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Y3 NEUROLOGY > Spinal Cord and Root Dysfunction > Flashcards

Spinal Cord and Root Dysfunction Flashcards

1
Q

List the symptoms associated with dysfunction of the spinal cord and roots

A 
Pain
Sensory disturbance
Weakness
Sphincter dysfunction
Sexual dysfunction
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2
Q

A lesion of the spinal cord affecting the cervical level would present with…

A

Involvement of arms

UMN or LMN symptoms

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3
Q

A lesion of the spinal cord affecting the thoracic level would present with…

A

Arms not/minimally involved

UMN or LMN features

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4
Q

A lesion of the spinal cord affecting the lumbar level would present with…

A

Only legs involved

No UMN features

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5
Q

For UMN lesions and LMN lesions, outline the weakness distribution respectively

A

Corticospinal CENTRAL distribution (weak extensory in arms and weak flexors in legs)
Generalized, predominantly proximal, distal or focal. No preferential involvement of corticospinal innervated muscles.

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6
Q

For UMN lesions and LMN lesions, outline the pattern of sensory loss respectively

A

Central pattern

None - glove stocking, peripheral nerve or root distribution

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7
Q

For UMN lesions and LMN lesions, outline the effect on deep tendon reflexes respectively

A

Increased/ brisk (unless very acute - flaccid)

Normal or decreased

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8
Q

For UMN lesions and LMN lesions, outline the effect on muscle tone respectively

A

Increased

Normal or decreased

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9
Q

For UMN lesions and LMN lesions, outline the effect on muscle bulk respectively

A

Sometime hypertrophy

Wasting

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10
Q

What types of pathology cause UMN lesion?

A

LESION IN SPINAL CORD OR BRAIN
Stroke
SOL
Spinal cord problems

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11
Q

What types of pathology cause LMN lesion?

A

LESION IN SPINAL NERVE (AFTER CN NUCLEUS)
MND
Spinal muscular atrophy (lead poisoning, poliomyelitis)

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12
Q

Spinal cord dysfunction presenting with UMN symptoms suggests the position of the lesion is where on the spinal cord?

A

Central

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13
Q

Spinal cord dysfunction presenting with LMN symptoms suggests the position of the lesion is where on the spinal cord?

A

Lateral

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14
Q

Brisk reflexes of the lower limb would suggest the lesion is coming from the lumbar spinal cord only? True/ False?

A

False

No lumbar spinal cord involvement as there is no UMN features at this level

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15
Q

For UMN lesions and LMN lesions, state whether fasciculations are present, respectively

A

Absent

Present

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16
Q

For UMN lesions and LMN lesions, outline the plantar response for each, respectively

A

Upgoing

Downgoing

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17
Q

For UMN lesions and LMN lesions, state whether clonus is present, respectively

A

Present

Absent

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18
Q

Which chart allows you to localise spinal cord lesions via dermatomes and myotomes?

A

ASIA chart

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19
Q

Which clinical symptoms would be suggestive of a cervical disc prolapse?

A 
Arm pain
Depends on level of lesion - think dermatomes and myotomes 
Numbness/ tingling along dermatome
Weakness along myotome
LMN symptoms
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20
Q

Which clinical symptoms would be suggestive of a thoracic disc prolapse? What is a common cause?

A 
Thoracic pain
Depends on level of lesion - think dermatomes and myotomes
Numbness/ tingling along dermatome
Weakness along myotome
Central causing myelopathy
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21
Q

Which clinical symptoms would be suggestive of a lumbar disc prolapse?

A 
Leg pain
Depends on level of lesion - think dermatomes and myotomes
Numbness/ tingling along dermatome
Weakness along myotome
LMN symptoms
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22
Q

Spinal claudication symptoms are typically continuous. True/ False?

A

False

Typically intermittent

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23
Q

List an exacerbating and relieving factor for spinal claudication

A

Mobilisation

At rest and bending forward (flexion) - ARTHROPOID posture

24
Q

List clinical features suggestive of spinal claudication

A

Dull achy pain (typically back of thighs/ calves)
Altered sensation
Heaviness/ weakness of limbs

25
Q

How does spinal claudication appear on imaging?

A

Whole canal is squashed and ligaments surround the canal are thick

26
Q

Chronic spinal claudication leads to…

A

Spinal stenosis

27
Q

What clinical feature would be more suggestive of vascular rather than spinal claudication? What investigation can be done to differentiate?

A

Absent peripheral pulses

ABPI

28
Q

What is cauda equina syndrome?

A

Emergency condition in which there is massive disc prolapse compressing all lumbosacral spinal roots

29
Q

How is cauda equina diagnosed?

A

MRI scan and PR exam

30
Q

Which clinical features are suggestive of cauda equina syndrome?

A 
Bilateral leg pain (can resolve) - S1
Perianal sensory loss to pinprick
Genital numbness
Erectile dysfunction
Painless urinary retention with overflow incontinence (no control or urgency) - S2-4
31
Q

List the red flag symptoms used for spinal conditions

A 
Bilateral leg pain
Thoracic back pain
Weight loss, night sweats, fever
Night pain
Sphincter disturbance
Perianal sensory loss
Age <20 or >55
History of carcinoma
Immunocompromised
Progressive neurological deficit
Trauma
32
Q

What is cervical myelopathy? Is it reversible?

A

Central disc prolapse in cervical spine, typically irreversible

33
Q

What are the presenting symptoms in a patient with cervical myelopathy?

A 
Finger tip paraesthesia progressing to 'numb clumsy hands' - usually bilateral
Difficulty with fine motor tasks
Dropping objects
Reduced mobility (FALLS)
Hypereflexia (legs jump at night)
34
Q

What two clinical signs should be checked for if cervical myelopathy is suspected?

A

UMN:

Hoffman sign: Finger reflex whereby flicking of the nail on the middle finger leads to flexion of the ipsilateral thumb
Lhermittes sign: Sudden sharp electric shock down all four limbs, especially on head movement

35
Q

Treatment for radiculopathy e.g. sciatica is typically conservative. True/ False?

A

True

Patients do not require surgery

36
Q

List some complications of spinal surgery

A 
Pain
Bleeding
Infection
CSF leak
Instability
Nerve injury/ paralysis
Failed back syndrome
Medical risks (DVT/ PE, chest, MI, drug reactions)
Cauda equine syndrome
Risk to life
37
Q

Outline the clinical features of failed back syndrome

A 
Recurrence, residual compression
Nerve injury
Altered joint mability/ instability
Fibrosis/ arachnoiditis
Infection
38
Q

List the main risk factors for failed back syndrome

A

Depression/ anxiety
Diabetes
Smoking
High BMI

39
Q

Outline management options for failed back syndrome

A 
Reoperation?
Antibiotics if infection
Anti-inflammatories
Anti-depressants
Physio
CBT
TENS
Spinal cord stimulation
Referral to chronic pain team
40
Q

What type of fracture is caused by rapid flexion to the spine, common in RTAs?

A

Burst fracture - crush injury to disc

41
Q

What acute spinal condition causes autonomic dysreflexia?

A

Spinal shock

42
Q

How does an epidural haematoma appear on imaging?

A

Long collection posterior to spinal cord

43
Q

A syrinx in the spinal cord is associated with what condition?

A

Syringomyelia - build up of CSF in spinal cord

44
Q

How does a syrinx appear on imaging?

A

Hyperdense mass in the spinal cord

45
Q

What is a chiari malformation?

A

Cerebellar tonsils displace downwards through the foramen mangnum

46
Q

Name 2 groups of people who are likely to have a disc herniation

A

Young patients carrying a heavy load

Older patient with degeneration or spondylosis

47
Q

A paramedian or posterolateral disc prolapse in L4/5 is likely to affect which nerve root?

A

L5

Traversing nerve root below the disc

48
Q

A lateral or extraforaminal disc prolapse in L4/5 is likely to affect which nerve root?

A

L4

Exiting nerve root leaving at level of prolapse

49
Q

What is a radiculopathy?

A

Dysfunction of nerve root resulting in dermatomal/ sensory deficit/weakness of muscle groups supplied

50
Q

Outline the management of cauda equina syndrome

A

Disectomy for herniated disc
Decompression and fixation for fracture
Haematoma evacuation

51
Q

How is spinal stenosis managed?

A

Conservation (physio, analgesia) 1st line

Laminectomy 2nd line

52
Q

What is cervical spondylosis? What can it lead to?

A

Reduction in water and fragmenting nucleus pulposus due to a degenerative arthritic process of cervical spine
Radiculopathy - LMN
Myelopathy - UMN

53
Q

What is the age of onset for cervical spondylosis?

54
Q

How does cervical spondylosis appear on MRI scan?

A

Narrowing of disc space and osteophyte formation

55
Q

Outline the management for cervical spondylosis

A

Laminectomy (multilevel posterior compression)
Disectomy (anterior compression)
Foraminectomy (unilateral root compression)

Y3 NEUROLOGY (22 decks)

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