Spinal cord disease

Question 1

paraplegia

Answer 1

weakness of both legs, common in spinal cord lesion (hemiplagia in brain lesion)

Question 2

symptoms of spinal cord compression

Answer 2

progressive weakness of the legs with UMN pattern

paralysis

Question 3

when are arms affected by spinal cord compression

Answer 3

when lesion is above the thoracic spine

Question 4

sensory level

Answer 4

sensory loss below the level of the lesion

sensation abruptly diminishes one or two spinal cord segments below the level of the compression

Question 5

common causes spinal cord compression

Answer 5

vertebral tumour, gliomas
spinal TB in endemic areas
trauma
degen disease

Question 6

investigations cord compression

Answer 6

urgent investigation is essential if pt suspected with cord compression ESP if acute onset as irreversible paraplegia may follow = life incontinence
MRI identifies cause and site
XR may show degenerative bone disease

Question 7

management cord compression

Answer 7

surgical decompression of cord and stabilisation of spine

dexamethasone reduces oedema around the lesion

Question 8

cauda equina lesion?

Answer 8

spinal damage distal to L1 injures the cauda equina

Question 9

common cause of cauda equina

Answer 9

lumbar disc prolapse at the L4/L5 and L5/S1 level

Question 10

presentation of cauda equina

Answer 10

can be acute or insidious
back pain
numbness and weakness in legs with reduced reflexes
bowel dysfunction and perianal numbness

Question 11

what would cause bowel dysfunction and perianal / perineal ‘saddle’ numbness in cauda equina ?

Answer 11

involvement of multiple sacral and lumbar nerve roots in the lumbar vertebral canal

Question 12

investigation and management cauda equina

Answer 12

MRI

surgical decompression