Spinal Cord Disease

Question 1

How do Spinal cord diseases differ from peripheral neuropathy in progression?

Answer 1

spinal cord - constant/variable rapidity or no progression after initial insult

peripheral - intermitten intially - later progressive

Question 2

What is Lhermitte’s Sign? what does it suggest?

Answer 2

tilting head forward gives shock-like sensation down spine

–suggests spinal cord problem

Question 3

What kind of nerve disorder:
No truncal pain
Nocturnal distal paresthesias common
“Restless leg” symptoms at rest

Answer 3

Peripheral nerve disorder

Question 4

What are some toxins that cause damage to:

1. Spinal cord
2. Peripheral neuropathy

Answer 4

1. Alcohol - B12 deficiency

2. Heavy metals (arsenic, lead, mercury, insecticides, chemotherapy)

Question 5

What is the blood supply for the spinothalamic tract and Corticospinal tract

Answer 5

Anterior spinal Artery

Question 6

What is the blood supply for the Posterior columns of the spine?

Answer 6

Posterior spinal artery

Question 7

What are acute and progressing motor symptoms of a spinal cord injury above lumbar enlargement (motor tone, power)

Answer 7

Acutely - Flaccid
1-2 weeks = Increased muscle tone

Motor power:

1. hemisection: monoplegia ipsilateral to and below hemicord lesion
2. complete cord lesion: Diplegia

Question 8

What are Sx of motor
1. tone
2. power
in peripheral neuropathy?

Answer 8

1. normal or reduced tone

2. distal extremity decreased in power, confined to affected peripheral nerves

Question 9

What kind of fibers transmit the following peripheral sensations

1. Vibration/proprioception/touch
2. light touch
3. pain, temperature, paresthesias, dysethesias
4. Nociceptive (deep burning, poorly localized)

Answer 9

1. Type 1a Heavily myelinated
2. all fiber sizes
3. small fibers poorly myelinated
4. Unmyelinated

Question 10

How do Spinal cord injuries differ from peripheral injuries in respect to

1. Reflexes
2. Babinski
3. Autonomic reflexes

Answer 10

1. spinal - increased (unless acute spinal cord shock)
   peripheral - lost/reduced
2. spinal - present
   peripheral - absent (EXCEPT for Vit b12 deficiency)
3. spinal - initially lost but later returns
   peripheral - variable loss

Question 11

Name the Syndome annd cause:

Arm>leg weakness, variable sensory loss often with a suspended sensory level

Answer 11

Central Cord syndrome

syringomyelia
hydromyelia
Tumor

Question 12

Name the Syndrome and cause:

Bilateral motor and sensory loss sparing vibratory and position sense

Answer 12

Anterior Cord syndrome

–anterior spinal artery occlusion

Question 13

Name the Syndrome and causes:

loss of Vibratory and proprioceptive sense

Answer 13

Posterior cord syndrome

–B12 deficiency, Syphilis, MS

Question 14

Name the syndrome
ipsilateral: weakness and Vibratory and position sense loss

contralateral: pain and temperature sense loss

Answer 14

Brown-Sequard Syndrome

-Hemisection of spinal cord

Question 15

What is a common cause of transverse myelitis

Answer 15

Viral: HSV, herpes zoster, CMV, EBV

Question 16

What is the disease:
bilateral sensorimotor and autonomic spinal cord dysfxn
spinal cord inflammation
CSF pleocytosis

Answer 16

Transverse Myelitis

Question 17

What are two demyelinating spinal cord syndromes?

Answer 17

SLE, MS

Question 18

What type of inflammatory deficit do Enteroviruses (Coxsackie and poliomyelitis) and West Nile virus usually have on the spinal cord?

Answer 18

Motor neuron predilection

Question 19

What type of inflammatory deficit does Herpes Zoster have on the spinal cord? what are Sx?

Answer 19

Dorsal root Ganglion

–painful paresthesia

Question 20

where are the most common origin sites for tumor metastasis to the thoracic spinal cord?

Answer 20

Ovarian, Prostate

Question 21

Subacute, occasionally acute
localized spinal pain
radicular myelopathic

Answer 21

Spinal tumor

Question 22

What is the most common origin signs for epidural, subdural, intramedullary spinal tumors?

Answer 22

Breast, lung, myeloma, kidney, lymphoma

Question 23

What are 4 common organisms in Spinal abscesses?

Answer 23

Staph, Strep, anaerobes, TB

Question 24

acute or subacute onset
localized spine pain
fever
localized radicular or myelopathy
radiology - spinal involvement crosses disk spaces

Answer 24

Spinal abscess

Question 25

white appearing plaque in spinal cord?

Answer 25

MS

Question 26

How do you differentiate Conus Medularis and Cauda Equina Syndrome? - Pain

Answer 26

CM: no intense
CES: moderate- sever asymmetric in L4-S1 (thighs, back, legs, perineum)

Question 27

How do you differentiate Conus Medularis and Cauda Equina Syndrome? - Motor loss

Answer 27

CM: mild and symmetric S1
CES: more sever symmetric w atrophy

Question 28

How do you differentiate Conus Medularis and Cauda Equina Syndrome? - Sensory loss

Answer 28

CM: symmetric (saddle distribution)
CES: asymmetric loss in lumbar and sacral distribution

Question 29

How do you differentiate Conus Medularis and Cauda Equina Syndrome? - Reflex

Answer 29

CM: loss S1 symmetric (achilles)
CES: Loss knee and ankle, asymmetric

Question 30

How do you differentiate Conus Medularis and Cauda Equina Syndrome? - Bowel and bladder

Answer 30

CM: EARLY AND SEVERE LOSS OF CONTINENCE
CES: late and less severe