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Neurology and Special Senses > Spinal Cord > Flashcards

Spinal Cord Flashcards

1
Q

What are the cervical myotomes?

A 
C5 - shoulder abduction and adduction, elbow flexion
C6 - elbow flexion and wrist extension
C7 - elbow extension, wrist flexion
C8 - wrist flexion, finger flexion
T1 - finger abduction
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2
Q

What myotomes are the biceps and brachioradialis reflexes?

A

C5 and C6

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3
Q

What myotome is the triceps reflex?

A

C7

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4
Q

What are the lumbosacral myotomes?

A

L2 - hip flexion and adduction
L3 - hyp adduction and knee extension
L4 - knee extension, foot inversion and dorsiflexion
L5 - hip extension and abduction, knee flexion, great toe dorsiflexion
S1 - knee flexion, foot plantarflexion and eversion

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5
Q

What are the myotomes for the lower limb reflexes?

A

Knee - L3/4

Great toe - L5

Ankle - S1

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6
Q

What is the common cause of spinal cord disease in 16-30 yo.?

A

Likely trauma of C4/5 or C5/6

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7
Q

What is the common cause of spinal cord disease in 30-50 yo.?

A

Likely disc disease of C5/6 or L4/5 or L5/S1

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8
Q

What is the common cause of spinal cord disease in 40+ yo.?

A

Likely malignancy

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9
Q

What are the potential causes of spinal cord problems?

A 
Trauma
Iatrogenic
Osteoporosis
Corticosteroid use
Osteomalacia
Osteomyelitis
Tumour infiltration
Disc herniation
Infection
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10
Q

How do spinal cord problems present?

A 
Back pain
Numbness and paraesthesia
Weakness and paralysis
Bladder and bowel dysfunction
Hyper-reflexia
Spinal shock
Neurogenic shoc
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11
Q

What happens in spinal shock?

A

Loss of reflexes, tone and motor function

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12
Q

What happens in neurogenic shock?

A

Following cervical or high thoracic injury

Bradycardia, hypotension, warm dry extremities, peripheral vasodilation, venous pooling, priapism, low cardiac output

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13
Q

When should a CT C Spine <1hr be considered?

A 
GCS < 13
Intubated
>65yo
High impact injury
Focal neurological deficit
Paraesthesia of UL or LL
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14
Q

How is Spinal cord compression managed?

A

Immobilise C spine - collar and backboard
Intubate if above C5
Decompressive surgery
Supportive management - VTE prophylaxis, maintain vitals, nutrition, catheter, laxatives, pressure sore prevention

If malignancy - palliative

Abscess - IV Vancomycin, metronidazole and cefotaxime + surgery

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15
Q

How should patients with spinal cord disease be assessed?

A

History - injury method, symptoms (sensory, motor, autonomic, systemic), PMH, IV drugs? osteoporosis?

Imaging - AP and lateral views, CT and plain films, MRI if tumour or abscess suspected

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16
Q

How would a complete cord transection present?

A

Complete loss of all modalities below lesion
Spinal shock
Neurogenic shock - higher cervical
Horners syndrome - higher transection as sympathetics involved
Bowel and bladder involvement if lower transection

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17
Q

What can cause brown-sequard?

A

Trauma
Tumour
Herniation
MS

18
Q

How would brown-sequard present?

A

Ipsilateral spastic paralysis
Ipsilateral loss of vibration and proprioception
Contralateral loss of pain and temperature

19
Q

What can cause an anterior cord injury?

A

Flexion injury

Anterior spinal artery damage

20
Q

How would an anterior spinal cord injury present?

A

Bilateral loss of motor function

Bilateral loss of pain and temperature

21
Q

What can cause posterior cord injury?

A

Posterior spinal artery damage
Spinal stenosis
B12 deficiency

22
Q

How would posterior cord injury present?

A

Bilateral loss of vibration and proprioception

23
Q

What causes central cord injury?

A

Hyperextension injury
Spondylosis
Syringomyelia

24
Q

How would central cord injury present?

A

Cape like distribution
Pain and temperature affected first
Motor affected more than sensory

25
Q

What would cause cauda equina and how does it present?

A

Herniated lumbar disc or spinal canal stenosis

Saddle anaesthesia
Bladder retention - may be overflow incontinence
Leg weakness

26
Q

What is cervical spondylosis?

A

Degeneration of annulus fibrosus + osteophyte formation leads to narrowing of the spinal canal and intervertebral foramina which can lead to a radiculopathy or myelopathy

27
Q

How is the cord irritated in cervical spondylosis?

A

Osteophytes anteriorly

Thickened ligamentum flavum posteriorly

28
Q

How does cervical spondylosis present?

A 
Neck pain and stiffness
Referred pain - headache and occipital
Lhermitte's sign
Cervical muscle spasm
Limited range of movement
29
Q

What is the difference between radiculopathy and myelopathy?

A

Radiculopathy - root compression
- pain and electrical sensations, numbness, dull reflexes, weakness, wasting of muscles

Myelopathy - cord compression
- Progressive symptoms, clumsy hands, gait disturbance, UMN leg and LMN arm signs, bladder and bowel features

30
Q

What are the differentials for cervical spondylosis?

A 
Acute hernia
Spinal mets
Multiple myeloma
Fibromyalgia
Ankylosing spondylitis
Rheumatoid arthritis
31
Q

How is cervical spondylosis managed?

A

Analgesia - NSAID’s
Gentle exercise - physio
Interlaminar cervical epidural injections
Surgical decompression

Radiculopathy - above + corticosteroids
Myelopathy - urgent referral, decompression or immobilisation if not fit for surgery

32
Q

What investigation should be done for cervical spondylosis?

A

Cervical MRI if no improvement at 4-6 weeks

Immediately if red flag signs

33
Q

Where can spondylosis also affect?

A

Lumbar - back pain, stiffness, leg claudication of buttocks and legs
Symptoms worse in morning

34
Q

What is syringomyelia?

A

Collection of CSF within spinal cord

35
Q

What causes syringomyelia?

A

Chiari malformation
Trauma
Tumours
Idiopathic

36
Q

How does syringomyelia present?

A

Cape like loss of sensation to temperature
Preservation of light touch, proprioception and vibration

Classic example - pt burn hands without realising

37
Q

What other signs and symptoms are associated with syringomyelia?

A 
Spastic weakness
Paraesthesia
Neuropathic pain
Upgoing plantars
Bladder and bowel dysfunction
38
Q

What complications are associated with syringomyelia?

A

Scoliosis
Horners

Syringobulbia is similar - fluid filled cavity within medulla of brainstem. Often extension of syringomyelia

39
Q

How is syringomyelia investigated?

A

Full spine MRI with contrast - exclude tumour or tethered cord
Brain MRI - exclude chiari malformation

40
Q

How is syringomyelia managed?

A

Treat underlying cause

Shunt can be placed into syrinx if persistent

Neurology and Special Senses (28 decks)

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