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Neurology SOH > Spinal cord and root dysfunction > Flashcards

Spinal cord and root dysfunction Flashcards

1
Q

Possible presentations

A 
Pain
Sensory disturbance 
Weakness 
Sphincter dysfunction
Sexual dysfunction
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2
Q

Management of spinal problems - surgery is first line in most cases. True or false?

A

False

- try 6 weeks of physiotherapy and if symptoms are persistent, patient should be sent for MRI scan

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3
Q

Central problem (something pressing on the spinal cord itself) then what are the likely symptoms?

A

UMN problem

  • increased tone
  • no weakness
  • brisk reflexes
  • upgoing plantars
  • no fasciculations
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4
Q

Lateral problem (something pressing on the nerve roots/plexus/peripheral nerve) then what are the likely symptoms?

A

LMN problem

  • weakness
  • atrophy
  • decreased tone
  • absent reflexes
  • fasciculations
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5
Q

Arm involvement if the problem is in which of the following regions:

  • cervical
  • thoracic
  • lumbar
A

Cervical

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6
Q

Leg involvement if the problem is in which of the following regions:

  • cervical
  • thoracic
  • lumbar
A

Lumbar

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7
Q

Which nerve root is affected: disorder of elbow flexion?

A

C5

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8
Q

Which nerve root is affected: disorder of wrist extension?

A

C6

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9
Q

Which nerve root is affected: disorder of finger flexion?

A

C8

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10
Q

Which nerve root is affected: disorder of knee extension?

A

L3

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11
Q

Which nerve root is affected: disorder of elbow extension?

A

C7

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12
Q

Which nerve root is affected: disorder of finger abduction?

A

T1

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13
Q

Which nerve root is affected: disorder of hip flexion?

A

L2

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14
Q

Which nerve root is affected: disorder of ankle plantar flexors ?

A

S1

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15
Q

Which nerve root is affected: Disorder of ankle dorsiflexion?

A

L4

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16
Q

Which nerve root is affected: disorder of long toe extension?

A

L5

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17
Q

Red flags in a back pain history

A 
Pain for longer than 6 weeks
Bilateral leg pain 
Pain troublesome at night 
New neurological deficit 
Systemic upset 
Saddle anaesthesia 
Bladder/bowel changes 
Weight loss 
Hx cancer 
Age under 20 
Age over 60
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18
Q

Bilateral leg pain, loss of bowel control, saddle anaesthesia, painless urinary retention with overflow incontinence. What is the likely diagnosis?

A

Cauda equinae syndrome

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19
Q

Cauda equinae syndrome - definition

A

Something causes compression on all of the nerve roots of the cauda equine region.
This is a surgical emergency

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20
Q

Cauda equinae syndrome - causes of compression

A

Prolapsed lumbar disc - central prolapse
Tumour compression
Trauma
Infection

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21
Q

Cauda eqinae syndrome - clinical examination

A

PR exam

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22
Q

Cauda equinae syndrome - what urgent imaging investigation must be carried out

A

MRI lumbosacral spine

- necessary to determine the level of prolapse

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23
Q

Cauda equina syndrome - management

A

Urgent surgery to remove the material that is compressing the nerves - discectomy

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24
Q

Patient who has been lifting heavy suitcases presents with back pain. What is the likely diagnosis?

A

Intervertebral disc prolapse

- slipped disc

25
Q

Intervertebral disc prolapse - definition

A

Tear in the outer annulus fibrosis of an invertebrate disc

26
Q

Intervertebral disc prolapse - how can you determine the exact location of the prolapse?

A

Analyse the myotomes and dermatomes

27
Q

Intervertebral disc prolapse - initial management

A

Conservative management

  • bed rest
  • anti-inflammatory
  • muscle relaxant
  • make sure patient remains mobile
28
Q

Intervertebral disc prolapse - when would you consider surgery

A

Patient isn’t getting better after 3 months of conservative treatment

29
Q

What are the 2 most common locations for lumbar disc prolapse?

A

L4/L5 level

L5/S1 level

30
Q

Spinal claudication - who gets it

A

Over 50

male

31
Q

Name 2 causes of spinal claudication?

A

Manual worker

Obesity

32
Q

Spinal claudication - distribution of pain

A

Dematomal distribution down bilateral legs

33
Q

Spinal claudication - pain is worse at rest/ with movement?

A

With movement

34
Q

Patient who experiences leg pain which is relieved when walking up a hip as they are more hunched over (spine flexion). What is the likely diagnosis?

A

Spinal claudication

35
Q

Spinal claudication - investigations?

A

MRI scan

  • lumbar spinal stenosis (squished spinal canal)
  • buldges present at several levels
36
Q

Spinal claudication - management if patients symptoms are intolerable

A

Elective surgery (lumbar spinal compression)

37
Q

How to tell the difference between spinal claudication and vascular claudication?

A

Check peripheral pulses:

  • if pulses are normal = spinal claudication
  • if pulses are diminished/absent = vascular claudication
38
Q

Cervical myelopathy - definition

A

Central disc prolapse in the cervical spine. Therefore, UMN signs are present

39
Q

Cervical myelopathy - clinical features

A 
Hands are usually affected first
usually bilateral 
paraesthesia 
numbness
difficulty with fine motor tasks 
dropping objects
40
Q

Cervical myelopathy - investigations

A

MRI cervical spine

41
Q

Cervical myelopathy - management

A

Decompressive cervical surgery to prevent the condition from deteriorating further

42
Q

Cervical spondylosis - definition

A

Degenerative arthritic process involving cervical spine and affecting intervertebral disc

43
Q

Cervical spondylosis - imaging investigations show

A

Osteophytes

44
Q

Causes of acute spinal cord compression

A

Trauma
Tumours
Infection

45
Q

Acute spinal cord compression - trauma - investigations

A

X ray
CT scan
MRI scan

46
Q

Acute spinal cord compression - trauma - management

A

Immobilise (neck brace)
Decompress
Stabilise (external fixation)

47
Q

Acute spinal cord compression - tumours - most common

A

Bony mets

48
Q

Acute spinal cord compression - tumours - management

A

IV dexamethasone
Radiotherapy
Chemotherapy

49
Q

Patient that has lost motor power on left side of body but on right side of body pain and temperature sensation is lost. What is this called?

A

Brown Sequard syndrome

50
Q

Brown Sequard syndrome - definition

A 
Cord hemisection
Affects
- ipsilateral corticospinal tract
- ipsilateral DCML tract
- contralateral spinothalamic tract
51
Q

Central cord syndrome - who gets it?

A

Old patients who fall over

52
Q

Central cord syndrome - pathophysiology

A

Inner part of the spinal cord is injured but the outer part is fine

53
Q

Central cord syndrome - clinical features

A

Signs that patient has fallen
Distal upper limb weakness
Hands are paralysed/weak
Lower limb power is preserved

54
Q

Central cord syndrome - management

A

Leave it alone and it gets better

55
Q

Chronic spinal cord compression - LMN signs predominate. True or false?

A

False

- UMN signs predominate

56
Q

Patient presents with bilateral weakness of the limbs. The upper limbs are more affected than the lower limbs. What is the likely diagnosis?

  • anterior cord syndrome
  • central cord syndrome
  • posterior cord syndrome
A

Central cord syndrome

57
Q

In central cord syndrome, why are the upper limbs more affected than the lower limbs?

A

In the corticospinal tracts, the upper limbs are represented medially and the lower extremities are laterally

58
Q

Patient presents with bilateral weakness and loss of pain and temperature sensation. Proprioception, vibratory sense and light touch are preserved. What is the likely diagnosis?

  • anterior cord syndrome
  • central cord syndrome
  • posterior cord syndrome
A

Anterior cord syndrome

Neurology SOH (31 decks)

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