Spinal Cord Compression

Question 1

How many neurones are there to a Corticospinal tract?

Answer 1

two

Question 2

What 4 signs are present with an upper motor neurone lesion?

Answer 2

Increased tone, Muscle wasting NOT marked, No fasciculation, Hyper - reflexia

Question 3

What 4 signs are present with an lower motor neurone lesion?

Answer 3

Decreased tone, muscle wasting, fasciculation, diminished reflexes

Question 4

Which motor neurone is responsible for directly sending a signal to the muscle to tell it to start contracting?

Answer 4

Lower motor neurone

Question 5

What tells the lower motor neurones to stop telling the muscles to contract?

Answer 5

upper motor neurones

Question 6

In which, upper or lower lesions, would you see muscle weakness?

Answer 6

BOTH

Question 7

What is a key feature of upper motor neurone lesions which is not seen in lower?

Answer 7

spasticity

Question 8

What is the name for the empty spaces between between myelin schwann cells?

Answer 8

nodes of ranver

Question 9

What is the Spinothalamic tract responsible for in terms of sensory signalling?

Answer 9

Pain, temperature and crude touch

Question 10

What is the dorsal column responsible for in terms of sensory signalling?

Answer 10

fine touch, proprioception, vibration

Question 11

At what level does the dorsal colum intersect (decussate)?

Answer 11

medullary level

Question 12

At what level does the spinothalamic tract intersect?

Answer 12

spinal level

Question 13

Give 4 causes of acute spinal cord compression.

Answer 13

Trauma
Tumours – haemorrhage or collapse
Infection
Spontaneous haemorrhage

Question 14

Give 3 causes of chronic spinal cord compression.

Answer 14

Degenerative disease – spondylosis
Tumours
Rheumatoid Arthritis

Question 15

What type of lesion is a Cord Transection?

Answer 15

complete - both upper and lower affected

Question 16

What are signs of a cord transection?

Answer 16

Initially a flaccid arreflexic paralysis “Spinal Shock”

Upper motor neurone signs appear later

Question 17

At what levels does a Brown-Sequard Syndrome (Cord Hemisection) occur?

Answer 17

Ipsilateral motor level
Ipsilateral Dorsal Column sensory level
Contralateral spinothalamic sensory level

Question 18

What is Central cord syndrome?

Answer 18

Hyperflexion or extension injury to already stenotic neck

Question 19

Main signs of central cord syndrome?

Answer 19

Predominantly distal upper limb weakness
“Cape-like” spinothalamic sensory loss
Lower limb power preserved
Dorsal Columns preserved

Question 20

Which signs predominate in chronic cord compression?

Answer 20

upper motor neurone signs

Question 21

What tumours are extradural?

Answer 21

normally metastasis

Question 22

What tumours are intradural?

Answer 22

Extramedullary: meningioma, Schwannoma
Intramedullary: Astrocytoma, Ependymoma

Question 23

What do these signs suggest has caused compression:
osteophyte formation					
bulging of intervertebral discs				
facet joint hypertrophy					
subluxation
?

Answer 23

Spinal cord stenosis

Question 24

Investigation for trauma causing spinal cord injury?

Answer 24

X-Ray/CT , then MRI

Question 25

Treatment for trauma causing spinal cord injury?

Answer 25

Methylprednisolone - Bolus 24hr infusion

Decompress + stabilise - Surgery (Traction,External fixation)