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CNS CLERKSHIP > Spinal Cord and Root Dysfunction > Flashcards

Spinal Cord and Root Dysfunction Flashcards

1
Q

How does spinal cord and root dysfunction present?

A
  • Pain.
  • Sensory disturbance.
  • Weakness.
  • Sphincter dysfunction.
  • Sexual dysfunction.
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2
Q

How does spinal cord and root dysfunction at a cervical level present?

A
  • Arm involvement.

- UMN features if central.

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3
Q

How does spinal cord and root dysfunction at a thoracic level present?

A
  • No/ minimal arm involvement.

- UMN features if central.

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4
Q

How does spinal cord and root dysfunction at a lumbar level present?

A
  • Only leg involvement.

- No UMN features.

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5
Q

In UMN pathology, what happens to tone?

A

Tone is increased.

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6
Q

In LMN pathology, what happens to tone?

A

Tone is decreased.

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7
Q

Does atrophy occur in UMN or LMN pathology?

A
  • UMN: no atrophy/late.

- LMN: atrophy present.

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8
Q

Do fasciculations occur in UMN or LMN pathology?

A

LMN pathology.

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9
Q

Describe reflexes indicative of UMN pathology.

A

Brisk reflexes in UMN pathology.

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10
Q

Describe reflexes indicative of LMN pathology.

A

Decreased/absent reflexes in LMN pathology.

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11
Q

Describe plantars action indicative of UMN pathology.

A

Upgoing plantars.

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12
Q

Describe plantars action indicative of LMN pathology.

A

Downgoing plantars.

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13
Q

Clonus is indicative of which MN pathology, upper or lower?

A

Clonus indicates UMN pathology.

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14
Q

Describe examination findings indicative of a cervical disc prolapse.

A
  • Arm pain.
  • Dermatomes affected.
  • Myotomes affected.
  • LMN pathology.
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15
Q

Describe examination findings indicative of a thoracic disc prolapse.

A

Rare.

  • Thoracic pain.
  • Dermatomes dermatomes affected.
  • Usually central causing myelopathy.
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16
Q

Describe examination findings indicative of a lumbar disc prolapse.

A
  • Leg pain.
  • Dermatomes affected.
  • Myotomes affected.
  • LMN pathology.
17
Q

Patient presents with intermittent pain that is worse on mobilising, eases at rest and on bending forwards.

The pain is often felt at the back of the thighs and calves where there is also altered sensation. Heaviness/ weakness is also experienced.

What is your diagnosis?

A

Spinal claudication.

18
Q

What is the principle concern of Cauda Equina syndrome?

A

Urinary function.

19
Q

What sensory symptoms would suggest cauda equina syndrome?

A
  • Perianal sensory loss to pinprick sensation.

- Genital numbness.

20
Q

Painless urinary retention with urinary incontinence (overflow) in cauda equina syndrome suggests involvement of which nerve roots?

A

S2-S4.

21
Q

What signs/ symptoms suggest cervical myelopathy?

A
  • “Numb, clumsy hands”.
  • Usually bilateral, one side may be more affected.
  • Fingertip paraesthesia.
  • Difficulty with fine motor tasks.
  • Dropping objects.
  • Reduced mobility.
  • Hoffman’s and Lhermitte’s sign.
22
Q

What is Hoffman’s sign?

A

Flick the nail of the middle finger.

-Positive: flexion of ipsilateral thumb and/or index finger.

23
Q

What does positive Hoffman’s sign indicate?

A
  • Corticospinal tract pathology e.g. cervical myelopathy.
  • Brain tumour.
  • MS.
  • Hyperreflexia.
  • Hyperthyroidism, anxiety, use of nervous system stimulants etc.
24
Q

What is Lhermitte’s sign?

A

Sensation similar to an electric shock passing down the back of the neck and into the spine. May then radiate out into the arms and legs.

Usually triggered by bending your head forwards towards your chest.

25
Q

Lhermitte’s sign is suggestive of?

A

Lesion or compression of upper cervical spinal cord or lower brainstem e.g. cervical myelopathy.

Often considered classical of MS.

26
Q

Should surgery or conservative management be utilised in cervical myelopathy?

A

Most do not need surgery.

Early surgery vs conservative treatment shows no difference at 1 year.

Surgery however has a faster rate of PERCEIVED recovery, but risks.

27
Q

What is failed back syndrome?

A
  • Recurrence of/ residual compression following surgery.
  • Nerve injury, altered joint mobility and instability.
  • Fibrosis, arachnoidities.
  • Infection.
  • Depression anxiety.
28
Q

What increases likelihood of Failed Back Syndrome?

A
  • Diabetes.
  • Smoking.
  • High BMI.
29
Q

Is surgery indicated in back/ neck pain?

A
  • No significant benefit with surgery, which may in fact worsen the pain.
30
Q

How should back/ neck pain be managed?

A

Conservative management:

  • Physiotherapy and analgesia.
  • Chronic pain teams.
31
Q

Present Babinski sign may indicate?

A
  • UMN lesion.
  • CNS pathology: most likely pyramidal tract.
  • Corticospinal dysfunction.
32
Q

What is the Babinski sign?

A

Stroking the sole of the foot produces extension of the big toe.

CNS CLERKSHIP (43 decks)

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