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Phase 3a - Geriatrics and Neurology > Spinal Cord and Peripheral Nerve Conditions > Flashcards

Spinal Cord and Peripheral Nerve Conditions Flashcards

1
Q

What is spinal cord injury?

A

Form of myelopathy caused by pressure on cord. It causes UMN lesion (unlike cauda equina = LMN)

Myelopathy is the result of compression of the spinal cord and nerve roots caused by inflammation, arthritis, bone spurs and spinal degeneration due to aging.

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2
Q

Causes of spinal cord compression?

A
  1. Trauma
  2. Malignancy
  3. Infection - abscess formation or TB
  4. Epidural haematoma
  5. Intervertebral disc prolapse
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3
Q

Sx of spinal cord compression?

Also describe UMN sx seen

A
  • Back pain - progressive, severe, aggravated by straining
  • Difficulty walking
  • Weakness/numbness below level compressed
  • Urinary/faecal incontinence
  • Constipation/urinary retention

UMN sx seen (below level of the lession):
* Hypertonia
* Hyperreflexia
* Clonus
* Upgoing plantars
* Sensory loss

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4
Q

Ix for spinal cord compression?

A

GS - MRI whole spine (if not whole body CT)
Other:
* Blader scan - urinary retention
* ECG + bloods

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5
Q

Mx of spinal cord compression?

A
  • If trauma - transfer to major trauma centre
  • Analgesia - pain
  • VTE prophylaxis
  • Catheterise if retention
  • Regular repositioning to prevent pressure ulceration
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6
Q

Mx of metastatic SCC

A
  • High dose steroids (usually 16mg dexamethasone initially) - reduce oedema to relieve pressure
  • PPI - prevent peptic ulcer by steroids
  • Surgical decompression
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7
Q

What is cauda equina syndrome?

A

Neuro emergency - Sx that arise from compression of bundle roots that extend from the termination of the spinal cord at L1/L2 - which supply the pelvis and lower extremities.

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8
Q

Causes of cauda equina?

A

MC - lumbar disc herniation at the L4/L5 or L5/S1 level.
Other:
* Malignancies
* Infx - abscess
* Trauma
* Congenital causes (e.g. spina bifida)

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9
Q

Sx of cauda equina?

Include LMN sx

A
  • Lower back pain
  • Assymetrical radicular pain
  • Leg weakness
  • Difficulty walking
  • Saddle anaesthesia
  • Bowel incontinence/constipation
  • Urinary incontinence/retention
  • Erectile dysfunction

LMN sx:
* Loss of lower limb power
* Hyptonia and hyporeflexia of lower limbs
* Paraesthesia in legs
* Reduced perianal sensation and anal tone loss

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10
Q

Ix for cauda equina

A

URGENT whole spine MRI

Other:
* Bladder scan
* ECG and bloods
* CT - if can’t have MRI

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11
Q

Mx of cauda equina?

A
  • Emergency neuro referral ideally within 24hrs of sx
  • Catheterise if urinary retention
  • Analgesia for pain
  • If malignant start on steroids + PPI
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12
Q

What are the most commonly fractured cervical vertebrae?

A

C2 and C7

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13
Q

Sx of cervical spine injury?

A
  • Neck pain
  • Midline cervical tenderness
  • Focal neuro deficits
  • Limited ROM in neck
  • Haematoma or oedema around cervical vertebrae
  • Peripheral paraesthesias
  • Sx of spinal shock - i.e. flaccid paralysi, loss of bowel/bladder control
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14
Q

What is Brown-Sequard syndrome?

A

Anatomical disruption of nerve fibre tracts in one half (hemisection) of spinal cord.

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15
Q

Causes of Brown-Sequard syndrome?

A

Cord trauma (penetrating injuries being the most common)
Neoplasms
Disk herniation
Demyelination
Infective/ inflammatory lesions
Epidural hematomas

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16
Q

Sx of Brown-Sequard syndrome?

A

Ipsilateral hemiplegia
Ipsilateral loss of proprioception and vibration
Contralateral loss of pain and temperature sensation

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17
Q

Mx of of Brown-Sequard syndrome?

A

Depends on causative pathology can be conservative or surgically managed.

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18
Q

What is the main cause of diabetic neuropathy?

A

Chronic hyperglycaemia

19
Q

The following are different types of diabetic neuropathy:
1. Distal symmetrical sensory neuropathy
2. Small-fibre predominant neuropathy
3. Diabetic amyotrophy
4. Mononeuritis multiplex
5. Autonomic neuropathy

Describe how each one presents.

A
  1. MC, Loss of large sensory fibres, ‘glove and stocking’ sensory loss - affects touch, vibration and proprioception
  2. Loss of small sensory fibres, ‘glove and stocking’ deficit in pain and temp + episodes of burning pain
  3. Infl. of lumbosacral or cervical plexus, severe pain around thighs and hips + proximal weakness
  4. Painful, involves 2 or more distinct peripheral nerves
  5. Postural hypotension, gastroparesis, constipation, urinary retention and erectile dysfunction.
20
Q

Ix for diabetic neuropathy?

A

Nerve conduction studies
Bloods - Glucose levels, HbA1c, B12, thyroid, LFTs

21
Q

Mx of diabetic neuropathy?

A
  • Control blood glucose levels
  • Pain control meds - gabapentin or pregabalin
22
Q

What is spinal stenosis?

A

Narrowing of the spinal canal which results in compression of spinal nerves.

23
Q

What are the causes of spinal stenosis?

A
  • Congenital spinal stenosis
  • Spinal trauma
  • Arthritis
  • Spinal tumours
  • Paget’s disease of the bone
24
Q

Sx of spinal stenosis?

A
  • Neurogenic claudication - proximal thigh or butt pain w/ sx such as burning or tingling
  • Pain worse w/physical activity + extended spinal positions i.e. going down stairs
  • Ability to cycle beyond their exercise tolerance on foot
  • Absence of vascular RF
25
Q

Ix for lumbar stenosis?

A

GS - MRI or CT
EMG - nerve function

26
Q

Mx of spinal stenosis?

A
  • 1st line - pain management (NSAIDs or opioids)
  • Surgical - i.e. spinal fusion or laminectomy
27
Q

What is spinal claudication?

A

Degenrative disease of the lumbar spine which leads to narrowing of spinal canal (spinal stenosis)

28
Q

Sx of spinal claudication

A
  • Back pain
  • Leg pain, weakness and numbness
  • Acitivty-related pain - bending over
  • Improved when walking uphill
29
Q

Mx of spinal claudication

A

Conservative - pain management w/NSAIDs or opioids

30
Q

What is cervical spondylosis?

A

Chronic degenerative disease of cervical spine associated with aging - wearing away of cartilage and bones in neck leading to pain and disability

31
Q

What is carpal tunnel syndrome?

A

Compression of the median nerve in the carpal tunnel.

32
Q

Causes of carpal tunnel syndrome?

A

Idiopathic
Pregnancy
Oedema e.g. heart failure
Lunate fracture
Rheumatoid arthritis

33
Q

What are the sx of carpal tunnel syndrome?

A
  • Pain/pins and needles in thumb, index, middle finger
  • Pt shakes hand for relief (classically at night)
  • Weakness of thum abduction
  • Wasting of thenar eminence
  • Tinel’s sx - tapping causes paraesthesia
  • Phalen’s sx - flexion of wrist causes sx
34
Q

Ix for carpal tunnel syndrome?

A

Electromyography (EMG)
Nerve Conduction Studies (NCS)

35
Q

Tx of carpal tunnel syndrome?

A

Conservative:
* Wrist splinting
* NSAIDs
* Corticosteroid injections

Surgery:
* Surgical release of transverse carpal ligament

36
Q

What are the sx of a radial nerve injury?

A
  • Weakness/paralysis of muscles innervated by radial nerve
  • Numbness, tingling or pain in sensory distribution of radial nerve

Muscles innervated = triceps brachii, brachioradialis, and extensor muscles of the forearm

Sensory distribution = posterior forearm, lateral aspect of the dorsum of the hand, and dorsal surface of the lateral 3 1/2 digits

37
Q

Sx of ulnar nerve injury?

A
  • Weakness/paralysis of muscles innervated by ulnar nerve
  • Numbness, tingling or pain in sensory distribution of ulnar nerve

Muscles innervated = most of the intrinsic hand muscles and two muscles in the forearm

Sensory distribution = skin of the medial 1.5 digits and associated palm area

38
Q

What are sx of common peroneal nerve injury?

A
  • Foot drop - paralysis of foot extensors
  • Foot inversion
  • Potential sensory loss or paraesthesia

Foot extensors = tibialis anterior, extensor digitorum longus, and extensor hallucis longus muscles

39
Q

What’s the most common cause of peroneal nerve injury?

A

Direct trauma around the knee

40
Q

What is neurofibromatosis and what are the two types?

A

A group of genetic disorders that cause tumors to form on nerve tissue.

Types:
1. NF1 - aka Recklinghausen’s syndrome, gene mutation on Chromosome 17
2. NF2 - mutation in the Schwannomin (Merlin) tumour suppressor gene on Chromosome 22

41
Q

Sx of neurfibromatosis 1 and 2?

A

NF1:
* Cafe-au-lait spots: Oval-shaped, coffee-coloured patches
* Axillary/inguinal freckling
* Neurofibromas (nodular tumours in skin)
* Lisch nodules: Hamartomas on the iris appearing as brown patches/mounds
* Optic glioma
* Scoliosis
* HTN

NF2:
* Bilateral vestibular schwannomas (acoustic neuromas), causing sensorineural hearing loss, tinnitus, and vertigo.
* Meningiomas
* Cerebral calcification
* Posterior lens opacities

42
Q

Ix for neurofibromatosis?

A
  • Genetic testing
  • Neuroimaging - detect other tumours
  • Slit lamp exam - identify Lisch nodules in NF1
43
Q

Mx of NF1/NF2?

A

Underlying cause - mx htn, epilepsy etc
Surgical - removal of tumours

Phase 3a - Geriatrics and Neurology (11 decks)

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