper absorption after gastric bypass or bowel surgery
Excess Zinc intake with supplements

87
Q

What is the most common mode of onset in arachnoiditis?

A

Pain int he distribution of the sensory roots– condition occurs with foreign substances in the CSF and repeated disc surgery and to infections such as syphillis

88
Q

What are the three classic symptoms of syringomyelia?

A
  1. Segmental weakness and atrophy of the hands and arms
  2. Loss of some or all tendon reflexes in the arms
  3. Segmental anaesthesia of a dissociated type over the neck shoulders and arms –> leading to painless injuries and burnin of the hands
89
Q

T/F Hydromyelia or Barnett Type 4 syringomyelia is nonprogressive

A

T

90
Q

What are the 4 Barnett classifications of syringomyelia?

A

I. With obstruction of the foramen magnum and dilatation of the central canal (Chiari T1 and other FM obstructions)
II. Without obstruction
III. Associated with other dz: Tumors, Trauma, Arachnoiditis
IV. Hydromyelia

Brain Power: Adam and Victor's Neurology (19 decks)

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