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Year 2 - Nervous > Spinal cord diseases & infections > Flashcards

Spinal cord diseases & infections Flashcards

1
Q

Define myelopathy

A

DISEASE OF SPINAL CORD

=neurological deficit due to compression of spinal cord

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2
Q

List motor (4) /sensory (1) /autonomic (2) signs of a spinal cord lesion

A

UMN signs (4)

Sensory:
Sensory level (loss of sensation at level damaged and below) - i.e. loss of pain, temp, vibration, JPS etc

Autonomic:
Bladder/ bowel dysfunction

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3
Q

Motor/sensory signs of a C5 cord lesion (6)

A

UMN lesion signs below C5, LMN signs at C5,
No sensation below C5

  • Wasting of C5 innervated muscles
  • ↑ tone in legs > arms
  • Biceps reflex decreased, ↑ lower limb reflexes
  • Weakness at shoulder and below
  • Babinski +Ve
  • Sensory level (loss of sensation at and below C5)
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4
Q

What does pyramidal weakness mean

A

extensors become weaker than flexors in arms and vice versa for legs

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5
Q

What is a hemicord lesion and what syndrome does it cause

A

Damage to just one half of spinal cord

Brown-sequard syndrome

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6
Q

Signs of a hemicord lesion (brown sequard syndrome) [2]

A

IPSILATERAL loss of vibration and joint position sense

CONTRALATERAL loss of pain and temperature

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7
Q

Causes of a non-compressive spinal cord lesion (6)

A

Vit B12 deficiency

MS

Inherited - hereditary spastic paraplegia, friedrich’s atxia

Infection – viral/bacterial/fungal, e.g. HSV, tropical spastic paraplegia

Autoimmune – e.g. sarcoidosis

Paraneoplastic

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8
Q

Causes of a compressive spinal cord lesion (6)

A

Spine trauma - e.g. gun shot wound, car accident

vertebral fracture,

intervertebral disc herniation,

primary or metastatic spinal tumour

infection - e.g. discitis, epidural abscess

Vascular - e.g. AVM

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9
Q

What is Friedrich’s taxia (cause of non-compressive spinal cord lesion)

A

Rare inherited disease that causes progressive nervous system damage and movement problems (difficulty walking, a loss of sensation in the arms and legs, and impaired speech)

Leads to impaired muscle coordination (ataxia) that worsens over time

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10
Q

Causes of spinal stroke (ischaemic myelopathy) (2)

A

Either ISCHAEMIA (e.g. blood clot in artery supplying spinal cord)

or HAEMORRHAGE (bursting and bleeding of arteries supplying spinal cord usually due to hypertension)

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11
Q

Spinal strokes are usually due to lack of blood supply from what artery

A

Anterior spinal artery

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12
Q

Risk factors of spinal stroke (4)

A

Aortic disease

  • aortic aneurysm
  • aortic dissection

Atherosclerosis

Thromboembolic disease - e.g. AF

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13
Q

Symptoms (2) /signs (4) of spinal stroke

A

Back pain
Visceral referred pain

Paraparesis (partial paralysis/weakness of both legs)
Numbness
Paraesthesia - tingling sensations
Urinary retention

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14
Q

What is spinal shock

A

Temporary loss of reflex, motor and sensory function below the level of a spinal cord injury

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15
Q

How is B12 deficiency related to the spine

A

B12 deficiency can cause myelopathy

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16
Q

Symptoms/signs of B12 deficient myelopathy (just think myelopathy is UMN)

A

L’hermitte’s sign - sensation like an electric shock moving down neck into your spine triggered by bending head forward

Paraesthesia - of hands and feet

Areflexia (hyporeflexia)

Paraplegia – partial motor OR sensory paralysis of lower limbs

Sensory ataxia (due to degeneration of dorsal column)

PAINLESS retention of urine

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17
Q

What is l’hermittes sign + what conditions do you get it in (4)

A

sensation like an electric shock moving down neck into your spine triggered by bending head forward

MS 
cervical spondylosis (degeneration of the disc spaces between the vertebrae), 
herniation of a cervical disc, 
a cervical spinal cord tumor
vitamin B12 deficiency myelopathy
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18
Q

Treatment of B12 deficiency myelopathy

A

Intramuscular B12

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19
Q

3 types of spinal tumours

A

Intradural
Extradural
Intradural-extramedullary

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20
Q

What type of tumour is the most common cause of compressive spinal cord lesion

A

Extradural

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21
Q

Extradural spinal tumours are usually metastases from (3) or a primary tumour of (1)

A

Metastases (from lung, bone, prostate)

Primary bone tumours

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22
Q

Symptoms (1) /signs (6) of malignant spinal tumours

A 
Back pain
Muscle weakness in limbs
Numbness in limbs
Sphincter disturbance --> bladder/bowel dysfunction --> urinary/bowel incontinence
Difficulty walking
Reduced sensation
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23
Q

Define incontinence in terms of bladder and bowel dysfunction

A

Incontinence = lack of voluntary control

Urinary/bowel incontinence = can’t control when you go, may suddenly go

24
Q

Investigation of spinal tumours

A

MRI spine

25
Q

Treatment of malignant spinal tumours (2)

A

Surgical decompression

Radiotherapy

26
Q

Intervertebral disc can compress what 2 things

A

Spinal cord and/or spinal nerve roots

27
Q

Label whether the following disc prolapses cause myelopathy or radiculopathy:

Cervical prolapse centrally –>

Cervical prolapse laterally –>

Lumbar prolapse centrally –>

Lumbar prolapse laterally –>

A

Cervical prolapse centrally –> CERVICAL MYELOPATHY

Cervical prolapse laterally –> CERVICAL RADICULOPATHY

Lumbar prolapse centrally –> CAUDA EQUINA SYNDROME (radiculopathy)

Lumbar prolapse laterally –> LUMBAR RADICULOPATHY

28
Q

IV disc prolapse symptoms (1) /signs (2)

A

Pain down leg/arms (Acute onset)

Numbness of muscles innervated by nerve root involved

Weakness of muscles innervated by nerve root involved

29
Q

Investigations of IV disc prolapse

A

MRI

30
Q

Treatment of IV disc prolapse (4)

A

Analgesics
Rehabilitation
Nerve root injection - local anaesthetic to relieve pain
Lumbar/cervical discectomy

31
Q

What is the umbrella term for degeneration of the cervical spine

A

Cervical spondylosis

32
Q

What can cervical spondylosis cause (2)

A

Myelopathy and/or radiculopathy

33
Q

Cervical spondylosis is a result of what 3 things

A

1) Disc prolapse
2) Ligamentum hypertrophy
3) Osteophyte formation

34
Q

Symptoms (3) /signs (3) of cervical spondylosis

A

Neck pain - sudden onset
Pain may radiate down arm
Headache

Cervical muscle spasm
Mild weakness in muscles and skin innervated by nerve root damaged
Mild sensory loss in muscles and skin innervated by nerve root damaged

35
Q

Treatment of cervical spondylosis

  • conservative (3) if mild myelopathy
  • surgical (1) if moderate-severe myelopathy
A

Conservative (i.e. non-invasive so not surgical) if mild myelopathy

  • analgesia e.g. NSAIDs
  • physio
  • epidural anaesthesia or cervical nerve root block

Surgical decompression if moderate-severe myelopathy

36
Q

Name 2 degenerative spinal diseases

A

Cervical spondylosis

Lumbar spinal stenosis

37
Q

What is lumbar spinal stenosis

A

Spinal canal narrows and compresses the nerves at the level of the lumbar vertebrae.

Usually due to spinal degeneration that occurs with aging

38
Q

Signs of lumbar spinal stenosis

A

Spinal claudication - pain down both legs

Leg pain worse on walking/standing

39
Q

Treatment of lumbar spinal stenosis (2)

A

Analgesia, e.g. NSAIDs

Lumbar laminectomy

40
Q

Level of spinal cord

A

C1 - L2

41
Q

Name conditions with back pain (8)

A 
Malignant spinal tumour
Spinal stroke
Disc prolapse
Spinal stenosis
Vertebral fracture
Epidural abscess
Discitis
Osteomyelitis
42
Q

Name 3 spinal infections

A

Osteomyelitis
Discitis
Epidural abscess

43
Q

What is osteomyelitis

A

Infection of the bone and bone marrow of the vertebrae

44
Q

Risk factors of vertebral osteomyelitis (5)

A 
lV drug abuse, 
diabetes, 
chronic renal failure, 
alcoholism, 
AIDS
45
Q

Symptoms (2) /signs (2) of vertebral osteomyelitis

A

Back pain
Night sweats

Fever
Swelling around infection site

46
Q

Treatment of vertebral osteomyelitis (2)

A

Long term IV antibiotics

Surgery if evidence of neurological deficit

47
Q

What is discitis + what can it lead to if not treated

A

Infection of IV disc space, usually bacterial

Epidural abscess

48
Q

Discitis often co-exists with

A

Vertebral osteomyelitis

49
Q

Symptoms/signs (2) of discitis

A

Back pain

Fever

50
Q

Treatment of discitis

A

Long term IV antibiotics

51
Q

What is an epidural abscess

A

Infection in the epidural space - pus collects outside dura

52
Q

Causative organisms of epidural abscess (3)

A

Staph aureus
Streptococcus
E. coli

53
Q

Risk factors of epidural abscess (6)

A 
lV drug abuse, 
diabetes, 
chronic renal failure, 
alcoholism
Vertebral osteomyelitis
Recent spine surgery
54
Q

Symptoms/signs of an epidural abscess (Triad)

A

Back pain
Pyrexia
Focal neurology

55
Q

Treatment of epidural abscess

A

Long term IV antibiotics

Surgical decompression if progressive neurological loss or not responsive to antibiotics

56
Q

List sinister features associated with back pain (6)

A

Fever (spinal tumour or spinal infection)
weight loss (spinal tumour, maybe spinal infection)
Leg weakness or pain
Sphincter disturbance - urinary/bowel incontinence (spinal tumour, spinal stroke )
Focal neurological deficits

57
Q

Elbow flexors innervated by what nerve root

Elbow extensors innervated by what nerve root

Wrist extensors innervated by what nerve root

Finger extensors innervated by what nerve root

Hip flexors innervated by what nerve root

Knee extensors innervated by what nerve root

Ankle dorsiflexors innervated by what nerve root

Ankle plantar flexors innervated by what nerve foot

A

C5

C7

C6

C8

L2

L3

L4

S1

Year 2 - Nervous (39 decks)

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