Spinal Cord Disease

Question 1

spinal cord compression px

Answer 1

• spinal cord TENDERNESS
• hyperreflexive DTRs (no inhibition from UMN)
• sensory loss below that level
• incontinence

Question 2

spinal cord compression causes

Answer 2

• cancer
• epidural abscess (fever)
• hematoma (trauma)

Question 3

spinal cord compression tx

Answer 3

-steroids = best initial (dexamethasone, dec inflammation)

• radiotherapy (tumors)
• surgical decmpression (herniation, abscess, hematoma)

Question 4

spinal cord compression dx

Answer 4

• CXR = best initial
• MRI
• biopsy = most accurate
• CT myelogram (when MRI unavailable)

Question 5

syringomyelia is..

Answer 5

• fluid filled cavity at center of spinal cord

- cervical spine often

Question 6

syringomyelia causes

Answer 6

• congenital: Arnold-Chiari malformation

- acquired: trauma (whiplash), tumors

Question 7

syringomyelia dx

Answer 7

MRI = most accurate

Question 8

syringomyelia px

Answer 8

-loss of nocioception (pain & temp) BILATERALLY
(cape-like distribution)
-dec strength
-absent reflexes

• proprioception
• no spinal tenderness

Question 9

syringomyelia tx

Answer 9

surgical decompression

Question 10

subacute combined degeneration cause & tx?

Answer 10

• B12 deficiency

- B12 replacement

Question 11

vitamin B12 deficiency px

Answer 11

-peripheral neuropathy
-weakness
-ovalocytes (oval shaped RBCs)
-megaloblastic anemia
-inc LDH
-inc bilirubin
(normal retic count)
-inc methylmalonic acid

Question 12

macrocytic vs megaloblastic

Answer 12

macrocytic = high MCV

megaloblastic = hyper segmented neutrophils (B12 and folate deficiencies)

Question 13

subacute combined degeneration px

Answer 13

• POSTERIOR COLUMN –> loss of positional & vibratory sensation
• CORTICOSPINAL TRACT –> weakness, spastic paresis
• peripheral neuropathy
• high bilirubin, high LDH

Question 14

posterior column deficit causes?

Answer 14

• syphilis

- subacute combined degeneration

Question 15

causes of B12 deficiency

Answer 15

• lack of intrinsic factor (secreted from parietal cells)
• malabsorption in ileum
• dietary deficiency

Question 16

anterior spinal artery occlusion px

Answer 16

• anterior spinal cord infarct –> weakness, pain & temp loss, autonomic loss
• flaccid –> spastic paresis

-proprioception INTACT

Question 17

anterior spinal artery occlusion tx

Answer 17

none

supportive

Question 18

Brown-Sequard syndrome =

Answer 18

hemisection of spinal cord –>

• contralateral loss of nocioception (pain & temp)
• ipsilateral proprioception (vibration) loss

-no tx